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193 East Main Street
Babylon, New York 11702


P: (631) 482-9966
F: (631) 482-9959
After Hours, Contact: (516) 776-0222 / (631) 561-8548
Email

Claims Adjustment

Special Investigations

Trial Preparation



Submit Assignment

To submit an assignment, please complete the online form. If you would like a copy of your submission, please use your browser print settings and print a copy for your records. Once the information is complete, your information will be sent to United Claims Service, Inc. for processing. If you experience any technical difficulties, simply contact our office at: 1-800-843-4374.

Please email any additional information, documentation or records pertinent to the assignment to info@unitedclaims.com. Please include your claim number in the subject line of the email. Thank you and we look forward to working with you.

Contact Information

* Required
First Name *
Last Name *
Company *
Claim Number *
Email *
Address *
City *
State
Zip Code *
Telephone Number *
Broker

Insured Information

Insured
Telephone Number
Additional Info
Insured Vehicle
Insured Attorney
Insured Passenger(s)
Witness(es)

Claimant Information

Claimant
Additional Info
Claimants Vehicle
Claimants Attorney
Claimants Passenger(s)
Date of Accident
Time of Accident
Police Report
Location of Accident
Description of Accident
Assignment
Comments / Special Instructions