• 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

  • Date Format: MM slash DD slash YYYY

  • Date Format: 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