EAGLE STATEWIDE • CLAIM SUPPORT
Report a Claim
Submit your claim information below and our team will review your request
and help direct you to the appropriate insurance carrier or claims process.
01
Report the Incident
02
Submit Information
03
Claims Follow-Up
Before You Submit
If available, have your policy number, date and location of the incident,
description of what happened, photos, police report information and other
supporting documents ready.
Emergency or Immediate Danger
If anyone is injured, there is an immediate safety concern, or emergency
assistance is required, contact the appropriate emergency authorities first.
This online form is not an emergency response service.
CLAIM REQUEST FORM
Tell Us What Happened
Complete the requested information below. Our team can review your
submission and help direct the claim to the appropriate next step.
Important Claim Information
Submitting this form does not constitute acceptance of a claim,
confirmation of coverage, admission of liability or a guarantee of payment.
Claim handling, coverage decisions, investigation and settlement are
determined by the applicable insurance carrier according to the policy
terms and available facts.
CLAIMS SUPPORT
Need Help Reporting Your Claim?
Contact Eagle Statewide if you need assistance submitting your claim
information or locating the appropriate carrier claims contact.