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On-line Claim Submission

Complete this form to file a non-emergency claim. If you need assistance, please call 217-422-5867, M-F 8:30a - 5:00p. If the claim is an emergency please call the emergency claim number provided from your insurance carrier. For Brotherhood Mutual Insurance policy holders, the afterhours emergency claim number is: 1-800-933-1849.
  Name:
  Address:
  City:
  ZIP:
  Email:
  Phone:
  Occurence Date:
  Occurence Location:
  Event Description:
  Contact:
After filling the details click on the SUBMIT button.
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