| Home  >  Consumer Information - Insurance > Ombudsman's Office > Filing an Auto Damage Claim with Your Own Insurer  | 
  
  
    | What You Should Know About...  | 
  
  
    | Filing an Auto Damage Claim with Your Own Insurance Company | 
  
  
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        When your vehicle is damaged or stolen, one of the first  things you should do is file an insurance claim. If another driver caused the  damage to your vehicle, you have the option to file the claim either with your  own insurance company, if you have the appropriate coverages (a "first  party" claim), or with the insurer for the owner of the other car (a "third party claim").  
          In order for you to be able to file a "first  party" claim, your policy must provide Collision or Comprehensive  coverage (see right). These are often referred to as "Physical Damage" coverages.   | 
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            Collision coverage protects you from damage caused to your  car by a collision with another vehicle, a fixed object, or an object lying in  the roadway. Collision coverage also protects you from damage caused by the  upset of your vehicle. 
                Comprehensive coverage protects you if your car is stolen or  vandalized or damaged by contact with an animal or falling objects (i.e., tree  limbs, rocks, stones, debris). It also covers your vehicle for glass breakage,  fire, wind, hail, and flood damage.   | 
           
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    If you file a first party claim, your insurance company will  either pay to repair the damages to your vehicle or pay you the value of your  vehicle if the damages exceed the car's worth. First, though, the company will  subtract the deductible amount you have chosen for that coverage.  
      If you file a third party claim against another driver, the  other driver's insurance company will only pay for damages to your vehicle to  the extent that their insured was legally responsible. In some instances, this  may not be enough to reimburse you for the full amount of your loss. (More information on third party claims...)        | 
    
  
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    | Frequently Asked Questions  | 
    Glossary of Insurance Terms  | 
  
  
     
      1. Can I collect under "no-fault" insurance for  damages to my vehicle if I was at fault for an accident and I do not carry  first party coverage? 
           
      2. What must I do after a loss? 
         
        3. What information must I give my insurance company? 
           
        4. When will my insurance company contact me and how long do  they have to look at my vehicle? 
         
        5. How long does my insurance company have to settle my claim? 
         
        6. Will my insurer pay for me to rent a car? 
             
        7. What about storage fees?  
             
        8. Who decides whether or not my vehicle can be repaired? 
         
        9. Can I choose my own repair shop? 
         
        10. Can I ask my insurer to recommend a repair shop?  
         
        11. Does my insurance company have to use new parts to repair my car?  
         
        12. Do I have to accept non-OEM parts?  
         
        13. Do I have to pay a deductible? 
         
        14. How will the value of my vehicle be calculated to determine if it is a total loss?  
         
        15. Can my insurer deduct for any damage or rust to my vehicle which existed before the loss? 
         
        16. I found a car just like mine that costs more than what I  got from the insurance company for my old car. What can I do? 
           
          17. Does my insurer have to give me the option to keep my car  after they have declared it a total loss?  
             
            18. If the insurer settles my total loss and lets me keep the  car, can I use the settlement money to fix it instead of selling it for  salvage? 
             
            19. Does my insurance company have to pay off my car loan? 
             
            20. What if my company and I can't agree on the amount of my loss? 
                    
                   
                  21. Must I conclude my claim within a certain time frame? 
                   
                  22. What else can I do if my insurance company and I can't agree, or if they deny my claim? 
            
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    1. Can I collect under "no-fault" insurance for  damages to my vehicle if I was at fault for an accident and I do not carry  first party coverage?        | 
  
  
    
      The answer is "NO". No-fault or Personal Injury  Protection (PIP) insurance only pays for your own medical expenses if you are  injured in an automobile accident, no matter who caused the accident. It does  not pay for damage to a vehicle. 
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    | 2. What must I do after a loss? | 
  
  
    
        - Immediately report all losses to your insurance agent or  company. 
 
        - Immediately report a loss to the police if your vehicle is  stolen, vandalized, or damaged by a hit-and-run driver. Without a police report  your company could deny your claim. In fact, under Division of Motor Vehicle  law you are required to report any accident involving property damage in excess  of $500.00 to the appropriate authorities. 
 
        - You must make the damaged vehicle available for inspection  by the insurance company before you have it repaired. 
 
        - Protect your vehicle from further damage. If you don't do  this, your insurer could refuse to pay for any subsequent damage. For example,  if you don't cover a broken windshield and rain damages the upholstery, your  company could refuse to pay for the damaged upholstery. 
 
        - Cooperate with the insurance company's investigator. If you  don't cooperate, the company could deny your claim. 
 
        - When you file a first party claim, you have a direct  contract with your insurer that requires the company to fulfill all the  conditions stated in your policy. However, the contract also places duties and  requirements on you, the insured, when filing a claim. Therefore, you need to  review that section of your policy often called "Conditions" or  "Insured's Duties After a Loss."
 
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    | 3. What information must I give my insurance company? | 
  
  
    
        - A copy of any legal documents you receive as a result of an  accident, such as a letter from an attorney or a summons and complaint. 
 
        - A proof of loss, as may be required by the insurance  company, describing the date of the loss, how it happened, who was driving, and  any other relevant information. If a proof of loss is required, your company  could deny your claim if you fail to provide it. 
 
        - Your company may also ask for other documents related to the  claim such as repair bills or estimates, a copy of the police report, or a copy  of the vehicle's title or bill of sale. 
 
        - In some cases, your company can also require you to submit  to an examination under oath and produce requested documents. You do have the  right to have an attorney present during the examination under oath. If you do  not submit to the examination under oath, your company could deny your claim.
 
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    | 4. When will my insurance company contact me and how long do  they have to look at my vehicle? | 
  
  
    
      New Jersey  insurance regulations require your insurance company to contact you within 10  working days after they have been notified of a loss, or if they intend to  exercise their right to inspect the damaged vehicle, they must do so within 7  working days.  
        Your insurer can only require your vehicle to be made  available for inspection at a time and place which is reasonably convenient for  you. 
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    | 5. How long does my insurance company have to settle my claim? | 
  
  
    
        Your insurance company is allowed 30 calendar days to settle  your first party claim from the time they receive notice of the loss. However,  this time may be extended if the company needs to conduct additional  investigation or if you fail to cooperate with them.  
        The company must provide you with written notice explaining  the reason for the delay if the claim settlement process takes longer than 30  days. 
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    | 6. Will my insurer pay for me to rent a car? | 
  
  
    
      It depends. If your car is stolen, most insurance policies  will reimburse you for a stated amount towards the cost of a rental vehicle for  a limited time starting 48 hours after the theft, as long as you report the  theft to the police and to the insurance company. Check your policy for the  exact wording.  
        For non-theft claims, most policies don't provide coverage  for a rental vehicle unless you buy this additional coverage. If another party  was responsible for the accident, that party's insurer may be responsible for  rental charges. (For more information, see  third party claims...) 
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    | 7. What about storage fees? | 
  
  
    
        If your vehicle is not drivable after an accident and is  towed to a storage facility, the storage facility will charge you a daily  storage fee. Your insurance company must give you 3 working days notice before  they stop paying for storage charges in order to give you time to move the  vehicle to someplace where you won't incur storage charges. 
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    | 8. Who decides whether or not my vehicle can be repaired?  | 
  
  
    
        After evaluating the damages to your vehicle, your insurance  company has the option of repairing your vehicle, replacing your vehicle, or  reimbursing you for the vehicle's actual cash value (ACV). Actual cash value is  the amount your vehicle would have sold for on the date of the accident.  
        Your insurance will elect to replace your vehicle or  reimburse you for the ACV in those instances where the vehicle is economically  impractical to repair.  
        A vehicle is considered economically impractical to repair,  or a total loss, if the cost to repair the vehicle equals or exceeds the  vehicle's ACV on the date of the loss. In many instances an insurance company  will total a vehicle if the appraised damages equal 80% of the vehicle's ACV  because often, once repairs are begun, additional damages or "hidden  damages" are found which would render the vehicle a total loss by  definition. (This is sometimes referred to as a "constructive total"  loss). 
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    | 9. Can I choose my own repair shop? | 
  
  
    
        Yes. Provided the repair shop is licensed, your insurer has  to try to reach an agreed price with the shop of your choice. If your company  cannot reach an "agreed price", they will provide you with the names  of licensed shops who can do the repairs for the price the company has  determined. 
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    | 10. Can I ask my insurer to recommend a repair shop?  | 
  
  
    
      Yes. At your request, your company must recommend a  qualified repair facility convenient to the vehicle's location which will  repair the vehicle at the price the company is willing to pay and whose work is  guaranteed. Your insurance company further stands behind the repair shop’s  guarantee. 
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    | 11. Does my insurance company have to use new parts to repair my car?  | 
  
  
    
        No. The contract of insurance only obligates the insurance  company to restore your vehicle to the same condition it was in before the  loss. Sometimes this requires the use of original equipment manufacturer (OEM)  parts and sometimes after-market parts can be used. After-market parts are parts  made by a manufacturer other than the original manufacturer.  
        If your vehicle is being repaired with newer parts, your  company doesn't have to pay for this "betterment". For example, if  your vehicle's transmission is five years old and is damaged due to a covered  loss, your insurer would only have to replace it with a five year old  transmission. If a five year old transmission can't be found, the repair shop  could use a new transmission but you'd have to pay the difference between the  value of a five-year-old transmission and a new transmission. 
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    | 12. Do I have to accept non-OEM parts? | 
  
  
    
        No. While New    Jersey regulations do permit the use of after-market  parts as long as they are warranted by the manufacturer to be of like kind and  quality as OEM parts, you don't have to accept them. The final choice is yours  but if the insurer wants to use non-OEM parts and you decide to use more  expensive OEM parts, you may have to pay the difference in cost.  
        The regulations also require the insurer to clearly indicate  in writing on the appraisal which parts are after-market parts and pay for any  modifications necessary. 
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    | 13. Do I have to pay a deductible?  | 
  
  
    
        When you bought your policy, you chose a deductible for your  physical damage coverages. This is the amount you are responsible for if a  claim occurs. The higher your deductible, the lower the cost of your physical  damage coverage. Your insurer will deduct that amount from the settlement of  your claim.  
        Keep in mind that insurance companies consider it to be  fraud if the repair shop inflates your repair estimate to help you recover the  cost of your deductible. 
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    | 14. How will the value of my vehicle be calculated to determine if it is a total loss?  | 
  
  
    
      Each insurance company is required to select one of three  prescribed methods for use in the settlement of all their total loss claims.  
        The three methods which have been approved by the  Commissioner of Banking and Insurance are: 
        
          
            | 1. Taking the average of the retail values of substantially  similar vehicles as listed in the current editions of the "Automobile Red  Book" (or "Older Car Red Book") published by Penton Media and the "N.A.D.A. Official Used Car Guide" (or "N.A.D.A.  Official Older Car Guide") published by the National Automobile Dealers  Used Car Company.
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            | 2. Using a quote obtained by the insurer for a substantially  similar vehicle available for you to purchase from a dealership within 25 miles  of where your car is normally garaged. | 
           
          
            | 3. Utilizing the services of an approved source, including  computerized databases that produce fair market values of substantially similar  vehicles. At this time Audatex, Mitchell International, CCC, Vehicle Valuation Services Inc and  CARFAX  are approved for use in determining fair  market values. | 
           
         
        If your vehicle cannot be valued using any of these three  methods because they fail to represent a true cross-section of the market to  determine the fair market value of your car, the company is then required to  use the best available method and fully explain to you, in writing, how they  calculated the amount they are offering you.  
        In addition to telling you which method is used to value  your car, your insurance company must also provide you with an itemized list  showing all additions, deductions, and sales tax applicable to your vehicle. 
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    | 15. Can my insurer deduct for any damage or rust to my vehicle which existed before the loss? | 
  
  
    
      Yes. However, deductions for previous damage or prior  condition must be itemized with a specific dollar amount and are limited to the  amount by which the resale value of the car is increased by the elimination of  the previous damage or correction of the prior condition. In other words, if  your car was damaged in a previous accident and you decided not to get it  repaired, or if you neglected the condition of your car which resulted in the  vehicle sustaining rust, your car would not be worth as much on the open market  if you tried to sell it than it would be had you elected to repair the previous  damage or maintain the car in good condition. The amount by which the resale  value of your car increases by eliminating the previous damage, or correcting  the prior condition, is the amount the insurance company can deduct from your  total loss settlement. 
        As New Jersey  does not have a law which specifies just how insurers can take deductions for  previous damage or prior condition, the example below is provided solely for  the purpose of giving you a better understanding of this concept to assist in  your negotiations with the insurer. 
        
          
            | Example - A quarter panel damaged prior to the covered accident which  the insurer estimates will cost $600 to replace may result in the following  deductions:  | 
           
          
            
              If the vehicle is 1 and 2 years old - $600 deduction for previous  damage 
                If the vehicle is 3 and 4 years old - $450 deduction for  previous damage 
                            If the vehicle is 5 through 7 years old - $300 deduction for  previous damage 
                      If the vehicle is over 7 years old - $150 deduction for  previous damage. 
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    | 16. I found  a car just like mine that costs more than what I  got from the insurance company for my old car. What can I do?  | 
  
  
    
      Provided you have located a substantially similar vehicle  within 30 days from receiving the company's settlement check, your company will  have to either: 
        
          - Pay you the difference between the cost of the car that you  found and the amount of the claim settlement.
 
          - Negotiate the purchase price of the car that you found.
 
          - Locate a substantially similar vehicle within a 25 mile  radius of your vehicle’s principle place of garaging which you can purchase at  the market value established by the company in their original offer of  settlement.
 
          - Invoke the Appraisal Clause of your policy. (See Question 20) 
 
           
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    | 17. Does my insurer have to give me the option to keep my car  after they have declared it a total loss?  | 
  
  
    
        No. Once they settle a total loss, your insurance company  assumes the rights to your car and can dispose of it however they wish  including selling it or its parts for salvage. They can, at their discretion,  let you keep the car and let you try to salvage it yourself.  
        If the insurer lets you keep your car, they will deduct its  salvage value from your total loss settlement before applying your deductible. 
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    | 18. If the insurer settles my total loss and lets me keep the  car, can I use the settlement money to fix it instead of selling it for  salvage? | 
  
  
    
        Yes. However, if your vehicle was manufactured 8 or fewer  years from the current model year, you must first obtain a salvage certificate  from the New Jersey Motor Vehicle Commission (MVC).  
        After the repairs are made, the vehicle must then be  presented to the MVC for a special inspection before it can be driven on public  roads.  
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    | 19. Does my insurance company have to pay off my car loan?  | 
  
  
    
        No. The insurance policy only requires the company to pay  the actual cash value of the vehicle less your deductible. If your car's value  is less than the loan, you are still responsible for the difference.  
        Keep in mind that if your lender is listed as a loss payee  on your policy (which is normally the case) the settlement check will be made  out to them as well as to you. 
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    | 20. What if my company and I can't agree on the amount of my loss?  | 
  
  
    
        If you and your insurer can't agree on the amount of your  physical damage loss either one of you may request an appraisal as explained in  your policy. Here is how the appraisal process usually works: 
        
          - You choose and pay for an appraiser to represent you.
 
          - The company will choose and pay for an appraiser to  represent them.
 
          - The two appraisers will select a neutral third party umpire  (for whom you and your company split the cost, if necessary).
 
          - Both appraisers will give their estimates for the loss.
 
          - If the appraisers can't agree, they will submit their  differences to the umpire and a decision by any two of the three is binding.
 
         
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    | 21. Must I conclude my claim within a certain time frame?  | 
  
  
    
        Yes. You must either accept a final settlement or file a  lawsuit within the time period specified by the appropriate statute of  limitations.  
        If you fail to accept a final settlement offer or to file a  suit before the statutory period runs out, you may jeopardize your right to  receive any settlement at all. 
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    | 22. What else can I do if my insurance company and I can't agree, or if they deny my claim?  | 
  
  
    
      You can file an appeal with the insurance company's internal  appeals panel. If you are still unsatisfied after the company's internal  appeals panel renders its decision, you can request a review of that decision  by the Insurance Claims Ombudsman.  
        
          
            | You can file a written complaint with: | 
            The Office of the Insurance Ombudsman 
                NJ Department of Banking and Insurance 
20 West State Street 
PO Box 472 
Trenton NJ 08625-0472  
1-800-446-7467 
            E-mail: ombudsman@dobi.nj.gov | 
           
         
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    | If you have any further questions or would like additional  information, you can contact the Department of Banking and Insurance either  through the Office of the Insurance Claims Ombudsman at 1-800-446-7467 or the Consumer Inquiry and Response Center (CIRC) at 609-292-7272. |