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Criminal Injuries Compensation Claim Statement

A completed fictional CICA supporting statement covering reporting, injury, eligibility, evidence and time-limit caveats.

Jurisdiction: England and Wales - completed fictional worked example

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Important: This sample provides general legal information only and is not legal advice. Check the law, prescribed forms and signing requirements that apply to your exact jurisdiction and circumstances before use.

# CRIMINAL INJURIES COMPENSATION CLAIM STATEMENT

Date: 12 July 2031

Parties: James Turner and the Criminal Injuries Compensation Authority

## 1. Purpose and parties

James Turner applies to the Criminal Injuries Compensation Authority for injuries suffered during an assault outside North Quay Station on 9 March 2031. A stranger struck him repeatedly, causing a fractured cheekbone, dental damage and psychological symptoms. James did not contribute to the incident and did not consent to the violence.

## 2. Facts, scope and terms

He reported the assault to British Transport Police on 10 March, crime reference BTP-31-4482, attended hospital that night and has cooperated with the investigation. The offender has not been identified. James explains the delay in his initial online application: he was receiving treatment and was told incorrectly that a conviction was required.

## 3. Process and responsibilities

The statement describes the injury, treatment, recovery, work absence, counselling referral and continuing symptoms without exaggerating prognosis. James asks CICA to assess the claim under the Scheme and to request medical or police evidence directly where permitted. He understands that the Scheme is not a civil damages claim and does not require a conviction.

## 4. Evidence, records and safeguards

He encloses the police reference, hospital discharge letter, dental report, GP notes, employer absence record, counselling referral and photographs. He consents to relevant enquiries, will notify CICA of address changes and will preserve receipts. Medical information should be shared only for claim assessment and stored securely.

## 5. Review, escalation and outcome

CICA may investigate conduct, cooperation, reporting, eligibility, time limits and tariff injury evidence, and may seek further information. James will answer requests promptly. A decision may be refused, reduced or deferred; he may request a review and, if still dissatisfied, appeal under the Scheme within the stated period.

## 6. Reservations and practical protections

James has checked the application deadline and asks CICA to consider any applicable exception for exceptional circumstances, without assuming it will be granted. The claim does not promise an award, compensation for every loss or a finding against the unknown offender. He will obtain advice if a review or appeal is needed.

## 7. England and Wales law and completion

The Criminal Injuries Compensation Scheme and England and Wales law apply. James signs the statement of truth on 12 July 2031 and submits it through the CICA portal, with a copy by post as a separate permitted method. He confirms the account is accurate to the best of his knowledge.

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