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How It Works

Follow these 3 easy steps to fill out a claim


1. Download the PDF


2. Fill Out the Form

Fill out the required fields in the PDF form.


3. Upload Your PDF

Upload and send us your PDF form below

Download the PDF

To file a claim, please download the Accord Loss Notice PDF Form

Upload Your PDF

Fill out the form & upload your auto loss notice PDF form

Upload Form
Thank you. One of our agents will reach out to you soon!

Form Requirements

If you would like to file a claim, please download the Accord Loss Notice Form, it is important that it must be completely filled out (Page 1 Only).


Date & Time Of The Incident


Full Description Of The Incident


Name Of The Driver


Name Of The Owner


All Vehicle Information In The Proper Section


Policy Number


Owner Information & Contact Number


Date The Form On The Top Right Corner


Location Of Loss


Police Report Number (If Applicable)


It is very important to note that when you are contacting L.A. West Insurance Services for any claim matter, please keep in mind that we are not the insurance company, we are the insurance agency. As much as we love to service all our of customers, our hand can only reach so far as far as the claims process goes. Your filled out form will be forwarded out to the insurance company you are insured with, thereafter you will receive the claims adjusters contact information & the claim number. Once this step is complete, it is important to know that any concerns or questions that have to do with the claim must be dealt with by contacting the adjuster/specialist.

Please note that all third party requests (anyone other than our insured) must first discuss & agree on terms with the insured of the incident before any claim can be processed.

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Claims Contact


(747) 324-8879

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