Claim Forms

If you’ve filed a claim with Plymouth Rock Assurance, you may need to provide additional information so your claim can be resolved as quickly as possible. Your claim representative will let you know exactly what you need to provide, assist you with questions about the forms and provide you with instructions on how and where to submit them.

New Jersey Forms

  • All Personal Injury Protection (PIP) related forms can be found here.

Massachusetts Forms

Connecticut Forms

New York Forms

New Hampshire Motor Vehicle Accidents

In New Hampshire, any motor vehicle accident causing death, personal injury, or combined vehicle/property damage in excess of $1,000 must be reported to the Division of Motor Vehicles within 15 days. File a New Hampshire Motor Vehicle Accident Form (if necessary) using the NH Motor Vehicle Accident Report form. If you need any other forms related to your accident, please contact your claims representative.

To download any of the following forms you will need Adobe Reader. If you do not have Adobe Reader installed, you may download it free of charge.

If you need any additional assistance with claim forms, please visit our Contact Us page.