Board of Claims Forms

Complaint Form [PDF - 10.3KB]
May be used by individuals in filing a complaint against a state agency.

Agency Answer Form [PDF - 27.8KB]
May be used by state agencies in responding to a claim.

Subpoena [MS Word - 32.5KB]
To be used to summons someone to appear at a hearing.

• Claims that will not be considered KRS 44.070 (1) include:
  • Claims under $100.
  • Claims for pain and suffering.
  • Collateral, dependent or subrogation claims.
  • Claims where a state agency has no jurisdiction (i.e., areas or events where legal responsibility lies with contracted nonstate agencies).
  • Claims where there is no control over circumstances or conditions (e.g., damage incurred from a vehicle hitting a deer or other wildlife).
    
    
• Neither will the Board of Claims consider claims which can be recovered through an agency’s own liability insurance policy (e.g., Transportation Cabinet or State Police). Before filing a claim, determine which state agency, department or employee the claim is against and list the appropriate name on the claim form.
  
  
• Examples of appropriate claims that may be considered include potholes on state roadways, vehicular accidents caused by the negligent design of a state roadway or slipping and falling on state property. These are just a few of the various types of claims that may be filed against state agencies.
  
  
• Social security number and insurance information must be included with a claim. The claimant’s social security number is required if a check is to be processed. Insurance information, even if the claimant does not intend to file for insurance reimbursement, is required before a claim will be processed. Processing time can be shortened by including this information.
  
  
• Vehicular claims must be filed by the registered owner of a vehicle, and must give the exact location of the incident, including county, any relevant mile marker or other identifying landmark, and the name of the road or street. Is it a state, county or city roadway? Only state roads will be considered.
  
  
• Required attachments for vehicular claims include a copy of the insurance declaration page and two estimates of damage or one actual paid receipt.
  
  
• For medical claims, a proof of insurance payment and the remaining balance are required.
  
  
• Recommended attachments include photographs of the damage and location/cause of the incident, law-enforcement reports (e.g., police, park rangers), incident reports, first-aid reports and witness statements.
  
  
• The claimant must sign the claim form, as well as the attorney representing the claimant, if an attorney is representing the claimant. 108 KAR 1:030
  
  
• The Board of Claims requires the original claim form. NO FAXED CLAIMS will be processed. Although a claim form may be faxed for purposes of filing within the statute of limitations, the original must be submitted before the claim will be processed.
  
  
• Excluding mowers, if the claim involves mailbox damage or damage from a state grader, snow plow or other large heavy equipment, contact:

• Simply because an incident occurs on state property does not make the state at fault or negligent for damage, loss or injury.
  
  
• For additional questions regarding the complaint form, contact Paula Woolums at paula.woolums@ky.gov or 800-469-2120, ext.229.