Claims Process and Standard Form 95 for Damage, Injury or Death as a Result of Gold King Mine Release
People who suffer personal injury or property damage from U.S. government actions may make a claim for compensation.
- Learn about the claims process in EPA's Regulation 40 Part 10; you may need to provide documentation to support your claims.
- Use Standard Form 95 (PDF)(2 pp, 539 K) to file claims for loss of employment, loss of income, loss or damage to property, or other claims. Please fill out the form as completely as possible.
- Mail the completed forms to ONE of the following individuals below, or email a signed electronic version to R8_GKM_Claims@epa.gov.
Kenneth A. Redden
U.S. EPA Office of General Counsel
1200 Pennsylvania Avenue, NW (MC 2399A)
Washington, DC 20460
To be clear - EPA is not offering immediate reimbursements for damages from the Gold King Mine water and it is not true that if someone submits a claim that by doing so they limit or waive future rights.
EPA’s Federal Tort Claims Act (FTCA) regulation provides that a person may amend their claim form at any time prior to reaching a settlement with EPA, or before the person files a lawsuit under the FTCA.
Although EPA’s regulations state that it has six months to resolve a claim, we will make every effort to respond to Gold King Mine release claims as soon as possible. Claims must be presented to EPA within two years after the claim accrues.
Please note that a completed form must state a claim for money damages in a "sum certain" amount (that is, a specific amount) claimed for personal injury, death, or injury to or loss of property. In addition, if a sum certain is not specified in Standard Form 95 block 12d, or in accompanying information, a submission cannot be considered a valid presentation of a claim.
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 allegedly caused by a federal employee's negligence or wrongful act or omission occurring within the scope of the employee's federal employment. Standard Form 95 is not required to present a claim under the FTCA, but it is a convenient format for supplying the information necessary to bring an FTCA claim.
Frequent questions about FTCA claims processing
Who is eligible to file a claim with EPA under the Federal Tort Claims Act for injury or damage?
Individuals, businesses or governmental entities that have a claim for money damages resulting from personal injury, property damage or economic loss caused by negligent or wrongful U.S. government actions.
How much time do I have to file a claim?
You have two years from the date of the event to file a claim with EPA under the FTCA for injury or damage.
The Standard Form 95 refers to personal injury and property damage, what if I suffered economic damages caused by the incident?
A loss of income may be claimed as a damage for this incident.
Can a claim be made for impacts to agriculture and agricultural yields?
A claim can be submitted for any type of claim allegedly caused by the negligence or wrongful act, like damage to property, personal injury or claimed economic losses. Please note that a completed form must state a claim for money damages in a specific amount claimed for personal injury, death, or injury to or loss of property.
The Standard Form doesn't seem to have a place to list these claims for economic losses? What should I do?
Block 8 of the Standard Form 95 should be used to describe the facts and circumstances for the claim and in that block describe the losses you suffered from the incident. Additional pages may be attached to the SF-95 if needed. In addition, you should attach any documentation to substantiate amounts of your claims to the Standard Form 95. You may submit amendments to the claim based on additional information at a later time. The EPA Claims Officer may request additional information as well.
As an employer, can I submit claims on behalf of my employees?
It is preferable that employees submit their own claims. An employee may also chose a representative who may submit a claim on his/her behalf. If a representative is chosen by the employee, the representative, in submitting the claim, must indicate the named employee has authorized the representative to submit the claim on his/her behalf. That representative may be an employee's employer.
Does the following language in the Federal Tort Claims Act (FTCA) claim Standard Form 95 (also identified as – OMB No.1105) limit or waive future rights of the claimants? "The language of concern appears above the signature block and states: I certify that the amount of the claim covers only damages and injury caused by the incident."
That language is not intended to waive any of the claimant's rights in connection with filing a claim and is intended to refer to a final payment to settle the claim. The EPA FTCA regulation, at 40 CFR Part 10, provides that a person may amend their claim form at any time prior to reaching a settlement with EPA, or before the person files a lawsuit under the FTCA. Additionally, a person claiming an injury or damage has two years from the date of the event to file a claim with EPA under the FTCA.
Does the FTCA provide for the payment of my attorney's fees?
Attorney's fees are not paid as part of the settlement of a FTCA claim. Under the FTCA, attorneys may not collect more than 20 percent of the amount of an administrative settlement (a settlement with EPA) paid to a claimant, or not more than 25 percent of a court judgment or settlement resulting from a FTCA lawsuit.
Do I have to use the Standard Form 95?
You are not required to use the Standard Form 95 to present a claim under the FTCA, but it is a convenient format to ensure you supply all the information necessary to submit an FTCA claim.
How do I submit a claim without using a Standard Form 95? What information should be in the claim?
You should submit a document that describes as completely as possible the facts and circumstances for the claim and describe the losses suffered that were allegedly caused by the incident. The document should set forth an amount claimed for personal injury and/or property damages, including any amount for economic related losses. The document must state a claim for money damages in a specific amount (or a "sum certain" amount) claimed for personal injury, death, or injury to or loss of property.
Can I amend a claim that I submit if additional information becomes available after the initial submission?
Yes. You may amend your claim at any time prior to reaching a settlement with EPA, or before you file a lawsuit under the FTCA. The EPA Claims Officer may request additional information as well.
After I reach a final settlement with EPA, can I file additional claims related to the Gold King Mine accident?
If you discover after submitting your claim that you have suffered more damages, you must amend your original claim in order to have EPA consider the new damages. If you accept a final settlement from EPA for your claim related to the Gold King Mine accident, you may not pursue additional claims originating from the Gold King Mine accident.You may need Adobe Reader to view files on this page. See EPA’s About PDF page to learn more.
- Standard Form 95 (PDF)(2 pp, 539 K)