Tort Claim Form

Filing a Tort Claim

(This is not the information about filing a Claim for Damages. To do that, go here. The Tort Claim Act allows lawsuits by people who claim they have been harmed by torts [wrongful acts], including negligence, by public agencies or their employees.)

Individuals who have been harmed or who have suffered a loss as a result of negligent actions by a city employee or agency can submit a tort claim to the City Clerk’s Office (City). The City is required by law (RCW Chapter 4.96) to receive these claims. Pursuant to RCW 42.56, tort claim forms are subject to public disclosure.

The City objectively determines the city’s liability for claimed injuries. It fairly compensates claimants for damages when liability is supported by evidence and denies claims when liability is unsupported. The City recognizes its stewardship role in protecting city resources by striving for efficient and timely service to citizens.

The City of Camas Tort Claim form is for use only if you believe that you were harmed by the city of Camas, 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.
Please note that the Tort Claim form is subject to public disclosure pursuant to RCW 42.56.

How to file a City of Camas Tort Claim

The City of Camas Tort Claim form may be filed online, by fax, by mail or in person.

Submit Tort Claim Online:

Submit a tort claim online securely. You can attach supporting documents and print out your submission at the end. However, online submission forms cannot be saved. Once started, they must be completed. Allow yourself enough time to complete and have all documents in electronic format. There is no need to send a duplicate copy by mail.

Submit Tort Claim by Fax:

Submit the completed City of Camas Tort Claim form to the following fax number: (360) 835-1535. 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 the city.

Submit Tort Claim by Mail:

Documents will not be returned, please keep copies of everything you submit. Submit the completed City of Camas Tort Claim form by mail to the following address:

City Clerk’s Office
City of Camas
616 NE 4th AVE
Camas, WA 98607

Submit Tort Claim in Person:

Please call (360) 834-6864 prior to coming to the building to make an appointment or ensure someone is available to receive the claim. Documents will not be returned, please keep copies of everything you submit. Submit the completed City of Camas Tort Claim form in person between 8 a.m. to 5 p.m. Monday through Friday at the following address:

City Clerk’s Office
City of Camas
616 NE 4th Avenue
Camas, WA 98607

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

Acknowledgement and follow-up questions

The City acknowledges receipt of the City of Camas Tort Claim by letter to the Claimant within approximately 10 days. For claim follow-up or acknowledgement questions, call (360) 834-6864.

Important items to note when completing the form

The City of Camas 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 City of Camas 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.

Checklist for filing your City of Camas Tort Claim form

Tort Claim form is typed or printed clearly in ink.
Tort Claim form is filled out completely.
If filing a claim for physical injuries, sign and return the attached "Authorization for Release of Protected Health Information."
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.
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.
Sign, date and provide residential address, city and county of claimant.

Frequently Asked Questions (FAQ)

RCW 4.92.100 permit claims for tortious conduct brought against the city of Camas to be submitted electronically or by fax to the City of Camas, City Clerk’s Office. Citizens may also file tort claims in hard copy form by mailing or delivering the original documents to:

City of Camas
City Clerk’s Office
616 NE 4th Avenue
Camas, WA 98607
Fax: (360) 834-1535

Business Hours: Monday – Friday 8 a.m. to 5 p.m. The City is closed on weekends and official state holidays.

When can I file a claim?

The City of Camas Tort Claim form is for use only if you believe that you were harmed by the city of Camas, its officers, employees, or volunteers.

What is the fax number I can use to send my City of Camas Tort Claim form?

(360) 835-1535

Who should I contact if I need assistance filing my tort claim form?

The City is available Monday through Friday from 8 a.m. to 5 p.m. at (360) 834-6864. If assistance is required outside of these hours, you can call the telephone number and leave a voice message and contact telephone number. These voice messages will receive a response the following business day.

Will my personal health or other confidential information I send be protected if I send it electronically?

No. The City is unable to ensure that personal health or other confidential information received by facsimile is secure according to applicable privacy laws. Therefore, you should not submit any personal health or other confidential information to the City electronically.

What about the statutory requirement to have an original signature on the claim form?

When you sign the City of Camas 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)

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.

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 City of Camas, City Clerk’s Office website. If you submit your claim electronically, you must submit it in PDF format. You can also submit your claim online securely.

Supporting Documents

City of Camas Tort Claim Form (715 KB)