Assign a Claim

Online Submission Form

New Assignment Form

Fill out the form below to assign a claim. One of our claims representatives will be in touch with you in 24 hours. If this is an emergency please call 1-800-426-7228.

(Fields marked with * are required)

Customer Information

First Name*
Last Name*
Title
Company*
Address*
City*
State*
Zip*
Phone*
Fax
Email Address*
Your Claim #*
Date of Accident/Loss*

Insured

Insured Type
Insured First Name
Insured Last Name*
Address
City
State
Zip
Phone
Email

Claimant

Claimant Type
Claimant First Name
Claimant Last Name
Address
City
State
Zip
Phone
Email

Assignment

Type of Assignment*

Loss Description*
Assignment (What do you want Frontier to do?)*
Assignment Location
Address*
City*
State*
Zip*

Injury / Damage / Coverage

Injury / Damage
Coverage Information

Attachments

Individual file size may not exceed 10MB