Report A Claim
Accident Information

To report a claim to Western General because you are a policyholder, were in an accident with one of our policyholders, or witnessed an accident involving our policyholder, please fill out the form below then click the "Next Page" button to enter Vehicle/Driver information.

* = Required Field


Policyholder/Claimant Information


Reported Date: Time:
Are you a Western General
policy holder?:*
Yes
No

.

Your First Name:* Your Last Name:*
Your Street:*
Your City:* State:* Zip:*

.

Date of Birth Driver's License #:
Primary Phone:* Alternate Phone:
Best time to call:
Email:* Confirm Email:*

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