General Liability Incident Submission Form

  • BUSINESS INFORMATION

  • Has an incident occurred at your home, work place or job site resulting in bodily injury or property damage? Complete the below form to the best of your ability and an InterWest property and casualty claims professional will contact you as soon as possible but not more than one business day. If this is a claim involving major injuries or death, see the Emergency Claims Reporting instructions on the Submit A Claim page. We ask you complete the form with the available information, however, if you do not have the information or it doesn’t apply simply leave it blank. Let our experience guide you!

  • Incident Information

  • MM slash DD slash YYYY
  • :

  • OTHER PARTY INFORMATION

  • Please attach a copy of photos or any other information obtained at the scene of the accident. Also, attach any other information obtained regarding the incident.
  • Drop files here or
    Max. file size: 40 MB.