• Claim Request Form

  • The following form is provided to you for making claim requests on your existing policy.

    Please select the type of claim you are making.

    We will review your request and we will contact you for more information by the end of the next business day.

    You must press the submit button before leaving the page for the request to go through.

  • Current Insurance Information

  • MM slash DD slash YYYY

  • MM slash DD slash YYYY


Coughlin Insurance Services, Inc.
178 Myrtle Boulevard, Floor 2, Larchmont, NY 10538
Toll Free : (800) 542-0661
Tel: (914) 834-1234 Tel: (212) 593-0200

AFI White Logo
NFRA logo
PTNPA logo