Claims

What to Do at the Scene of an Auto Accident >

Karen is our in-house claims specialist; she will guide you through the claims process. When a claim occurs during business hours, call our office at 402-475-3213 and ask for her. Please have claim information and your policy number on-hand, if possible.

Alternatively, you can complete the form below to simply notify Karen of the claim and she will contact you for further information. Please only use this option for non-emergency claims!

If you have a claim outside our business hours, you can call us at 402-475-3213 and our phone directory system will connect you with the claims hotline for your carrier or allow you to talk to a Copple representative. Additionally, below the Non-Emergency Claim Form is a list of our most popular carriers and their respective claim-hotlines or claim-reporting websites.

Non-Emergency Claim Form

Name

Provide the name of the person we need to contact regarding this claim.

First Name

Last Name

Insured Name

Provide the name of the Primary Named Insured, whether that is a person or a legal entity.

Phone

The best phone number to reach the contact person.

(###)

###

####

Email Address

The best email address to reach the contact person.

Date of Incident

Provide the date of the incident. For multi-day claims, provide the date when it first started.

YYYY

Time of Incident

Provide the time of the incident.

Hour

Minute

Second

Location of Incident

Provide the location of the incident.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Police Report Number

Provide the police report number (if applicable).

Checkbox

Please indicate the type or types of claims for this incident.

Property Loss

Automobile Loss

Liability Claim

Worker's Compensation Claim

Other

Description of Incident

As precisely as you can, describe the incident.

Additional Comments

Is there anything else you'd like to let us know?

Claims

Non-Emergency Claim Form

Carrier Claim Contacts

Cincinnati

CNA

General Casualty

Philadelphia

MetLife

Progressive