Claim Submission Form
Please note that claims must be reported to us in a timely manner. Your cooperation with our investigation is critical to ensure a timely resolution of your claim. This can include providing us with requested documentation, photographs, video, giving us a recorded statement and providing us with witness information or a police/fire department report case number. Please be sure to review your specific duties regarding damaged property on the appropriate page of this form.
Were you injured while conducting work?
Are you a service provider who sustained an injury while on a work order where the buyer has opted into Field Nation's Occupational Accident Insurance coverage? In this case, Field Nations partner Blue Star will process the claim, not Field Nation. If you were injured while conducting work, do not fill out this form. Instead, please visit
and submit a claim form or call 480-579-2501 for immediate assistance.
After you provide details about your claim during a 10-15 minute phone call, your claim should be verified within 24-48 hours. Once it is verified you will be assigned an adjuster. You may call 480-579-2501 with any questions about your claim or its status.
Page 1 of 9
Never submit passwords through Google Forms.
This form was created inside of Field Nation.