SEARCH:

You will need Adobe Acrobat Reader to view certain items on this web site. Use the following link to get this free software:

Claims

The JPIA's Claims Staff Coordinates the defense and/or settlement of all covered claims by or against the districts. Crucial to their efforts is cooperation by the members in the form of early reporting of all incidents.

If you wish to report a liability or property claim please call (800) 231-5742, fax information to (916) 786-0209, or E-Mail to Claims.
Do NOT email Workers' Comp Claims.


After hours please contact Vericlaim at 877-824-6615, Jim Stewart at 916-548-8283, or Casey McClintock at 916-607-6360.


Liability Claims Reporting and Handling Procedure

Guide for Handling Claims Against California Public Entities

Liability Program Claims Information

CA State DMV Traffic Accident Report

Claim Incident Form    Word Version   (Form in Word format)   * For District Members Only *

Claim Incident Form (Auto Only)    Word Version   (Form in Word format)   * For District Members Only *

Driver's Report of Accident

Claim Form   * For Claimants*

Small Claims Settlement Option

Monthly Small Claims Report Form

Sample Letters


Property Program Claims Information

Property Claims Reporting and Handling Procedures

CA State DMV Traffic Accident Report

Claim Incident Form    Word Version   (Form in Word format)   * For District Members Only *

Claim Incident Form (Auto Only)    Word Version   (Form in Word format)   * For District Members Only *

Driver's Report of Accident


Workers' Compensation Program Claims Information

Injury/Illness Claims Reporting Kit

Claim Form (DWC1) & Notice of Potential Eligibility

Employer's Report of Injury (5020)

Employer's Report of Injury (5020) Fill in

A Guide to High-Value Physician Services in Workers' Compensation (Revised 10/29/10)

Clinic Evaluation    Word Version    (Form in Word format)   

Fraud Prevention Procedures

Accident Investigation Form

Home | Training | Coverage Programs | Resources | Committees | About Us | Legal Disclaimer | Sitemap ©ACWA/JPIA 2007. Web Design by Rocklin Systems.