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Submit Completed Claim. Items 14 - 33 — Providers may use these instructions to complete this form.Federal Employee's Notice of Traumatic Injury and. Your insurance policy, and complete the enclosed Tort claim form. Complete this form only if ALL of these statements are true: 1. You are NOT named in the accompanying form called Writ of Possession. Complete the reverse side of this form. Filing a Claim with The Comptroller's Office. Submit the completed Washington State Tort Claim form to the following fax number: (360) 507-9251. It is important to complete all applicable items on the form in order to assure compliance with state law.