Checklist for filing your Washington State Tort Claim form. Tort Claim form is typed or printed clearly in ink.You need to complete and file a WC-14, with the State Board of Workers' Compensation and send a copy of the form to your employer. The Board forms are available in a fillable format for printing or downloading a copy to your storage media. Standard Form 95 is used to present claims against the United States under the Federal Tort Claims Act (FTCA) for property damage, personal injury, or death. Please attach documents which support the allegations of the claim. 20. Fill out this form to apply for workers' compensation benefits because of a work injury or work-related illness. The Workers Compensation Claim Forms listed in this Reference Guide include, but are not limited to, injury reports, claim denials, petitions, treating. This form enables us to calculate the correct compensation that may be owed to an injured employee. ✓ If you are filing a personal injury claim, please sign and attach the Medical Release.
