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Please use this form to report a loss to Markel American Insurance Company so that we can begin processing your claim. All fields marked with an "*" are required. An examiner or appraiser will contact you by the end of the next business day.
Policy Number:*
Date and Time of Loss:*            



           


Insured Name:*
Address:*
City:*
State:*      
Zip Code:*
E-mail Address:*
Daytime Phone Number:* ()          
Where did the loss occur?*
Tell us what happened:*
Do you have an estimate?*
If so, how much?
Injured parties: names, addresses, phone numbers:*
 
If you are not the Named Insured, please enter your name and contact information below:
 
 Name:  
 Relationship to Insured:  
 E-mail Address:  
 Daytime Phone Number:   ()          
   
 
Please review all information to be sure it is accurate.

It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.  Your state may have specific warnings against filing false claim information.

In Arizona: For your protection Arizona law requires the following statement to appear on this form.  Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties.

In New York: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

In Oregon: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in a state prison.

In Pennsylvania: Any person who knowingly and with intent to injure or defraud any insurer files an application or claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and payment of a fine of up to $15,000.

Call the BMW MOA Endorsed Insurance Program at 877-BMW-INS1 to speak with a motorcycle specialist today.