Source: http://peo7.com/CFRFiles/32909_CFR.Htm
Timestamp: 2018-07-16 18:37:23
Document Index: 429165496

Matched Legal Cases: ['art 1', 'art 10', 'art 10', 'art 25', 'art 30', 'art 30', 'art 61', 'art 61', 'art 71', 'ART 71', 'ART 71', 'art 61']

Chapter I--OFFICE OF WORKERS'COMPENSATION PROGRAMS,DEPARTMENT OF LABOR
Part 1_PERFORMANCE OF FUNCTIONS UNDER THIS CHAPTER--Table of Contents
Section 1.1 Under what authority was the Office of Workers' Compensation
Office of Workers' Compensation Programs established? 1.2 What functions are assigned to OWCP? 1.3 What rules are contained in this chapter? 1.4 Where are other...
Section 1.2 What functions are assigned to OWCP?
to the Director of OWCP for the Department of Labor's programs under the following statutes: (a) The Federal Employees' Compensation Act, as amended and...
Section 1.3 What rules are contained in this chapter?
Compensation Act, the War Hazards Compensation Act, the War Claims Act and the Energy Employees Occupational Illness Compensation Program Act...
Section 1.4 Where are other rules concerning OWCP functions found?
Harbor Workers' Compensation Act and its extensions are set forth in subchapter A of chapter VI of this title. (b) The rules of the OWCP governing its functions under the...
Section 1.5 When was the former Bureau of Employees' Compensation abolished?
concurrently with Employment Standards Order 2-74, 39 FR 34722, the Secretary revoked the prior Secretary's Order No. 18-67, 32 FR 12979, which had delegated authority...
Section 1.6 How were many of OWCP's current functions administered in the past?
the Longshore and Harbor Workers' Compensation Act was initially vested in an independent establishment known as the U.S. Employees' Compensation Commission. By Reorganization...
Part 10_CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION
Section 10.0 What are the provisions of the FECA, in general?
general? Subpart A_General Provisions Introduction Sec. 10.0 What are the provisions of the...
Section 10.1 What rules govern the administration of the FECA and this chapter?
the FECA and this chapter? In accordance with 5 U.S.C. 8145 and Secretary's Order 5-96, the responsibility for administering the FECA, except for 5 U.S.C. 8149 as...
Section 10.2 What do these regulations contain?
This part 10 sets forth the regulations governing administration of all claims filed under the FECA, except to the extent specified in certain particular provisions....
Section 10.3 Have the collection of information requirements of this part
of this part been approved by the Office of Management and Budget (OMB)? The collection of information requirements in this part have been approved by OMB...
Section 10.5 What definitions apply to these regulations?
Certain words and phrases found in this part are defined in this section or in the FECA. Some other words and phrases that are used only in limited situations...
Section 10.6 What special statutory definitions apply to dependents and
to dependents and survivors? (a) 5 U.S.C. 8133 provides that certain benefits are payable to certain enumerated survivors of employees who have died from an...
Section 10.7 What forms are needed to process claims under the FECA?
the FECA? (a) Notice of injury, claims and certain specified reports shall be made on forms prescribed by OWCP. Employers shall not modify these forms or...
Section 10.10 Are all documents relating to claims filed under the FECA
under the FECA considered confidential? All records relating to claims for benefits, including copies of such records maintained by an employer, are...
Section 10.11 Who maintains custody and control of FECA records?
FECA records? All records relating to claims for benefits filed under the FECA, including any copies of such records maintained by an employing agency, are covered by...
Section 10.12 How may a FECA claimant or beneficiary obtain copies of
copies of protected records? (a) A claimant seeking copies of his or her official FECA file should address a request to the District Director of the OWCP...
Section 10.13 What process is used by a person who wants to correct
wants to correct FECA-related documents? Any request to amend a record covered by DOL/GOVT-1 should be directed to the district office having custody of the official...
Section 10.15 May compensation rights be waived?
No employer or other person may require an employee or other claimant to enter into any agreement, either before or after an injury or death, to waive his or her right...
Section 10.16 What criminal penalties may be imposed in connection with
connection with a claim under the FECA? (a) A number of statutory provisions make it a crime to file a false or fraudulent claim or statement with the Government...
Section 10.17 Is a beneficiary who defrauds the Government in connection
in connection with a claim for benefits still entitled to those benefits? When a beneficiary either pleads guilty to or is found guilty on either Federal or...
Section 10.18 Can a beneficiary who is incarcerated based on a felony
on a felony conviction still receive benefits? (a) Whenever a beneficiary is incarcerated in a State or Federal jail, prison, penal institution or...
Section 10.100 How and when is a notice of traumatic injury filed?
of traumatic injury filed? Notices and Claims for Injury, Disease, and Death--Employee or Survivor's Actions (a) To...
Section 10.101 How and when is a notice of occupational disease filed?
notice of occupational disease filed? (a) To claim benefits under the FECA, an employee who has a disease which he or she believes to be work-related must give notice of...
Section 10.102 How and when is a claim for wage loss compensation filed?
for wage loss compensation filed? (a) Form CA-7 is used to claim compensation for periods of disability not covered by COP. (1) An employee who is disabled with...
Section 10.103 How and when is a claim for permanent impairment filed?
for permanent impairment filed? Form CA-7 is used to claim compensation for impairment to a body part covered under the schedule established by 5 U.S.C. 8107. If...
Section 10.104 How and when is a claim for recurrence filed?
for recurrence filed? (a) A recurrence should be reported on Form CA-2a if it causes the employee to lose time from work and incur a wage loss, or if the...
Section 10.105 How and when is a notice of death and claim for benefits
notice of death and claim for benefits filed? (a) If an employee dies from a work-related traumatic injury or an occupational disease, any survivor may file a claim...
Section 10.110 What should the employer do when an employee files a notice
when an employee files a notice of traumatic injury or occupational disease? (a) The employer shall complete the agency portion of Form CA-1 (for traumatic...
Section 10.111 What should the employer do when an employee files an initial
do when an employee files an initial claim for compensation due to disability or permanent impairment? (a) When an employee is disabled by a work-related injury and...
Section 10.112 What should the employer do when an employee files a claim
when an employee files a claim for continuing compensation due to disability? (a) If the employee continues in a leave-without-pay status due to a...
Section 10.113 What should the employer do when an employee dies from a
when an employee dies from a work-related injury or disease? (a) The employer shall immediately report a death due to a work- related traumatic injury or...
Section 10.115 What evidence is needed to establish a claim?
to establish a claim? Forms CA-1, CA-2, CA-5 and CA-5b describe the basic evidence required. OWCP may send any request for additional evidence to the claimant and to...
Section 10.116 What additional evidence is needed in cases based on
is needed in cases based on occupational disease? (a) The employee must submit the specific detailed information described on Form CA-2 and on any checklist...
Section 10.117 What happens if, in any claim, the employer contests any
any claim, the employer contests any of the facts as stated by the claimant? (a) An employer who has reason to disagree with any aspect of the claimant's report shall...
Section 10.118 Does the employer participate in the claims process in any
in the claims process in any other way? (a) The employer is responsible for submitting to OWCP all relevant and probative factual and medical evidence in...
Section 10.119 What action will OWCP take with respect to information submitted
take with respect to information submitted by the employer? OWCP will consider all evidence submitted appropriately, and OWCP will inform the employee, the...
Section 10.120 May a claimant submit additional evidence?
evidence? A claimant or a person acting on his or her behalf may submit to OWCP at any time any other evidence relevant to...
Section 10.121 What happens if OWCP needs more evidence from the claimant?
more evidence from the claimant? If the claimant submits factual evidence, medical evidence, or both, but OWCP determines that this evidence is not sufficient to meet...
Section 10.125 How does OWCP determine entitlement to benefits?
entitlement to benefits? (a) In reaching any decision with respect to FECA coverage or entitlement, OWCP considers the claim presented by the claimant, the report...
Section 10.126 What does the decision contain?
The decision shall contain findings of fact and a statement of reasons. It is accompanied by information about the claimant's appeal rights, which may...
Section 10.127 To whom is the decision sent?
A copy of the decision shall be mailed to the employee's last known address. If the employee has a designated representative before OWCP, a copy of the...
Section 10.200 What is continuation of pay?
(a) For most employees who sustain a traumatic injury, the FECA provides that the employer must continue the employee's regular pay during any periods of...
Section 10.205 What conditions must be met to receive COP?
COP? (a) To be eligible for COP, a person must: (1) Have a ``traumatic injury'' as defined at Sec. 10.5(ee) which is job-related and the cause of the...
Section 10.206 May an employee who uses leave after an injury later decide
an injury later decide to use COP instead? On Form CA-1, an employee may elect to use accumulated sick or annual leave, or leave advanced by the agency, instead...
Section 10.207 May an employee who returns to work, then stops work again
then stops work again due to the effects of the injury, receive COP? If the employee recovers from disability and returns to work, then becomes disabled again and...
Section 10.210 What are the employee's responsibilities in COP cases?
COP cases? An employee who sustains a traumatic injury which he or she considers disabling, or someone authorized to act on his or her behalf, must take...
Section 10.211 What are the employer's responsibilities in COP cases?
COP cases? Once the employer learns of a traumatic injury sustained by an employee, it shall: (a) Provide a Form CA-1 and Form CA-16 to authorize medical...
Section 10.215 How does OWCP compute the number of days of COP used?
days of COP used? COP is payable for a maximum of 45 calendar days, and every day used is counted toward this maximum. The following rules apply: (a) Time lost...
Section 10.216 How is the pay rate for COP calculated?
The employer shall calculate COP using the period of time and the weekly pay rate. (a) The pay rate for COP purposes is equal to the employee's...
Section 10.217 Is COP charged if the employee continues to work, but in
to work, but in a different job that pays less? If the employee cannot perform the duties of his or her regular position, but instead works in another job...
Section 10.220 When is an employer not required to pay COP?
pay COP? An employer shall continue the regular pay of an eligible employee without a break in time for up to 45 calendar days, except when, and only when: ...
Section 10.221 How is a claim for COP controverted?
When the employer stops an employee's pay for one of the reasons cited in Sec. 10.220, the employer must controvert the claim for COP on Form CA-1, explaining in...
Section 10.222 When may an employer terminate COP which has already begun?
which has already begun? (a) Where the employer has continued the pay of the employee, it may be stopped only when at least one of the following circumstances...
Section 10.223 Are there other circumstances under which OWCP will not
which OWCP will not authorize payment of COP? When OWCP finds that an employee or his or her representative refuses or obstructs a medical examination required by...
Section 10.224 What happens if OWCP finds that the employee is not entitled
employee is not entitled to COP after it has been paid? Where OWCP finds that the employee is not entitled to COP after it has been paid, the employee may chose to...
Section 10.300 What are the basic rules for authorizing emergency medical
emergency medical care? Emergency Medical Care (a) When an employee sustains a work-related traumatic injury that...
Section 10.301 May the physician designated on Form CA-16 refer the
Form CA-16 refer the employee to another medical specialist or medical facility? The physician designated on Form CA-16 may refer the employee for further...
Section 10.302 Should the employer authorize medical care if he or she
care if he or she doubts that the injury occurred, or that it is work-related? If the employer doubts that the injury occurred, or that it is work- related, he...
Section 10.303 Should the employer use a Form CA-16 to authorize medical
Form CA-16 to authorize medical testing when an employee is exposed to a workplace hazard just once? (a) Simple exposure to a workplace hazard, such as an infectious...
Section 10.304 Are there any exceptions to these procedures for obtaining
procedures for obtaining medical care? In cases involving emergencies or unusual circumstances, OWCP may authorize treatment in a manner other than as stated in...
Section 10.310 What are the basic rules for obtaining medical care?
medical care? (a) The employee is entitled to receive all medical services, appliances or supplies which a qualified physician prescribes or recommends and...
Section 10.311 What are the special rules for the services of chiropractors?
the services of chiropractors? (a) The services of chiropractors that may be reimbursed are limited by the FECA to treatment to correct a spinal subluxation. The costs...
Section 10.312 What are the special rules for the services of clinical
the services of clinical psychologists? A clinical psychologist may serve as a physician only within the scope of his or her practice as defined by State law. Therefore,...
Section 10.313 Will OWCP pay for preventive treatment?
The FECA does not authorize payment for preventive measures such as vaccines and inoculations, and in general, preventive treatment may be a responsibility...
Section 10.314 Will OWCP pay for the services of an attendant?
an attendant? Yes, OWCP will pay for the services of an attendant up to a maximum of $1,500 per month, where the need for such services has been medically...
Section 10.315 Will OWCP pay for transportation to obtain medical treatment?
obtain medical treatment? The employee is entitled to reimbursement of reasonable and necessary expenses, including transportation needed to obtain authorized...
Section 10.316 After selecting a treating physician, may an employee choose
may an employee choose to be treated by another physician instead? (a) When the physician originally selected to provide treatment for a work-related...
Section 10.320 Can OWCP require an employee to be examined by another
be examined by another physician? OWCP sometimes needs a second opinion from a medical specialist. The employee must submit to examination by a qualified physician...
Section 10.321 What happens if the opinion of the physician selected by
the physician selected by OWCP differs from the opinion of the physician selected by the employee? (a) If one medical opinion holds more probative value, OWCP will...
Section 10.322 Who pays for second opinion and referee examinations?
referee examinations? OWCP will pay second opinion and referee medical specialists directly. OWCP will reimburse the employee all necessary and reasonable...
Section 10.323 What are the penalties for failing to report for or
to report for or obstructing a second opinion or referee examination? If an employee refuses to submit to or in any way obstructs an examination required by OWCP,...
Section 10.324 May an employer require an employee to undergo a physical
employee to undergo a physical examination in connection with a work-related injury? The employer may have authority independent of the FECA to require the employee...
Section 10.330 What are the requirements for medical reports?
medical reports? In all cases reported to OWCP, a medical report from the attending physician is required. This report should include: (a) Dates of examination...
Section 10.331 How and when should the medical report be submitted?
be submitted? (a) Form CA-16 may be used for the initial medical report, while Form CA-20 may be used for the initial report and for subsequent reports,...
Section 10.332 What additional medical information will OWCP require to
OWCP require to support continuing payment of benefits? In all cases of serious injury or disease, especially those requiring hospital treatment or...
Section 10.333 What additional medical information will OWCP require to
OWCP require to support a claim for a schedule award? To support a claim for a schedule award, a medical report must contain accurate measurements of...
Section 10.335 How are medical bills submitted?
Usually, medical providers submit bills directly to OWCP. The rules for submitting and paying bills are stated in subpart I of this part. An employee...
Section 10.336 What are the time frames for submitting bills?
bills? To be considered for payment, bills must be submitted by the end of the calendar year after the year when the expense was incurred, or by the end of...
Section 10.337 If OWCP reimburses an employee only partially for a medical
partially for a medical expense, must the provider refund the balance of the amount paid to the employee? (a) The OWCP fee schedule sets maximum limits on...
Section 10.400 What is total disability?
Compensation for Disability and Impairment (a) Permanent total disability is presumed to result from the loss of use of both hands, both arms,...
Section 10.401 When and how is compensation for total disability paid?
total disability paid? (a) Compensation is payable when the employee starts to lose pay if the injury causes permanent disability or if pay loss continues for...
Section 10.402 What is partial disability?
An injured employee who cannot return to the position held at the time of injury (or earn equivalent wages) due to the work-related injury, but who is not totally...
Section 10.403 When and how is compensation for partial disability paid?
partial disability paid? (a) 5 U.S.C. 8115 outlines how compensation for partial disability is determined. If the employee has actual earnings which fairly...
Section 10.404 When and how is compensation for a schedule impairment paid?
a schedule impairment paid? Compensation is provided for specified periods of time for the permanent loss or loss of use of certain members, organs and functions...
Section 10.405 Who is considered a dependent in a claim based on disability
a claim based on disability or impairment? (a) Dependents include a wife or husband; an unmarried child under 18 years of age; an unmarried child over 18 who...
Section 10.406 What are the maximum and minimum rates of compensation in
rates of compensation in disability cases? (a) Compensation for total or partial disability may not exceed 75 percent of the basic monthly pay of the highest step...
Section 10.410 Who is entitled to compensation in case of death, and what
case of death, and what are the rates of compensation payable in death cases? (a) If there is no child entitled to compensation, the employee's surviving...
Section 10.411 What are the maximum and minimum rates of compensation in
rates of compensation in death cases? (a) Compensation for death may not exceed the employee's pay or 75 percent of the basic monthly pay of the highest step of...
Section 10.412 Will OWCP pay the costs of burial and transportation of
burial and transportation of the remains? In a case accepted for death benefits, OWCP will pay up to $800 for funeral and burial expenses. When an employee's home is...
Section 10.413 If a person dies while receiving a schedule award, to whom
a schedule award, to whom is the balance of the schedule award payable? The circumstances under which the balance of a schedule award may be paid to an...
Section 10.414 What reports of dependents are needed in death cases?
needed in death cases? If a beneficiary is receiving compensation benefits on account of an employee's death, OWCP will ask him or her to complete a report once...
Section 10.415 What must a beneficiary do if the number of beneficiaries
if the number of beneficiaries decreases? The circumstances under which compensation on account of death shall be terminated are described in 5 U.S.C. 8133(b)....
Section 10.416 How does a change in the number of beneficiaries affect
of beneficiaries affect the amount of compensation paid to the other beneficiaries? If compensation to a beneficiary is terminated, the amount of compensation...
Section 10.417 What reports are needed when compensation payments continue
compensation payments continue for children over age 18? (a) Compensation payable on behalf of a child, brother, sister, or grandchild, which would otherwise end when...
Section 10.420 How are cost-of-living adjustments applied?
applied? (a) In cases of disability, a beneficiary is eligible for cost-of- living adjustments under 5 U.S.C. 8146a where injury-related disability began more...
Section 10.421 May a beneficiary receive other kinds of payments from the
kinds of payments from the Federal Government concurrently with compensation? (a) 5 U.S.C. 8116(a) provides that a beneficiary may not...
Section 10.422 May compensation payments be issued in a lump sum?
issued in a lump sum? (a) In exercise of the discretion afforded under 5 U.S.C. 8135(a), OWCP has determined that lump-sum payments will not be made to persons...
Section 10.423 May compensation payments be assigned to, or attached by,
assigned to, or attached by, creditors? (a) As a general rule, compensation and claims for compensation are exempt from the claims of private creditors. This rule...
Section 10.424 May someone other than the beneficiary be designated to
beneficiary be designated to receive compensation payments? A beneficiary may be incapable of managing or directing the management of his or her benefits because of...
Section 10.425 May compensation be claimed for periods of restorable leave?
periods of restorable leave? The employee may claim compensation for periods of annual and sick leave which are restorable in accordance with the rules of the...
Section 10.430 How does OWCP notify an individual of a payment made?
of a payment made? (a) In addition to providing narrative descriptions to recipients of benefits paid or payable, OWCP includes on each periodic check a...
Section 10.431 What does OWCP do when an overpayment is identified?
overpayment is identified? Before seeking to recover an overpayment or adjust benefits, OWCP will advise the beneficiary in writing that: (a) The overpayment exists,...
Section 10.432 How can an individual present evidence to OWCP in response
to OWCP in response to a preliminary notice of an overpayment? The individual may present this evidence to OWCP in writing or at a pre-recoupment hearing....
Section 10.433 Under what circumstances can OWCP waive recovery of an
OWCP waive recovery of an overpayment? (a) OWCP may consider waiving an overpayment only if the individual to whom it was made was not at fault in accepting...
Section 10.434 If OWCP finds that the recipient of an overpayment was not
of an overpayment was not at fault, what criteria are used to decide whether to waive recovery of it? If OWCP finds that the recipient of an overpayment was not at...
Section 10.435 Is an individual responsible for an overpayment that resulted
an overpayment that resulted from an error made by OWCP or another Government agency? (a) The fact that OWCP may have erred in making the overpayment, or that...
Section 10.436 Under what circumstances would recovery of an overpayment
recovery of an overpayment defeat the purpose of the FECA? Recovery of an overpayment will defeat the purpose of the FECA if such recovery would cause hardship to...
Section 10.437 Under what circumstances would recovery of an overpayment
recovery of an overpayment be against equity and good conscience? (a) Recovery of an overpayment is considered to be against equity and good conscience when...
Section 10.438 Can OWCP require the individual who received the overpayment
received the overpayment to submit additional financial information? (a) The individual who received the overpayment is responsible for providing information...
Section 10.439 What is addressed at a pre-recoupment hearing?
hearing? At a pre-recoupment hearing, the OWCP representative will consider all issues in the claim on which a formal decision has been issued. Such a...
Section 10.440 How does OWCP communicate its final decision concerning
final decision concerning recovery of an overpayment, and what appeal right accompanies it? (a) OWCP will send a copy of the final decision to the individual from...
Section 10.441 How are overpayments collected?
(a) When an overpayment has been made to an individual who is entitled to further payments, the individual shall refund to OWCP the amount of the overpayment as...
Section 10.500 What are the basic rules governing continuing receipt of
receipt of compensation benefits and return to work? Rules and Evidence (a) Benefits are available only while the...
Section 10.501 What medical evidence is necessary to support continuing
support continuing receipt of compensation benefits? (a) The employee is responsible for providing sufficient medical evidence to justify payment of any...
Section 10.502 How does OWCP evaluate evidence in support of continuing
support of continuing receipt of compensation benefits? In considering the medical and factual evidence, OWCP will weigh the probative value of the attending...
Section 10.503 Under what circumstances may OWCP reduce or terminate
reduce or terminate compensation benefits? Once OWCP has advised the employee that it has accepted a claim and has either approved continuation of pay or paid...
Section 10.505 What actions must the employer take?
Upon authorizing medical care, the employer should advise the employee in writing as soon as possible of his or her obligation to return to work under Sec. 10.210 and...
Section 10.506 May the employer monitor the employee's medical care?
care? The employer may monitor the employee's medical progress and duty status by obtaining periodic medical reports. Form CA-17 is usually adequate for...
Section 10.507 How should the employer make an offer of suitable work?
of suitable work? Where the attending physician or OWCP notifies the employer in writing that the employee is partially disabled (that is, the employee can perform...
Section 10.508 May relocation expenses be paid for an employee who would
for an employee who would need to move to accept an offer of reemployment? If possible, the employer should offer suitable reemployment in the location where the...
Section 10.509 If an employee's light-duty job is eliminated due to
eliminated due to downsizing, what is the effect on compensation? (a) In general, an employee will not be considered to have experienced a compensable recurrence...
Section 10.515 What actions must the employee take with respect to
with respect to returning to work? (a) If an employee can resume regular Federal employment, he or she must do so. No further compensation for wage loss is payable...
Section 10.516 How will an employee know if OWCP considers a job to be
a job to be suitable? OWCP shall advise the employee that it has found the offered work to be suitable and afford the employee 30 days to accept the job...
Section 10.517 What are the penalties for refusing to accept a suitable
accept a suitable job offer? (a) 5 U.S.C. 8106(c) provides that a partially disabled employee who refuses to seek suitable work, or refuses to or neglects to...
Section 10.518 Does OWCP provide services to help employees return to work?
employees return to work? (a) OWCP may, in its discretion, provide vocational rehabilitation services as authorized by 5 U.S.C. 8104. These services include...
Section 10.519 What action will OWCP take if an employee refuses to undergo
an employee refuses to undergo vocational rehabilitation? Under 5 U.S.C. 8104(a), OWCP may direct a permanently disabled employee to undergo vocational rehabilitation....
Section 10.520 How does OWCP determine compensation after an employee
an employee completes a vocational rehabilitation program? After completion of a vocational rehabilitation program, OWCP may adjust compensation to reflect...
Section 10.525 What information must the employee report?
(a) An employee who is receiving compensation for partial or total disability must advise OWCP immediately of any return to work, either part-time or full-time....
Section 10.526 Must the employee report volunteer activities?
An employee who is receiving compensation for partial or total disability is periodically required to report volunteer activity or any other kind of...
Section 10.527 Does OWCP verify reports of earnings?
To make proper determinations of an employee's entitlement to benefits, OWCP may verify the earnings reported by the employee through a variety of means, including...
Section 10.528 What action will OWCP take if the employee fails to file
employee fails to file a report of activity indicating an ability to work? OWCP periodically requires each employee who is receiving compensation benefits to complete...
Section 10.529 What action will OWCP take if the employee files an incomplete
employee files an incomplete report? (a) If an employee knowingly omits or understates any earnings or work activity in making a report, he or she shall forfeit the...
Section 10.535 How are dependents defined, and what information must
information must the employee report? (a) Dependents in disability cases are defined in Sec. 10.405. While the employee has one or more dependents, the employee's...
Section 10.536 What is the penalty for failing to submit a report of
submit a report of dependents? If an employee fails to submit a requested statement or supporting document within 30 days of the date of the request, OWCP will...
Section 10.537 What reports are needed when compensation payments continue
continue for children over age 18? (a) Compensation payable on behalf of a child that would otherwise end when the child reaches 18 years of age...
Section 10.540 When and how is compensation reduced or terminated?
or terminated? (a) Except as provided in paragraphs (b) and (c) of this section, where the [[Page 47]] evidence establishes that compensation should...
Section 10.541 What action will OWCP take after issuing written notice of
written notice of its intention to reduce or terminate compensation? (a) If the beneficiary submits evidence or argument prior to the issuance of the decision,...
Section 10.600 How can final decisions of OWCP be reviewed?
reviewed? There are three methods for reviewing a formal decision of the OWCP (Sec. Sec. 10.125-10.127 discuss how decisions are made). These methods...
Section 10.605 What is reconsideration?
The FECA provides that the Director may review an award for or against compensation upon application by an employee (or his or her representative) who receives an adverse...
Section 10.606 How does a claimant request reconsideration?
(a) An employee (or representative) seeking reconsideration should send the application for reconsideration to the address as instructed by OWCP in the...
Section 10.607 What is the time limit for requesting reconsideration?
(a) An application for reconsideration must be sent within one year of the date of the OWCP decision for which review is sought. If submitted by...
Section 10.608 How does OWCP decide whether to grant or deny the request
or deny the request for reconsideration? (a) A timely request for reconsideration may be granted if OWCP determines that the employee has presented evidence...
Section 10.609 How does OWCP decide whether new evidence requires
evidence requires modification of the prior decision? When application for reconsideration is granted, OWCP will review the decision for which reconsideration is sought...
Section 10.610 What is a review by the Director?
The FECA specifies that an award for or against payment of compensation may be reviewed at any time on the Director's own motion. Such review may be made without regard...
Section 10.615 What is a hearing?
hearing is a review of an adverse decision by a hearing representative. Initially, the claimant can choose between two formats: An oral hearing or a review of the written record. At...
Section 10.616 How does a claimant obtain a hearing?
(a) A claimant, injured on or after July 4, 1966, who has received a final adverse decision by the district office may obtain a hearing by writing to the...
Section 10.617 How is an oral hearing conducted?
(a) The hearing representative retains complete discretion to set the [[Page 50]] time and place of the hearing, including the amount of time allotted...
Section 10.618 How is a review of the written record conducted?
(a) The hearing representative will review the official record and any additional evidence submitted by the claimant and by the agency. The...
Section 10.619 May subpoenas be issued for witnesses and documents?
documents? A claimant may request a subpoena, but the decision to grant or deny such a request is within the discretion of the hearing representative. The...
Section 10.620 Who pays the costs associated with subpoenas?
(a) Witnesses who are not employees or former employees of the Federal Government shall be paid the same fees and mileage as paid for like services in...
Section 10.621 What is the employer's role when an oral hearing has
oral hearing has been requested? (a) The employer may send one (or more, where appropriate) representative(s) to observe the proceeding, but the agency...
Section 10.622 May a claimant withdraw a request for or postpone a hearing?
or postpone a hearing? (a) The claimant and/or representative may withdraw the hearing request at any time up to and including the day the hearing is held, or...
Section 10.625 What kinds of decisions may be appealed?
Only final decisions of OWCP may be appealed to the ECAB. However, certain types of final decisions, described in this part as not subject to further review, cannot...
Section 10.626 Who has jurisdiction of cases on appeal to the ECAB?
to the ECAB? While a case is on appeal to the ECAB, OWCP has no jurisdiction over the claim with respect to issues which directly relate to the issue or issues...
Section 10.700 May a claimant designate a representative?
Representation (a) The claims process under the FECA is informal. Unlike many workers' compensation laws, the employer is...
Section 10.701 Who may serve as a representative?
A claimant may authorize any individual to represent him or her in regard to a claim under the FECA, unless that individual's service as a representative would violate...
Section 10.702 How are fees for services paid?
A representative may charge the claimant a fee and other costs associated with the representation before OWCP. The claimant is solely responsible for paying the fee...
Section 10.703 How are fee applications approved?
(a) Fee Application. (1) The representative must submit the fee application to the district office and/or the Branch of Hearings and Review, according to where the work...
Section 10.705 When must an employee or other FECA beneficiary take action
beneficiary take action against a third party? (a) If an injury or death for which benefits are payable under the FECA is caused, wholly or partially, by someone...
Section 10.706 How will a beneficiary know if OWCP or SOL has determined
or SOL has determined that action against a third party is required? When OWCP determines that an employee or other FECA beneficiary must take action against a...
Section 10.707 What must a FECA beneficiary who is required to take action
is required to take action against a third party do to satisfy the requirement that the claim be ``prosecuted''? At a minimum, a FECA beneficiary must do...
Section 10.708 Can a FECA beneficiary who refuses to comply with a request
comply with a request to assign a claim to the United States or to prosecute the claim in his or her own name be penalized? When a FECA beneficiary refuses...
Section 10.709 What happens if a beneficiary directed by OWCP or SOL to
OWCP or SOL to take action against a third party does not believe that a claim can be successfully prosecuted at a reasonable cost? If a beneficiary consults...
Section 10.710 Under what circumstances must a recovery of money or other
of money or other property in connection with an injury or death for which benefits are payable under the FECA be reported to OWCP or SOL? Any person who...
Section 10.711 How much of any settlement or judgment must be paid to the
must be paid to the United States? The statute permits a FECA beneficiary to retain, as a minimum, one- fifth of the net amount of money or property remaining after...
Section 10.712 What amounts are included in the gross recovery?
recovery? (a) When a settlement or judgment is paid to, or for, one individual, the entire amount, except for the portion representing damage to real or...
Section 10.713 How is a structured settlement (that is, a settlement
is, a settlement providing for receipt of funds over a specified period of time) treated for purposes of reporting the gross recovery? In this situation, the...
Section 10.714 What amounts are included in the refundable disbursements?
disbursements? The refundable disbursements of a specific claim consist of the total money paid by OWCP from the Employees' Compensation Fund with respect to...
Section 10.715 Is a beneficiary required to pay interest on the amount of
on the amount of the refund due to the United States? If the refund due to the United States is not submitted within 30 days of receiving a request for payment...
Section 10.716 If the required refund is not paid within 30 days of the
30 days of the request for repayment, can it be collected from payments due under the FECA? If the required refund is not paid within 30 days of the request...
Section 10.717 Is a settlement or judgment received as a result of allegations
a result of allegations of medical malpractice in treating an injury covered by the FECA a gross recovery that must be reported to OWCP or SOL? Since an...
Section 10.718 Are payments to a beneficiary as a result of an insurance
result of an insurance policy which the beneficiary has purchased a gross recovery that must be reported to OWCP or SOL? Since payments received by a FECA...
Section 10.719 If a settlement or judgment is received for more than one
received for more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim be attributed to different conditions for purposes...
Section 10.725 When is a Federal grand or petit juror covered under the FECA?
covered under the FECA? (a) Federal grand and petit jurors are covered under the FECA when they are in performance of duty as a juror, which includes that time when...
Section 10.726 When does a juror's entitlement to disability compensation
disability compensation begin? Pursuant to 28 U.S.C. 1877, entitlement to disability compensation does not commence until the day after the date of termination of...
Section 10.727 What is the pay rate of jurors for compensation purposes?
compensation purposes? For the purpose of computing compensation payable for disability or death, a juror is deemed to receive pay at the minimum rate for Grade GS-2 of...
Section 10.730 What are the conditions of coverage for Peace Corps volunteers
Peace Corps volunteers and volunteer leaders injured while serving outside the United States? (a) Any injury sustained by a volunteer or volunteer leader while he...
Section 10.731 What is the pay rate of Peace Corps volunteers and volunteer
volunteers and volunteer leaders for compensation purposes? The pay rate for these claimants is defined as the pay rate in effect on the date following...
Section 10.735 When is a non-Federal law enforcement officer (LEO) covered
(LEO) covered under the FECA? (a) A law enforcement officer (officer) includes an employee of a State or local Government, the Governments of U.S....
Section 10.736 What are the time limits for filing a LEO claim?
LEO claim? OWCP must receive a claim for benefits under 5 U.S.C. 8191 within five years after the injury or death. This five-year limitation is not subject to...
Section 10.737 How is a LEO claim filed, and who can file a LEO claim?
file a LEO claim? A claim for injury or occupational disease should be filed on Form CA-721; a death claim should be filed on Form CA-722. All claims should be...
Section 10.738 Under what circumstances are benefits payable in LEO claims?
in LEO claims? (a) Benefits are payable when an officer is injured while apprehending, or attempting to apprehend, an individual for the commission of a...
Section 10.739 What kind of objective evidence of a potential Federal
a potential Federal crime must exist for coverage to be extended? Based on the facts available at the time of the event, the officer must have an awareness of...
Section 10.740 In what situations will OWCP automatically presume that
that a law enforcement officer is covered by the FECA? (a) Where an officer is detailed by a competent State or local authority to assist a Federal...
Section 10.741 How are benefits calculated in LEO claims?
claims? (a) Except for continuation of pay, eligible officers and survivors are entitled to the same benefits as if the officer had been an employee under 5 U.S.C....
Section 10.800 What kind of medical records must providers keep?
providers keep? Medical Records and Bills Agency medical officers, private physicians and hospitals are required to keep records...
Section 10.801 How are medical bills to be submitted?
be submitted? (a) All charges for medical and surgical treatment, appliances or supplies furnished to injured employees, except for treatment and supplies provided...
Section 10.802 How should an employee prepare and submit requests for
and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses? (a) If an employee has paid bills...
Section 10.803 What are the time limitations on OWCP's payment of bills?
OWCP's payment of bills? OWCP will pay providers and reimburse employees promptly for all bills received on an approved form and in a timely manner. However, no...
Section 10.805 What services are covered by the OWCP fee schedule?
the OWCP fee schedule? (a) Payment for medical and other health services furnished by physicians, hospitals and other providers for work-related injuries shall not...
Section 10.806 How are the maximum fees defined?
For professional medical services, the Director shall maintain a schedule of maximum allowable fees for procedures performed in a given locality. The schedule...
Section 10.807 How are payments for particular services calculated?
calculated? Payment for a procedure identified by a HCPCS/CPT code shall not exceed the amount derived by multiplying the relative values for that...
Section 10.808 Does the fee schedule apply to every kind of procedure?
every kind of procedure? Where the time, effort and skill required to perform a particular procedure vary widely from one occasion to the next, the Director may...
Section 10.809 How are payments for medicinal drugs determined?
drugs determined? Payment for medicinal drugs prescribed by physicians shall not exceed the amount derived by multiplying the average wholesale price of...
Section 10.810 How are payments for inpatient medical services determined?
services determined? (a) OWCP will pay for inpatient medical services according to pre- determined, condition-specific rates based on the Prospective...
Section 10.811 When and how are fees reduced?
(a) OWCP shall accept a provider's designation of the code to identify a billed procedure or service if the code is consistent with medical reports and other...
Section 10.812 If OWCP reduces a fee, may a provider request reconsideration
a provider request reconsideration of the reduction? (a) A physician or other provider whose charge for service is only partially paid because it exceeds a...
Section 10.813 If OWCP reduces a fee, may a provider bill the claimant
a provider bill the claimant for the balance? A provider whose fee for service is partially paid by OWCP as a result of the application of its fee schedule or other...
Section 10.815 What are the grounds for excluding a provider from payment
excluding a provider from payment under the FECA? A physician, hospital, or provider of medical services or supplies shall be excluded from payment under the FECA if...
Section 10.816 What will cause OWCP to automatically exclude a physician
exclude a physician or other provider of medical services and supplies? (a) OWCP shall automatically exclude a physician, hospital, or provider of...
Section 10.817 When are OWCP's exclusion procedures initiated?
initiated? Upon receipt of information indicating that a physician, hospital or provider of medical services or supplies (hereinafter the provider) has engaged...
Section 10.818 How is a provider notified of OWCP's intent to exclude him
OWCP's intent to exclude him or her? The Regional Director shall initiate the exclusion process by sending the provider a letter, by certified mail and with...
Section 10.819 What requirements must the provider's reply and OWCP's
provider's reply and OWCP's decision meet? (a) The provider's answer shall be in writing and shall include an answer to OWCP's invitation to resign voluntarily. If...
Section 10.820 How can an excluded provider request a hearing?
a hearing? A request for a hearing shall be sent to the official representative named under Sec. 10.818(f) and shall contain: (a) A concise notice of...
Section 10.821 How are hearings assigned and scheduled?
scheduled? (a) If the designated OWCP representative receives a timely request for hearing, the OWCP representative shall refer the matter to the Chief...
Section 10.822 How are subpoenas or advisory opinions obtained?
obtained? (a) The provider may apply to the administrative law judge for the issuance of subpoenas upon a showing of good cause therefor. (b) A...
Section 10.823 How will the administrative law judge conduct the hearing
judge conduct the hearing and issue the recommended decision? (a) To the extent appropriate, proceedings before the administrative...
Section 10.824 How can a party request review by the Director of the
by the Director of the administrative law judge's recommended decision? (a) Any party adversely affected or aggrieved by the decision of the administrative law...
Section 10.825 What are the effects of exclusion?
exclusion? (a) OWCP shall give notice of the exclusion of a physician, hospital or provider of medical services or supplies to: (1) All OWCP district offices; ...
Section 10.826 How can an excluded provider be reinstated?
reinstated? (a) If a physician, hospital, or provider of medical services or supplies has been automatically excluded pursuant to Sec. 10.816, the provider...
Part 25_Compensation for Disability and Death of Noncitizen Federal
Section 25.1 How are claims of Federal employees who are neither citizens
employees who are neither citizens nor residents adjudicated? Subpart A_General Provisions Sec. 25.1 How are claims of...
Section 25.2 In general, what is the Director's policy regarding such
policy regarding such claims? (a) Pursuant to 5 U.S.C. 8137, the benefit features of local workers' compensation laws, or provisions in the nature of...
Section 25.3 What is the authority to settle and pay such claims?
settle and pay such claims? In addition to the authority to receive, process and pay claims, when delegated such representative or agency receiving delegation...
Section 25.4 What type of evidence is required to establish a claim under
required to establish a claim under this part? Claims of employees of the United States who are neither citizens nor residents of the United States, any territory...
Section 25.5 What special rules does OWCP apply to claims of third and
apply to claims of third and fourth country nationals? (a) Definitions. A ``third country national'' is a person who is neither a citizen nor resident of the...
Section 25.6 How does OWCP adjudicate claims of non-citizen residents
of non-citizen residents of possessions? An employee who is a bona fide permanent resident of any United States possession, territory, commonwealth or...
Section 25.100 How is compensation for disability paid?
for disability paid? Compensation for disability shall be paid to the employee as follows: (a) Permanent total disability. In cases of permanent...
Section 25.101 How is compensation for death paid?
for death paid? If the disability causes death, the compensation shall be payable in the amount and to or for the benefit of the following persons: (a) To...
Section 25.102 What general provisions does OWCP apply to the Special
provisions does OWCP apply to the Special Schedule? (a) The definitions of terms in the FECA, as amended, shall apply to terms used in this subpart. (b)...
Section 25.200 How is the Special Schedule applied for employees in the
How is the Special Schedule applied for employees in the Republic of the Philippines? (a) Modified special schedule of compensation. Except for injury or death...
Section 25.201 How is the Special Schedule applied for employees in Australia?
the Special Schedule applied for employees in Australia? (a) The special schedule of compensation established by subpart B of this part shall apply in Australia with...
Section 25.202 How is the Special Schedule applied for Japanese seamen?
How is the Special Schedule applied for Japanese seamen? (a) The special schedule of compensation established by subpart B of this part shall apply as of November 1, 1971,...
Section 25.203 How is the Special Schedule applied to non-resident aliens
How is the Special Schedule applied to non-resident aliens in the Territory of Guam? (a) The special schedule of compensation established by subpart B of this part...
Part 30_CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL
Section 30.0 What are the provisions of the EEOICPA, in general?
What are the provisions of the EEOICPA, in general? Subpart A_General Provisions ...
Section 30.1 What rules govern the administration of the EEOICPA and this
rules govern the administration of the EEOICPA and this chapter? In accordance with the EEOICPA, Executive Order 13179 and Secretary's Order No. 4-2001, the...
Section 30.2 In general, how have the tasks associated with the
In general, how have the tasks associated with the administration of the EEOICPA claims process been assigned? (a) In E.O. 13179, the President assigned various tasks...
Section 30.3 What do these regulations contain?
do these regulations contain? This part 30 sets forth the regulations governing administration of all claims that are filed with OWCP, except to the extent specified...
Section 30.5 What are the definitions used in this part?
What are the definitions used in this part? (a) Act or EEOICPA means the Energy Employees Occupational Illness Compensation Program Act of 2000, as amended (42 U.S.C. 7384...
Section 30.10 Are all OWCP records relating to claims filed under the
Are all OWCP records relating to claims filed under the EEOICPA considered confidential? All OWCP records relating to claims for benefits under the EEOICPA are...
Section 30.11 Who maintains custody and control of claim records?
Who maintains custody and control of claim records? All OWCP records relating to claims for benefits filed under the Act are covered by the Privacy Act system of...
Section 30.12 What process is used by a person who wants to obtain copies
What process is used by a person who wants to obtain copies of or amend EEOICPA claim records? (a) A claimant seeking copies of his or her official EEOICPA file...
Section 30.15 May EEOICPA benefits be assigned, transferred or garnished?
May EEOICPA benefits be assigned, transferred or garnished? (a) Pursuant to section 7385f(a) of the Act, no claim for EEOICPA benefits may be assigned or transferred. ...
Section 30.16 What penalties may be imposed in connection with a claim
What penalties may be imposed in connection with a claim under the Act? (a) Other statutory provisions make it a crime to file a false or fraudulent claim or statement...
Section 30.17 Is a beneficiary who defrauds the government in connection
Is a beneficiary who defrauds the government in connection with a claim for benefits still entitled to those benefits? When a beneficiary either pleads guilty to or is...
Section 30.100 In general, how does an employee file for benefits?
Procedures for Certain Cancer Claims Sec. 30.100 In general, how does an employee file for benefits? Claims for Occupational Illness--Employee...
Section 30.101 In general, how is a survivor's claim filed?
Procedures for Certain Cancer Claims Sec. 30.101 In general, how is a survivor's claim filed? (a) A survivor of an employee who sustained an...
Section 30.102 How does a claimant make sure that OWCP has the evidence
Procedures for Certain Cancer Claims Sec. 30.102 How does a claimant make sure that OWCP has the evidence necessary to process the claim? ...
Section 30.105 What must DOE do after an employee files a claim for an
Procedures for Certain Cancer Claims Sec. 30.105 What must DOE do after an employee files a claim for an occupational illness? (a) DOE shall...
Section 30.106 What should DOE do when an employee with a claim for an
Procedures for Certain Cancer Claims Sec. 30.106 What should DOE do when an employee with a claim for an occupational illness dies? (a)...
Section 30.110 Who is entitled to compensation under the Act?
Procedures for Certain Cancer Claims Sec. 30.110 Who is entitled to compensation under the Act? (a) Compensation is payable to the following...
Section 30.111 What is the claimant's responsibility with respect to
Procedures for Certain Cancer Claims Sec. 30.111 What is the claimant's responsibility with respect to burden of proof, production of documents,...
Section 30.112 What kind of evidence is needed to establish covered
Procedures for Certain Cancer Claims Sec. 30.112 What kind of evidence is needed to establish covered employment and how will that evidence...
Section 30.113 What are the requirements for written medical documentation,
Procedures for Certain Cancer Claims Sec. 30.113 What are the requirements for written medical documentation, contemporaneous records, and other records...
Section 30.114 What kind of evidence is needed to establish a covered
Procedures for Certain Cancer Claims Sec. 30.114 What kind of evidence is needed to establish a covered medical condition and how will that evidence...
Section 30.115 For those claims that do not seek benefits pursuant to the
Procedures for Certain Cancer Claims Sec. 30.115 For those claims that do not seek benefits pursuant to the Special Exposure Cohort provisions, what...
Section 30.200 What is the scope of this subpart?
What is the scope of this subpart? General Provisions The regulations in this subpart describe the criteria for eligibility...
Section 30.205 What are the criteria for eligibility for benefits relating
What are the criteria for eligibility for benefits relating to covered beryllium illness? To establish eligibility for benefits under this section, the claimant...
Section 30.206 How does a claimant prove that the employee was a ``covered
How does a claimant prove that the employee was a ``covered beryllium employee'' exposed to beryllium dust, particles or vapor in the performance of duty? ...
Section 30.207 How does a claimant prove a diagnosis of a covered beryllium
How does a claimant prove a diagnosis of a covered beryllium disease? (a) Written medical documentation is required in all cases to prove that the employee developed...
Section 30.210 What are the criteria for eligibility for benefits relating
What are the criteria for eligibility for benefits relating to cancer? To establish eligibility for benefits for cancer, an employee or his or her survivor must...
Section 30.211 How does a claimant establish that the employee has or had
How does a claimant establish that the employee has or had contracted cancer? A claimant establishes that the employee has or had contracted cancer with medical...
Section 30.212 How does a claimant establish that the employee contracted
How does a claimant establish that the employee contracted cancer after beginning employment at a DOE facility or an atomic weapons employer facility? (a) Proof...
Section 30.213 How does a claimant establish that the cancer was at least
How does a claimant establish that the cancer was at least as likely as not related to the employment at the DOE facility or the atomic weapons employer facility? ...
Section 30.214 How does a claimant establish that the employee is a member
How does a claimant establish that the employee is a member of the Special Exposure Cohort? (a) For purposes of establishing eligibility as a member of the...
Section 30.215 How does a claimant establish that the employee has been
How does a claimant establish that the employee has been diagnosed with cancer or has sustained a consequential injury, illness or disease? (a) Evidence that...
Section 30.220 What are the criteria for eligibility for benefits relating
What are the criteria for eligibility for benefits relating to chronic silicosis? To establish eligibility for benefits for chronic silicosis, an employee or his or...
Section 30.221 How does a claimant prove exposure to silica in the
How does a claimant prove exposure to silica in the performance of duty? (a) Proof of the employee's employment and presence for the requisite days during the mining...
Section 30.222 How does a claimant establish that the employee has been
How does a claimant establish that the employee has been diagnosed with chronic silicosis or has sustained a consequential injury, illness or disease? (a)...
Section 30.225 What are the criteria for eligibility for benefits for
What are the criteria for eligibility for benefits for certain uranium employees? In order to be eligible for benefits under this section, the claimant must establish...
Section 30.226 How does a claimant establish that a covered uranium
How does a claimant establish that a covered uranium employee has sustained a consequential injury, illness or disease? An injury, illness, impairment or disability...
Section 30.300 What process will OWCP use to decide claims and to provide
What process will OWCP use to decide claims and to provide for administrative review of those decisions? OWCP district offices will issue recommended decisions...
Section 30.305 How does OWCP determine entitlement to EEOICPA compensation?
How does OWCP determine entitlement to EEOICPA compensation? (a) In reaching a recommended decision with respect to EEOICPA compensation, OWCP considers the claim presented...
Section 30.306 What does the recommended decision contain?
What does the recommended decision contain? The recommended decision shall contain findings of fact and conclusions of law. The recommended decision may accept or reject...
Section 30.307 To whom is the recommended decision sent?
To whom is the recommended decision sent? (a) A copy of the recommended decision will be mailed to the claimant's last known address. However, if the claimant has a...
Section 30.310 What must the claimant do if he or she objects to the
What must the claimant do if he or she objects to the recommended decision or wants to request a hearing? (a) Within 60 days from the date the recommended decision is...
Section 30.311 What happens if the claimant does not object to the
What happens if the claimant does not object to the recommended decision or request a hearing within 60 days? (a) If the claimant does not file a written statement that...
Section 30.312 What will the FAB do if the claimant objects to the
What will the FAB do if the claimant objects to the recommended decision but does not request a hearing? If the claimant files a written statement that objects to...
Section 30.313 How is a review of the written record conducted?
How is a review of the written record conducted? (a) The FAB reviewer will consider the written record forwarded by the district office and any additional evidence...
Section 30.314 How is a hearing conducted?
How is a hearing conducted? (a) The FAB reviewer retains complete discretion to set the time and place of the hearing, including the amount of time allotted for...
Section 30.315 May a claimant postpone a hearing?
May a claimant postpone a hearing? (a) The FAB will entertain any reasonable request for scheduling the hearing, but such requests should be made at the time the hearing...
Section 30.316 How does the FAB issue a final decision on a claim?
How does the FAB issue a final decision on a claim? (a) If the claimant does not file a written statement that objects to the recommended decision and/or requests a...
Section 30.317 Can the FAB request a further response from the claimant
Can the FAB request a further response from the claimant or remand a claim to the district office? At any time before the issuance of its final decision, the FAB...
Section 30.318 Can the FAB consider an objection to a determination by
Can the FAB consider an objection to a determination by HHS with respect to an employee's dose reconstruction? (a) If the claimant objects to HHS's reconstruction of...
Section 30.319 May a claimant request reconsideration of a final decision
May a claimant request reconsideration of a final decision of the FAB? (a) A claimant may request reconsideration of a final decision of the...
Section 30.320 Can a claim be reopened after the FAB has issued a final
Can a claim be reopened after the FAB has issued a final decision? (a) At any time after the FAB has issued a final decision pursuant to Sec. 30.316, and without regard...
Section 30.400 What are the basic rules for obtaining medical care?
What are the basic rules for obtaining medical care? Medical Treatment and Related Issues (a) A covered employee who fits into at least...
Section 30.401 What are the special rules for the services of chiropractors?
What are the special rules for the services of chiropractors? (a) The services of chiropractors that may be reimbursed by OWCP are limited to treatment to correct a...
Section 30.402 What are the special rules for the services of clinical
What are the special rules for the services of clinical psychologists? A clinical psychologist may serve as a physician within the scope of his or her practice...
Section 30.403 Will OWCP pay for the services of an attendant?
Will OWCP pay for the services of an attendant? OWCP will authorize payment for personal care services under section 7384t of the Act, whether or not such care...
Section 30.404 Will OWCP pay for transportation to obtain medical treatment?
Will OWCP pay for transportation to obtain medical treatment? (a) The employee is entitled to reimbursement of reasonable and necessary expenses, including...
Section 30.405 After selecting a treating physician, may an employee choose
After selecting a treating physician, may an employee choose to be treated by another physician instead? (a) OWCP will provide the employee with an opportunity...
Section 30.406 Are there any exceptions to these procedures for obtaining
Are there any exceptions to these procedures for obtaining medical care? In cases involving emergencies or unusual circumstances, OWCP may authorize treatment in...
Section 30.410 Can OWCP require an employee to be examined by another
Can OWCP require an employee to be examined by another physician? (a) OWCP sometimes needs a second opinion from a medical specialist. The employee must submit...
Section 30.411 What happens if the opinion of the physician selected by
What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee? (a) If one medical opinion holds...
Section 30.412 Who pays for second opinion and referee examinations?
Who pays for second opinion and referee examinations? OWCP will pay second opinion and referee medical specialists directly. OWCP will also reimburse the employee...
Section 30.415 What are the requirements for medical reports?
What are the requirements for medical reports? In general, medical reports from the employee's attending physician should include the following: (a) Dates...
Section 30.416 How and when should medical reports be submitted?
How and when should medical reports be submitted? (a) The initial medical report (and any subsequent reports) should be made in narrative form on the...
Section 30.417 What additional medical information may OWCP require to
What additional medical information may OWCP require to support continuing payment of benefits? In all cases requiring hospital treatment or prolonged care, OWCP...
Section 30.420 How are medical bills submitted?
How are medical bills submitted? Usually, medical providers submit bills directly for processing. The rules for submitting and processing bills are stated in subpart H...
Section 30.421 What are the time frames for submitting bills?
What are the time frames for submitting bills? To be considered for payment, bills must be submitted by the end of the calendar year after the year when the expense...
Section 30.422 If OWCP reimburses an employee only partially for a medical
If OWCP reimburses an employee only partially for a medical expense, must the provider refund the balance of the amount paid to the employee? (a) The OWCP...
Section 30.500 What special statutory definitions apply to survivors
30.500 What special statutory definitions apply to survivors under the EEOICPA? Survivors For the purposes of...
Section 30.501 What order of precedence will OWCP use to determine which
30.501 What order of precedence will OWCP use to determine which survivors are entitled to receive compensation under the EEOICPA? If OWCP determines that a survivor...
Section 30.502 When is entitlement for survivors determined for purposes
30.502 When is entitlement for survivors determined for purposes of the EEOICPA? Entitlement to any lump-sum payment for survivors under the EEOICPA will...
Section 30.505 What procedures will OWCP follow before it pays any
30.505 What procedures will OWCP follow before it pays any compensation? (a) In cases involving the approval of a claim, OWCP shall take all necessary steps...
Section 30.506 To whom and in what manner will OWCP pay compensation?
30.506 To whom and in what manner will OWCP pay compensation? (a) Except with respect to claims related to beryllium sensitivity, payment shall be made to the...
Section 30.507 What compensation will be provided to covered employees who
30.507 What compensation will be provided to covered employees who only establish beryllium sensitivity? The establishment of beryllium sensitivity does not entitle...
Section 30.508 What is beryllium sensitivity monitoring?
30.508 What is beryllium sensitivity monitoring? Beryllium sensitivity monitoring shall consist of medical examinations to confirm and monitor the extent and...
Section 30.510 How does OWCP notify an individual of a payment made on a
30.510 How does OWCP notify an individual of a payment made on a claim? (a) In addition to providing narrative descriptions to recipients of benefits paid...
Section 30.511 What is an ``overpayment'' for purposes of the EEOICPA?
30.511 What is an ``overpayment'' for purposes of the EEOICPA? An ``overpayment'' is any amount of compensation paid under sections 7384s or 7384u of the EEOICPA to...
Section 30.512 How does OWCP determine that a beneficiary owes a debt as
30.512 How does OWCP determine that a beneficiary owes a debt as the result of the creation of an overpayment? OWCP will notify the beneficiary of the existence...
Section 30.513 How are overpayments collected?
30.513 How are overpayments collected? The overpaid individual shall refund to OWCP the amount of the overpayment as soon as possible. The overpayment is subject to...
Section 30.600 May a claimant designate a representative?
May a claimant designate a representative? Representation (a) The claims process under this part is informal, and OWCP acts as...
Section 30.601 Who may serve as a representative?
Who may serve as a representative? A claimant may authorize any individual to represent him or her in regard to a claim under the EEOICPA, unless that individual's service...
Section 30.602 Who is responsible for paying the representative's fee?
Who is responsible for paying the representative's fee? A representative may charge the claimant a fee for services and for costs associated with the representation...
Section 30.603 Are there any limitations on what the representative may
Are there any limitations on what the representative may charge the claimant for his or her services? (a) Notwithstanding any contract, the representative may not...
Section 30.605 What rights does the United States have upon payment of
What rights does the United States have upon payment of compensation under the EEOICPA? If an illness for which compensation is payable under the EEOICPA is caused,...
Section 30.606 Under what circumstances must a recovery of money or other
Under what circumstances must a recovery of money or other property in connection with an illness for which benefits are payable under the EEOICPA be reported to OWCP? ...
Section 30.607 How is a structured settlement (that is, a settlement
How is a structured settlement (that is, a settlement providing for receipt of funds over a specified period of time) treated for purposes of reporting the recovery? ...
Section 30.608 How does the United States calculate the amount to which
How does the United States calculate the amount to which it is subrogated? The subrogated amount of a specific claim consists of the total money paid by OWCP from...
Section 30.609 Is a settlement or judgment received as a result of
Is a settlement or judgment received as a result of allegations of medical malpractice in treating an illness covered by the EEOICPA a recovery that must be reported...
Section 30.610 Are payments to an employee or eligible surviving beneficiary
Are payments to an employee or eligible surviving beneficiary as a result of an insurance policy which the employee or eligible surviving beneficiary has purchased a recovery...
Section 30.611 If a settlement or judgment is received for more than one
If a settlement or judgment is received for more than one medical condition, can the amount paid on a single EEOICPA claim be attributed to different conditions for purposes...
Section 30.615 What type of tort suits filed against beryllium vendors or
What type of tort suits filed against beryllium vendors or atomic weapons employers may disqualify certain claimants from receiving benefits under EEOICPA? ...
Section 30.616 What happens if this type of tort suit was filed prior to
What happens if this type of tort suit was filed prior to October 30, 2000? (a) If a tort suit described in Sec. 30.615 was filed prior to October 30, 2000, the...
Section 30.617 What happens if this type of tort suit was filed during the
What happens if this type of tort suit was filed during the period from October 30, 2000 through December 28, 2001? (a) If a tort suit described in Sec. 30.615 was filed...
Section 30.618 What happens if this type of tort suit is filed after
What happens if this type of tort suit is filed after December 28, 2001? (a) If a tort suit described in Sec. 30.615 is filed after December 28, 2001, the claimant...
Section 30.619 Do all the parties to this type of tort suit have to take
Do all the parties to this type of tort suit have to take these actions? The type of tort suits described in Sec. 30.615 may be filed by more than one individual,...
Section 30.620 How will OWCP ascertain whether a claimant filed this type
How will OWCP ascertain whether a claimant filed this type of tort suit and if he or she has been disqualified from receiving any benefits under the EEOICPA? Prior...
Section 30.700 What kinds of medical records must providers keep?
What kinds of medical records must providers keep? Medical Records and Bills Federal government medical officers, private...
Section 30.701 How are medical bills to be submitted?
How are medical bills to be submitted? (a) All charges for medical and surgical treatment, appliances or supplies furnished to employees, except for treatment...
Section 30.702 How should an employee prepare and submit requests for
How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses? ...
Section 30.703 What are the time limitations on OWCP's payment of bills?
What are the time limitations on OWCP's payment of bills? OWCP will pay providers and reimburse employees promptly for all bills received on an approved form and in...
Section 30.705 What services are covered by the OWCP fee schedule?
What services are covered by the OWCP fee schedule? (a) Payment for medical and other health services furnished by physicians, hospitals and other providers...
Section 30.706 How are the maximum fees defined?
How are the maximum fees defined? For professional medical services, OWCP shall maintain a schedule of maximum allowable fees for procedures performed in a...
Section 30.707 How are payments for particular services calculated?
How are payments for particular services calculated? Payment for a procedure identified by a CCPCS/CPT code shall not exceed the amount derived by multiplying...
Section 30.708 Does the fee schedule apply to every kind of procedure?
Does the fee schedule apply to every kind of procedure? Where the time, effort and skill required to perform a particular procedure vary widely from one occasion to...
Section 30.709 How are payments for medicinal drugs determined?
How are payments for medicinal drugs determined? Payment for medicinal drugs prescribed by physicians shall not exceed the amount derived by multiplying the...
Section 30.710 How are payments for inpatient medical services determined?
How are payments for inpatient medical services determined? (a) OWCP will pay for inpatient medical services according to pre- determined, condition-specific rates...
Section 30.711 When and how are fees reduced?
When and how are fees reduced? (a) OWCP shall accept a provider's designation of the code to identify a billed procedure or service if the code is consistent...
Section 30.712 If OWCP reduces a fee, may a provider request reconsideration
If OWCP reduces a fee, may a provider request reconsideration of the reduction? (a) A physician or other provider whose charge for service is only partially...
Section 30.713 If OWCP reduces a fee, may a provider bill the employee
If OWCP reduces a fee, may a provider bill the employee for the balance? A provider whose fee for service is partially paid by OWCP as a result of...
Section 30.715 What are the grounds for excluding a provider from payment
What are the grounds for excluding a provider from payment under this part? A physician, hospital, or provider of medical services or supplies shall be...
Section 30.716 What will cause OWCP to automatically exclude a physician
What will cause OWCP to automatically exclude a physician or other provider of medical services and supplies? (a) OWCP shall automatically exclude a...
Section 30.717 When are OWCP's exclusion procedures initiated?
When are OWCP's exclusion procedures initiated? Upon receipt of information indicating that a physician, hospital or provider of medical services or...
Section 30.718 How is a provider notified of OWCP's intent to exclude him
How is a provider notified of OWCP's intent to exclude him or her? The Regional Director shall initiate the exclusion process by sending the provider a...
Section 30.719 What requirements must the provider's reply and OWCP's
What requirements must the provider's reply and OWCP's decision meet? (a) The provider's answer shall be in writing and shall include an answer to...
Section 30.720 How can an excluded provider request a hearing?
How can an excluded provider request a hearing? A request for a hearing shall be sent to the OWCP representative named pursuant to Sec. 30.718(f) and...
Section 30.721 How are hearings assigned and scheduled?
How are hearings assigned and scheduled? (a) If the designated OWCP representative receives a timely request for hearing, the OWCP representative shall refer...
Section 30.722 How are advisory opinions obtained?
How are advisory opinions obtained? A certification of a request for an advisory opinion concerning professional medical standards, medical ethics or medical...
Section 30.723 How will the administrative law judge conduct the hearing
How will the administrative law judge conduct the hearing and issue the recommended decision? (a) To the extent appropriate, proceedings before the...
Section 30.724 How can a party request review by OWCP of the administrative
How can a party request review by OWCP of the administrative law judge's recommended decision? (a) Any party adversely affected or aggrieved by the decision of...
Section 30.725 What are the effects of non-automatic exclusion?
What are the effects of non-automatic exclusion? (a) OWCP shall give notice of the exclusion of a physician, hospital or provider of medical services or...
Section 30.726 How can an excluded provider be reinstated?
How can an excluded provider be reinstated? (a) If a physician, hospital, or provider of medical services or supplies has been automatically excluded pursuant to...
Part 61_CLAIMS FOR COMPENSATION UNDER THE WAR HAZARDS COMPENSATION ACT,
Section 61.1 Statutory provisions
Subpart A_General Provisions Sec. 61.1 Statutory provisions. 61.2 Administration of the Act and this chapter. 61.3 Purpose and scope of...
Section 61.2 Administration of the Act and this chapter.
(a) Pursuant to 42 U.S.C. 1706, Secretary of Labor's Order 6-84, (49 FR 32473), and Employment Standards Order 78-1, (43 FR 51469), the responsibility for administration...
Section 61.3 Purpose and scope of this part.
(a) This part 61 sets forth the rules applicable to the filing, processing, and payment of claims for reimbursement and workers' compensation benefits under the provisions of the...
Section 61.4 Definitions and use of terms.
For the purpose of this part-- (a) The Act means the War Hazards Compensation Act, 42 U.S.C. 1701 et seq., as amended. (b) Office or OWCP means the Office of...
Section 61.100 General reimbursement provisions.
(a) The Office shall reimburse any carrier that pays benefits under the Defense Base Act or other applicable workers' compensation law due to the injury,...
Section 61.101 Filing a request for reimbursement.
(a) A carrier or employer may file a request for reimbursement. The request shall be submitted to the U.S. Department of Labor, Office of Workers' Compensation...
Section 61.102 Disposition of reimbursement requests.
(a) If the Office finds that insufficient or inadequate information has been submitted with the claim, the carrier shall be asked to submit further...
Section 61.103 Examination of records of carrier.
Whenever it is deemed necessary, the Office may request submission of case records or may inspect the records and accounts of a carrier for the purpose of verifying...
Section 61.104 Reimbursement of claims expense.
(a) A carrier may claim reimbursement for reasonable and necessary claims expense incurred in connection with a case for which reimbursement is claimed under the...
Section 61.105 Direct payment of benefits.
(a) The Office may pay benefits, as they accrue, directly to any entitled beneficiary in lieu of reimbursement of a carrier. (b) The Office will not accept a case for...
Section 61.200 Entitlement to benefits.
(a) Compensation under section 101(a) of the Act is payable for injury or death due to a war-risk hazard of an employee listed in Sec. 61.1(a), whether or not the...
Section 61.201 Filing of notice and claim.
An employee or his or her survivors may file a claim under section 101(a) of the Act only after a determination has been made that no benefits are payable under the...
Section 61.202 Time limitations for filing notice and claim.
and claim. The time limitation provisions found in 5 U.S.C. 8119 apply to the filing of claims under section 101(a) of the War Hazards Compensation Act. The...
Section 61.203 Limitations on and deductions from benefits.
benefits. (a) Compensation payable for injury, disability or death may not exceed the maximum limitations specified in section 6(b) of the Longshore and...
Section 61.204 Furnishing of medical treatment.
All medical services, appliances, drugs and supplies which in the opinion of the Office are necessary for the treatment of an injury coming within the purview...
Section 61.205 Burial expense.
(a) When the death of a person listed in Sec. 61.1(a) results from an injury caused by a war-risk hazard, the Office shall pay reasonable burial expenses up to the amount specified...
Section 61.206 Reports by employees and dependents.
The Office may require a claimant to submit reports of facts materially affecting the claimant's entitlement to compensation under the Act. These may...
Section 61.300 Payment of detention benefits.
(a) The Office shall pay detention benefits to any person listed in Sec. 61.1(a) who is detained by a hostile force or person, or who is not returned to his or her home...
Section 61.301 Filing a claim for detention benefits.
(a) A claim for detention benefits shall contain the following information: Name, address, and occupation of the missing employee; name, address and relation to the...
Section 61.302 Time limitations for filing a claim for detention benefits.
benefits. The time limitation provisions found in the Federal Employees' Compensation Act, as amended (5 U.S.C. 8101 et seq.) apply to the filing of claims...
Section 61.303 Determination of detention status.
A determination that an employee has been detained by a hostile force or person may be made on the basis that the employee has disappeared under circumstances that make...
Section 61.304 Limitations on and deductions from detention benefits.
benefits. (a) In determining benefits for detention, the Office shall not apply the minimum limits found in sections 6(b) [[Page 127]] and 9(e) of...
Section 61.305 Responsibilities of dependents receiving detention benefits.
benefits. A dependent having knowledge of a change of status of a missing employee shall promptly inform the Office of the change. The Office must be...
Section 61.306 Transportation of persons released from detention and return
and return of employees. (a) The Office may furnish the cost of transporting an employee from the point of the employee's release from detention to his or...
Section 61.307 Transportation of recovered bodies of missing persons.
persons. If an employee dies while in detention and the body is later recovered, the Office may provide the cost of transporting the body to the home of the...
Section 61.400 Custody of records relating to claims under the War Hazards
the War Hazards Compensation Act. All records, medical and other reports, statements of witnesses and other papers filed with the Office with respect to...
Section 61.401 Confidentiality of records.
Records of the Office pertaining to injury, death, or detention are confidential, and are exempt from disclosure to the public under section 552(b)(6) of title 5, U.S. Code....
Section 61.402 Protection, release, inspection and copying of records.
of records. The protection, release, inspection and copying of the records shall be accomplished in accordance with the rules, guidelines and provisions contained...
Section 61.403 Approval of claims for legal and other services.
(a) No claim for legal services or for any other services rendered in respect to a claim or award for compensation under the Act to or on account of any...
Section 61.404 Assignments; creditors.
The right of any person to benefits under the Act is not transferable of assignable at law or in equity except to the United States, and none of the moneys paid or payable (except...
Part 71_GENERAL PROVISIONS--Table of Contents
Section 71.1 General administrative provisions.
Limitation upon benefits. 71.5 Payment of benefits. 71.6 Notice of injury or death. 71.7 Claim filing, processing, adjudication and time limits. ...
Section 71.2 Computation of benefits.
whether employed, self-employed, or not employed, shall be deemed to have been $37.50. The provisions of this subchapter are applicable and benefits are payable...
Section 71.3 Deductions from benefits.
the same injury or death, or from his employer in the form of wages or payments in lieu of wages, or in any form of support or compensation (including workmen's compensation)...
Section 71.4 Limitation upon benefits.
[Code of Federal Regulations] [Title 20, Volume 1] [Revised as of April 1, 2004] From the U.S. Government Printing Office via GPO Access [CITE: 20CFR71.4] [Page 130] TITLE 20--EMPLOYEES' BENEFITS CHAPTER I--OFFICE OF WORKERS'COMPENSATION PROGRAMS,DEPARTMENT OF LABOR PART 71_GENERAL PROVISIONS--Table of Contents Sec. 71.4 Limitation upon benefits. No person, except a widow or a child, shall be entitled to benefits under this subchapter for disability with respect to himself and to death benefits on account of the death of another.
Section 71.5 Payment of benefits.
legal or natural guardian if he has one, and shall not upon death of the person so entitled survive for the benefit of his estate or any other person. (b) The benefit of a...
Section 71.6 Notice of injury or death.
[Code of Federal Regulations] [Title 20, Volume 1] [Revised as of April 1, 2004] From the U.S. Government Printing Office via GPO Access [CITE: 20CFR71.6] [Page 130] TITLE 20--EMPLOYEES' BENEFITS CHAPTER I--OFFICE OF WORKERS'COMPENSATION PROGRAMS,DEPARTMENT OF LABOR PART 71_GENERAL PROVISIONS--Table of Contents Sec. 71.6 Notice of injury or death. Notwithstanding any of the provisions in part 61 of this chapter, no notice or report of injury or death shall be required for claims filed under this subchapter. [[Page 131]]
Section 71.7 Claim filing, processing, adjudication and time limits.
Claims Act of 1948, originating in the United States or in its Territories or possessions, shall be filed by mailing to the Bureau of Employees' Compensation, United...