Automobile Claim Report

If you are reporting an Automobile Claim, please print and review this information first:

Company Reporting: To report your claim directly to your Insurance Company, use the information provided here:

IRMS Reporting: To report an Automobile Claim to IRMS, please complete this form and click “Submit”.

If you need assistance, please contact your Client Service Manager.

  • Contact Information

  • General Information

  • MM slash DD slash YYYY
  • Driver of Your Vehicle

  • Your Vehicle

  • Driver of Other Vehicle