Loss of Use Claim Letter for a Damaged NEMT Van: Lost Trips, Rental Costs, Diminished Value, and Exhibits

A loss of use claim is the bill for the days a damaged van could not earn. This page is the letter to send, the weekly summary that backs it up, and the exhibit list. Who pays, what each state allows, and the deadlines to sue are in what to do when another driver hits your wheelchair van. The first hour after a crash is in the NEMT vehicle accident guide.

How to use this template

1. Tell your own insurer, then open the claim with the other driver’s. Report the crash to your own insurer and say you are claiming against the other driver. Once your insurer pays, the business auto form says you must do nothing after the loss to impair its right to recover from the other driver (ISO form CA 00 01 10 13, Section IV.A.5), and a release signed with the other side may do that. Then send the other driver’s insurer the police report, as the Texas Department of Insurance advises (page updated April 24, 2025), and write down the claim number and the adjuster’s name for Part 1.
2. Get the shop’s estimate and return date in writing. Loss of use is counted in days, so the days need a paper trail. Ask the shop to date its notes about parts delays.
3. Fill in Part 2 from your own records. Use totals for each week, not trip-by-trip lists. The privacy section below explains why.
4. Choose how you count loss of use in Part 3. For any one trip, count it once.
5. Write Part 1, then the letter in Part 4. Number the exhibits in Part 5 the way the letter names them.
6. Send it so you can prove delivery, and fill in Part 6. Put the reply date on your calendar.
7. Use Part 7 if the offer is low or nothing comes back. If the other side has a lawyer, or you hire one, send nothing more without that lawyer.

The template

Part 1: Claim details

Field	Write it here
Your company name, address, phone, and the person handling the claim
Your van: year, make, model, VIN, license plate, and what it is fitted with (ramp or lift, tie-downs)
Date, time, and place of the crash
Police report: agency and report number
At-fault driver’s name
Their insurer, policy number, and claim number
Claim representative: name, phone, email, mailing address
Your own insurer, policy number, and claim number
Repair shop and its phone number
Date the van went in, the date the shop promised it back, and the date it came back
Total loss? Date declared, and the date you bought or leased a replacement
Last day to sue in your state (the guide lists three states; ask a lawyer for yours)
Reply date you will ask for in the letter

Part 2: Weekly trips and pay for this van

Use the 4 to 8 weeks before the crash, then each week the van was out. Fill in totals only. Leave out rider names, addresses, and destinations.

Week starting	Before the crash, or van out of service	Trips run	Pay for those trips	Fuel and other costs

Line	Write it here
A. Pay for trips run in the weeks before the crash
B. Fuel and other costs for those same weeks
C. Number of weeks counted
D. Weekly profit before the crash: (A minus B) divided by C
E. Weeks the van was out of service: days out divided by 7
F. Profit the van would have earned: D times E
G. Profit from this van’s usual trips that you still ran with another vehicle
H. Lost profit: F minus G

If your drivers were sent home without pay while the van was down, the pay you did not owe them belongs in the cost column. If you kept paying them, leave it out and say so in the letter.

Part 3: What you are claiming

Line	What it is	Amount	Exhibit
1	Repairs: the shop’s final invoice, or its estimate while the van is still in the shop
2	Towing and storage
3	Loss of use, method A: lost profit on trips nobody at your company ran (Part 2, line H)
4	Loss of use, method B: rental invoices for the days a rental ran trips
5	Diminished value, only if your state allows it: the written appraisal figure
	Total claimed

Lines 3 and 4 never cover the same trip. If the van is a total loss, replace line 1 with the van’s value just before the crash.

Part 4: The letter

[Your letterhead]

Date: ______________

Sent by: [certified mail, return receipt requested, number ______________] [email to ______________]

To: ______________________________ (claim representative), ______________________________ (insurer and address)

Re: Claim number ______________. Your insured: ______________. Date of loss: ______________. Police report: ______________ (agency). Our vehicle: ______________ (year, make, model), VIN ______________.

Dear ______________:

I am writing for [company name] about the claim above. On ______________ at ______________, your insured ______________ [say what the driver did, in one plain sentence], and our wheelchair van was damaged. The police report [names your insured as at fault] [gives this cause: ______________]. [Use only what the report says. Delete this sentence if the report does not address fault.]

How we use the van. The van carries riders to medical appointments under contracts with health plans and transportation brokers [and for private-pay riders]. When it is out of service, the trips it would have run go to another provider or go undone, and we are not paid for them.

What happened to the van. The van went to ______________ on ______________. The shop’s estimate (Exhibit 2) calls for ______ days of work [and parts that arrived on ______________]. The van came back on ______________, ______ days after the crash. [If a total loss: your insurer declared the van a total loss on ______________, and we bought or leased a replacement on ______________ (Exhibit ___).]

What we ask you to pay.

1. Repairs: $__________ (Exhibit ___)
2. Towing and storage: $__________ (Exhibit ___)
3. Loss of use, lost profit: $__________ (Exhibits ___)
4. Loss of use, rental: $__________ (Exhibit ___)
5. Diminished value: $__________ (Exhibit ___)

Total: $__________

How we figured loss of use. [Keep what applies.] Lost profit: in the ______ weeks before the crash this van earned an average of $__________ a week and cost $__________ a week to run. During the ______ weeks it was out of service we did not spend the fuel and other costs shown in Exhibit 5, and we ran none of its usual trips with another vehicle [except ______________]. The weekly totals are in Exhibit 5, and the pay records behind them are in Exhibit 6. Rental: we rented a ______________ wheelchair-accessible van from ______________ from ______________ to ______________ to keep trips running. The invoices are in Exhibit 9. No trip is counted twice.

What we did to keep the loss down. [Write what you really did.] We told our brokers the day of the crash. We called ______ rental companies and dealers for a replacement wheelchair van (Exhibit 9). We [moved drivers to our other vans] [asked the shop to rush the parts].

Rider privacy. The summaries we enclose show totals only. We do not release rider names, addresses, or destinations.

What we ask you to do. By ______________, please send a written response that accepts each line above or gives the reason for each line you do not accept, and tells us what else you need. Please pay the part you accept now. Send payment to ______________ (payee and address), and send all messages about this claim to ______________ (name, phone, email). We are not releasing any part of this claim, and the loss of use amount grows for each day the van is out of service.

Sincerely,

______________________________ Name and title, phone, email

Enclosures: Exhibits 1 to ______ (Part 5)

Part 5: Exhibit list

No.	Exhibit	What it shows	Leave out
1	Police report	What happened and who was at fault
2	Shop estimate and final invoice, with the shop’s notes on parts delays	Repair cost and the days the van was out
3	Photos of the damage	The damage
4	Towing and storage invoices	Line 2
5	Part 2 weekly summary	What the van earned before the crash and nothing while out	Rider names, addresses, destinations
6	Your bookkeeping report or bank deposits for the same weeks	That the pay figures are real	Any page that lists riders or trips
7	Your own table of how many trips the broker took back each week because the van was out	Trips lost, with counts only	Rider details, trip numbers, and trip dates
8	Your own table of how many standing orders moved to another provider, by weekday	Recurring work you lost	Rider names, addresses, and pickup times
9	Rental invoices, quotes, and notes of calls to rental companies and dealers	Rental cost and how fast you tried to replace the van
10	Pay records for drivers sent home while the van was down	Costs you did not spend	Anything beyond the driver, dates, and hours
11	Written appraisal of the van’s value before and after repair, and the conversion invoice	Diminished value
12	Registration or title	The van is yours

Part 6: Sending record

Date sent	Sent to (name, address, email)	How (certified mail number, email, portal)	Delivered on	Reply asked for by	Reply received

Part 7: Follow-up letters

If the offer is low

[Your letterhead]

Date: ______________

Re: Claim number ______________. Your insured: ______________. Date of loss: ______________.

Dear ______________:

Thank you for your offer of $__________ dated ____. It is lower than the $ we claimed on ______________. Please send, in writing, the reason for each line you are not paying in full, and the figure you used for each one: repair days, rental rate, or value. [If the offer values the van like a plain van: our van is fitted with a wheelchair ______________ (ramp or lift) and tie-downs. The conversion invoice is Exhibit ___.] Please pay the amount you agree is owed now, and tell us in writing that doing so does not release the rest of the claim. We ask for your answer by ______________. If we cannot agree, we will ask the ______________ (state) department of insurance to review how this claim is being handled.

Sincerely,

______________________________ Name and title, phone, email

If there is no answer

[Your letterhead]

Date: ______________

Re: Claim number ______________. Your insured: ______________. Date of loss: ______________.

Dear ______________:

We sent our claim and ______ exhibits on ______________ by ______________ (certified mail number), and the delivery record shows it arrived on ______________. We have not had a written response. Our van [is still out of service] [was out of service for ______ days], and the loss of use amount grows each day. Please send a written response by ______________. If we do not hear from you, we will ask the ______________ (state) department of insurance to review the claim and will talk to a lawyer.

Sincerely,

______________________________ Name and title, phone, email

What a loss of use claim has to show

This template is built on the tests the Texas Supreme Court set in J&D Towing v. American Alternative Insurance Corp. (opinion delivered January 8, 2016). Loss of use is measured by the loss the owner actually had, such as lost profits, the cost of renting a substitute, or the rental value of the owner’s own vehicle. The damages must be foreseeable and directly traceable to the crash, they must not be speculative, and they are limited to a reasonable period of lost use, which for a destroyed vehicle is the time reasonably needed to replace it. Evidence has to rise above pure conjecture, though mathematical exactness is not required. For a vehicle damaged but not destroyed, the court called Texas law clear that the owner may also recover the pecuniary loss of its use.

Other states set their own rules, so treat these tests as the model for a strong file, not as a promise about your state. Each part of the template answers one of them:

• Foreseeable and traceable: the dates in Part 1 tie the downtime to the crash and the shop’s notes.
• Not speculative: Part 2 uses the van’s own pay for the weeks before the crash.
• Reasonable time: the line in Part 4 about what you did to keep the loss down, backed by Exhibits 2 and 9.
• Counted once: lines 3 and 4 of Part 3 never cover the same trip.

Diminished value, the drop in what a repaired van is worth, is a separate line (Part 3, line 5), and states differ on it. In Texas, Commissioner’s Bulletin B-0027-00 (April 6, 2000), written for private passenger auto insurers, says an insurer may be obligated to pay a third party claimant for any loss of market value of the claimant’s automobile, whether or not the repair was complete. Elsewhere, ask the insurer in writing whether it pays diminished value, and ask your agent how your state treats it.

What the insurer will push on

• “Your trips were never guaranteed.” Broker agreements can say so. MTM’s Pennsylvania agreement (January 1, 2023) says it does not guarantee any minimum number of trips (section 2.K), that all trips, including recurring ones, may be assigned or reassigned at MTM’s sole discretion, and that the provider has no right to carry any particular person (section 2.Q). Your answer is the pay you actually earned in the weeks before the crash.
• “You should have used another van.” The same agreement asks a provider to keep a contingency or back-up plan for trips it accepts (section 2.P). Keep proof of the calls and quotes in Exhibit 9. See renting a wheelchair van for what a rental involves.
• “The van was down too long.” Keep the shop’s dated notes on parts and scheduling, because the Texas court limits loss of use to a reasonable period.

A broker’s own rules can treat a van that is out of service as a valid reason to hand trips back. CareOregon’s NEMT provider manual (version 1.3, February 2024) lists vehicle capacity limits, with a vehicle out for maintenance as its example, among the acceptable reasons to ask for reassignment, and it asks for as much advance notice as possible. Ask your own broker how it records the request, then build Exhibit 7 from those dates. The trip documentation guide covers the records behind the totals.

What to leave out of the package to protect riders

Your trip records name riders and show where they go for care. The insurer on the other side has no part in those rides, so send the least it needs to value the claim.

• Totals identify no one. HIPAA treats health information as not individually identifiable when it does not identify a person and there is no reasonable basis to believe it can be used to (45 CFR 164.514(a)). A weekly count of trips and pay for one van names no rider, address, or trip, so it holds none of the identifiers the rule lists (164.514(b)(2)), and the Privacy Rule’s requirements do not apply to information de-identified that way (164.502(d)(2)).
• A redacted trip list may not. The rule’s safe harbor list for de-identification names street addresses and cities, all dates except the year that relate to a person, telephone numbers, and any other unique identifying number or code (164.514(b)(2)). A day-by-day list with trip numbers still has dates and codes in it.
• Keep to the minimum necessary. A covered entity or business associate must make reasonable efforts to limit the information it uses or discloses to the minimum necessary, with exceptions that include treatment, disclosures to the rider, and disclosures required by law (45 CFR 164.502(b)). You do not need to decide whether a claim against another driver counts as one of your own health care operations, because totals carry no rider information.
• Your broker agreement may be stricter. A business associate may use or disclose protected health information only as its contract allows (164.502(a)(3)), which can include making totals from member records. MTM’s Pennsylvania agreement bars disclosing information about members to anyone without MTM’s written consent, except for internal use needed to do the work (section 21.B). Broker emails about reassignments can fall under that, so send your own table (Exhibit 7), not the broker’s messages, unless the agreement lets you share them.
• In California, the insurer may not keep asking for what it does not need. The fair claims rules say an insurer shall not persist in seeking information not reasonably required for or material to the resolution of a claim dispute (10 CCR 2695.7(d)).
• If a lawsuit follows, a covered entity may disclose protected health information in response to a court order, or to a subpoena or discovery request when it gets the satisfactory assurances the rule lists, such as notice to the person involved or a qualified protective order (164.512(e)). A lawyer who receives rider-level records for your case is a business associate when the lawyer provides legal services that involve that information (160.103), so sign a business associate agreement first.

The HIPAA for NEMT guide explains whether you are a covered entity or a business associate, the rider records guide covers other requests for rider records, and the minimum necessary glossary entry gives dispatch examples.

Reply dates and proof that you sent it

The date in your letter is a request, not a deadline the insurer must meet. The legal clocks come from your state, and the guide lists California’s. Three details matter for this letter:

• The 40 days start at proof of claim. In California the insurer must accept or deny within 40 calendar days after it has proof of claim, which the regulation defines as any evidence in its possession that reasonably supports the amount of the loss (10 CCR 2695.7(b) and 2695.2). Your letter and exhibits are that evidence, so send them in one package.
• Payment follows acceptance. An insurer that accepts the claim in whole or in part must pay within 30 calendar days (2695.7(h)). That is why Part 4 asks it to pay the part it accepts now.
• A denial must be in writing. A denial of a third party claim, or a dispute over damages, must be in writing (2695.7(b)(1)). That is why the letter asks for the reason for each line.

In California, ask for a reply at least 40 days after the letter is delivered. Elsewhere, ask your state department of insurance which claim rules apply and use that window.

If the insurer refuses or goes quiet, your state department of insurance takes complaints. In Texas, the department says that when you complain about another driver’s insurance company, the company must write back to explain why it denied a claim or paid the way it did (page updated April 24, 2025). Georgia’s Office of Commissioner of Insurance says its Consumer Services Division may be able to help with a complaint about how a claim is being handled.

Send the letter so you can prove it arrived. As of October 2026, the Postal Service’s Domestic Mail Manual says Certified Mail gives the sender a mailing receipt and, on request, electronic verification that the item was delivered or that delivery was tried. The Postal Service keeps a record of delivery that includes the recipient’s signature, and you get it by buying a return receipt when you mail the letter (DMM 503, section 3.1.1). Write the certified mail number and the delivery date in Part 6, and keep a full copy of what you sent. Record every call and letter in one insurance claims log, and bring a not-at-fault crash to your loss runs review at renewal. For the amount the van was worth before the crash, see stated value vs actual cash value.