Claim Application

On what date did the accident occur?If exact date is unknown please select date range

Date range

Do you know the name and address of the Respondent? The Respondent is the person or entity you are making the claim against and are holding responsible for the injury/accident.

Yes
No

Can you pay the €45.00 application fee by either credit or debit card? Approved PIAB Solicitor Portal users may also pay by account.

Yes
No

Do you have a completed medical report from your doctor?

Yes
No

Are you the injured party, their parent or legal guardian if the injured party is under 18 years of age, or otherwise a Solicitor authorised to act on behalf of the injured party?

Yes
No

The respondent (the individual(s), entity or entities you are making a claim against) will be notified that you are making a claim against them once you have submitted your completed application.

By starting this claim, the claimant acknowledges that his or her personal data shall be processed by the Personal Injuries Assessment Board in the context of this application and in accordance with data protection legislation, and with the Personal Injuries Assessment Board Acts 2003 and 2007 and our Data Protection Code of Practice.

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Starting Your Claim Application