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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
(Form in Word format)
* For District Members Only *
Claim Incident Form (Auto Only)
(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
(Form in Word format)
* For District Members Only *
Claim Incident Form (Auto Only)
(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
(Form in Word format)
Fraud Prevention Procedures
Accident Investigation Form
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