New Hampshire Code of Administrative Rules
Jus - Attorney General, Department of Justice
Chapter Jus 600 - VICTIMS' COMPENSATION
Part Jus 604 - FORMS
Section Jus 604.03 - Vehicular Crimes Insurance Form

Universal Citation: NH Admin Rules Jus 604.03

Current through Register No. 40, October 3, 2024

(a) Each claimant seeking compensation from the fund shall, if the underlying crime is a vehicular crime, complete and submit a "Vehicular Crimes Insurance Form," revised 8/23/2019 and available from the unit.

(b) In addition, each claimant shall provide the following:

(1) A copy of the entire policy;

(2) An itemized list of bills including the amounts billed and the amounts paid by the insurance carrier;

(c) If an attorney has been retained, an indication of whether the claimant has informed the attorney that the claimant is seeking compensation under these rules;

(d) An indication of whether any restitution or payment of a civil suit judgment has been received, and if so, the total amounts received;

(e) If any of the responses indicate that money has been paid to or on behalf of the claimant, the claimant shall provide:

(1) The name and mailing address of the person, company, agency or other entity that paid or will be paying any portion of any expense; and

(2) A description of the expenses incurred, and the amounts covered by those providing payment pursuant to (1) above; and

(f) A dated declaration that the information provided by the claimant is true, accurate, and complete, as evidenced by the claimant's signature.

#4864, eff 7-13-90, EXPIRED: 7-13-96

New. #7117, eff 10-8-99, EXPIRED: 10-8-07

New. #9553, eff 9-25-09

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