Claim for Damages for Accident or Injury

How to File a Claim

Online

Claim forms can be submitted electronically via the Claim for Damages Form below.

In Person or By Mail

A PDF Claim for Damages Form can also be completed and submitted to the Safety Department at Ben Franklin Transit either in person, by email, or by mail. Please carefully read all the information before completing and presenting your claim for damages.

Claim for Damages Form (PDF)

Mailing Address

Safety Department
1000 Columbia Park Trail
Richland, WA 99352

BFT Business Hours

Monday through Friday, 8 a.m. to 5 p.m.
Closed weekends and holidays

BFT Claim for Damages Form

Personal Information

Claimant's Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Residence/Mailing Address(Required)

Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code

Daytime Phone Number(Required)

Your Email Address(Required)

Email Address Confirm Email Address

Incident Information

Date of Incident(Required)

MM slash DD slash YYYY

Time of Incident(Required)

Hours

:

Minutes

AM PM AM/PM

Location of Incident(Required)

Names, addresses, and phone numbers of all persons involved in or witness to this incident:(Required)

Names and phone numbers of all Ben Franklin Transit employees who have knowledge about this incident:(Required)

Describe conduct and circumstances causing injury or damage, explaining extent of medical, physical, or mental injuries:(Required)

Name, address, and phone number of treating medical provider(s):(Required)

Damages Claimed

I/we do hereby claim damages from Ben Franklin Transit in the sum of:

Amount of Claim(Required)

To be determined (TBD) is appropriate if you do not have a damage estimate or have not completed medical treatment.

CLAIMANT OR LEGAL GUARDIAN MUST SIGN THIS CLAIM FORM

I certify or declare under penalty of perjury under the laws of the State of Washington that the foregoing is true and correct.

Signature(Required)

Today's Date(Required)

MM slash DD slash YYYY

Address City and County(Required)

e.g., Kennewick, Benton County

If the claimant is incapacitated from verifying, presenting, and filing the claim, or if the claimant is a minor or is a nonresident of this state, the claim may be verified, presented, and filed on behalf of the claimant by any relative, attorney, or agent representing the claimant. All claims for damages against Washington State Transit Insurance Pool (WSTIP) members arising out of tortious conduct shall be presented to and filed with the appropriate transit agency.

Frequently Asked Questions

The following frequently asked questions are not intended to constitute legal advice and are for informational purposes only.

I filled out a report and called Customer Service after an incident. Do I still need to submit a Claim for Damages?

Yes. You must submit a Claim for Damages if you feel Ben Franklin Transit (BFT) is responsible for your loss, injury, or damages.

When will my claims representative contact me?

After a Claim for Damages form is submitted, BFT will forward your claim to the Washington State Transit Insurance Pool (WSTIP). Once an adjuster is assigned, they will reach out to you with a claim number and request any additional documents needed.

How long will the investigation take?

Investigations vary in length. Please reach out to your WSTIP adjuster directly with any questions. BFT is unable to assist or answer questions about your claim.

I was injured on Ben Franklin Transit property or by a BFT vehicle. Who will pay my medical expenses?

You are responsible for your medical care and expenses. If you believe that Ben Franklin Transit is responsible for your loss, injury, or damages, you must file a Claim for Damages. The circumstances surrounding your claim will be investigated.

Should I contact my own insurance carrier about this incident?

At your discretion, you may ask about coverage provided by your own insurer.

Should I get estimates for the damage to my property or vehicle?

It is always appreciated if an estimate is submitted along with your Claim for Damages. However, please reach out to your adjuster directly with any questions.