Report a Claim

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Policyholders may complete and submit the Claim Form below or call (315) 687-3211 to report a claim.

Name of Person Completing This Form

Insured Name

Policy Number

Loss Location - Street Address

Loss Location - City, State & Zip

Contact Name

Phone

Date & Time of Loss

Describe Loss

Mandatory Fraud Statement

Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

AGREE By checking the "Agree" button, you acknowledge that you have read and understand this MANDATORY FRAUD STATEMENT.

Disclaimer: This claim will be reviewed and contact will be made as soon as possible on the next regular business day following receipt of this notice. We may not receive this promptly if the report is being completed after office hours or on weekends. This reporting capability is solely for the convenience of filing a claim after hours or when it is not feasible to contact your agent during normal business hours.

I hereby certify that I have the authority to report this claim by being the insured or a representative of the insured.