Submit the completed Washington State Tort Claim form to the following fax number: 360-507-9251. The claim must be reported to the agency allegedly responsible and submitted through FARM's Origami Risk portal.The Claim for Damages and Authorization for Release of Medical Information Forms may be completed online below or you may download and print the forms. 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. Are there other ways to submit the Washington State Tort Claim? Block 1, First-Class Mail. Before filing a Tort Claim, please read these instructions the Tort Claim form and other appropriate forms in their entirety. They filed lawsuit after lawsuit after lawsuit, and drove insurance companies and providers out of the State. All Providers who oversee the Member's health care are responsible for providing the following appointments to Molina Members in the timeframes noted. We value your privacy.
