Policy Claim Forms



In order to report a Claim, you must notify Haylor, Freyer & Coon of the incident within 90 days of the date of the loss. The Proof of Loss form, which you can download from this Website, must be completed, signed and returned to Haylor, Freyer & Coon, Inc. for handling within 60 days of our request for information. Please submit a copy of the receipt or the original bill for the damaged or stolen items when submitting the Proof of Loss. If this information is not available, we require a written estimate from the place of purchase (or similar store) for the same or comparable items. For Claims involving theft or vandalism, a Security or Police report is required. We must advise you that any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime. Should you have any questions, please contact Wendy Bigford at our office. Phone # 1-888-201-5988 or wbigford@haylor.com

You can download the Proof of Loss form by clicking the icon below. Once completed, mail to Haylor, Freyer & Coon, Inc.at PO Box 4743 in Syracuse, NY 13221 attn: Claim Department. You can Fax the Claim form to 1-315-453-2184 or E-Mail it to wbigford@haylor.com. Haylor, Freyer & Coon handles all claims in our office. Please note that Adobe Reader is required to view these forms. Click on the icon to download the reader.