Gulf Coast v. Esurance

After clicking the button below, you will be asked to provide the Unique ID you received with your Postcard Notice from the Claims Administrator. If you did not receive a Postcard Notice or have lost yours, please contact the Claims Administrator at 1-866-516-8962 (Toll-Free) for assistance. To complete the Claim Form, you will be asked to provide your contact information, detailed information about the insured individual(s), and any documentation you wish to provide. Please have all your documentation as described above ready, as your claim will not be saved if you have to come back and finish at a later time.

Please click the button below to get started.

After submitting your completed claim online, you will receive an email with a Confirmation Code for your completed submission. Receipt of a Confirmation Code means your claim was successfully submitted. Be sure to keep your confirmation email and code and refer back to them if you have any questions about your Claim Form. If additional information is required to complete your Claim, you will be contacted by the Claims Administrator.

If you wish to submit a Claim Form via standard mail, you may download a copy of the Claim Form here. You will need to provide all the information requested on the Claim Form and attach any supporting documentation. Make sure to sign and date the Claim Form, and then mail it to the following address:

Gulf Coast Injury Center v. Esurance Claims Administrator
P.O. Box 2480
Portland, OR 97208-2480