(a) Under section 10 of the Act. This section provides for initial
and subsequent annual adjustments in compensation and continuing
payments to beneficiaries in cases of permanent total disability or
death which commenced or occurred prior to enactment of the 1972
Amendments to this Act (Pub. L. 92-576, approved Oct. 27, 1972). At the
discretion of the Director, such payments may be paid directly by him to
eligible beneficiaries as the obligation accrues, one-half from the
special fund and one-half from appropriations, or he may require
insurance carriers or self-insured employers already making payments to
such beneficiaries to pay such additional compensation as the amended
Act requires. In the latter case such carriers and self-insurers shall
be reimbursed by the Director for such additional amounts paid, in the
proportion of one-half the amount from the special fund and one-half the
amount from appropriations. To obtain reimbursement, the carriers and
self-insurers shall submit claims for payments made by them during
previous periods at intervals of not less than 6 months. A form has been
prescribed for such purpose and shall be used. No administrative claims
service expense incurred by the carrier or self-insurer shall be
included in the claim and no such expense shall be allowed. The amounts
reimbursed to such carrier or self-insurer shall be limited to amounts
actually due and previously paid to beneficiaries.
(b) Under section 8(f) of the Act (Second Injuries). In any case in
which an employee having an existing permanent partial disability
suffers injury, the employer shall provide compensation for such
disability as is found to be attributable to that injury based upon the
average weekly wages of the employee at the time of injury. If,
following an injury falling within the provisions of section 8(c)(1)-
(20), the employee with the pre-existing permanent partial disability
becomes permanently and totally disabled after the second injury, but
such total disability is found not to be due solely to his second
injury, the employer (or carrier) shall be liable for compensation as
provided by the provisions of section 8(c)(1)-(20) of the Act, 33 U.S.C.
908(c)(1)-(20) or for 104 weeks, whichever is greater. However, if the
injury is a loss of hearing covered by section 8(c)(13), 33 U.S.C.
908(c)(13), the liability shall be the lesser of these periods. In all
other cases of a second injury causing permanent total disability (or
death), wherein it is found that such disability (or death) is not due
solely to the second injury, and wherein the employee had a pre-existing
permanent partial disability, the employer (or carrier) shall first pay
compensation under section 8(b) or (e) of the Act, 33 U.S.C. 908(b) or
(e), if any is payable thereunder, and shall then pay 104 weeks
compensation for such total disability or death, and none otherwise. If
the second injury results in permanent partial disability, and if such
disability is compensable under section 8(c)(1)-(20) of the Act, 33
U.S.C. 908(c)(1)-(20), but the disability so compensable did not result
solely from such second injury, and the disability so compensable is
materially and substantially greater than that which would have resulted
from the second injury alone, then the employer (or carrier) shall only
be liable for the amount of compensation provided for in section
8(c)(1)-(20) that is attributable to such second injury, or for 104
weeks, whichever is greater. However, if the injury is a loss of hearing
covered by section 8(c)(13), 33 U.S.C. 908(c)(13), the liability shall
be the lesser of these periods. In all other cases wherein the employee
is permanently and partially disabled following a second injury, and
wherein such disability is not attributable solely to that second
injury, and wherein such disability is materially and substantially
greater than that which would have resulted from the second injury
alone, and wherein such disability following the second injury is not
compensable under section 8(c)(1)-(20) of the Act, then the employer (or
carrier) shall be liable for such compensation as may be appropriate
under section 8(b) or (e) of the Act, 33 U.S.C. 908(b) or (e), if any,
to be followed by a payment of compensation for 104 weeks, and none
other. The term ``compensation'' herein means money benefits only, and
does not include medical benefits. The procedure
for determining the extent of the employer's (or carrier's) liability
under this paragraph shall be as provided for in the adjudication of
claims in subpart C of this part 702. Thereafter, upon cessation of
payments which the employer is required to make under this paragraph, if
any additional compensation is payable in the case, the district
director shall forward such case to the Director for consideration of an
award to the person or persons entitled thereto out of the special fund.
Any such award from the special fund shall be by order of the Director
or Acting Director.
(c) Under sections 8(g) and 39(c)(2) of the Act. These sections, 33
U.S.C. 908(g) and 939(c)(2), respectively, provide for vocational
rehabilitation of disabled employees, and authorize, under appropriate
circumstances, a maintenance allowance for the employee (not to exceed
$25 a week) in additional to other compensation benefits otherwise
payable for his injury-related disability. Awards under these sections
are made from the special fund upon order of the Director or his
designee. The district directors may be required to make investigations
with respect to any case and forward to the Director their
recommendations as to the propriety and need for such maintenance.
(d) Under section 39(c)(2) of the Act. In addition to the
maintenance allowance for the employee discussed in paragraph (c) of
this section, the Director is further authorized to use the fund in such
amounts as may be necessary to procure the vocational training services.
(e) Under section 7(e) of the Act. This provision, 33 U.S.C. 907(e),
authorizes payment by the Director from the special fund for special
medical examinations, i.e., those obtained from impartial specialists to
resolve disputes, when such special examinations are deemed necessary
under that statutory provision. The Director has the discretionary
power, however, to charge the cost of such examination to the insurance
carrier or self-insured employer.
(f) Under section 18(b) of the Act. This section, 33 U.S.C. 918(b),
provides a source for payment of compensation benefits in cases where
the employer is insolvent, or other circumstances preclude the payment
of benefits due in any case. In such situations, the district director
shall forward the case to the Director for consideration of an award
from the special fund, together with evidence with respect to the
employer's insolvency or other reasons for nonpayment of benefits due.
Benefits, as herein used, means medical care or supplies within the
meaning of section 7 of the Act, 33 U.S.C. 907, and subpart D of this
part 702, as well as monetary benefits. Upon receipt of the case, the
Director shall promptly determine whether an award from the special fund
is appropriate and advisable in the case, having due regard for all
other current commitments from the special fund. If such an award is
made, the employer shall be liable for the repayment into the fund of
the amounts paid therefrom, as provided in 33 U.S.C. 918(b).
(The information collection requirements contained in paragraph (a) were
approved by the Office of Management and Budget under control number
1215-0065. The information collection requirements contained in
paragraph (b) were approved by the Office of Management and Budget under
control number 1215-0073)
(Pub. L. No. 96-511)
[38 FR 26861, Sept. 26, 1973, as amended at 49 FR 18294, Apr. 30, 1984;
51 FR 4282, Feb. 3, 1986]
