QUESTIONNAIRE FOR THE STANDARDIZED LABOR RATE SURVEY
To: (Auto Body Repair Facility) | From: (Insurance Company name, address, telephone number, email address) |
Instructions: We are conducting a survey of auto body repair labor rates for all auto body repair shops in your area. Please ensure that this questionnaire is completed by an authorized representative of the auto body repair facility to which it is addressed, and returned to [Insurance Company] at [insert address] no later than [insert due date]. If the information is not complete, the survey may be rejected.
FAILURE TO COMPLETE THIS QUESTIONNAIRE IN FULL MAY RESULT IN ITS EXCLUSION FROM THE AUTO BODY LABOR RATE SURVEY FILED WITH THE CALIFORNIA DEPARTMENT OF INSURANCE. HOWEVER, YOU ARE NOT REQUIRED TO COMPLETE THIS SURVEY. IF YOU CHOOSE NOT TO COMPLETE THIS SURVEY, OR IF YOUR SHOP IS NOT ELIGIBLE TO PARTICIPATE IN THIS SURVEY, PLEASE RETURN IT TO US FOR OUR RECORDS. IF YOU CHOOSE TO NOT COMPLETE THIS SURVEY, PLEASE CHECK THE FOLLOWING DECLINATION:
I DECLINE TO PARTICIPATE IN THIS SURVEY: __________
Question 1: The survey may only use labor rates of auto body repair shops registered with, or licensed by, the California Bureau of Automotive Repair as an auto body and/or paint shop. Is your shop duly registered or licensed as an auto body and/or paint shop with or by the California Bureau of Automotive Repair?
YES _____ | NO_______ |
If you answered Yes to question 1, please provide your license number with the California Bureau of Automotive Repair__________.
If you answered No to question 1, stop here, proceed to declaration to complete your survey and return the survey questionnaire to us.
Question 2: We may only use labor rates in a survey reported by auto body repair shops that meet certain specific standards. Please confirm below whether you meet all of the following specific standards:
In order for a shop labor rate to be used in a survey it must:
I confirm that this auto body repair shop meets all of the above standards:
YES _____ | NO_______ |
If you answered NO to question 2, stop here, proceed to declaration to complete your survey and return this survey questionnaire to us.
Question 3: Hourly Rate Charged -- Please indicate the hourly rate charged by your facility for non-Direct Repair Program or other non-discounted auto body repair work for each category of repair identified below.
Question 4: Does your repair shop have a contract or agreement with this insurer to perform repair work for a discounted rate or other considerations in exchange for referrals by the insurer?
YES _____ | NO_______ |
If you answered YES to Question 4, you may not include discounted rates in your response to Question 3, above. Your response to Question 3 must only reflect the hourly rate charged by your facility for non-Direct Repair Program or other non-discounted auto body repair work for each category of repair identified.
PLEASE MAKE A COPY OF THIS SIGNED AND COMPLETED QUESTIONNAIRE FOR YOUR RECORDS AND MAIL TO THE ADDRESS SHOWN ON THIS QUESTIONNAIRE
DECLARATION
By signing below, I declare that the information provided above is true and correct.
___________________________Signature: | Date: |
Print Name: ________________________________________
Title: ________________________________________
Telephone: ________________________________________
Email Address (optional):______________________________
Physical Address of Repair Shop: ______________________________
Cal. Code Regs. Tit. 10, § 2695.82
Note: Authority cited: Sections 758, 790.10, 12921 and 12926, Insurance Code. Reference: Sections 758 and 790.03, Insurance Code.