Western General Insurance Company

	Company FAQ	Online Quick Pay

Report A Claim

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Accident Information

If your policy starts with LST, please DO NOT report your claim online. Please contact SNAP MGA at 214-446-1144 to report your claim.

To report a claim to Western General because you are a policyholder, were in an accident with one of our policyholders, or witnessed an accident involving our policyholder, please fill out the form below then click the "Next Page" button to enter Vehicle/Driver information.

* = Required Field

Policyholder/Claimant Information

Reported Date:		Time:
Are you a Western General policy holder?:*	Yes No	WG Policy Number:*	WG Policy Number:	* This field is required
Were you involved in the accident?:	Yes No	Your Insurance Co. Name:*	* This field is required
Were you a witness?:	Yes No	Your Policy Number:*	* This field is required
Relationship to Claimant:*	* This field is required
.
Your First Name:*	* This field is required	Your Last Name:*	* This field is required
Your Street:*	* This field is required
Your City:*	* This field is required	State:*		Zip:*	* This field is required
.
Date of Birth		Driver's License #:
Primary Phone:*	* this field is required	Alternate Phone:
Best time to call:
Email:*	* This field is required	Confirm Email:*	* This field is required

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Fill out the form below then click the "SUBMIT" button to send notification to Western General Insurance Company.

* = Required Field

Description of the Incident

.
Please tell us what happened:*
Date of Incident:*
.
Street, Intersection or Area:
City:		State:		Zip:
.
Did the police assist after the incident?*	Yes No	Police Incident Number:*		Jurisdiction:*
.
Were there any injuries?*	Yes No Unknown	Was there any additional property damage involved?		Yes No Unknown
		Please list a general description of all injuries*	* this field is required		Please list a general description of all property damage*	* this field is required
.
Any additional information you would like to provide?
Upload Images:

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Other Driver's Insurance
Company Name (if known):		Policy Number (if known):
.

Year:		Make:	Model:
License Plate or VIN:
.

Who was driving this vehicle?
.
Were there any passengers in the other vehicle?*	Yes No Unknown
If known, Please list full names, addresses and phone numbers for all passengers in the other vehicle
Additional Vehicles Involved
Were there any other vehicles involved?:*	Yes No Unknown
If known, Please list vehicle year, make, model, driver, driver contact information for all additional vehicles involved.

Is your WESTERN GENERAL vehicle damaged?:*	*	Yes No Unknown
.
Where is the damage on your vehicle? *
Was there a child seat in your vehicle during the incident?*	Yes No
.
Year:*		* this field is required	Make:*		* this field is required	Model:*		* this field is required
License Plate or VIN:*		* this field is required
.
Where the vehicle is currently located (Name of facility/residence):*		* this field is required
Street:*		* this field is required
City:*		* this field is required	State:*		Zip:*		* this field is required
Phone of Facility/Residence:*		* this field is required
.
Is the vehicle still drivable?:*	Yes No Unknown
.

Were you driving during this incident?*	Yes No	Is the driver the same as the owner of the vehicle involved?*	Yes No
		Please list full name and contact information for driver *	* this field is required	Please list full name and contact information for registered owner *	* this field is required
.
Were there any passengers in the vehicle?*	Yes No Unknown
Please list full names, addresses and phone numbers for all passengers *

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