Vehicle Incident Report at a glance
What it is: Vehicle Incident Report: Incident Reports involving damage to the rental vehicle only must be sent to HCMFirstNoticeofLoss@Hertz.com. Incident Reports involving injury or death and/or damage to other vehicles or property must be sent to HCMFirstNoticeofLoss_bipd@Hertz.com.
Who signs: RENTER/DRIVER/SUBMITTER SIGNATURE: Renter/Driver acknowledges that damage to the rental vehicle as indicated occurred during their rental of the vehicle. Renter/Driver/Submitter further agrees to cooperate with HCM investigation of the incident.
A filled-in Vehicle Incident Report example: a Hertz renter reports a deer strike
How to fill out Vehicle Incident Report, box by box
Today's Date
Enter Today's Date.
Rental Agreement No. or License Plate/State
Must provide Rental Agreement No. or License Plate/State.
Enter the Rental Agreement No. or the State License Plate, or both.
Damaged area of the rental vehicle
INDICATE DAMAGED AREA OF RENTAL VEHICLE "X": PASSENGER SIDE, FRONT, REAR, DRIVER SIDE.
Was there an Injury or Fatality?
Was there an Injury or Fatality?
Explain the cause of damage
Explain the cause of damage in the RENTER/DRIVER/SUBMITTER STATEMENT.
Renter of Vehicle
Under Renter of Vehicle, enter Name (Last, First), Email, Street Address, City, State / Province, Zip Code / Postal Code, and Telephone No. for Work, Home and Cell.
Enter Name of Insurance Co. & Agent, Phone No. and Policy No.
Name of Credit Card Issuer Card Type Phone No. Claim No.
Enter the Name of Employer & Address.
Type of rental
TYPE OF RENTAL: Business Pleasure Insurance Replacement.
Date and location of the incident, police information
Enter the Date & Time of Incident and the Location of the Incident (City, State / Province).
POLICE INFORMATION (Department, Name of Officer, Badge No., Phone No.) Police Report No.
Driver of Rental
Driver of Rental (Only if different from renter)
Enter Driver's Name, Driver's Age, Relation to Renter, No. of Occupants in Rental Vehicle, Street Address, City, State / Province, Zip Code / Postal Code, Phone No. and Driver's License No. & Issue State / Province.
Name of Insurance Company & Agent Policy No. Phone No.
Driver or Owner of Other Vehicle or Property
Driver or Owner of Other Vehicle or Property: Driver's Name, Phone No, Email.
Owner's Name (if different from driver) Phone No Email
Street Address City, State / Province, Zip Code / Postal Code
Name of Insurance Co. & Agent Phone No. Policy No.
(Vehicle no. 2 / or Owner of Property): Vehicle Make/Model & Year, License Plate No. & State / Province, No. of Occupants in Vehicle, Describe Damage to Vehicle / Property.
Persons Injured
Persons Injured: Name and Street Address, City, State / Province, Zip Code / Postal Code, Phone No., Age, Sex, Occupant Veh. No., Pedestrian, Describe Injuries.
More rules for Vehicle Incident Report
In most cases, if Loss or Partial Damage Waiver was not accepted at the commencement of the rental, or you do not have other contractually provided damage coverage, the person whose name appears on the Rental Agreement will be held financially responsible for damage to the rental vehicle.
For all initial inquiries about this claim, please contact First Notice of Loss at 1-877-584-7159.
In many cases your own automobile insurance policy and/or some charge card companies cover damage to a rental vehicle. In order to be eligible for such benefits, you should notify your automobile insurance carrier and/or charge card company as soon as possible of a potential claim. A delay in notifying them may limit or entirely negate coverage, especially in the case of coverage provided by charge card companies.
Customer: Please return completed form to a Company Representative or email per Submission Instructions. Any other correspondence should be emailed to HCMfirstnoticeofloss@hertz.com. Please include the rental agreement number on each page of the correspondence.
Common questions about Vehicle Incident Report
Is there a deadline?
For rentals in New York only: failure to completely and accurately fill out and return an incident report within ten days of receipt of this notice may make the authorized driver liable for damages sustained to the rental vehicle.
Where do I file it?
Please print, scan, and email the signed form to: hcmfirstnoticeofloss@hertz.com. You must have the following information in order to submit the form online: date and time of the accident as well as either the rental agreement number or the license plate number and state of the Hertz, Dollar or Thrifty vehicle. Incident Reports involving injury or death and/or damage to other vehicles or property must be sent to HCMFirstNoticeofLoss_bipd@Hertz.com.
Sources
[1] Vehicle Incident Report (Rev 8/16), Hertz (the Official source link on this page).