Injury Protection Claim Reporting
Getting Started
Fill out each section thoroughly and to the best of your ability.
Forms must be completed in a single session. Information will not be saved.
Requirements
Estimated Completion Time: 10 minutes
You will need the following information:
Driver Information
Vehicle Information
Accident Information
Lost Income
Once the form is completed, signed and submitted, you will receive an email of acknowledgement.
If your injuries require immediate attention, go directly to the nearest hospital for medical treatment or call 911.