Endurance Claims Processing and Policy Standards

Posted on Mar 12, 2026 in Business Administration and Innovation Management

Claims & Payments

• Customer Out-of-Pocket: Total Amount Due – (Deductible + LLW AVA Remainder Amount).
• Deductible: Always collected by the Repair Facility.
• Next Payment: Found under the Claim/Policy Review tab.
• Inspection Costs: Endurance pays for these.
• Labor Rates: Always use National Labor Time Guides.

Handling Denials (Scripts)

• Pre-Existing/Wait Period: “The nature of the failure indicates a longer-term condition that would not first occur in the short time since the waiting period ended.”
• “Bumper to Bumper” Complaint: Remind them of the 3 steps: 1. Agent Qualify, 2. Recap Script, 3. 30-Day Money Back Review Period.
• Stated Component Policy: “The part is not listed in your specific level of coverage; therefore, it results in a denial.”

Communication & Transfers

• Adjusters vs. CS: Adjusters speak to Service Advisors; CS speaks to Customers.
• Policy Changes: If a shop/customer wants to change a claim status, they must speak to an Adjuster.
• Transfer Adjuster Lines: 855-292-9313 or 800-242-7316.
• Roadside Assistance: 1-888-246-2014 (Available 24/7/365, max $100 benefit).
• Documents: Send to claimsupport@endurancedirect.com (Include Claim # and “Maintenance Docs” in subject).

Key Terms & Codes

• (P): Power Train Sports (ATVs, etc.).
• (T): Tesla Claims.
• (R/R): Remove and Replace (Always check notes, not just the failure list).
• TF: Tech Finds.
• LLW AVA: Remainder amount found under “Under Review.”
• Pre-IR Review: Check here to see miles driven since the Waiting Period.

Smart AutoCare (SAPE) Policies

• Identification: Contract numbers start with SAPE.
• Tracking: Use secure.ase-profittrack.com (Claims Tab).
• Validation Period: This is what they call the “Waiting Period.”
• Exclusions: No salvage or rebuilt titles allowed.
• Ride Share (2018 vs 2024): 2018 has a specific surcharge; 2024 considers it Commercial/Business Use.

Component Coverage

• Core 4 & Advantage: Generally eligible for coverage (Bearing failure/Metal debris).
• Select Premier:
  • 2012 Version: Not listed.
  • 2022 Version: Only covered if damaged by an internally lubricated part.

Critical Restrictions: Select Premier (EVPH)

• Self-Performed Maintenance: This is strictly prohibited on EVPH contracts.
• Maintenance Proof: Customers must provide verifiable documents (receipts from a professional shop).
• Owner’s Manual: Customers must strictly follow the manufacturer’s service schedule to keep coverage active.

Parts & Labor

• Labor Rate: Calculated as: (Shop’s Published Hourly Rate) x (National Labor Time Guide).
• Part Selection: Endurance reserves the right to price claims based on OEM, Aftermarket, Reman, or Used parts.
• Customer Upgrades:
  • Endurance pays the set amount for the standard part.
  • The customer can pay the difference to upgrade.
  • Warning: Installing upgraded/performance parts (e.g., an Alpine audio system) voids future coverage for that specific component.

Claims Processing & Documentation

• MILEAGE VERIFICATION NEEDED: Always check for this tag on the claim.
• LOF: Lube, Oil, and Filter documentation is required for engine/transmission claims.
• 911 Services: These are high-priority/emergency; parts must be ordered specifically for these.
• Non-Business Hours: Refer the customer to the “Filing a Breakdown Claim” section of their contract for instructions if the shop is closed.

Quick Troubleshooting

• Maintenance Failure: Failure to maintain the vehicle or produce receipts results in a denial.
• Notes: Always add specific details within the Moxy or Max disposition notes for every interaction.
• The “Why”: Documentation is needed to verify the customer followed the owner’s manual and to prove the issue isn’t a pre-existing condition.

Deductibles & Payments

• One Deductible Rule: The customer pays their deductible once per approved claim, no matter how many parts are being fixed.
• Customer-Supplied Parts: Endurance never pays for parts the customer bought themselves.
• Why?: Parts must come from the shop or an Endurance vendor to ensure the correct fit and a valid shop warranty.
• Price Adjustments: You have the right to adjust estimates to Aftermarket/Reman/Used prices. This is the amount Endurance pays; the customer can pay the difference for OEM.

Waiting & Validation Periods

• Standard Rule: 30 Days AND 1,000 Miles must pass before a claim can be filed.
• Purpose: To “weed out” Pre-Existing Conditions (issues that started before the contract or during the waiting period).
• Pre-Existing Definition: A condition that, within mechanical probability, existed before the contract started or before the waiting period ended.

Call Handling & Scripts

• The “Why” for Docs: “We need to verify the owner’s manual was followed and ensure this isn’t a pre-existing condition.”
• Bumper-to-Bumper Complaints: Remind them of the 3-step process (Agent talk, Recap script, and 30-day money-back review period).
• Shop Call-Backs: Shops can call 855-292-9313 or 800-242-7316 to speak with an adjuster.
• Customer Support: Direct customers to claimsupport@endurancedirect.com for document uploads.

Policy Type Definitions

• Stated Component Coverage: Only parts specifically listed in the contract are eligible for repair (unless an exclusion applies). If it’s not on the list, it’s not covered.
• Select Premier (EVPH): Strictly no self-performed maintenance. Professional shop receipts are required for all services.
• Smart AutoCare (SAPE): Uses the term “Validation Period.” Does not allow salvage or rebuilt titles.

Coverage Levels & Eligibility

• Qualification: Not all cars get all plans. High-mileage cars (e.g., 175k+ miles) do not qualify for most coverage, and 120k+ miles typically disqualifies them from Supreme levels.
• Exclusionary: Covers everything except what is specifically listed in the “Exclusions” section.
• Stated Component: Only covers the specific parts named in the contract.
• Surcharges: These are found on the Declarations Page (e.g., Commercial Use, Tire Mod).
• Add-Ons: High-Tech and Hybrid are added automatically by VIN; Commercial and Tire Mod must be manually selected at sale.

Roadside & Support Contacts

• Quest Towing (New Contracts): No producer code needed—just the Contract Number.
• Nation Motor Club: Call (866) 330-0760.
• Roadside (General): 1-888-246-2014 (24/7/365, max $100 benefit).
• Adjuster Line (For Shops): 855-292-9313 or 800-242-7316.
• Document Uploads: claimsupport@endurancedirect.com (Subject: Claim # & Maintenance Docs).

Closing Checklist

• The Betterment: If the shop refuses our part, offer the dollar amount we would have paid the vendor (No tax/shipping).
• The Math: Total Due – (Deductible + LLW AVA Remainder) = Out-of-Pocket.
• Terminology: Use “Ineligible,” never “Void.”
• RepairPal: repairpal.com (PW: Custom3rS3rvic3!).

Vendor Ordering Checklist

• Identifiers: Contract #, Holder Name, Claim/Auth #, and Repair Order #.
• Vehicle: Full VIN, YMM, Engine Size, Driving Wheels, and Mileage.
• Part: Part # and Preferred Warranty Length.
• Facility: Shop Address, Contact Name, and Phone #.
• Specifics: Transmission Tag # (if applicable) and Shop Hourly Rate.
• EOC (End of Contract): Provide Expiration Odometer and Date if choosing this warranty.

Dealer Markup Rules

• Active Selling Dealer: 15% markup (Not to exceed $500). Note: This applies to any active selling dealer, not just the original one.
• Non-Selling Dealer: 15% markup (Not to exceed $100 for Minor; $200 for Major).
• Terminated Sellers: No markup allowed.

Must-Shop Parts

• Major Assemblies: Engines, Turbos/Superchargers, Transmissions, Drive Axles, Transfer Cases, and PTUs.
• Minor Assemblies: Steering Gears, Radios/Navigation, AC Compressors/Kits, Alternators, Starters, Evaporators, Control Arms, and Air Suspension (Struts/Springs/Compressors).

Parts Sourcing & Shipping Thresholds

Internal Directory

• Shop Auth: 877-414-0134.
• Elite (EPA): 844-770-2497 (Key/Windshield).
• Elite (CARCO): 877-902-8790 (Total Loss).
• DTC Roadside (VAS): 855-416-6894.
• Dealer Roadside (VAS): 866-993-8655.

System Search & Tools

• PCRS Search:
  • All Contracts start with letters; all Claims start with CL.
  • Search by Phone Number (no dashes/parentheses) or Last 8 of VIN.
  • Red Flag: Do NOT click contracts ending in -DC or -AC.
• KITT Search: Accepts Full VIN or Last 6. Always use the “Add Note” button.
• Attachments: Always upload docs to Other 1 or Other 2 in PCRS immediately.
• Labor Units: Quantity (Qty) in the system = Hours

Mileage & Contract “Rollbacks”

• Mileage Discrepancy: Claims can be denied if mileage doesn’t match.
• Rollback vs. Fat Finger: A “fat finger” is a typo. A Rollback is when mileage consistently shows as lower than previously recorded.
• Consequence: If a contract is cancelled and rewritten due to mileage issues, the waiting period starts over.

Transmission & 4WD/AWD Components

• Torque Converter: Fluid coupling that transfers rotating power from engine to transmission.
• Valve Body: The “Control Center” of the transmission.
• Clutch Pack: Engages via fluid pressure to lock the assembly and drive the wheels.
• Front Pump: Pulls ATF through the filter and sends it to the rest of the transmission.
• Cooler Lines: Transfers heat from the transmission to the cooler and back.
• Transfer Case (4WD): Receives power from the transmission and sends it to front/rear differentials.
• Power Transfer Unit (PTU/AWD): Attached to the side of the transmission; transfers power to half-shafts/rear differentials.

RepairPal Partnership

• Access: repairpal.com/endurance/associates
• Login: endurance+agent@repairpal.com | PW: Custom3rS3rvic3!
• When to Recommend RepairPal:
  1. The customer is unfamiliar with the area and needs a shop.
  2. The current shop refuses to work with Endurance.
  3. The current shop is uncooperative.
  4. The claim was denied, and the customer needs a cheaper labor rate for out-of-pocket repairs.
• Note: Monro Family Stores do NOT perform engine or transmission repairs. Refer those to RepairPal.

Communication: The “Never Say” List

• Don’t Control: “Listen to me,” “Do not interrupt me,” or “That does not matter.”
• Don’t Blame: “You are wrong,” “You caused this failure,” or “You didn’t maintain the vehicle.”
• Don’t Condescend: “Calm down/Relax,” “Do you feel better?”, or “Unfortunately.”
• Policy: No slang, no swearing, and never place blame on the customer or the shop.

Verifiable Document Checklist

• Shop Info: Name and Address (Phone and Google verification preferred).
• Vehicle Info: Year, Make, Model, VIN/Plate, and Mileage.
• Parts: Specific part numbers for materials used.
• Customer: Name must match (or VIN must match perfectly).
• Mileage: Documents for discrepancy must be dated within 7 days (before/after).

Call Handling & Verification

• Greeting: “Good (Time), thank you for calling Endurance Claims Customer Service, my name is [Name], how may I assist you?”
• Outbound: State name/company and the recorded line disclosure immediately.
• Verification: Confirm First/Last Name, Vehicle, Address, and Phone Number.
• Authorized Users: Spouses can verify; others need verbal consent or an email from the holder.

Claims & Policy Rules

• Maintenance: We follow Manufacturer Guidelines, not the owner’s manual directly.
• Documentation: Use one line per complaint and one box for each technician find.
• Adjusters: If an Under Adjuster is assigned, have the shop call back (don’t reach out). If a Senior Adjuster (S) is assigned, you can chat/email them.

De-escalation & Denials

• The “Jump In” (Interrupting nicely): “I’m sorry to jump in, but it’s important I understand where you’re coming from… let me see if I got this right.”
• The 2-Step Warning: State it is a professional conversation; warn twice before the 3rd-strike disconnect.
• Handling Denials: Explain that we follow contract terms, then ask: “What is the repair shop charging you for this repair?”
• Stated Policies: Explain that if a part isn’t explicitly listed in their specific coverage level, it cannot be covered.

Resolution Tools

• Part Sourcing (Finding cheaper parts).
• Shop Relocation (Finding a different repair facility).
• Deferrals (Payment flexibility).
• DigniFi (Financing/Loan options).