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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 Number Email
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/yyyy City* 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. Hood F. Rear bumper J. Front driver side fender
B. Front Bumper G. Rear trunk K. Roof
C. Front passenger side fender H. Rear driver side quater panel L. 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 Name Last Name Phone Number(include area code)
Other Vehicle Year Vehicle Make Vehicle 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




StateFraud Language
AKALASKA LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: A person who knowingly and with intent to injure, defraud, or deceive an insurance company files a claim containing false, incomplete, or misleading information may be prosecuted under state law.
ALAny person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or who knowingly presents false information in an application for insurance is guilty of a crime and may be subject to restitution fines or confinement in prison, or any combination thereof.
ARThe following statement is required by Arkansas Law 23-66-503(a): Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
AZ"For your protection Arizona law requires the following statement to appear on this form: Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties."
CAFor your protection California law requires the following to appear on this form: Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.
COCOLORADO LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policy holder or claimant for the purpose of defrauding or attempting to defraud the policy holder or claimant with regard to a settlement or award payable for insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.
DC"The District of Columbia requires us to notify you of the following: WARNING: It is a crime to provide false or misleading information to an insurer for the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines. In addition, an insurer may deny insurance benefits in false information materially related to a claim was provided by the applicant."
DEDELAWARE STATE LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who knowingly, and with intent to injure, defraud or deceive any insurer, files a statement of claim containing any false, incomplete or misleading information is guilty of a felony.
FLFLORIDA LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who knowingly and with intent to injure, defraud, or deceive any insurance company files a statement of claim containing any false, incomplete, or misleading information is guilty of a felony of the third degree.
IDIDAHO LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who knowingly, and with intent to defraud any insurance company, files a statement containing any false, incomplete, or misleading information is guilty of a felony.
ININDIANA LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: A person who knowingly and with intent to defraud an insurer files a statement of claim containing any false, incomplete, or misleading information commits a felony.
KYTHE COMMONWEALTH OF KENTUCKY REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.
LALOUISIANA LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
MDTHE STATE OF MARYLAND REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
MEMaine law requires us to advise you of the following regulation per title 24-A Section 2186 (3): It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines, or denial of insurance benefits.
MNMINNESOTA LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime.
NHNew Hampshire law requires us to advise you of the following regulation: Any person who, with a purpose to injure, defraud or deceive any insurance company, files a statement of claim containing any false, incomplete or misleading information is subject to prosecution and punishment for insurance fraud as provided in section 638:20.
NJNEW JERSEY STATE LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties.
NMNew Mexico state law requires us to notify you of the following: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilt of a crime and may be subject to civil fines and criminal penalties.
NYAPPLICABLE TO AUTO CLAIMS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for commercial insurance or a statement of claim for any commercial or personal insurance benefits containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, and any person who, in connection with such application or claim, who knowingly makes or knowingly assists, abets, solicits or conspires with another to make a false report of the theft, destruction, damage or conversion of any motor vehicle to a law enforcement agency, the department of motor vehicles or an insurance company, commits a fraudulent act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the value of the subject motor vehicle or stated claim for each violation.
NYAPPLICABLE TO HOME CLAIMS: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.
OHOHIO STATE LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud.
OKOklahoma state law requires us to notify you of the following: WARNING: Any person who knowingly, and with any intent to injure, defraud or deceive any insurer, makes any claim for the proceeds of an insurance policy containing any false, incomplete or misleading information is guilty of a felony.
PATHE COMMONWEALTH OF PENNSYLVANIA REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
RIThe Department of Business Regulation requires us to inform you of your legal time to pursue this claim. The legal time limit is commonly referred to as the statute of limitations. In the state of Rhode Island, the statute of limitations for a property damage claim is ten (10) years, and three (3) years for a bodily injury claim. If you have any questions, please feel free to contact us at the above number.
RIAny person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
TNTENNESSEE STATE LAW REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: "It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits."
TXPlease note that your policy was directly issued by Liberty County Mutual Company and is 100% reinsured and serviced by Metropolitan Property and Casualty Insurance Company.
VATHE COMMONWEALTH OF VIRGINIA REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines, and denial of insurance benefits.
WATHE STATE OF WASHINGTON REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: "It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits."
WVTHE STATE OF WEST VIRGINIA REQUIRES US TO NOTIFY YOU OF THE FOLLOWING: "Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison."