Samel/Paramount Insurance Agency :: Report an Auto Claim

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serving New England for over 65 years!

Automobile Insurance — Report a Claim

During normal business hours, you are encouraged to contact our office directly for assistance in reporting your claim. If you wish to call the insurance company directly or complete the online claims form on their website, please click here for a directory.
Please note that submitting a claim from this website does not confirm coverage or authorize payment. An agency representative will verify your coverage and contact you to complete the claims process. Note: If more than two people are involved, please contact our agency directly to report the claim.
Policy Number	(if you know it)
Full Name

Contact Information Who should the claims adjuster contact regarding repairs?
Name
Home Telephone
Work Telephone
Email	required

Authority Contacted
Police Department
Police Report Number

Claim Information
Date of Accident
Location of Accident
Cause of Accident
Describe, if other cause of loss

Injuries Reminder: If more than two people are involved, please contact our agency directly to report the claim.
Information about person injured
Name
Address
Telephone Number
Nature of injuries
Information about person injured
Name
Address
Telephone Number
Nature of injuries

Damage to Your Vehicle
Year, Make & Model
Driver Name
Driver Address
Driver Telephone Number
Describe the damage to your vehicle
Location of vehicle now

Damage to Other Vehicle
Year, Make & Model
Owner's Name
Owner's Address
Owner's Telephone Number
Driver Name
Driver Address
Driver Telephone Number
Describe the damage to the vehicle
Insurance agent and/or company

Accident Details
Describe what happened
Comments and/or other information