Report a Claim

PLEASE READ BEFORE REPORTING A CLAIM!

Have your Insurance Board number and the details of the loss before you attempt to report a claim.

IMPORTANT: When your claim is submitted AND accepted, you will receive a message indicating your claim has been received.

IF YOU DO NOT receive that message, we have not received your claim. After the initial message, you will also receive an email from us within 48 hours.

If you need to report an AUTO/WORKERS’ COMPENSATION CLAIM, follow the instructions in this document.

Claim Reporting Instructions

PLEASE READ BEFORE REPORTING A CLAIM!
Have your Insurance Board number and the details of the loss before you attempt to report a claim.
IMPORTANT: When your claim is submitted AND accepted, you will receive a message indicating your claim has been received.
IF YOU DO NOT receive that message, we have not received your claim. After the initial message, you will also receive an email from us within 48 hours.
If you need to report an AUTO/WORKERS' COMPENSATION CLAIM, follow the instructions in this document.
Claim Reporting Instructions
(including details on all required fields)
Loss Type(Required)
Select a Loss Type to get started.
Property Loss Type(Required)
Liability Loss Type(Required)
Claim or Incident Only?(Required)
General Information
Agent(Required)
Have you discussed this claim with your agent?(Required)
- Yes
- No
Your First Name(Required)
Your Last Name(Required)
Your Email Address
Date of Accident(Required)
MM slash DD slash YYYY
Church / Organization Name(Required)
IB Church ID#(Required)
Street Address
PO Box
City(Required)
State(Required)
Zip Code
Did the loss occur at the address above?(Required)
- Yes
- No
Please enter the address where the accident occurred.(Required)
Street Address Address Line 2 City State ZIP Code
Contact Information
Person to contact regarding this claim(Required)
Contact Title
Contact Business Phone(Required)
Contact Mobile Phone(Required)
Contact Email(Required)
Details of the Loss
General description of what happened(Required)
General description of what happened / details of the loss including the building(s) involved(Required)
How was it damaged(Required)
This field is hidden when viewing the form
Details of Loss Pt 2
Have you received an estimate?(Required)
Estimated amount of loss?(Required)
This field is hidden when viewing the form
Details of Loss Pt 3
Do you have any other documentation or photos to provide to the adjuster?
Drop files here or
Max. file size: 50 MB.
Maximum File Size 50MB
Has a police report been completed?(Required)
- Yes
- No
Police report date
MM slash DD slash YYYY
Police report number
Name of police department that completed the report
Is it possible that you or anyone else previously reported this claim?(Required)
- Yes
- No
Please provide details such as claim number(Required)
Anything additonal we should know about?
Details of the Incident
General description of damages or injury, and how it occurred
General description of damages, and how they occurred
Claimant Name(Required)
Claimant Address
Claimant City
Claimant State
Claimant Zip
Claimant Phone
If injury occurred, has there been medical treatment?(Required)
- Yes
- No
Medical Provider Name
Medical Provider Address
Medical Provider City
Medical Provider State
Medical Provider Zip
Medical Provider Phone
Do you have any additional documentation or photos to provide the adjuster?
Drop files here or
Max. file size: 50 MB.
Has a police report been completed?(Required)
- Yes
- No
Police report date
MM slash DD slash YYYY
Police report number
Name of police department that completed the report
Is it possible that you or anyone else previously reported this claim?(Required)
- Yes
- No
Please provide details such as claim number(Required)
Was a non-owned or hired vehicle involved?(Required)
- Yes
- No
Vin #
Make
Model
Anything additional we should know about?
This field is hidden when viewing the form
Section Break
File
Max. file size: 50 MB.
File
Max. file size: 50 MB.
Email
This field is for validation purposes and should be left unchanged.

We Know Church. We Know Insurance.

Report your claim below to receive prompt and professional assistance. Our team will quickly review your submission and begin the process of resolving your claim, keeping you informed every step of the way.

Report a Claim

Report a Claim

PLEASE READ BEFORE REPORTING A CLAIM!

General Information

Contact Information

Details of the Loss

Details of Loss Pt 2

Details of Loss Pt 3

Details of the Incident

Section Break

We Know Church. We Know Insurance.

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