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File A Claim

Meet our Claims Coordinator, Matthew Hall

As the Claims Coordinator, I am responsible for initial claim reporting, and addressing any questions or concerns that may arise throughout the life of your claim. Here at Stahlka Agency, we understand that an unexpected event can be extremely disruptive to your life. It is my personal goal to ensure your claim is handled seamlessly.

The Process

For claims reporting, simply report your claim online below or contact me directly. Once I have the necessary details I will establish the claim with your carrier, and then provide you with the claim number and adjuster’s contact information. Thereafter, the adjuster should contact you within 24-48 business hours. At that point, your carrier will typically take over the handling of your claim. If for any reason you are having trouble getting in contact with the adjuster or have additional questions or concerns, please do not hesitate to contact me for assistance.

If you would like to report your claim online please complete the forms below.

If you’re submitting a claim after hours or on the weekend and would like to contact your carrier directly, please click HERE.

File A Claim Form

Type of Insurance
Select Type of Commercial Insurance*
Select Type of Personal Insurance*
Person Reporting Claim:*
Best Contact Number:*
Email:*
Insured Name/Company:*
Please call our Claims Coordinator, Cody, at 716-932-7805. Thank you!
For reporting glass-only damage to your vehicle, please contact your insurance carrier directly. Click here to access your carrier's contact information.
Please complete the Workers Compensation form here and email to Cody Burns at cburns@emsinsurance.com or fax it to us at 716-634-6411. Thank you!
MOTOR VEHICLE ACCIDENT EXCHANGE FORM
Date of Incident & Time of Incident*
Location of loss including city, state, & zip:*
Police Contacted?*
Police report # and Police Department:
Insured Driver
Name:
Phone Number:
Injured?
Full Address:
License Plate Number
Vehicle Year/Make/Model*
Vehicle VIN:
Driver's Name:
Insured's Phone Number:
Insurance Company:
Airbag Deployment:
Damaged area(s) of automobile:
Claimant Driver
Name:
Phone Number:
Injured?
Full Address:
License Plate Number
Vehicle Year/Make/Model
Vehicle VIN:
Claimant's Name:
Claimant's Phone Number:
Claimant Owner's Name (If different than the driver.)
Insurance Company:
Insurance Policy Number:
Airbag Deployment:
Damaged area(s) of automobile:
Claim Contact:*
DON’T FORGET TO TAKE PHOTOS OF THE ACCIDENT SCENE AND THE AUTOMOBILE(S) INVOLVED.
GENERAL LIABILITY CLAIM REPORTING:
Accident Information
Date of Incident & Time of Incident*
Incident Location*
Description of Incident*
Police Contacted?*
Accident Report Number/Police Department
Claimant Information
Name of Claimant:
Address of Claimant:
Phone Number:
Injured?*
Did you seek medical treatment?*
Location/type of injury?
Brief description of claimant injury:
Fatality?
Has claimant received treatment?
What kind of treatment did the claimant receive? What is the name of the facility where claimant received treatment?*
Witness Information
Were there any witnesses?
Name:
Phone Number:
Address:
Property Damage Information
Claimant Property:
Where is the property located?:
What damage was caused to claimant property?:
Do you have a repair estimate?
Please attach copy of estimate/photos:
Max. file size: 49 MB.
PROPERTY CLAIM REPORTING:
Accident Information
Date of Incident & Time of Incident*
Incident Location:*
Incident Description:*
Police contacted?*
Damage to others property?*
Was anyone injured?*
Claim Contact:*
Please call our Claims Coordinator, Cody Burns, at 716-932-7805.
For reporting glass only damage to your vehicle, please contact your insurance carrier directly.
Please attach any accident photos:
Max. file size: 49 MB.
Consent*
I acknowledge the following:
Stahlka Agency cannot honor any request to bind coverage, to amend or alter coverage of terms and conditions of any policy, or record claims directly via online forms.
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File A Claim

Meet our Claims Coordinator, Matthew Hall

The Process

File A Claim Form

MOTOR VEHICLE ACCIDENT EXCHANGE FORM

Insured Driver

Claimant Driver

GENERAL LIABILITY CLAIM REPORTING:

Accident Information

Claimant Information

Witness Information

Property Damage Information

PROPERTY CLAIM REPORTING:

Accident Information

I use them for home, auto and business!

5-Star!

My agent does a great job, saved me a lot of money on my premiums.

5-Star!

Fast cheap service

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