Repair Authorization Form - Insurance

TAX ID 23-2915063

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REPAIR ESTIMATE DISCLOSURE

Estimates performed prior to disassembly of vehicle are not accurate due to the probability of hidden damage. Therefore, it is our procedure that accurate estimates of the cost to repair and the expected time to complete repairs, are not made until we have disassembled the area of damage to your vehicle. Note: After disassembly additional repairs and parts will cause delays.

Before dropping off your vehicle, please ensure it is washed and that all personal belongings are removed. Repairs will be on hold, and you will be notified to remove your belongings. Smitty’s is not responsible for any missing belongings left in the vehicle during the repair process. Additionally, Smitty’s is not liable for any damage caused by fire, theft, vandalism, or other incidents, whether occurring inside or outside the vehicle.

Employees of Smitty's and its sublet vendors may occasionally operate your vehicle for testing, moving, or pickup/delivery purposes. During the process of repair, it is normal for the battery to be disconnected which may result in memory presets.

Smitty’s labor rates are posted in the collision office. 

Insurance Estimate: The estimate provided by the insurance company is an estimate of the repairs the insurance company has agreed to pay for. It is not an estimate prepared or guaranteed by Smitty’s Maintenance Repair & Collision, Inc. The insurance estimate may include aftermarket, non-OEM, recycled, or other replacement parts that may differ from the vehicle manufacturer's original parts in fit, finish, function, or quality.

Estimates will be reviewed and determined whether the labor rates, parts, and repair procedures are acceptable based on the work required to properly and safely repair your vehicle. If Smitty’s does not agree with the insurance estimate, we will make every reasonable effort to work with the insurance company to address differences in labor rates, parts, procedures, and repair costs. If Smitty’s and the insurance company cannot agree on an acceptable labor rate or other repair cost, the customer may be responsible for the difference.

The insurance estimate may include less labor time than Smitty’s determines is necessary to properly and safely complete the repairs. It may also exclude repair procedures, parts, materials, or labor recommended or required by the vehicle manufacturer (OEM procedures). The insurance company may also request that Smitty’s purchase parts outside of our normal vendor accounts. We will make reasonable efforts to obtain the parts requested by the insurance company; however, some parts may no longer be available, may not meet Smitty’s quality standards, or may be otherwise unsuitable for the repair. I understand that the use of non-OEM or recycled parts, as well as the vehicle's accident history, may affect the vehicle's safety, appearance, resale value, or market value and may result in diminished value. Smitty’s reserves the right to decline parts or repairs that do not meet our standards for quality, fit, function, safety, or warranty.

Smitty’s will make every reasonable effort to work with the insurance company; however, the warranty for the repairs performed by Smitty’s is provided by Smitty’s and is not provided by the insurance company. Smitty’s takes pride in the quality, service, and safety of the repairs we provide to our customers.

VEHICLE OPERATION & BATTERY DISCONNECT

Employees of Smitty's and its sublet vendors may operate your vehicle for testing, moving, or pickup/delivery purposes. During repairs, the vehicle battery may be disconnected which may result in loss of memory presets.

CANCELLATION AND WITHDRAWAL FEES – Once the repair authorization is signed by customer, parts will be ordered per the estimate. If Smitty's does not repair your vehicle, the customer is responsible for:

• Estimate fees
• Administrative processing fees
• Disassembly and estimating labor
• Parts and materials ordered
• Restocking fees
• Storage Charges
• Any other reasonable costs incurred related to the vehicle

SUPPLEMENTAL/ADDITIONAL DAMAGES - During the teardown process of repairing said vehicle additional damage may be found. Smitty’s will complete a supplement damage analysis.

Insurance Claim:   Additional parts, materials, or repair procedures may be identified after disassembly or further inspection.  These items may be submitted to insurance as a supplement for approval. Repairs will be on hold until approval is received from the insurance company. The insurance company may deny or refuse to pay for some or all supplemental charges. If this occurs, I understand that I may be responsible for any unpaid balance.

Supplement Payments from Insurance: I agree to allow my insurance company handling the claim to issue supplement payments directly to Smitty's once a supplement has been approved. I understand that any payment not received by the time the vehicle repair is complete may delay the delivery of the vehicle. If payment has not been received, proof of payment from the insurance company will be required to release the vehicle.

 

PAYMENT POLICY -Vehicle owner accepts full financial responsibility for the cost of repairs.

Forms of Payment Accepted and Card Processing Convenience Fee:

• Also accepted Insurance checks, Cashier's checks, Money orders, Cash, ACH or Zelle.     
• A 2% convenience fee applies for processing of collision repair payments.  

Personal and Business Check Payments: Checks are accepted only if received 14 days prior to repair scheduled start date. Checks returned unpaid for any reason is subject to a $30 returned check fee due immediately. Payment must be made by Cash.

Change from Customer/Third Party Pay to Insurance Claim: If switching to insurance coverage after repairs begin:

• Administrative fee up to $250 may apply
• Customer responsible for any uncovered balance.
• This change will cause delays. 

Vehicle Completion:

• Vehicle must be picked up within 24 hours of completion notice unless otherwise arranged,
• After 3 days, storage fees apply at the posted daily rate.

Final Bill: All customer-responsible repair costs must be paid in full before the vehicle will be released. 

Insurance Payment/Financial Responsibility/Verification:

• If payment is recieved from insurance for repairs, promptly notify and remit payment to Smitty’s
• If any payment cannot be verified by insurance, full payment by customer will be required for delivery.
• Vehicle release may be withheld until payment clears.
• You will be reimbursed if duplicate payment is later received.

Customer Financial Responsibilities:  

• Deductibles
• Depreciation and Betterment adjustments
• Labor/Parts not covered by insurance
• Labor rate differences if Smitty’s is not a direct repair facility
• Labor rates that cannot be agreed upon with insurance that are not within the regional market standards.  

Insurance Follow-Up and Payment Authorization:  In certain cases, your assistance may be required to follow up with the insurance company to ensure the timely progression of the repair process, receipt of necessary documentation, and issuance of payments. If the insurance company does not respond to Smitty’s submission for supplements and/or payments, it will be the customer’s responsibility to contact and follow up with the insurer directly. This may include, but is not limited to, matters such as supplement damages identified during the repair process, final supplement adjustments, insurance payments.

STORAGE FEES & INSURANCE BILLING ACKNOWLEDGMENT (IF APPLICABLE)

• Storage rate: $150.00 per day may apply if I decline repairs and choose to remove my vehicle from Smitty’s, leave the vehicle at Smitty’s after repairs are completed without prior arrangements for more than 3 days, or otherwise leave the vehicle on the property for an extended period without communication or notification.
• Additional administrative or handling fees may apply
• Customer authorizes Smitty’s to bill insurance if applicable.
• Customer remains responsible for any unpaid or denied charges
• Vehicle will not be released until all charges are paid in full.

RENTAL ACKNOWLEDGMENT: Smitty’s is not responsible for rental vehicle charges, regardless of who pays for the rental.

PHOTO/VIDEO DISCLOSURE: Smitty's may take photos/videos during the repair process and may use the photographs/videos for:

• Website
• Advertising
• Social Media
• Brochures or other marketing materials

Photos/videos become property of Smitty’s. No compensation will be provided. You release any claims related to their use.

Insurance Communication & Payment Authorization

I authorize Smitty's Maintenance Repair & Collision, Inc. to communicate directly with my insurance company regarding my claim, including discussing damages, negotiating estimate and supplements, requesting approvals, receiving claim information, and obtaining payment and payment details related to repairs on my vehicle.

I hereby authorize and direct my insurance carrier(s) to pay directly to the provider any payments otherwise payable to me for services rendered. I understand that I am financially responsible for any charges not covered by my insurance, including but not limited to deductibles, betterments, appearance allowances, and denials.

This Agreement does not relieve me of responsibility for payment in full for services provided. I understand that this authorization will remain in effect until revoked by me in writing.

Authorization

I have read the above paragraphs and I hereby authorize the repair to the above referenced vehicle as described in the estimate and acknowledge that I understand all the above.  Smitty's is not responsible for the security or condition of any personal property left in the vehicle. An express mechanics lien is hereby acknowledged on this vehicle to secure payment for the repairs performed.