Report Claim Online | Eastern Atlantic Insurance Company

Report Claim Online
If you are reporting this claim, are you insured by Eastern Atlantic?*
- Yes
- No
Which of the following describes you best:*
Other -- please specify*
Name of insured’s business*
Eastern Atlantic policy number*
Eastern Atlantic Policy Number or the Name of Insured Party*
Name of person reporting this claim*
Phone where we can reach you*
Which of the following describes you best*
Other -- please specify*
Phone where we can reach you*
Email*

After submitting the online Claims Form, you will be contacted by one of our claims representatives as soon as possible. You only need to fill out fields marked with an asterisk (*).
When did the accident or loss happen ?
MM slash DD slash YYYY
Please provide the following if different from what you have already provided.
First Name
Last Name
Where did it happen*
Street, highway, or mile marker City or nearest town State
Phone
Email
Describe the insured’s vehicle
Year - insured’s vehicle*
Make - insured’s vehicle*
Model - insured’s vehicle*
Describe other party's vehicle
Year - other party's vehicle
Make - other party's vehicle
Model - other party's vehicle
Is anyone hurt?*
Have the police or other first responders been contacted ?*
If you know, please provide the name(s) of other persons involved in the accident
Did anyone witness the accident or loss?*
Please provide any contact information you may have obtained from witnesses of the accident.
If you can, please provide a brief description of the accident or loss
Is there a police report?
Police department and incident number
Thank you, for this vital claim information. You will receive a confirmation email soon after you click submit.