Title 20--Employees' Benefits
CHAPTER I--OFFICE OF WORKERS'
COMPENSATION PROGRAMS,
DEPARTMENT OF LABOR
PART 10--CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED
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| 10.0 |
What are the provisions of the FECA, in general? |
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| 10.1 |
What rules govern the administration of the FECA and this chapter? |
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| 10.2 |
What do these regulations contain? |
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| 10.3 |
Have the collection of information requirements of this part been approved by the Office of Management and Budget (OMB)? |
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| 10.5 |
What definitions apply to these regulations? |
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| 10.6 |
What special statutory definitions apply to dependents and survivors? |
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| 10.7 |
What forms are needed to process claims under the FECA? |
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| 10.10 |
Are all documents relating to claims filed under the FECA considered confidential? |
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| 10.11 |
Who maintains custody and control of FECA records? |
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| 10.12 |
How may a FECA claimant or beneficiary obtain copies of protected records? |
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| 10.13 |
What process is used by a person who wants to correct FECA-related documents? |
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| 10.15 |
May compensation rights be waived? |
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| 10.16 |
What criminal penalties may be imposed in connection with a claim under the FECA? |
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| 10.17 |
Is a beneficiary who defrauds the Government in connection with a claim for benefits still entitled to those benefits? |
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| 10.18 |
Can a beneficiary who is incarcerated based on a felony conviction still receive benefits? |
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| 10.100 |
How and when is a notice of traumatic injury filed? |
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| 10.101 |
How and when is a notice of occupational disease filed? |
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| 10.102 |
How and when is a claim for wage loss compensation filed? |
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| 10.103 |
How and when is a claim for permanent impairment filed? |
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| 10.104 |
How and when is a claim for recurrence filed? |
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| 10.105 |
How and when is a notice of death and claim for benefits filed? |
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| 10.110 |
What should the employer do when an employee files a notice of traumatic injury or occupational disease? |
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| 10.111 |
What should the employer do when an employee files an initial claim for compensation due to disability or permanent impairment? |
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| 10.112 |
What should the employer do when an employee files a claim for continuing compensation due to disability? |
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| 10.113 |
What should the employer do when an employee dies from a work-related injury or disease? |
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| 10.115 |
What evidence is needed to establish a claim? |
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| 10.116 |
What additional evidence is needed in cases based on occupational disease? |
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| 10.117 |
What happens if, in any claim, the employer contests any of the facts as stated by the claimant? |
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| 10.118 |
Does the employer participate in the claims process in any other way? |
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| 10.119 |
What action will OWCP take with respect to information submitted by the employer? |
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| 10.120 |
May a claimant submit additional evidence? |
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| 10.121 |
What happens if OWCP needs more evidence from the claimant? |
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| 10.125 |
How does OWCP determine entitlement to benefits? |
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| 10.126 |
What does the decision contain? |
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| 10.127 |
To whom is the decision sent? |
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| 10.200 |
What is continuation of pay? |
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| 10.205 |
What conditions must be met to receive COP? |
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| 10.206 |
May an employee who uses leave after an injury later decide to use COP instead? |
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| 10.207 |
May an employee who returns to work, then stops work again due to the effects of the injury, receive COP? |
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| 10.210 |
What are the employee's responsibilities in COP cases? |
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| 10.211 |
What are the employer's responsibilities in COP cases? |
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| 10.215 |
How does OWCP compute the number of days of COP used? |
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| 10.216 |
How is the pay rate for COP calculated? |
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| 10.217 |
Is COP charged if the employee continues to work, but in a different job that pays less? |
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| 10.220 |
When is an employer not required to pay COP? |
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| 10.221 |
How is a claim for COP controverted? |
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| 10.222 |
When may an employer terminate COP which has already begun? |
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| 10.223 |
Are there other circumstances under which OWCP will not authorize payment of COP? |
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| 10.224 |
What happens if OWCP finds that the employee is not entitled to COP after it has been paid? |
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| 10.300 |
What are the basic rules for authorizing emergency medical care? |
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| 10.301 |
May the physician designated on Form CA-16 refer the employee to another medical specialist or medical facility? |
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| 10.302 |
Should the employer authorize medical care if he or she doubts that the injury occurred, or that it is work-related? |
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| 10.303 |
Should the employer use a Form CA-16 to authorize medical testing when an employee is exposed to a workplace hazard just once? |
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| 10.304 |
Are there any exceptions to these procedures for obtaining medical care? |
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| 10.310 |
What are the basic rules for obtaining medical care? |
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| 10.311 |
What are the special rules for the services of chiropractors? |
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| 10.312 |
What are the special rules for the services of clinical psychologists? |
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| 10.313 |
Will OWCP pay for preventive treatment? |
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| 10.314 |
Will OWCP pay for the services of an attendant? |
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| 10.315 |
Will OWCP pay for transportation to obtain medical treatment? |
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| 10.316 |
After selecting a treating physician, may an employee choose to be treated by another physician instead? |
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| 10.320 |
Can OWCP require an employee to be examined by another physician? |
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| 10.321 |
What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee? |
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| 10.322 |
Who pays for second opinion and referee examinations? |
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| 10.323 |
What are the penalties for failing to report for or obstructing a second opinion or referee examination? |
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| 10.324 |
May an employer require an employee to undergo a physical examination in connection with a work-related injury? |
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| 10.330 |
What are the requirements for medical reports? |
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| 10.331 |
How and when should the medical report be submitted? |
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| 10.332 |
What additional medical information will OWCP require to support continuing payment of benefits? |
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| 10.333 |
What additional medical information will OWCP require to support a claim for a schedule award? |
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| 10.335 |
How are medical bills submitted? |
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| 10.336 |
What are the time frames for submitting bills? |
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| 10.337 |
If OWCP reimburses an employee only partially for a medical expense, must the provider refund the balance of the amount paid to the employee? |
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| 10.400 |
What is total disability? |
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| 10.401 |
When and how is compensation for total disability paid? |
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| 10.402 |
What is partial disability? |
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| 10.403 |
When and how is compensation for partial disability paid? |
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| 10.404 |
When and how is compensation for a schedule impairment paid? |
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| 10.405 |
Who is considered a dependent in a claim based on disability or impairment? |
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| 10.406 |
What are the maximum and minimum rates of compensation in disability cases? |
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| 10.410 |
Who is entitled to compensation in case of death, and what are the rates of compensation payable in death cases? |
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| 10.411 |
What are the maximum and minimum rates of compensation in death cases? |
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| 10.412 |
Will OWCP pay the costs of burial and transportation of the remains? |
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| 10.413 |
If a person dies while receiving a schedule award, to whom is the balance of the schedule award payable? |
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| 10.414 |
What reports of dependents are needed in death cases? |
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| 10.415 |
What must a beneficiary do if the number of beneficiaries decreases? |
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| 10.416 |
How does a change in the number of beneficiaries affect the amount of compensation paid to the other beneficiaries? |
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| 10.417 |
What reports are needed when compensation payments continue for children over age 18? |
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| 10.420 |
How are cost-of-living adjustments applied? |
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| 10.421 |
May a beneficiary receive other kinds of payments from the Federal Government concurrently with compensation? |
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| 10.422 |
May compensation payments be issued in a lump sum? |
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| 10.423 |
May compensation payments be assigned to, or attached by, creditors? |
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| 10.424 |
May someone other than the beneficiary be designated to receive compensation payments? |
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| 10.425 |
May compensation be claimed for periods of restorable leave? |
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| 10.430 |
How does OWCP notify an individual of a payment made? |
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| 10.431 |
What does OWCP do when an overpayment is identified? |
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| 10.432 |
How can an individual present evidence to OWCP in response to a preliminary notice of an overpayment? |
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| 10.433 |
Under what circumstances can OWCP waive recovery of an overpayment? |
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| 10.434 |
If OWCP finds that the recipient of an overpayment was not at fault, what criteria are used to decide whether to waive recovery of it? |
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| 10.435 |
Is an individual responsible for an overpayment that resulted from an error made by OWCP or another Government agency? |
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| 10.436 |
Under what circumstances would recovery of an overpayment defeat the purpose of the FECA? |
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| 10.437 |
Under what circumstances would recovery of an overpayment be against equity and good conscience? |
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| 10.438 |
Can OWCP require the individual who received the overpayment to submit additional financial information? |
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| 10.439 |
What is addressed at a pre-recoupment hearing? |
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| 10.440 |
How does OWCP communicate its final decision concerning recovery of an overpayment, and what appeal right accompanies it? |
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| 10.441 |
How are overpayments collected? |
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| 10.500 |
What are the basic rules governing continuing receipt of compensation benefits and return to work? |
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| 10.501 |
What medical evidence is necessary to support continuing receipt of compensation benefits? |
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| 10.502 |
How does OWCP evaluate evidence in support of continuing receipt of compensation benefits? |
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| 10.503 |
Under what circumstances may OWCP reduce or terminate compensation benefits? |
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| 10.505 |
What actions must the employer take? |
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| 10.506 |
May the employer monitor the employee's medical care? |
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| 10.507 |
How should the employer make an offer of suitable work? |
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| 10.508 |
May relocation expenses be paid for an employee who would need to move to accept an offer of reemployment? |
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| 10.509 |
If an employee's light-duty job is eliminated due to downsizing, what is the effect on compensation? |
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| 10.515 |
What actions must the employee take with respect to returning to work? |
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| 10.516 |
How will an employee know if OWCP considers a job to be suitable? |
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| 10.517 |
What are the penalties for refusing to accept a suitable job offer? |
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| 10.518 |
Does OWCP provide services to help employees return to work? |
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| 10.519 |
What action will OWCP take if an employee refuses to undergo vocational rehabilitation? |
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| 10.520 |
How does OWCP determine compensation after an employee completes a vocational rehabilitation program? |
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| 10.525 |
What information must the employee report? |
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| 10.526 |
Must the employee report volunteer activities? |
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| 10.527 |
Does OWCP verify reports of earnings? |
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| 10.528 |
What action will OWCP take if the employee fails to file a report of activity indicating an ability to work? |
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| 10.529 |
What action will OWCP take if the employee files an incomplete report? |
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| 10.535 |
How are dependents defined, and what information must the employee report? |
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| 10.536 |
What is the penalty for failing to submit a report of dependents? |
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| 10.537 |
What reports are needed when compensation payments continue for children over age 18? |
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| 10.540 |
When and how is compensation reduced or terminated? |
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| 10.541 |
What action will OWCP take after issuing written notice of its intention to reduce or terminate compensation? |
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| 10.600 |
How can final decisions of OWCP be reviewed? |
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| 10.605 |
What is reconsideration? |
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| 10.606 |
How does a claimant request reconsideration? |
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| 10.607 |
What is the time limit for requesting reconsideration? |
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| 10.608 |
How does OWCP decide whether to grant or deny the request for reconsideration? |
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| 10.609 |
How does OWCP decide whether new evidence requires modification of the prior decision? |
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| 10.610 |
What is a review by the Director? |
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| 10.615 |
What is a hearing? |
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| 10.616 |
How does a claimant obtain a hearing? |
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| 10.617 |
How is an oral hearing conducted? |
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| 10.618 |
How is a review of the written record conducted? |
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| 10.619 |
May subpoenas be issued for witnesses and documents? |
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| 10.620 |
Who pays the costs associated with subpoenas? |
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| 10.621 |
What is the employer's role when an oral hearing has been requested? |
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| 10.622 |
May a claimant withdraw a request for or postpone a hearing? |
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| 10.625 |
What kinds of decisions may be appealed? |
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| 10.626 |
Who has jurisdiction of cases on appeal to the ECAB? |
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| 10.700 |
May a claimant designate a representative? |
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| 10.701 |
Who may serve as a representative? |
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| 10.702 |
How are fees for services paid? |
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| 10.703 |
How are fee applications approved? |
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| 10.705 |
When must an employee or other FECA beneficiary take action against a third party? |
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| 10.706 |
How will a beneficiary know if OWCP or SOL has determined that action against a third party is required? |
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| 10.707 |
What must a FECA beneficiary who is required to take action against a third party do to satisfy the requirement that the claim be ``prosecuted''? |
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| 10.708 |
Can a FECA beneficiary who refuses to 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? |
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| 10.709 |
What happens if a beneficiary directed by OWCP or SOL to take action against a third party does not believe that a claim can be successfully prosecuted at a reasonable cost? |
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| 10.710 |
Under what circumstances must a recovery 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? |
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| 10.711 |
How much of any settlement or judgment must be paid to the United States? |
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| 10.712 |
What amounts are included in the gross recovery? |
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| 10.713 |
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 gross recovery? |
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| 10.714 |
What amounts are included in the refundable disbursements? |
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| 10.715 |
Is a beneficiary required to pay interest on the amount of the refund due to the United States? |
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| 10.716 |
If the required refund is not paid within 30 days of the request for repayment, can it be collected from payments due under the FECA? |
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| 10.717 |
Is a settlement or judgment received as 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? |
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| 10.718 |
Are payments to a beneficiary as a result of an insurance policy which the beneficiary has purchased a gross recovery that must be reported to OWCP or SOL? |
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| 10.719 |
If a settlement or judgment is 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 of calculating the refund or credit owed to the United States? |
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| 10.725 |
When is a Federal grand or petit juror covered under the FECA? |
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| 10.726 |
When does a juror's entitlement to disability compensation begin? |
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| 10.727 |
What is the pay rate of jurors for compensation purposes? |
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| 10.730 |
What are the conditions of coverage for Peace Corps volunteers and volunteer leaders injured while serving outside the United States? |
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| 10.731 |
What is the pay rate of Peace Corps volunteers and volunteer leaders for compensation purposes? |
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| 10.735 |
When is a non-Federal law enforcement officer (LEO) covered under the FECA? |
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| 10.736 |
What are the time limits for filing a LEO claim? |
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| 10.737 |
How is a LEO claim filed, and who can file a LEO claim? |
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| 10.738 |
Under what circumstances are benefits payable in LEO claims? |
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| 10.739 |
What kind of objective evidence of a potential Federal crime must exist for coverage to be extended? |
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| 10.740 |
In what situations will OWCP automatically presume that a law enforcement officer is covered by the FECA? |
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| 10.741 |
How are benefits calculated in LEO claims? |
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| 10.800 |
What kind of medical records must providers keep? |
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| 10.801 |
How are medical bills to be submitted? |
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| 10.802 |
How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses? |
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| 10.803 |
What are the time limitations on OWCP's payment of bills? |
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| 10.805 |
What services are covered by the OWCP fee schedule? |
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| 10.806 |
How are the maximum fees defined? |
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| 10.807 |
How are payments for particular services calculated? |
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| 10.808 |
Does the fee schedule apply to every kind of procedure? |
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| 10.809 |
How are payments for medicinal drugs determined? |
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| 10.810 |
How are payments for inpatient medical services determined? |
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| 10.811 |
When and how are fees reduced? |
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| 10.812 |
If OWCP reduces a fee, may a provider request reconsideration of the reduction? |
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| 10.813 |
If OWCP reduces a fee, may a provider bill the claimant for the balance? |
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| 10.815 |
What are the grounds for excluding a provider from payment under the FECA? |
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| 10.816 |
What will cause OWCP to automatically exclude a physician or other provider of medical services and supplies? |
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| 10.817 |
When are OWCP's exclusion procedures initiated? |
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| 10.818 |
How is a provider notified of OWCP's intent to exclude him or her? |
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| 10.819 |
What requirements must the provider's reply and OWCP's decision meet? |
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| 10.820 |
How can an excluded provider request a hearing? |
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| 10.821 |
How are hearings assigned and scheduled? |
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| 10.822 |
How are subpoenas or advisory opinions obtained? |
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| 10.823 |
How will the administrative law judge conduct the hearing and issue the recommended decision? |
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| 10.824 |
How can a party request review by the Director of the administrative law judge's recommended decision? |
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| 10.825 |
What are the effects of exclusion? |
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| 10.826 |
How can an excluded provider be reinstated? |