CLAIM SUBMISSION FORM

Please look at your policy documents carefully before filing a claim using this form. This online claims submission form is ONLY available for the following Insurance Companies: Lloyds of London, Great Lakes and Chubb European. Applicable Policy Prefixes: MHL, MHN, MHA, LNW, VP, DWL, HO4, MHG, CMH

If your policy number does not begin with the available prefixes in this form then you must visit https://ibgreen.com/claims/ for instructions on how to file a claim with you Insurance Company. If you file a claim using this form and your carrier/prefix is not listed above, this delays the processing of your claim. It is up to YOU to file the claim with the appropriate Insurance Company to avoid any delays.
Todays's Date:
Select the Prefix of the Policy Number:
Enter the Policy Number/Certificate Number:
Enter Insured's Name:
Enter Insured Location Address:
Phone Number:
Alternate Phone Number:
Date Damage Occurred:
Type of Loss:
Decription of Damage:
Claim Reported By (Individual First/Last Name):
Your Email Address:
Any person who knowingly and with intent to injure, defraud or deceive any insurer,
files a statement of claim containing any false, incomplete or misleading information
is guilty of a felony of the third degree.
By clicking SUBMIT you declare all the provided information is true and correct.