City of MEMPHIS Claims Department Memphis Claims Reporting Instruction Manual
- June 5, 2024
- City of MEMPHIS
Table of Contents
City of MEMPHIS Claims Department Memphis Claims Reporting
Product Information
Specifications
- Product Name: City of Memphis Claims Department Claim Filing Instructions
- Manufacturer: City of Memphis
- Usage: Claims filing for the City of Memphis Claims Department
- Location: City of Memphis, TN
- Contact: 170 N. Main St., 5th Floor, Memphis, TN 38103
- Contact Number: 901-636-6605 (Fax)
Product Usage Instructions
Claim Form Completion
- Complete all required fields on the Claim Form legibly. Use “UNK” for unknown information and “N/A” for not applicable information.
- If additional space is needed, attach additional sheets.
- Sign and date the claim form.
Submission Process
- Return the completed claim form and supporting documents by mail or fax to the provided address or fax number.
- Do not combine multiple claims; each claim should be filed separately.
- If filing pothole claims, file each claim separately for different incidents.
Claimant’s Information
Provide accurate personal or business information, including contact details and identification.
Accident Information
Record detailed accident information such as date, time, location, and any additional relevant details.
Frequently Asked Questions
- Q: Can I combine multiple claims into one submission?
- A: No, each claim must be filed separately to ensure efficient processing.
- Q: What should I do if I need more space to provide information on the form?
- A: Attach additional sheets if more space is required to complete the form legibly.
- Q: Is it mandatory to provide my SSN and DOB for bodily injury claims?
- A: Yes, providing SSN and DOB is mandatory for bodily injury claims to process your claim accurately.
CLAIM FILING INSTRUCTIONS
CITY OF MEMPHIS CLAIMS DEPARTMENT
Please follow the below instructions to satisfy the requirements of the City of Memphis Claims Department.
- Complete the attached Claim Form legibly by completing all required fields on the form. If the information is unknown, indicate unknown (UNK). If the information does not apply, indicate not applicable (N/A). If additional space is needed on any section, please attach additional sheets. Failure to complete the form in its entirety will delay the progress of the claim.
- Sign and date the claim form (the claim will not be accepted without a signature).
- Attach the following required documents with the claim form:
- Individual – copy of your driver’s license, or State-issued ID.
- Business – updated W-9 with the correct mailing address.
- Two estimates of the damages (must be on the business letterhead), or receipts of the repairs.
- For an injury claim; copies of all medical and out-of-pocket expenses.
- Copy of the police/incident report; if not available, please provide the report number.
- If you are filing a property damage claim, provide photos of the damages to the property (if available).
- If you are filing an injury claim, provide photos of your injuries (if available).
- Provide any statements from witnesses (if available).
- Any documents/information that will support the claim.
- Return the claim form (by mail or fax) and all supporting documents to the address or fax number below.
- Please do not combine claims (if you have two claims that involve injuries and damages, each claim must be filed separately).
- Please do not combine pothole claims (if you struck two, or more, potholes on different dates and at different locations, each claim must be filed separately).
- Your cooperation and immediate attention to this matter are greatly appreciated. Please note, that it takes time to properly input, investigate, evaluate, and prepare a response to your claim.
- We appreciate your patience with this process. The Claims Department will contact you upon the completion of our investigation.
- PLEASE BE ADVISED THAT ANY PROPOSED SETTLEMENT OFFERS ARE SUBJECT TO APPROVAL BY MANAGEMENT.
PLEASE READ CAREFULLY BEFORE FILING A POTHOLE CLAIM
If you are filing a claim for striking a pothole, please read the following
information.
Please be advised that the fact that this accident may have occurred does not
make the City of Memphis automatically liable for any damages. Claims such as
this are governed by Tennessee State law, particularly The Governmental Tort
Liability Act, T.C.A. 29-20-101, et seq.
The provision of that law applicable in this matter is section 29-20-203, which reads as follows:
§ 29-20-203. Highways, streets, and sidewalks; unsafe conditions
- (a) Immunity from the suit of a governmental entity is removed for any injury caused by a defective, unsafe, or dangerous condition of any street, alley, sidewalk, or highway, owned and controlled by such governmental entity. Street” or “highway” includes traffic control devices thereon.
- (b) This section shall not apply unless constructive and/or actual notice to the governmental entity of such condition is alleged and proved in addition to the procedural notice required.
This means for liability to ensue against the City in this claim, the City must be shown to have had notice (known before) of the condition and failed to take any action.
The City also must have had reasonable time to inspect the condition and take
reasonable actions after receiving notice. That time is typically 5 business
days from the time the City receives notice of the condition.
Please be informed that there are claims preceding your on file, and we are
committed to investigating your claim as expeditiously as possible.|
Please contact us if you have any questions.
City of Memphis Claims Department
CITY OF MEMPHIS Claims Department Claim Form
- Mail or Fax to: City of Memphis Claims Department., 170 N. Main St., 5th Floor, Memphis, TN 38103 (Fax: 901-636-6605)
Contact
- Room 523
- 170 North Main Street
- Memphis, Tennessee 38103-2079
- 901-636-6616