Please note that submitting a claim from this web site does not confirm coverage or authorize payment. A customer
service representative at Suburban Insurance will verify your coverage and contact you to complete the claims process.
Note: If more than two people are involved, please contact our agency directly to report the
claim.
Policy Number (if you know it)
Full Name
Contact Information Who should the claims adjuster contact regarding repairs?
Name
Home Telephone
Work Telephone
Email
Authority Contacted
Police Department
Police Report Number
Claim Information
Date of Accident
Location of Accident
Cause of Accident
Describe, if other cause of loss
Injuries Reminder: If more than two people are involved, please contact our agency directly to report
the claim.