Report a Claim | NeitClem Wholesale Insurance and Brokerage

What to Expect

Submit Your Report

Complete all required fields in the claim form below. Provide as much detail as possible about the incident — the more information you include, the faster we can process your claim.

Claims Team Reviews

Our claims team reviews your report and verifies your policy information. We will contact you within one business day to confirm receipt and outline the next steps.

Assigned to Adjuster

Your claim is assigned to a licensed adjuster who will contact you directly to assess the loss, gather any additional documentation, and guide you through the resolution process.

Claim Report Form

All fields marked with * are required. Please be as detailed as possible — it helps speed up your claim.

01 Policyholder Information

First Name * First Name is required.

Last Name * Last Name is required.

Company Name (if applicable)

Email Address * Please enter a valid email address.

Phone Number * Phone Number is required.

Policy Number * Policy Number is required.

02 Incident Details

Date of Loss * Date of Loss is required.

Type of Loss * Type of Loss is required.

Location of Loss * Location of Loss is required.

03 Description of Loss

Describe What Happened * Description of Loss is required.

04 Additional Information

Was a Police / Fire Report Filed? (optional)

Report Number (if available)

Additional Notes (optional)

You'll be shown a summary to review before your report is submitted. A confirmation email will be sent immediately.
For urgent matters, call us directly at (323) 258-2600.