Kenneth Vercammen (732) 572-0500

2053 Woodbridge Ave. Edison, NJ 08817

Ken is a NJ trial attorney who has published 130 articles in national and New Jersey publications on litigation topics. He was awarded the NJ State Bar Municipal Court Practitioner of the Year. He lectures for the Bar and handles litigation matters. He is Past Chair of the ABA Tort & Insurance Committee, GP on Personal Injury and lectured at the ABA Annual Meeting attended by 10,000 attorneys and professionals.

New clients email us evenings and weekends go to www.njlaws.com/ContactKenV.htm

Thursday, December 27, 2007

Notice of Claim

Notice of Claim

Title 59 requires you or your attorney file a formal notice of claim against a public entity and you have been seriously and permanently injured as a result of negligent and reckless conduct by a public entity. Meet with your attorney in their office imedaitly.

Notice of Claim

Forward to: (Public entity)

1. Claimant

____________________________________________________________ Last Name, First, Middle

_______________________

Date of Birth

____________________________________________________________

Street Address Mailing address if other then street

_____________________________________________________________ City, State , Zip Code

_____________________________________________________________ Social Security

If notice and correspondence in connection with this claim are to be sent to a person other than claimant, complete item #2.

2.

_____________________________________________________________

Name

_____________________________________________________________

Mailing Address

_______________________________

City, State, Zip Code

Relationship to claimant: Attorney at law or ________________________________________

Explain relationship

3. The occurrence or accident which gave rise to this claim:

a. __________________

Date

___________________

Time b. Describe the location or place of the accident of occurrence:

___________________________________________________________________ Municipality Exact place of the occurrence

c. Describe how the accident or occurrence happened: If a diagram will assist your explanation, please use the reverse side of this form.

___________________________________________________________________

d. State the name and address of the state agency or agencies that you claim caused your damage:

___________________________________________________________________

State the name of state employees whom you claim were at fault, including any information that will assist in identifying and locating them.

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ___________

e. State the negligence or wrongful acts of the state agency and state employees which caused your damage.

____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ________________

f. State the name and address of all witnesses to the accident or occurrence.

___________________________________________________________________

g. State the name of all police officers and police departments who investigated the accident.

___________________________________________________________________

4. Damages

a. Claim for damages: ( ) Personal Injury ( ) Property Damage ( ) or

If other, explain in detail __________________________________________________________________________

b. If you claim personal injury, 1. Describe your injuries resulting from this accident or occurrence:

___________________________________________________________________

2. Do you claim permanent disability resulting from this injury? ( ) Yes ( ) No

If yes, describe the injuries believed to be permanent.

3. For each hospital, doctor, or other practitioner rendering treatment examination or diagnostic service state:

Name of hospital or doctor or other facility :

___________________________________________________________________

Address: ___________________________________________________________________

Dates if treatment or services: ___________________________________________________________________

Amount of charges to date: ___________________________________________________________________

Amount paid or payable by other sources such as insurance: ___________________________________________________________________

4. If you claim loss of wages or income as a result of the injury state: ___________________________________________________________________

Name of employer: Address of employer:

___________________________________________________________________

Your Occupation: Dates employed at this job:

___________________________________________________________________

Rate of Pay: Dates of absence from work:

___________________________________________________________________

Total of lost wages: If still out of work expected date of return: $___________________________________________________________________

Note: If your claimed loss of income arises form self-employment or other than wages, attach a calculation showing the basis of your calculation of lost income.

5. Set forth any and all other losses or damages claimed by you: ___________________________________________________________________

c. If you claim property damage: ___________________________________________________________________

1. Describe the property damaged:

___________________________________________________________________

2. The present time and location where item can be examined: ___________________________________________________________________

3. Date property was acquired: ___________________________________________________________________

4. Cost of the property: ___________________________________________________________________

5. Value of property at time of accident: ___________________________________________________________________

6. Description of damage:

___________________________________________________________________

7. Has the damage been repaired? If so by whom? ___________________________________________________________________

8. Attach each estimate of repair costs to this form. ___________________________________________________________________

9. Set forth in detail the loss claimed by you for property damage: ___________________________________________________________________

d. Set forth in detail all other items of loss or damages claimed by you and the method by which you made the calculation. ___________________________________________________________________

5. The amount of the claim: ___________________________________________________________________

6. Have you made a claim against anyone else for any of the losses claimed in this notice? ___________________________________________________________________

If yes set forth the names and addresses of all persons and insurance companies whom you've made claims against. ___________________________________________________________________

7. Are any of the losses or expenses claimed herein covered by any policy of insurance? ___________________________________________________________________

8. Have you received or agreed to receive any money from anyone for the damages claimed herein? If so set forth the details of this agreement. ___________________________________________________________________

9. The following items must be submitted with his notice: ___________________________________________________________________

(1) Copies of itemized bills for each medical expense and other losses and expenses claimed.

___________________________________________________________________

(2) Full copies of all appraisals and estimates of property damage claimed by you...

___________________________________________________________________

(3) Copies of all written reports of all expert witnesses and treating physicians..

___________________________________________________________________

(4) A letter from your employer verifying your lost wages. If self employed, a statement showing the calculation of your claimed lost income. ___________________________________________________________________

I hereby certify that the foregoing statements made by me are true, that the attached statements, bills, reports and documents are the only ones known to me to be in existence at this time. I am aware that if any statement made herein is willfully false or fraudulent, that I am subject to punishment provided by law.

Dated: ________________________________________

Disclaimer:

This web site is purely a public resource of general New Jersey information (intended, but not promised or guaranteed to be correct, complete, or up-to-date). It is not intended be a source of legal advice, do not rely on information at this site or others in place of the advice of competent counsel. The Law Office of Kenneth Vercammen complies with the New Jersey Rules of Professional Conduct. This web site is not sponsored or associated with any particular linked entity unless specifically stated. The existence of any particular link is simply intended to imply potential interest to the reader, inclusion of a link should not be construed as an endorsement.




Receive free NJ Laws Email newsletter with current laws and cases
New Article of the Week

Meet with an experienced Attorney to handle your important legal needs.
Please call the office to schedule a confidential "in Office" consultation.
Attorneys are not permitted to provide legal advice by email.

Since 1985, KENNETH VERCAMMEN has worked as a personal injury attorney, working for injury victims and their families. By taking a hard-hitting, aggressive approach toward the insurance companies, KENNETH VERCAMMEN and our co-counsel have consistently obtained outstanding results for many injured clients over the years I am proud to have worked on cases in various capacities, small and large. While obviously prior results cannot guarantee the outcome of future cases, I can guarantee that you case will receive the same degree of dedication and hard work that went into each of these prior cases.

In direct contrast to the hard-hitting approach we take toward the insurance companies is the “soft” approach we take toward our clients. I am proud of my compassionate staff as I am of the outstanding financial results they have achieved. For many years, I have watched them treat our clients with patience, dignity and respect. I would have it no other way.

Many years ago, I attended a seminar sponsored by the American Bar Association on Law Practice Management. This was to help insure that each of our clients is always treated like a person -- not a file! We recognize that you are innocent victims and that you have placed your trust in us. Please understand that we understand what you are going through. Feel comforted that we are here to help you.

If you retain KENNETH VERCAMMEN to represent you, we will give you the same advice we give each of our clients -- concentrate on your life, you family and your health. We will take care of everything else. Leave all of the work and worry about your legal rights to us. Trust us. Believe in us. Have faith in us as your attorneys. Understand that we will always to do what we believe is best for you and your case. Helping you is our job. In fact, it is our only job -- guiding injury victims like you through one of the most difficult times of your lives, with care and concern -- while fighting aggressively to the limits of the law to obtain compensation and justice for each of you!

Print our Personal Injury Questionnaire on our Website, Fill it out and Fax back, so we can determine if we can help you obtain an injury settlement. We would welcome an opportunity to prove to you what we have proven to thousands of injured clients -- that you can feel comfortable and secure in the fact that KENNETH VERCAMMEN - Trial Attorney We Fight To Win.

When you have been injured in an accident or collision, you are worried about who is going to pay your medical bills, lost wages, and other damages. The last thing you want is to be taken advantage of by an insurance company. If you don’t protect your rights, you may not be able to make a claim.

Insurance companies have attorneys and adjusters whose goal is to pay you as little as they can. You need a New Jersey personal injury lawyer to fight for you. I am dedicated to helping your recover as much money as possible under the law.

You need an attorney who will work hard to protect your rights, maximize your insurance settlement and minimize the hassles of dealing with the insurance companies. You need an experienced and aggressive New Jersey trial lawyer with PROVEN RESULTS who will fight for you. Having an experienced Oregon personal injury lawyer can make the difference between getting what you deserve and getting nothing.

Without the threat of a lawyer who is willing to go to trial and seek a big jury verdict, why would an insurance company pay you what your claim is really worth? Lawsuits can be expensive, and many people do not have the money to pursue their claim. In every case, I advance all costs associated with pursuing your case and I do not ask you for a penny until we recover from the other side.

I am an experienced aggressive trial lawyer and a 3rd degree Black Belt. I am not afraid to take your case to trial if that is what it takes to maximize the amount of money your recover for your personal injury. I offer one-on-one service, and I will not hand your case off to an inexperienced lawyer or a paralegal.

Reduce the stress of making a claim.

Personal injury accidents can turn your life upside down. Making a personal injury claim can be difficult and time consuming. Once I take your case, you can stop worrying about dealing with the insurance companies and focus on recovering from your injuries. I take care of all of the paperwork, phone calls, and negotiations, so you can get on with your life.

p.s. For those clients who are afraid or reluctant to go to Court, KENNETH VERCAMMEN also offers a special -- “For Settlement Only” -- program. This means that if we are unable to settle with the insurance company, we will not go any further -- unless you want us to. You have my personal assurance that there will be absolutely no pressure and no obligation.

We handle personal injury cases on a contingency fee basis.

This means:
YOU DON’T OWE ME A LEGAL FEE UNLESS I RECOVER MONEY FOR YOU.

Call our office to schedule a "confidential" appointment 732-572-0500

Kenneth A. Vercammen is the Managing Attorney at Kenneth Vercammen & Associates in Edison, NJ. He is a New Jersey trial attorney has devoted a substantial portion of his professional time to the preparation and trial of litigated matters. He has appears in Courts throughout New Jersey each week on personal injury matters, Criminal /Municipal Court trials, and contested Probate hearings.

Mr. Vercammen has published over 125 legal articles in national and New Jersey publications on criminal, elder law, probate and litigation topics. He is a highly regarded lecturer on litigation issues for the American Bar Association, NJ ICLE, New Jersey State Bar Association and Middlesex County Bar Association. His articles have been published in noted publications included New Jersey Law Journal, ABA Law Practice Management Magazine, and New Jersey Lawyer. He is the Editor in Chief of the American Bar Association Tort and Insurance Committee Newsletter.

Admitted In NJ, NY, PA, US Supreme Court and Federal District Court.

Contact the Law Office of
Kenneth Vercammen & Associates, P.C.
at 732-572-0500
for an appointment.

The Law Office cannot provide legal advice or answer legal questions over the phone or by email. Please call the Law office and schedule a confidential "in office" consultation.

No comments: