NBIS Claims Adjustment Services - Report A Claim

Claims can also be reported by phone to our 24/7 hotline at 1-888-567-7285.

As a customer of ours, we will work with you throughout the process from start to finish, in ensuring you receive prompt service as we work together in settling your claim. Please provide the following information so that we can start servicing your needs as soon as possible. Please Note : You must complete steps one and two before the form can be submitted.

Step 1. Please enter your name and contact information

* Name : * Email Address : Company Name : * Telephone : * Address : * City : * State : -- Select One -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes 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 Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming * Zip : * Who Am I : -- Select One -- Agent/Producer Current Insured Claimant Other

Step 2. Please enter the following information about the claim

Date of Accident : * What type of claim      are you submitting? : -- Select One -- Residence Crane Auto Other     Has a Lawsuit been filed? : YesNo       * Description of Accident :

Step 3. Enter the name and address of the insured (if available)

Name : Email Address : Company Name : Telephone : Address : City : State : -- Select One -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes 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 Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip : Policy Number :

Step 4. Please enter the following information about the claimant (if available)

Name : Email Address : Company Name : Telephone : Address : City : State : -- Select One -- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusettes 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 Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip :

Additional Information/Documents can be faxed to: 619-278-2479 or Email: newclaims@nbis.com for claim inquiries.