Verified Statement of Claim for Lost or Damaged Goods

We are sorry you have found it necessary to report a claim. Roadway Vanlines attempts to settle all claims in an equitable and timely manner. We appreciate your cooperation in filling out the form. Upon receipt of the form, a file will be established and assigned to an adjuster.

General Instructions:

A. Please retain the damaged articles, including shipping cartons. These items must be available for inspection.

B. Time limit for filing claim is 9 months from date of delivery or conversion to permanent storage. The 9-month claim filing period does not apply to government, military and some national account contracts. Contact your booking agent, transportation management office or move coordinator for specific claim filing information.

C. Please have shipping documents available at time of inspection.

D. Transportation charges must be paid prior to claim settlement.

In the event that you need to file a claim please contact our Claims Service provider CSI directly. Our claims process is simple. Follow the steps below to expedite your claim:

Claim Filing Instructions:
Please have the following documents available (saved to your computer or phone) before you start your claim:
1. Bill of Lading
2. Inventory Sheet

Start your claim:
1. Please register online at https://claims.csipros.org/claims/register or Click Here to be directed to the registration page.
2. Enter your contact and move information, and upload the required documents where instructed.
3. Submit your registration.

Your information will be verified within 48 business hours and once verified, an email with your login credentials will be sent to you. Check your “Spam” or “Junk” folder if you can’t find it in your inbox.

Once you have received your login information follow these easy steps:
1. Log in to your online account
2. Enter your claim information
3. If claiming damages please make sure to have the pictures of the damaged items saved to your computer or phone so you can upload them when asked for it. Keep in mind the adjusters will need
pictures clearly showing the damage claimed and 1 picture showing the entire item.
4. If claiming Real Property damage (floors, ceilings, walls, etc.) please provide 3 repair estimates. Repair estimates may be obtained free of charge from reputable professionals.
5. Any additional documents including repair estimate (for real property damage only) can be uploaded directly to the Documents Tab.

Claim Support:
Chat support is now available on www.csipros.org
For Phone support please call 772-742-5246 Ext. 1 and follow the prompts
For post-claim filing support please contact your Case Manager: Vivian M.

CSI Business Hours: Mon-Fri 9AM-5PM EST

Main Fax number: 772-742-2407
Website: www.CSIpros.org

Helpful Hints:

A. The ORDER FOR SERVICE NUMBER must be referenced on claim form and any subsequent correspondence or inquiries. If not already entered on the claim form, this number can be found at the top right hand corner of the Bill of Lading. This number also appears on the top right hand corner of the Order for Service.

B. Complete top portion of form thoroughly. Include zip codes with addresses and area codes with telephone number. Please give us the phone numbers where you can be reached during normal business hours.

C. Complete all columns for articles claimed:

1. Not providing Inventory Numbers may delay the processing of your claim.

2. Give a brief description of article claimed including make and model number if applicable, (COFFEE TABLE, TV-XYZ, MODEL 123).

3. Describe the extent, location and nature of damage, (SCRATCH TOP RIGHT EDGE, OR LEFT REAR LEG BROKEN).

4. Indicate the article’s replacement cost today for same, or similar articles.

5. Enter the amount you are claiming in settlement. The CLAIM FORM is not complete without this amount.

6. If the claimed item was packed, please indicate whether the carton was damaged by marking YES or NO in the appropriate column. This information is important since we allocate responsibility to the party responsible for the reported damage.

7. A claim process may take up to 120 days.

D. If additional space is required, please be sure attached pages include the same information requested on this form.

E. The claim must be signed and dated. Failure to sign will result in the form being returned for signature.

F. Be sure all unpacking has be accomplished, and all items checked, before submitting claim.

G. Do not have any items repaired unless we advise you to do so.

Sample:

1		2	3		4	5	6
Inventory number	Article weight	Article Description	Description of loss / damage	Date of purchase/ age of item	Cost to replace	Amount claimed	Carton Damaged? Yes or No
38	40 lbs	End Table	SCRATCHED TOP	4 YRS.	$275	$50	N/A
15	30 lbs	Glass Bowl	BROKEN	8 MTH.	$22.50	$22.50	No

Minimum Filing Requirements:

Federal regulations establish the minimum filing requirements as a “communication in writing from a claimant filed with a proper carrier within the time limits specified in the bill of lading or contract of carriage for transportation, and (i) containing facts sufficient to identify the baggage or shipment (or shipments) of property involved, (ii) asserting liability for alleged loss, damage, injury or delay, and (iii) making a claim for the payment of a specified or determinable amount of money, shall be considered as sufficient compliance with the provisions for filling claims embraced in the bill of lading or other contract of carriage.”

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