FILING A CLAIM FOR PERSONAL PROPERTY LOSS DUE TO
FIRE, FLOOD, THEFT, VANDALISM AND OTHER PERSONAL
PROPERTY LOSSES
1. GENERAL.
These instructions are designed to provide specific guidance to DON personnel who
want to file a claim with the government for damage or loss sustained
to your personal property incident to service and caused by fire, flood, theft, vandalism,
natural disaster or other unusual occurrence. You should file your claim at the
Personnel Claims Unit (PCU) at:
Personnel Claims Unit Norfolk
9053 First Street Suite 102
Norfolk, VA 23511-3605
Toll Free (888) 897-8217/Fax (866) 782-7297
Commercial (757) 440-6315
DSN 564-3310/FAX DSN 564-3337
Email: norfolkclaims@navy.mil
Read these instructions carefully and answer all questions in order to ensure the
most expeditious processing of your claim. Failure to complete the forms properly or
to provide all required documents and substantiation will result in delay or even denial of
your claim. Keep copies of all documents submitted.
Remember, it’s your claim. You, the claimant, are in the best position to provide
the specific information necessary for the fast and fair adjudication of your claim.
The claim will be adjudicated pursuant to the Military Personnel and Civilian
Employees Claims Act (PCA) (31 U.S.C. § 3721). The PCA is a gratuitous payment
statute and is not intended to replace insurance. The PCA only allows payment
up to the fair market value (FMV) (depreciated value) of lost or destroyed items.
2. DEADLINES FOR FILING YOUR CLAIM.
Federal law requires that you deliver your claim with the PCU within two years after it
accrues. The claim accrues on the date the incident occurred that gave rise to your
claim. This requirement is statutory and cannot be waived.
3. WHO MAY FILE A CLAIM?
a. Proper Claimant. The Military Personnel and Civilian Employees’ Act
(PCA) covers all active duty members and reservists on active duty for training under
federal law. The PCA also applies to Department of the Navy (DON) Federal employees.
Reservists or retired members may only claim for damages under the PCA if loss or
damage to their personal property occurred while they were on active duty.
b. Power of Attorney (POA). A legal representative who has been designated
as your legal representative by a POA in order to communicate with the PCU. Payment
will be made to the claimant’s account, not to the agent’s, unless the POA specifically
authorizes the agent to both file the claim and receive payment. If an agent is filing a
claim on your behalf, the agent must include a copy of the POA. Your agent must have
either a General POA granting the agent the power to do everything the claimant could
do, or a Specific Power of Attorney, granting the agent the authority to file your claim.
Many Region Legal Service Offices (RLSOs) provide POA on a walk-in basis. The
prospective claimant must be present to grant a POA. Remember, the POA must be
effective on the date the claim is submitted.
4. WHAT FORMS WILL I NEED TO FILE?
The two forms you need to file your PCA claim are the DD Form 1842, Claim for Loss
of or Damage to Personal Property Incident to Service, and the DD Form 1844, List
of Property and Claims Analysis Chart. Forms, and this package, can be found on-
line through the Navy’s Office of the Judge Advocate General website,
www.jag.navy.mil (by selecting ”Claims” on the screen) or the Navy Knowledge
Online website, wwwa.nko.navy.mil (by going into your “Personal Development” page in
NKO and selecting the claims page in your “Personal Legal Affairs” portal). When
preparing your claim, please read and follow the attached check-off list.
Make sure that you completely fill in the information required on each form and on the
check-off list and attach all supporting documentation listed on the check-off list before
you file your claim.
Be sure that your claim is completed, as described in this package, and signed before
filing your claim. If you are e-mailing the claim, remember to sign the DD Form 1842
before scanning your documents. Please make sure that if you are e-mailing your claim
all scanned documents are legible and in one of the following formats: ADOBE, PDF,
JPG File, TIFF Document, GIF File, or Bitmap Image. Claims examiners will then
adjudicate your completed claim and determine the amount of compensation you are
entitled to receive based on the information you provide. You will be provided a written
explanation of the adjudication of your claim.
5. PRIVATE INSURANCE.
You are required to file a claim against private insurance (home owners, renters,
vehicles etc.,). You do not have to wait for your private insurance company to settle
your claim before filing a claim with the government. However, we will not be able to
finalize your claim until we receive a copy of the insurance settlement package.
6. HOW DO I GET PAID?
Your claim will be adjudicated pursuant to the Military Personnel and Civilian
Employees Claims Act (PCA) (31 U.S.C. § 3721). The PCA is a gratuitous payment
statute and is not intended to replace insurance The PCA only allows payment up to
the fair market value (FMV) (depreciated value) of lost or destroyed items.
Claims Payments by the PCU are processed through the Defense Finance and
Accounting Service (DFAS). DFAS electronically deposits payments directly into your
account. If you do not have a DFAS pay account (i.e., you are no longer in the military
or work for any Department of Defense agency), you will need to fill out the attached
Electronic Funds Transfer (EFT) Data sheet. If you are a nonappropriated fund (NAF)
employee, your claim will be submitted to your activity for payment from NAF funds.
A checklist is attached to this package to assist you in completing your claim.
Failure to comply with this checklist will delay processing of your claim.
CLAIMS PACKET
CHECKLIST FOR LOSS OR DAMAGE TO PERSONAL PROPERTY DUE TO FIRE,
FLOOD,THEFT, VANDALISM AND OTHER PERSONAL PROPERTY LOSSES
I understand that my claim must contain the following information and documentation. I
have included one copy of each document and I have kept a copy of each document for
my own records. My initials on each line mean I have included a copy of the requested
document in this file.
I MUST BE SURE THE PCU RECEIVES MY CLAIM WITHIN TWO YEARS FROM
THE DATE OF THE INCIDENT FOR WHICH I AM MAKING THIS CLAIM. I
UNDERSTAND THAT SIMPLY MAILING THE CLAIM WITHIN THE TWO YEARS IS
INSUFFICIENT; THE PCU MUST RECEIVE THE CLAIM WITHIN TWO YEARS.
1. _____ This checklist.
2. _____ DD Form 1842 (Claim for Loss of or Damage to Personal Property Incident to
Service). I have completed every section of the DD Form 1842,including Block 9,
Amount Claimed, and Block 10, Circumstance of Loss or Damage, and Block 17,
Signature.
3. _____ I have private homeowner's insurance, renter’s insurance, or vehicle insurance.
I understand I must submit a demand against the insurer for payment at the same time I
submit my claim with the government, and I understand that I will not be paid by the
government until my claim is adjudicated by my private insurer. For claims for damage
to POV’s, the declarations page from my policy, showing types and limits on coverage,
is attached. I have included a copy of any correspondence from my insurance company.
4. _____ If I have authorized someone else to file my claim or to receive payment, I
have included a POWER OF ATTORNEY. (A SIGNED STATEMENT IS NOT
SUFFICIENT).
5. _____ DD Form 1844, (List of Property and Claims Analysis Chart). I have completed
each section of the DD Form 1844 including all applicable information in Blocks 1 and 2.
I have provided detailed descriptions of damage to each item claimed, original cost,
month and year of purchase (date of manufacture if I acquired the item used), and
repair cost or replacement cost (Blocks 5-11).
6. _____ One repair estimate or if the item is missing or destroyed, a replacement cost
estimate for any and all articles over $100.00. If the cost of the estimate will be over
$75, I will contact the PCU before I obligate myself to pay that estimate fee.
a. _____ REPLACEMENT COST. I have verified a claimed replacement cost
of $100.00 or more by clippings from catalogs, newspaper advertisements, etc., which
show pictures and prices of identical or comparable items or written quotes from a firm
which sells identical or comparable items.
b. _____ REPAIR COST. If I am claiming the cost to repair an item exceeds
$100.00, I have provided an estimate from a firm that is in the business of repairing
such items (e.g., washer/dryer from an appliance repair firm, furniture from a furniture
repair or re-upholstery shop). If the item is damaged beyond economical repair, the
estimate must state this and I have submitted evidence to prove the replacement price
of the item as described above. The estimate must clearly state the specific area on
the item and damages to the item that are being repaired. An estimate that simply
shows "repair" or "refinish" is not acceptable.
c. _____ ELECTRICAL/ELECTRONIC ITEMS. For each electrical/ electronic
item (such as TV's, stereos, computers, refrigerators, etc.) with a value over $100 that I
am claiming a repair cost over $100.00, I submitted one of the attached
electrical/electronic repair forms completed by a person in the business of repairing
such items. (You can copy the form.)
d. _____ Re-upholstery. The estimate must state that:
1) the materials used are of comparable quality to the original material;
2) patching, reweaving, using material from a different part of the item or
any less expensive method of repair is not possible; and
3) must list cost of material and labor separately.
e. _____ PHOTOGRAPHS. If I have pictures of visible damages to the items
being claimed, I have included them with my claim. I placed the item’s line number, from
the DD Form 1844, on the picture. I understand I will not be reimbursed for the cost of
the pictures.
ALL ESTIMATES MUST BE IN ENGLISH OR HAVE AN ENGLISH TRANSLATION
ATTACHED.
7. _____ I understand the claims examiner may require further information or additional
repair estimates or proof of replacement costs for any item listed on the DD Form 1844
while in the process of adjudicating the claim or if the repair or replacement cost
submitted is excessive for average repairs or replacement of like items in the area. For
instance, I may be asked to provide proof that I owned the type and quality of item I
have claimed.
8. _____ Military or civilian police or fire report (if available) is attached.
9. _____ For POV claims, copy of current registration for vehicle.
10. _____ I have completed the Electronic Fund Transfer (EFT) Data sheet. (Only
necessary if you do not have a current pay account through the Defense Finance and
Accounting Service [DFAS], such as personnel who have left military service without
retiring).
If any information is missing, my claim will be adjudicated with the information provided
and may result in items being paid for lesser amounts than claimed or denied for failure
to substantiate the claim.
____________________ _____________
(CLAIMANT SIGNATURE) (Date)
____________________
(EMAIL ADDRESS)
ELECTRICAL/ELECTRONIC REPAIR FORM
__________
Date
To the Estimator:
We must determine if damage to this item is as a result of some other cause rather than a
manufacturer's defect or the result of normal wear and tear by age. Please complete this form to
document your evaluation, or attach your firm/company documentation as appropriate, as long as
the same type of information is provided.
Firm Name & Address: _________________________________________
_________________________________________
_________________________________________
Firm Telephone Number: _______________________________________
Firm Contact Representative: ____________________________________
ITEM ESTIMATED: ______________________________________________
_______________________________________________________________
(Include Make/Model/Description) Estimated Age:____________
1. There (was) (was not) external damage to the item.
2. I (was) (was not) able to determine the cause of the damage. To the best of my knowledge, I
have determined the nature and extent of damage as follows:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
3. I summarize the cost of repairs as follows:
(parts) ___________________________________________ $_____________
(parts) ___________________________________________ $_____________
(parts) ___________________________________________ $_____________
(parts) ___________________________________________ $_____________
(labor) ___________________________________________ $_____________
Totals: Parts/Labor: $ ____________ Overall Total: _________
Tax: $ ____________ _________
4. I (have) (have not) determined that the item damaged as described above (is) (is not) beyond
economical repair. I estimate a similar or comparable replacement item to be valued at
$_________________
AMOUNT
ALLOWED
1. NAME OF CLAIMANT (Last, First, Middle Initial)
3. PICK-UP DATE
(YYYYMMDD)
LIST OF PROPERTY AND CLAIMS ANALYSIS CHART
(Items 14 through 31 to be filled out by Claims Office)
2. CLAIMANT'S INSURANCE COMPANY (If applicable)
a. NAME b. POLICY NO.
4. DELIVERY DATE
(YYYYMMDD)
14. ORIGIN CONTRACTOR 17. 2ND CONTRACTOR 21. CLAIM NUMBER 22. NET WT/MAX CAR
15. INVENTORY DATE
(YYYYMMDD)
18. EXCEPTION SHEET
DATE
(YYYYMMDD)
23. GBL NUMBER 24. LOT NUMBER5.
LINE
NO.
6.
QTY
7. LOST OR DAMAGED ITEMS
(Describe the item fully, including brand name,
model and size. List the nature and extent of
damage. If missing, state "MISSING.")
8.
INV
NO.
9. ORIGINAL
COST
11. AMOUNT
CLAIMED
a. Repair
Cost
10.
MM/YYYY
PURCHASED
(or)
b.
Replace-
ment
Cost
16.
EXCEPTIONS
19.
INV
NO.
20.
EXCEPTIONS
25.
ADJUDICATOR'S
REMARKS
26.
ITEM
WT
27.
HOUSE
LIABILITY
28.
CARRIER
LIABILITY
29.
12. REMARKS 13. TOTAL
$ 30. TOTAL
AMOUNT
ALLOWED
$ 31. THIRD
PARTY
LIABILITY
$ $
DD FORM 1844, MAY 2000
PREVIOUS EDITION IS OBSOLETE. Page of Pages
CLAIM FOR LOSS OF OR DAMAGE TO PERSONAL PROPERTY INCIDENT TO SERVICE
PART I - TO BE COMPLETED BY CLAIMANT (See back for Privacy Act Statement and Instructions.)
1. NAME OF CLAIMANT (Last, First, Middle Initial)
2. BRANCH OF SERVICE 3. RANK OR GRADE 4. SOCIAL SECURITY NUMBER
5. HOME ADDRESS (Street, City, State and Zip Code) 6. CURRENT MILITARY DUTY ADDRESS (If applicable) (Street, City,
State and Zip Code)
7. HOME TELEPHONE NO. (Include area code) 8. DUTY TELEPHONE NO. (Include area code) 9. AMOUNT CLAIMED
10. CIRCUMSTANCES OF LOSS OR DAMAGE (Explain in detail. Include date, place, and all relevant facts. Use additional sheets if necessary.)
11. DID YOU HAVE PRIVATE INSURANCE COVERING YOUR PROPERTY? (E.g., say "Yes" on a shipment or quarters claim if you
had transit, renter's or homeowner's insurance; say "Yes" on a vehicle claim if you had vehicle insurance. Attach a copy of
your policy.)
YES NO
12. HAVE YOU MADE A CLAIM AGAINST YOUR PRIVATE INSURER? (If "Yes," attach a copy of your correspondence. If you
have insurance covering your loss, you must submit a demand before you submit a claim against the Government.)
13. HAS A CARRIER OR WAREHOUSE FIRM INVOLVED PAID YOU OR REPAIRED ANY OF YOUR PROPERTY? (If "Yes," attach
a copy of your correspondence with the carrier or warehouse firm.)
14. DID ANY OF THE CLAIMED ITEMS BELONG TO THE GOVERNMENT OR TO SOMEONE OTHER THAN YOU OR YOUR
FAMILY MEMBER? (If "Yes," indicate this on your "List of Property and Claims Analysis Chart," DD Form 1844.)
15. WERE ANY OF THE CLAIMED ITEMS ACQUIRED OR HELD FOR SALE, OR ACQUIRED OR USED IN A PRIVATE PROFESSION
OR BUSINESS? (If "Yes," indicate this on your "List of Property and Claims Analysis Chart," DD Form 1844.)
16. UNDER PENALTY OF LAW, I DECLARE THE FOLLOWING AS PART OF SUBMITTING MY CLAIM:
If any missing items for which I am claiming are recovered, I will notify the office paying this claim. (For shipment claims.) Missing items
were packed by the carrier; they were owned prior to shipment but not delivered at destination; after my property was packed, I/my agent
checked all rooms in my dwelling to make sure nothing was left behind.
I assign to the United States any right or interest I have against a carrier, insurer, or other person for the incident for which I am claiming; I
authorize my insurance company to release information concerning my insurance coverage.
I authorize the United States to withhold from my pay or accounts for any payments made to me by a carrier, insurer, or other person to
the extent I am paid on this claim, and for any payment made on this claim in reliance on information which is determined to be incorrect or
untrue. I have not made any other claim against the United States for the incident for which I am claiming. I understand that if any
information I provide as part of my claim is false, I can be prosecuted.
17. SIGNATURE OF CLAIMANT (or designated agent) 18. DATE SIGNED
(YYYYMMDD)
PART II - CLAIMS APPROVAL (To be completed by Claims Office)
19. PROCEDURE (X one)
a. SMALL CLAIMS
b. REGULAR CLAIMS
$
21. SIGNATURES (Signatures at a and c not required if small claims procedure is utilized)
a. CLAIMS EXAMINER b. DATE SIGNED
(YYYYMMDD)
c. REVIEWING AUTHORITY d. DATE SIGNED
(YYYYMMDD)
e. TYPED NAME AND GRADE OF APPROVING AUTHORITY f. SIGNATURE OF APPROVING AUTHORITY g. DATE SIGNED
(YYYYMMDD)
DD FORM 1842, MAY 2000 PREVIOUS EDITION IS OBSOLETE.
20. AMOUNT AWARDED. The claim is cognizable and meritorious under 31 U.S.C. 3721;
the claimant is a proper claimant; the property is reasonable and useful; the loss has
been verified in accordance with applicable procedures as prescribed by the controlling
departmental regulation; and the following award is substantiated:
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PRIVACY ACT STATEMENT
AUTHORITY: 31 U.S.C. 3721, and EO 9397, November 1943 (SSN).
PRINCIPAL PURPOSE(S): Filing, investigation, processing and settlement of claims for losses incident to service.
ROUTINE USES:
a. Information is principally used to provide a legal basis for the administrative payment of claims against the Government.
Information is also used in connection with:
(1) Recovery from common carriers, warehouse firms, insurers and other third parties.
(2) Collection from claimants of improper payments or overpayments.
(3) Investigation of possible fraudulent claims.
(4) Possible criminal prosecution by the Department of Justice or other agencies if fraud is established.
b. Social Security Numbers are used to assure correct identification of claimants in order to assure payment to the proper
claimant and avoid duplication of claims.
DISCLOSURE: Voluntary; however, failure to supply information will cause delay in settlement and may result in denial of a
portion or all of the claim.
INSTRUCTIONS TO CLAIMANTS
1. You must submit your claim in writing within two
years of the date of the incident giving rise to the claim.
This two year time limitation may not be waived.
2. The claimant or an authorized agent must complete
and sign Part I of this form, answering all questions. If
the claim is signed by an agent (such as a spouse) or a
survivor of a deceased proper claimant, that person must
have a document showing his or her authority to present
the claim, such as a power of attorney, etc.
3. If the claim is for property lost or damaged while being
shipped or stored pursuant to travel orders, submit copies
of your orders and all shipping documents, including your
inventory and your "Joint Statement of Loss or Damage
at Delivery/Notice of Loss or Damage," DD Forms
1840/1840R. If you notice damage after delivery, you
must complete the DD Form 1840R and get it to the
Claims Office
within 70 days after delivery.
4. You may obtain further information from a Claims
Office.
5. You are entitled to claim the following:
a. Reasonable local repair cost, if an item can be
economically repaired.
(You may claim small amounts
without an estimate. Otherwise, submit an estimate of
repair from a repair firm or, if repairs have been
completed, your receipt. The claims office may waive
this in appropriate cases.)
b. Reasonable local replacement cost if an item is
missing, destroyed, or not economic to repair.
(Replacement costs may be obtained from commercial
catalogs or a military exchange. If you cannot find the
item in a catalog or the exchange and the cost is more
than $100.00, obtain a statement from a commercial firm
for the cost of a similar item. If you have purchase
receipts, bring these to the Claims Office as well.)
c. Reasonable cost of obtaining local estimates of
repair, if the cost of such estimates will not be credited if
repair work is done.
(Normally, you may not claim
appraisal fees.)
PART III - DENIAL OR SUPPLEMENTAL PAYMENT (To be completed by Claims Office)
23. DENIAL (X if applicable)
The claim is not cognizable or meritorious under 31 U.S.C.
3721 and the applicable provisions of the controlling
departmental regulation, and is denied.
24. SUPPLEMENTAL PAYMENT (X and complete if applicable)
The claim is cognizable and meritorious
under 31 U.S.C. 3721, and the following
additional award is substantiated:
$
26. APPROVING/SETTLEMENT AUTHORITY (Settlement Authority is required for denial.)
25. SIGNATURES
DD FORM 1842 (BACK), MAY 2000
a. CLAIMS EXAMINER b. DATE SIGNED
(YYYYMMDD)
c. REVIEWING AUTHORITY d. DATE SIGNED
(YYYYMMDD)
a. TYPED NAME b. SIGNATURE c. DATE SIGNED
(YYYYMMDD)
b. GRADE
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