File A Claim

Instructions and Information

Please find below the SWACO Claim form. Please complete the form, sign in front of a notary and return the form to [email protected]. It is important to note that SWACO will not open a claim and an investigation will not begin until a completed claim form is received.

If a portion of the form does not apply to your particular situation, please write not applicable or n/a. All details, dates, times and location provided must be accurate.

Chapter 2744 of the Ohio Revised Code provides political subdivisions, such as SWACO, with certain immunities from liability in civil actions for injury, death, or loss to person or property allegedly caused by any act or omission of SWACO or its employees.

Chapter 2744 of the Ohio Revised Code also states that if you have insurance benefits that relate to the nature of your claim, e.g., health insurance that may cover costs of an injury or automobile insurance that may cover the damage to your vehicle, you must first utilize and exhaust those insurance benefits prior to filing a claim with SWACO. As such, the amount of benefit available through insurance shall be deducted from any award against SWACO recovered by the claimant. Therefore, please file a claim with your insurance company first.

Once liability has been determined, you will receive a written response from SWACO as to the approval or denial of your claim. If your claim has been approved for payment, you will be required to sign a Release and Agreement and complete a W-9 before payment will be issued. If it is determined that SWACO is not liable for your injuries or damages, there is no formal appeal process established. However, you may consult with legal counsel of your choice at your expense.

If claiming vehicle damage, you need to provide:

Declaration Page of car insurance policy showing deductible, copy of title, registration or lease contract, two written estimates, police report (if applicable), current mileage and photographs of vehicle damage. If you are claiming tire damage, the age of the tire is required.

Please Note: SWACO is not responsible for hazards of the road.

If claiming personal injury:

Copies of all medical reports including doctor bills, hospital bills and pharmacy receipts.

If claiming other property damage:

A copy of the homeowner’s insurance policy that includes the deductible amount is required. A separate itemized list of property damages with a description of each item, serial number, quantity lost, purchase date or age and purchase price, bills, receipts and estimates. If the damage was to a business, you must submit proof of business ownership and/or lease rights and responsibilities.

Once you have collected all of the required information and completed the claimant statement form, please forward the information to [email protected] to begin the investigation process. If SWACO is liable and damages are verified, you will be issued a check. You will be required to sign a Release Agreement and a W-9 form and return them to SWACO prior to SWACO issuing any payment.

Printable Documents:

Claim Form

Authorization for Release of Medical Records

Affidavit of Insurance