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
Please preserve a copy of the video
Other Party Information
