Sec. 1.
(b) The claim form is as follows:
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INSTRUCTIONS: Anyone who has a claim for personal injury or
property damage against the State of Indiana must either use this form to file
a claim or make the claim in writing as prescribed in IC 34-13-3. Immunities
are listed on the back of this form.
1. If applicable, include copies of
accident/incident report, vehicle registration, paid receipts for repair or two
(2) estimates for repair, medical reports, photographs, and any additional
documentation in reference to this matter.
2. Each person who had a loss should file a
separate form.
3. Sign and date
this form.
4. State statute
requires the claim be delivered in person or be sent via Certified or
Registered mail to the address in the upper right corner above.
5. Do not delay making your claim. Indiana
law gives you two hundred seventy (270) days after the loss to make a claim,
and it must comply with IC 34-13-3.
6. Keep a copy of your claim form, receipts,
bills, and certified/registered mail receipt.
7. If your claim is properly filed, the
Office of the Attorney General will investigate it and will notify you in
writing within ninety (90) days of receipt if your claim is approved. A claim
is denied if not approved within ninety (90) days.
8. The filing of this claim is part of a
legal process. If you have any questions about the right way to file a claim,
please contact an attorney of your choice. The state's attorneys are not
authorized by law to assist you with filing this claim. For your information, a
list of actions, or conditions, resulting in nonliability pursuant to IC
34-13-3 are shown on the back of this form.
Please be advised that this form is not intended for use for
claims against political subdivisions, which have some different requirements,
including only one hundred eighty (180) days after the loss to make a
claim.
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Immunity of governmental entity or employee A governmental
entity or an employee acting within the scope of the employee's employment is
not liable if a loss results from the following:
(1) The natural condition of unimproved
property.
(2) The condition of a
reservoir, dam, canal, conduit, drain, or similar structure when used by a
person for a purpose that is not foreseeable.
(3) The temporary condition of a public
thoroughfare or extreme sport area that results from weather.
(4) The condition of an unpaved road, trail,
or footpath, the purpose of which is to provide access to a recreation or
scenic area.
(5) The design,
construction, control, operation, or normal condition of an extreme sport area,
if all entrances to the extreme sport area are marked with:
(A) a set of rules governing the use of the
extreme sport area;
(B) a warning
concerning the hazards and dangers associated with the use of the extreme sport
area; and
(C) a statement that the
extreme sport area may be used only by persons operating extreme sport
equipment.
This subdivision shall not be construed to relieve a
governmental entity from liability for the continuing duty to maintain extreme
sports areas in a reasonably safe condition.
(6) The initiation of a judicial or an
administrative proceeding.
(7) The
performance of a discretionary function; however, the provision of medical or
optical care as provided in IC
34-6-2-38
shall be considered as a ministerial act.
(8) The adoption and enforcement of or
failure to adopt or enforce:
(A) a law
(including rules and regulations); or
(B) in the case of a public school or charter
school, a policy; unless the act of enforcement constitutes false arrest or
false imprisonment.
(9)
An act or omission performed in good faith and without malice under the
apparent authority of a statute which is invalid if the employee would not have
been liable had the statute been valid.
(10) The act or omission of anyone other than
the governmental entity or the governmental entity's employee.
(11) The issuance, denial, suspension, or
revocation of, or failure or refusal to issue, deny, suspend, or revoke any
permit, license, certificate, approval, order, or similar authorization, where
the authority is discretionary under the law.
(12) Failure to make an inspection, or making
an inadequate or negligent inspection, of any property, other than the property
of a governmental entity, to determine whether the property complied with or
violates any law or contains a hazard to health or safety.
(13) Entry upon any property where the entry
is expressly or impliedly authorized by law.
(14) Misrepresentation if
unintentional.
(15) Theft by
another person of money in the employee's official custody, unless the loss was
sustained because of the employee's own negligent or wrongful act or
omission.
(16) Injury to the
property of a person under the jurisdiction and control of the department of
correction if the person has not exhausted the administrative remedies and
procedures provided by IC
34-13-3-7.
(17) Injury to the person or property of a
person under supervision of a governmental entity and who is:
(A) on probation; or
(B) assigned to an alcohol and drug services
program under IC 12-23, a minimum security release program under IC 11-10-8, a
pretrial conditional release program under IC 35-33-8, or a community
corrections program under IC 11-12.
(18) Design of a highway (as defined in IC
9-13-2-73
), toll road project (as defined in IC
8-15-2-4(4)
), tollway (as defined in IC
8-15-3-7 ),
or project (as defined in IC
8-15.7-2-14 )
if the claimed loss occurs at least twenty (20) years after the public highway,
toll road project, tollway, or project was designed or substantially
redesigned; except that this subdivision shall not be construed to relieve a
responsible governmental entity from the continuing duty to provide and
maintain public highways in a reasonably safe condition.
(19) Development, adoption, implementation,
operation, maintenance, or use of an enhanced emergency communication
system.
(20) Injury to a student or
a student's property by an employee of a school corporation if the employee is
acting reasonably under a:
(A) discipline
policy adopted under IC
20-33-8-12;
or
(B) restraint and seclusion plan
adopted under IC
20-20-40-14.
(21) An act or omission performed
in good faith under the apparent authority of a court order described in IC
35-46-1-15.1
or IC
35-46-1-15.3
that is invalid, including an arrest or imprisonment related to the enforcement
of the court order, if the governmental entity or employee would not have been
liable had the court order been valid.
(22) An act taken to investigate or remediate
hazardous substances, petroleum, or other pollutants associated with a
brownfield (as defined in IC
13-11-2-19.3
) unless:
(A) the loss is a result of
reckless conduct; or
(B) the
governmental entity was responsible for the initial placement of the hazardous
substances, petroleum, or other pollutants on the brownfield.
(23) The operation of an off-road
vehicle (as defined in IC
14-8-2-185
) by a nongovernmental employee, or by a governmental employee not acting
within the scope of the employment of the employee, on a public highway in a
county road system outside the corporate limits of a city or town, unless the
loss is the result of an act or omission amounting to:
(A) gross negligence;
(B) willful or wanton misconduct;
or
(C) intentional misconduct.
This subdivision shall not be construed to relieve a
governmental entity from liability for the continuing duty to maintain highways
in a reasonably safe condition for the operation of motor vehicles licensed by
the bureau of motor vehicles for operation on public highways.
(24) Any act or
omission rendered in connection with a request, investigation, assessment, or
opinion provided under IC 36-9-28.7.