Employee Claims Manual

DOT 2770.9A Page 1-1 CHAPTER 1. GENERAL 1. PURPOSE. This Manual establishes procedures and guidelines for employee claims for personal property lost or damaged incident to service with It also prescribes requirements and procedures for the Department, investigating such claims.

2. APPLICABILITY.

a . This Manual covers employee claims up to $25,000 for personal prop- erty loss or damage incident to service with the Department as pro- vided by 31 United States Code 3721, Military Personnel and Civilian Employees' Claims Act. (Claims covered by the Federal Tort Claims Act are not allowable under this Manual.) As used in this Manual, the word "employee" includes U . S . Coast Guard mi 1 i tary personnel.

Allowable claims may be submitted by any employee, the authorized agent or legal representative of an employee, or survivors of an employee in the following order: (1) Spouse; (2) Child or children; (3) Father or mother, or both; and (4) Brothers or sisters, or both.

b . The insurer's or other subrogee's rights cannot be substituted for the rights of an employee or his survivors under the law.

3. RESPONSIBILITIES.

The Office of the Secretary and the Operating Administrations are a .

responsible for implementing the procedures in this Manual.

b . The Office of the Secretary and the Operating Administrations will provide for appointment of claims investigators and will develop necessary procedures to enable a thorough investigation and verifi- cation of each claim made. The investigation of a claim shall be considered an action distinct from and subsequent to investigative and related actions taken upon initial receipt of a report of loss or damage. This, however, does not preclude the use of the same Department investigative element if appropriate.

4. DELEGATION OF AUTHORITY. The authority to settle and pay claims is granted to the Assistant Secretary for Administration (for the Office of the Secretary) and Heads of operating ~dministrations under the Department of Transportation Organization Manual, DOT 1100.60, of 3-7-79. Authority may be redelegated to office directors, regional directors, district com- manders or other comparable levels and to those individuals that report to the above officials. Further redelegation is not authorized.

DOT 2770.9A 8 / 1 /83

5. - FORMS. A claim will be submitted on DOT F 2700.6, Employee Claim for

Loss or Damage to Persona1 Property, (Appendix 1) as discussed in Chap- ter 2. Payment of the claim will be made on DOT F 2700.5, Voucher for Payment Under Military and Civilian Employees Claims Act, (Appendix 2) as provided in Chapter 3. Appendix 3 provides a sample of the type of information required by employees when submitting a claim against a carrier for loss or damage to property. The sample is not intended as a Departmental form and none will be prescribed for this purpose.

DOT 2770.9A Page 2-1 8/1/83 CHAPTER 2 . CLAIMS 1.

ALLOWABLE CLAIMS. The approving official will decide whether or not a claim is allowable based on the facts in the claim investigator's report and on the recommendation of legal counsel when appropriate.

Before approving a claim, the official will use the criteria in this Manual to determine if a claim is reasonable and whether the loss or damage was incurred incident to the employee's service.

General. No compensation shall be paid for loss or damage to personal property unless, considering the place and circumstances, an individual could reasonably be expected to have such property in his possession.

Losses in Quarters or Other Authorized Places. Losses which occur in the quarters of the employee or other authorized place when on official business are compensable only if the quarters are provided by the Government or are located outside the 5 0 States and the District of Columbia, see 31 USC 3721(e).

Storage Losses. Where losses occur at any warehouse, office, baggage holding area, or other place authorized for receiving or storing property, storage of the personal property lost or damaged must have been authorized by the Department, and the claimant must have complied with regulations concerning storage at that place in order for the loss to be cornpensable.

Travel and Transportation Losses. Compensable losses incurred in transit in connection with official temporary duty and permanent change of station travel include losses of unaccompanied baggage or household goods, losses of personal property accompanying the employee, and losses or damage to other authorized items (e.g., Losses items required for the performance of an assignment).

incurred while property was stored at a commercial facility for the personal convenience of the claimant at his expense See decision pursuant to an authorized move are not compensable.

of the Comptro 1 ler General, 8-153031, 1-28-64, concerning commuted rate household goods shipments.

Theft losses are not compensable when the claimant Theft Losses.

,did not use reasonable care'in protecting the property.

When clothing and articles being Clothing and Articles Being Worn.

worn are lost, damaged or destroyed under circumstances. incident to service, a claim is allowable provided such loss resulted from an unusual occurrence; i . e . , beyond the risk of usual daily activity.

Page 2-2 DOT 2770.9A 8/ 1 /83 g. Motor V e h i c l e s . Claims f o r l o s s o r damage t o motor v e h i c l e s i n c i d e n t t o oversea shipwents a u t h o r i z e d by t h e Government w i l l o r d i n a r i l y be allowed. M e r i t o r i o u s c l a i m s f o r l o s s o r damage may be s u b m i t t e d i n some i n s t a n c e s when a v e h i c l e i s used i n connection w i t h o f f i c i a l business, see 60 Comp. Gen. 633 f o r a d d i t i o n a l guidance.

2. NONALLOWABLE CLAIMS. Claims o t h e r w i s e considered a1 lowable w i t h i n t h e scope o f t h i s Manual a r e NOT a l l o w a b l e when t h e damage o r l o s s o f p e r s o n a l l v e s any o f t h e f o l l o w i n g : p r o p e r t y i n c i d e n t t o Department s e r v i c e i n v o a. Business P r o p e r t y . Any a r t i c l e used, o r f o r use, i n a p r i v a t e business e n t e r p r i s e .

b. Money. Claim?. f o r l o s s of money may be a lowable under t h e f o l l o w i n g c o n d i t i o n s . a ( 1 ) When d e p o s i t e d w i t h personnel a u t h o r i z e d t o r e c e i v e funds f o r t h e purpose of safekeeping o r t r a n s m i t t a l p r o v i d e d an a p p r o p r i a t e s e c u r i t y c o n t a i n e r i s used which i s d e d i c a t e d t o t h e s t o r a g e o f funds and i s under t h e e x c l u s i v e c o n t r o l o f t h e a u t h o r i z e d r e c i p i e n t .

( 2 ) When l o s t i n c i d e n t t o an accident, f i r e o r n a t u r a l d i s a s t e r .

When s t o l e n from q u a r t e r s p r o v i d e d t h e c l a i m a n t had e x e r c i s e d ( 3 ) due care.

m e y i n c l u d e s cash and n e g o t i a b l e i n s t r u m e n t s As used h e r e i n , b u t excludes any l i a b i l i t y i n c u r r e d b y t h e l o s s of p e r s o n a l c r e d i t cards.

c. Neqliqence o f Claimant. Damage o r l o s s o f p e r s o n a l p r o p e r t y caused i n whole o r p a r t by n e g l i g e n c e o r wrongful a c t on t h e p a r t o f t h e c l a i m a n t o r h i s agent o r h i s employee. F o r t h e purpose o f t h i s Manual, n e g l i g e n c e i s d e f i n e d as f a i l u r e t o e x e r c i s e t h a t degree o f c a r e which a reasonable and p r u d e n t person would have e x e r c i s e d under t h e same o r s i m i l a r circumstances. Damage o r l o s s t o p o r t i o n s o f personal p r o p e r t y denied because of t h e n e g l i g e n c e o f t h e c l a i m a n t w i l l n o t a c t t o b a r c l a i m s f o r damage o r l o s s t o o t h e r p o r t i o n s of t h e same p r o p e r t y which a r e a l l o w a b l e under paragraph 1 o f t h i s Chapter.

d. V i o l a t i o n o f D i r e c t i v e s . Items which were acquired, possessed, o r t r a n s p o r t e d i n v i o l a t i o n o f p e r t i n e n t d i r e c t i v e s and r e q u l a t i o n s .

T h i s subparagraph does n o t p r o h i b i t payment o f c l a i m s for losses t o shipments t o t h e e x t e n t t h a t those shipments exceeded maximum w e i g h t e n t i t l e m e n t s .

e. Personal E f f e c t s . Personal p r o p e r t y , i n c l u d i n g items t o be used i n l i e u o f o r i n a d d i t i o n t o Government-furnished equipment, which i s b r o u g h t i n t o Government o f f i c e s o r o t h e r a u t h o r i z e d p l a c e a t t h e d i s c r e t i o n o f t h e employee.

DOT 2770.9A Page 2-3 8/ 1 /83 3. LIMITATION. The t o t a l amount of a c l a i m f i l e d by an employee a r i s i n g from a s i n g l e i n c i d e n t may n o t be s e t t l e d f o r more t h a n $25.000.

> - - Claims a r i s i n g p r i o r t o ~ u l y 28, 1982 may n o t be s e t t l e d f o r more t h a n $15,000.

4. CLAIMS ARISING I N FOREIGN AREAS BECAUSE O F HOSTILE ACTS.

Claims f o r l o s s o r damage t o p e r s o n a l p r o p e r t y i n a f o r e i g n c o u n t r y may be p a i d up t o $40,000 if t h e l o s s o r damage a. was i n c i d e n t t o an e v a c u a t i o n of U n i t e d S t a t e s personnel i n response t o p o l i t i c a l u n r e s t o r h o s t i l e a c t s o r b. r e s u l t e d f r o m a c t s of mob violence, t e r r o r i s t attacks, o r o t h e r h o s t i l e a c t s d i r e c t e d a g a i n s t t h e U n i t e d S t a t e s Government c r i t s personnel.

Upon payment o f a claim, t h e U n i t e d S t a t e s becomes subrogated t o t h e c l a i m a n t ' s r i g h t s a g a i n s t t h e f o r e i g n c o u n t r y i n which t h e l o s s o r damage occurred. A d d i t i o n a l l y , funds may be o b l i g a t e d o r expended under t h i s a u t h o r i t y ( 3 1 USC 3721(c)) o n l y t o t h e e x t e n t t h e y a r e s p e c i f i c a l l y p r o v i d e d f o r i n a p p r o p r i a t i o n acts.

FILING O F CLAIMS.

a. General. A l l c l a i m s coming w i t h i n t h e scope of t h i s Manual should be s u b m i t t e d t o t h e designated o f f i c e . The law p r o v i d e s t h a t a c l a i m must be submitted w i t h i n two y e a r s a f t e r i t accrues u n l e s s i n which case i f good cause war o r armed c o n f l i c t intervenes, t h e c l a i m may be presented n o t l a t e r than two y e a r s i s shown, t o e x i s t , o r two y e a r s a f t e r t h e war o r a f t e r t h e cause ceases armed c o n f l i c t i s terminated, whichever i s e a r l i e r . For f i 1 i n g c l a i m s f o r l o s s o r damage t o p r o p e r t y shipped under a Government B i l l o f Lading, see Chapter 3.

b. Evidence t o be Submitted b y Claimant. DOT F 2700.6, Employee Claim f o r Loss o r Damage t o Personal Property, (Appendix 1 ) s h a l l be s u b m i t t e d i n an o r i g i n a l and one copy for a l l c i a i m s coming w i t h i n t h e scope o f I n a d d i t i o n t o DOT F 2700.6, t h e f o l l o w i n g s u p p o r t i n g t h i s Manual.

evidence s h a l l be s u b m i t t e d when a p p l i c a b l e .

( 1 ) I t e m i z e d b i l l f o r r e p a i r o f damaged p r o p e r t y .

( 2 ) Evidence t h a t t h e employee has f i l e d a c l a i m w i t h t h e c a r r i e r .

( 3 ) A statement concerning any insurance coverage and r e imbursement o b t a i n e d from t h e i n s u r e r . The statement should d e s c r i b e t h e g i v e t h e name o f t h e i n s u r e r and t y p e o f insurance and coverage, i n c l u d e t h e amount o f reimbursement r e c e i v e d f o r each item.

( 4 ) B i l l o f l a d i n g where goods are l o s t o r damaged i n t r a n s i t i n c l u d i n g a l l s h i p p i n g / r e c e i v i n g documents e v i d e n c i n g the c o n d i t i o n o f t h e claimed items.

Page 2-4 DOT 2770.9A ( 5 ) A t l e a s t one w r i t t e n e s t i m a t e o f t h e c o s t o f r e p a i r s from a competent b i d d e r o r person if t h e p r o p e r t y i s r e p a i r a b l e b u t has n o t been r e p a i r e d . "Competent b i d d e r o r person'' means one who has experience i n t h e l i n e of needed r e p a i r s and i s i n a p o s i t i o n t o know t h e c o s t of r e p a i r of such items i n t h e c u r r e n t market.

(The c o s t of p r e p a r i n g t h e e s t i m a t e i s reimbursable i n accordance w i t h t h i s Manual.) Exceptions t o t h e above a r e p e r m i s s i b l e when i n t h e o p i n i o n of t h e c l a i m i n v e s t i g a t o r t h e probable e s t i m a t e f e e w i l l be o u t of p r o p o r t i o n t o t h e c o s t o f r e p a i r .

I n t h i s s i t u a t i o n , t h e c l a i m i n v e s t i g a t o r , w i t h t h e concurrence o f t h e claimant, w i l l recommend an amount f o r payment. The approving o f f i c i a l may r e j e c t any e s t i m a t e o r statement o f t h e c o s t o f r e p a i r s t h a t does n o t meet t h e above standards. The c l a i m a n t s h a l l s a t i s f y t h e c l a i m i n v e s t i g a t o r t h a t items claimed as beyond economical r e p a i r a r e i n f a c t i n t h a t c o n d i t i o n by s u b m i t t i n g evidence r e c e i v e d f r o m a competent person.

c. Submission o f DOT F 2700.6, Employee Claim f o r Loss o r Damage t o Personal P r o p e r t y . Claimant s h a l l submit DOT F 2700.6 t o t h e c l a i m i n v e s t i g a t o r designated b y each Operating A d m i n i s t r a t i o n i n accord- ance w i t h Chapter 1. Claimants w i t h i n t h e O f f i c e o f t h e S e c r e t a r y should f o r w a r d c l a i m s t o t h e O f f i c e of A d m i n i s t r a t i v e Operations, M-40, f o r r e v i e w and i n v e s t i g a t i o n p r i o r t o u l t i m a t e s e t t l e m e n t by t h e A s s i s t a n t S e c r e t a r y f o r A d m i n i s t r a t i o n .

D O T 2770.9A Page 3-1 8/ 1 /83 CHAPTER 3. PROCESSING CLAIMS 1. FACTORS APPLIED I N PROCESSING CLAIMS.

a. Cost o r Value. In most cases t h e value of t h e loss o r damage i n c u r r e d should be p r e d i c a t e d upon t h e replacement c o s t a t t h e time o f t h e i n c i d e n t .

Replacement c o s t should be computed on t h e b a s i s o f t h e c o s t o f a new i t e m l e s s t h e a p p r o p r i a t e percentage o f depreci- a t i o n so as t o compensate f o r the age and l e n g t h o f t i m e t h e i t e m has been i n use. T h i s r u l e i s designed t o r e f l e c t changes i n t h e purchasing power of t h e d o l l a r which have taken place s i n c e t h e i t e m was o r i g i n a l l y purchased. The amount of settlement w i l l be determined b y a p p l y i n g t h e a p p l i c a b l e r a t e s o f d e p r e c i a t i o n t o t h e replacement c o s t o f p r o p e r t y l o s t o r damaged beyond economical r e p a i r , and by approving , t h e c o s t o f r e p a i r s when an i t e m i s economically r e p a i r a b l e , p r o v i d e d t h e c o s t o f r e p a i r s does n o t exceed t h e depreciated value o f t h e item.

b. Depreciation. Depreciation i n t h e value o f an i t e m w i l l be determined by c o n s i d e r i n g t h e t y p e of a r t i c l e involved, i t s cost, c o n d i t i o n when l o s t o r damaged beyond economical r e p a i r , and t h e time elapsed between t h e date o f a c q u i s i t i o n and t h e date o f accrual o f t h e claim.* To help assure u n i f o r m i t y i n a p p l y i n g r a t e s o f depreciation, t h e standard guide f o r use w i t h i n the Department w i l l be t h e J o i n t M i l i t a r y / I n d u s t r y D e p r e c i a t i o n Guide a v a i l a b l e from the American Movers Conference, P.O. Box 2303, Arlington, V i r g i n i a 22202. This guide i s g e n e r a l l y a v a i l a b l e a t most agencies' t r a n s p o r t a t i o n o f f ices, l o c a l o f f i c e s o f c a r r i e r s and r e g i o n a l o f f i c e s o f t h e General Services A d m i n i s t r a t i o n .

Other s i m i l a r standard guides may be used i n exceptional circumstances.

*Date o f accrual of t h e c l a i m i s g e n e r a l l y t h e date o f t h e i n c i d e n t causing t h e l o s s o r damage. I n some instances, such as w i t h stored should household goods, t h i s date may be t h e date t h e claimant (1) have discovered the l o s s o r damage through t h e exercise o f due d i l i g e n c e o r ( 2 ) was o f f i c i a l l y n o t i f i e d o f t h e l o s s o r damage.

c. Special Allowance f o r Locations Outside t h e 48 Contiguous States.

An a d d i t i o n a l amount, n o t i n excess of 25 percent of t h e depreciated value o f t h e property, may be allowed by t h e designated o f f i c i a l t o compensate employees s t a t i o n e d o u t s i d e t h e contiguous 48 S t a t e s f o r l o s s o r damage t o t h e i r personal property. This i s t o o f f s e t t h e a d d i t i o n a l c o s t s o f r e p a i r s o r replacement t h a t may be encountered by employees a t such l o c a t i o n s . The determination by t h e designated o f f i c i a l as t o the a d d i t i o n a l amount allowable, i f any, w i l l be f i n a l .

The b a s i s f o r the determination t o a l l o w an a d d i t i o n a l amount should be f u l l y explained i n t h e c l a i m f i l e .

D O T 2770.9A Page 3-2 C 8/ 1 /83 2. CLAIMS AGAINST C A R R I E R OR INSURER.

a. C a r r i e r Claims.

(1) Whenever p r o p e r t y shipped under the commuted r a t e system i s l o s t , damaged, o r destroyed whi l e b e i n g shipped pursuant t o authorized t r a v e l orders; the employee must f i l e a w r i t t e n c l a i m f o r reim- bursement w i t h t h e c a r r i e r according t o t h e terms o f t h e commercial b i l l of l a d i n g o r c o n t r a c t . This demand should be made a g a i n s t t h e l a s t c o n e r c i a l c a r r i e r known o r b e l i e v e d t o have handled the goods, unless t h e c a r r i e r who was i n possession o f t h e p r o p e r t y when t h e damage o r l o s s occurred i s known. I n t h i s event, t h e de- mand should be made against the l a s t c a r r i e r on each such document.

( 2 ) If it i s apparent t h a t t h e damage o r l o s s i s a t t r i b u t a b l e t o packing, storage, o r unpacking w h i l e i n the custody of t h e Govern- ment, no demand need be made against the c a r r i e r . Damage o r l o s s a t t r i b u t a b l e t o the Government g e n e r a l l y occurs o n l y when employees are being moved from or t o remote l o c a t i o n s .

( 3 ) When shipment i s authorized a t a c t u a l expense by Government b i l l o f lading, claims f o r l o s s o r damage t o p r o p e r t y can f r e q u e n t l y be r e s o l v e d through d i r e c t c o n t a c t between t h e employee and t h e c a r r i e r o r i t s insurer. The servqcing t r a n s p o r t a t i o n o f f i c e w i 11 a s s i s t t h e employee if .necessary o r w i l l handle the c l a i m e n t i r e l y w i t h t h e assistance of t h e employee. The employee must p r o v i d e t h e t r a n s p o r t a t i o n o f f i c e r w i t h suff i c f e n t supporting evidence t o p e r m i t f i l i n g a c l a i m against the c a r r i e r . This may r e q u i r e t h a t m e employee p r o v i d e an estimate of the cost of r e p a i r o r r e p lacement o f p r o p e r t y damaged o r l ~ s t .

b. I n s u r e r Claims. Whenever p r o p e r t y i s damaged, l o s t o r destroyed and t h e employee must make a demand i n i s insured i n whole o r i n p a r t , w r i t i n g f o r reimbursement under t h e terms and c o n d i t i o n s o f t h e i n s u r - ance coverage. Such demand shodld be made w i t h i n t h e time 1 i m i t e s t a b l i s h e d i n the p o l i c y and p r i o r t o f i l i n g a concurrent claim, i f any, a g a i n s t t h e Government. See paragraph 8.

c. Demand on C a r r i e r o r Insurer. It i s suggested t h a t such demands be made i n s u b s t a n t i a l l y t h e format as i n d i c a t e d i n Appendix 3.

d. Replacement i n Kind. Replacement i n k i n d i s allowable i n l i e u o f a cash settlement f o r claims by U.S. Coast Guard personnel i n accordance w i t h t h e Coast Guard Claims Manual.

CONCURRENT CLAIMS AGAINST THE CARRIER, THE INSURER, A N D THE GOVERNMENT.

3.

Generally claims against the Government w i l l n o t be p a i d u n t i l claims against c a r r i e r s o r i n s u r e r s have been s e t t l e d . However, i n s i t u a t i o n s where settlement o f a c l a i m against a c a r r i e r and/or i n s u r e r w i 11 be prolonged so as t o impose a hardship upon the employee, a c l a i m may be presented t o t h e Government w i t h o u t w a i t i n g f o r t h e d i s p o s i t i o n o f t h e c l a i m against the c a r r i e r o r i n s u r e r . Payment of t h e c l a i m i s subject t o t h e f o l l o w i n g c o n d i t i o n s : D O T 2770.9A Page 3-3 81 1/83 The employee must f u r n i s h the c l a i m i n v e s t i g a t o r w i t h a copy o f a l l a.

documents r e l a t i n g t o t h e c l a i m (insurance p o l i c i e s , etc.) together w i t h a signed statement waiving the r i g h t t o reimbursement from the c a r r i e r o r i n s u r e r .

b. The employee s h a l l n o t i f y t h e c a r r i e r o r i n s u r e r t o forward copies o f a l l correspondence r e l a t e d t o t h e c l a i m t o t h e c l a i m i n v e s t i g a t o r .

The c l a i m against t h e Government w i l l be p a i d i n an amount approved c.

by t h e settlement a u t h o r i t y under t h e p r o v i s i o n s o f t h i s Manual.

d. The accounting o f f i c e w i l l e s t a b l i s h an account r e c e i v a b l e f o r the amount o f t h e c l a i m a g a i n s t t h e c a r r i e r o r insurer.

Proceeds received as a r e s u l t of payment of the c l a i m by the c a r r i e r o r i n s u r e r w i l l be c r e d i t e d as an a p p r o p r i a t i o n refund against t h e a p p r o p r i a t i o n from which payment t o t h e employee was o r i g i n a l l y made.

e. I n t h e event the amount of t h e c l a i m from t h e c a r r i e r o r i n s u r e r exceeds t h e amount p r e v i o u s l y p a i d t o t h e employee by t h e Department, t h e excess w i l l be refunded t o the employee.

4. PREPARATION O F CLAIM INVESTIGATOR REPORTS.

a. Form f o r Claim ~ n v e s t i g a t o r Reports. The c l a i m i n v e s t i g a t o r w i l l Employee Claim f o r complete t h e appropriate s e c t i o n of D O T F 2700.6, Loss o r Damage t o Personal Property.

b. I n v e s t i g a t i o n . The c l a i m i n v e s t i g a t o r w i l l consider a l l i n f o r m a t i o n and evidence submitted w i t h the c l a i m and conduct such i n v e s t i g a t i o n as may be necessary, i n c l u d i n g securing testimony from witnesses.

Claims A r i s i n g Out o f t h e Same I n c i d e n t . A separate r e p o r t w i l l be c.

prepared on each claim. However, w i t h several separate claims, t h e c l a i m i n v e s t i g a t o r may avoid d u p l i c a t i o n o f e f f o r t by completing necessary e x h i b i t s and t h e d e t a i l e d r e p o r t o f i n v e s t i g a t i o n w i t h a l l i n one c l a i m and i n c o r p o r a t i n g documents which are common t o the group by r e f e r e n c e t h e r e p o r t w i t h supporting e x h i b i t s i n t h e o t h e r claims a r i s i n g o u t o f the same i n c i d e n t . A b r i e f summary o f f a c t s r e l a t i n g t o t h e common i n c i d e n t should be included i n these l a t t e r claims, as w e l l as reference t o the c l a i m i n which the d e t a i l e d r e p o r t and e x h i b i t s may be found.

5. ACTION B Y LEGAL COUNSEL. Normally claims w i l l be handled by the c l a i m i n v e s t i g a t o r , and review by t h e l e g a l counsel i s o p t i o n a l . However, if there i s a question o f l e g a l i t y , complex claims w i l l be reviewed by the l e g a l counsel who w i l l make a r e c o n e n d a t i o n as t o whether t h e recomen- d a t i o n s o f t h e i n v e s t i g a t o r are supported by t h e evidence a v a i l a b l e and whether t h e allowance o f t h e c l a i m would be i n compliance w i t h t h e M i l i t a r y Personnel and C i v i l i a n Employees' Claims Act (31 USC 3721).

DOT 2770.9A ACTION BY DESIGNATED OFFICIALS. If the l e g a l counsel recommends payment o f t h e claim, t h e designated o f f i c i a l s h a l l approve o r disapprove it f o r payment, and i f approved, w i l l i n i t i a t e D O T F 2700.5, Voucher f o r Payment Under M i l i t a r y and C i v i l i a n Employees' Claims Act (Appendix 2 ) .

PAYMENT O F CLAIM. F o l l o w i n g c e r t i f i c a t i o n by t h e claimant and approval by t h e settlement a u t h o r i t y , t h e c l a i m and a l l supporting documentation w i 11 be forwarded t o the s e r v i c i n g accounting o f f ice.

FAILURE T O MAKE DEMAND ON CARRIER OR INSURER. F a i l u r e t o make a demand on a c a r r i e r o r i n s u r e r o r t o make a l l reasonable e f f o r t s t o c o l l e c t the amount recoverable may r e s u l t i n reducing t h e amount recoverable from t h e Government by t h e maximum amount which would have been recoverable had the c l a i m been t i m e l y and d i l i g e n t l y processed.

RECOVERY O F LOST ITEMS. I n t h e event a l o s t i t e m f o r which a c l a i m has been p a i d i s subsequently recovered, the employee must n o t i f y t h e settlement a u t h o r i t y and may be r e q u i r e d t o refund t h a t p o r t i o n o f t h e reimbursement t o t h e Government.

F O R THE SECRETARY O F TRANSPORTATION Robert L. Fairman A s s i s t a n t Secretary f o r A d m i n i s t r a t i o n

Appendix 1

DOT 2770.9A

8/1/83

Page 1 (and 2)

D E P A R T M E N T O F T R A N S P O R T A T I O N

EMPLOYEE CLAIM FOR LOSS OR DAMAGE TO PERSONAL PROPERTY

I

S E C T I O N A - C L A I M A N T I D E N T I F I C A T I O N

- ..-

I. N A M E A N C ADDRESS O F C k A I M A N T 2. T I T L E A N D G R A D E 3 . T E L E P H O N E NO.

I

4. O F F I C E OR S E R V I C E 5. L O C A T I O N (City and mtatej 6. L O C A T I O N WHERE LOSS OR D A M A G E O C C U R R E D 7. D A T E O F LOSSOR DAMAGE & T O T A L AMT.CLAMED

I s

S E C T I O N B - D E S C R I P T I O N O F P R O P E R T Y

BE BY I T E M I Z E D L I S T I N G D A T E P U R C H A S E P R I C E I N V E S T I G A T O R ( ~ t t e c h mrgplemantel aheel, I ! nece*rery) A C Q U I R E D O R V A L U E D E P R E C l A T ED VALUE 9. C L A I M IS FOR (Check one) 10. B R I E F S T A T E M E N T O F CIRCUMSTANCES

LOSS (Includes theft)

DAMAGE -- .

I t ( A . WAS P R O P E R T Y INSURED?

IZA. WAS P R O P E R T Y I N POSSESSION O F COMMON C A R R I E R A T T I M E O F LOSS YES ( I F 'YES.. complete 1 1 8 m d 1 1 0

: : 1 NO ~ Y E S ~ I ~ .YES. ~ o w l o e 1 2 8 s r d 1 2 ~ )

El NO

8. N A M E O F INSURER 8. H A S C L A I M B E E N M A O E

ONO DYES

C. AMOUNT C O L L E C T E D (Attach i f m i z e d lialing) C. DISPOSITION O F C L A I M I C E R T I F I C A T I O N - I m a k e l h ~ s c l a i m w i t h f u l l k n o w l e d q e o f t h e p e n a l t ~ e s l o r w i l l f u l l y m a k ~ n q a f a l s e clmm a n d c e r t l l y t h a t I m e n t ~ t l e d to a n y p a y m e n t s .

4. I F C L A I M A N T I S N O T OWNER. S T A T E R E L A T I ON- 13. WTE 15. S I G N A T U R E O F C L A I M A N T S H I P I I C R I M I N A L P E N A L T Y F O R P R E S E N T I N G A F R A U D U L E N T C L A I M OR M A K I N G F A L S E S T A T E M E N T : Fine of not more than f 10,000 or imprisonment for not more than 5 years or both (1.8 U.S.C. 287, 1091)

S E C T I O N C - (Ta &. Camoleted Bv Desionated I n v e s t i w t n r )

I 1 6 N A M E O F I N V E S T I G A T O R 117. T I T L E A N D G q A D E / 10. T E L E P H O N E NO.

19. O F F I C E OR S E R V I C E 20. L O C A T I O N (City and State) 21, V E R I F I C A T I O N O F F A C T S / D I S C R E P A N C I E S 22. R E M A R K S A N D RECOMMENDATIONS

I

23. D A T E 24. S I G N A T U R E O F I N V E S T I G A T O R I

S E C T I O N D - A P P R O V A L

26. D A T E 2 5 . P A Y M E N T IS A P P R O V E D I N T H E AMOUNT 27. S I G N A T U R E O F A P P R O V I N G O F F I C I A L

O F s

--

I I

Form DOT F 2700.6 12-731

DOT 2770.9A

A pendix 2

d g a 1 (end 2)

8/1/83

o m Approved B y Tho SCHEDULE NO.

DEPARTMENT OF TRANSPORTATION ompuoller Cen*td. U.S.

ecember 7. 1967 voucn s~ NO.

VOUCHER FOR PAYMENT

UNDER MILITARY AND CIVILIAN EMPLOYEES CLAIMS ACT (PL 88-558) CLAIM NO.

L IAMB OF CLAIMANT PAID BY AILING ADDRESS MOUNT O F AWARD, COMPROMISE, OR SETTLEMENT $ IRIEF DESCRIPTION OF CLAIM IS.. .Ita&mmte lor hrr(h*t . ~ l m e t l a in kl.11) CLAIMANT'S CERTIFICATE I C E R T I F Y THAT: t h e d a m a g e , l o s s , o r d e s t r u c t i o n w a s not c a u s e d i n w h o l e or in p r t by a n y n e g l i g e n c e or wrongful a c t on t h e part o f t h e c l a i m n t , or h i s a g e n t a employee; none of t h e p o p e r t y h a s b e e n r e c o v e r e d , nor h a s a n y of t h e p r o p erty b e e n r e p l a c e d (exc.pr a. e x p l a f n e d on the a t t a c h e d ~ o r m DOT F 3700.61; t h e damage, l o s s o r d e s t r u c t i o n w a s noc cov- e r e d by i n s u r a n c e nor r e i m b u r s a b l e by common c a r r i e r (except a* *xplaln*d o n t h e a t t a c h e d Form DOT F . 2700.6); a11 a r t i c l e s l i s t e d on Form DOT F 2700.6 (end on additional ehoet. made p a r t thereof) h a v e b e e n p i v a t e l y p u r c h a s e d a n d a r e n a Govern- ment property; a n d n o p e v i o u s c l a i m h a s b e e n made t o r h e Government for t h e property lor v h i c h t h i s cl&m i s made ( e x c * ~ t a e expla1n.d on the F o m DOT F 2700.6).

If a n y of t h e property for which c l a i m i s m a d e is l a t a r e c o v a e d , c l a i m a n t a g r e e s t o g i v e n a i c e immcdiacely t o t h e DOT 1 make t h e foregoing c l a i m with f u l l k n o w l d ~ e of t h e p e n a l t i e s i n v o l v d f a wilfully making a f a l s e c l a i m , (v.s. cod..

T i t l e 1 6 , Sectdon 267, provide* br l maximum l i n e o f 110.000 o r Impdaonment l o r J yeare o r b t h ) . I, t h e c l a i m a n t a l s o a c c e p t t h e within-stated a w a r d , c o m p r o m i s e , u s a t l e m e n t a s f i n a l and c o n c l u s i v e o n m e , and a g r e e that s a i d a c c e p t a n c e c o n s t i t u t e s a c o m p l e t e r e l e a s e by me of a n y c l a i m a g a i n s t t h e United S c a t e s a n d a g a i n s t t h e employee of t h e Govetnment w h o s e s c t or o m i s s i o n g a v e r i s e t o t h e c l a i m , by r e a s o n of t h e s a m e s u b j e c t matter.

i I G N A T U R E O F WITNESS TO CLAIMANT'S SIGNATURE SIGNATURE O F CLAIMANT ( a u l h o d r a d a g m 0 DATE

I I

- T h i s c l a i m h a s b e e n fully examined i n a c c o r d a n c e with t h e P u r s u a n t t o t h e authority v e s t e d in me. I C E R T I F Y t h a t t h i s provisions of [he Military personnel and Civilian Employees, and proper for payment in the C l a i m s Act a p p r o v e d August 31, 1964 a n d i s a p p r o v e d i n t h e I voucher is AMOUNT O F s AMOUNT O F S PIGNATURE OF APPROVING OFFICIAL SIGNATURE O F AUTHORIZED CERTIFYING D A T E D A T E OF FlCER T I T L E r l T L E I iCCOUNTING CLASSIFICATION PAID BY CHECK NO.

I

: o m DOT F 2700.5 12-73)

DOT 2770.9A Appendix 3 8/1/83 Page 1 (and 2 ) .

SAMPLE DEMAND ON CARRIER FOR DAMAGE TO SAMPLE

.- .OR LOSS OF PROPERTY

N AMC O F C 1 I R l . I A 0 0 R C l l T O T A L V A L U E O C E N T I R E SYIPMCNT PLEASF MAIL A L L CORRESPONDENCE o( REGARD TO THIS CLAIM TO: I N A M E O F C L A I M A N T

I