Claim Form Submission Mercer Insurance Company

Answer the following questions regarding your claim.  Provide as much detail as possible. Phone numbers that we can reach you at during the next hour will help us begin expediently processing your claim.

If you have suffered a loss outside the normal business hours of Monday through Friday, between 8:00 a.m. and 5:00 p.m., please take whatever steps are necessary to protect your property from further damage, and submit the form below. You will be contacted on the next business day.

HOWEVER, if you have sustained a severe loss outside normal business hours, in which the damage caused by the loss requires you to leave your home or stops you from conducting your business, please call 1-800-621-5410 to report the loss, and a Mercer Representative will be notified.

Policy & Contact Information
Policy Number
Your Name (First & Last)
Policyholder Name
Relationship to Insured
Address
Apt/Suite
City/State/Zip

Phone Number
Work Number
E-mail Address
Accident/Loss Details:
Date of Loss / /      
Time of Loss :

Location of Loss
Description of Loss