What is your first name?
What is your last name?
What is your email address?
What type of insurance claim did you recently have?
How did you report the claim to the insurance company?
Were you satisfied with the responsiveness of your insurance company to your claim?
Did the insurance company's claims adjuster provide a clear understanding of the claims process?
Was your claim settled in an acceptable timeframe?
How satisfied are you with how your agent/agency handled your claim?
What is the name of the agent who assisted you?
Please provide a brief description of the assistance you received from the agent/agency.
Did the policy coverage match your expectations as outlined to you by your agent/broker when your policy was written?
Please provide a brief explanation about how your coverage program did not meet your expectations.
How satisfied are you with how your insurance company handled your claim?
Please feel free to provide further details about your claims experience below.
How satisfied are you with the final claim settlement?
How would you rate your overall satisfaction with the handling of your claim?
Policy Credit Identification
Complete this section to help identify policy credits that you might be eligible for because of the repairs and work done to your home during this claim.
Did any of the following take place as part of this claim? (Select all that apply)
Roof Repair Information
What percentage of the roof was repaired/replaced?
Please provide a brief explanation why the roof was not fully replaced.
Please select your roof type.
Does your roof have a specific UL (Underwriting Laboratories) rating?
Please enter the date the roof repair/replacement occurred.
MM slash DD slash YYYY
What is the name of the contractor?
Please enter the contractor's address.
Please enter the contractor's phone number.
Do you have a copy of your contractor's work estimate and/or invoice confirming the type of roof material and the date the replacement of the roof was completed?
Please upload a copy of the contractor's work estimate and/or invoice confirming the type of roof material and the date the replacement of the roof was completed.
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Please enter any additional remarks you would like to share with us in the space below.