REPORT CLAIM

REPORT A CLAIM

Reporting a claim is not the most exciting thing to do but we are here to help. Before proceeding, make sure you collected as much information as possible including pictures, reports and other documents.

To report the claim directly to your insurance carrier please use the button bellow.

Report Claim Directly To Insurance Carrier

To report claim to Double Shield Please fill out the form bellow.

Report a Claim

    Name Of Person Completing The Form*
    Insured Name*
    Policy Number(If Available)
    Insured Phone*
    Insured Email*
    Date Of Loss*
    Time Of Accident(If Available)
    HH
    MM

    Location Of Loss

    Street Address
    City
    State*
    Zip
    Was The Police Department Connected ?*
    Briefly Describe The Accident

    Was There Damage To Third Party Property Or State Property*
    Were There Injuries ?*

    Driver Information

    Name Of Driver*
    Driver's Phone Number
    Driver's Date Of Birth
    License Number
    State*

    Tractor Information

    Year Of Tractor*
    Make Of Tractor*
    VIN Of Tractor*
    Was There Damage To Tractor?*

    Trailer Information

    Was There Damage To Trailer?*

    Towing Information

    Was Your Vehicle/Trailer Towed?*

    Cargo Information

    Was There Cargo Damage?*

    Additional Information

    Please Provide Additional Information Or Details That You Would Like To Include In The Claim (Such As Witness Information, Freight Broker Information etc..)

    Upload Files

    Please Upload Any Photos, Estimates, Policy Report Information, Bill Of Lading Etc..