Claim for damage on a State Road

If you have suffered damage to a vehicle from an incident on a State road you can submit a claim for compensation by completing the below form.

IMPORTANT: Claims will only be considered if they relate to a State road (State roads map). If adequate information is not provided, your application cannot be processed.

Claimant contact details

First Name *

Last Name *

Contact phone number *

Contact email address *

Acknowledgement

The department will not accept any claims for matters already the subject of an insurance claim (if you have claimed under your insurance, you cannot also claim from the department).

Have you made a claim for damage with any other party or insurer? *

Yes - I have made a claim for damage with another other party or insurerNo - I have not made a claim for damage with another other party or insurer

You cannot make a claim from the department if you have claimed with your insurance or any other party

Incident details

Name of State road *

Date and approximate time of incident *Applications must be submitted within 30 days of the incident occurring.

Who was driving at the time? *

ClaimantOther

If Other, please specify *

Did the incident occur within an area of roadworks? *

YesNoUnsure

Specific location of incident *Were there nearby junctions, landmarks, businesses or services? Which direction were you travelling / where were you headed? Were machinery / trucks in use on site at the time? Contractor name?

Cause/details of incident (for example, pothole, tree hitting car, loose stones) *

Reasons why you believe you should be compensated *You will have to show that we failed to take reasonable steps to prevent foreseeable risks of harm. You will also have to show that our actions (or inactions) caused the incident, caused you to suffer loss; and that such loss was foreseeable to us.

Evidence of damage

Make/model of vehicle *

Vehicle registration number *

State in which vehicle is registered? *

Description of damage (for example, damaged right rear tyre, chipped windscreen) *

Amount of compensation you are claiming *You will need to submit evidence as part of your claim.

Supporting document(s)

At a minimum you will need:

a tax invoice, or at least one written quotation, to support the amount you are claiming
photos and / or video of the damage to support your claim

You should also submit other relevant documentation that may support your claim, such as:

police report
loss adjustor report
dash camera footage
map references.

You can upload multiple files, however the maximum upload size is 300MB per file. If you have files larger than this, please tick the checkbox below and we will contact you to organise a secure file transfer after we receive your application.

Supporting document upload

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I have files larger than 300mb, please contact me
*

Submission

By clicking the 'Submit' button, you confirm that:

the information provided in this claim form is correct
you have read the Personal Information Protection Statement.

Personal Information Protection Statement

You are providing personal information to the Department of State Growth, which will manage that information in accordance with the Personal Information Protection Act 2004.

The personal information collected here will be used by the department for the purpose of dealing with your claim, which may include providing the information to relevant third parties. Failure to provide this information may result in your claim not being processed or records not being properly maintained. The department may also use the information for related purposes, or disclose it to third parties in circumstances allowed for by law. You have the right to access your personal information by request to the department and you may be charged a fee for this service.

Verification *