Casualty & Liability

If you prefer not to complete the form, you may submit the assignment or any special instructions by emailing claims@legionclaims.com.

Do you have an FNOL?

Yes

Client/Carrier Name(Required)

Claim Representative

Claim Representative's Phone Number

Claim Representative's Email

Insured Name

Insured Phone

Insured Email

Loss Location

Date of Loss

Claim Number(Required)

Claim Number

Policy Number

Upload Claim Documents

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, doc, docx, odt, xls, xlsx, mp4, m4v, mov, wmv, avi, mpg, Max. file size: 128 MB.

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