Sample Notice of Injury Claim Against a Government Entity

Here's what a notice of claim might look like when a government agency or employee might be at fault for your injury.

If you were in an accident or suffered an injury—anything from a slip and fall in front of a state government office to a car accident with a city bus—and a government entity or employee might be at fault (even just partially), you'll need to follow special rules in bringing a claim for injuries. While the specific process varies from state to state (or city to city), it typically starts with the filing of a "notice of claim" within a certain time after the accident or injury.

Sample Notice of Injury Claim to Government Entity

The sample claim below relates to an accident the claimant (Martin Johnson) had when he tripped in a hole in the public parking lot of the county medical building, while on his way to a medical appointment. He sprained his left wrist and right knee in the fall, and also jammed his back. His medical bills, at the time of filing the claim, were $1,680. He missed two weeks of work for which his pay was $2,450.

(Note: It's crucial to follow the procedure put in place by the specific state or local government you're making a claim against. This sample notice is just an example of what this kind of step might look like. You may need to submit your notice on a specific form provided by the government, and/or you may need to provide different details than the ones presented on this sample. Get the basics on making an injury claim against the government.)

Claim of Martin Johnson Against Wabash County

The claimant's name is Martin Johnson, 323 Cannonball Lane, Wabash, Missouri 00000.

All notices regarding this claim should be sent to 323 Cannonball Lane, Wabash, MO 00000.

This claim arises from injuries I suffered on January 13, 20xx when I tripped in a hole in the county parking lot next to the county medical building on East Pine Street, Wabash, Wabash County, Missouri. I was in the parking lot after having parked my car there on my way to an appointment in the county medical building.

As a result of the fall, I suffered injuries to my left wrist, my right knee, and my back and neck. I missed two weeks of work as a result of my injuries.

I do not know the name of any public employee who may have caused this accident.

I claim compensation in the amount of $10,000.

Dated: February 10, 20xx
[signature]
Martin Johnson

Where to File an Injury Claim Against the Government

The clerk’s office of the government agency or entity you believe was responsible for your accident is the first place to contact about filing your claim. For example, if you have a claim to file against the county, check with the county clerk’s office. It might accept claims directly, or direct you to another agency, such as the county attorney or controller’s office. If your claim is against the state, email or call the state board of claims, board of control, or state attorney general’s office to find out where to file. After you talk to someone, send them a confirming email or letter repeating what they told you about where and how to file. Keep a copy for your records.

If you are not sure whether your claim is against the city, the county, or some state agency, file a separate claim against each of them. In most states, it does not cost anything to file a claim against the government, and filing in each place will protect you against failing to file against the correct entity before the time limit runs out. If it turns out later that one or another government entity was not responsible, you can simply ignore or drop your claim against it.

Double-check the date. When you take or send your claim for filing, make an extra copy and ask the clerk to mark on your copy the date on which the office received it. If you mail in your claim, include at least one extra copy and a return envelope with a request that they send you back a copy stamped with the date it was filed. If you have not received a dated copy near the end of the time limit, go to the office in person to file your claim, making sure your copy is marked “received” or “filed,” and that it includes the date.

Getting More Information and Legal Help

For more tips on filing every kind of injury claim—including claims against the government—and everything you’ll need to navigate your case, get How to Win Your Personal Injury Claim by Joseph L. Matthews (Nolo). And you may want to consider talking with a personal injury attorney to make sure that all your legal bases are covered and your rights are protected. Learn how to find the right personal injury lawyer for you and your case.

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