Komodo Report a Claim

Report a Claim

If you need additional assistance reporting a new claim please call us at 1-888-453-5316.
Date of Loss:

MonthDayYear

Hour MinutesAM/PM Option
Accident State:
Your Role:
Your Full Name:

First NameLast Name
Your Email Address:
example@example.com
Your phone number:
Please enter a valid phone number.Format: (000) 000-0000.
Please confirm the policy number for the claim being reported today by filling out the four fields below. These four fields break up the policy number into its key parts:
Policy Prefix
Policy Year
Code
Policy Suffix
Policy Number
Vehicles Involved
Please select multiple vehicles if there was another
Our Vehicle VIN or License Plate:
Vehicle Year
Vehicle Make
Vehicle Model
Komodo Driver's Name:

First NameLast Name
Komodo Driver's Email Address
example@example.com
Komodo Driver's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Komodo Driver's Address

Street Address

Street Address Line 2

CityState

Zip Code
Were there any passengers in Our Vehicle?
Passenger Name

First NameLast Name
Passenger Email Address
example@example.com
Passenger Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Any known injuries in Our Vehicle?
Please describe the injuries:
Facts of Accident:

0/250
Was there any additional non-vehicle damage:
Pedestrians, property damage, or other damage beyond vehicle damage.
Does this loss involve a ride-sharing platform?
Has this loss also been reported to a ride-sharing platform?
Which Rideshare Platform?
Has this loss also been reported with another carrier?
Please provide the claim number and/or adjusters information:
Has a police report been filed?
Please provide the agency and/or police report number:
Please provide any witness information:
Third Party Vehicle Insurance Information
Third Party VIN or License Plate:
Third Party Vehicle Year
Third Party Vehicle Make
Third Party Vehicle Model
Third Party Driver's Name:

First NameLast Name
Third Party Driver's Email Address
example@example.com
Third Party Driver's Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Third Party Driver's Address

Street Address

Street Address Line 2

CityState

Zip Code
Were there any passengers in the Third Party's Vehicle?
Passenger Name

First NameLast Name
Passenger Email Address
example@example.com
Passenger Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Any known injuries in your Vehicle?
Please describe the injuries in your Vehicle:
Any additional information you'd like to provide?

0/250
Please post any attachments related to this claim here:

Cancelof
Should be Empty: