Welcome to the Florida Auto Insurance Claims Center

Report a Claim Form

Give Us A Call Toll Free at:
1-888-267-1733

Introduction
As part of our commitment to superior customer service, Florida Auto Insurance now offers you the opportunity to report claims on-line. This site was created to make the reporting of routine claims more convenient and can be used for reporting any claim in which you do not require immediate assistance.

How does it work?
Your claim report will be electronically routed to the office that is best suited to handle your claim. You will receive a return E-mail acknowledging that we have received your claim report. We will then forward the claims information to your insurance company. On the next business day, a claims service representative will review your claim report and initiate the claims process. They may need to call you for more details so it is important you provide guidance on where and when you can be contacted.

How long will it take to report a claim?
Depending on the type of the claim and how much information you would like to provide, the online process will take between 5 and 30 minutes to complete. There are two basic options for reporting claims on-line:

1. Abbreviated Claim Report
One option is to provide basic information in about three to four pages. Once you have completed these pages you will be given the opportunity on subsequent pages to submit the report. If you do not wish to continue, indicate so and press the proceed button. A claims service representative will contact you on the next business day to gather any additional information necessary to process your claim.

2. Full On-line Report
This option will ask for more detailed information and is more time-consuming to complete. However, depending on the completeness of the information provided, we may be able to respond to your claim without a follow-up phone call. We have tried to make the pages as easy to complete as possible. However, if you are unclear on a question or do not have the information, just leave the box blank and continue on with the report.

What information do I need to report the claim?
Basically, the information you need is just the Florida Auto Insurance policyholder's information and your knowledge of how the accident or loss occurred. The entry screens will prompt you for the rest of the information. Remember, you only need to complete the information you know.

Required fields are marked with *

To proceed, please tell us your relationship with Florida Auto Insurance.

Choose the one that best describes your situation: I am insured by FLORIDA AUTO INSURANCE and wish to report a claim. I am reporting a claim on behalf of someone insured by FLORIDA AUTO INSURANCE. I am making a claim against a FLORIDA AUTO INSURANCE policyholder. I am providing additional information concerning a previously reported claim.

Auto Claim (8)
Please choose the type of claim that best describes your situation:
	Collision-Related Damage/Injury Damage/injury caused by impact of a vehicle with other vehicles, property, people, or animals. All vehicle collisions and collision-related injuries should be reported here.
	Medical Claim Bodily injury caused by non-collision-related contact with a vehicle. This includes injuries such as closing a door on a finger, etc.

Claimant Information (9) Please provide the following information as listed on your insurance policy. We need to know your primary residence and where you can be reached.
*Name:
Date of Birth:	(MM/DD/YY)
Insurance Co:
*Policy Number:
Primary Residence
*Address:
*City:
*Residence State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Zip Code:
County:
*Home Phone:
Work Phone:
Fax:
Cell Phone:
Alternate Phone:
*E-mail:
Where you can be reached, if different from above:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
County:
Phone Number:

Auto Claim (1)
Please choose the type of claim that best describes your situation:
	Collision-Related Damage/Injury Damage/injury caused by impact of a vehicle with other vehicles, property, people, or animals. All vehicle collisions and collision-related injuries should be reported here.
	Medical Claim Bodily injury caused by non-collision-related contact with a vehicle. This includes injuries such as closing a door on a finger, etc.
	Theft and Theft Related Damage This would include: stolen vehicle, stolen vehicle components, attempted theft, and damage to a vehicle resulting from theft.
	Glass Damage Only No other damage or injuries
	Non-collision Damage Damage to the vehicle that is not covered by one of the above. This would include: things falling on the vehicle, vandalism, weather-related damage, fire, etc.
	Towing Only Towing claim not related to a damage claim. This would apply to a disabled vehicle. Please send a copy of your towing bill to your insurance company for payment consideration.

Insured Information (2) Please provide the following information as listed on your Insurance policy. We need to know your primary residence and where you can be reached if you are not at your primary residence.
*Name:
Date of Birth:	(MM/DD/YY)
*Policy Number:
Valid Through:
Driver's License Number:
State Issued:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Primary Residence (as listed on your Insurance Policy)
*Address:
*City:
*Residence State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Zip Code:
County:
*Home Phone:
Work Phone:
Fax:
Cell Phone:
Other Phone:
*E-mail:
Where you can be reached, if different from above:
Owner or Hotel Name:
Address:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
County:
Phone Number:
Will be at this address from: to: (MM/DD/YY)

Incident Report(3)
When did the incident occur?	Date: Time: AM PM
State where incident occurred:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Where did the incident occur? (Please be as specific as possible: if you don't know the exact address, try to provide the name of an intersection, street, highway, interstate, nearest exit or mile marker, or other landmark - and the city and state where the incident occurred.)
Please tell us what happened:
What were the weather conditions?	Clear Cloudy Fog/Smoke Raining Sleet/Hail Snowing
What were the road conditions?	Dry Icy Muddy Snowy Wet
Check all that apply:	A police/fire report was taken Driver information was exchanged
Police Department Address:
Police Department Phone #:
Report/Case#:
Officer Type:	City police Fire dept Highway Patrol Security guard Sheriff State police
City/County where officer reports:

Incident Report(4)
When did the incident occur?	Date: Time: AM PM
State where incident occurred:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Where did the incident occur? (Please be as specific as possible: if you don't know the exact address, try to provide the name of an intersection, street, highway, interstate, nearest exit or mile marker, or other landmark - and the city and state where the incident occurred.)
Please tell us what happened:

Glass Claim (5) Vehicle Information
Vehicle Identification Number:
Make/Model:
Model Year:
Color:
License Plate No.:
State Issued:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Vehicle Type:	Car Cargo van Minivan SUV Truck Other
Ownership:	Lease Own Rental Unknown
Incident Report
When did the incident occur?	Date: Time: AM PM
Where did the incident occur? (Please be as specific as possible: if you don't know the exact address, try to provide the name of an intersection, street, highway, interstate, nearest exit or mile marker, or other landmark - and the city and state where the incident occurred.)
Please tell us what happened:
Damage Type and Location
Crack Chip Other
Front Windshield Rear Glass (fixed) Rear Glass (movable - hatch, minivan rear door, etc.)
Side Door Window (Front or Back Seat) Side Window (No Door) Sun/Moon Roof
Other
Is the defect in the driver's line of vision? Yes No

Towing Claim Report(6)
The vehicle was:	Towed Repaired on-site (flat tire, new belt, etc.)
Vehicle Make: (Ford, Pontiac, etc.)
Vehicle Model:
Model Year:
Destination:
Distance Towed (in miles):
Cost:
Name of towing service:
Phone number of towing service:
Tell us what happened to the vehicle that necessitated towing: Please send a copy of your towing bill to your insurance company for payment consideration.

Insured Information Provided by a Third Party on behalf of an FLORIDA AUTO INSURANCE Customer(7) Please give us some information about yourself:
*Name:
Date of Birth:	(MM/DD/YY)
*Address:
*City:
*State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Zip Code:
County:
*Home Phone:
Work Phone:
Pager:
Fax:
Cell Phone:
*E-mail:

Additional Claim Information (10) Each claim is assigned a File Number, an Occurrence Number, and a Claims Handler. If you know any of these it will greatly help match this new information to the existing claim.
File Number:
Occurrence Number:
Claims Handler:
*Name:
Date of Birth:	(MM/DD/YY)
*Address:
*City:
*Residence State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Lousiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
*Zip Code:
County:
*Home Phone:
Work Phone:
Fax:
Cell Phone:
*E-mail:
Policy Number:
Insurance Company:
Additional information you'd like to provide:

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