Online Claim Form

THIS WEBSITE ALLOWS THE USER TO PROVIDE NOTICE OF A POTENTIAL CLAIM TO FIDUCIARY INSURANCE COMPANY OF AMERICA (FICA). COMPLETION OF THIS SUBMISSION DOES NOT MEAN THAT A CLAIM WILL BE OPENED OR THAT A CLAIM OR COVERAGE EXISTS. UPON COMPLETION OF THIS PROCESS FICA WILL INVESTIGATE THE MATTER AND IF APPROPRIATE A CLAIM WILL BE OPENED AND THE CLAIMANT CONTACTED. WHETHER A CLAIM EXISTS AND/OR WHETHER SUCH A CLAIM WILL RESULT IN ANY PAYMENT TO A CLAIMANT DEPENDS ON MANY FACTORS INCLUDING BUT NOT LIMITED TO COVERAGE, TIMELINESS OF THE NOTICE, THE LIABILITY OR FACTS OF THE INCIDENT, THE DAMAGES INVOLVED, ETC.

IF A CLAIM IS TO BE OPENED OR IF ADDITIONAL INFORMATION IS NEEDED SOMEONE FROM FICA WILL CONTACT YOU WITHIN 24 HOURS. CALLING FICA OR OTHERWISE REFILING THIS CLAIM WILL ONLY CAUSE CONFUSION AND RESULT IN DELAY.

BY PROCEEDING PAST THIS NOTICE, YOU HEREBY ACKNOWLEDGE THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE ABOVE.