Higger & Associates LLC : Intelligent Insurance and Financial Solutions : Client's Index

client services > Claim Submission Form

CLAIM SUBMISSION FORM

Higger & Associates, LLC will provide you with the best possible claim response time. Please fill this form out and submit it to us. As soon as we receive your claim information we will contact you.

Personal Information
Name:
Company:
Personnel To Contact:
Address:
City:
State:
ZIP:
Business Phone:
Alternate Phone:
Best Time To Call:	AM PM
Email Address:
Fax:
Loss Information
Insurance Company:
Policy Number:
Date of Claim:
Time of Claim:
Where Loss Occurred:
Were the authorities contacted?	YES NO
Please provide any case number:
Were there any injuries?	YES NO
Was a vehicle involved?	YES NO

If Yes, Please provide V.I.N.:
Loss Occurrence Information:
Please provide Higger & Associates, LLC with any additional comments you feel appropriate regarding your claim. If you have additional information, please enter it here.

Please click on the "Submit Claim" button to send us your claim. One of our representatives will respond to your claim submission as soon as possible.