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    New Claim Information

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    New Claim Information

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    5 views2 pages

    New Claim Information

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    STATE OF COLORADO JAWS us ers: navigate usi ng arrow keys

    NOTICE TO ATTORNEY GENERAL

    C.R.S 24-10-101, et seq.

    24-10-109, (in part) 3(a)

    (1) Any person claiming to have suffered an injury by a public entity or an employee thereof while in the course of such employment
    shall file a written notice as provided in this section within 182 days after the date of the discovery of the injury. . .
    (2) If the claim is against the State or an employee thereof, the notice shall be filed with the attorney general. . . Such notice shall be
    effective upon mailing by registered or certified mail, return receipt requested, or upon personal service.

    ADDRESS: COLORADO DEPARTMENT OF LAW


    CIVIL LITIGATION AND EMPLOYMENT LAW SECTION
    TORT LITIGATION UNIT
    RALPH L. CARR COLORADO JUDICIAL CENTER
    1300 BROADWAY, 10TH FLOOR
    DENVER, CO 80203
    *
    Date format: MM/DD/YYYY

    NAME OF CLAIMANT CONTACT PHONE

    ADDRESS CITY STATE ZIP CODE

    EMAIL ADDRESS DATE OF BIRTH

    STATE AGENCY INVOLVED STATE EMPLOYEE(S) INVOLVED

    DATE OF OCCURRENCE / TIME OF DAY CITY / COUNTY LOCATION (see instructions)

    DESCRIPTION OF OCCURRENCE

    DESCRIPTION OF INJURIES/DAMAGES/LOSSES

    $ AMOUNT CLAIMED

    I certify that the foregoing statements made by me are true.

    CLAIMANT SIGNATURE DATE

    RETURN ORIGINAL TO ATTORNEY GENERAL. MAINTAIN A COPY FOR YOUR PERSONAL RECORDS.

    ATTACH COPIES OF ANY SUPPORTING DOCUMENTS. PROCESSING TIME MAY TAKE UP TO 8 WEEKS.
    State Office of Risk Management

    Claim Process & Instructions

    To file a claim with the State of Colorado, you must:

    1. Complete the attached form and return it to the address listed at the top of the page. You may fill in
    the form on line, but you must print out the form in order to send it to the Attorney General’s Office
    (AGO). Please use the arrow keys to navigate through the fields in the form. Do not use the enter
    key.

    2. Provide as much detail as possible about the incident, especially the location where it happened; e.g.
    highway traveling on, direction traveling, lane traveling in, mile marker or nearest exit, streets at a
    specific intersection, city, county, or nearest landmark. Please provide an approximate dollar amount
    of damages.

    3. After your claim has been received at the Attorney General’s Office for filing, it will be forwarded to
    the State Office of Risk Management. An insurance adjuster will be assigned to investigate your claim.

    4. If any further information or documentation is needed from you, the adjuster will contact you.
    Investigation of your claim may take an additional 4 - 6 weeks from the time you mail your form to the
    AGO.

    5. Once liability has been established, the insurance adjuster will contact you by phone or mail,
    depending on the nature of your incident.
     If your claim is denied you will receive a letter in the mail.
     If the State accepts liability, an Adjuster will contact you for estimates and send a release for
    payment. A check will be mailed to you approximately 2 weeks from the date you send the
    signed release to the Adjuster.

    6. You may visit the State Office of Risk Management (SORM) website at
    https://osc.colorado.gov/liability-claims to check on the status of your claim or call SORM at
    303-866-4987 (Denver Metro Area).

    Please note: The total estimated time to complete the claim process is 6 – 8 weeks.

    RETURN ORIGINAL TO ATTORNEY GENERAL. MAINTAIN A COPY FOR YOUR PERSONAL RECORDS.

    ATTACH COPIES OF ANY SUPPORTING DOCUMENTS. PROCESSING TIME MAY TAKE UP TO 8 WEEKS.

    October 2022

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