Different insurance carriers have different policies. Some pay up front. Some reimburse. You are entitled to full rental costs and/or "loss of use" (daily damages even if you don't rent a car). Your other option is to put the rental through your own carrier if you have rental car coverage. If you were injured, you should retain an attorney to present your bodily injury claim and to assist you with the rental issues. http://bit.ly/10QNJ0A
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They can pay up front (direct pay) but they are not required to. If you have rental coverage on your policy use it. If you have full coverage I suggest you do not purchase the additional insurance offered by the rental company because it will not be reimbursed.
Generally, the insurance company will require that you pay upfront and will reimburse you after receiving the rental bill. However, you can ask the insurance adjuster to arrange a direct billing with the car rental agency; if the adjuster agrees you would not have to pay anything to obtain the rental. Be aware that there is no law that requires the other driver’s insurance company to pay your rental expenses or any other expenses in advance. Your rental should be a vehicle that is comparable to the vehicle that was damaged in the accident. Ask nicely and they might be agreeable to working with you; better yet hire an attorney to handle your case if you want results.
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Every insurance company is different, but you shouldn't be concerned about getting a rental because you will be reimbursed. You need to hire an attorney ASAP! There is no upfront cost to hire an attorney. With a case like yours it seems like you have some good facts in order to get a high settlement. The most important thing when building your case are: liability (were you at fault); how bad are your injuries to your body and your property; and of course how high is the at fault person's policy. A lot of these things sound like they are not complete yet in your case so its something that is worth hiring an attorney for in order to get a sense of whether you have a case and what the strategy would be for you to build a strong case! I've handled many of these cases and wouldn't mind speaking to you
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