{"id":1412,"date":"2017-05-29T13:44:34","date_gmt":"2017-05-29T18:44:34","guid":{"rendered":"https:\/\/www.jsausa.com\/site\/?page_id=1412"},"modified":"2026-04-03T13:13:56","modified_gmt":"2026-04-03T17:13:56","slug":"report-a-claim","status":"publish","type":"page","link":"https:\/\/www.jsausa.com\/site\/report-a-claim\/","title":{"rendered":"Report a Claim"},"content":{"rendered":"<p><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-1 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1216.8px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-0 fusion_builder_column_1_1 1_1 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-section-separator section-separator horizon fusion-section-separator-1\" style=\"--awb-spacer-padding-top:inherit;--awb-svg-margin-left:1.92%;--awb-svg-margin-right:1.92%;--awb-svg-margin-left-medium:1.92%;--awb-svg-margin-right-medium:1.92%;--awb-svg-margin-left-small:1.92%;--awb-svg-margin-right-small:1.92%;--awb-divider-height:60px;--awb-spacer-height:60px;--awb-sep-font-size:0;--awb-sep-line-height:0;\"><div class=\"fusion-section-separator-svg\"><svg class=\"fusion-horizon-candy\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" version=\"1.1\" width=\"100%\" viewBox=\"0 0 1024 178\" preserveAspectRatio=\"none\" fill=\"rgba(58,108,153,1)\"><path class=\"st0\" d=\"M1024 177.193L507.699 43.254 0 177.193V.041h1024v177.152z\"\/>\n\t\t\t\t\t\t\t\t\t<path class=\"st1\" d=\"M1024 138.076L507.699 43.152 0 138.076V-.266h1024v138.342z\"\/>\n\t\t\t\t\t\t\t\t\t<path class=\"st2\" d=\"M1024 67.728L507.699 43.152 0 67.728V-.266h1024v67.994z\"\/>\n\t\t\t\t\t\t\t\t\t<path class=\"st3\" d=\"M1024 3.625L507.699 43.152 0 3.625V-.266h1024v3.891z\"\/>\n\t\t\t\t\t\t\t\t<\/svg><\/div><div class=\"fusion-section-separator-spacer\"><div class=\"fusion-section-separator-spacer-height\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-2 fusion-flex-container nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-sizes-top:3px;--awb-border-sizes-bottom:3px;--awb-border-sizes-left:0px;--awb-border-sizes-right:0px;--awb-border-color:#ffffff;--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-padding-top:-5px;--awb-padding-right:200px;--awb-padding-bottom:-5px;--awb-padding-left:200px;--awb-margin-top:0px;--awb-margin-bottom:0px;--awb-background-color:rgba(255,230,122,0);--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1216.8px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-1 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-flex-start fusion-column-no-min-height fusion-animated\" style=\"--awb-padding-top:0px;--awb-padding-right:12px;--awb-padding-bottom:0px;--awb-padding-left:0px;--awb-bg-color:#fff3c6;--awb-bg-color-hover:#fff3c6;--awb-bg-size:cover;--awb-border-color:#e22a1d;--awb-border-top:0;--awb-border-right:0;--awb-border-bottom:0;--awb-border-left:0;--awb-border-style:solid;--awb-width-large:100%;--awb-margin-top-large:0px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-order-medium:0;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-order-small:0;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\" data-animationType=\"shake\" data-animationDuration=\"0.3\" data-animationOffset=\"top-into-view\" data-scroll-devices=\"small-visibility,medium-visibility,large-visibility\"><div class=\"fusion-column-wrapper fusion-column-has-shadow fusion-flex-justify-content-center fusion-content-layout-column\"><div class=\"fusion-text fusion-text-1\">\n<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-fullwidth fullwidth-box fusion-builder-row-3 fusion-flex-container has-pattern-background has-mask-background nonhundred-percent-fullwidth non-hundred-percent-height-scrolling\" style=\"--awb-border-radius-top-left:0px;--awb-border-radius-top-right:0px;--awb-border-radius-bottom-right:0px;--awb-border-radius-bottom-left:0px;--awb-margin-top:0px;--awb-margin-bottom:0px;--awb-flex-wrap:wrap;\" ><div class=\"fusion-builder-row fusion-row fusion-flex-align-items-flex-start fusion-flex-content-wrap\" style=\"max-width:1216.8px;margin-left: calc(-4% \/ 2 );margin-right: calc(-4% \/ 2 );\"><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-2 fusion_builder_column_1_1 1_1 fusion-flex-column fusion-flex-align-self-flex-start fusion-column-no-min-height\" style=\"--awb-bg-size:cover;--awb-width-large:100%;--awb-margin-top-large:10px;--awb-spacing-right-large:1.92%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:1.92%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-title title fusion-title-1 fusion-sep-none fusion-title-text fusion-title-size-one\" style=\"--awb-text-color:var(--awb-color5);--awb-margin-top:40px;--awb-margin-bottom:60px;--awb-margin-top-small:0px;--awb-margin-right-small:0px;--awb-margin-bottom-small:20px;--awb-margin-left-small:0px;\"><h1 class=\"fusion-title-heading title-heading-left awb-gradient-text fusion-responsive-typography-calculated\" style=\"margin:0;text-transform:capitalize;background-color:#2456a5;background-image:linear-gradient(180deg, #2456a5 0%,#1d2a51 100%);--fontSize:60;line-height:var(--awb-typography1-line-height);filter:drop-shadow(2px 2px 0px var(--awb-color3));\"><div style=\"text-align: center;\"><span style=\"font-size: 1em; background-color: rgba(0, 0, 0, 0);\">Report a Claim to JSA<\/span><\/div><\/h1><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-3 fusion_builder_column_1_3 1_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:33.333333333333%;--awb-margin-top-large:10px;--awb-spacing-right-large:3.84%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:5.76%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-2\"><p>Please complete and attach a claims notice&nbsp;to this form or email to&nbsp;<a href=\"mailto:claims@jsausa.com\" target=\"_blank\" rel=\"noopener noreferrer\">claims@jsausa.com<\/a>. If you prefer to fax, please send your request to&nbsp;<strong><span class=\"m_-3763685025622424440shoretel_phone_link\" title=\"ShoreTel Web Dialer: 918282620754\">1-828-262-0754<\/span><\/strong> (attn. Claims). If it&#8217;s after-hours, please refer to your policy for claims information to contact the carrier directly.&nbsp;<\/p>\n<\/div><div class=\"fusion-person person fusion-person-left fusion-person-1 fusion-person-icon-top\" style=\"--awb-pic-style-color:var(--awb-color8);--awb-pic-borderradius:0px;--awb-margin-top:0px;--awb-margin-right:0px;--awb-margin-bottom:0px;--awb-margin-left:0px;--awb-social-box-border-top:0px;--awb-social-box-border-right:0px;--awb-social-box-border-bottom:0px;--awb-social-box-border-left:0px;--awb-social-box-border-color:var(--awb-color3);--awb-social-box-border-color-hover:var(--awb-color4);--awb-social-box-colors-hover:hsla(var(--awb-color2-h),var(--awb-color2-s),var(--awb-color2-l),calc(var(--awb-color2-a) - 25%));--awb-social-icon-boxed-colors:var(--awb-color2);--awb-social-icon-colors:var(--awb-color6);--awb-social-icon-colors-hover:hsla(var(--awb-color6-h),var(--awb-color6-s),var(--awb-color6-l),calc(var(--awb-color6-a) - 25%));\"><div class=\"person-shortcode-image-wrapper\"><div class=\"person-image-container hover-type-none\" style=\"border:0px solid var(--awb-color2);-webkit-border-radius:0px;-moz-border-radius:0px;border-radius:0px;\"><img decoding=\"async\" class=\"lazyload person-img img-responsive wp-image-35192\" width=\"580\" height=\"388\" src=\"https:\/\/www.jsausa.com\/wp-content\/uploads\/2021\/06\/DianaTownsend2-1.jpg\" data-orig-src=\"https:\/\/www.jsausa.com\/wp-content\/uploads\/2021\/06\/DianaTownsend2-1.jpg\" alt=\"Diana Assante\" srcset=\"data:image\/svg+xml,%3Csvg%20xmlns%3D%27http%3A%2F%2Fwww.w3.org%2F2000%2Fsvg%27%20width%3D%27580%27%20height%3D%27388%27%20viewBox%3D%270%200%20580%20388%27%3E%3Crect%20width%3D%27580%27%20height%3D%27388%27%20fill-opacity%3D%220%22%2F%3E%3C%2Fsvg%3E\" data-srcset=\"https:\/\/www.jsausa.com\/wp-content\/uploads\/2021\/06\/DianaTownsend2-1-200x134.jpg 200w, https:\/\/www.jsausa.com\/wp-content\/uploads\/2021\/06\/DianaTownsend2-1-400x268.jpg 400w, https:\/\/www.jsausa.com\/wp-content\/uploads\/2021\/06\/DianaTownsend2-1.jpg 580w\" data-sizes=\"auto\" data-orig-sizes=\"(max-width: 1024px) 100vw, (max-width: 640px) 100vw, 400px\" \/><\/div><\/div><div class=\"person-desc\" style=\"background-color:rgba(200,235,244,0.44);padding:40px;margin-top:0;\"><div class=\"person-author\"><div class=\"person-author-wrapper\"><span class=\"person-name\">Diana Assante<\/span><span class=\"person-title\">Claims Specialist <\/span><\/div><div class=\"fusion-social-networks boxed-icons\"><div class=\"fusion-social-networks-wrapper\"><a class=\"fusion-social-network-icon fusion-tooltip fusion-mail awb-icon-mail custom\" aria-label=\"fusion-mail\" href=\"mailto:d&#105;a&#110;a&#064;j&#115;aus&#097;&#046;com\" target=\"_self\" style=\"color:var(--awb-color6);background-color:var(--awb-color2);border-color:var(--awb-color3);border-radius:4px;font-size:16px;padding:8px;\" data-placement=\"top\" data-title=\"Mail\" title=\"Mail\" data-toggle=\"tooltip\"><\/a><\/div><\/div><\/div><div class=\"person-content fusion-clearfix\">  If at any time you need assistance please contact our Claim&#8217;s Specialist Diana Assante, at 828-264-2787 or <a href=\"mailto:diana@jsausa.com\">diana@jsausa.com<\/a>.<\/div><\/div><\/div><\/div><\/div><div class=\"fusion-layout-column fusion_builder_column fusion-builder-column-4 fusion_builder_column_2_3 2_3 fusion-flex-column\" style=\"--awb-bg-size:cover;--awb-width-large:66.666666666667%;--awb-margin-top-large:0px;--awb-spacing-right-large:2.88%;--awb-margin-bottom-large:0px;--awb-spacing-left-large:3.84%;--awb-width-medium:100%;--awb-spacing-right-medium:1.92%;--awb-spacing-left-medium:1.92%;--awb-width-small:100%;--awb-spacing-right-small:1.92%;--awb-spacing-left-small:1.92%;\"><div class=\"fusion-column-wrapper fusion-flex-justify-content-flex-start fusion-content-layout-column\"><div class=\"fusion-text fusion-text-3\"><noscript 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form.\",\"currency_symbol\":\"\",\"beforeForm\":\"\",\"beforeFields\":\"\",\"afterFields\":\"\",\"afterForm\":\"\"};form.fields=[{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":1,\"idAttribute\":\"id\",\"type\":\"textbox\",\"label\":\"Policy Number\",\"key\":\"policy_number_1506098819241\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"<p><br><\\\/p>\",\"desc_text\":\"<p>Please list all policy numbers that need a claim filed<br><\\\/p>\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"wrap_styles_background-color\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_border-style\":\"\",\"wrap_styles_border-color\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_display\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":0,\"wrap_styles_advanced\":\"\",\"label_styles_background-color\":\"\",\"label_styles_border\":\"\",\"label_styles_border-style\":\"\",\"label_styles_border-color\":\"\",\"label_styles_color\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_display\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":0,\"label_styles_advanced\":\"\",\"element_styles_background-color\":\"\",\"element_styles_border\":\"\",\"element_styles_border-style\":\"\",\"element_styles_border-color\":\"\",\"element_styles_color\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_display\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":0,\"element_styles_advanced\":\"\",\"cellcid\":\"c4804\",\"drawerDisabled\":false,\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"id\":154,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":2,\"idAttribute\":\"id\",\"label_pos\":\"above\",\"required\":1,\"placeholder\":\"\",\"default\":\"\",\"wrapper_class\":\"\",\"element_class\":\"\",\"container_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) 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Contact Name\",\"key\":\"agency_contact_name_1562944917657\",\"type\":\"textbox\",\"drawerDisabled\":false,\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"id\":6,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":3,\"idAttribute\":\"id\",\"type\":\"phone\",\"label\":\"Agency Contact Phone Number\",\"key\":\"agency_contact_phone_number_1562944963945\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"phone\",\"personally_identifiable\":1,\"wrap_styles_show_advanced_css\":0,\"label_styles_show_advanced_css\":0,\"element_styles_show_advanced_css\":0,\"cellcid\":\"c4811\",\"drawerDisabled\":false,\"value\":\"\",\"id\":201,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"tel\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":4,\"idAttribute\":\"id\",\"label_pos\":\"above\",\"required\":1,\"placeholder\":\"\",\"default\":\"\",\"wrapper_class\":\"\",\"element_class\":\"\",\"container_class\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"wrap_styles_background-color\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_border-style\":\"\",\"wrap_styles_border-color\":\"\",\"wrap_styles_color\":\"\",\"wrap_styles_height\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_font-size\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_display\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":0,\"wrap_styles_advanced\":\"\",\"label_styles_background-color\":\"\",\"label_styles_border\":\"\",\"label_styles_border-style\":\"\",\"label_styles_border-color\":\"\",\"label_styles_color\":\"\",\"label_styles_height\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_display\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":0,\"label_styles_advanced\":\"\",\"element_styles_background-color\":\"\",\"element_styles_border\":\"\",\"element_styles_border-style\":\"\",\"element_styles_border-color\":\"\",\"element_styles_color\":\"\",\"element_styles_height\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_display\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":0,\"element_styles_advanced\":\"\",\"cellcid\":\"c4814\",\"label\":\"Agency Contact Email\",\"key\":\"agency_contact_email_1562944994375\",\"type\":\"email\",\"drawerDisabled\":false,\"custom_name_attribute\":\"email\",\"personally_identifiable\":1,\"value\":\"\",\"id\":7,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"email\",\"element_templates\":[\"email\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":5,\"idAttribute\":\"id\",\"label_pos\":\"above\",\"required\":1,\"placeholder\":\"\",\"default\":\"\",\"wrapper_class\":\"\",\"element_class\":\"\",\"container_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"<p><br><\\\/p>\",\"desc_text\":\"<p><span style=\\\"color: rgb(34, 34, 34); font-family: arial, helvetica, sans-serif; font-size: small;\\\">Named Insured as listed on policy.<\\\/span><br><\\\/p>\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"wrap_styles_background-color\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_border-style\":\"\",\"wrap_styles_border-color\":\"\",\"wrap_styles_color\":\"\",\"wrap_styles_height\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_font-size\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_display\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":0,\"wrap_styles_advanced\":\"\",\"label_styles_background-color\":\"\",\"label_styles_border\":\"\",\"label_styles_border-style\":\"\",\"label_styles_border-color\":\"\",\"label_styles_color\":\"\",\"label_styles_height\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_display\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":0,\"label_styles_advanced\":\"\",\"element_styles_background-color\":\"\",\"element_styles_border\":\"\",\"element_styles_border-style\":\"\",\"element_styles_border-color\":\"\",\"element_styles_color\":\"\",\"element_styles_height\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_display\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":0,\"element_styles_advanced\":\"\",\"cellcid\":\"c4817\",\"label\":\"Named Insured\",\"key\":\"named_insured_1567085628365\",\"type\":\"textbox\",\"drawerDisabled\":false,\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"id\":261,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":6,\"idAttribute\":\"id\",\"label_pos\":\"above\",\"required\":1,\"placeholder\":\"\",\"default\":\"\",\"wrapper_class\":\"\",\"element_class\":\"\",\"container_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"\",\"desc_text\":\"\",\"disable_browser_autocomplete\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"wrap_styles_background-color\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_border-style\":\"\",\"wrap_styles_border-color\":\"\",\"wrap_styles_color\":\"\",\"wrap_styles_height\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_font-size\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_display\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":0,\"wrap_styles_advanced\":\"\",\"label_styles_background-color\":\"\",\"label_styles_border\":\"\",\"label_styles_border-style\":\"\",\"label_styles_border-color\":\"\",\"label_styles_color\":\"\",\"label_styles_height\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_display\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":0,\"label_styles_advanced\":\"\",\"element_styles_background-color\":\"\",\"element_styles_border\":\"\",\"element_styles_border-style\":\"\",\"element_styles_border-color\":\"\",\"element_styles_color\":\"\",\"element_styles_height\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_display\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":0,\"element_styles_advanced\":\"\",\"cellcid\":\"c4820\",\"label\":\"Insured's Contact Name\",\"key\":\"insured_s_contact_name_1567085569093\",\"type\":\"textbox\",\"drawerDisabled\":false,\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"value\":\"\",\"id\":200,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":7,\"idAttribute\":\"id\",\"type\":\"phone\",\"label\":\"Insured's Contact Phone Number\",\"key\":\"insured_s_contact_phone_number_1562945075627\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"phone\",\"personally_identifiable\":1,\"wrap_styles_show_advanced_css\":0,\"label_styles_show_advanced_css\":0,\"element_styles_show_advanced_css\":0,\"cellcid\":\"c4823\",\"drawerDisabled\":false,\"value\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_float\":\"\",\"label_styles_border\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_float\":\"\",\"element_styles_border\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_float\":\"\",\"id\":252,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"tel\",\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":8,\"idAttribute\":\"id\",\"label\":\"Date of Loss\",\"type\":\"textbox\",\"key\":\"date_of_loss_1652711820452\",\"label_pos\":\"above\",\"required\":1,\"default\":\"\",\"placeholder\":\"\",\"container_class\":\"\",\"element_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":false,\"admin_label\":\"\",\"help_text\":\"\",\"mask\":\"\",\"custom_mask\":\"\",\"custom_name_attribute\":\"\",\"personally_identifiable\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":0,\"label_styles_border\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":0,\"element_styles_border\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":0,\"cellcid\":\"c4826\",\"value\":\"\",\"drawerDisabled\":false,\"id\":353,\"beforeField\":\"\",\"afterField\":\"\",\"parentType\":\"textbox\",\"element_templates\":[\"textbox\",\"input\"],\"old_classname\":\"\",\"wrap_template\":\"wrap\"},{\"objectType\":\"Field\",\"objectDomain\":\"fields\",\"editActive\":false,\"order\":9,\"idAttribute\":\"id\",\"label_pos\":\"above\",\"required\":1,\"placeholder\":\"\",\"default\":\"\",\"wrapper_class\":\"\",\"element_class\":\"\",\"container_class\":\"\",\"input_limit\":\"\",\"input_limit_type\":\"characters\",\"input_limit_msg\":\"Character(s) left\",\"manual_key\":\"\",\"disable_input\":\"\",\"admin_label\":\"\",\"help_text\":\"<p class=\\\"m_-4541882433705891639gmail-MsoListParagraphCxSpFirst\\\" style=\\\"color: rgb(34, 34, 34); margin: 0in 0in 0.0001pt 21pt; line-height: 15.6933px; font-size: 11pt; font-family: Arial, sans-serif;\\\"><br><\\\/p>\",\"desc_text\":\"<p class=\\\"m_-4541882433705891639gmail-MsoListParagraphCxSpFirst\\\" style=\\\"color: rgb(34, 34, 34); margin: 0in 0in 0.0001pt 21pt; line-height: 15.6933px; font-size: 11pt; font-family: Arial, sans-serif;\\\"><span style=\\\"font-size: 14.6667px;\\\">-&nbsp; &nbsp; Provide a brief description of the loss.<\\\/span><\\\/p><p class=\\\"m_-4541882433705891639gmail-MsoListParagraphCxSpFirst\\\" style=\\\"color: rgb(34, 34, 34); margin: 0in 0in 0.0001pt 21pt; line-height: 15.6933px; font-size: 11pt; font-family: Arial, sans-serif;\\\">-<span style=\\\"font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: &quot;Times New Roman&quot;;\\\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\\\/span>If Auto Accident: provide VIN, Year, Make, Model, and Driver Information if applicable.<\\\/p><p class=\\\"m_-4541882433705891639gmail-MsoListParagraphCxSpMiddle\\\" style=\\\"color: rgb(34, 34, 34); margin: 0in 0in 0.0001pt 21pt; line-height: 15.6933px; font-size: 11pt; font-family: Arial, sans-serif;\\\">-<span style=\\\"font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: &quot;Times New Roman&quot;;\\\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\\\/span>If Property Loss: provide the physical address of property involved.<span style=\\\"font-size: 11pt;\\\">&nbsp;<\\\/span><\\\/p><p class=\\\"m_-4541882433705891639gmail-MsoListParagraphCxSpLast\\\" style=\\\"color: rgb(34, 34, 34); margin: 0in 0in 8pt 21pt; line-height: 15.6933px; font-size: 11pt; font-family: Arial, sans-serif;\\\">-<span style=\\\"font-variant-numeric: normal; font-variant-east-asian: normal; font-stretch: normal; font-size: 7pt; line-height: normal; font-family: &quot;Times New Roman&quot;;\\\">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\\\/span>If Liability Loss: provide location of incident<\\\/p>\",\"disable_browser_autocomplete\":\"\",\"textarea_rte\":\"\",\"disable_rte_mobile\":\"\",\"textarea_media\":\"\",\"wrap_styles_background-color\":\"\",\"wrap_styles_border\":\"\",\"wrap_styles_border-style\":\"\",\"wrap_styles_border-color\":\"\",\"wrap_styles_color\":\"\",\"wrap_styles_height\":\"\",\"wrap_styles_width\":\"\",\"wrap_styles_font-size\":\"\",\"wrap_styles_margin\":\"\",\"wrap_styles_padding\":\"\",\"wrap_styles_display\":\"\",\"wrap_styles_float\":\"\",\"wrap_styles_show_advanced_css\":0,\"wrap_styles_advanced\":\"\",\"label_styles_background-color\":\"\",\"label_styles_border\":\"\",\"label_styles_border-style\":\"\",\"label_styles_border-color\":\"\",\"label_styles_color\":\"\",\"label_styles_height\":\"\",\"label_styles_width\":\"\",\"label_styles_font-size\":\"\",\"label_styles_margin\":\"\",\"label_styles_padding\":\"\",\"label_styles_display\":\"\",\"label_styles_float\":\"\",\"label_styles_show_advanced_css\":0,\"label_styles_advanced\":\"\",\"element_styles_background-color\":\"\",\"element_styles_border\":\"\",\"element_styles_border-style\":\"\",\"element_styles_border-color\":\"\",\"element_styles_color\":\"\",\"element_styles_height\":\"\",\"element_styles_width\":\"\",\"element_styles_font-size\":\"\",\"element_styles_margin\":\"\",\"element_styles_padding\":\"\",\"element_styles_display\":\"\",\"element_styles_float\":\"\",\"element_styles_show_advanced_css\":0,\"element_styles_advanced\":\"\",\"cellcid\":\"c4829\",\"label\":\"Claim 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