Food Spoilage Claims
Please itemize all losses. Proof is required for food losses of $235–$540. Examples of acceptable proof of loss include: cash register tapes, store or credit card receipts, and canceled checks. Receipts must contain the date the items were purchased; date of purchase should be no later than 30 days prior to the outage.
- You may file a claim up to a maximum of $540 for actual losses of food spoiled due to lack of refrigeration.
- Proof is not required for food losses under $235.
Prescription Medication Loss Claims
You must provide an itemized list and proof of all prescription medication losses. Examples of acceptable proof of loss include pharmacy prescription labels or pharmacy receipts identifying the medicine and amount paid.
- We may request authorization to verify the loss of prescription medicine.
- Reimbursement for prescription medicine is not included in the $540 maximum for food spoilage.
Claims for reimbursement for losses sustained as a result of power outages caused by storms or other conditions beyond our control will not be paid.
Please provide details about the item(s) you lost during the outage. Please fill in details for at least one item, or create and attach an itemized list. You can add up to 20 items manually. If you have more than 20 items, attach the list as a file.
Please provide proof of all prescription medication losses and food losses totaling $235–$540. Proof is not required for food losses under $235
Accepted file types: JPG, JPEG, PNG, GIF, PDF, DOC, DOCX, XLS, XLSX
Maximum number of attachments: 10
Individual file size limit: 5MB
Total file size limit: 15MB
Your electronic signature is the same as your handwritten signature and is certification of the truth and accuracy of the information submitted. Your signature confirms that all of the information provided on this form is true and accurate to the best of your knowledge and represents your actual losses.