Claim Filing Procedures for Medical Malpractice Claims by Navy and Marine Corps Service Members
The following guidance is provided to assist Navy or Marine Corps Service Members or their representatives who desire to file a claim for medical malpractice by members of the uniformed service for personal injury or wrongful death caused by the negligence of Department of Defense health care providers in a military medical treatment facility. Such claims will be considered pursuant to 10 U.S.C. § 2733a.
It is important to note that a claim must be presented to the Navy’s Tort Claims Unit (TCU) or other appropriate federal agency within 2 years after it occurs (or accrues). A claim may be filed via letter if it contains key elements but it is easiest to file a claim by completing a Fillable Standard Form 95. When filing a claim, it should be submitted with the specific supporting documents noted below to be considered a complete filing. Failure to submit those documents may result in the denial of the claim.
In order to properly adjudicate a claim fairly and quickly, we encourage you to fill out the SF-95 according to the following directions and attach all requested documents:
| Block 1 |
Office of the Judge Advocate General Tort Claims Unit 9620 Maryland Avenue, Suite 205 Norfolk, VA 23511-2949 |
| Block 2 | Name and current mailing address of claimant (or authorized agent, or legal representative). If authorized agent, provide evidence establishing express authority to act for claimant, showing title/legal capacity of the person signing with evidence of authority to present a claim. |
| Block 3 | Check “Military” for claimant who is/was a member of the armed forces on active duty at the time of the incident. |
| Block 4 | Claimant’s date of birth |
| Block 5 | Claimant’s marital status |
| Block 6 | Fill in day and date of incident when claim accrued. A specific date, not a date range needs to be entered. |
| Block 7 | Fill in approximate time of incident when claim accrued. |
| Block 8 | The factual basis of the claim, including the identification of the conduct allegedly constituting malpractice (e.g., the theory of liability and/or breach of the applicable standard of care). To the best of your ability, provide detailed facts that form the basis of the claim and identify all people involved, including the city and state of occurrence. The more information that is provided regarding the government employee and military treatment facility involved, the faster the TCU can complete its investigation. Without sufficient information to investigate, the TCU cannot adjudicate your claim. Note: The law requires the Department of Navy independently investigates each claim presented. |
| Block 9 | Not applicable (N/A) for claims of personal injury or wrongful death presented under the 10 U.S.C. § 2733a. |
| Block 10 |
Claimants presenting a claim for personal injury or wrongful death must state the nature and extent of each injury or cause of death and should include the following additional information: Personnel records establishing the claimant’s active duty status or proof of a reserve component member’s Federal duty status at the time of the incident; Copies of complete medical records, both inpatient and outpatient, related to the incident; Identity of any pertinent health care providers outside of DoD and a copy of medical records from each of the identified health care providers, including a statement that the records are complete. Medical release(s) enabling DoD to obtain medical records from any of these health care providers; Itemized bills for medical, dental, and hospital expenses incurred, or itemized receipts of payments for such expenses; If claiming lost wages, provide a written statement from your employer showing job description, actual time lost from employment, and wages/salary actually lost. If claiming loss of self-employed income, provide documentary evidence showing the number of earnings actually lost, including tax returns; Any Department of Veteran Affairs and/or Department of Defense medical disability/retirement evaluations in relation to your injuries directly related to the incident; and Any other relevant information regarding the medical care involved that supports the claim, such as information regarding the medical care involved, the acts or omissions believed to constitute malpractice, medical opinions from non-DOD providers, and evidence of pain and suffering or other harm. |
| Block 11 | List names and addresses of any witnesses. If none, fill in “N/A” or “unknown.” |
| Block 12 |
12a - Total property damage claimed will be “N/A”, 12b - Total amount for personal injury claimed. If none, fill in “N/A.” 12c - Total amount for wrongful death claimed. If none, fill in “N/A." 12d - Total amount claimed (12a + 12b + 12c). You must demand a specified dollar amount. Approximate amounts or “see attached” are not acceptable. Failure to specify a dollar amount may result in the denial of your claim. |
| Block 13 |
13a - Original signature or a verified electronic signature of the claimant (or authorized representative) required. Faxed or photocopies are acceptable. 13b - Provide the telephone number where the claimant can be reached. |
| Block 14 | Fill in the date claim is signed by claimant. |
| Block 15-19 | Not applicable for claims of personal injury and/or wrongful death. |
Additional Claim Requirements under 10 U.S.C. § 2733a
32 C.F.R. §45.4(b) also requires one of the following be submitted with the claim at the time of filing:
- If the claim is filed by an attorney, an affidavit from claimant affirming the attorney’s authority to file the claim on behalf of the claimant;
- If the claim is filed by an authorized representative, an affidavit from the representative affirming his/her authority to file on behalf of claimant;
- If the claimant is not represented by an attorney, unless the alleged medical malpractice is within the general knowledge and experience of ordinary laypersons, an affidavit from the claimant affirming the claimant consulted with a non-DOD health care professional who opined that a DoD health care provider breached the standard of care that caused the alleged harm.* Alternatively, if the claimant is represented by an attorney, unless the alleged medical malpractice is within the general knowledge and experience of ordinary laypersons, the claimant must submit an affidavit from the attorney affirming that the attorney consulted with a non-DOD health care professional who opined that a DoD health care provider breached the standard of care that caused the alleged harm.*
*NOTE - The expert should be a qualified health care professional who specializes in the same specialty as the health care provider against whom or on whose behalf the testimony is offered.
Failure to submit the required aforementioned information may result in an Initial Determination- Denial of Claim IAW 32 C.F.R. §45.12(a).
Additional Guidance
For further guidance and procedural information regarding medical malpractice claims by members of the uniformed services please visit Code of Federal Regulations.
Questions
If you have any questions concerning your claim, please contact the TCU at (757) 350-3085 or by fax at (757) 341-4563. You may also contact the office via e-mail at TCUMedMal@us.navy.mil. Please understand that filing a claim is not a guarantee of payment. You will be notified if your claim will be settled or denied. Send the completed SF-95, all required documents, and any supporting documents to:
Mailing Address:
Office of the Judge Advocate General
Tort Claims Unit
9620 Maryland Avenue, Suite 205
Norfolk, VA 23511-2949