Home | RMDP | Agent Access Login | Submit Claim | NEED HELP? CALL US.
208.336.3100
Forms   |   Services   |   Claims   |   About Us   |   Contact Us   |   Links
Submit a claim
This form is for our insured members only.  If you wish to file a claim against one of our insured members, please submit your claim in writing directly to the county, city or other special purpose district.  If you need further instructions on filing a claim, please visit the State of Idaho's website (www3.state.id.us) for Idaho Code Statutes.
Member Notice of Potential Claim

 For Notification Use Only

 To Be Completed When Tort HAS NOT been filed by claimant
Your Name:    Your Affiliation:

Your Phone:    Your E-mail:

Member Name:    Address:

Check here if you are the primary contact for this form.

Contact Person:    Contact's Affiliation:

Contact's Phone:    Contact's E-mail:

Incident Date:    Department Involved:

Details of Claim:






3100 Vista Avenue, Suite 300 · Boise, ID 83705 · (208) 336-3100 · Fax (208) 336-2100 · email: intake@icrmp.org Privacy · Legal Disclaimer