CL Claims Submission Step 1 of 7 14% Claim Submission*If you need to file a claim, we're here to help. We hope that everyone is safe and that you're out of immediate danger. If you have questions or prefer to speak to someone *before filing the claim*, please call our office at (210) 708-3203. Please provide us with the pertinent info needed to submit the claim to your carrier. Commercial Auto Claim Liability Claim Property Damage Claim Work Comp Is the person submitting this claim the Policyholder or Claimant* Policyholder Claimant Policyholder Name:* Cell Phone Number*Please provide your cell phone number to receive confirmation of claims submission by text.Email*Please provide the best email address where the carrier can send you confirmation of claim submission and progress updates (if applicable). Insurance Company Name:* Policy Number*Please provide the policy number on which you wish to file your claim Driver*Is the driver of the covered vehicle involved in the claim the same as the policy holder? Yes No Driver Name*If the driver is not the same as the policy holder, please provide the information on the driver involved in the claim. First Last Year / Make / Model of Vehicle*Please list the vehicle on your policy involved in this loss. Other parties involved?*If there are other parties involved in the loss, please check "Yes". Yes No Name of other driver involved in the loss*Please provide any information you can about the third party involved in the loss. If unknown, please type: "UNKNOWN" First Last Year / Make / Model / License Plate Number*Please provide any information you can about the third party involved in the loss. If unknown, please type: "UNKNOWN" Was a police and/or fire report filed?* Yes No Name of the department where report was filed:* Report/Incident Number:* Date and Time of Loss*Please be as accurate as possible. Location of Loss*Please provide the address where the loss occurred. Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Details of Loss*Please be as specific and provide as much detail as possible in order to help expedite the handling of your claim. Document UploadUpload any documents or photos that will help in the handling of your claim. You can include: police reports, photos of vehicles/property, copy of other parties information, etc. Drop files here or Select files Accepted file types: jpg, png, pdf, Max. file size: 25 MB, Max. files: 5. CAPTCHA
