Homepage Fillable Authorization And Direction Pay Template

File Details

Fact Name Description
Purpose The Authorization and Direction to Pay form allows a policyholder to direct their insurance company to pay a specific repair facility directly for services rendered.
Owner Information The form requires the owner's name, address, and contact information, including home and business/cell phone numbers.
Vehicle Details Vehicle information must be provided, including the year, make, model, and license plate number.
Insurance Company The form requires the name of the insurance company and the claim number associated with the vehicle repair.
Payment Authorization The owner must authorize the insurance company to pay the repair facility directly, specifying the amount to be paid.
Notification Requirement If the insurance company mistakenly sends the payment to the owner, the owner must notify the repair facility and deliver the check within 24 hours.
Body Shop Information Details about the repair facility, including the body shop's name, tax ID, address, phone number, and contact person, must be included.
Signature Requirement The form requires the owner's printed name, signature, and date to validate the authorization.
State-Specific Laws In some states, specific laws govern the use of this form, ensuring compliance with insurance regulations. Check local laws for details.

Sample - Authorization And Direction Pay Form

DIRECTION TO PAY FORM

OWNER/CLAIM INFORMATION

Name _________________________________________________________________ License Plate ______________________________

Address ___________________________________________________________________________________________________________

Home Phone _________________________________________

Business/Cellphone __________________________________________

Year _____________________ Make _____________________

Model _ _____________________________________________________

Insurance Company ___________________________________

Claim # _____________________________________________________

DIRECTION TO PAY

I authorize ____________________________________________ Insurance Company to pay ____________________________________

directly on claim number ________________________________ in the amount of $___________________. In the event the insurance

or adjustment company inadvertently mails the settlement/supplement check to me in error, I hereby agree to notify the repair facility immediately and deliver the check to that facility within 24 hours of my receipt of said check.

Customer Printed Name

Customer Signature

Date

Body Shop _________________________________________________________________________________________________________

Body Shop Tax ID ___________________________________________________________________________________________________

Body Shop Address _________________________________________________________________________________________________

Body Shop Phone __________________________________________________________________________________________________

Body Shop Contact _________________________________________________________________________________________________

Common mistakes

Filling out the Authorization and Direction Pay form can seem straightforward, but many people make mistakes that can delay their claims. One common error is leaving out essential personal information. For instance, the name, license plate, and address must be complete and accurate. Missing even one detail can cause confusion and lead to processing delays.

Another frequent mistake involves incorrect claim numbers. It's crucial to double-check the claim number entered on the form. An incorrect number can result in payments being sent to the wrong account or not at all. Always verify this information with your insurance provider before submitting the form.

Many individuals also overlook the section that specifies the amount to be paid. Leaving this blank or entering an incorrect figure can complicate the payment process. Ensure that the amount matches what was agreed upon in your claim settlement.

People sometimes forget to sign the form. A signature is necessary to validate the authorization. Without it, the insurance company may not process the payment. This simple oversight can lead to significant delays in receiving funds.

Another mistake is failing to provide the correct contact information for the body shop. The body shop’s name, address, and phone number must be accurate. If this information is incorrect, the insurance company may have trouble contacting the repair facility, which can slow down the payment process.

Additionally, some individuals do not include the body shop's tax ID. This information is often required for proper processing. Omitting it can lead to complications and potential delays in payment.

People also sometimes neglect to read the entire form carefully. Understanding each section is important. Misinterpretations can lead to errors in filling out the form. Take the time to read through the instructions and ensure all parts are completed accurately.

Another common mistake is not notifying the repair facility if a check is sent directly to the claimant. If the insurance company mistakenly sends the check to you instead of the body shop, you must inform the facility and deliver the check promptly. Failing to do so can create issues in the repair process.

Finally, some individuals submit the form without making copies for their records. Keeping a copy is essential for tracking the status of your claim. It provides a reference point if any issues arise later in the process.