Let’s start with the basics.

To legally represent you, we need to confirm your property details and make sure this claim matches state-specific requirements.

Full Legal Name(s) (exactly as shown on policy — required for signatures):

First Name *

Last Name *

Phone

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Address Of Loss *

City of Loss *

Select State Of Loss: *

Postal Code of Loss *

Your Mailing Address If Different From The Loss Address

Email *

Terms & Conditions and Privacy Policy

Is there another homeowner? *

Yes

Second Homeowner Name *

Please List The First And Last Name Of Any Additional Person(s) On Your Policy

Addional Insured 1
Addional Insured 2
Addional Insured 3

Tell us about what happened.

The more we know about the event, the faster we can determine if it falls within your policy and file it in a timely manner.

We’re only licensed to represent property owners. If you’re a renter, your coverage would come through renter’s insurance.

Are you the owner or renter of this property? *

Owner

Renter

How long has it been since the loss?

Less than 30 days

31-90 days

Over 90 Days

Date Of Loss *

Knowing whether this is a new or supplemental claim helps us determine how to proceed and which documents may already exist.

Claim Type *

Emergency: ⓘDamage is recent and still causing active issues (e.g., water intrusion, roof collapse, or fire). These claims often need urgent response and documentation, and may require emergency mitigation before we can move forward.

Non-Emergency: ⓘ The damage has occurred, but the situation is now stable and safe. These are the easiest to review and proceed with, and often allow for the cleanest file and strongest representation.

Supplemental: ⓘ The insurance company already paid or closed the claim, but you believe they missed or underpaid for damage. We'll need to review the prior estimate and payment, and confirm that no waiver was signed or check cashed that might limit your rights.

Most policies require the policyholder to take steps to prevent further damage. This question helps us document what’s been done, or what may still be needed, and can affect claim eligibility.

What Have You Done To Prevent Further Damages? *

Nothing

Other

Please Explain

Where are you in the claim process?

Some clients have already started working with their insurance company. That’s okay — we’ll meet you wherever you are in the process.

This helps us understand what stage you’re in and how quickly we may need to intervene.

Have you filed a claim? *

Yes

Insurance Company *

Policy Number *

Claim Number (Optional)

This tells us whether the carrier has responded or issued a payment — and if so, whether it was fair or needs review.

Claim Status *

Not Filed: ⓘ You haven’t contacted the insurance company yet or opened a claim file. That’s totally fine, this is often the best time to engage a Public Adjuster so we can handle it correctly from the start.

Filed-No Response: ⓘ You’ve submitted a claim, but haven’t heard back or received an inspection. We can step in to ensure your file moves forward and is documented correctly.

Underpaid: ⓘ The carrier sent a payment, but it’s not enough to cover the damage. We’ll review their estimate and advocate for what you’re truly owed.

Denied: ⓘ Your claim was denied by the carrier. We’ll need to carefully review the denial letter and all communications to determine if we can move forward.

Paid But Not Satisfied: ⓘ You received payment, but it feels incomplete, rushed, or inaccurate. We can help assess if a supplement is possible and negotiate a better outcome.

If a settlement was offered, we want to understand whether it was accepted and how it compares to the damage.

* Has the insurance company offered a settlement? *

Yes

If you received a check from the insurance company, did you cash it? *

Yes

Some insurance checks contain language that limits your ability to request more money if cashed. This question helps us determine whether your claim is still eligible for review.

Do you have an insurance declaration page that you can upload? *

Yes

Insurance Declarations Page

Do you have photos and/or videos of the damage you can upload? *

Yes

Photos/Videos of Damage

Let’s collect what you’ve got so far.
You don’t need to have everything ready right now. Even a few documents can help us start assessing your claim.

This page outlines your coverages and deductibles. We need it to verify eligibility and begin your file.

Images help us begin evaluating the severity and type of damage before the inspection.

Contractor or Engineer Estimates

Communications with Insurance Company

A few final questions to help us match you with the right adjuster.

We ask these to determine how to best support you, and whether there are any red flags or extra steps needed before proceeding.

This helps us understand if another professional is already involved and may affect the claim’s handling.

Have you worked with a PA, contractor, or attorney on this claim before? *

Yes

Were you referred by a contractor?
We work with many trusted contractors. If one referred you to us, let us know their name and company so we can keep them informed on your claim status.

Referred Contractor (Name & Company)

If an adjuster has already been out, we’ll want to review their findings and compare it to our own scope.

Has your Insurance carrier sent an adjuster yet? *

Yes

If the property isn’t livable, we may be able to help with temporary housing coverage or emergency recovery efforts.

Is the property currently habitable? *

Yes

To legally represent you, we need your full authorization to manage the claim, communicate with the carrier, and negotiate on your behalf.

Are you comfortable with the Public Adjuster handling all aspects of the claim? *

Yes

Not Sure Yet