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Home » Service Center » Report a Claim

Do you need help reporting a claim? We’re here to help make the experience as simple and convenient as possible.

What happens during the claims process? Read about our claims process and procedures.

Worker’s Compensation Claim

Click here to report a workers’ compensation claim.

Report Workers' Comp Claim

Report a Claim With Empire Insurance Agency

Need help reporting a claim? Fill out the form below and we’ll be in touch.

"*" indicates required fields

Name

First Name Last Name

Phone Number

May we contact you via text message?

Yes

Insurance Carrier

Policy number

Date Your Loss Occurred

Month

Day

Year

Time

Type of Claim

Auto/Vehicle

Property

Other

Your vehicle year/make/model

Is vehicle able to be driven?

Where is vehicle being kept?

Give address of garage, house, etc where vehicle is located

Full name of driver at time of incident

Location of incident

Street Address Address Line 2 City State ZIP Code

Provide approximate location and/or cross streets

Any other occupants in your vehicle?

Other occupants

List names, relationship, date of birth, and any injuries

Is anyone injured?

Describe injuries

Include names and extent of injuries. Include hospital name if transported.

Details of incident

Include description of damage to your vehicle.

Were any other vehicles involved?

Other vehicle information

Include: year/make/model of other vehicle(s) Name of driver(s) with phone number Insurance carrier(s) and policy number Damage to other vehicle(s) Injuries to occupants of other vehicle(s)

Were police called to scene?

Police information

Include department name, officer name, badge number, and report number

Address of damage

Street Address Address Line 2 City State ZIP Code

Describe property damage

Include extent and location (i.e. room name, area on property). Include description of injuries, if any.

Claim Details

Please do not include sensitive, private information in this area.

This field is for validation purposes and should be left unchanged.

Report Your Claim Directly

Click the link below, find your insurance provider, and follow their process.

Find Your Insurance Company

Prefer to speak with someone from Empire Insurance Agency?
Contact us directly.