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Submit A Claim

You can submit your claim assignment information online using the form below.

We do not take claim assignments from the general public; this form is for industry professionals. If you are a policyholder, please contact your insurance company directly.

Assignment Details

Type of Claim Assignment
If Other: Please Specify
Type of Loss
If Other: Please Specify
Claim Number *
Policy Number
Date of Loss *
Location of Loss *
Special Instructions / Assignment Notes

Insured Information

Client First Name (Insured Party) *
Client Last Name (Insured Party) *
Insured Party Street Address
Insured Party City
Insured Party State
Insured Party ZIP Code
Insured Party Phone Number

Claimant Information

Claimant First Name
Claimant Last Name
Claimant Street Address
Claimant City
Claimant State
Claimant ZIP Code
Claimant Phone Number

Submitting Party / Company Information

Company Name *
Submitting Party First Name
Submitting Party Last Name
Contact Name (If Different From Above)
Submitting Party Street Address
Submitting Party City
Submitting Party State
Submitting Party ZIP Code
Submitting Party Phone Number
Submitting Party Email Address
Submitting Party Fax Number
How did you hear about Allied American USA?
If Other: Please Specify

Supporting Documents / File Uploads

Assignment Documents
Examples: Assignment writeups, claim documents, photos, supporting reports. Up to 6 total files, less than 10 MB each.
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By submitting this form, you confirm that you are authorized to provide this information and agree to our Privacy Policy and Terms & Conditions.
Thank you for submitting your claim information. We’ll be back in touch with you as soon as possible. If you have any immediate questions or concerns, please call our Tampa, FL Headquarters at (800) 794-2529.
There was an issue with your submission. Please try again, or call our Tampa, FL Headquarters at (800) 794-2529.
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SOC 1 Type 2 and SOC 2 Type 2 compliant
Lloyd's Delegated Claims Administrator
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