M&PL Liability Report Claim- Philadelphia Insurance Companies

Report a Claim

By using this service, you can expedite the handling of your claim. After you complete the notice, it is sent electronically to the appropriate claims department personnel who will contact you within 24 hours.For more information visit the Claim Notification Center.

Risk Management Hotline

Wilson Elser provides policyholders with two free hours of legal consultation with knowledgeable attorneys on any matter that could potentially result in a claim under a PHLY policy Read More

Management and Professional Liability

Progress

Contact Information

Required Fields

Name of Person Reporting the Claim/Circumstance

Phone Number of Person Reporting Claim/Circumstance

- -

Email Address of Person Reporting Claim/Circumstance

Name of Person to Contact

Email Address of Person to Contact

Phone Number of Person to Contact

- -

Check here if the Reporting Person is the same as the Contact Person

Policy Profile

Policy Number

Policy Holder Name (individual or company)

Policy Holder Street Address

Policy Holder City

Policy Holder State

Policy Holder Phone

- -

Description of Claim/Circumstance

Date of Loss

Description of Loss/ What is alleged?

Claimant/ Client Name

Claimant/ Client Contact Information

Suit Information

Has Suit been filed?

YesNo

If Yes, Date Served

Venue

Submit Claim Form Here

File Attachments

File size is limited to 3 (MB) per file. Maximum Files: 5

Following packages will be used to scan file(s): * MSCW 5.1.2

Allowed file types: .doc .docx .pdf .jpg .jpeg .gif .bmp .png .tif .rar .zip .xls .xlsx

By checking this box, I confirm that I’ve read and understand the fraud language pertaining to the submission of this claim.

Claims

MP Liability Report Claim

Report a Claim

Risk Management Hotline

Management and Professional Liability