If you received notice of an incident or claim filed against you, complete the form below to provide us with the details. We will contact you to discuss next steps.
To notify us, you may:
- Submit the form online by clicking Submit below
- Print the form and fax to 1-866-202-6601
- Print the form and mail to:
1100 Virginia Drive, Suite 250
Fort Washington, PA 19034
You will receive a response within three business days from our receipt of your incident report.If you need immediate assistance, please feel free to contact us toll free at (888) 778-3981. Our service hours are Monday - Friday, from 8:00 a.m. to 6:00 p.m. ET.
For NH residents only:
Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud, as provided in RSA 638:20. However, the lack of such a statement shall not constitute a defense against prosecution under RSA 638:20. N.H. R.S.A 402:82
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