Please utilize the form below to submit an assignment online.

Alternately, you can download the new matter submission form HERE.

You can also email newclaims@losssolutionsgroup.com or

call us at 866-899-8756 option 1 to submit a new assignment.

PLEASE NOTE: This form is not compatible with Internet Explorer or some versions of Microsoft Edge, please use an alternate browser (Chrome preferred) or contact us for other ways to submit your claim assignment.

Client/Adjuster Details

First Name*

Last Name*

Company*

Phone Number*

Email Address*

Street Address or PO Box (if you're a new client)

City/State/Zip (if you're a new client)

Claim Details

Claim #

Named Insured

Insured Contact Name

Insured Contact Business Phone

Insured Contact Mobile Phone

Insured Contact Home Phone

Insured Contact Email

Date of Loss

Loss Location

Damage Type* (i.e. lightning, fire, water, theft)

Property Type* (i.e. furnace, computer, structure)

Claimant (if applicable)

Claimant Contact Name

Claimant Contact Business Phone

Claimant Contact Mobile Phone

Claimant Contact Home Phone

Claimant Contact Email

Perferred LSG Consultant (if applicable)

Assignment Tasking

Site Inspection (if not selected, assignment will be handled as a desk review)

Cause of Loss / Origin

Repair vs Replacement Analysis

Replacement Cost Valuation (RCV)

Actual Cash Valuation (ACV)

Salvage Analysis

Other (add notes below)

Additional Claim/Assignment Notes

Do you have claim documentation or photos?

NoYes, I'll email them to newclaims@losssolutionsgroup.com