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Looking For A Ftca Sample Complaint Or Template



My husband and I are 1) looking for a lawyer to handle a FTCA suit, but in the meantime don't want to lose our six month deadline (after the denied Admin. process) and have to file the initial paperwork ourselves.


Does anyone have a sample or template complaint that can be used as a guide? I heard that a hadit member (Berta?) had a successful filing; is that complaint or lawsuit available online to give us an idea of what the format needs to cover for the fed court?

Any assistance given is greatly appreciated. Thanx and blessings all!



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This is the SF 95 form-

there are many lawyers on the net these days handling Malpractice against VA.

Just google malpractice or FTCA lawyers-

Under # 8 briefly describe the malpractice and it's results

Under Property Damage question put not applicable

Under Personal injury /Wrongful death fill as appropriate

Under Witnesses-

I put here the names of the VA doctors who malpracticed

against my husband and referred then to additional pages.

A lawyer might advise filling this form out differently then I did.

Under 12 a, 12, b, 12 c and 12 d-

put the amount of damages (ask for millions) in the appropriate box and then be sure to total it in the last box.

The amount of damages must appear twice.

This is one of the biggest errors that claimants make on these forms.

A OGC VA lawyer told me that.

If the form is not filled out properly they will reject the claim.

I didnt have a lawyer o IMO when I succeeded under FTCA-

I strongly suggest that most FTCA claimants get both-

unless they have time to study the nuances of FTCA law as well as medicine.

My FTCA case was easier to win than the recent AO claim I won- because real VACO doctors and lawyers understood my evidence.

The malpractice was well hidden in the medical records but still it became obvious -the more I studied the med recs.

I overlooked one malpracticed condition-which I proved in my recent AO award.

It was this condition that has recently rendered my husband's death as directly service connected.

That claim took 6 years but the FTCA claim-VA wanted to settle within 3 months.

There are some lawyers who might access your case for free on the net-or give you a referral if they cannot handle it.

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forgot to add-

I added additional page to my FTCA claim and referred to it on the main SF 95 page.

I laid out the documented evidence of 6 years of VA malpractice and gave dates of the specific medical records that revealed it.I enclosed the autopsy findings as well and then sent separately copies of the actual medical records showing the malpractice after the Regional Counsel got the case.

Like many malpractice cases, there were initial erroneous diagnoses and these led to the major disabilities and death of my husband.

Also there had been a cover up at an additional VA hospital of the malpractice that occurred here at the Bath VAMC.

Every single medical record has to be carefully read and assessed when a vet or widow/widower files a FTCA claim against the VA.

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our 'vacations' are always exhausting!

To add to this FTCA thread-

the part in # 8 as to the charges-

this part has to be carefully stated as this is what the Office of General Counsel will focus on.

-what disability (ies) did VA malpractice or negligence cause to the veteran and what evidence shows this happened.

There isnt much room there but this can be expanded on with additional page.

The additional disabilities must be at a ratable level with no other etiology but for proven and negligent VA care.

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