SurSafe | Report A Claim

Need to report a claim?

Complete the form below, call 800-310-2717, or contact your agent. If you are an agent, please use the agent login to submit a claim.

Report a Claim

I am a(n)

Please indicate submitter type.

Submitter Information

First Name

Please provide a first name.

Last Name

Please provide a last name.

Please provide an email address.

Primary Phone

Please provide a primary phone.

Alternate Phone

Address

City

State

Zip

Insured Information

Same as Submitter Information

First Name

Please provide a first name.

Last Name

Please provide a last name.

Please provide an email address.

Primary Phone

Alternate Phone

Address

City

State

Zip

SurSafe Policy Number

Location of Loss

Same as Submitter Address

Address

City

State

Zip

Claim Details

Please provide as much detail about your loss/accident.

Date Of Loss

Please provide the date of loss.

Describe What Happened

Attach Photo(s) (5mb max file upload size)

Any persons who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime.