Make a claim.

At Market Lane - the process is simple.

Fairlight Insurance

To submit a claim for Fairlight Insurance please:

For all Medical Malpractice claims, please ensure the First Notice of Loss form is completed at your earliest convenience.
Download the claims form via the button below
Fill out the form then submit it via Fairlight Claims form.

PROPERTY & LIABILITY CLAIMS FORM

 <a href="https://thebarn.wufoo.com/forms/z1gxohbv1d009ru/">Fill out my Wufoo form!</a> 

First Notice of Loss Form

For all Fairlight Medical Malpractice claims, please ensure the First Notice of Loss (FNOL) form is completed at your earliest convenience.

Policyholder Name

First Name

Last Name

Policy Number

Policyholder Email Address

Policyholder Phone Number

Country

(###)

###

####

Date of Incident / Date of Attendance or Care

MM

DD

YYYY

Time of Incident / Time of Attendance or Care

Hour

Minute

Second

Brief Description of Incident

Claimant Name

First Name

Last Name

Any Additional Relevant Information

Has this matter been notified to Fairlight previously?

YES

NO

Advisor / Solicitor Name (if any)

Advisor / Solicitor Advice (if any)

In the event of a claim please contact your insurance broker immediately or please contact our Claims Team: claims@marketlanegroup.com.au

Antonia Topic
Group Head of Claims

02 8067 0600 | 0424 892 317

antonia@marketlanegroup.com.au

Marie Domingo
Claims Executive

02 7254 6810 | 0415 280 977

marie@marketlanegroup.com.au

Chloe Brunker
Trainee Claims Executive

02 7254 6813 | 0415 061 223

chloe@marketlanegroup.com.au

Declan Punch
Trainee Claims Executive

02 7254 6822

declan@marketlanegroup.com.au

Meet the Claims Team

Back to Claims Page

Make a claim.

At Market Lane - the process is simple.

Fairlight Insurance

To submit a claim for Fairlight Insurance please:

For all Medical Malpractice claims, please ensure the First Notice of Loss form is completed at your earliest convenience.

Download the claims form via the button below

Fill out the form then submit it via Fairlight Claims form.

First Notice of Loss Form

In the event of a claim please contact your insurance broker immediately or please contact our Claims Team: claims@marketlanegroup.com.au