If you’re planning to make a claim against an insurance company—because you were in a car accident, suffered a slip and fall or animal bite, or have any other type of claim—you can use this Notice of Insurance Claim to notify the appropriate insurance company or companies.
If you've been hurt in an accident -- such as from a car accident, slipping on a store's floor, or a dog bite -- use this form to let the responsible party's insurance company know you're seeking compensation.
Important to Know:
Keep this notice short, simple, and factual. Use the "Accident Claim Worksheet" to help you keep track of all the details.
If you’re working with an attorney on this claim, discuss whether you or the attorney will file this notice before sending it.