Proof of amount claimed for personal injury or death.

§ 25.117 Proof of amount claimed for personal injury or death. The following evidence must be presented when appropriate: (a) Itemized medical, hospital, and burial bills. (b) A written report by the attending physician including: (1) The nature and extent of the injury and the treatment, (2) The necessity and reasonableness of the various medical expenses incurred, (3) Duration of time injuries prevented or limited employment, (4) Past, present, and future limitations on employment, (5) Duration and extent of pain and suffering and of any disability or physical disfigurement, (6) A current prognosis, (7) Any anticipated medical expenses, and (8) Any past medical history of the claimant relevant to the particular injury alleged. Note: An examination by an independent medical facility or physician may be required to provide independent medical evidence against which to evaluate the written report of the claimant's physician. The settlement authority determines the need for this examination, makes mutually convenient arrangements for such an examination, and bears the costs thereof. (c) All hospital records or other medical documents from either this injury or any relevant past injury. (d) If the claimant is employed, a written statement by the claimant's employer certifying the claimant's: (1) Age, (2) Occupation, (3) Hours of employment, (4) Hourly rate of pay or weekly salary, (5) Time lost from work as a result of the incident, and (6) Claimant's actual period of employment, full-time or part-time, and any effect of the injury upon such employment to support claims for lost earnings. (e) If the claimant is self-employed, written statements, or other evidence showing: (1) The amount of earnings actually lost, and (2) The Federal tax return if filed for the three previous years. (f) If the claim arises out of injuries to a person providing services to the claimant, statement of the cost necessarily incurred to replace the services to which claimant is entitled under law.