Claim Submission

Submit a claim using the form below or send via email to claims@wheeler-defusco.com. Make sure to include all loss details and policy.

*If you do not receive a claim acknowledgement within 24hrs please reach out to support at Admin@wheeler-defusco.com

Client *

Examiner Name *

First

Last

Email *

Claim Number *

Policy Holder Information

Policy Number *

Named Insured ( Policy Holder) *

Contact Name *

First

Last

Insured Mailing Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone *

Email *

Loss Information

Date *

Loss Location *

Address Line 1

Address Line 2

City

State

Zip Code

Loss Description *

File Upload- Notice of Loss

Drag & Drop Files, Choose Files to Upload

File Upload – Policy

Drag & Drop Files, Choose Files to Upload

File Upload – Additional Documents

Drag & Drop Files, Choose Files to Upload You can upload up to 10 files.