---
kind: "section"
citation: "33 C.F.R. § 25.117"
title: "33"
number: "25.117"
heading: "Proof of amount claimed for personal injury or death."
url: "https://uscodex.org/cfr/33/25.117"
---

# §25.117. Proof of amount claimed for personal injury or death.


The following evidence must be presented when appropriate:

- (a) **Itemized medical, hospital, and burial bills.**
- (b) **A written report by the attending physician including—**
  - (1) The nature and extent of the injury and the treatment,
  - (2) The necessity and reasonableness of the various medical expenses incurred,
  - (3) Duration of time injuries prevented or limited employment,
  - (4) Past, present, and future limitations on employment,
  - (5) Duration and extent of pain and suffering and of any disability or physical disfigurement,
  - (6) A current prognosis,
  - (7) Any anticipated medical expenses, and
  - (8) **Any past medical history of the claimant relevant to the particular injury alleged.**
- (c) **All hospital records or other medical documents from either this injury or any relevant past injury.**
- (d) If the claimant is employed, a written statement by the claimant's employer certifying the claimant's:
  - (1) Age,
  - (2) Occupation,
  - (3) Hours of employment,
  - (4) Hourly rate of pay or weekly salary,
  - (5) Time lost from work as a result of the incident, and
  - (6) Claimant's actual period of employment, full-time or part-time, and any effect of the injury upon such employment to support claims for lost earnings.
- (e) If the claimant is self-employed, written statements, or other evidence showing:
  - (1) The amount of earnings actually lost, and
  - (2) **The Federal tax return if filed for the three previous years.**
- (f) If the claim arises out of injuries to a person providing services to the claimant, statement of the cost necessarily incurred to replace the services to which claimant is entitled under law.

## Notes

### Authority

Authority: 14 U.S.C. 503; 49 CFR 1.45(a); 49 CFR 1.45(b); 49 CFR 1.46(b), unless otherwise noted.

### Source

Source: CGD 80-033, 46 FR 27109, May 18, 1981, unless otherwise noted.