Palffy Insurance Group

Accident Insurance Quote Request

Accident Insurance Quote Form
*Required Fields

First Name*

Last Name*

Phone Number*

Email Address*

Zip Code*

Date of Birth*


Tobacco Use*

Occupation* (if you're retired, type "retired")

Additional Comments:

A sales agent may call you as a result of submitting this form. We may need to clarify some information while completing your quote request. We may call you to discuss your options after you receive your quote.

The information you provide will only be used to satisfy your quote request. Certain information will be shared with insurance companies for quoting purposes only. No insurance company and no other insurance agency will market to you as a result of submitting this form. We do not share your information with outside organizations for marketing purposes.

Accident Insurance

Accident Insurance provides you with a lump-sum payment after you receive treatment for an injury due to an accident. Accident policies complement your health insurance by providing benefits beyond what your health coverage provides.

Many health insurance plans have high deductibles and, after an accident, you could end up having to pay the entire cost of your treatment. An accident policy can help lessen or eliminate this financial burden.

An accident could force you to miss a few days of work. The payment from an accident policy could help you pay your bills and buy groceries while you're recovering.

Accidents happen. You can't plan for them. But, with an accident policy, you can be financially prepared for when they do happen.