Saga Uploads
Step 1: Tell us about yourself
I have an insurance policy with American Property & Casualty
I was involved in an accident with someone insured by American Property & Casualty
Other – I am not directly involved in the loss (agent, carrier, body shop, etc.)
Insured’s Full Name
*
Insured's Policy Number
Specify your relationship to the claim
*
Select
Insured’s producer
Insured’s attorney
Claimant’s insurer
Claimant’s producer
Claimant’s attorney
Other
Please specify relationship
*
Next
Step 1: Tell us about yourself
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Insured’s Full Name:
Insured's Policy Number:
Relationship:
Specific Relationship:
Step 2: Your information...
Business Name
*
First Name
*
Last Name
*
Email Address
*
Invalid email format
Phone Number
*
Invalid phone number
Extension
Can this number receive text messages?
Select
Yes
No
Preferred Contact Method
Select
Email
Phone
Text
This option is invalid because you already selected that you cannot receive text messages.
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Step 2: Your information...
Edit
Business Name:
First Name:
Last Name:
Email Address:
Phone Number:
Extension:
Can this number receive text messages?:
Preferred Contact Method:
Step 3: Your address...
Address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
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
Pennyslvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
Washington D.C.
West Virginia
Wisconsin
Wyoming
Zip Code
*
Next
Step 3: Your address...
Edit
Address:
City:
State:
Zip Code:
Step 4: Your insurance information...
Are you insured?
*
Select
Yes
No
Insurance Company
*
Your Policy Number
*
Have you reported it to your company?
*
Select
Yes
No
Policy Holder Name
Driver's Name
Can we contact the insured?
*
Select
Yes
No
Relevant Contact Information
*
Next
Step 4: Your insurance information...
Edit
Are You Insured?:
Insurance Company:
Your Policy Number:
Have you reported it to your company?:
Policy Holder Name:
Driver's Name:
Can we contact the insured?:
Insured Contact Info:
Step 5: Tell us about your accident...
Date of Accident
*
The Date Of Accident cannot be in the future.
Time of Accident
*
Accident Location (city and state)
*
Accident Description
*
Can the vehicle still be driven?
*
Select
Yes
No
Where is the vehicle now?
*
How many child safety seats, if any, were in your vehicle?
*
Select
0
1
2
3
4
5
Next
Step 5: Tell us about your accident...
Edit
Date of Accident:
Time of Accident:
Accident Location (city and state):
Accident Description:
Can the vehicle still be driven?:
Where is the vehicle now?:
How many child safety seats, if any, were in your vehicle?:
Step 6: Any injuries and witnesses...
Was anyone injured in this accident?
*
Select
Yes
No
If so, list their names, ages, and injuries
Witnesses' names and phone numbers
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Step 6: Any injuries and witnesses...
Edit
Was anyone injured in this accident?:
If so, list their names, ages, and injuries:
Witnesses' names and phone numbers:
Step 7: Any police report...
Is there a Police Report?
*
Select
Yes
No
Police Department
Police Report Number
Next
Step 7: Any police report...
Edit
Is there a Police Report?:
Police Department:
Police Report Number:
Step 8: Any other claims...
Have you made an online claim before?
*
Select
Yes
No
Claim Number
*
Approximate Date
*
Carrier Name
*
Next
Step 8: Any other claims...
Edit
Have you made an online claim before?:
Claim Number:
Approximate Date:
Carrier Name:
Step 9: Final step
Anything else we need to know....?
TBD
TBD
TBD
Submit
Step 9: Final step
Edit