20 C.F.R. Subpart A—Claims Against the Government Under the Federal Tort Claims Act
Title 20 - Employees' Benefits
(a) This subpart applies only to claims filed under the Federal Tort Claims Act, as amended, 28 U.S.C. 2671–2680 (FTCA), for money damages against the United States for damage to or loss of property or personal injury or death that is caused by the negligent or wrongful act or omission of an employee of the Social Security Administration (SSA). The loss, damage, injury or death must be caused by the employee in the performance of his or her official duties, under circumstances in which the United States, if a private person, would be liable in accordance with the law of the place where the act or omission occurred. This subpart does not apply to any tort claims excluded from the FTCA under 28 U.S.C. 2680. (b) This subpart is subject to and consistent with the regulations on administrative claims under the FTCA issued by the Attorney General at 28 CFR part 14. (a) Filing an initial claim. You must either file your claim on a properly executed Standard Form 95 or you must submit a written notification of the incident accompanied by a claim for the money damages in a sum certain for damage to or loss of property you believe occurred because of the incident. For purposes of this subpart, we consider your claim to be filed on the date we receive it at the address specified in paragraph (c) of this section. If you mistakenly send your claim to another Federal agency, we will not consider it to be filed until the date that we receive it. If you mistakenly file a claim meant for another Federal agency with SSA, we will transfer it to the appropriate Federal agency, if possible. If we are unable to determine the appropriate agency, we will return the claim to you. (b) Filing an amendment to your claim. You may file an amendment to your properly filed claim at any time before the SSA Claims Officer (as defined in §429.201(d)(3)) makes a final decision on your claim or before you bring suit under 28 U.S.C. 2675(a). You must submit an amendment in writing and sign it. If you file a timely amendment, SSA has 6 months in which to finally dispose of the amended claim. Your option to file suit does not begin until 6 months after you file the amendment. (c) Where to obtain claims forms and file claims. You may obtain claims forms and must file your claim with the Social Security Administration, Office of the General Counsel, Office of General Law, Administrative Claims Unit, Suite No. 56, P.O. Box 26430, Baltimore, Maryland 21207. (a) Claims for damage to or loss of property. If you are the owner of the property interest that is the subject of the claim, you, your duly authorized agent, or your legal representative may file the claim. (b) Claims for personal injury. If you suffered the injury, you, your duly authorized agent, or your legal representative may file the claim. (c) Claims based on death. The executor or administrator of your estate or any other person legally entitled to do so may file the claim. (d) Claims for loss wholly compensated by an insurer with the rights of a subrogee. The insurer may file the claim. When an insurer presents a claim asserting the rights of a subrogee, the insurer must present with the claim appropriate evidence that it has the rights of a subrogee. (e) Claims for loss partially compensated by an insurer with the rights of a subrogee. You and the insurer may file, jointly or separately. When an insurer presents a claim asserting the rights of a subrogee, the insurer must present with the claim appropriate evidence that it has the rights of a subrogee. (f) Claims by authorized agents or other legal representatives. Your duly authorized agent or other legal representative may submit your claim, provided satisfactory evidence is submitted establishing that person has express authority to act on your behalf. A claim presented by an agent or legal representative must be presented in your name. If the claim is signed by the agent or legal representative, it must show the person's title or legal capacity and must be accompanied by evidence that the person has the authority to file the claim on your behalf as agent, executor, administrator, parent, guardian or other representative. (a) Property damage. To support a claim for property damage, either real or personal, you 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, market value of the property as of date of damage, and salvage value, where repair is not economical. (5) Any other evidence or information that may have a bearing either on the responsibility of the United States for the injury to or loss of property or the damages claimed. (b) Personal injury. To support a claim for personal injury, including pain and suffering, you may be required to submit the following evidence or information: (1) A written report from your attending physician or dentist setting forth the nature and extent of your injury, nature and extent of treatment, any degree of temporary or permanent disability, your prognosis, period of hospitalization, and any diminished earning capacity. You may also be required to submit to a physical or mental examination by a physician employed or designated by SSA. If you submit a written request, we will provide you with a copy of the report of the examining physician provided you agree to make available to SSA any other physician's reports made of the physical or mental condition that is the subject of your claim. (2) Itemized bills for medical, dental, and hospital expenses incurred, or itemized receipts of payment for such expenses. (3) If your prognosis reveals that you will need future treatment, a statement of expected duration of and expenses for such treatment. (4) If you claim a loss of time from employment, a written statement from your employer showing actual time lost from employment, whether you are a full or part-time employee, and wages or salary you actually lost. (5) If you claim a loss of income and are self-employed, documentary evidence showing the amount of earnings you actually lost. For example, we may use income tax returns for several years prior to the injury in question and the year in which the injury occurred to indicate or measure lost income. A statement of how much it cost you to hire someone to do the same work you were doing at the time of the injury might also be used in measuring lost income. (6) Any other evidence or information that may have a bearing on either the responsibility of the United States for the personal injury or the damages claimed. (c) Claim based on death. To support the claim, we need the following evidence or information: (1) An authenticated death certificate or other believable documentation showing cause of death, date of death, and age at the time of death. (2) The decedent's employment or occupation at time of death, including monthly or yearly salary or earnings (if any), and the duration of 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 upon the decedent for support at the time of death. (4) Degree of support the decedent provided to each survivor dependent on the decedent for support at the time of death. (5) The decedent's general physical and mental condition before death. (6) Itemized bills for medical and burial expenses incurred, or itemized receipts of payments 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 that may have a bearing on either the responsibility of the United States for the death or the damages claimed. (d) Time limit for submitting evidence. You must furnish all the evidence required by this section within a reasonable time. If you fail to furnish all the evidence necessary to determine your claim within 60 days after being asked to do so, we may find that you have decided to abandon your claim. When we receive your claim, we will investigate to determine its validity. After our investigation, we will forward your claim to the SSA Claims Officer with our recommendation as to whether your claim should be fully or partially allowed or denied. (a) If your claim is denied, the SSA Claims Officer will send you, your agent, or your legal representative a written notice by certified or registered mail. The notice will include an explanation of why your claim was denied and will advise you of your right to file suit in an appropriate U.S. District Court not later than 6 months after the date of the mailing of the notice if you disagree with the determination. (b) Before filing suit and before expiration of the 6-month period after the date of the mailing of the denial notice, you, your duly authorized agent, or your legal representative may file a written request with SSA for reconsideration by certified or registered mail. If you file a timely request for reconsideration, SSA has 6 months from the date you file your request in which to finally dispose of your claim. Your right to file suit will not begin until 6 months after you file your request for reconsideration. Final SSA action on your request for reconsideration will occur in accordance with the provisions of paragraph (a) of this section. (a) Claims under $2,500. If your claim is approved, you must complete a “Voucher for Payment under the Federal Tort Claims Act,” Standard Form 1145. If you are represented by an attorney, the voucher for payment (SF 1145) must designate both you and your attorney as “payees”; we will then mail the check to your attorney. (b) Claims in excess of $2,500. If your claim is approved, SSA will forward the appropriate Financial Management Service (FMS) Forms 194, 195, 196, 197, and/or 197-A to the Judgment Fund Section, Financial Management Service, Department of the Treasury, Room 6D37, 3700 East-West Highway, Hyattsville, Maryland 20782. FMS will then mail the payment to you. If you, your agent, or your legal representative accept any award, compromise, or settlement under this subpart, your acceptance is final and conclusive on you, your agent or representative, and any other person on whose behalf or for whose benefit the claim was filed. The acceptance constitutes a complete release of any claim against the United States and against any employee of the Government whose act or omission gave rise to the claim, by reason of the same subject matter. A person who files a false claim or makes a false or fraudulent statement in a claim against the United States may be imprisoned for not more than 5 years. (18 U.S.C. 287, 1001). In addition, that person may be liable for a civil penalty of not less than $5,000 and not more than $10,000 and damages of triple the loss or damage sustained by the United States, as well as the costs of a civil action brought to recover any penalty or damages. (31 U.S.C. 3729). (a) An award, compromise or settlement of a claim under this subpart in excess of $25,000 needs the prior written approval of the Attorney General or his designee. For the purposes of this paragraph, we treat a principal claim and any derivative or subrogated claim as a single claim. (b) An administrative claim may be adjusted, determined, compromised, or settled under this subpart only after consultation with the Department of Justice when, in the opinion of SSA: (1) A new precedent or a new point of law is involved; (2) A question of policy is or may be involved; (3) The United States is or may be entitled to indemnity or contribution from a third party and SSA is unable to adjust the third-party claim; or (4) The compromise of a particular claim, as a practical matter, will or may control the disposition of a related claim in which the amount to be paid may exceed $25,000. (c) An administrative claim may be adjusted, determined, compromised or settled only after consultation with the Department of Justice when it is learned that the United States, or an employee, agent, or cost-plus contractor of the United States, is involved in litigation based on a claim arising out of the same incident or transaction.
Title 20: Employees' Benefits
PART 429—ADMINISTRATIVE CLAIMS UNDER THE FEDERAL TORT CLAIMS ACT AND RELATED STATUTES
Subpart A—Claims Against the Government Under the Federal Tort Claims Act
§ 429.101 What is this subpart about?
§ 429.102 How do I file a claim under this subpart?
§ 429.103 Who may file my claim?
§ 429.104 What evidence do I need to submit with my claim?
§ 429.105 What happens when you receive my claim?
§ 429.106 What happens if my claim is denied?
§ 429.107 If my claim is approved, how do I obtain payment?
§ 429.108 What happens if I accept an award, compromise, or settlement under this subpart?
§ 429.109 Are there any penalties for filing false claims?
§ 429.110 Are there any limitations on SSA's authority under this subpart?
