Reporting a Claim | Regan Insurance Agency Inc

Please fill out an Accident Report Form, if you haven’t already done so.

Report an Auto Claim

Insured Information

Name (First, Last) *
Policy Number
Phone *
Email *
Date of Accident *
Time Accident Ocurred HHMMAM/PM

Current Location of Vehicle

Street Address *
City *
State *
Zip Code *
Is Vehicle Driveable? *
YesNo

Location of Accident

Street Name *Please describe where accident happened. (Indicate street name, intersection, parking lot, etc.)
City *
State *
Zip Code *

Insured Vehicle Information

Name of person operating your vehicle (If you were not driving)
Driver's License Number Please list the license number of the operator of your vehicle.
License State
Date of Birth
Vehicle Year/Make/Model *
Vehicle Plate # *
Vehicle Damaged Area *Please select the area in which your car has damage.

Other Vehicle Information

Name of Other Driver
Other Driver's License Number
License State
Date of Birth
Vehicle Year/Make/Model
Vehicle Plate #
Other Vehicle Damaged Area *Please select the area in which the other vehicle has damage.

Additional Information

Description of What Happened *
Please describe the accident in detail.
If you believe that you were less than 50% at fault, please explain why.
Upload File Please upload any images of the scene of the accident or an accident report document.
Upload Additional File
Upload Additional File

Verification

Please enter any two digits *Example: 12
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The following links and phone numbers will take you directly to the claim department for your insurance carrier. Please contact an agent for additional information or assistance.

Report a Claim online	or Call Toll Free
Safety Insurance Claims	(800) 951-2100
Quincy Mutual	(800) 490-0047
Travelers Personal Claims	(800) 252-4633
Travelers Business Claims	(800) 238-6225
Mass Fair Plan	(800) 392-6108