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File a Claim

At Unique, it's easy to file an online claim with us. Fill out the below form and an agent will get back to you within 24 hours.

File an Auto Claim

Step 1 of 7

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Are you an insured or representing an insured with Unique Insurance?*
- Yes
- No
*
- I'm presenting a liability claim
- I'm an Insurance Representative/Agent
- I'm a Medical Provider
- I'm an Attorney
- I'm a Contractor/Independent Appraiser
Reporter's Name*
First Middle Last
Reporter's Phone*
Reporter's Email*
Unique Insurance Policy Number*
Date of Loss*
MM slash DD slash YYYY
Time of Loss*
: Hours
Minutes
AM/PM
Location of Loss Address
Street Address Address Line 2
*
City State

UNIQUE'S POLICYHOLDER INFORMATION
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Home Phone*
Cell Phone
Work Phone
Email*

INSURED PROPERTY DAMAGE
Describe Cause of Loss*
Is there damage to the insured property/contents?
- Yes
- No
Describe Damage to Property*
Describe Damage to Contents*
Is the insured currently working with a contractor?
- Yes
- No
Contractor/Business Name
Contractor/Business Address
Street Address Address Line 2 City State ZIP Code
Contractor Phone Number
Is the insured property livable?
- Yes
- No
Temporary Residence Location
Street Address Address Line 2 City State ZIP Code
Best Contact Number at this Location

SUBROGATION POTENTIAL
Is another person/business responsible for damage to your property?*
- Yes
- No
Responsible Party Name
First Middle Last
Responsible Party Address
Street Address Address Line 2 City State ZIP Code
Insurance Company Name
Insurance Company Policy Number

CLAIMANT INFORMATION
Is a liability or Medical Payments claim being submitted?*
- Yes
- No
OTHER PERSON'S INFORMATION
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Email Address
Date of Birth
MM slash DD slash YYYY
Is this person a minor?
- Yes
- No
Insurance Company Name
Insurance Company Policy Number
Describe Property Damage Involved
Relationship to Insured
Was this person injured?*
- Yes
- No
- Unknown
Describe Injuries
Was medical treatment sought?
- Yes
- No
- Unknown
PARENT/GUARDIAN
Name
First Middle Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Email
Hidden
Was an additional person involved?*
- Yes
- No
2ND ADDITIONAL PERSON'S INFORMATION
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Email Address
Date of Birth
MM slash DD slash YYYY
Is this person a minor?
- Yes
- No
Insurance Company Name
Insurance Company Policy Number
Describe Property Damage Involved
Relationship to Insured
Was this person injured?*
- Yes
- No
- Unknown
Describe Injuries
Was medical treatment sought?
- Yes
- No
- Unknown
PARENT/GUARDIAN
Name
First Middle Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Email
Hidden
Was an additional person involved?*
- Yes
- No
3RD ADDITIONAL PERSON'S INFORMATION
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Email Address
Date of Birth
MM slash DD slash YYYY
Is this person a minor?
- Yes
- No
Insurance Company Name
Insurance Company Policy Number
Describe Property Damage Involved
Relationship to Insured
Was this person injured?*
- Yes
- No
- Unknown
Describe Injuries
Was medical treatment sought?
- Yes
- No
- Unknown
PARENT/GUARDIAN
Name
First Middle Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Email
Hidden
Was an additional person involved?*
- Yes
- No
4TH ADDITIONAL PERSON'S INFORMATION
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Email Address
Date of Birth
MM slash DD slash YYYY
Is this person a minor?
- Yes
- No
Insurance Company Name
Insurance Company Policy Number
Describe Property Damage Involved
Relationship to Insured
Was this person injured?*
- Yes
- No
- Unknown
Describe Injuries
Was medical treatment sought?
- Yes
- No
- Unknown
PARENT/GUARDIAN
Name
First Middle Last
Address
Street Address Address Line 2 City State ZIP Code
Home Phone
Cell Phone
Work Phone
Email

LOSS DETAILS
Describe what happened in this loss*
Were the police notified?*
- Yes
- No
- Unknown
Police Department Name
Police Report Number
Reported Through
Was the Fire Department notified?*
- Yes
- No
- Unknown
Fire Department Name
Fire Report Number
Were there any witnesses to the incident not listed above?*
- Yes
- No
- Unknown
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
Email
Any Additional Comments?

Do you understand and accept these conditions?*
Yes, I understand and accept these conditions
Please take reasonable and prudent measures to preserve, protect and secure property from further damage. Take photographs of all damaged property and gather any and all receipts/invoices for lost, stolen, or damaged property in connection with this claim.

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