Policy Claim Forms



In order to report a Claim, the Proof of Loss form, which you can download from this Website, must be completed, signed and returned to Haylor, Freyer & Coon, Inc. To prevent a delay in settlement we request that you submit your claim form within 90 days of the date of loss. Required Documentation: A copy of the receipt or the original bill for the damaged or stolen items. If this information is not available, we require written estimate from the place of purchase (or similar store) for the same or comparable items. We also accept website documentation to determine value. For Claims involving theft or vandalism, a Security or Police report is required. For Accidental Damage to electronic items valued over $500 a repair estimate or bill is needed. If the item is not repairable, then we will need a statement from an authorized repair facility. 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.