Sec. 25.02.03.05. Documentation

A. Death. In support of a claim for death, the claimant may be required to submit the following evidence or information:

(1) An authenticated death certificate or report, or both, of postmortem examination showing the date and cause of death and the age of the decedent;

(2) Documentation of the decedent's employment or occupation, if any, at time of death, including the decedent's monthly or yearly salary or earnings and the duration of the decedent's last employment or occupation;

(3) Identification by full name, address, birthdate, kinship, and marital status of each of the decedent's survivors, including identification of those survivors who were dependent for support upon the decedent at the time of the decedent's death;

(4) Documentation of the degree of support afforded by the decedent to each survivor dependent for support upon the decedent at the time of the decedent's death;

(5) Evidence of the decedent's general physical and mental condition before death;

(6) Itemized bills for medical and burial expenses incurred by reason of the incident causing death or itemized receipts of payment for these expenses;

(7) If damages for pain and suffering before death are claimed, a physician's detailed statement specifying the:

(a) Injuries suffered,

(b) Duration of pain and suffering,

(c) Drugs administered for pain, and

(d) Decedent's physical condition in the interval between injury and death; and

(8) Other evidence or information that, in the Treasurer's judgment, may have a bearing on either the responsibility of the State for the death or for the damages claimed.

B. Personal Injury. In support of a claim for personal injury, the claimant may be required to submit the following evidence or information:

(1) A written report by the claimant's attending physician or dentist setting forth the nature and extent of the injury, the nature and extent of treatment, any degree of temporary or permanent disability, the prognosis, the period of any hospitalization, and any diminished earning capacity;

(2) If the claimant is required by the Treasurer to submit to a physical or mental examination by a physician employed or retained by the State, a copy of the report of the examining physician, which shall be made available to the claimant upon the claimant's written request provided that the claimant has:

(a) Upon the Treasurer's request, furnished the report referred to in §B(2), above, and

(b) Made or agrees to make available to the Treasurer any other physician's reports previously or thereafter made of the physical or mental condition that is the subject matter of the claim;

(3) Itemized bills for medical, dental, and hospital expenses incurred or itemized receipts of payment for those expenses;

(4) If the prognosis reveals the necessity for future treatment, a statement of expected expenses for that treatment;

(5) If a claim is made for lost wages due to loss of time from employment, a written statement from the claimant's employer stating the actual time lost from employment, whether the claimant is a full or part-time employee, and the wages or salary actually lost;

(6) If a claim is made for loss of income and the claimant is self-employed, documentary evidence showing the amount of earnings actually lost; and

(7) Other evidence or information that, in the Treasurer's judgment, may have a bearing on either the responsibility of the State for the personal injury or for the damages claimed.

C. Property Damage. In support of a claim for property damage or loss, the claimant may be required to submit the following evidence or information:

(1) Proof of ownership or evidence of the claimant's contractual obligation to repair or replace the property;

(2) A detailed statement of the date of purchase, purchase price, actual cash value at time of the incident, and amount claimed with respect to each item of property reasonably capable of economical repair;

(3) A detailed statement of the date of purchase, purchase price, actual cash value at time of the incident, and salvage value with respect to each item of property not reasonably capable of economical repair;

(4) An itemized receipt of payment for emergency repairs or three itemized written estimates of the cost of necessary repairs; and

(5) Other evidence or information that, in the judgment of the Treasurer, may have a bearing on either the responsibility of the State for the property damage or loss or for the damages claimed.