Submit Assignment

Submitting an Assignment with RPA is Quick and Easy! We offer 5 options to make it happen:

  1. Send an email with all assignment details and documents to assignments@rpaclaims.com
  2. Fax your new assignment to (860) 388-1832.
  3. Telephone your new assignment to us by calling (860) 310-4380
  4. Also reach us on XactAnalysis! Use our XacNet address: Jeffrey.Old_Saybrook.CT
  5. Complete the Assignment form below. Note: We will send you a confirmation email. If more documents need to be sent to us, you can respond with those documents attached. 
Submit Assignment
  • Adjuster or Examiners Contact Information
    0
  • First*First Name
    1
  • Last*Last Name
    2
  • Company Name*Insurance Company
    3
  • Address*Company Address
    4
  • City*
    5
  • State*Prefix
    6
  • Zip Code*
    7
  • Phone Number*Your Contact number
    8
  • Your Email*or email of main contact
    9
  • Insured's Information
    10
  • Your Claim #*Numbers or Letters
    11
  • Policy #*Not Required
    12
  • Insured's Name*Full Name
    13
  • Phone Number*Insured's Number
    14
  • Insured's Email*If available
    15
  • Address*Insured's Address
    16
  • City*
    17
  • State*Prefix
    18
  • Zip Code*
    19
  • Mortgagee*Not Required
    20
  • Claimant Information (only for 3rd party claims)
    21
  • Claimants Name*full name
    22
  • Address*Claimants Address
    23
  • City*Claimants City
    24
  • State*Claimants State
    25
  • Zip Code*Claimants Zip
    26
  • Claimant Contact*Phone Number
    27
  • Loss Information
    28
  • Date of Loss*As Reported
    29
  • Loss Description*Be as specific as possible
    30
  • Type of Loss*Wind, Fire, Theft , etc..
    31
  • Deductible*
    32
  • Wind Deductible*if applicable
    33
  • Coverage A*Limits
    34
  • Coverage B*Limits
    35
  • Coverage C*Limits
    36
  • Coverage D*Limits
    37
  • 38

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