HomeMy WebLinkAbout06. Claims A) Jeannee Haugen Statewide Services Inc.
Claim Division 1241 John Q. Hammons Dr.
P.O. Box 5555
Madison,WI 53705-0555
877-204-9712
December 6, 2013
JEANNE HAUGEN ,
1343 CEAPE AVE 2
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OSHKOSH,WI 54901 � .i
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RE: Our Insured : City of Oshkosh4`
Claim No WM000702660670
Date of Loss: 09/17/2013
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Dear Ms. Haugen,
Statewide Services, Inc. administers the claims for the League of Wisconsin
Municipalities Mutual Insurance, which provides the insurance coverage for the City of
Oshkosh. We have been notified of the above-referenced incident in which you are
asserting you sustained property damage and injuries when you allegedly hit a pothole
with the front tire of your bike on September 17, 2013.
Please be advised that I am the adjuster handling your claim, and we will be performing
an investigation regarding this incident. It is not clear based on the Claim Form you filled
out with the City of Oshkosh what your total claim is. Is your total and final claim,
including your property damage and injury claims for everything, $11,068.01? If so, we
will review this claim after our investigation is complete. If your total claim amount is
something other than this amount, you will need to file a formal "Notice of Claim"with
the City Clerk pursuant to Wis. Stat. 893.80 along with supporting documentation for
your Claim.There is no form for this.Please also fill out the enclosed forms and return to
me. Thank you.
Sincerely,
Ginger Kimpton
Casualty Claims Adjuster II
608-828-5515 office
866-828-6613 fax
gkimpton @statewidesvcs.com
Cc: City of Oshkosh
Tim Nickels, Agent
Enclosure