Submit a Claim

To report a claim for mine subsidence damage, please complete the information below to the best of your ability. Please also attach a copy of the property owner’s declarations page showing the policy type, coverage limits and Mine Subsidence Insurance coverage endorsement. 

Contact us at 614-823-6008 for claims emergencies or questions about this process.

Insured Information

First Name

Last Name

Phone 1

Type Cell Home Business Fax

Phone 2

Type Cell Home Business Fax

I consent to receive text messages regarding this claim.

Email

Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Property Address

Same as Mailing Address

Address Line 1

Address Line 2

City

State

County

Zip Code

Insurance Information

Name of Insurance Company

Name of Insurance Agency

Primary Contact For Claim

Same as Insured

First Name

Last Name

Phone 1

Type Cell Home Business Fax

Phone 2

Type Cell Home Business Fax

I consent to receive text messages regarding this claim.

Email

Claim Information

Date Of Loss

Description Of Loss

Reported By

First Name

Last Name

Phone

Email

Documentation

Please attach a copy of the property owner’s declarations page and any other documentation to support this claim.

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Submit Claim