New potential claim form

About this form
  • You will be asked to provide details about the incident and why you believe the council is to blame
  • You will be asked to provide details about witnesses to the incident (if you have them)
  • You will be asked to provide supporting evidence by uploading documents to this form (if you have them)

Terms and conditions

  1. The existence of a defect does not mean that the Council is at fault. Although you have had cause to make a claim this does not mean that you will automatically receive compensation. A claim will only be successful if it is proven that any damage or injury has been caused due to the Councils breach of statutory duty.
  2. The claim form should contain all relevant background details relating to your claim and clearly state the precise incident date and location. The Council reserves the right to reject your claim should this information not be provided.
  3. Should compensation be paid your claim would be subject to depreciation to take into account pre-incident wear and tear on the damaged items.
  4. The Council is not responsible for the maintenance of the A34, A43 or M40. All claims involving these roads should be made directly to Highways England
  5. The Council are not responsible for the actions of any contractor or utility company, even if they are acting on behalf of the Council. All claims must therefore by made directly to the contractor or utility company
  6. You are entitled to seek independent legal advice at any stage of the claim process
The following fields must be populated before you can continue:
  • firstname
Your details All fields are mandatory, unless marked 'optional'.
The following fields must be populated before you can continue:
  • firstname
Vehicle claim All fields are mandatory, unless marked 'optional'.
Was your vehicle involved with the incident?
The following fields must be populated before you can continue:
  • firstname
Vehicle damage

Details of registered owner

Same as claimant
£
Has a claim been made to your vehicle insurers?
Are you registered for VAT?
The following fields must be populated before you can continue:
  • firstname
Property claim All fields are mandatory, unless marked 'optional'.
Was property involved with the incident?
The following fields must be populated before you can continue:
  • firstname
Property damage All fields are mandatory, unless marked 'optional'.
£
Do you have separate house insurance which would cover this claim?
Has a claim been made to your Insurers?
The following fields must be populated before you can continue:
  • firstname
Injury Claim All fields are mandatory, unless marked 'optional'.
Was there an injury as result of the incident?
The following fields must be populated before you can continue:
  • firstname
Injury Details All fields are mandatory, unless marked 'optional'.
Have you suffered loss of Earnings / Income?
Was an ambulance called?
Did you seek medical attention?
The following fields must be populated before you can continue:
  • firstname
Incident details All fields are mandatory, unless marked 'optional'.
Did the incident happen in daylight?
The following fields must be populated before you can continue:
  • firstname
Tell us what happened All fields are mandatory, unless marked 'optional'.
Was a council vehicle involved with the incident?
Was the incident reported to the police?
The following fields must be populated before you can continue:
  • firstname
Why do you think the incident happened? All fields are mandatory, unless marked 'optional'.
Was there a defect involved with the incident (e.g. pothole)?
Did you report it to the council?
The following fields must be populated before you can continue:
  • firstname
Witnesses to the incident All fields are mandatory, unless marked 'optional'.
Do you want to add any witnesses?
The following fields must be populated before you can continue:
  • firstname
Supporting evidence

In order for your claim to be considered, please provide documentation as evidence of the damage, loss, or injury suffered.

Examples of documents accepted for motor claims

  • Photographs of defect/area
  • Photographs of vehicle damage
  • UK driving License
  • Certificate of Insurance
  • Valid MOT certificate
  • Vehicle registration document
  • Copy of repair receipts to support your loss (including if available copy of original purchase receipts)
  • Confirmation of any loss of income from your employer (if appropriate)

Examples of documents accepted for injury and property damage claims

  • Photographs of defect/area
  • Photographs of injury
  • Photographs of any damage
No documentation to be added?

Upload your documents

The following fields must be populated before you can continue:
  • firstname
Summary of your claim
Please check the information on this page carefully before you complete your claim.
Your details
Incident details
Tell us what happened
Why do you think the incident happened
Witnesses to the incident
Supporting evidence
Now send your claim

This authority is under a duty to protect the public funds it administers, and to this end we have a responsibility to ensure that all claims received are legitimate.

For further information, visit our National Fraud Initiative page.

How we use your information

All information provided on this form and obtained during the investigation of your claim may be used by Oxfordshire County Council and other outside organisations, including, but not limited to, the Claims & Underwriting Exchange (CUE) and the Motor Insurers Anti-Fraud and Theft Register run by the Motor Insurers’ Bureau (MIB) to detect dishonest claimants and take appropriate action against anyone attempting to defraud the Council. In addition, it can be necessary to share all the information you provide on our forms and in any correspondence with other bodies pertinent to your claim (such as our legal representatives, insurers or contractors) who may be involved with the defence of your claim.

I agree to the use of my information as described above

Declaration

I declare that the information I have given on this form, and any associated documentation, is true and complete. I am aware that I may be liable to prosecution if I have provided the Council with information that I know to be false.

I agree
The following fields must be populated before you can continue:
  • firstname