Join ClaimsMax 1Select a Plan & Add Members2Provide Contact Information3Complete Payment Select Your Plan* Personal Plan Only $50 for 18 months, Regularly $100/year Family Plan Only $100 for 18 months, Regularly $200/year Pay $50 for 18 Months Today, Pay $100 Per Year After ThatPay $100 for 18 Months Today, Pay $200 Per Year After ThatHiddenMembership Start Date MM slash DD slash YYYY HiddenMembership End Date MM slash DD slash YYYY Is this plan covering you or someone else?Select an OptionMeSomeone ElseIndividual Member To Be Covered by Your Plan*First NameLast NameDate of BirthFamily Members To Be Covered by Your Plan*First NameLast NameDate of Birth Click the "+" button to the right to add family members. You've selected the Personal PlanYou've selected the Family PlanName* First Last Email Address* Phone NumberStreet Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code You've selected the Personal PlanYou've selected the Family PlanTotal $0.00 Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name Please acknowledge that you agree to the ClaimsMax terms and conditions.* I have read and agree to the ClaimsMax terms and conditions.Terms and Conditions The family membership includes the member (a natural person), and all other covered persons(s), including the member’s spouse and anyone else who lives with the member, regardless of age or dependency, so long as the member lists all household members on his initial application or on any subsequent updates to the application. Membership is effective on the date the completed application and membership fee is received by Claims Max. The membership period continues for 18 (first time only) or 12 (after the first time) complete months. For example, an application fee received in December 2019 is effective through December 31, 2020 (12 complete months) or June 30, 2020 (18 complete months). In any car accident where the member causes a car accident that injures another household member who is a covered person, all covered persons, including the member, have to consent in writing to the ClaimsMax provider attorney making a claim against the member. ClaimsMax pays the legal fees to the provider attorney if a member or any covered person becomes a car accident victim. A member or covered person is a car accident victim if he or she sustains an injury and is 100% not at fault in causing the accident, the accident occurs in the State of Connecticut and the accident does not involve a commercial vehicle/is not caused by a vehicle that is being used for commercial or income producing purposes. The member must inform ClaimsMax immediately of any changes in his or her contact information, including the member’s home address, phone number, email address and the household members. The member or any other covered person must let ClaimsMax know immediately if he or she is in a car accident. The member or any other covered person must sign a retainer agreement with the Claims Max provider attorney. The member or any other covered person must agree to pay for all costs of litigation and court fees when the matter is resolved, except that the member or other covered person must pay up front for a private investigator’s report if in the ClaimsMax provide lawyer’s professional opinion the police report does not establish who is at fault in causing the car accident. The ClaimsMax provider lawyer will determine whether the member or other covered person has the legal right to make a claim or whether the claim is frivolous, without merit or groundless. ClaimsMax can cancel membership for fraud, nonpayment of membership fees, or if the ClaimsMax provider attorney determines, in his or her professional judgment, that the member is unable, unwilling or incapable of accepting or understanding legal advice and services. All disputes between the company and a member or covered persons will be settled totally and finally by binding arbitration. Δ
