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INSTRUCTIONS: ALABAMA CLAIM FOR PERSONAL INJURY (Form A)

 

 

When involved in an incident resulting in personal injury in Alabama involving some government agency or department, you can use a form A to seek compensation. This document can be obtained from the website of the Alabama Department of Finance.

 

Alabama Claim For Personal Injury A Step 1: If you are filing this as a supplement to a previously filed claim, enter its number and the department or agency processing it.

 

Alabama Claim For Personal Injury A Step 2: On line 1, give the name and mailing address of the claimant, as well as their home and business telephone numbers and their Social Security or federal identification number. If filing on behalf of an injury done to a minor, the guardian or parent completing this form should give the minor's name and age, as well as their own name and relationship to the minor.

 

Alabama Claim For Personal Injury A Step 3: On line 2, if the claimant is represented by an attorney completing this form who is authorized to discuss all related correspondence, give their name, mailing address and telephone number. 

 

Alabama Claim For Personal Injury A Step 4: On line 3, give the date of the accident or injury.

 

Alabama Claim For Personal Injury A Step 5: If this is not a claim related to an accident or injury, enter the date on which the claim began on line 4.

 

Alabama Claim For Personal Injury A Step 6: On line 5, give the county, city, building name and all location information about the site of the accident or injury.

 

Alabama Claim For Personal Injury A Step 7: On line 6, provide a description of the event in your own words. Note any prior fiscal year invoices and give their numbers. Note if you have incurred any travel expenses. Line 7 is for those seeking compensation for uninsured medical expenses, permanent disability or lost wages or leave used to detail the amount of the compensation sought.

 

Alabama Claim For Personal Injury A Step 8: Line 8 is for those seeking compensation for damage to personal property. Line 9 is for those seeking compensation for other, miscellaneous expenses. 

 

Alabama Claim For Personal Injury A Step 9: Enter the total amount claimed on line 10 and any payments received on line 11. Sign and date the form before a notary public.

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