[HISTORY: Adopted by the Mayor and Council of the Borough of Washington 5-24-1983 by Ord. No. 9-83. Amendments noted where applicable.]
The purpose of this chapter is to require that a claimant for damage or injury rising under the New Jersey Tort Claims Act (N.J.S.A. 59:1-1 et seq.) provide certain needed information to the Borough of Washington in order that the appropriate Borough officials and the Borough insurance carrier, if any, may receive all necessary information in order to properly evaluate and dispose of such claims.
A claimant, or some other person acting on behalf of the claimant, shall file an initial notice of claim for damages against the Borough of Washington containing all the information required under the provisions of N.J.S.A. 59:8-4. A copy of the required form specifying information to be contained in said initial notice of claim for damages is annexed hereto as Exhibit A and shall be on file at the office of the Borough Clerk.
A claimant, or some person acting on behalf of such claimant, shall be required to file a claim for damages against the Borough of Washington within the time required by the New Jersey Tort Claims Act.
Said claim for damages shall contain all of the information required to be submitted by N.J.S.A. 59:8-4 and, in addition, shall contain the following additional information:
Description of accident or occurrence.
Names and addresses of all witnesses.
Name and address of the Borough agency or agencies which caused the damage or injury.
Name and address of Borough employee or employees claimed to be at fault.
A statement of the negligent or wrongful acts of the Borough agency and/or Borough employees which caused the damage or injury.
The names of all police officers and police department that investigated the accident.
A statement as to whether the claim is for personal injury, property damage or other.
If a personal injury claim, a description of the injuries resulting from the accident or occurrence and whether permanent disability is claimed.
If a personal injury is claimed, a listing of the name of each hospital, doctor or other facility providing examination, treatment or diagnostic service; the address and the date of treatment or services; the amount of charges to date; and the amounts paid or payable by other sources such as insurance.
If a claim for loss of wages or income is made, the claimant shall provide the name of the employer, the address, occupation, date of employment, rate of pay, date of absence from work, total lost wages up to date and expected date of return. If self-employed, the claimant shall attach a calculation showing the basis of calculation of lost income.
If property damage is claimed, the claimant shall provide a description of the property; the location of the property and the time when it may be inspected; date of acquisition of the property at the time of the accident; a description of the damage; copies of estimates of repair costs or, if the damage has been repaired, a statement specifying by whom repairs were made, when and the cost of repairs; and a statement of the loss claimed by the claimant for property damage.
A statement in detail by the claimant of all other items of loss or damages and the method of calculating such loss or damages.
The amount of the claim.
Whether the claimant has made a claim against anyone else for any of the losses or expenses claimed in said notice and, if so, the name and addresses of all persons and insurance companies against whom the claimant has made such claims.
A statement as to whether any of the losses or expenses claimed against the Borough are covered by any policy of insurance and, if so, a statement of the name and address of the insurance company, policy number and benefits paid or payable.
A statement as to whether the claimant has received or agreed to receive any money for the damages claimed herein and, if so, a statement of the details of such agreement.
The claimant shall be required to submit with the notice of claim for damage the following:
Copies of itemized bills for each medical expense and other losses and expenses claimed.
Full copies of appraisals and estimates for property damage claimed.
Copies of all written reports of all expert witnesses and treating physicians.
A letter from the claimant's employer verifying lost wages or, if self-employed, a statement showing the calculations of claimed lost income.
An authorization to all doctors, hospitals or other medical service facilities to release to the Borough of Washington any and all records, reports and other information concerning the treatment of the claimant.
A copy of the forms specifying the information to be contained in the claim for damages against the Borough of Washington is annexed hereto as Exhibit B and shall be on file at the office of the Clerk of the Borough of Washington.
The aforesaid claim forms shall be signed by the claimant or by some person on his behalf and shall be filed with the Borough Clerk of the Borough of Washington at her office located in the Municipal Building, 100 Belvidere Avenue, Washington, New Jersey 07882.