Rental Reimbursement Protection
CLAIM INSTRUCTIONS

   Print Page    Home

Please be advised that this is a generic claim form and may refer to several types of coverages. This does not imply or suggest that your policy contains these coverages. Should you have any questions regarding your coverages, please read your policy carefully and/or consult your agent.

  1. The following documentation is required on all claims. All items must be legible:
    1. Copy of your primary automobile insurance declarations page (this is the page that indicates your applicable coverages and limits).
    2. Name and address of your attorney (if applicable).
    3. This original signed claim form. Photocopies or fax copies are not acceptable.
    4. Original paid rental bill. Photocopies or fax copies are not acceptable.
    5. Complete copy of your rental reimbursement policy.
  2. For rental reimbursement due to theft or collision, please also submit the following:
    1. If vehicle repairable, copy of primary insurance company estimate, and copy of body shop repair bill showing date repairs began and were completed.
    2. If vehicle is a total loss, statement from primary insurance company indicating the actual cash value and the deduction made for application of your deductible.
    3. Copy of police report including narrative. Note: Driver’s Exchange of Information is not acceptable.
    4. If there was no police report filed, please complete and return the Accident Affidavit form. You can find this form attached to the online claim form.
  3. For rental reimbursement due to mechanical breakdown, please also complete and return the Mechanical Breakdown Affidavit. This document must be signed and notarized.

Note: some products provide for the daily rental car charge only and do not include collision damage waivers, taxes, other insurance, or any other fees or surcharges that may be incurred at the time of rental. Please see your contract for specific coverage terms and conditions.

Click Here To Print Claim Form

Return all documentation to:
Claims Center
800 Yamato Rd, Suite#100.
Boca Raton, FL 33431
888-684-9327