Collision Claim: HELPWITHMYPOLICY

POLICY

importance
UNDERSTANDING: documentation*

The most important document for your claim is your insurance policy information. We also need a list of supporting documents, with some being more important than others. If you don't have the complete list, don't worry, Helpwithmypolicy.com and our team of public adjusters will assist you in gathering the necessary data and information.

AGREEMENT

Pay structure
AGREEMENT: I fully understand and am in agreement with helpwithmypolicy.com's payment structure for their public adjusting services. They charge a fee of 10% based on the successfully identified and secured coverage for you as a policyholder, creating a direct link between their efforts and the maximization of benefits for you claim. This arrangement, motivating their diligence, is appealing to me. Moreover, the fact that there will be no charge if they don't succeed in securing additional coverage adds to the transparency and fairness of the agreement. I am on board with and appreciate the clear terms of the pay structure.*

“I wholeheartedly agree and comprehend that the optimal path for achieving the best outcome is through the utilization of your public adjusting services. I look forward to your evaluation of my claim, and I trust that you will advise me on whether it's worth pursuing and guide me on the next steps to take.”

LEGAL

Information
LEGAL: representation*

I hereby authorize helpwithmypolicy.com, comprising legal professionals, claims handlers, and public adjusters, to represent my rights and benefits throughout the insurance claim process. I grant them the authority to assess and diligently pursue all potential coverage for the losses my vehicle has incurred under my insurance policy. Their fiduciary duty is solely to me, prioritizing my interests over those of my insurance company, any contractors involved, and even the public adjuster themselves. I assert my authority as the policyholder, emphasizing that decisions regarding my vehicle are ultimately mine to make.
SIGNATURE: I want to assure you that I am committed to offering precise and transparent information about my claim to the best of my abilities. Your guidance and transparency are highly valued as we navigate through this process together.*

Clear

POLICY INFO

We kindly request information regarding your policy, address, and coverage. Please provide your policy details, including the policy number and coverage type. Additionally, kindly provide your current address (where the loss occurred) and specific coverage details, such as coverage limits and deductibles. Your cooperation will help us effectively retrieve your payment. Thank you.
POLICY: number*
INSURED: names on the policy*
OTHER: named insured
DEDUCTIBLE: amount
DATE: Suspected Date of Loss*

MonthDayYear
Date

Driver

info
DRIVER: during the collision

First NameLast Name
PASSENGERS: during the collision
PASSENGER 1: during collision

First NameLast Name
PASSENGER 2: during collision

First NameLast Name
PASSENGER 3: during collision

First NameLast Name
PASSENGER 4: during collision

First NameLast Name
PASSENGER 5: during collision

First NameLast Name

Vehicle Overview

The Insured 🚙
Pre-damage images

I do not have pre-damage imagesI have uploaded pre-damage images of my vehicle
Pre-damaged images

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VIN: vehicle identification number
PLATE: license number
REGISTRATION: expiration
STATE: registered
YEAR: vehicle made
MAKE: producer vehicle
MODEL: series of vehicle
CLASSIFICATION: vehicle
passenger, commercial, etc.
BODY: type
2 door, 4 door.
CYLINDER: engine type
CLAIM: number*

I have not received a claim number yetInput Claim Number
PHONE: policyholder*
Please enter a valid phone number.
EMAIL: policyholder*
example@example.com
ADDRESS: insured’s address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Street

collision occurrence
ADDRESS: loss occurred *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
COLLISION AREA: street view

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Insurance Agent

Information Is Found Inside Your Policy
PRODUCER: soliciting agent's name

First NameLast Name
PRODUCER: soliciting agent's business name
PRODUCER: email
example@example.com
PRODUCER: phone number*
Please enter a valid phone number.
Insurance Company

Insurer
INSURER: insurance company name*
INSURER: claim's reporting phone number*
Please enter a valid phone number.
REPORTED: I or someone called the claim in to the insurance claims department.*

YesNo
CLAIMS: date called in the claim*

MonthDayYear
Date
Hour MinutesAM/PM Option
CLAIMS: representative I spoke with*

First NameLast Name
CLAIMS: what was said during the phone call and the conversation about your claim? Or, what happened?*
Adjuster Information

point of contact
ADJUSTER: type

Field AdjusterDesk Adjuster (remote)
ADJUSTER: name of the assigned adjuster

First NameLast Name
ADJUSTER: phone number of the assigned adjuster
Please enter a valid phone number.
ADJUSTER: email
example@example.com

Repairabilty
Is your vehicle deemed unrepairable?

Yes, it is deemed unrepairable and cannot be fixed.We are not sure yet.No, it is repairable.

Repair Service Provider Info

We kindly request the insured to gather at least one estimate for the claim right away. However, it would be even better if you could gather three estimates. Gathering multiple estimates will help us in accurately assessing the damage and expediting the claim process. Thank you for your prompt attention to this matter!
PROVIDER: Contractor’s Company Name:*
PROVIDER: Business Card:*

YesNo
CARD: Service Provider Business Card:*

front and back
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PROVIDER: phone number
PROVIDER: project supervisor:

First NameLast Name
PROVIDER: Type of Contractor?
PROVIDER: License and state

Helping you get paid!
DAMAGES: To expedite the payment process, it is important for you as the homeowner to provide a detailed report of the damage, including thorough descriptions and pictures. Additionally, including information about the cause of the damage strengthens your claim and increases the likelihood of receiving payment quickly.*

I acknowledge the importance of the requests made by Helpwithmypolicy.com to ensure the correct and expedient processing of this claimI will need to gather more information and I will have to get back to you regarding a damage report.Other
DAMAGE: report*

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PROPOSAL or ESTIMATE: I acknowledge the significance of the requests made by Helpwithmypolicy.com to ensure the accurate and swift processing of this Repair or Replacement Estimate. It is crucial to prepare a comprehensive estimate outlining the scope of work required for repairing or replacing the damaged areas. The estimate should include a detailed breakdown of costs related to materials, labor, safety requirements, staging of materials and waste, storing valuable tools and materials, project delivery endeavors, dumpster rental or pick-up, and any additional services or equipment necessary. Additionally, 10% each for overhead and profit should be included in the estimate. This comprehensive approach, including all tests, retests, and inspections for inspection-related concerns, aims to provide a detailed and itemized estimate. This ensures that the insurance company fully understands the work involved and the associated expenses.*

I have provided all the information you have requested above for the detailed proposal for a favorable outcome. I acknowledge the importance of the requests made by Helpwithmypolicy.com to ensure the correct and expedient processing of this claimI will need to gather more information and I will have to get back to you regarding the proposal estimation.Other
PROPOSAL: reported estimation to fix your property*

Upload PDF, Word Doc, or a photo images
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POLICE REPORT: please provide the police report and other relevant information*

I have provided all the information you have requested above for the detailed proposal for a favorable outcome. I acknowledge the importance of the requests made by Helpwithmypolicy.com to ensure the correct and expedient processing of this claimI will need to gather more information and I will have to get back to you regarding the police report.Other
File Upload

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MATERIAL SPECIFIC: To ensure comprehensive details for the planned repairs or replacement, we require specific information from you regarding the materials involved. Please provide detailed specifications, including the type, quality, and cost of materials. Specify the brand, model, or grade of components such as fans, materials, or any other services with material-specific requirements. Additionally, include details on elements like tile type, paint color or texture, special sealants, and distinctions between granite and marble. Transparency about the materials used is crucial for establishing fair value and quality, ultimately optimizing the contractor's payout. Your openness in providing this material specification will be highly appreciated by the homeowner.*

I have provided all the information you have requested above for the Material Specific Report for a favorable outcome. I acknowledge the importance of the requests made by Helpwithmypolicy.com to ensure the correct and expedient processing of this claimI will need to gather more information and I will have to get back to you regarding any material specific requirements.Refer to the estimates I have already uploaded.Other
MATERIAL SPECIFIC: report, brochures, images*

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CODE COMPLIANCE: It's crucial to ensure that you are well-versed in and strictly adhere to all local vehicle codes and regulations relevant to the repair or replacement work. If feasible, please furnish documentation or references showcasing any compliance with these requirements for this project. This proactive measure is essential to preemptively address any potential issues that might pose obstacles to the insurance claim process.*

I have provided all the information you have requested above for the code requirement report for a favorable outcome. I acknowledge the importance of the requests made by Helpwithmypolicy.com to ensure the correct and expedient processing of this claimI will need to gather more information and I will have to get back to you on the Ordinance Code Compliance Report.No ordinance code requirements are necessary for this project.Other
CODE: compliance report*

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PERMITS:*

I have provided all the information you have requested above for the detailed permits required for the project for a favorable outcome. I acknowledge the importance of the requests made by Helpwithmypolicy.com to ensure the correct and expedient processing of this claimI will need to gather more information and I will have to get back to you in regards to any required permits for this project.I am confident no permits will be required for this project.Other
PERMITS: records and requirements*

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MAINTENANCE: Establishing that the property was adequately maintained prior to the damage is vital. Kindly submit documentation such as other regular maintenance inspection reports, proposals, or estimates, maintenance receipts, or service contracts that verify the property's consistent upkeep and care. This documentation is essential in demonstrating that the damage was not a result of neglect or insufficient maintenance, thereby fortifying the insurance claim and optimizing the potential payout.*

I have provided all the information you have requested above for the detailed property maintenance assessment for a favorable outcome. I have provided another proposal or maintenance assessment of the property prior to my inspectionI will need to gather more information and I will have to get back to you about any previous maintenance issues of the property.There is no maintenance report to reference.Other
MAINTENANCE: reports*

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WARRANTY: As the vehicle owner receiving assistance from Helpwithmypolicy.com, if there are any existing warranties covering your property, we kindly request that you provide details about the coverage terms and conditions. Include information about the duration of the warranty, what is covered, and any applicable limitations or exclusions. This information not only establishes the value and protection associated with your property but also strengthens your claim for coverage. Your cooperation in providing these details is essential in facilitating a thorough assessment of the claim.*

I have provided all the information you have requested above for the detailed warranty report for a favorable outcome. I acknowledge the importance of the requests made by Helpwithmypolicy.com to ensure the correct and expedient processing of this claim.I will need to gather more information on any property or material warranties and I will have to get back to you.There are no warranties .Other
WARRANTY: information*

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DATE: got to shop

MonthDayYear
Date
DATE: begin work

MonthDayYear
Date
DATE: estimated completion

MonthDayYear
Date
NOTES: timeframe
TIMELINE: schedule of events*

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HIDDEN or UNSEEN: Please ensure to bring to our attention any concealed or unseen damages that might not be immediately visible during the inspection, such as water infiltration or structural issues. Your transparent communication about these hidden concerns is crucial as it significantly impacts the overall scope of work and the subsequent insurance claim.*

I have provided all the information of any unseen damages, I have uploaded it below for a favorable outcome for me.I will need to gather more information and I will have to get back to you.I do not anticipate any unseen or hidden damages.Other
HIDDEN or UNSEEN: areas of concern not readily visible*

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INSPECTION: Please provide a copy of the Insurance inspection report from when you purchased the car. Additionally, if there are any existing property inspection reports or documented records of past inspections, repairs, or restoration work conducted on the property, kindly furnish us with the pertinent details. This information will aid our assessment by providing valuable insights into the vehicle history and any potential impact on the current insurance claim project.*

I have provided all the information you have requested above for the detailed inspection report for a favorable outcome.I will need to gather more information and I will have to get back to you.I do not have the information on the latest property inspection report.Other
Property Inspection Analysis and Repairs*

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APPRAISAL: Providing the appraisal value of the vehicle when you purchased it and sharing any notable observations or findings from the appraisal report will greatly assist in the insurance claim process. This information will contribute to a more comprehensive understanding of the condition and characteristics of the car, strengthening our case for an optimal claim resolution. Your cooperation in furnishing these details is invaluable in facilitating a successful claim.*

I have all the information you have requested above for the detailed appraisal report for a favorable outcome for me.I will need to gather more information and I will have to get back to you.I do not have access to any appraisals.I will be calling my agent for the last appraisal of my property.Other
Historical Appraisals*

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TOW-YARD: information*

I have all the information you have requested above for the detailed towing report for a favorable outcome for me.I will need to gather more information and I will have to get back to you.I do not have access to any towing.Other
Company Name:
Company Contact:
Hours of Operation:
Phone Number
Please enter a valid phone number.
TOW-YARD: address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
TOW-YARD: information

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Thank You!

We want to acknowledge and appreciate the time and energy you invested in filling out the form. Emphasizing the importance of ongoing communication, we value your efforts as the policyholder in assisting with the claim. Please stay tuned to your email for updates and further communication regarding this claim matter.
DETAIL: Please provide any additional information or comments that were not mentioned before.
ACCOUNTABILITY: acknowledgement agreement*

All the above has been completed to the best of my ability: Thank you for transparently and accurately documenting the necessary information and assisting with my claim.
Should be Empty:

COLLISION HELP IS HERE!

POLICY

AGREEMENT

LEGAL

REPORTS

POLICY INFO

Driver

Vehicle Overview

Street

Insurance Agent

Insurance Company

Adjuster Information

Cause of Loss

Repairabilty

Repair Service Provider Info

EXTERIOR

INTERIOR CONDITION

Helping you get paid!

Thank You!