File a Tort Claim

Filing a Tort Claim

Individuals who have been harmed or who have suffered a loss as a result of negligent actions by a state employee or agency can submit a tort claim to the Office of Risk Management (ORM). ORM is required by law (RCW Chapter 4.92) to receive these claims.

ORM objectively determines the state's liability for claimed injuries. It fairly compensates claimants for damages when liability is supported by evidence and denies claims when liability is unsupported. ORM recognizes its stewardship role in protecting state resources by striving for efficient and timely service to citizens. Approved claims are paid out of the Self-Insurance Liability Program (SILP), which is funded by state agencies.

The Washington State Tort Claim Form is for use only if you believe that you were harmed by the state of Washington, its officers, employees, or volunteers. DO NOT USE THIS FORM if you were harmed by another entity (for example, the United States Government, another country, another State, a county, city, or private citizen). You must file your claim against the other entity or entities.

Documents will not be returned, please keep copies of everything you submit.

How to file a Washington State Tort Claim

Complete the Washington State Tort Claim form and submit by one of the methods listed below.

Submit Tort Claim in person: 

Submit the completed form in person at the following address:

Office of Risk Management
Department of Enterprise Services
1500 Jefferson Street SE
Olympia, WA 98504-1466 

Business hours: Monday – Friday 8:00 a.m. to 5:00 p.m. Office closed on weekends and official state holidays.

Submit Tort Claim by mail:

Submit the completed form by mail to the following address:

Office of Risk Management
Department of Enterprise Services
PO Box 41466
Olympia, WA  98504-1466

Submit Tort Claim by email:

  • Complete the Form
  • Type your signature onto the signature line
  • Save the Form as a PDF document
  • Open the saved Form and verify all the data has been saved to it
  • Attach the completed Form to an email
  • Put the Claimant's name in the subject line of the email
  • Enter your name and contact information in the body of the email
  • Ensure that any attachments to the email are in PDF format
  • Email the Claim Form to:

The Washington State Tort Claim form may now be filed electronically pursuant to recent legislative changes to RCW 4.92.100 allowing the claim to be submitted as an attachment to electronic mail or by fax. Please do NOT mail an additional copy of the claim to DES.

Submit the completed form as an email attachment to the following email address: WashingtonStateTortClaimE-Filing@des.wa.gov. The email submittal must include the date, time the claim document was submitted, and the fax number from which it was sent.

Submit Tort Claim by Fax:

Submit the completed form to the following fax number:  (360) 407-8022. The fax submittal must include the date, time the claim document was submitted, and the fax number from which it was sent. Please do NOT mail an additional copy of the claim to DES.

Additional information about email and Fax submissions:

If you need assistance submitting your tort claim electronically, you may contact ORM Customer Service at
(360) 407-9199.  Assistance is available Monday through Friday from 8:00 a.m. to 5:00 p.m.  If assistance is required outside of these hours you can leave a voice message and contact telephone number.  Voice messages will be responded to the following business day.  
 

As of July 28, 2013, until further notice, ORM is unable to receive emails and attachments larger than 10 megabytes.  If you attempt to submit an email and attachment larger than 10 megabytes, you will receive email notification that the message exceeds the domain’s maximum per-message size limit.  You should try to reduce the size of the message and resend it or submit the document in person or by regular mail delivery.
As of July 28, 2013, until further notice, ORM is unable to ensure that personal health or other confidential information received through the above email address or facsimile number is secure according to applicable privacy laws.  You should not submit any personal health or other confidential information to ORM electronically.

Acknowledgement and follow-up questions

ORM acknowledges receipt of the Washington State Tort Claim by letter to the Claimant within approximately 10 days.  For claim follow-up or acknowledgement questions, call (360) 407-9199. 
Important items to note when completing the form
The Washington State Tort Claim form must be signed by one of the following:
·         the Claimant
·         a person holding a written power of attorney from the Claimant
·         the attorney in fact for the Claimant
·         an attorney admitted to practice in Washington state on the Claimant's behalf, or
·         a court-approved guardian ad litem on behalf of the Claimant
The length of the Washington State Tort Claim investigation varies greatly depending on the complexity of the issues and the availability of documents and witnesses to support causation and damages. The tort claim can be resolved and closed quicker when all relevant information and documents are provided initially for the investigator's consideration.
Do not submit any documents that you wish to be returned to you.  ORM will not return any documents submitted in support of your tort claim.
Checklist for filing your Washington State Tort Claim form
ü  Tort Claim form is typed or printed clearly in ink.
ü  Tort Claim form is filled out completely.
ü  If filing a claim for physical injuries, sign and return the attached “Authorization for Release of Protected Health Information.”
ü  Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) requires that liability insurers (including self-insurers like the state of Washington) report specific information about Medicare beneficiaries who have other insurance coverage.  If filing a claim for physical injuries, sign and return the attached “MMSEA Reporting Compliance Declaration.”  This is required for all claims for physical injuries regardless of claimant’s Medicare eligibility status. 
ü  If the claim involves a motor vehicle accident, complete, sign and return the attached “Vehicle Collision Form.” 
ü  Provide all requested information and any available documents or evidence supporting your claim, such as medical records or bills for physical injuries, photographs, proof of ownership for property damages, receipts for property value, etc. 
ü  Sign, date and provide residential address, city and county of claimant. If submitting electronically, be sure claimant's name is in the email subject line and contact information is included in the body of the email.
Frequently Asked Questions (FAQ)
Recent legislative changes to RCW 4.92.100 permit claims for tortious conduct brought against Washington state to be submitted electronically as an attachment to email or by fax to the Department of Enterprise Services, Office of Risk Management (ORM).  Citizens may also file tort claims in hard copy form by mailing or delivering the original documents to:
Department of Enterprise Services
Office of Risk Management
1500 Jefferson Street SE
PO Box 41466
Olympia, WA  98504-1466
Fax:  (360) 407-8022
 
Business Hours: Monday – Friday 8:00 a.m. to 5:00 p.m.  ORM is closed on weekends and official state holidays.
 
1.     When can I file a claim?
 
The Washington State Tort Claim form is for use only if you believe that you were harmed by the state of Washington, its officers, employees, or volunteers. DO NOT USE THIS FORM if you were harmed by another entity (for example, the United States Government, another country, another State, a county, city, or private citizen). You must file your claim against the other entity or entities.
2.     What is the email address where I can send my Washington State Tort Claim form?
 
 
3.     What is the fax number I can use to send my Washington State Tort Claim form?
 
360-407-8022
 
4.     Are there restrictions I need to be aware of before I submit my Washington State Tort Claim form electronically?
 
Yes.  As of July 28, 2013, until further notice, ORM is unable to receive emails and attachments larger than 10 megabytes.  If you attempt to submit an email and attachment larger than 10 megabytes, you will receive email notification that the message exceeds the domain’s maximum per-message size imit. You should try to reduce the size of the email and attachments to resend or file the tort claim in hard copy form by mailing or submitting in person.
 
5.     Who should I contact if I need assistance filing my tort claim form?
ORM Customer Service is available Monday through Friday from 8:00 a.m. to 5:00 p.m. at (360) 407-9199.  If assistance is required outside of these hours, you can call the Customer Service telephone number and leave a voice message and contact telephone number.  These voice messages will receive a response the following business day.
6.     Will my personal health or other confidential information I send be protected if I send it electronically?
No.  As of July 28, 2013, until further notice, ORM is unable to ensure that personal health or other confidential information received through the above email address or facsimile number is secure according to applicable privacy laws.  Therefore, you should not submit any personal health or other confidential information to ORM electronically.
7.     What about the statutory requirement to have an original signature on the claim form?
When you sign the Washington State Tort Claim form, you are declaring under penalty of perjury under the laws of the state of Washington that information contained in your tort claim is true and correct.  If submitting the tort claim in hard copy form by mail or in person, you must sign and date the claim.  If the claim is submitted electronically, an electronic signature must be used.  An electronic signature is defined as an original signature that is place on the claim form and executed or adopted by the claimant with the intent to sign the form.  (Final Bill Report SB 5136)
8.     Who is authorized to sign the tort claim form?
The claim form must be signed by one of the following:
a.   The claimant
b.  A person holding a written power of attorney from the Claimant
c   The attorney in fact for the Claimant
d.  An attorney admitted in Washington on the claimant’s behalf, or
e.  A court-approved guardian or guardian ad litem on the claimant’s behalf
 
9.     If I send my tort claim by email or fax, how will you able to verify it is coming from me?
When an electronic signature is used and the claim is submitted as an attachment to e-mail, the submittal of the claim must include the date, time, and email address from which it was sent. Please include the Claimant's name in the subject line of the transmittal email(s). If sent by fax, the submittal must include the date, time, and fax number from which it was sent.
10.  Does it matter what format I use for the tort claim?
Yes.  According to RCW 4.92.100 all claims for damages must be presented on the standard tort claim form that is posted on the Department of Enterprise Services, Office of Risk Management website.  If you submit your claim electronically, you must submit it in PDF format.