Claim Information and Instructions
To open a claim with the City of Dayton for injury or property damage, please complete the Claimant Statement form in its entirety. If filing a claim for property damage, the Claimant Statement Form must be completed by the property or vehicle owner. Your completed form, along with any requested accompanying documentation (see attached list), should be included with your form. It is important to note that the City will not begin an investigation until a completed claim form and all necessary accompanying documents are received. Once your claim packet is received, a thorough investigation will be conducted to determined liability. Please make certain that your claim form is signed and notarized prior to submitting it to the City.
Chapter 2744 of the Ohio Revised Code provides political subdivisions, including municipalities such as the City of Dayton, with certain immunities from liability in civil actions for injury, death, or loss to person or property allegedly caused by any act or omission of the City or its employees. However, there are exceptions to this immunity.
Chapter 2744 also states that if you have insurance benefits that relate to the nature of your claim, e.g., health insurance that may cover costs of an injury or automobile insurance that may cover the damage to your vehicle, you must first utilize and exhaust those insurance benefits prior to filing a claim with the City of Dayton. As such, the amount of benefit available through insurance shall be deducted from any award against the City recovered by the claimant.
Once liability has been determined, you will receive a written response from the City Law Department as to the approval or denial of your claim. If your claim has been approved for payment, you will be required to sign a Release of All Claims and complete a W-9 before payment will be issued. If it is determined that the City is not liable for your injuries or damages, you may request a re-evaluation but there is no formal appeal process established under the City of Dayton Codes. However, you may consult with legal counsel of your choice at your expense.
Claim Statement Form Instructions
- Complete the Claim Statement Form including as much detail as possible. You may attach additional sheets as necessary.
- Sign your Claim Statement Form in the presence of a Notary Public.
- The completed and notarized Claimant Statement Form along with the required documentation should be sent to the address below or emailed to firstname.lastname@example.org.
City of Dayton
Department of Law
101 West Third Street
P.O. Box 22
Dayton, Ohio 45401
- Personal Injury
- Medical records
- Medical bills showing insurance adjustments and payments.
- Vehicle damage
- Automobile Insurance Declaration Page – showing deductible amount and policy limits.
- Title or Memorandum of Title to your vehicle, and/or lease contract
- Two estimates for repairs from different companies. If you are only requesting your deductible amount, only one estimate is necessary. If you already had your vehicle repaired, please provide the receipt.
- Current vehicle mileage.
- Photos of the damage to your vehicle.
- If claiming pothole damage to tires, provide the age of your tires.
- Property Damage
- Homeowner’s or Renter’s insurance policy showing deductible amount and policy limits.
- Two estimates for repairs. If the repairs have already been made, provide the invoice and receipt.
Upon receipt of the completed form and all documentation, an investigation will be conducted. Because the processing of your claim generally involves several City Departments, the claims process takes a minimum of six (6) to eight (8) weeks. You will be contacted in writing as soon as the investigation of your claim is complete, advising you of the results.
FAILURE TO PROVIDE ALL REQUIRED DOCUMENTATION/INFORMATION OR FAILURE TO FULLY COMPLETE ALL SECTIONS OF THE CLAIM STATEMENT FORM WILL DELAY THE PROCESSING OF YOUR CLAIM.
If you have any questions regarding this matter, please contact the Law Department at 937-333-4100 or at email@example.com.