28 C.F.R. § 14.4

Administrative claims; evidence and information to be submitted

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(a) Death. In support of a claim based on death, the claimant may be required to submit the following evidence or information:

(1) An authenticated death certificate or other competent evidence showing cause of death, date of death, and age of the decedent.

(2) Decedent's employment or occupation at time of death, including his monthly or yearly salary or earnings (if any), and the duration of his last employment or occupation.

(3) Full names, addresses, birth dates, kinship, and marital status of the decedent's survivors, including identification of those survivors who were dependent for support upon the decedent at the time of his death.

(4) Degree of support afforded by the decedent to each survivor dependent upon him for support at the time of his death.

(5) Decedent's general physical and mental condition before death.

(6) Itemized bills for medical and burial expenses incurred by reason of the incident causing death, or itemized receipts of payment for such expenses.

(7) If damages for pain and suffering prior to death are claimed, a physician's detailed statement specifying the injuries suffered, duration of pain and suffering, any drugs administered for pain, and the decedent's physical condition in the interval between injury and death.

(8) Any other evidence or information which may have a bearing on either the responsibility of the United States for the death or the damages claimed.

(b) Personal injury. In support of a claim for personal injury, including pain and suffering, the claimant may be required to submit the following evidence or information:

(1) A written report by his attending physician or dentist setting forth the nature and extent of the injury, nature and extent of treatment, any degree of temporary or permanent disability, the prognosis, period of hospitalization, and any diminished earning capacity. In addition, the claimant may be required to submit to a physical or mental examination by a physician employed by the agency or another Federal agency. A copy of the report of the examining physician shall be made available to the claimant upon the claimant's written request provided that he has, upon request, furnished the report referred to in the first sentence of this paragraph and has made or agrees to make available to the agency any other physician's reports previously or thereafter made of the physical or mental condition which is the subject matter of his claim.

(2) Itemized bills for medical, dental, and hospital expenses incurred, or itemized receipts of payment for such expenses.

(3) If the prognosis reveals the necessity for future treatment, a statement of expected expenses for such treatment.

(4) If a claim is made for loss of time from employment, a written statement from his employer showing actual time lost from employment, whether he is a full or part-time employee, and wages or salary actually lost.

(5) If a claim is made for loss of income and the claimant is self-employed, documentary evidence showing the amounts of earnings actually lost.

(6) Any other evidence or information which may have a bearing on either the responsibility of the United States for the personal injury or the damages claimed.

(c) Property damage. In support of a claim for injury to or loss of property, real or personal, the claimant may be required to submit the following evidence or information:

(1) Proof of ownership.

(2) A detailed statement of the amount claimed with respect to each item of property.

(3) An itemized receipt of payment for necessary repairs or itemized written estimates of the cost of such repairs.

(4) A statement listing date of purchase, purchase price and salvage value, where repair is not economical.

(5) Any other evidence or information which may have a bearing on either the responsibility of the United States for the injury to or loss of property or the damages claimed.

Notes of Decisions

Cited in 41 cases (2 in the last 5 years), 1971–2024 · leading case: Gary L. Adams v. United States, 615 F.2d 284 (5th Cir. 1980).

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Gary L. Adams v. United States, 615 F.2d 284 (5th Cir. 1980). · cites it 6× “The claims officer responded on March 81, requesting, under authority of 28 C.F.R. § 14.4 (b), written reports by any attending physicians who were not government employees, itemized bills and expenses, a statement of future expenses and a signed medical authorization.”

Mary E. Tucker v. United States Postal Serv., 676 F.2d 954 (3rd Cir. 1982). · cites it 5× “28 C.F.R. § 14.4 (b) (1980) (emphasis supplied).”

Parrish Ian Charlton v. United States, 743 F.2d 557 (7th Cir. 1984). · cites it 5× “The question remains, however, whether the condition precedent to jurisdiction of presenting a claim incorporates the requirement of 28 C.F.R. § 14.4 (b), as defendant argues that it does.”

Mader v. United States, 654 F.3d 794 (8th Cir. 2011). “1999) — as bills and physicians’ reports verifying the extent of the claimant’s *813 asserted injuries, full names of decedent’s survivors entitled to recovery (particularly relevant here), proof of ownership of the property, or other quintessential substantiation items listed…”

Keene Corp. v. United States, 700 F.2d 836 (2d Cir. 1983). “2 (1980), and because it does not provide sufficient information to permit an investigation, see 28 C.F.R. § 14.4 (1980), as required by regulations promulgated pursuant to 28 U.”

James L. Tidd, Adm'r of the Est. of Cordia C. Robinson, Deceased v. United States, 786 F.2d 1565 (11th Cir. 1986). · cites it 2× “After receiving no response, the Justice Department 2 again requested this information observing that it had authority to do so under 28 C.F.R. § 14.4 and that a failure to comply would result in the jurisdictional requirement of filing an administrative claim under 28 U.”

State Farm Mut. Auto. Ins. v. United States, 326 F. Supp. 2d 407 (E.D.N.Y 2004). · cites it 2× “1984) (“An agency cannot prevent litigation by requesting more information pursuant to 28 C.F.R. § 14.4 (b) and, upon failure of a claimant to provide the information, insist that the claim was insufficient thereby precluding court action”); Warren v.”

Miles v. Bell, 621 F. Supp. 51 (D. Conn. 1985). · cites it 2× “3 ; and 4) the notice provided no evidence or information in support of the claim such as medical, psychological or psychiatric records establishing the alleged injuries, 28 C.F.R. § 14.4 . Defendants essentially take the position that plaintiffs are required to satisfy the…”

Ronald Warrum, in His Capacity as Pers. Rep. of the Est. of Joseph F. Sayyah, Deceased v. United States, 427 F.3d 1048 (7th Cir. 2005). “Indeed, in the case of a claim based on death, the applicable regulations allow the government to request the names of the decedent’s survivors as well as the “[djegree of support afforded by the decedent to each survivor dependent upon him for support at the time of his death.”

Surratt v. United States, 582 F. Supp. 692 (N.D. Ill. 1984). · cites it 4× “The letter went on to state that the VA was authorized by 28 C.F.R. § 14.4 and 38 C.F.R. § 14.607 to request additional information to assist it in investigating plaintiff’s claim.”

Willard D. Douglas & Violet A. Douglas v. United States, 658 F.2d 445 (6th Cir. 1981). “40 (1980); 28 C.F.R. § 14.4 (b) (1980). Under Navy regulations, failure to provide requested information “may result in no *448 administrative consideration of the claim.”

Carter v. United States, 667 F. Supp. 2d 1259 (D. Kan. 2009). “See 28 C.F.R. § 14.4 . 40 . 564 F.2d 284 (9th Cir.”

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— 28 C.F.R. § 14.4(a)(3) — 1 case

Est. of Sullivan v. United States, 777 F. Supp. 695 (N.D. Ind. 1991).

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