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Auto Accident Claim Form

We're very sorry to hear you were in an accident. You can submit your vehicle claim using the form below. If you have any questions, please call our claim department at 1-800-854-6011.

Note: You must have a MetLife Auto & Home policy to use this form. If your insurance is through another company, you'll need to contact them directly.

* Indicates required Fields

Accident Injuries

Most importantly, were you or anyone else injured and/or receive medical treatment as a result of this accident?*
No Yes


Policy Holder Information

First, we need to know a little about you and how to contact you.
First Name*Last Name*DOB*
Auto Insurance Policy Number*Driver's License Number*
Preferred Phone Number*Secondary Phone NumberEmail
Street Address*City*State*Zip*


Policy Holder Vehicle

OK, now we need to know about your vehicle.
Vehicle Year*Vehicle Make*Vehicle Model*
Vehicle Color*Vehicle Licence Plate


Accident Information

Please give us details of the accident.
On which date did your accident occur?*What time did the accident occur?*Where did the accident occur?
mm/dd/yyyyCity*State*
Who was driving your vehicle?
First Name*Last Name*Was your vehicle towed?
Yes No
Excluding the driver(s), were there passengers in any of the cars involved in the accident?Not including your car, how many other vehicles were involved in the accident?
Yes No
Where is your car damaged as a result of this accident?*
A. HoodF. Rear bumperJ. Front driver side fender
B. Front BumperG. Rear trunkK. Roof
C. Front passenger side fenderH. Rear driver side quater panelL. Undercarriage
D. Passenger door(s)I. Passenger door(s)M. Other (please explain damage in notes area below)
E. Rear passenger side quarter panel
above_view1


Other Driver & Vehicle Information

Please include what you know about the other driver and vehicle, if your accident involved another car
Other Driver's First NameLast NamePhone Number(include area code)
Other Vehicle YearVehicle MakeVehicle Model
Vehicle License Plate


Notes

Finally, please provide an explanation of the accident including but not limited to name(s) of streets, direction vehicles were traveling, weather conditions, speed limits, along with any other information you would like to share. Please include the name(s) and contact information for any other drivers or witnesses whose information you collected but haven't already provided.

Please read your state's fraud warning.

MetLife respects your Privacy

Vehicle Accidents with Injuries

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We’re very sorry to hear that someone was injured in your accident.


Accidents involving injuries require specialized claims support. We’ll need to discuss the details of your claim with you over the phone.


Please call: 1-800-854-6011