Report a Claim for Damages

This form is to report damages to private property or personal injury as a result of water leakage or other activities of the Pittsburgh Water and Sewer Authority.

Please note:

  1. If you do not have available all the information requested, complete as much as possible at this time so that there will not be an unnecessary delay in the processing of your claim. 
  2. You must submit documentation to support your claim, such as photos, videos, witness statements, estimates, invoices, receipts, and homeowner’s, automobile, and renter’s insurance documentation. Please note that PWSA will not return any items submitted as part of a claim. Please keep duplicates for your records.
  3. Any person who knowingly and with intent to injure or defraud any insurer, files an application or claim containing any false, incomplete or misleading information shall, upon conviction, be subject to imprisonment for up to seven years and payment of a fine up to $15,000.00.
  4. Your claim will be investigated as soon as possible to determine if additional information will be required. During the course of the investigation, we may require further documents and will advise you accordingly.
  5. By receiving your claim form, PWSA is not making an admission of liability nor does this mean PWSA will pay your claim. PWSA must investigate the circumstances surrounding your claim before it can be determined whether your claim will be denied or approved for payment.
  6. PWSA is a political subdivision and is granted certain immunity under the Political Subdivision Tort Claims Act (PSTCA).

Submission

Please submit the webform below or print the Claim for Damages Form and deliver, mail, email, or fax the completed form and attachments to:

Pittsburgh Water and Sewer Authority (PWSA)
ATTN: Claims Division
1200 Penn Avenue
Pittsburgh, PA 15222

Email: claims@pgh2o.com

Fax: 412-393-0522

If you have any questions, please call our Claims Division at 412-255-2376.

Claim for Damages Webform

Claimant Information
*Name
*Address
Incident Information
Attach additional information or documentation, if available.
*Type of Incident
*Type of Incident
*Address of Occurrence
Prior Incidents
*For a line break, are you aware of any prior line breaks in the vicinity?
Witnesses
Add witness names here and attach any witness statements in the File Upload section, if available.
Add witness names here and attach any witness statements in the File Upload section, if available.
more items
Property Owner Information
*Name
*Address
Insurer Information
*Is the property insured?
*Was the carrier notified?
*Address
File Upload

If your files are above the upload size limit, please email them to claims@pgh2o.com along with your name and a note explaining which claim they are for. 
 
Unlimited number of files can be uploaded to this field.
14 MB limit.
Allowed types: gif jpg png bmp eps tif pict psd txt rtf html odf pdf doc docx ppt pptx xls xlsx xml avi mov mp3 ogg wav bz2 dmg gz jar rar sit svg tar zip.
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