Claim Form

Welcome to the USSCI Online Claim Form. We’ve worked hard to make this process as simple as possible. To get started, please complete and submit this online form or click here to download the Fillable PDF Claims Form. As soon as we receive your completed form, we will begin processing your claim and get back to you within 3 business days. If you have any questions or experience any issues as you’re filling out this form, we are here to help! Please call us at 833-227-6018.


Please use the links above to review and/or edit your responses before submitting. If you are satisfied that your responses are complete and accurate, please complete the final information below and then click to Submit.

Any person who knowingly and with intent to defraud any insurance company or other person files a statement of claim containing any materially false information, or conceals for the purpose of misleading, commits a fraudulent insurance act which is a crime for each violation.