Online Claims Form

Insurance claims can be submitted directly to the RMA through our form below. If you have any questions, please email claims@RMAInsurance.com.

Tell us what happened. *

Please provide any additional information or description of the incident. *

What is the date and time of the incident? *

Where there any witnesses? *

If you’re able to, please provide the GPS latitude and longitude of the incident.

If you have photos of the incident or an incident report, please attach.

Click or drag files to this area to upload. You can upload up to 10 files.

What is your name? *

First

Last

What is the name of your organization? *

What is the best phone number to reach you at? *

What is your email address? *