Source: http://www.injuryselfhelpkit.org/claim-form-1/
Timestamp: 2018-09-21 09:52:31
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The Personal Injury Self-Help Kit | Part 1 Notice
The Part 1 Notice
The Part 1 Notice initiates your personal injuries claim against one or more Respondent. To begin, you can download the form from the Queensland Department of Justice Website and print to complete the form by hand. Download the complete Claim Form
Please enter the date you were injured
Have you instructed a solicitor to act for you in this claim?
"Instructing a solicitor to act for you" means you have signed formal documents (a client agreement) to employ the solicitor to act for you in relation to that particular claim.
Please enter the date you instructed a solicitor
You must complete & serve the Part 1 Notice to the respondent.
Your solicitor should lodge the Part 1 notice on your behalf. This must be lodged within one month of instructing a solicitor.
Your claim is now late. Your claim is almost due.
The Part 1 Notice initiates your personal injuries claim and covers three key areas:
Establishing the parties, in which you are identified as a Claimant, and you identify the individual or organisation responsible for your injury,
Establishing the injury, in which details about the circumstances surrounding your injury are provided, including supporting evidence from third parties,
Establishing responsibility, in which you describe the events that led to your injury and provide statements to establish the responsibility for your injury.
Whilst you have 9 months to complete and serve the Part 1 notice, it is recommended you do so as soon as possible.
Anytime within nine months of injury
Consulted a solicitor.
Once represented, you and your solicitor must complete the Part 1 Notice within one month.
Within nine months, or one month with a solicitor
Complete the Part 1 Notice and send to Respondent.
If sending via Registered Post, it may take up to a week to be delivered.
Book yourself relevant medico-legal appointments for 12 months post-incident.
Within one month of serving the Part 1 Notice.
The Respondent must supply you with a compliance response.
The steps you take next are dependent on the response you receive.
The Part 1 Notice is a detailed form. You will need to provide a lot of information about the circumstances surrounding your claim. It is recommended that you begin collecting as much of this information as soon as you can. You will need to include:
contact details for the individual or organisation responsible for your injury,
related medical reports and contact details for your doctors,
statements and contact details of any witnesses to your injury,
reports from emergency responders (e.g. Police or Paramedics), including report reference numbers and their contact details (if applicable).
The Part 1 Notice Walkthrough
Start the Claim by addressing the person or organisation you feel is responsible for your injury. If there were multiple parties responsible for your injury, you will need to complete separate notices for each of them.
To avoid delays, ensure you have the correct contact details for the respondent. If the respondent is a company, telephone their registered office to check.
In Section A, the first questions you must answer identify the injured person. If you are the injured person, enter your own personal details. If you are completing the form on behalf of the injured person, enter their details.
If you or the injured person has private legal representation regarding your claim, list the details of any law firm you have formally instructed to act on your behalf with respect to the claim for personal injury (if applicable)
If you're making multiple claims, list the names and addresses of each of the individuals or organisations you feel are responsible for the injury.
If the Queensland State Government is named as part of your Claim, ensure you declare this in Question 6.
In Section B, you will need to accurately describe the events that led to the injury. If you have them, refer to any photos, notes or police reports from the incident.
Be clear in your wording and as accurate as possible,
List the date and time of the incident,
Describe the incident but not the injury.
As you continue your statement regarding the incident, you will need to list any emergency services that assisted you at the time of your injury. These include:
Public transport officers,
Emergency services authorities may have reports supporting your version of events. For further information, you will need to call the authorities in the local area where the incident occurred.
You should also detail the injured person's actions at the time of the incident and whether safety equipment was necessary and/or available. If safety equipment is not relevant to your case, skip to question 14 →
List any individuals who witnessed the events that led to the injury. If you have more than two witnesses, write their details on a separate page, titled 'Witnesses' and attach it to the Part 1 Notice.
You will also need to provide details of substances or medication taken in the 12 hours before the time of the incident.
You should seek legal advice if the information requested could be incriminating.
You will need to provide further details about the person/s responsible for the injury. Detail why you say the respondent is responsible for the incident occurring.
Use a separate piece of paper attached to this form if you need more room
If multiple people are responsible for the injury and you are initiating multiple claims, describe the actions of all individuals in one statement and repeat this information in each claim.
Continue to list the individuals involved on this page. If there were less than four individuals involved, you can disregard this page.
If you are naming more than four individuals as directly responsible for the injury, complete their details on a separate sheet of paper labelled 'Persons involved in the incident' and attach it to your form.
Section C of this form requires you to explain the injuries caused by the incident. The injury you have suffered must be as a result of the incident. Injuries may be temporary or permanent, physical or psychological, single or multiple injuries.
Firstly, provide a summary of the injuries sustained. Be thorough and refer to your doctor if you are unsure how to describe your injury.
List all hospitals and other health care providers used to treat the injury.
Continue to list all health care providers that are treating your injury. This includes;
Physiotherapists, occupational or speech therapists, osteopaths or other physical rehabilitation specialists,
You'll need to provide contact information for each medical practitioner.
If you have more than four providers, attach separate pages titled 'Health Care Providers, etc' to your claim.
You must provide details of any injuries, disabilities or illnesses that you have suffered before OR after the incident which may have affected the incident or the amount of compensation you may be entitled to.
If your pre-existing or unrelated injury resulted in a separate Personal Injury Claim (or equivalent), you'll need to provide details about:
the individuals or organisation who received the claim,
the insurance firm that handled the claim, and
the claim type.
If you have made more than one claim, or your claims covered multiple individuals, complete the details on a separate sheet labelled 'Previous claims' and attach it to your form.
Section D requires you to provide the attached documentation as listed.
Relevant Medical reports and/or doctor's certificates relating to your injury and your previous medical history,
A diagram of the incident including any photos that may document or describe the events leading to your injury,
Statements from individuals who witnessed the events leading to your injury.
An official incident report (if applicable),
Other documentation that illustrates clearly the events surrounding your injury.
You will also need to provide written permission to allow your doctors, insurers, hospital, government agencies, education institutions and employer to disclose information related to your injury to the respondent.
The injured person will need to sign the Part 1 Notice in the presence of a solicitor, Justice of the Peace or Commissioner for Declarations. If you have completed and signed this form on behalf of the injured person, you will need to complete the relevant section
Completing the Part 1 Notice
Once the form is complete and signed, you are required to serve it on the respondent. If your respondent is a company or organisation, you can post it to the company's registered office address.
You can look up a company's address using the ASIC Connect Database →
If your respondent is a Queensland Government department, you can post it to the relevant government department, ℅ Crown Law. If your respondent is an individual, you can post it to their current address.
It is recommended you send the Part 1 Notice by Registered Post so you can prove receipt of the notice and the date of delivery.
The respondent's response is due within one month of service of the Part 1 Notice. The response to the Part 1 Notice will cover two areas:
Whether the respondent has been correctly identified in the Part 1 Notice, or
whether the Part 1 notice is compliant with the relevant legislation.
The respondent must tell you whether:
they are the proper respondent; or
they cannot decide if they are the proper respondent; or
they are NOT the proper respondent.
If they are unsure or are not the proper respondent, seek legal advice as to how to proceed.
A Part 1 Notice is 'Compliant' if the respondent is satisfied you have answered all the questions correctly, it is properly signed and witnessed and all relevant documentation is attached. If the response to the Part 1 Notice says the Notice is not compliant, the respondent must tell you in a letter what part of the Notice does not comply and what you can do to fix it. To fix this, you have one calendar month from the time you receive the respondent's letter.
If the respondent does not confirm compliance after you have taken steps to fix non-compliance, seek urgent legal advice.
All Done With Part 1?
Start Claim Form 2 →