Accident Claim Forms

1st Jan 2007 · · Link ·

I started to slow down but the traffic was more stationary than I thought.

I pulled into a lay-by with smoke coming from under the bonnet. I realised the car was on fire so took my dog and smothered it with a blanket.

I started to turn and it was at this point I noticed a camel and an elephant tethered at the verge. This distraction caused me to lose concentration and hit a bollard.

On approach to the traffic lights the car in front suddenly broke.

I was going at about 70 or 80 mph when my girlfriend on the pillion reached over and grabbed my testicles so I lost control.

I didn't think the speed limit applied after midnight

I knew the dog was possessive about the car but I would not have asked her to drive it if I had thought there was any risk.

First car stopped suddenly, second car hit first car and a haggis ran into the rear of second car.

Windscreen broken. Cause unknown. Probably Voodoo.

The car in front hit the pedestrian but he got up so I hit him again

I pulled away from the side of the road, glanced at my mother-in-law and headed over the embankment.

The other car collided with mine without giving warning of its intention.

I collided with a stationary truck coming the other way

A truck backed through my windshield into my wife's face

A pedestrian hit me and went under my car

In an attempt to kill a fly, I drove into a telephone pole.

I had been shopping for plants all day and was on my way home. As I reached an intersection a hedge sprang up obscuring my vision and I did not see the other car.

I was on my way to the doctor with rear end trouble when my universal joint gave way causing me to have an accident.

To avoid hitting the bumper of the car in front I struck the pedestrian.

My car was legally parked as it backed into the other vehicle.

An invisible car came out of nowhere, struck my car and vanished.

I was thrown from the car as it left the road. I was later found in a ditch by some stray cows.

Coming home I drove into the wrong house and collided with a tree I don't have.

The other car collided with mine without giving warning of its intention.

I thought my window was down, but I found it was up when I put my head through it.

I collided with a stationary truck coming the other way.

The guy was all over the road. I had to swerve a number of times before I hit him.

I had been driving for forty years when I fell asleep at the wheel and had an accident.

As I approached an intersection a sign suddenly appeared in place where no stop sign had ever appeared before. I was unable to stop in time to avoid the accident.

I told the police that I was not injured, but on removing my hat found that I had a fractured skull.

I was sure the old fellow would never make it to the other side of the road when I struck him.

The pedestrian had no idea which way to run as I ran over him. I saw a slow moving, sad faced old gentleman as he bounced off the roof of my car.

The indirect cause of the accident was a little guy in a small car with a big mouth.

I was thrown from my car as it left the road. I was later found in a ditch by some stray cows.

The telephone pole was approaching. I was attempting to swerve out of its way when it struck my front end.

The gentleman behind me struck me on the backside, he went to rest in the bush with just his rear end showing.

My girlfriend kissed me, I lost control and woke up in hospital.

A car drove away at speed catching our client who went up in the air and his head went through the windscreen and then rolled off at the traffic lights a good few feet away. The car then sped off and miraculously our client remained conscious and managed to cross the road.

I am responsible for the accident as I was miles away at the time.

I had one eye on a parked car, another on approaching lorries, and another on the woman behind.

On the M6 I moved from the centre lane to the fast lane but the other car didn't give way.

Three men approached me from the minibus. I thought they were coming to apologise. Two of the men grabbed hold of me by my arms and the first slapped me several times across the face. I kneed the man in the groin but didn't connect properly so I kicked him in the shin.

I didn't think the speed limit applied after midnight I was on my way to see an unconscious patient who had convulsions and was blocked by a tanker.

Mr. X is in hospital and says I can use his car and take his wife while he is there. What shall I do about it?

No witnesses would admit having seen the mishap until after it happened.

I knew the dog was possessive about the car but I would not have asked her to drive it if I had thought there was any risk.

While proceeding through 'Monkey Jungle', the vehicle was enveloped by small fat brown grinning monkeys. Number three fat brown monkey (with buck teeth) proceeded to swing in an anticlockwise direction on the radio aerial. Repeated requests to desist were ignored. Approximately 2 minutes and 43 seconds later, small fat brown monkey disappeared in 'Monkey Jungle' clutching radio aerial.

My finger hit the band saw, damaging it.

I had been learning to drive with power steering. I turned the wheel to what I thought was enough and found myself in a different direction going the opposite way

No one was to blame for the accident, but it never would have happened if the other driver had been alert.

The accident happened when the right door of a car came around the corner without giving a signal

My wench slipped, losing my balance, and I hurt my back

I was unable to stop in time, and my car crashed into the other vehicle. The driver and passengers then left immediately for a vacation with injuries

The accident occurred when I was attempting to bring my car out of a skid by steering it into the other vehicle.

Officer Patrick McGuire of the New York City Police Department answers a call on his radio and reports to the scene of a car accident in the Queens-Midtown Tunnel. Officer McGuire notes that a new Buick had its front end merged with the rear end of a Chrysler.

The driver of the Buick was Father Francis O'Boyle; the driver of the Chrysler was Rabbi Isaac Goldstein. After Officer McGuire verifies that Rabbi Goldstein has suffered no physical injuries in the accident, he walks back to survey the damages to each vehicle.

Then, Officer McGuire walks over to Father O'Boyle and asks him: "Tell me, Father, just how fast was that Rabbi going when he backed into you?"

Dear Sir:

I am writing in response to your request for additional information In Block #3 of the accident report form. I put "Poor Planning" as the Cause of my accident. You asked for a fuller explanation and I trust the following details will be sufficient.

I am a bricklayer by trade. On the day of the accident, I was working alone on the roof of a new six-story building. When I completed my work, I found I had some bricks left over which, when weighed later were found to be slightly in excess of 500lbs. Rather than carry the bricks down by hand, I decided to lower them in a barrel by using a pulley, which was attached to the side of the building at the sixth floor. Securing the rope at ground level, I went up to the roof, swung the barrel out and loaded the bricks into It.. Then I went down and untied the rope, holding it tightly to ensure a slow descent of the bricks. You will note in block #11 of the accident report form that my weight is 135lbs.

Due to my surprise at being jerked off the ground so suddenly, I lost my presence of mind and forgot to let go of the rope. Needless to say, I proceeded at a rapid rate up the side of the building. In the vicinity of the third floor, I met the barrel which was now proceeding downward at an equally impressive speed. This explains the fractured skull, minor abrasions and the broken collarbone, as listed in Section 3 of the accident report form.

Slowed only slightly, I continued my rapid ascent, not stopping until the fingers of my right hand were two knuckles deep into the pulley. Fortunately by this time I had regained my presence of mind and was able to hold tightly to the rope, in spite of the excruciating pain I was now beginning to experience. At approximately the same time, however, the barrel of bricks hit the ground and the bottom fell out of the barrel. Now devoid of the weight of the bricks, that barrel weighed approximately 50 lbs. I refer you again to my weight.

As you might imagine, I began a rapid descent down the side of the building. In the vicinity of the third floor, I met the barrel coming up. This accounts for the two fractured ankles, broken tooth and severe lacerations of my legs and lower body.

Here my luck began to change slightly. The encounter with the barrel seemed to slow me enough to lessen my injuries when I fell into the pile of bricks and fortunately only three vertebrae were cracked. I am sorry to report, however, as I lay there on the pile of bricks, in pain, unable to move, I again lost my composure and presence of mind and let go of the rope and I lay there watching the empty barrel begin its journey back onto me. This explains the two broken legs.

I am an amateur radio operator and on the day of the accident, I was working alone on the top section of my new 80 foot tower. When I had completed my work, I discovered that I had, over the course of several trips up the tower, brought up about 300 pounds of tools and spare hardware.

Rather than carry the now un-needed tools and material down by hand, I decided to lower the items down in a small barrel by using a pulley, which was fortunately attached to the gin pole at the top of the tower. Securing the rope at ground level, I went to the top of the tower and loaded the tools and material into the barrel. Then I went back to the ground and untied the rope, holding it tightly to ensure a slow descent of the 300 pounds of tools. You will note in block number 11 of the accident reporting form that I weigh only 155 pounds.

Due to my surprise of being jerked off the ground so suddenly, I lost my presence of mind and forgot to let go of the rope. Needless to say, I proceeded at a rather rapid rate of speed up the side of the tower. In the vicinity of the 40 foot level, I met the barrel coming down. This explains my fractured skull and broken collarbone. Slowed only slightly, I continued my rapid ascent, not stopping until the fingers of my right hand were two knuckles deep into the pulley.

Fortunately, by this time, I had regained my presence of mind and was able to hold onto the rope in spite of my pain. At approximately the same time, however, the barrel of tools hit the ground and the bottom fell out of the barrel. Devoid of the weight of the tools, the barrel now weighed approximately 20 pounds. I refer you again to my weight in block number 11.

As you might imagine, I began a rapid descent down the side of the tower. In the vicinity of the 40 foot level, I met the barrel coming up. This accounts for the two fractured ankles, and the lacerations of my legs and lower body. The encounter with the barrel slowed me enough to lessen my injuries when I fell onto the pile of tools and, fortunately, only three vertebrae were cracked.

I am sorry to report, however, that as I lay there on the tools, in pain, unable to stand and watching the empty barrel 80 feet above me, I again lost my presence of mind. I let go of the rope...

Strange Pet Claims

Case #1: Chilly Dog

With guests on the way and meal preparation in high gear, no one noticed Rex, the wily Yorkshire terrier, climb into the refrigerator (perhaps disguised as Yorkshire pudding). By the time he was discovered, the well-chilled pooch had managed to nosh half the family's holiday ham. Diagnosis: Pancreatitis from overindulgence; hypothermia from excess refrigeration.

Case #2: Dream Kitty

Think you have wild dreams? Stuffie, a Himalayan cat, was catnapping on a window ledge when she suddenly awoke and jumped straight up in the air. Too straight, unfortunately, because as gravity kicked in and she hurtled down to the floor, her back paws smacked against the ledge. Diagnosis: Two broken paws. Recommendation: No more catnip before bedtime.

Case #3: Pane and Suffering

What's a dog to do? Cora, an Alaskan malamute, was walking along minding her own business, when she saw a cat sunning itself in a house window. To any normal, red-blooded American pup, this is an invitation to playtime. Diagnosis: Severe lacerations from crashing through the window.

Case #4: Nailed

Enu, a Yorkshire terrier, took "sleeping at the feet of his master" a step too far when he climbed into his owner's work boot for a little snooze. Not realizing his puppy was in there, the owner tried to pull on his boot. Diagnosis: Scratched cornea from owner's toenail.

Case #5: Stick-to-it-tiveness

While chasing a rabbit through the desert, one determined border collie named Jesse zigged when he should have zagged. Diagnosis: Severe lacerations on nose, face and body from an encounter of the cactus kind.

Case #6: Getting a Seasonal Glow

Every year, a brightly lit tree stands in the living room. And those electrical cords from the strings of lights are mighty tempting to dogs and cats alike. But curiosity nearly got the best of Honey. The orange Tabby's shocking discovery nearly dimmed everyone's holiday. Diagnosis: Severe burns. Near diagnosis: Electrocution.

Case #7: One Tough Chew

Cabot, the Beagle wasn't sure: Was it a chew toy or was it a rawhide? Neither. It was a metal pipe. Diagnosis: Broken jaw.

Case #8: Rear-ender

Chasing cats is normal for dogs. Chasing cats and running into cars is not. Tockey, the chocolate Laborador retriever was so focused on getting the neighbor's cat that he didn't notice a car coming down the street. Fortunately, the car stopped. Unfortunately, Tockey didn't. Diagnosis: Soft tissue trauma and multiple lacerations. Strong recommendation: Switch to fetching tennis balls in the back yard.

Case #9: It Was Raining Cats and Dogs

A New Yorker was walking little Snowflake one dark and stormy day when he slipped and fell right on top of bichon frise. Diagnosis: Broken leg (the dog). Severe remorse (the owner).

Q: Could either driver have done anything to avoid the accident?
A: Travelled by bus?

This Norwich Union customer collided with a cow. The questions and answers on the claim form were:
Q - What warning was given by you?
A - Horn
Q - What warning was given by the other party?
A - Moo

Q: Do you engage in motorcycling, hunting or any other pastimes of a hazardous nature?
A: I Watch the Lottery Show and listen to Terry Wogan.

Q: What gear was you in when the accident happened?
A: Reebocks, and Wranglers.

Driving Fines/Points (Apparently)

If you get a speeding ticket or went through a red light or whatever the case may be, and you are going to get points on your licence, then there is a method to ensure that you DO NOT get any points. When you get your fine, send in the cheque to pay for it and if the fine is say, 40, then make the cheque out for 41 or some small amount over the fine. The system will then have to send you back a cheque for the difference, but here is the trick! DO NOT CASH THE REFUND CHEQUE!!! Throw it away!! Points are not assessed to your licence until all financial transactions are complete. If you do not cash the cheque, then the transactions are NOT complete. However, the system has gotten its money and is happy and will not bother you any more. This information came to our attention from a very reliable computer company that sets up the standard database used by each county's computing system.


This remarkable accident report, which appeared in the Ontario Provincial Police News, arose from a railroad crossing mishap in the Midlands of England, at a place called Willenhall.

According to the official British accident report, it was 11:30am when the automatic gates at the level crossing went down to block traffic for a train.
Waiting at the crossing were an Austin mini, a Norton motorcycle, a horse and cart loaded with scrap metal, and a Maxi. Behind them were a Ford Cortina and, last in line, a Mercedes.
As they waited in line for the train to pass, the horse suddenly whinnied and dripped spit on the motorcycle driver's neck. Thinking the horse might bite him, the cyclist ducked, throwing his right elbow in the horse's face, his foot slipping off the clutch. The motorcycle lurched forward and hit the back of the Mini, the cyclist falling off of his machine. The horse, punched in the face, reared up, tipping its cart so that the scrap metal fell on the Maxi. This pushed the Maxi backwards a few feet, ramming the front of the Ford Cortina.
At this point a man walking his dog, a Jack Russell terrier the report says, happened on the scene. He hurried to aid the injured motorcyclist, but first tied his barking dog's leash to the automatic gate. Since the train had passed, the automatic gate went up, yanking the yapping dog 20 feet into the air. Seeing his dog in the air, the owner shouted to a nearby pedestrian to lower the barrier. The far-from-the-gate driver of the Mercedes, at the end of the line, pulled out into the passing lane and headed across the railroad tracks.
At this point the gate came down, crashing on top of the Mercedes, leaving the yapping dog dangling from the roof.


Crash Dummy: A driving instructor had been involved in a car accident. He said his injuries left him unable to drive, and therefore, unable to work, so he filed for accident benefits. But the adjuster noticed that the driving instructor wasn't responding to medical treatment, so he placed him under surveillance. The investigator discovered that the driving instructor was back on the road and had driven over 2,000 kilometres in just three weeks. One of his favorite destinations was the local amusement park, where he was spotted slamming around in bumper cars! Claim denied.

Cell Phoney: The man limped into the local claim centre. He said his foot had been fractured when it was run over in a parking lot, and he filed a claim. But when he left the claim centre, he was spotted on a surveillance camera walking normally and obviously pain-free. On his next visit, he said he was in so much pain he couldn't drive. Later, he hobbled into his physiotherapist's office on crutches, saying the pain was almost unbearable. Following the appointment, the man went into the mall next door. Unfortunately, he misplaced his cell phone and ran around the mall looking for a payphone. He found one, but as he ran up to it, he also ran into his physiotherapist.

Miracle Watch: It was a very expensive watch worth over $4,000, and the man who lost it told a rather fishy story. He said that it must have slipped off his wrist while he was jet-skiing on a local lake. But the details were a little fuzzy. Then there was the fact that he still owed a jeweller for the watch and was demanding a cash settlement from his insurer. The claimant offered to take a polygraph examination, but a few days before it was to take place, he called the insurance company with good news. He'd placed an ad in the local newspaper, he said, asking for the return of the watch. And, surprise, surprise, someone had answered the ad. Apparently, the watch had been found at the bottom of the lake.

The Camera Never Lies: The back and neck pain was agonizing and, he said, he couldn't possibly go back to work. It was a routine claim interview, but the adjuster noticed that the man didn't seem to be suffering very much. A surveillance camera was set up next to a piece of land the man had just purchased, and it soon captured a very fit claimant chopping down trees, clearing brush, and lifting boulders. Claim denied.

Car vs. Roller Blades: Sometimes, it's hard to put the brakes on. That's what happened to one man who was rollerblading downhill. He saw a car ahead of him stopped at a red light, but he couldn't slow down, and bounced off the car. The rollerblader was fine, but, astoundingly, the two people in the car filed for accident benefits, claiming their injuries had left them incapacitated. Although one of the claimants worked for an insurance company as an underwriter, no one believed they could be in such agony while the rollerblader could simply skate away. The

Overmedicated Pedestrian: A man walking through an intersection was clipped by a car and knocked to the ground. But he got up and refused any help from an ambulance crew. He eventually reappeared at the office of the driver's insurance company to demand compensation. He produced a pile of prescription receipts that totalled well over $2,000. A review of the receipts revealed that he had visited 11 different doctors and over 20 pharmacies. Along the way, he had accumulated so many stress-reducing pills that no one person could possibly take them all and live to tell about it. The claimant was asked to explain. But apparently, the whole issue was too stressful for him, and he was never heard from again.

The Phantom Worker: A woman had been injured in a car accident, and she provided a stack of wage slips to support her claim for benefits. But the adjuster noticed that none of the wage slips included the standard Canada Pension Plan deduction. An investigator visited the employer, who was the woman's brother-in- law. He said she didn't work at his company and never had. Then the investigator showed him the Employer's Confirmation of Income form that had been received from his company. It had been completed and signed by the man's wife. He said his wife was illiterate and couldn't possibly have filled it out. This sister act is now appearing in court.

A Tangled Web: Originally, there was nothing suspicious about the accident-benefit claim. It was paid out and the file closed. Then another claimant from the same car accident demanded compensation. The investigation proved that the second claimant wasn't even in the car at the time of the collision, and it also raised questions about the first claimant. It turned out the accident was minor and there was no damage to the car. The claimant had been paid compensation based on a form supplied by his employer that turned out to be forged. He was convicted of forgery, but before he was sentenced, he was instructed to produce letters attesting to his good character. When he did so, the handwriting turned out to be virtually the same on all three letters, and he now faces three more counts of forgery.

That Sinking Feeling: His beloved Camaro had been stolen and had vanished without a trace. At least, that was the story he told the insurance adjuster and later a judge. Neither of them was convinced. The car was found at the bottom of a local river. The claimant testified that he was nowhere near the scene when the car was dumped. But it turned out that an undercover police officer was. The officer was there on an unrelated case when he saw the claimant and two of his buddies push the car into the water.

Reel to Real: A film crew was working on a television special sponsored by the Insurance Bureau of Canada. The subject of the show was car theft, and the producers had brought in some police officers to offer technical assistance. The officers offered to show them how to find the tell-tale signs that a vehicle had been stolen, and they used the crew's rental van for their demonstration. It proved to be a very informative exercise. You guessed it: the van was stolen.

Old Forms: In France, not very long ago, the forms used for notifying insurers of accident, illness, or pregnancy were based on the same mold. Consequently, expectant mothers were asked, "Was the accident caused by some third party?" Invariably, the answer was, "No, only by my husband.

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