Liability Claim AssignmentLeading Claims InnovationLiability Claim Assignment Staff Adjuster / Requester Information From (Carrier Name): * Adjuster: * Adjuster Phone: * Adjuster Email: * Claim Return Email – if different: Claim Information Claim Number: * Insured Name: * Insured Phone: * Insured Email: Date of Loss: * Claimant Name: * Claimant Phone: * Claimant Email: Loss Address: * Loss Summary / Additional Information: Add Claim Documents File Upload: Drop files here or click to upload Choose FilesMaximum file size: 150MB If you are human, leave this field blank. Submit
