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Equine & Cattle Insurance Program - Berkley Program Specialists

Submit a Farm Liability Claim

TO REPORT A PROPERTY LIABILITY LOSS THAT INVOLVES A SEVERE INJURY OR DEATH TO A THIRD PARTY, IMMEDIATELY CONTACT: YORK RISK SERVICES GROUP, INC. AT (866) 391-9675

IMMEDIATELY CONTACT YORK RISK SERVICES GROUP, INC. AT (866) 391-9675 IF YOU ARE SERVED SUIT PAPERS BY A THIRD PARTY, WHETHER YOU BELIEVE IT IS VALID OR APPLIES TO YOUR INSURANCE POLICY.  BE PREPARED TO FAX OR MAIL A COPY OF THESE PAPERS TO YORK RISK SERVICES GROUP, INC.

York Risk Services Group, Inc.
605 Crescent Executive Court
Lake Mary, FL 32746
Fax: (800) 393-8104

TO SUBMIT A PROPERTY CLAIM OR AN INCIDENT THAT YOU BELIEVE MAY RESULT IN A CLAIM OR SUIT FILED AGAINST YOU, COMPLETE THIS FORM

REMEMBER NOT TO ADMIT ANY FAULT

Please complete the following information:

Name of Your Insurance Agent:

Insured's Name:

Phone Number of the Insured:

Policy Number:

Date of Loss:

Description of what happened

If this is a property claim, describe all buildings and or items that were damaged

If this is a liability claim involving bodily injury to a third party, do you have a signed release/waiver of liability from the third party that was injured?

YesNo

If this is a liability claim involving bodily injury to a third party, where there any witnesses to what happened?

YesNo

If yes, list their names and contact information (if known)

Is there a police report?

YesNo

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