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21st Century Insurance, CA (improper accident surcharge)
Please complete this claim form to request a free case evaluation from a lawyer listed on BigClassAction.com.
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Defendant:
(who caused the harm?)
21st Century Insurance (accident surcharge)
*
Describe your complaint:
(briefly describe the damages you have suffered)
Did you purchase auto insurance from 21st Century insurance company?
Yes
No
When were you insured for your automobile coverage by 21st Century:
Were you ever surcharged or otherwise assessed an additional premium because 21st Century said they were unable to verify your accident record?
Yes
No
Were you assessed this surcharge or additional premium because you could not demonstrate to the insurance company you had continuous insurance for the past few years?
Yes
No
Did you otherwise have a clean accident record but were nevertheless surcharged because you had a gap in your insurance coverage?
Yes
No
How much money was this surcharge or additional premium?
Do you know of any others who are in the same situation as you?
Yes
No
Would you agree to be contacted and interviewed to discuss your situation further?
Yes
No
Would you consider being a named plaintiff and/or class representative in this case?
Yes
No
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First name:
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Last name:
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Email address:
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Confirm email address:
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Phone number(s):
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Zip/Postal Code:
Best time & way to contact you:
I would like to be interviewed by a journalist.
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