1190 Devon Park Drive | Wayne, PA 19087
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This Online Reporting System allows you to report a claim to United States Liability Insurance Company, Mount Vernon Fire Insurance Company or U.S. Underwriters Insurance Company d/b/a United States Liability Insurance Group ("Group") and to Mount Vernon Specialty Insurance Company or Radnor Specialty Insurance Company d/b/a Devon Park Insurance at your convenience twenty-four hours a day seven days a week. You will be guided through a screen that will enable us to collect your claim information. Please do not proceed with this loss report unless you intend to report a claim under your policy. Before you begin the reporting process, please make sure that you have all of your claim information available. We cannot act on your claim report if it does not include a valid policy number, telephone number, or other information that would allow us to contact you. Once you have completed your online claim report, click on the "Submit" button at the bottom of the "Report a Claim" (next) page. You will receive an e-mail confirming that your report was received by us. A claims representative will contact you (either by e-mail or by phone) after your report is submitted. If you cannot complete your report or elect to discontinue your reporting, please click the "Cancel" button at the bottom of the "Report a Claim" (next) page and contact "Your local agent" to report your claim.
Arizona: 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.
California: For your protection California law requires the following to appear on this form. Any person who knowingly presents false or fraudulent information to obtain or amend insurance coverage or to make a claim for payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison. District of Columbia: 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 if false information materially related to a claim was provided by the applicant. Kentucky: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance 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. Minnesota: A person who files a claim with intent to defraud or helps commit a fraud against an insurer is guilty of a crime. New Hampshire: 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 RSA 638:20. New Jersey: Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties. New Mexico: 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 CIVIL FINES AND CRIMINAL PENALTIES. New York: 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. Oklahoma: WARNING: Any person who knowingly, and with 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. All Other States: 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.
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1190 Devon Park Drive Wayne, PA 19087