Title 20--EMPLOYEES' BENEFITS
Chapter I--OFFICE OF WORKERS'COMPENSATION PROGRAMS,DEPARTMENT OF LABOR


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...


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...


Compensation Act, the War Hazards Compensation Act, the War Claims Act and the Energy Employees Occupational Illness Compensation Program Act...


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...


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...


the Longshore and Harbor Workers' Compensation Act was initially vested in an independent establishment known as the U.S. Employees' Compensation Commission. By Reorganization...


general? Subpart A_General Provisions Introduction Sec. 10.0 What are the provisions of the...


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...


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....


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...


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...


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...


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...


under the FECA considered confidential? All records relating to claims for benefits, including copies of such records maintained by an employer, are...


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...


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...


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...


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...


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...


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...


on a felony conviction still receive benefits? (a) Whenever a beneficiary is incarcerated in a State or Federal jail, prison, penal institution or...


of traumatic injury filed? Notices and Claims for Injury, Disease, and Death--Employee or Survivor's Actions (a) To...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


take with respect to information submitted by the employer? OWCP will consider all evidence submitted appropriately, and OWCP will inform the employee, the...


evidence? A claimant or a person acting on his or her behalf may submit to OWCP at any time any other evidence relevant to...


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...


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...


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...


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...


(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...


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...


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...


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...


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...


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...


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...


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...


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...


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: ...


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...


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...


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...


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...


emergency medical care? Emergency Medical Care (a) When an employee sustains a work-related traumatic injury that...


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...


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...


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...


procedures for obtaining medical care? In cases involving emergencies or unusual circumstances, OWCP may authorize treatment in a manner other than as stated in...


medical care? (a) The employee is entitled to receive all medical services, appliances or supplies which a qualified physician prescribes or recommends and...


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...


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,...


The FECA does not authorize payment for preventive measures such as vaccines and inoculations, and in general, preventive treatment may be a responsibility...


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...


obtain medical treatment? The employee is entitled to reimbursement of reasonable and necessary expenses, including transportation needed to obtain authorized...


may an employee choose to be treated by another physician instead? (a) When the physician originally selected to provide treatment for a work-related...


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...


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...


referee examinations? OWCP will pay second opinion and referee medical specialists directly. OWCP will reimburse the employee all necessary and reasonable...


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,...


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...


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...


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,...


OWCP require to support continuing payment of benefits? In all cases of serious injury or disease, especially those requiring hospital treatment or...


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...


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...


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...


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...


Compensation for Disability and Impairment (a) Permanent total disability is presumed to result from the loss of use of both hands, both arms,...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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)....


of beneficiaries affect the amount of compensation paid to the other beneficiaries? If compensation to a beneficiary is terminated, the amount of compensation...


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...


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...


kinds of payments from the Federal Government concurrently with compensation? (a) 5 U.S.C. 8116(a) provides that a beneficiary may not...


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...


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...


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...


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...


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...


overpayment is identified? Before seeking to recover an overpayment or adjust benefits, OWCP will advise the beneficiary in writing that: (a) The overpayment exists,...


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....


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...


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...


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...


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...


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...


received the overpayment to submit additional financial information? (a) The individual who received the overpayment is responsible for providing information...


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...


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...


(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...


receipt of compensation benefits and return to work? Rules and Evidence (a) Benefits are available only while the...


support continuing receipt of compensation benefits? (a) The employee is responsible for providing sufficient medical evidence to justify payment of any...


support of continuing receipt of compensation benefits? In considering the medical and factual evidence, OWCP will weigh the probative value of the attending...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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....


an employee completes a vocational rehabilitation program? After completion of a vocational rehabilitation program, OWCP may adjust compensation to reflect...


(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....


An employee who is receiving compensation for partial or total disability is periodically required to report volunteer activity or any other kind of...


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...


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...


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...


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...


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...


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...


or terminated? (a) Except as provided in paragraphs (b) and (c) of this section, where the [[Page 47]] evidence establishes that compensation should...


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,...


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...


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...


(a) An employee (or representative) seeking reconsideration should send the application for reconsideration to the address as instructed by OWCP in the...


(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...


or deny the request for reconsideration? (a) A timely request for reconsideration may be granted if OWCP determines that the employee has presented evidence...


evidence requires modification of the prior decision? When application for reconsideration is granted, OWCP will review the decision for which reconsideration is sought...


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...


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...


(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...


(a) The hearing representative retains complete discretion to set the [[Page 50]] time and place of the hearing, including the amount of time allotted...


(a) The hearing representative will review the official record and any additional evidence submitted by the claimant and by the agency. The...


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...


(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...


oral hearing has been requested? (a) The employer may send one (or more, where appropriate) representative(s) to observe the proceeding, but the agency...


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...


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...


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...


Representation (a) The claims process under the FECA is informal. Unlike many workers' compensation laws, the employer is...


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...


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...


(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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


disbursements? The refundable disbursements of a specific claim consist of the total money paid by OWCP from the Employees' Compensation Fund with respect to...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


(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....


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...


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...


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...


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...


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...


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....


providers keep? Medical Records and Bills Agency medical officers, private physicians and hospitals are required to keep records...


be submitted? (a) All charges for medical and surgical treatment, appliances or supplies furnished to injured employees, except for treatment and supplies provided...


and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses? (a) If an employee has paid 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...


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...


For professional medical services, the Director shall maintain a schedule of maximum allowable fees for procedures performed in a given locality. The schedule...


calculated? Payment for a procedure identified by a HCPCS/CPT code shall not exceed the amount derived by multiplying the relative values for that...


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...


drugs determined? Payment for medicinal drugs prescribed by physicians shall not exceed the amount derived by multiplying the average wholesale price of...


services determined? (a) OWCP will pay for inpatient medical services according to pre- determined, condition-specific rates based on the Prospective...


(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...


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...


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...


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...


exclude a physician or other provider of medical services and supplies? (a) OWCP shall automatically exclude a physician, hospital, or provider of...


initiated? Upon receipt of information indicating that a physician, hospital or provider of medical services or supplies (hereinafter the provider) has engaged...


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...


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...


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...


scheduled? (a) If the designated OWCP representative receives a timely request for hearing, the OWCP representative shall refer the matter to the Chief...


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...


judge conduct the hearing and issue the recommended decision? (a) To the extent appropriate, proceedings before the administrative...


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...


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; ...


reinstated? (a) If a physician, hospital, or provider of medical services or supplies has been automatically excluded pursuant to Sec. 10.816, the provider...


employees who are neither citizens nor residents adjudicated? Subpart A_General Provisions Sec. 25.1 How are claims of...


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...


settle and pay such claims? In addition to the authority to receive, process and pay claims, when delegated such representative or agency receiving delegation...


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...


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...


of non-citizen residents of possessions? An employee who is a bona fide permanent resident of any United States possession, territory, commonwealth or...


for disability paid? Compensation for disability shall be paid to the employee as follows: (a) Permanent total disability. In cases of permanent...


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...


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)...


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...


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...


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,...


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...


What are the provisions of the EEOICPA, in general? Subpart A_General Provisions ...


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...


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...


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...


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...


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...


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...


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...


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. ...


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...


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...


Procedures for Certain Cancer Claims Sec. 30.100 In general, how does an employee file for benefits? Claims for Occupational Illness--Employee...


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...


Procedures for Certain Cancer Claims Sec. 30.102 How does a claimant make sure that OWCP has the evidence necessary to process the claim? ...


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...


Procedures for Certain Cancer Claims Sec. 30.106 What should DOE do when an employee with a claim for an occupational illness dies? (a)...


Procedures for Certain Cancer Claims Sec. 30.110 Who is entitled to compensation under the Act? (a) Compensation is payable to the following...


Procedures for Certain Cancer Claims Sec. 30.111 What is the claimant's responsibility with respect to burden of proof, production of documents,...


Procedures for Certain Cancer Claims Sec. 30.112 What kind of evidence is needed to establish covered employment and how will that evidence...


Procedures for Certain Cancer Claims Sec. 30.113 What are the requirements for written medical documentation, contemporaneous records, and other records...


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...


Procedures for Certain Cancer Claims Sec. 30.115 For those claims that do not seek benefits pursuant to the Special Exposure Cohort provisions, what...


What is the scope of this subpart? General Provisions The regulations in this subpart describe the criteria for eligibility...


What are the criteria for eligibility for benefits relating to covered beryllium illness? To establish eligibility for benefits under this section, the claimant...


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? ...


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...


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...


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...


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...


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? ...


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...


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...


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...


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...


How does a claimant establish that the employee has been diagnosed with chronic silicosis or has sustained a consequential injury, illness or disease? (a)...


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...


How does a claimant establish that a covered uranium employee has sustained a consequential injury, illness or disease? An injury, illness, impairment or disability...


What process will OWCP use to decide claims and to provide for administrative review of those decisions? OWCP district offices will issue recommended decisions...


How does OWCP determine entitlement to EEOICPA compensation? (a) In reaching a recommended decision with respect to EEOICPA compensation, OWCP considers the claim presented...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


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...


May a claimant request reconsideration of a final decision of the FAB? (a) A claimant may request reconsideration of a final decision of the...


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...


What are the basic rules for obtaining medical care? Medical Treatment and Related Issues (a) A covered employee who fits into at least...


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...


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...


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...


Will OWCP pay for transportation to obtain medical treatment? (a) The employee is entitled to reimbursement of reasonable and necessary expenses, including...


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...


Are there any exceptions to these procedures for obtaining medical care? In cases involving emergencies or unusual circumstances, OWCP may authorize treatment in...


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...


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...


Who pays for second opinion and referee examinations? OWCP will pay second opinion and referee medical specialists directly. OWCP will also reimburse the employee...


What are the requirements for medical reports? In general, medical reports from the employee's attending physician should include the following: (a) Dates...


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...


What additional medical information may OWCP require to support continuing payment of benefits? In all cases requiring hospital treatment or prolonged care, OWCP...


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...


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...


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...


30.500 What special statutory definitions apply to survivors under the EEOICPA? Survivors For the purposes of...


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...


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...


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...


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...


30.507 What compensation will be provided to covered employees who only establish beryllium sensitivity? The establishment of beryllium sensitivity does not entitle...


30.508 What is beryllium sensitivity monitoring? Beryllium sensitivity monitoring shall consist of medical examinations to confirm and monitor the extent and...


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...


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...


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...


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...


May a claimant designate a representative? Representation (a) The claims process under this part is informal, and OWCP acts as...


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...


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...


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...


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,...


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? ...


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? ...


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...


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...


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...


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...


What type of tort suits filed against beryllium vendors or atomic weapons employers may disqualify certain claimants from receiving benefits under EEOICPA? ...


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...


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...


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...


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,...


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...


What kinds of medical records must providers keep? Medical Records and Bills Federal government medical officers, private...


How are medical bills to be submitted? (a) All charges for medical and surgical treatment, appliances or supplies furnished to employees, except for treatment...


How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses? ...


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...


What services are covered by the OWCP fee schedule? (a) Payment for medical and other health services furnished by physicians, hospitals and other providers...


How are the maximum fees defined? For professional medical services, OWCP shall maintain a schedule of maximum allowable fees for procedures performed in a...


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...


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...


How are payments for medicinal drugs determined? Payment for medicinal drugs prescribed by physicians shall not exceed the amount derived by multiplying the...


How are payments for inpatient medical services determined? (a) OWCP will pay for inpatient medical services according to pre- determined, condition-specific rates...


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...


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...


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...


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...


What will cause OWCP to automatically exclude a physician or other provider of medical services and supplies? (a) OWCP shall automatically exclude a...


When are OWCP's exclusion procedures initiated? Upon receipt of information indicating that a physician, hospital or provider of medical services or...


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...


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...


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...


How are hearings assigned and scheduled? (a) If the designated OWCP representative receives a timely request for hearing, the OWCP representative shall refer...


How are advisory opinions obtained? A certification of a request for an advisory opinion concerning professional medical standards, medical ethics or medical...


How will the administrative law judge conduct the hearing and issue the recommended decision? (a) To the extent appropriate, proceedings before the...


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...


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...


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...


Subpart A_General Provisions Sec. 61.1 Statutory provisions. 61.2 Administration of the Act and this chapter. 61.3 Purpose and scope of...


(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...


(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...


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...


(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,...


(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...


(a) If the Office finds that insufficient or inadequate information has been submitted with the claim, the carrier shall be asked to submit further...


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...


(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...


(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...


(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...


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...


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...


benefits. (a) Compensation payable for injury, disability or death may not exceed the maximum limitations specified in section 6(b) of the Longshore and...


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...


(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...


The Office may require a claimant to submit reports of facts materially affecting the claimant's entitlement to compensation under the Act. These may...


(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...


(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...


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...


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...


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...


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...


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...


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...


the War Hazards Compensation Act. All records, medical and other reports, statements of witnesses and other papers filed with the Office with respect to...


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....


of records. The protection, release, inspection and copying of the records shall be accomplished in accordance with the rules, guidelines and provisions contained...


(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...


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...


Limitation upon benefits. 71.5 Payment of benefits. 71.6 Notice of injury or death. 71.7 Claim filing, processing, adjudication and time limits. ...


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...


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)...


[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. ...


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...


[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]] ...


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...




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