Claim for Compensation

Claims Investigation Process

Only complete this form if you are the person claiming personal injury or you are the owner of the motor vehicle or property.

Please note - The request of this information is not acceptance of liability.  All claims are assessed on their own merit and any payments made will come from City of Newcastle (CN) funds

If you wish to make a claim against us, there are 2 options:

1.  Make a claim against your own insurance policy - for a Property or Motor Vehicle Claim.

Your insurer may consider seeking recovery against CN. Please note that this option may result in an initial up front payment to your insurer for the applicable excess. In general, insurance companies will pursue us for reimbursement where they consider us to be liable.  In such cases, the excess amount may be waived. You should discuss this with your insurer prior to lodging a claim with us.

2.  Make a claim directly to CN - for Personal Injury, Property or a Motor Vehicle Claim

If you are seeking compensation directly from us for injury, loss or damage arising from an incident, please complete the ‘Claim for Compensation’ form below and provide photographs and documentation as required.
 

We will investigate the circumstances surrounding the incident to establish whether or not we have any legal liability.

Completion and acceptance of this form is not acceptance of liability or a waiver of its rights on the part of Council.  All claims are assessed on their own merit and any payments made will come from CN funds.

We will endeavour to respond to claims as quickly as possible. However the processing of claims is dependent on the supply of relevant information and, therefore, assessment of your claim may take some time to complete.
 

Complete on-line submission

1.  Contact
Did you stop at the time of the alleged accident / incident occurring and report it to our staff member?:
2. Type of compensation sought
Please select the compensation being sought:



3. Your contact details
These are mandatory fields
Correspondence:

Do you agree for all correspondence to be sent to you via email
Please provide preferred method of contact
4. Date and time of alleged accident / incident
Today
Date and time are mandatory fields
5. Location of alleged accident / incident
To assist us in identifying the exact location, please provide details of the nearest cross streets and / or any identifying landmarks where the alleged accident / incident occurred.
6. Insurance details
Have you claimed against your insurer:
7. Witness
It is the responsibility of the claimant to obtain the witness statement and submit with your claim.

If a witness statement has not been attached to your claim, a decision will be made in the absence of this evidence.  We will not contact the nominated witness. 
 
Did anyone witness the accident / incident?:
8. Evidence and supporting documentation

You are required to establish that we caused the alleged loss and/or damage through some form of negligence. In any public liability claim, the burden of providing proof of negligence rests with you as the person seeking compensation. We cannot assist you in this. Evidence and supporting documentation are required to evaluate your claim. If this information is not provided it may delay your application. Please refer to our website for additional information to assist you in determining the evidence and documentation required to be submitted with your claim.
Evidence:
For example a report from a qualified service provider ie engineer, plumber, medical practitioner.
Supporting documentation:
For example quotations, out of pocket medical expenses.
9. Photographs
One of the most effective ways to avoid confusion about the circumstances surrounding your claim is through the use of photographs. We use photographs to ensure that we are investigating the correct location and/or issue.  
 
Only take photographs if it is safe to do so.
 
You are requested to provide a variety of shots and angles to clearly show the situation that supports your claim.
 
Your photographs need to show the following (where applicable): 

Vehicle damage
  • The area that has sustained damage e.g., car door, windscreen
  • A photo clearly showing the side where the damage occurred e.g., passenger / driver's side.
Personal injury examples
  • A clearly marked area where the accident /  incident occurred
  • A photo clearly showing the surrounding area in relation to the alleged hazard.
Have you attached the required photos?:
If you need to attached more than six photographs please email them to claims@ncc.nsw.gov.au
10. Authority for an Agent to Act
Do you wish for a third party to act on your behalf in this claim:
11. Acknowledgement
I declare that the information supplied to the City of Newcastle in this claim form is true and correct and confirm the statements are honestly made.
 
Completion and acceptance of this form (including completion of the Authority for an Agent to Act, when completed) does not represent an admission of liability on the part of the City of Newcastle and/or our insurers.
 
Your claim for compensation will be subject to investigation and will be assessed on its own merits.
 
I declare that the information supplied to Council in this claim form is true and correct and confirm the statements are honestly made. Completion and acceptance of this form (including completion of the Authority for an Agent to Act, when completed) does not represent an admission of liability on the part of Council and/or their insurers. Your claim for compensation will be subject to investigation and will be assessed on its own merits.


 

Privacy Disclaimer

City of Newcastle is committed to protecting your privacy. We take reasonable steps to comply with relevant legislation and our Privacy Management Plan. By giving us your personal information you consent to us collecting, storing, using and disclosing it in accordance with our Record Management Policy.
 
Purpose: We will use the information to process your claim
Intended recipients: Authorised CN Officers, contractors or agents
Supply: Voluntary
Consequence of non-provision: We may not be able to process your claim
Storage and security: Information will be stored in our electronic database and will only be available to authorised CN Officers, contractors and agents and will be kept in accordance with the State Records Act and our Record Management Policy
Access: Your information can be checked for accuracy by calling us on (02) 4974 2000 or attending the City Administration Centre at 282 King Street, Newcastle.
 
Printable Form