Submit Assignment - Powertrain Analytics | Fuel Contamination Claims

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Fuel Contamination Claims – Submit Assignment Form

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Pre-Inspection Research Service

Please reference our Questions to Consider | Fuel Contamination Claims before filling out the form. Although most of the questions we suggest will be considered by most adjusters and appraisers, there might be additional questions that are not.

Answer all of the questions the best you can. Be as precise as possible. If there is a section you cannot answer, or answer accurately, feel free to type unknown or none. This may or may not change the accuracy of our research, data or recommendations.

Powertrain Analytics - Fuel Contamination Claims

Basic Claim and Vehicle Data

Your First Name *

Your Last Name *

Your Company Name *

Street or PO Box *

City *

State *

Zip *

Your Telephone # *

Your Email *

Claim or File # *

Date of Loss *

Insured Name *

Claimant Name

Vehicle Year *

Vehicle Make *

Vehicle Model *

Current Mileage *

VIN *

Basic Claim Synopsis

In just a few sentences provide a synopsis of the claim. *

What is the Alleged Fuel Contaminant?

Gasoline

Diesel Fuel

DEF (Diesel Exhaust Fluid)

Water, Dirt or Rust

Microbial Growth

Unknown

Questions for Vehicle Operator/Owner

Does the vehicle operator have an opinion regarding the source of the alleged fuel contamination? *

How much fuel was added in gallons during the last fuel fill? *

How far in miles or time was the vehicle driven before an abnormal symptom was first noticed since the last fuel fill?

Which warning lights or messages were observed on the dashboard? *

How far did the vehicle operator continue to drive the vehicle after the first symptom? *

When was the last time the fuel system was professionally serviced? *

What type of fuel system service does the owner/operator themselves perform if any? *

Has any fuel been recently added to the vehicle from a small portable fuel container? *

If the vehicle is a pick up, does the truck have an aftermarket auxiliary fuel tank mounted in the bed? *

Questions for Repair Shop

What are the abnormal symptoms they have observed? (e.g.: Warning lights, lack of power, engine runs rough, etc.) *

What specific tests have they performed? (e.g.: Reviewed trouble codes, tested fuel injectors, tested fuel pump output, etc.) *

What Diagnostic Trouble “P” Codes have they obtained from the vehicle’s powertrain computer? (Ex: P0521, P0130, P0195, etc.) *

What does the shop believe happened, which resulted in the fuel system or powertrain damages? *

What parts if any have been removed or disassembled from the fuel system or powertrain? *

What parts or assemblies do they believe are damaged? *

Additional comments or information.

1 + 2 = ?Please prove that you are human by solving the equation *