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Expand List item 1185Collapse List item 1185  A Civilian Not Employed by the Coast Guard

•Who may file a claim against the Coast Guard?

Anyone (e.g., an individual, a country, a territory, a partnership, or an association).
•What is a claim?
A demand for payment, made from any member of the community, against the Coast Guard, for damage or loss arising from the Coast Guard’s action.
•I think I have a claim. What do I do?
If you think you have a claim for damage, injury, or death, against the Coast Guard, you need to fill out a SF-95 and mail it to LSC-C.
  1. Legal Service Command (LSC-C)
    US Coast Guard
    300 East Main Street, Suite 400
    Norfolk, VA 23510-9100


    2.  
•When should I use the SF-95?
Any time you request an administrative resolution of your claim.
Note: A SF-95 is not required for Admiralty claims but we recommend using the form to ensure that you provide all of the required information.
•Where can I find a SF-95?
Click here for a printable copy of the SF-95 .
•I am not sure what to enter in a certain Block on the SF-95.
    What should I do?
Read the SF-95 instruction contained on page 2 of the SF-95 form
Use the Line by Line Instructions contained within this webpage by moving your cursor over the applicable block.
Note: That these comments are for instructional purposes only and are not intended to be legal advice.
If you still have questions regarding the SF-95, you may call the LSC at (757) 628-4212, or e-mail us at:
D05-SMB-Claims@uscg.mil
•I have completed the SF-95. Now what do I do?
1. Make sure the SF-95 is completed and signed in ink.
2. Attach any and all supporting documentation to the SF-95.
3. Send the completed and signed SF-95, with any and all supporting documentation to:
  1. Legal Service Command (LSC-C)
    US Coast Guard
    300 East Main Street, Suite 400
    Norfolk, VA 23510-9100


    2.  
•What are examples of supporting documentation for the SF-95?
  1. •Two estimates for repair or 1 itemized repair bill (once repairs are made)
    •Pictures of damaged property
    •Rental car receipts
    •Witness Statements
    •Police reports
    •Any other documentation that supports the amount claimed


    2.  
•If I am claiming personal injury, what supporting documentation should I      provide?
  1. • Medical bills
    • Doctor reports (e.g., ambulance and emergency room records, in-patient and out-patient records, doctors’ and nurses’ notes, x-rays, lab reports, and any other reports prepared in connection with diagnosis and treatment).
    • Lost wages
    • Any information that helps describe or support your personal injury amount.


    2.  
•Can I submit the SF-95 electronically?
No. The original SF-95 must be signed in ink and mailed to the LSC office.
  1. Legal Service Command (LSC-C)
    US Coast Guard
    300 East Main Street, Suite 400
    Norfolk, VA 23510-9100


    2.  
•I filled out a SF-95. Where do I mail it?
Send the completed and signed SF-95, with any and all supporting documentation to:
  1. Legal Service Command Norfolk
    LSC-C, Claims Division
    300 East Main Street, Suite 400
    Norfolk, VA 23510-9100



    2.  
If you have already submitted your claim form to an office other than LSC-C you may contact LSC-C to ensure we have received your claim form.
 
•I am an active duty military member not employed by the Coast Guard
    and I have a claim against the Coast Guard; what should I do?
The action you take and the forms you complete are fact dependent as a result of your military status, please contact the legal service command at:
  1. Legal Service Command (LSC-C)
    US Coast Guard
    300 East Main Street, Suite 400
    Norfolk, VA 23510-9100


    2.  
Contact Us

If you have questions, you can call us at (757) 628-4212, e-mail us at: D05-SMB-Claims@uscg.mil or write us at our mailing address:

  1. Legal Service Command (LSC-C)
    US Coast Guard
    300 East Main Street, Suite 400
    Norfolk, VA 23510-9100

 

Expand List item 1187Collapse List item 1187  A Coast Guard Unit or an Investigating Officer Completing an Investigation

I am an Investigating Officer for a potential administrative claim against the government. What should I know?

• You need to fill out a Letter Incident Report (LIR). ATTACH SAMPLE LIR or a CG-4112A for personnel claims.
• Report facts in a clear and concise manner.
• Avoid including your opinion of fault in the report.
• Sometimes it may be necessary to contact the claimant during your investigation. It is acceptable to contact the claimant during your investigation if you need specific information from the claimant but NEVER contact the claimant if they have retained counsel.
• Attached is a Checklist for Investigating Officers

What is involved in a Claims Investigation?

• As soon as possible after an incident that might give rise to a claim against the Coast Guard, the responsible unit should undertake an investigation.
• In most claims matters, the preferred investigation format is the Letter Incident Report (LIR). If the Claimant is a Coast Guard employee use CG-4112A as the format for the investigation.
• Refer to the Administrative Investigations Manual (AIM), COMDTINST M5830.1, and Chapter 2 of the Coast Guard Claims and Litigation Manual, COMDTINST M5890.9 for specific guidance.

How long do I have to complete an investigation?

• Claims investigations should be completed immediately after an incident and forwarded to LSC-5E no later than 45 days after the date of incident.

What forms are required for Personnel claims and where can I find each form?

• Personnel claims should b filled out by the claimant (Coast Guard or Civilian Employee) on form CG-4112.

• Personnel claims normally do not require full administrative investigations. Instead, units should use the CG-4112A, Claims Investigating Officer’s Report of Personal Property Claim.
• Page 2 of the CG-4111, which is an inventory sheet, may also be requested by the Settlement Officer when the claim involves damage to several items.
 

I received a SF-95. What do I do with the form?
• Mail the original to the LSC office immediately.
  1. Legal Service Command (LSC-C) US Coast Guard 300 East Main Street, Suite 400 Norfolk, VA 23510-9100

I received papers from an attorney or insurance company regarding a CG-related incident. What do I do?

• Contact LSC immediately. Do not respond to the company or the attorney.
• If you receive a phone call please inform the attorney or insurance company that LSC-C, the Coast Guard’s Claims office is the responsible office. Provide them with our contact information. Contact LSC-C and provide contact information for the attorney or insurance company.

 

 

Contact Us

If you have questions, you can call us at (757) 628-4212, e-mail us at: D05-SMB-Claims@uscg.mil or write us at our mailing address:

  1. Legal Service Command (LSC-C)
    US Coast Guard
    300 East Main Street, Suite 400
    Norfolk, VA 23510-9100
Expand List item 3179Collapse List item 3179  How to file a claim

If you have questions, you can call us at (757) 628-4212, e-mail us at: D05-SMB-Claims@uscg.mil or write us at our mailing address:

  1. Legal Service Command (LSC-C)
    US Coast Guard
    300 East Main Street, Suite 400
    Norfolk, VA 23510-9100

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