Claim Appeal & Escalation

We consider it an honor to serve you. In order to expedite your request for appeal or escalation, we need some information from you. Please fill out the form below and upload the required documentation listed. Once all information is received, your appeal will be processed within five (5) business days. Questions? Just call us at 800-527-1984. Follow the prompts for contract holders.

Contract Holder Name*
Contract Number or VIN*
Email*
Phone*
Date the vehicle symptom was first noted

MM slash DD slash YYYY
Reason for appealing the claim
What area of your contract do you believe covers this repair?
Attach complete and legible copies of the following:
Copy of the repair order/invoice from your repair facility
Max. file size: 700 MB.
Written diagnosis, including cause of failure from your repair facility
Max. file size: 700 MB.
Copy of vehicle maintenance record
Max. file size: 700 MB.
Vehicle bill of sale & odometer statement if contract purchased in the last 90 days
Max. file size: 700 MB.