Thank you for choosing to submit a new assignment to Loss Solutions Group! Please complete the form below with your contact information, claim information and assignment information.

If you’d prefer to speak with a Loss Solutions Group Client Service Specialist, please contact admin@LossSolutionsGroup.com or call 866.899.8756 ext. 1 and we’d be happy to help!

Client/Adjuster Details

First Name (required)

Last Name (required)

Company (required)

Phone Number (required)

Email Address (required)

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

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