Property Subrogation Assignment

Please submit as much of the following information currently known for all subrogation matters (time is of the essence, thus partial information is acceptable):

If after hours or urgent, call, text, or email directly:

Anthony Antonellis, Senior Partner at Sloane and Walsh.
aantonellis@sloanewalsh.com,
Direct Line: 857-321-7007
Mobile: 617-593-6700

We will confirm receipt within 24 hours. If you have not received a confirmation email, please contact Ann Piazza at apiazza@sloanewalsh.com

ATTORNEY CLIENT COMMUNICATION AND WORK PRODUCT PRIVILEGED COMMUNICATION

TEST Amica Subrogation Portal TEST

Date of Loss

Estimated Damages

Over $250,000

Between $50,000 and $250,000

Under $50,000

Claim No.

Amica Representative

First Name

Last Name

Representative Phone

Extension

Representative Email

Do you have an HLPS?

Yes

No

Upload HPLS

Maximum file size: 15MB

Upload jpg, jpeg, jpe, png, doc, docm, docx, pdf

____________________________________

Insured's Full Name (First name/last name)

Insured's Phone

Insured's Email

Potential responsible party or parties:

Please upload any communications and contact information regarding potential responsible parties.

Maximum file size: 15MB

Address of Loss (street address):

City

State

Zip Code

Type of Loss

Fire

Water

Other

____________________________________

If there has been an expert assigned, please provide:

Expert Name

First Name

Last Name

Expert Phone

Expert Email

Any additional information you want to share:

If you are human, leave this field blank.

Please forward your complete claims file to our subro team assistants at loconnor@sloanewalsh.com and jcontrado@sloanewalsh.com at your earliest convenience.