Administrative claims; evidence and information to be submitted.

CFR · 2024-01-01 · US · Title 12

(a) (1) An authenticated death certificate or other competent evidence showing the cause of death, date of death, and age of the decedent. (2) Decedent's employment or occupation at the 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, birthdates, kinship, and marital status of the decedent's survivors, including 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 or payments for such expenses. (7) If damages for pain and suffering before 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 the responsibility of the United States for the death or the damages claimed. (b) (1) A written report by his attending physician or dentist setting forth the nature and extent of the injury, nature and extent of the treatment, any degree of temporary or permanent disability, the prognosis, period of ho

official document · source cfr-2024 · id 12:§ 793.4