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State Agencies Reporting a Loss
Liability
The State damaged someone´s property or injured him or her, promptly send in State Self-Insurance Claim Report Form.
 
If, in your opinion, the situation needs immediate attention, call us at (503) 373-7475.

State Property
All state property losses must be reported within 90 days of occurrence. To access any kind of Insurance Fund coverage, send us our State Self-Insurance Claim Report form (read back of report form for instructions). It is an all-purpose self-insured claim and lawsuit report form. It replaces all earlier claim forms. Use it for auto, liability, property and dishonesty losses, but not for workers& compensation. Include supporting information such as:
  1. A copy of any summons and complaint;
  2. A copy of Motor Vehicles Division´s (DMV) Traffic Accident and Insurance Report form.
  3. Explanations, photographs and copies of any letters, reports, rules, orders, witnesses names or other material you may have, related to the claim.
Note: Never let formalities or incomplete data, documentation or reports delay the prompt reporting of a claim.  You can start things by just giving us a call, a fax or electronic mail.
If you need printed forms, contact your agency Risk Coordinator, or call us at (503) 373-7475.
 
If you have questions, call us. Our Claim Consultants would be glad to help you.
 
State Self-Insurance Claim Report Form (pdf)
 
Appealing a Property Claim Denial
DAS Risk Management (RM) objectively determines whether a property claim is payable.  We make payments for substantiated claims, denies claims that are not substantiated, and fairly compensate state agencies based on applicable coverage.  RM strives for efficient, timely service and careful stewardship of the state's resources.  If an agency does not agree with a denial, state agencies may appeal.
 
Agency Claim Appeal Process
The first step is to appeal the claim denial to the claims manager.  The appeal should be in writing and clearly state why the claim should be covered.  The agency may attach additional documents if needed.  Appeals must be made timely, no later than 90 days after the coverage denial letter.
 
The Review Process
Claims with the apparent value of $10,000 or less:  The RM claims manager will review and make the final decision.
Claims over $10,000:  Upon receipt of the appeal a RM committee of four will review and decide if the denial will be upheld or reversed.
The review committee will include two members of RM’s management team, two claims adjusters, and the adjuster whose claim is in dispute.  On cases where the decision may affect other agencies, a fifth member may be added to the committee.  That fifth member would be a risk coordinator from another agency.
 
Decision
  • The majority of the committee shall rule.
  • If there is a tie vote, the risk manager shall make the final decision.
  • A written response will be given to the agency informing them of the decision and the reason.
  • A record of all appeals and decisions will be made.  This record will be used in determining future cases.
  • The Attorney General must be consulted if a question of legality or interpretation of law arises.