Submit A Claim

Submitting a claim is as easy as answering the question below and then filling out the form that follows.

    Are you insured with American Alliance?
    YesNo

    Basic Information


    Your Contact Information















    Driver of Vehicle Information







    Owner of Vehicle Information






    Purpose of Operation at time of Accident:

    Weather:

    Was operation of vehicle with permission of owner? YesNo
    Is your vehicle ever used for paid ride share services such as Uber, Lyft or a similar ride share service? YesNo
    Name of Service:
    When did you start with this service?
    Were you driving for this service at the time of loss: YesNo

    Description of Accident

    Accident Type:











    Was there intoxication involved? YesNo
    Did the police respond? YesNo
    Was a police report made? YesNo

    Was a ticket issued? YesNo

    Did an ambulance respond? YesNo
    Were there injuries to the Insured? YesNo

    Were there injuries to the Claimant? YesNo


    Storage Addendum

    It is our understanding that your vehicle has been involved in an accident. It is in your best interest to pay any accruing charges and have your vehicle released immediately from any towing and/or storage facility and then have it moved to your residence, body shop or any other place where it will not accrue any additional expenses.

    Should additional expenses arise as a result of your vehicle being at its present location (ie storage charges, difference in labor, parts, removal of salvage, etc.) please be advised that you may be responsible for those expenses. In the event that you wish to move your vehicle at a later date, you may be responsible for any and all storage charges.

    Electronic Notification Notice

    This will confirm that I have been made aware that unless a claim document is required to be sent by mail it will be sent electronically to the valid email address I have provided Alliance with. If I would like a document sent by mail I can request this by contacting us at (847) 916-3200 or by contacting the claims team assigned to my loss.

    Please contact our claims department at (847) 916-3200 Monday through Friday between the hours of 8:30 a.m. and 4:30 p.m., if you have further inquiries.

    I acknowledge that I have read and understand the above (required)

    Rental Reimbursement Notice

    Please be advised our company has a rental reimbursement agreement with Hertz for a rate of $23.99 per day.
    If rental is approved for your claim, you are to submit a copy of the paid invoice to our office via email, mail or fax
    Attn: (claim number)
    To access this rate provide code number: 2144219 to any Hertz facility.
    Please note reimbursement will be based on reasonable repair time

    I acknowledge that I have read and understand the above (required)

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