Performance of Functions; Claims for Compensation Under the Federal Employees' Compensation Act; Compensation for Disability and Death of Noncitizen Federal Employees Outside the United States, 49596-49653 [2010-18965]
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49596
Federal Register / Vol. 75, No. 156 / Friday, August 13, 2010 / Proposed Rules
Written comments must be
submitted on or before October 12,
2010.
1240–AA03, by one of the following
methods:
• Federal e-Rulemaking Portal: The
Internet address to submit comments on
the rule is https://www.regulations.gov.
Follow the Web site instructions for
submitting comments.
• Mail: Submit written comments to
Shelby Hallmark, Director, Office of
Workers’ Compensation Programs, U.S.
Department of Labor, Room S–3524, 200
Constitution Avenue, NW., Washington,
DC 20210. Because of security measures,
mail directed to Washington, DC is
sometimes delayed. We will only
consider comments postmarked by the
U.S. Postal Service or other delivery
service on or before the deadline for
comments.
Instructions: All comments must
include the RIN 1240–AA03 for this
rulemaking. Receipt of any comments,
whether by mail or Internet, will not be
acknowledged. Because DOL continues
to experience delays in receiving postal
mail in the Washington, DC area,
commenters are encouraged to submit
any comments by mail early.
Comments on the proposed rule will
be available for public inspection during
normal business hours at the address
listed above for mailed comments.
Persons who need assistance to review
the comments will be provided with
appropriate aids such as readers or print
magnifiers. Copies of this proposed rule
may be obtained in alternative formats
(e.g., large print, audiotape or disk)
upon request. To schedule an
appointment to review the comments
and/or to obtain the proposed rule in an
alternative format, contact OWCP at
202–693–0031 (this is not a toll-free
number).
Written comments on the information
collection requirements described in
this proposed rule should be sent to the
Office of Information and Regulatory
Affairs, Office of Management and
Budget, Attention: Desk Officer for
Office of Workers’ Compensation
Programs, Washington, DC 20503.
FOR FURTHER INFORMATION CONTACT:
Shelby Hallmark, Director, Office of
Workers’ Compensation Programs, U.S.
Department of Labor, Room S–3524, 200
Constitution Avenue, NW., Washington,
DC 20210, Telephone: 202–693–0031
(this is not a toll-free number).
Individuals with hearing or speech
impairments may access this telephone
number via TTY by calling the toll-free
Federal Information Relay Service at 1–
800–877–8339.
SUPPLEMENTARY INFORMATION:
You may submit comments
on the proposed rule, identified by
Regulatory Information Number (RIN)
I. Background
The FECA provides compensation for
wage loss, medical care, and vocational
DEPARTMENT OF LABOR
Office of Workers’ Compensation
Programs
20 CFR Parts 1, 10, and 25
RIN 1240–AA03
Performance of Functions; Claims for
Compensation Under the Federal
Employees’ Compensation Act;
Compensation for Disability and Death
of Noncitizen Federal Employees
Outside the United States
Office of Workers’
Compensation Programs, Department of
Labor.
ACTION: Notice of proposed rulemaking.
AGENCY:
The Department of Labor
proposes to amend the regulations
governing the administration of the
Federal Employees’ Compensation Act
(FECA), which provides benefits to all
civilian Federal employees and certain
other groups of employees and
individuals who are injured or killed
while performing their jobs. The
Department of Labor also proposes to
revise the regulations establishing the
authority of the Office of Workers’
Compensation Programs (OWCP) which
administers the FECA.
The existing rules have been amended
to acknowledge a change in the
organization of the OWCP and
amendments to the FECA which have
occurred since the last time the
regulations were amended in 1999.
These changes also update the
regulations by taking into account
changes in technology and other
changes to improve administrative
efficiency. As many FECA claimants are
not represented, the regulations are
revised to insert FECA statutory
references as a frame of reference for
clarity and ease of use. The regulations
include adding the skin as an organ
pursuant to 5 U.S.C. 8107(c)(22). The
regulations also create a new special
schedule covering injuries to noncitizen non-resident Federal employees
outside the United States. Finally, the
regulations covering the processing of
medical bills have been updated to
provide for greater use of technology in
that process to reduce costs and to
clarify requirements for such
submissions.
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SUMMARY:
DATES:
ADDRESSES:
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rehabilitation to Federal employees and
certain other individuals who are
injured in the performance of their
duties, or who develop illnesses as a
result of factors of their Federal
employment. It also provides monetary
benefits to the survivors of employees
who are killed in the performance of
duty or die as the result of factors of
their Federal employment.
II. Overview of the Regulations
The program’s regulations were last
substantially revised in 1999. Since
then, the organization and authority of
OWCP has changed. Furthermore, new
provisions have been added to the
statute, and experience has shown that
certain parts of the regulations need
clarification or revision to promote
fairness and efficiency in the claims
process. In addition, technological
advances that may help preserve
administrative resources and improve
efficiency in the claims process have
been made since the last update of the
regulations. Accordingly, OWCP has
determined that the regulations
governing the administration of claims
under FECA require updating.
As many sections of the regulations
are based on longstanding
interpretations and program practice
and do not require revision, this is not
a wholesale revision of the existing
regulations. However, consistent with
past practice on FECA regulatory
revisions, the entire regulation is being
republished for ease of use. A detailed
listing of the regulations changed and a
description of those changes follows.
20 CFR Part 1
This part has been amended to reflect
the change in organization at the
Department of Labor that occurred on
November 8, 2009, when the
Employment Standards Administration
(ESA) was dissolved and the authority
that the Secretary of Labor had
previously delegated under the FECA to
ESA was delegated by the Secretary to
the Director, OWCP.
20 CFR Part 10
Subpart A—General Provisions
This subpart is substantially the same
as current subpart A (§§ 10.0 through
10.18). The majority of the changes to
this subpart involve updating the
regulations as a result of the addition of
the new death gratuity benefit which
was added to the FECA by 5 U.S.C.
8102a and by adding clarification
language in a number of sections, as
described below.
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Definitions and Forms
Section 10.1 has been modified by
deleting the references to the Assistant
Secretary for Employment Standards, as
that position no longer exists.
Section 10.2 now includes the new
subpart J of this part which administers
the new death gratuity benefit that was
added to the FECA in 2008 by 5 U.S.C.
8102a.
Section 10.3 has been revised to
update the list of OMB control numbers
to include the new death gratuity forms
and the subrogation forms.
Section 10.5 has been revised to
restore statutory definitions and
citations, as experience has shown that
the absence of these citations caused
confusion regarding what definitions
were applicable and to clarify the
definition of a recurrence of disability in
paragraph (x).
Section 10.6 now includes a reference
to the special definitions for
survivorship and dependency that apply
only to the new death gratuity benefit to
promote clarity.
Section 10.7 has been updated to list
all new forms described above and to
eliminate forms that are no longer in
use.
Information in Program Records
Section 10.10 has been amended to
state that information may be released
under the Privacy Act through the
routine uses that apply to the records if
such release is consistent with the
purpose for which the records were
created. This change has been made to
clarify that there are certain situations
where release of claim files is not
appropriate under the Privacy Act.
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Rights and Penalties
These sections have been updated to
reflect current provisions that impose
civil penalties on false claims under the
FECA and to affirmatively require
submission of documentation where
appropriate.
Section 10.16 has been revised to note
that a civil action may be maintained
under the False Claims Act to recover
erroneous payments under the FECA.
Section 10.17 has been revised to
clarify when benefits are terminated for
defrauding the Federal Government to
eliminate confusion concerning what
day should be used when a guilty plea
has been entered. The addition specifies
what date to use in such a situation.
This section has also been revised to
provide an affirmative duty for the
employing agency (which may be
fulfilled by the employing agency’s
Office of Inspector General (OIG) in a
case where the agency OIG is actively
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involved) to submit this information to
OWCP.
Section 10.18 has been revised to
provide an affirmative duty for a
beneficiary to report to OWCP any
incarceration based on a felony
conviction that would result in
forfeiture of that beneficiary’s right to
compensation during incarceration.
Subpart B—Filing Notices and Claims;
Submitting Evidence
This subpart is substantially the same
as the current subpart B (§§ 10.100
through 10.127). Most changes involve
the electronic submission of forms, a
method of submission that was not
feasible when the regulations were last
changed. Other changes include the
administration of the change to the
waiting period for employees of the
United States Postal Service
necessitated by a statutory amendment
in 5 U.S.C. 8117.
Notices and Claims for Injury, Disease,
and Death—Employee or Survivor’s
Actions
Sections 10.100, 10.101, 10.102,
10.103 and 10.105 all have been revised
by an identical provision that allows for
electronic submission of notices and
claims forms. This change includes a
provision that all agencies should create
a method to submit such forms
electronically by December 31, 2012, by
which time OWCP will have
implemented a method to enhance the
agencies’ ability to file forms
electronically. Electronic filing will
speed OWCP’s processing of claim
forms.
Section 10.102 was also revised to
clarify the language specifying that CA–
7 should be used to claim compensation
for additional periods of disability.
Section 10.103 has been revised to
provide authority to create a separate
form for schedule award claims under 5
U.S.C. 8107.
Section 10.104 was revised to make
clear what constitutes a recurrence of
disability and to explain the basis for a
modification of a loss of wage-earning
capacity determination. The addition of
paragraph (c) to this section clarifies the
distinction by incorporating
longstanding case law from the
Employees’ Compensation Appeals
Board.
Notices and Claims for Injury, Disease,
and Death—Employer’s Actions
Section 10.111 has been amended to
reflect the change in law regarding
waiting periods and Postal Service
employees incorporated in the
amendment to 5 U.S.C. 8117.
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Evidence and Burden of Proof
Section 10.115 has been revised to
clearly state that the burden of proof
remains with the claimant even when
OWCP requests additional information,
as provided by ECAB case law.
Section 10.116 has been amended to
reflect current OWCP practice, in that
OWCP does not require the submission
of the checklist in all situations.
Decisions on Entitlement to Benefits
Section 10.127 has been amended to
remove the language stating that service
of a decision on either the claimant or
the representative would count as
service to both, as this no longer reflects
current practice of the OWCP. OWCP
serves decisions on entitlement on both
the claimant and the representative.
Subpart C—Continuation of Pay
Subpart C (§§ 10.200 through 10.224)
continues unchanged from the previous
regulations, except for a change to
§ 10.200. The change to this section
reflects the change to continuation of
pay to Postal Service employees as a
result of the statutory change to 5 U.S.C.
8117 which provides that Postal Service
employees are not entitled to
continuation of pay for the first 3 days
of temporary disability unless that
disability exceeds 14 days or is followed
by permanent disability.
Subpart D—Medical and Related
Benefits
Subpart D (§§ 10.300 through 10.337)
is mostly unchanged. Most of the
changes involve technological advances
since the last update of the regulations;
these advances caused procedures to be
changed. Other changes clarify the prior
regulations or codify current practice.
Additionally, OWCP seeks to codify
authority to make changes to the
manner in which durable medical
equipment and other non-physician
services are provided.
Emergency Medical Care
Section 10.300 has been amended to
clarify that the Form CA–16, which
provides authorization for initial
medical treatment, authorizes treatment
from the date of injury, not the date the
form is signed. This change corrects
situations where this form has not been
signed immediately—this posed
difficulties for employees obtaining
treatment at the time of injury.
Medical Treatment and Related Issues
Section 10.310 has been amended in
a number of places. First, this section
was amended to cross-reference the
sections of this part that provide for
medical billing and authorization. This
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section has also been modified to codify
OWCP’s authority to utilize field nurses
in facilitating and coordinating medical
care. Furthermore, this section has been
modified to codify OWCP’s authority to
contract with specific providers to
provide services and appliances; OWCP
has determined that providing such
services in this method may aid in
delivering such benefits as well as
controlling medical costs. This section
has also been amended to clearly state
that certain non-physician providers
provide authorized services to injured
employees, to the extent allowed under
Federal and state law including
licensure by any appropriate regulating
body for that profession. This change
was made to clarify that OWCP pays for
such services.
Section 10.310 has also been amended
to add a new paragraph (c) that covers
durable medical equipment. This
paragraph provides first that any
provider of such equipment must be
registered in Medicare’s Durable
Medical Equipment, Prosthetics,
Orthotics and Supplies Competitive
Bidding Process. This requirement
provides OWCP a measure of reliability
(including financial security) in such
providers, while helping OWCP avoid
using scarce program resources to police
all such providers. Furthermore, this
paragraph allows OWCP, when
purchasing such equipment, to offset
the costs of prior rental payments
against a future purchase and provide
refurbished equipment when
appropriate. Both of these additions
were done to help control the cost of
providing this equipment.
Section 10.311(d) has been amended
to clarify that, for a chiropractor’s
service to be under the direction of a
qualified physician, that physician must
prescribe those services.
Section 10.314 relating to attendant
services has been substantially
shortened from the prior regulation. As
the number of attendant services
provided in cases prior to January 4,
1999 has decreased and since the
current policy has been successfully in
place for over a decade, the extended
discussion is no longer necessary.
Section 10.315 has been substantially
modified, increasing the reasonable
distance of travel up to a roundtrip
distance of 100 miles. OWCP
encountered situations where
employees no longer had doctors within
the old distance of 25 miles and
determined that such an increase is
needed. This section has also been
amended to explain procedures
regarding types and manner of transport
allowed.
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Directed Medical Examinations
Section 10.320 has been amended to
add language allowing another person to
be present at an OWCP directed
examination where there is rationalized
medical evidence demonstrating that
such a person is needed in addition to
situations such as where a translator or
sign language interpreter is needed to
aid communication. This change is in
response to a number of claims where
such a person may be needed. This
language sets forth one method to meet
the ‘‘exceptional circumstances’’ test for
allowing an additional person in the
examination where medically indicated.
Section 10.321 has been updated to
add the word ‘‘impartial’’ to the referee
medical review to conform with
terminology normally used by OWCP
and ECAB.
Section 10.323 has been amended by
expressly noting that examinations
required by OWCP includes testing such
as functional capacity evaluations and
by adding a new paragraph (b) which
details the process of how OWCP
suspends compensation for obstructing
a medical examination, as well as to
explain how the employee can end that
obstruction. This paragraph was added
to provide additional guidance to
claimants and to consolidate all such
information in one location.
Medical Reports
Section 10.333 has been amended to
provide a cross reference to the
information necessary to support an
award for loss to a scheduled member
and to include additional language used
in the AMA Guides.
Medical Bills
Section 10.335 has been amended to
bring this section in line with current
OWCP procedures, and to provide
notice that OWCP may contract with a
third party for bill payment processing.
Section 10.337 has been amended to
update the cross-references contained in
that section.
Subpart E—Compensation and Related
Benefits
Subpart E (§§ 10.400 through 10.441)
also is largely unchanged. Of the
changes made to this subpart, most are
to clarify the prior regulation by
codifying ECAB case law or promoting
administrative efficiency by changing
practices that experience has shown
waste program resources. A few
additions have been made, including
the addition of the skin as a scheduled
member and including language
regarding electronic payments and their
effect on overpayments.
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Section 10.400 has been amended to
include the statutory citation for when
permanent total disability is presumed
to clarify the origin of that definition.
Section 10.401 has been amended to
reflect the change in when the waiting
period begins for Postal Service
employees after the amendment to 5
U.S.C 8117 as described above.
Section 10.403 has been amended to
restore the factors used in determining
wage-earning capacity where actual
earnings do not fairly and reasonably
represent that capacity as described in
5 U.S.C. 8115 to facilitate ease of use of
that section.
Section 10.404, which describes how
compensation is paid for loss to
scheduled members under 5 U.S.C.
8107, has been revised to include the
statutory scheduled members as well as
those that have been added by
regulation. Furthermore, Section 10.404
has been amended to include the skin
as a schedule member, for up to 205
weeks of compensation, for injuries
sustained on or after September 11,
2001. In determining compensation
payable for the skin, OWCP considered
a number of factors, including relative
percentage impairments of the other
scheduled members under the AMA
Guides, as well as the length of
compensation that had been previously
given for members added by regulation.
After considering these factors, OWCP
determined that the skin should be
given the maximum amount of
compensation that had been previously
given when adding new members. As to
the date of applicability of this section,
OWCP determined that use of
September 11, 2001 would allow
individuals who had sustained severe
burns or other skin conditions on or
after September 11, 2001 to file
schedule award claims. OWCP further
determined that use of an earlier date
would create problems of proof and
eligibility under § 10.413 of this section.
Compensation for Death
Section 10.410 has been amended to
clarify that survivor’s benefits under 5
U.S.C. 8133 are separate and distinct
from the death gratuity benefits under 5
U.S.C. 8102a.
Section 10.412 has been amended to
include statutory citations to the
amounts provided for burial and related
expenses.
Section 10.413 has been amended to
codify in the regulations the
requirement of 5 U.S.C. 8109 and ECAB
case law which states a claim for a
schedule award must be filed while the
claimant is still alive in order for the
claim to be paid.
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Section 10.415 has been amended to
modernize the regulation to provide
additional detail on handling the
increasing number of governmental
payments made by electronic fund
transfer (EFT).
Section 10.417 has been revised to
streamline the process by which
employees establish the dependency for
adult children who are incapable of selfsupport. In this section, OWCP has
reduced the reporting requirements in
those instances to once each year, while
placing an affirmative duty on the
employee to report any change in the
conditions to OWCP. This change will
promote efficiency for OWCP when, in
a number of instances, the circumstance
of such dependency will not change
more than annually. Furthermore, this
section was amended to add a new
section allowing an employee to
establish the permanency of an adult
child’s mental or physical disability;
such a change will save OWCP
administrative resources while
eliminating an employee’s burden to
continuously submit reports for an adult
child with permanent mental or
physical disabilities.
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Adjustments to Compensation
Section 10.421 has been amended to
reflect the change in language to 5
U.S.C. 8116 made after the repeal of 5
U.S.C. 5532.
Section 10.422 has been amended to
note that the availability of lump sum
payments for non-citizen non-resident
employees will be addressed in Part 25
of this title.
Section 10.423 has been amended to
delete the discussion that suggests
claims for compensation are subject to
garnishment from claims from other
Federal agencies. The authority for this
language is unclear and has not been
used.
Section 10.425 has been amended to
clarify that leave donated to an
employee through an employing
agency’s leave program is not leave that
may be restored through the leave buy
back process.
Overpayments
Since the last time the regulations
were updated, most recipients of FECA
benefits have been moved to electronic
payment (EFT). This has created
questions as to when an employee has
knowledge of receipt of their FECA
benefits. Accordingly, § 10.430 has been
amended to reflect a growing concern
regarding when a claimant receives, or
has knowledge of, an electronic
payment. This section has been
amended to add the normal business
transaction definition of such receipt,
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where a payee is presumed to have
knowledge of any payment once the
payee has had the opportunity to
receive a bank statement from the
payee’s financial institution.
Section 10.433 was likewise amended
to reflect that an employee is required
to review such bank statements in order
to ensure proper receipt of FECA
benefits.
Section 10.440 was amended to
include District Court and ECAB case
law which allow OWCP to pursue
collection of a debt while any such
determination is pending before ECAB.
Section 10.441 was amended to
describe the process used by OWCP to
collect overpayment debts following the
death of an employee.
Subpart F—Continuing Benefits
Subpart F (§§ 10.500 through 10.541)
is largely unchanged. Most changes
clarify the prior regulations by further
describing the procedures and policies
of OWCP and by including ECAB case
law explaining those prior regulations.
Section 10.500 was amended to
clarify the difference between light duty
work and a suitable work determination
and to restore statutory citations to the
regulations.
Section 10.501 was amended to
include a new subparagraph (2), which
allows OWCP to require less medical
documentation for continuing benefits
where circumstances merit such
reduced documentation, reducing the
burden on those employees and the
OWCP in administering their claims.
Section 10.502 was revised to update
the language used to describe the
impartial referee examination to bring
the terminology in line with OWCP and
ECAB usage.
Return to Work—Employer’s
Responsibilities
Section 10.509 was also modified by
splitting that section into two sections,
§§ 10.509 and 10.510. Section 10.509
now covers only situations involving
the effect of downsizing of a light duty
position on compensation. New § 10.510
describes when a light duty job may be
used as a basis for a loss of wage-earning
capacity determination.
Section 10.511 is a new section that
codifies longstanding ECAB case law
which delineates the only
circumstances under which a loss of
wage-earning capacity determination
may be modified.
Return to Work—Employee’s
Responsibilities
Section 10.517 has been modified to
make clear that, when an employee
refuses to seek or accept suitable work,
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the resulting termination of
compensation applies to any prior
injuries in which compensation may be
payable as well as the claim under
which compensation has ended.
Consistent with longstanding program
practice, medical benefits remain
payable in all cases following such
termination.
Sections 10.518 and 10.519 have been
modified to delete references to
registered nurses under the vocational
rehabilitation of employees, as ECAB
ruled that the sanctions for failing to
cooperate with vocational rehabilitation
do not apply to nurse services.
New § 10.521 has been added to
explain the process followed by OWCP
when an employee that is involved in
the vocational rehabilitation process or
other return to work effort elects to
receive benefits from the Office of
Personnel Management instead of FECA
benefits, and is no longer participating
in the vocational rehabilitation process.
In such instances, OWCP may use the
evidence of file to perform a loss of
wage-earning capacity determination.
Reports of Earnings From Employment
and Self-Employment
Section 10.525 has been amended to
clarify that an employee must report all
employment activities, including all
outside employment, as such
employment is material to a disability
determination. This is so even where
such earnings from concurrent
dissimilar employment held at the time
of injury do not reduce compensation
payable but may still assist OWCP in
assessing disability for work.
Section 10.526 has been amended to
clarify that, in reporting volunteer
activities, the fact that the employee
received no monetary compensation for
those activities is not a basis for not
reporting those activities to OWCP
under ECAB case law.
Reports of Dependents
Section 10.537 was amended to reflect
the change in reporting for non-minor
children to once a year as described
above in the discussion regarding
§ 10.417.
Reduction and Termination of
Compensation
Section 10.540 has been reorganized
by splitting paragraph (a) into new
paragraphs (a) and (b), to promote
clarity and ease of use of the section.
Subpart G—Appeals Process
Subpart G (§§ 10.600 through 10.626)
also continues largely unchanged; the
changes that have been made were made
to promote clarity and update the
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regulations to reflect changes in practice
and technology that have taken place
since the regulations were last updated.
Reconsiderations and Reviews by the
Director
Section 10.606 has been modified to
add language requiring that
reconsideration requests be signed and
dated. This change has been made to
clarify when such requests have been
made and to allow OWCP to ascertain
that the person (such as a
representative) requesting
reconsideration is authorized to do so at
the time such request is made.
Section 10.607 has been modified by
changing the date of the reconsideration
request for timeliness purposes from the
date mailed to the date received by
OWCP. This change has been made to
promote efficiency in administering
these requests; current electronic case
files and associated scanning
procedures and resources would be
unnecessarily strained by the
requirement to scan in every envelope
from every letter sent to OWCP.
Accordingly, the prior regulation which
referenced the date of mailing on the
envelope led to some uncertainty
regarding when a request was filed.
Rather than reduce the amount of time
given to file the reconsideration request,
OWCP has chosen simply to require that
the request must have been received by
OWCP within the one year period, a
period which provides more than ample
time to obtain the necessary evidence or
make the legal arguments in support of
a reconsideration request.
Section 10.609 has been modified to
note that OWCP will not wait for
comments from an employing agency
regarding a request for reconsideration
when comments from the agency are not
germane to the issue being resolved on
reconsideration.
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Hearings
The sections governing hearings
before the OWCP’s Branch of Hearings
and Review (BHR) have been modified
to reference that procedures are
available for reasonable accommodation
in the hearing process. The sections
include procedures for BHR to conduct
hearings by teleconference and
videoconference. Such methods
although permissible under the
regulations were not in active use at the
time of the last regulation update. These
sections have also been modified to
clarify certain policies related to such
processes and to provide discretion to
utilize other technology to conduct
hearings as it may become available.
OWCP has found that use of
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teleconferences and videoconferences
allows hearings to be held more quickly.
Section 10.616 has been modified to
accommodate the alternative types of
hearings as described above.
Section 10.617 has been amended to
cover a number of policies that were
previously not contained in the
regulation. First, this section has been
amended to note how an employee may
request accommodations from BHR.
This section has also been amended to
note that hearings are generally limited
to one hour, and to note that the
transcript is the official record of the
hearing. This section has also been
modified to clarify the time limits for
submitting comments following a
hearing. Finally, a new paragraph (h)
has been inserted as a reference to a
statutory section that allows an OWCP
hearing representative to certify any
misconduct to a District Court for
appropriate handling.
Section 10.618 has been amended to
clarify that when an employee requests
that a hearing be changed to a review of
the written record, all evidence should
be submitted with that request.
Section 10.619 has been amended to
clarify that, if a request for a subpoena
has been made, the requestor must
explain why that subpoena is necessary
at the time the request is made.
Section 10.621 has been amended to
clarify that it is in the discretion of the
hearing representative whether the
employing agency may be allowed to
have more than one representative
attend the hearing.
Section 10.622 has been amended to
accommodate the alternative forms of
hearings discussed above and to explain
how these types of hearings are handled
with a monthly docket. Furthermore,
this section has been amended to add
new paragraph (d) which restores prior
regulatory language addressing
abandonment of hearings, as experience
since that language was removed has
shown that this section is necessary.
Review by the Employees’
Compensation Appeals Board (ECAB)
Section 10.626 has been amended to
cross reference ECAB’s rules of
procedure to promote ease of use of
these regulations.
Subpart H—Special Provisions
While a majority of the provisions in
subpart H (§§ 10.700 through 10.741)
remain unchanged, some extensive
changes have been made to certain
portions of this subpart. This subpart
has been changed to reference that an
attorney associated with a law firm may
represent claimants and to explicitly
state that OWCP will communicate with
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the law firm. The regulation clarifies
OWCP policy that contingency fees are
not allowed under any circumstances.
The FECA subrogation sections have
been expanded to codify current
practice; to promote transparency and
clarity where a third party is responsible
for an injury or death; and to better
explain how subsequent FECA
subrogation claims are handled. Finally,
the provision relating to coverage of
Peace Corps volunteers has been
amended to restore statutory language
concerning such coverage.
Representation
Section 10.700 has been amended to
clarify that where a claimant’s
representative is an attorney, OWCP
may communicate with any attorney or
employee in the attorney’s law firm.
This change has been made to comport
with the normal practice of law firms,
and to promote efficient administration
of the program.
Section 10.702 has been amended to
clearly state that contingency fees are
not allowed when representing
beneficiaries under the FECA. This
explicit language addressing
contingency fees was removed during
the last regulatory update; however,
experience since that update has shown
that the removal of this language caused
some to believe that the ban on
contingency fees had been removed as
well.
Section 10.703 has been amended to
make clear that OWCP can only approve
representative’s fees for services that
have been performed before OWCP and
references that ECAB must approve fees
for services performed in front of ECAB.
This section has also been amended to
clarify that contingency fees will not be
approved for any reason. Contingency
fees are not subject to the deemed
approved process where a fee may be
approved if a claimant concurs with
such a fee. If the fee is disputed, the
regulations provide that OWCP will
consider the customary local charge for
a representative with similar
qualifications in considering what
constitutes a reasonable fee.
New § 10.704 takes a sentence that
was formerly the last sentence of
§ 10.702 and makes that language its
own section in the regulations to
highlight that a person who collects a
fee without OWCP approval may be
charged with a misdemeanor. OWCP
believes that adding this section is
useful to provide notice of the potential
consequences for failing to comport
with the OWCP fee approval process.
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Third Party Liability
Section 10.705 has been amended to
give the full address where information
on subrogation claims may be sent.
Section 10.707 has been amended to
require that certain information be
submitted in circumstances where the
employee is not the only plaintiff in a
suit.
The provisions in 10.711 have been
moved to 10.712 and the provisions in
10.712 have been moved to 10.711. The
new order reflects the process of
calculating the refund and surplus in
accordance with the statement of
recovery form CA–1108. New section
10.711 substantially revises existing
10.712 by setting out in greater detail
the manner in which the amount of
recovery of the employee is determined
including situations where property loss
is part of the recovery or where loss of
consortium or wrongful death and
survival actions have been asserted.
New section 10.711 reflects the
procedures that have been in place for
a number of years. New section 10.712
clarifies that the crediting of a surplus
is done against both wage-loss
compensation and medical benefits, sets
out in greater detail the steps to follow
in calculating the refund and surplus,
and provides additional examples of
how these calculations are made,
including cases where loss of
consortium and wrongful death and
survival actions have been asserted.
Section 10.714 has been amended to
clarify that OWCP may seek
reimbursement for all types of benefits
paid to an employee when that
employee has successfully sued a third
party for that injury. This section was
also amended to clarify how that
employee may obtain a copy of the
disbursements made by OWCP in their
claim.
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Peace Corps Volunteers
Section 10.730 has been amended to
restore the statutory language applicable
to coverage of claims involving Peace
Corps volunteers. The statutory
language is a recognition of the
difficulties for such volunteers to
establish that certain injuries or illness
are related to their covered activities.
The change in language allows OWCP to
consider evidence that controverts
coverage, while still allowing the
volunteer to establish the claim, and
clarifies that a temporary aggravation of
a preexisting condition may be paid
without the necessity of accepting all
disability related to that condition.
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Subpart I—Information for Medical
Providers
A number of changes have been made
to subpart I. The majority of these
changes have been made to address
OWCP’s electronic bill processing
system and to comport this processing
with that done in other compensation
programs administered by OWCP. This
subpart has also been revised to modify
the process by which OWCP excludes
medical providers by including the
Department of Labor’s Office of
Inspector General (DOL OIG) in the
process.
Medical Records and Bills
Section 10.800 has been amended to
describe OWCP’s provider enrollment
process and automated bill processing
and authorization system, which has
been substantially revised since the last
time the regulations were updated.
Section 10.801 has been amended to
clarify how medical bills are currently
processed. In addition to those changes,
this section has been amended to codify
that OWCP may require nursing homes
to abide by a fee schedule for
admissions made after the effective date
of the regulations, which will
standardize billing practices and
promote cost containment. This change
was made to allow additional
modifications to restrain medical costs.
This section has also been amended to
provide language making it clear that
providers must adhere to accepted
industry standards when billing. Since
the advent of the automated bill
processing system, OWCP wishes to
make clear that billing practices such as
upcoding and unbundling are not in
accord with industry standards and
such attempts to circumvent the fee
schedule through practices described in
that language are prohibited under the
regulations.
Section 10.802 has been amended to
clarify how an injured employee
currently seeks reimbursement for out of
pocket expenses.
Medical Fee Schedule
Section 10.805 has been revised in
order to give the Director of OWCP the
express authority to determine a fee
schedule for services provided by
nursing homes.
Sections 10.806, 10.807 and 10.810
have been revised to update the indices
used in determining maximum fees.
Section 10.809 has been revised to
clarify that the fee schedule regarding
medicinal drugs applies whether the
drugs are dispensed by a pharmacy or
by a doctor in his office. This section
has also been modified by providing
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OWCP the authority to require the use
of a specific contract provider for
medicinal drugs. This language has been
added so that OWCP may explore the
use of such providers to contract for
better prices on such drugs. Finally, the
authority to require the use of generic
drugs has been moved to this section as
new paragraph (c).
Section 10.811 has been amended to
clarify that OWCP will not correct
procedure or diagnosis codes on
submitted bills. Instead those bills will
be returned to the provider for
correction as the responsibility for
proper submission lies with the
provider.
Exclusion of Providers
Section 10.815 has been amended by
adding new sections (i) and (j) which set
out additional reasons for excluding
providers. These new reasons are failure
to update a change in provider status
and having engaged in conduct found
by OWCP to be misleading, deceptive or
unfair. Experience has shown that a
number of ambiguities existed in the
exclusion process. These new reasons
for exclusion are meant to address any
perceived loopholes.
Section 10.816 has been amended to
add new section (c), which clarifies that
a provider may be voluntarily excluded
without the exclusion procedures being
initiated. This clarification is meant to
address situations where providers
agree to be excluded, for example,
where a provider may be faced with
criminal charges.
Section 10.817 has been amended to
provide that the DOL OIG is primarily
responsible for investigating possible
exclusions of providers. This duty was
previously handled by OWCP; OWCP
has no investigatory arm and lacks
resources to carry out this
responsibility. Accordingly, this change
in the exclusion process has been made
in an effort to improve administrative
efficiency of this process.
Sections 10.818 through 10.821 have
been revised to change the deciding
official in exclusion matters from just
the Regional Director to the Regional
Director or any other official specified
by the Director of the Division of
Federal Employees’ Compensation. This
change has been made in recognition of
the fact that there may be instances
(such as where more than one region is
involved) where the Regional Director
should not be the deciding official.
These sections have also been modified
to recognize the role of DOL OIG.
Sections 10.823 through 10.824 have
been modified to change the manner in
which the administrative law judge’s
recommended decision becomes final.
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Previously, the decision became final if
no objection was filed, which could lead
to confusion regarding the finality of
this decision. Accordingly, these
sections were changed to reflect that no
recommended decision regarding
exclusion will become final until the
Director of OWCP issues the decision in
final form.
Section 10.825 has been amended to
reflect current practices of OWCP, as
OWCP may use discretion in
determining who should receive the
notice of exclusion.
Section 10.826 has been modified to
correct terminology and to clarify that
the Director of OWCP can order
reinstatement of excluded providers.
Subpart J—Death Gratuity
Subpart J (§§ 10.900 through 10.916)
is unchanged.
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20 CFR Part 25
Section 8137 provides the conditions
and parameters for FECA coverage for
non-citizen non-resident employees of
the United States, any territory, or
Canada. Part 25 describes how benefits
will be paid to such employees. Since
the last time the regulations were
revised in 1999, OWCP encountered a
number of situations where the current
regulatory scheme proved difficult to
administer. Although payment of FECA
compensation across the board in all
such cases remains substantially
disproportionate, benefits payable under
local law may be insufficient. Moreover,
many of the distinctions and definitions
such as those for third country and
fourth country nationals do not comport
with the current governmental hiring
realities for non-citizen non-resident
employees. In conducting the
comparison required by the current
regulations between compensation
payable under local law and that paid
under FECA, OWCP encountered
situations where the families of
employees who were killed received
very limited compensation under local
law. However, payment of ongoing
FECA benefits in such cases would
result in disproportionately high
payments and would pose
administrative challenges in managing
such cases on an ongoing basis. Under
the statute, the Director has authority to
create a special schedule. In the
interests of fairness, the Director has
created a new more comprehensive
special schedule for disability that will
pay benefits on an ongoing basis for up
to two years and will pay a lump sum
thereafter for cases of permanent total
disability. Payment for death benefits
will also be paid in a lump sum to
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facilitate benefit delivery and to ease
administrative burdens.
Subpart A—General Provisions
Section 25.1 has been revised to
reflect a change in policy in the
payment of compensation under the
FECA to employees of the United States
who are neither citizens nor residents of
the United States, any territory or
Canada, as well as any dependents of
such employees. The proposed revision
would modify the benefit structure for
foreign nationals by using the authority
under section 8137 to create a special
schedule of compensation for foreign
nationals to provide a reduced
percentage of FECA benefits.
Section 25.2(a) has been revised to
provide that the special schedule set
forth in subpart B would apply to any
non-citizen non-resident federal
employee who is neither hired nor
employed in the United States, Canada
or in a possession or territory of the
United States, with respect to any injury
(or injury resulting in death) occurring
subsequent to the effective date of the
publication of the final rule in the
Federal Register. This paragraph has
also been amended to provide that the
benefit provisions adopted under this
paragraph shall apply to injuries that
occur on or after 60 days after the
publication of the final rule in the
Federal Register.
Section 25.2(b) has been revised to
provide that the special schedule in
subpart B shall apply to cases unless the
injured non-citizen non-resident
employee receives compensation
pursuant to a specific separate
agreement between the United States
and another government (or similar
compensation from another sovereign
government); or the employee receives
compensation pursuant to the special
schedule under subpart C; or the
employee otherwise establishes
entitlement to compensation under local
law pursuant to section 25.100(e) of this
part.
Section 25.2(c) has been revised to
provide that compensation in all cases
of such non-citizen non-resident
employees paid and closed prior to 60
days after the publication of the final
rule in the Federal Register are deemed
paid in full under 5 U.S.C. 8137.
Section 25.2(d) has been revised to
provide that the compensation received
under the special schedule set forth in
subpart B or as otherwise specified in
25.2(b) is the exclusive measure of
compensation in cases of injury (or
death from injury) to non-citizen nonresident employees of the United States.
Section 25.2(e) was revised to clarify
the information in former section 25.2(e)
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that compensation for disability and
death of non-citizen non-resident
employees outside the United States
under this part shall in no event exceed
that generally payable under the FECA.
Section 25.3 remains unchanged,
providing that the Director has the
authority to make lump-sum awards (in
the manner prescribed by 5 U.S.C. 8135)
to settle claims pursuant to section 8137
of the FECA.
Section 25.4 remains unchanged
except for section (c) which is revised
to read ‘‘Verification of the employment
and casualty by Department of Defense
personnel’’ instead of military personnel
to reflect the responsibility for
providing the type of evidence
necessary to make a claim under this
section resides with that department.
Section 25.5 has been renumbered but
otherwise remains unchanged,
providing that an employee who is a
permanent resident of any United States
possession, territory, commonwealth or
trust territory will receive full FECA
benefits.
Subpart B—the Special Schedule of
Compensation
Section 25.100 has been amended to
provide that the definitions under this
subpart are generally the same as those
provided under the rest of the FECA
statute and regulations.
25.101 has been modified to describe
how compensation for temporary total
and partial disability, and permanent
total and permanent partial disability
are paid to non-citizen non-resident
employees. Provisions under the former
section 25.101 for death benefits have
been revised and currently appear in
section 25.102.
Section 25.101(a) has been amended
to provide for temporary total disability,
where the injured employee is disabled
for less than two years. Under this
provision, the employee receives 50
percent of the monthly pay during the
period of such disability.
Section 25.101(b) has been amended
to provide for temporary partial
disability, where the injured employee
is unable to earn equivalent wages to
those earned at the time of injury, but
is not totally disabled for work. Under
this section, the injured employee
receives a proportional amount of
compensation for the period of
disability. The compensation amount is
that portion of compensation for
temporary total disability, as
determined under paragraph (a) of this
section, which is equal in percentage to
the degree or percentage of physical
impairment caused by the disability.
Section 25.101(c) has been amended
to provide for permanent total
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disability, where the injured employee
will be disabled for greater than two
years. This section provides that the
injured employee will receive a lump
sum settlement, made by the manner
prescribed under 5 U.S.C. 8135, based
on compensation equaling 50 percent of
the monthly pay.
Section 25.101(d) has been amended
to provide for permanent partial
disability, where there is permanent
impairment involving the loss, or loss of
use, of a member or function of the
body. This section describes how
compensation is paid for loss to
scheduled members, and has been
revised to be consistent with the time
periods listed under 5 U.S.C. 8107 and
the regulations listed in 20 CFR 10.404.
In addition to the revision of the time
periods, this section has been amended
to include the skin as a schedule
member, for up to 205 weeks of
compensation. This change is consistent
with changes made under Part 10. The
employee will be paid in a lump sum
according to 5 U.S.C. 8135, at 50 percent
of the monthly pay.
Section 25.101(e) has been amended
to provide that if a beneficiary can show
that the amount payable under the
special schedule would be
demonstrably less than the amount
payable under the law of his home
country, the Director has the discretion
to pay an amount in excess of the
special schedule of compensation under
5 U.S.C. 8137(a)(2)(A), not to exceed the
amount payable under FECA. This
section provides that to request such
benefits, the beneficiary must submit
the following information: translated
copies of the applicable local statute as
well as any regulations, policies and
procedures the beneficiary asserts are
applicable; and a translated copy of an
opinion rendered by an attorney
licensed in that jurisdiction or an
advisory opinion from a court or
administrative tribunal that explains the
benefits payable to the beneficiary.
Section 25.102 has been amended to
describe how compensation for death of
a non-citizen non-resident employee is
paid. Section 25.102(a) has been
amended to provide for burial expenses
not to exceed $800. Sections 25.102(b)–
(i) remain similar in the distribution of
death benefits (as delineated in former
sections 25.101(a)–(i)) but have been
limited to a total of 50 percent of
monthly pay. Section 25.102(j) has been
added to provide that death benefits
should be paid in a lump sum where
practicable pursuant to 5 U.S.C. 8135.
Section 25.102(k) has been added to
provide if a beneficiary can show that
the amount payable under the special
schedule would be demonstrably less
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than the amount payable under the law
of his home country, the Director has
the discretion to pay an amount in
excess of the special schedule under 5
U.S.C. 8137(a)(2)(A), not to exceed the
amount payable under FECA. This
section provides that the beneficiary
must submit the same information as
noted in section 25.101(e).
Section 25.102(l) has been added to
inform claimants that a FECA death
gratuity of $65,000 may be payable for
the death of a non-citizen non-resident
employee should the death be a result
of injury incurred in connection with
service with an Armed Force in a
contingency operation as set forth in
subpart J of part 10.
Subpart C
The provisions of subpart C are
largely unchanged in this regulatory
revision. Section 25.202 has been
amended to adjust the maximum
amount of compensation payable under
that section for inflation, and to provide
an automatic, yearly escalator to that
amount.
Section 25.203 has been amended to
apply the special schedule created by
subpart B to non-citizen, non-resident
employees in the Territory of Guam,
without the modifications contained in
the prior regulations.
III. Administrative Requirements for
the Proposed Rulemaking
Executive Order 12866
This proposed regulatory action
constitutes a ‘‘significant’’ rule within
the meaning of Executive Order 12866
in that any executive agency could be
required to participate in the
development of claims for benefits
under this regulatory action. The
Department believes, however, that as
this regulatory action merely updates
existing regulations, this regulatory
action will not have a significant
economic impact on the economy, or
any person or organization subject to the
proposed changes. The Department has
projected that the addition of the skin as
an organ under the schedule award
provision as well as the revision of the
part 25 compensation for non-citizen
non-resident employees will result in
additional expenditures of $10,893,434
over ten years.
This projection is based on a very
limited amount of data and a single
significant event could result in
substantially higher than projected
expenditures. This has been reviewed
by the Office of Management and
Budget for consistency with the
President’s priorities and the principles
set forth in Executive Order 12866.
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Regulatory Flexibility Act of 1980
This proposed rule has been reviewed
in accordance with the Regulatory
Flexibility Act of 1980, as amended by
the Small Business Regulatory
Enforcement Fairness Act of 1996, 5
U.S.C. 601–612. The Department has
concluded that the rule does not involve
regulatory and informational
requirements regarding businesses,
organizations, and governmental
jurisdictions subject to regulation.
Paperwork Reduction Act (PRA)
This rule contains information
collection requirements subject to the
Paperwork Reduction Act (PRA) of
1995, 44 U.S.C. 3501, et seq. The
requirements set out in this rule were
both submitted to and approved by the
OMB under the OMB Control Numbers
1240–0001, 1240–0007, 1240–0008,
1240–0009, 1240–0012, 1240–0013,
1240–0015, 1240–0016, 1240–0017,
1240–0018, 1240–0019, 1240–0022,
1240–0044, 1240–0045, 1240–0046,
1240–0047, 1240–0049, 1240–0050 and
1240–0051.
The National Environmental Policy Act
of 1969
The Department certifies that this
proposed rule has been assessed in
accordance with the requirements of the
National Environmental Policy Act of
1969, 42 U.S.C. 4321 et seq. (NEPA).
The Department concludes that NEPA
requirements do not apply to this
rulemaking because this proposed rule
includes no provisions impacting the
maintenance, preservation, or
enhancement of a healthful
environment.
Federal Regulations and Policies on
Families
The Department has reviewed this
proposed rule in accordance with the
requirements of section 654 of the
Treasury and General Government
Appropriations Act of 1999, 5 U.S.C.
601 note. These proposed regulations
were not found to have a potential
negative effect on family well-being as
it is defined thereunder.
Executive Order 13045: Protection of
Children From Environmental Health
Risks and Safety Risks
The Department certifies that this
proposed rule has been assessed
regarding environmental health risks
and safety risks that may
disproportionately affect children.
These proposed regulations were not
found to have a potential negative effect
on the health or safety of children.
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Unfunded Mandates Reform Act of 1995
and Executive Order 13132
The Department has reviewed this
proposed rule in accordance with the
requirements of Executive Order 13132,
64 FR 43225 (Aug. 10, 1999), and the
Unfunded Mandates Reform Act of
1995, 2 U.S.C. 1501 et seq., and has
found no potential or substantial direct
effects on the States, on the relationship
between the national government and
the States, or on the distribution of
power and responsibilities among the
various levels of government. As there
is no Federal mandate contained herein
that could result in increased
expenditures by State, local, or tribal
governments or by the private sector,
the Department has not prepared a
budgetary impact statement.
Executive Order 13175: Consultation
and Coordination With Indian Tribal
Governments
The Department has reviewed this
proposed rule in accordance with
Executive Order 13175, 65 FR 67249
(Nov. 9, 2000), and has determined that
it does not have ‘‘tribal implications.’’
The proposed rule does not ‘‘have
substantial direct effects on one or more
Indian tribes, on the relationship
between the Federal government and
Indian tribes, or on the distribution of
power and responsibilities between the
Federal government and Indian tribes.’’
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Executive Order 12630: Governmental
Actions and Interference With
Constitutionally Protected Property
Rights
The Department has reviewed this
proposed rule in accordance with
Executive Order 12630, 53 FR 8859
(Mar. 15, 1988), and has determined that
it does not contain any ‘‘policies that
have takings implications’’ in regard to
the ‘‘licensing, permitting, or other
condition requirements or limitations
on private property use, or that require
dedications or exactions from owners of
private property.’’
Executive Order 13211: Energy Supply,
Distribution, or Use
The Department has reviewed this
proposed regulation and has determined
that the provisions of Executive Order
13211, 66 FR 28355 (May 18, 2001), are
not applicable as there are no direct or
implied effects on energy supply,
distribution, or use.
The Privacy Act of 1974, 5 U.S.C. 552a,
as Amended
Claims filed under these regulations
are subject to the current Privacy Act
System of Records, DOL/GOVT–1,
Office of Workers’ Compensation
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Programs, Federal Employees’
Compensation Act File, 67 FR 16826
(April 8, 2002).
Clarity of This Regulation
Executive Order 12866, 58 FR 51735
(September 30, 1993), and the
President’s memorandum of June 1,
1998, require each agency to write all
rules in plain language. The Department
invites comments on how to make this
proposed rule easier to understand.
List of Subjects in 20 CFR Parts 1, 10,
and 25
Administrative practice and
procedure, Claims, Government
employees, Labor, Workers’
compensation.
For reasons set forth in the preamble,
the Office of Workers’ Compensation
Programs, Department of Labor, amends
20 CFR chapter I as follows:
1. Part 1 is revised to read as follows:
PART 1—PERFORMANCE OF
FUNCTIONS
Sec.
1.1 Under what authority does the Office of
Workers’ Compensation Programs
operate?
1.2 What functions are assigned to OWCP?
1.3 What rules are contained in this
chapter?
1.4 Where are other rules concerning OWCP
functions found?
1.5 When was the former Bureau of
Employees’ Compensation abolished?
1.6 How were many of OWCP’s current
functions administered in the past?
Authority: 5 U.S.C. 301, 8145 and 8149
(Reorganization Plan No. 6 of 1950, 15 FR
3174, 3 CFR, 1949–1953 Comp., p. 1004, 64
Stat. 1263); 42 U.S.C. 7384d and 7385s–10;
E.O. 13179, 65 FR 77487, 3 CFR, 2000 Comp.,
p. 321; Secretary of Labor’s Order No. 13–71,
36 FR 8155; Employment Standards Order
No. 2–74, 39 FR 34722; Secretary of Labor’s
Order No. 10–2009, 74 FR 218.
§ 1.1 Under what authority does the Office
of Workers’ Compensation Programs
operate?
(a) The Assistant Secretary of Labor
for Employment Standards, by authority
vested in him by the Secretary of Labor
in Secretary’s Order No. 13–71 (36 FR
8755), established in the Employment
Standards Administration (ESA) an
Office of Workers’ Compensation
Programs (OWCP) by Employment
Standards Order No. 2–74 (39 FR
34722). The Assistant Secretary
subsequently designated as the head
thereof a Director who, under the
general supervision of the Assistant
Secretary, administered the programs
assigned to OWCP by the Assistant
Secretary.
(b) Effective November 8, 2009, ESA
was dissolved into its four component
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parts, including OWCP. Secretary of
Labor’s Order 10–2009 (74 FR 218)
cancelled or modified all prior orders
and directives referencing ESA,
devolved certain authorities and
responsibilities of ESA to OWCP, and
delegated authority to the Director,
OWCP, to administer the programs now
assigned directly to OWCP.
§ 1.2 What functions are assigned to
OWCP?
The Secretary of Labor has delegated
authority and assigned responsibility 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
extended (5 U.S.C. 8101 et seq.), except
5 U.S.C. 8149 as it pertains to the
Employees’ Compensation Appeals
Board.
(b) The War Hazards Compensation
Act, as amended (42 U.S.C. 1701 et
seq.).
(c) The War Claims Act of 1948, as
amended (50 U.S.C. App. 2003 et seq.).
(d) The Energy Employees
Occupational Illness Compensation
Program Act of 2000, as amended (42
U.S.C. 7384 et seq.), except 42 U.S.C.
7385s–15 as it pertains to the Office of
the Ombudsman, and activities,
pursuant to Executive Order 13179
(‘‘Providing Compensation to America’s
Nuclear Weapons Workers’’) of
December 7, 2000, assigned to the
Secretary of Health and Human
Services, the Secretary of Energy and
the Attorney General.
(e) The Longshore and Harbor
Workers’ Compensation Act, as
amended and extended (33 U.S.C. 901 et
seq.), except: 33 U.S.C. 919(d) with
respect to administrative law judges in
the Office of Administrative Law Judges;
33 U.S.C. 921(b) as it pertains to the
Benefits Review Board; and activities,
pursuant to 33 U.S.C. 941, assigned to
the Assistant Secretary of Labor for
Occupational Safety and Health.
(f) The Black Lung Benefits Act, as
amended (30 U.S.C. 901 et seq.).,
including 26 U.S.C. 9501, except: 33
U.S.C. 919(d) as incorporated by 30
U.S.C. 932(a), with respect to
administrative law judges in the Office
of Administrative Law Judges; and 33
U.S.C. 921(b) as incorporated by 30
U.S.C. 932(a), as it applies to the
Benefits Review Board.
§ 1.3 What rules are contained in this
chapter?
The rules in this chapter are those
governing the OWCP functions under
the Federal Employees’ Compensation
Act, the War Hazards Compensation
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Act, the War Claims Act and the Energy
Employees Occupational Illness
Compensation Program Act of 2000.
§ 1.4 Where are other rules concerning
OWCP functions found?
(a) The rules of OWCP governing its
functions under the Longshore and
Harbor Workers’ Compensation Act and
its extensions are set forth in subchapter
A of chapter VI of this title.
(b) The rules of OWCP governing its
functions under the Black Lung Benefits
Act program are set forth in subchapter
B of chapter VI of this title.
(c) The rules and regulations of the
Employees’ Compensation Appeals
Board are set forth in chapter IV of this
title.
(d) The rules and regulations of the
Benefits Review Board are set forth in
Chapter VII of this title.
§ 1.5 When was the former Bureau of
Employees’ Compensation abolished?
By Secretary of Labor’s Order issued
September 23, 1974 (39 FR 34723),
issued 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
and assigned responsibility for the
various workers’ compensation
programs enumerated in § 1.2, except
the Black Lung Benefits Program and
the Energy Employees Occupational
Illness Compensation Program not then
in existence, to the Director of the
former Bureau of Employees’
Compensation.
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§ 1.6 How were many of OWCP’s current
functions administered in the past?
(a) Administration of the Federal
Employees’ Compensation Act and the
Longshore and Harbor Workers’
Compensation Act was initially vested
in an independent establishment known
as the U.S. Employees’ Compensation
Commission. By Reorganization Plan
No. 2 of 1946 (3 CFR, 1943–1949 Comp.,
p. 1064; 60 Stat. 1095, effective July 16,
1946), the Commission was abolished
and its functions were transferred to the
Federal Security Agency to be
performed by a newly created Bureau of
Employees’ Compensation within such
Agency. By Reorganization Plan No. 19
of 1950 (15 FR 3178, 3 CFR, 1949–1954
Comp., page 1010, 64 Stat. 1271), said
Bureau was transferred to the
Department of Labor (DOL), and the
authority formerly vested in the
Administrator, Federal Security Agency,
was vested in the Secretary of Labor. By
Reorganization Plan No. 6 of 1950 (15
FR 3174, 3 CFR, 1949–1953 Comp., page
1004, 64 Stat. 1263), the Secretary of
Labor was authorized to make from time
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to time such provisions as he shall deem
appropriate, authorizing the
performance of any of his functions by
any other officer, agency, or employee of
the DOL.
(b) In 1972, two separate
organizational units were established
within the Bureau: an Office of
Workmen’s Compensation Programs (37
FR 20533) and an Office of Federal
Employees’ Compensation (37 FR
22979). In 1974, these two units were
abolished and one organizational unit,
the Office of Workers’ Compensation
Programs, was established in lieu of the
Bureau of Employees’ Compensation (39
FR 34722).
2. Part 10 is revised to read as follows:
PART 10—CLAIMS FOR
COMPENSATION UNDER THE
FEDERAL EMPLOYEES’
COMPENSATION ACT, AS AMENDED
Subpart A—General Provisions
Sec.
Introduction
10.0
What are the provisions of the FECA,
in general?
10.1 What rules govern the administration
of the FECA and this chapter?
10.2 What do these regulations contain?
10.3 Have the collection of information
requirements of this part been approved
by the Office of Management and Budget
(OMB)?
Definitions and Forms
10.5
What definitions apply to these
regulations?
10.6 What special statutory definitions
apply to dependents and survivors?
10.7 What forms are needed to process
claims under the FECA?
Information in Program Records
10.10 Are all documents relating to claims
filed under the FECA considered
confidential?
10.11 Who maintains custody and control
of FECA records?
10.12 How may a FECA claimant or
beneficiary obtain copies of protected
records?
10.13 What process is used by a person who
wants to correct FECA-related
documents?
Rights and Penalties
10.15 May compensation rights be waived?
10.16 What criminal and civil penalties
may be imposed in connection with a
claim under the FECA?
10.17 Is a beneficiary who defrauds the
Government in connection with a claim
for benefits still entitled to those
benefits?
10.18 Can a beneficiary who is incarcerated
based on a felony conviction still receive
benefits?
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49605
Subpart B—Filing Notices and Claims;
Submitting Evidence
Notices and Claims for Injury, Disease, and
Death—Employee or Survivor’s Actions
10.100 How and when is a notice of
traumatic injury filed?
10.101 How and when is a notice of
occupational disease filed?
10.102 How and when is a claim for wage
loss compensation filed?
10.103 How and when is a claim for
permanent impairment filed?
10.104 How and when is a claim for
recurrence filed?
10.105 How and when is a notice of death
and claim for benefits filed?
Notices and Claims for Injury, Disease, and
Death—Employer’s Actions
10.110 What should the employer do when
an employee files a notice of traumatic
injury or occupational disease?
10.111 What should the employer do when
an employee files an initial claim for
compensation due to disability or
permanent impairment?
10.112 What should the employer do when
an employee files a claim for continuing
compensation due to disability?
10.113 What should the employer do when
an employee dies from a work-related
injury or disease?
Evidence and Burden of Proof
10.115 What evidence is needed to
establish a claim?
10.116 What additional evidence is needed
in cases based on occupational disease?
10.117 What happens if, in any claim, the
employer contests any of the facts as
stated by the claimant?
10.118 Does the employer participate in the
claims process in any other way?
10.119 What action will OWCP take with
respect to information submitted by the
employer?
10.120 May a claimant submit additional
evidence?
10.121 What happens if OWCP needs more
evidence from the claimant?
Decisions on Entitlement to Benefits
10.125 How does OWCP determine
entitlement to benefits?
10.126 What does the decision contain?
10.127 To whom is the decision sent?
Subpart C—Continuation of Pay
10.200 What is continuation of pay?
Eligibility for COP
10.205 What conditions must be met to
receive COP?
10.206 May an employee who uses leave
after an injury later decide to use COP
instead?
10.207 May an employee who returns to
work, then stops work again due to the
effects of the injury, receive COP?
Responsibilities
10.210 What are the employee’s
responsibilities in COP cases?
10.211 What are the employer’s
responsibilities in COP cases?
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Calculation of COP
Medical Reports
10.215 How does OWCP compute the
number of days of COP used?
10.216 How is the pay rate for COP
calculated?
10.217 Is COP charged if the employee
continues to work, but in a different job
that pays less?
10.330 What are the requirements for
medical reports?
10.331 How and when should the medical
report be submitted?
10.332 What additional medical
information will OWCP require to
support continuing payment of benefits?
10.333 What additional medical
information will OWCP require to
support a claim for a schedule award?
Controversion and Termination of COP
10.220 When is an employer not required to
pay COP?
10.221 How is a claim for COP
controverted?
10.222 When may an employer terminate
COP which has already begun?
10.223 Are there other circumstances under
which OWCP will not authorize payment
of COP?
10.224 What happens if OWCP finds that
the employee is not entitled to COP after
it has been paid?
Medical Bills
10.335 How are medical bills submitted?
10.336 What are the time frames for
submitting bills?
10.337 If an employee is only partially
reimbursed for a medical expense, must
the provider refund the balance of the
amount paid to the employee?
Subpart E—Compensation and Related
Benefits
Subpart D—Medical and Related Benefits
Compensation for Disability and Impairment
Emergency Medical Care
10.400 What is total disability?
10.401 When and how is compensation for
total disability paid?
10.402 What is partial disability?
10.403 When and how is compensation for
partial disability paid?
10.404 When and how is compensation for
a schedule impairment paid?
10.405 Who is considered a dependent in a
claim based on disability or impairment?
10.406 What are the maximum and
minimum rates of compensation in
disability cases?
10.300 What are the basic rules for
authorizing emergency medical care?
10.301 May the physician designated on
Form CA–16 refer the employee to
another medical specialist or medical
facility?
10.302 Should the employer authorize
medical care if he or she doubts that the
injury occurred, or that it is workrelated?
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?
10.304 Are there any exceptions to these
procedures for obtaining medical care?
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Medical Treatment and Related Issues
10.310 What are the basic rules for
obtaining medical care?
10.311 What are the special rules for the
services of chiropractors?
10.312 What are the special rules for the
services of clinical psychologists?
10.313 Will OWCP pay for preventive
treatment?
10.314 Will OWCP pay for the services of
an attendant?
10.315 Will OWCP pay for transportation to
obtain medical treatment?
10.316 After selecting a treating physician,
may an employee choose to be treated by
another physician instead?
Directed Medical Examinations
10.320 Can OWCP require an employee to
be examined by another physician?
10.321 What happens if the opinion of the
physician selected by OWCP differs from
the opinion of the physician selected by
the employee?
10.322 Who pays for second opinion and
referee examinations?
10.323 What are the penalties for failing to
report for or obstructing a second
opinion or referee examination?
10.324 May an employer require an
employee to undergo a physical
examination in connection with a workrelated injury?
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Compensation for Death
10.410 Who is entitled to compensation in
case of death, and what are the rates of
compensation payable in death cases?
10.411 What are the maximum and
minimum rates of compensation in death
cases?
10.412 Will OWCP pay the costs of burial
and transportation of the remains?
10.413 May a schedule award be paid after
an employee’s death?
10.414 What reports of dependents are
needed in death cases?
10.415 What must a beneficiary do if the
number of beneficiaries decreases?
10.416 How does a change in the number of
beneficiaries affect the amount of
compensation paid to the other
beneficiaries?
10.417 What reports are needed when
compensation payments continue for
children over age 18?
Adjustments to Compensation
10.420 How are cost-of-living adjustments
applied?
10.421 May a beneficiary receive other
kinds of payments from the Federal
Government concurrently with
compensation?
10.422 May compensation payments be
issued in a lump sum?
10.423 May compensation payments be
assigned to, or attached by, creditors?
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?
Overpayments
10.430 How does OWCP notify an
individual of a payment made?
10.431 What does OWCP do when an
overpayment is identified?
10.432 How can an individual present
evidence to OWCP in response to a
preliminary notice of an overpayment?
10.433 Under what circumstances can
OWCP waive recovery of an
overpayment?
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?
10.435 Is an individual responsible for an
overpayment that resulted from an error
made by OWCP or another Government
agency?
10.436 Under what circumstances would
recovery of an overpayment defeat the
purpose of the FECA?
10.437 Under what circumstances would
recovery of an overpayment be against
equity and good conscience?
10.438 Can OWCP require the individual
who received the overpayment to submit
additional financial information?
10.439 What is addressed at a prerecoupment hearing?
10.440 How does OWCP communicate its
final decision concerning recovery of an
overpayment, and what appeal right
accompanies it?
10.441 How are overpayments collected?
Subpart F—Continuing Benefits
Rules and Evidence
10.500 What are the basic rules governing
continuing receipt of compensation
benefits and return to work?
10.501 What medical evidence is necessary
to support continuing receipt of
compensation benefits?
10.502 How does OWCP evaluate evidence
in support of continuing receipt of
compensation benefits?
10.503 Under what circumstances may
OWCP reduce or terminate
compensation benefits?
Return to Work—Employer’s
Responsibilities
10.505 What actions must the employer
take?
10.506 May the employer monitor the
employee’s medical care?
10.507 How should the employer make an
offer of suitable work?
10.508 May relocation expenses be paid for
an employee who would need to move
to accept an offer of reemployment?
10.509 If an employee’s light duty job is
eliminated due to downsizing, what is
the effect on compensation?
10.510 When may a light duty job form the
basis of a loss of wage-earning capacity
determination?
10.511 How may a loss of wage-earning
capacity determination be modified?
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Return to Work—Employee’s
Responsibilities
10.515 What actions must the employee
take with respect to returning to work?
10.516 How will an employee know if
OWCP considers a job to be suitable?
10.517 What are the penalties for refusing
to accept a suitable job offer?
10.518 Does OWCP provide services to help
employees return to work?
10.519 What action will OWCP take if an
employee refuses to undergo vocational
rehabilitation?
10.520 How does OWCP determine
compensation after an employee
completes a vocational rehabilitation
program?
10.521 If an employee elects to receive
retirement benefits instead of FECA
benefits, what effect may such an
election have on that employee’s
entitlement to FECA compensation?
Reports of Earnings From Employment and
Self-Employment
10.525 What information must the
employee report?
10.526 Must the employee report volunteer
activities?
10.527 Does OWCP verify reports of
earnings?
10.528 What action will OWCP take if the
employee fails to file a report of activity
indicating an ability to work?
10.529 What action will OWCP take if the
employee files an incomplete report?
Reports of Dependents
10.535 How are dependents defined, and
what information must the employee
report?
10.536 What is the penalty for failing to
submit a report of dependents?
10.537 What reports are needed when
compensation payments continue for
children over age 18?
Reduction and Termination of
Compensation
10.540 When and how is compensation
reduced or terminated?
10.541 What action will OWCP take after
issuing written notice of its intention to
reduce or terminate compensation?
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Subpart G—Appeals Process
10.600 How can final decisions of OWCP be
reviewed?
Reconsiderations and Reviews by the
Director
10.605 What is reconsideration?
10.606 How does a claimant request
reconsideration?
10.607 What is the time limit for requesting
reconsideration?
10.608 How does OWCP decide whether to
grant or deny the request for
reconsideration?
10.609 How does OWCP decide whether
new evidence requires modification of
the prior decision?
10.610 What is a review by the Director?
Hearings
10.615 What is a hearing?
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10.616 How does a claimant obtain a
hearing?
10.617 How is an oral hearing conducted?
10.618 How is a review of the written
record conducted?
10.619 May subpoenas be issued for
witnesses and documents?
10.620 Who pays the costs associated with
subpoenas?
10.621 What is the employer’s role when an
oral hearing has been requested?
10.622 May a claimant withdraw a request
for or postpone a hearing?
Review by the Employees’ Compensation
Appeals Board (ECAB)
10.625 What kinds of decisions may be
appealed?
10.626 Who has jurisdiction of cases on
appeal to the ECAB?
Subpart H—Special Provisions
Representation
10.700 May a claimant designate a
representative?
10.701 Who may serve as a representative?
10.702 How are fees for services paid?
10.703 How are fee applications approved?
10.704 What penalties apply to
representatives who collect a fee without
approval?
Third Party Liability
10.705 When must an employee or other
FECA beneficiary take action against a
third party?
10.706 How will a beneficiary know if
OWCP or SOL has determined that
action against a third party is required?
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’’?
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?
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?
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?
10.711 How is the amount of the recovery
of the FECA beneficiary determined?
10.712 How much of any settlement or
judgment must be paid to the United
States?
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?
10.714 What amounts are included in the
refundable disbursements?
10.715 Is a beneficiary required to pay
interest on the amount of the refund due
to the United States?
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?
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?
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?
Federal Grand and Petit Jurors
10.725 When is a Federal grand or petit
juror covered under the FECA?
10.726 When does a juror’s entitlement to
disability compensation begin?
10.727 What is the pay rate of jurors for
compensation purposes?
Peace Corps Volunteers
10.730 What are the conditions of coverage
for Peace Corps volunteers and volunteer
leaders injured while serving outside the
United States?
10.731 What is the pay rate of Peace Corps
volunteers and volunteer leaders for
compensation purposes?
Non-Federal Law Enforcement Officers
10.735 When is a non-Federal law
enforcement officer (LEO) covered under
the FECA?
10.736 What are the time limits for filing a
LEO claim?
10.737 How is a LEO claim filed, and who
can file a LEO claim?
10.738 Under what circumstances are
benefits payable in LEO claims?
10.739 What kind of objective evidence of
a potential Federal crime must exist for
coverage to be extended?
10.740 In what situations will OWCP
automatically presume that a law
enforcement officer is covered by the
FECA?
10.741 HHow are benefits calculated in
LEO claims?
Subpart I—Information for Medical
Providers
Medical Records and Bills
10.800 How do providers enroll with
OWCP for authorizations and billing?
10.801 How are medical bills to be
submitted?
10.802 How should an employee prepare
and submit requests for reimbursement
for medical expenses, transportation
costs, loss of wages, and incidental
expenses?
10.803 What are the time limitations on
OWCP’s payment of bills?
Medical Fee Schedule
10.805 What services are covered by the
OWCP fee schedule?
10.806 How are the maximum fees defined?
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?
10.809 How are payments for medicinal
drugs determined?
10.810 How are payments for inpatient
medical services determined?
10.811 When and how are fees reduced?
10.812 If OWCP reduces a fee, may a
provider request reconsideration of the
reduction?
10.813 If OWCP reduces a fee, may a
provider bill the claimant for the
balance?
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Exclusion of Providers
10.815 What are the grounds for excluding
a provider from payment under the
FECA?
10.816 What will cause OWCP to
automatically exclude a physician or
other provider of medical services and
supplies?
10.817 How are OWCP’s exclusion
procedures initiated?
10.818 How is a provider notified of
OWCP’s intent to exclude him or her?
10.819 What requirements must the
provider’s answer and OWCP’s decision
meet?
10.820 How can an excluded provider
request a hearing?
10.821 How are hearings assigned and
scheduled?
10.822 How are subpoenas or advisory
opinions obtained?
10.823 How will the administrative law
judge conduct the hearing and issue the
recommended decision?
10.824 How does the recommended
decision become final?
10.825 What are the effects of exclusion?
10.826 How can an excluded provider be
reinstated?
Subpart J—Death Gratuity
10.900 What is the death gratuity under this
subpart?
10.901 Which employees are covered under
this subpart?
10.902 Does every employee’s death due to
injuries incurred in connection with his
or her service with an Armed Force in
a contingency operation qualify for the
death gratuity?
10.903 Is the death gratuity payment
applicable retroactively?
10.904 Does a death as a result of
occupational disease qualify for payment
of the death gratuity?
10.905 If an employee incurs a covered
injury in connection with his or her
service with an Armed Force in a
contingency operation but does not die
of the injury until years later, does the
death qualify for payment of the death
gratuity?
10.906 What special statutory definitions
apply to survivors under this subpart?
10.907 What order of precedence will
OWCP use to determine which survivors
are entitled to receive the death gratuity
payment under this subpart?
10.908 Can an employee designate alternate
beneficiaries to receive a portion of the
death gratuity payment?
10.909 How does an employee designate a
variation in the order or percentage of
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gratuity payable to survivors and how
does the employee designate alternate
beneficiaries?
10.910 What if a person entitled to a
portion of the death gratuity payment
dies after the death of the covered
employee but before receiving his or her
portion of the death gratuity?
10.911 How is the death gratuity payment
process initiated?
10.912 What is required to establish a claim
for the death gratuity payment?
10.913 In what situations will OWCP
consider that an employee incurred
injury in connection with his or her
service with an Armed Force in a
contingency operation?
10.914 What are the responsibilities of the
employing agency in the death gratuity
payment process?
10.915 What are the responsibilities of
OWCP in the death gratuity payment
process?
10.916 How is the amount of the death
gratuity calculated?
Authority: 5 U.S.C. 301, 8102a, 8103, 8145
and 8149; 31 U.S.C. 3716 and 3717;
Reorganization Plan No. 6 of 1950, 15 FR
3174, 64 Stat. 1263; Secretary of Labor’s
Order No. 10–2009, 74 FR 218.
Subpart A—General Provisions
Introduction
§ 10.0 What are the provisions of the
FECA, in general?
The Federal Employees’
Compensation Act (FECA) as amended
(5 U.S.C. 8101 et seq.) provides for the
payment of workers’ compensation
benefits to civilian officers and
employees of all branches of the
Government of the United States. The
regulations in this part describe the
rules for filing, processing, and paying
claims for benefits under the FECA.
Proceedings under the FECA are nonadversarial in nature.
(a) The FECA has been amended and
extended a number of times to provide
workers’ compensation benefits to
volunteers in the Civil Air Patrol (5
U.S.C. 8141), members of the Reserve
Officers’ Training Corps (5 U.S.C. 8140),
Peace Corps Volunteers (5 U.S.C. 8142),
Job Corps enrollees and Volunteers in
Service to America (5 U.S.C. 8143),
members of the National Teachers Corps
(5 U.S.C. 8143a), certain student
employees (5 U.S.C. 5351 and 8144),
certain law enforcement officers not
employed by the United States (5 U.S.C.
8191–8193), and various other classes of
persons who provide or have provided
services to the Government of the
United States.
(b) The FECA provides for payment of
several types of benefits, including
compensation for wage loss, schedule
awards, medical and related benefits,
and vocational rehabilitation services
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for conditions resulting from injuries
sustained in performance of duty while
in service to the United States.
(c) The FECA also provides for
payment of monetary compensation to
specified survivors of an employee
whose death resulted from a workrelated injury and for payment of certain
burial expenses subject to the provisions
of 5 U.S.C. 8134.
(d) All types of benefits and
conditions of eligibility listed in this
section are subject to the provisions of
the FECA and of this part. This section
shall not be construed to modify or
enlarge upon the provisions of the
FECA.
§ 10.1 What rules govern the
administration of 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 it
pertains to the Employees’
Compensation Appeals Board, has been
delegated to the Director of the Office of
Workers’ Compensation Programs
(OWCP). Except as otherwise provided
by law, the Director, OWCP and his or
her designees have the exclusive
authority to administer, interpret and
enforce the provisions of the Act.
§ 10.2
What do these regulations contain?
This part 10 sets forth the regulations
governing administration of all claims
filed under the FECA, except to the
extent specified in certain particular
provisions. Its provisions are intended
to assist persons seeking compensation
benefits under the FECA, as well as
personnel in the various Federal
agencies and the Department of Labor
who process claims filed under the
FECA or who perform administrative
functions with respect to the FECA.
This part 10 applies to part 25 of this
chapter except as modified by part 25.
The various subparts of this part contain
the following:
(a) Subpart A. The general statutory
and administrative framework for
processing claims under the FECA. It
contains a statement of purpose and
scope, together with definitions of
terms, descriptions of basic forms,
information about the disclosure of
OWCP records, and a description of
rights and penalties under the FECA,
including convictions for fraud.
(b) Subpart B. The rules for filing
notices of injury and claims for benefits
under the FECA. It also addresses
evidence and burden of proof, as well as
the process of making decisions
concerning eligibility for benefits.
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(c) Subpart C. The rules governing
claims for and payment of continuation
of pay.
(d) Subpart D. The rules governing
emergency and routine medical care,
second opinion and referee medical
examinations directed by OWCP, and
medical reports and records in general.
It also addresses the kinds of treatment
which may be authorized and how
medical bills are paid.
(e) Subpart E. The rules relating to the
payment of monetary compensation
benefits for disability, impairment and
death. It includes the provisions for
identifying and processing
overpayments of compensation.
(f) Subpart F. The rules governing the
payment of continuing compensation
benefits. It includes provisions
concerning the employee’s and the
employer’s responsibilities in returning
the employee to work. It also contains
provisions governing reports of earnings
and dependents, recurrences, and
reduction and termination of
compensation benefits.
(g) Subpart G. The rules governing the
appeals of decisions under the FECA. It
includes provisions relating to hearings,
reconsiderations, and appeals before the
Employees’ Compensation Appeals
Board.
(h) Subpart H. The rules concerning
legal representation and for adjustment
and recovery from a third party. It also
contains provisions relevant to three
groups of employees whose status
requires special application of the
provisions of the FECA: Federal grand
and petit jurors, Peace Corps volunteers,
and non-Federal law enforcement
officers.
(i) Subpart I. Information for medical
providers. It includes rules for medical
reports, medical bills, and the OWCP
medical fee schedule, as well as the
provisions for exclusion of medical
providers.
(j) Subpart J. Death Gratuity. The rules
relating to the payment of the death
gratuity benefit under 5 U.S.C. 8102a.
Definitions and Forms
§ 10.5 What definitions apply to these
regulations?
Certain words and phrases found in
this part are defined in this section or
in the FECA. Some other words and
phrases that are used only in limited
situations are defined in the later
subparts of these regulations.
(a) Benefits or Compensation in these
regulations means Compensation as
defined by the FECA at 5 U.S.C.
8101(12), which is the money OWCP
pays to or on behalf of a beneficiary
from the Employees’ Compensation
Fund. The terms Benefits and
Compensation include payments for lost
wages, loss of wage-earning capacity,
and permanent physical impairment.
The terms Benefits and Compensation
also include the money paid to
beneficiaries for an employee’s death,
including both death benefits and any
death gratuity benefit. These two terms
also include any other amounts paid out
of the Employees’ Compensation Fund
for such things as medical treatment,
medical examinations conducted at the
request of OWCP as part of the claims
adjudication process, vocational
rehabilitation services under 5 U.S.C.
8111, services of an attendant and
funeral expenses under 5 U.S.C. 8134,
but do not include continuation of pay
as provided by 5 U.S.C. 8118.
(b) Beneficiary means an individual
who is entitled to a benefit under the
FECA and this part.
(c) Claim means a written assertion of
an individual’s entitlement to benefits
under the FECA, submitted in a manner
authorized by this part.
(d) Claimant means an individual
whose claim has been filed.
(e) Director means the Director of
OWCP or a person designated to carry
out his or her functions.
(f) Disability means the incapacity,
because of an employment injury, to
earn the wages the employee was
receiving at the time of injury. It may be
partial or total.
(g) Earnings from employment or self§ 10.3 Have the collection of information
employment means:
requirements of this part been approved by
(1) Gross earnings or wages before any
the Office of Management and Budget
deductions and includes the value of
(OMB)?
subsistence, quarters, reimbursed
expenses and any other goods or
The collection of information
services received in kind as
requirements in this part have been
remuneration; or
approved by OMB and assigned OMB
(2) A reasonable estimate of the cost
control numbers 1240–0001, 1240–0007,
to have someone else perform the duties
1240–0008, 1240–0009, 1240–0012,
of an individual who accepts no
1240–0013, 1240–0015, 1240–0016,
remuneration. Neither lack of profits,
1240–0017, 1240–0018, 1240–0019,
nor the characterization of the duties as
1240–0022, 1240–0044, 1240–0045,
a hobby, removes an unremunerated
1240–0046, 1240–0047, 1240–0049,
individual’s responsibility to report the
1240–0050 and 1240–0051.
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49609
estimated cost to have someone else
perform his or her duties.
(h) Employee means, but is not
limited to, an individual who fits within
one of the following listed groups:
(1) A civil officer or employee in any
branch of the Government of the United
States, including an officer or employee
of an instrumentality wholly owned by
the United States pursuant to 5 U.S.C.
8101(1)(A);
(2) An individual rendering personal
service to the United States similar to
the service of a civil officer or employee
of the United States, without pay or for
nominal pay, when a statute authorizes
the acceptance or use of the service, or
authorizes payment of travel or other
expenses of the individual pursuant to
5 U.S.C. 8101(1)(B);
(3) An individual, other than an
independent contractor or an individual
employed by an independent contractor,
employed on the Menominee Indian
Reservation in Wisconsin in operations
conducted under a statute relating to
tribal timber and logging operations on
that reservation pursuant to 5 U.S.C.
8101(1)(C);
(4) An individual appointed to a
position on the office staff of a former
President under section 1(b) of the Act
of August 25, 1958 (72 Stat. 838)
pursuant to 5 U.S.C. 8101(1)(E); or
(5) An individual selected and serving
as a Federal petit or grand juror
pursuant to 5 U.S.C. 8101(1)(F).
(i) Employer or Agency means any
civil agency or instrumentality of the
United States Government, or any other
organization, group or institution
employing an individual defined as an
‘‘employee’’ by this section. These terms
also refer to officers and employees of
an employer having responsibility for
the supervision, direction or control of
employees of that employer as an
‘‘immediate superior,’’ and to other
employees designated by the employer
to carry out the functions vested in the
employer under the FECA and this part,
including officers or employees
delegated responsibility by an employer
for authorizing medical treatment for
injured employees.
(j) Entitlement means entitlement to
benefits as determined by OWCP under
the FECA and the procedures described
in this part.
(k) FECA means the Federal
Employees’ Compensation Act, as
amended.
(l) Hospital services means services
and supplies provided by hospitals
within the scope of their practice as
defined by State law.
(m) Impairment means any anatomic
or functional abnormality or loss. A
permanent impairment is any such
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abnormality or loss after maximum
medical improvement has been
achieved.
(n) Knowingly means with knowledge,
consciously, willfully or intentionally.
(o) Medical services means services
and supplies provided by or under the
supervision of a physician.
Reimbursable chiropractic services are
limited to physical examinations (and
related laboratory tests), x-rays
performed to diagnose a subluxation of
the spine and treatment consisting of
manual manipulation of the spine to
correct a subluxation.
(p) Medical support services means
services, drugs, supplies and appliances
provided by a person other than a
physician or hospital.
(q) Occupational disease or illness
means a condition produced by the
work environment over a period longer
than a single workday or shift.
(r) OWCP means the Office of
Workers’ Compensation Programs.
(s) Pay rate for compensation
purposes means the employee’s pay, as
determined under 5 U.S.C. 8114, at the
time of injury, the time disability begins
or the time compensable disability
recurs if the recurrence begins more
than six months after the injured
employee resumes regular full-time
employment with the United States,
whichever is greater, except as
otherwise determined under 5 U.S.C.
8113 with respect to any period.
(t) Physician means an individual
defined as such in 5 U.S.C. 8101(2),
except during the period for which his
or her license to practice medicine has
been suspended or revoked by a State
licensing or regulatory authority.
(u) Qualified hospital means any
hospital licensed as such under State
law which has not been excluded under
the provisions of subpart I of this part.
Except as otherwise provided by
regulation, a qualified hospital shall be
deemed to be designated or approved by
OWCP.
(v) Qualified physician means any
physician who has not been excluded
under the provisions of subpart I of this
part. Except as otherwise provided by
regulation, a qualified physician shall
be deemed to be designated or approved
by OWCP.
(w) Qualified provider of medical
support services or supplies means any
person, other than a physician or a
hospital, who provides services, drugs,
supplies and appliances for which
OWCP makes payment, who possesses
any applicable licenses required under
State law, and who has not been
excluded under the provisions of
subpart I of this part.
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(x) Recurrence of disability means an
inability to work after an employee has
returned to work, caused by a
spontaneous change in a medical
condition which had resulted from a
previous injury or illness without an
intervening injury or new exposure to
the work environment that caused the
illness. This term also means an
inability to work that takes place when
a light-duty assignment made
specifically to accommodate an
employee’s physical limitations due to
his or her work-related injury or illness
is withdrawn or when the physical
requirements of such an assignment are
altered so that they exceed his or her
established physical limitations. A
recurrence of disability does not apply
when a light-duty assignment is
withdrawn for reasons of misconduct,
non-performance of job duties or other
downsizing or where a loss of wageearning capacity determination as
provided by 5 U.S.C. 8115 is in place.
(y) Recurrence of medical condition
means a documented need for further
medical treatment after release from
treatment for the accepted condition or
injury when there is no accompanying
work stoppage. Continuous treatment
for the original condition or injury is not
considered a ‘‘need for further medical
treatment after release from treatment,’’
nor is an examination without
treatment.
(z) Representative means an
individual or law firm properly
authorized by a claimant in writing to
act for the claimant in connection with
a claim or proceeding under the FECA
or this part.
(aa) Student means an individual
defined at 5 U.S.C. 8101(17). Two terms
used in that particular definition are
further defined as follows:
(1) Additional type of educational or
training institution means a technical,
trade, vocational, business or
professional school accredited or
licensed by the United States
Government or a State Government or
any political subdivision thereof
providing courses of not less than three
months duration, that prepares the
individual for a livelihood in a trade,
industry, vocation or profession.
(2) Year beyond the high school level
means:
(i) The 12-month period beginning the
month after the individual graduates
from high school, provided he or she
had indicated an intention to continue
schooling within four months of high
school graduation, and each successive
12-month period in which there is
school attendance or the payment of
compensation based on such
attendance; or
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(ii) If the individual has indicated that
he or she will not continue schooling
within four months of high school
graduation, the 12-month period
beginning with the month that the
individual enters school to continue his
or her education, and each successive
12-month period in which there is
school attendance or the payment of
compensation based on such
attendance.
(bb) Subluxation means an
incomplete dislocation, off-centering,
misalignment, fixation or abnormal
spacing of the vertebrae which must be
demonstrable on any x-ray film to an
individual trained in the reading of xrays.
(cc) Surviving spouse means the
husband or wife living with or
dependent for support upon a deceased
employee at the time of his or her death,
or living apart for reasonable cause or
because of the deceased employee’s
desertion, unless otherwise defined
under the FECA for the specific benefit
such as the FECA death gratuity at 5
U.S.C. 8102a.
(dd) Temporary aggravation of a preexisting condition means that factors of
employment have directly caused that
condition to be more severe for a limited
period of time and have left no greater
impairment than existed prior to the
employment injury.
(ee) Traumatic injury means a
condition of the body caused by a
specific event or incident, or series of
events or incidents, within a single
workday or shift. Such condition must
be caused by external force, including
stress or strain, which is identifiable as
to time and place of occurrence and
member or function of the body
affected.
§ 10.6 What special statutory definitions
apply 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 injury sustained in
the performance of duty.
(b) 5 U.S.C. 8148 also provides that
certain other benefits may be payable to
certain family members of employees
who have been incarcerated due to a
felony conviction.
(c) 5 U.S.C. 8110(b) further provides
that any employee who is found to be
eligible for a basic benefit shall be
entitled to have such basic benefit
augmented at a specified rate for certain
persons who live in the beneficiary’s
household or who are dependent upon
the beneficiary for support.
(d) 5 U.S.C. 8101, 8110, 8133, and
8148, which define the nature of such
survivorship or dependency necessary
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to qualify a beneficiary for a survivor’s
benefit or an augmented benefit, apply
to the provisions of this part but not to
the death gratuity provided under
subpart J.
(e) 5 U.S.C. 8102a provides the
definitions for survivorship or
dependency necessary to qualify as a
beneficiary for a death gratuity benefit
as well as allowing half the death
gratuity benefit to be paid to alternate
beneficiary.
§ 10.7 What forms are needed to process
claims under the FECA?
49611
prescribed by OWCP. Employers shall
not modify these forms or use substitute
forms. Employers are expected to
maintain an adequate supply of the
basic forms needed for the proper
recording and reporting of injuries.
(a) Notice of injury, claims and certain
specified reports shall be made on forms
Form No.
Title
(1) CA–1 ...............................
(2) CA–2 ...............................
(3) CA–2a .............................
(4) CA–3 ...............................
(5) CA–5 ...............................
(6) CA–5b .............................
(7) CA–6 ...............................
(8) CA–7 ...............................
(9) CA–7a .............................
(10) CA–7b ...........................
(11) CA–16 ...........................
(12) CA–17 ...........................
(13) CA–20 ...........................
(14) CA–20a .........................
(15) CA–40 ...........................
Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation.
Notice of Occupational Disease and Claim for Compensation.
Notice of Employee’s Recurrence of Disability and Claim for Pay/Compensation.
Report of Work Status.
Claim for Compensation by Widow, Widower and/or Children.
Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren.
Official Superior’s Report of Employee’s Death.
Claim for Compensation Due to Traumatic Injury or Occupational Disease.
Time Analysis Form.
Leave Buy Back (LBB) Worksheet/Certification and Election.
Authorization of Examination and/or Treatment.
Duty Status Report.
Attending Physician’s Report.
Attending Physician’s Supplemental Report.
Designation of a Recipient of the Federal Employees’ Compensation Act Death Gratuity Payment under Section
1105 of Public Law 110–181 (Section 8102a).
Claim for Survivor Benefits Under the Federal Employees’ Compensation Act Section 8102a Death Gratuity.
Official Notice of Employees’ Death for Purposes of FECA Section 8102a Death Gratuity.
Statement of Recovery Letter with Long Form.
Statement of Recovery Letter with Short Form.
(16)
(17)
(18)
(19)
CA–41 ...........................
CA–42 ...........................
CA–1108 .......................
CA–1122 .......................
(b) Copies of the forms listed in this
paragraph are available for public
inspection at the Office of Workers’
Compensation Programs, U.S.
Department of Labor, Washington, DC
20210. They may also be obtained from
district offices, employers (i.e., safety
and health offices, supervisors), and the
Internet, at https://www.dol.gov.
Information in Program Records
§ 10.10 Are all documents relating to
claims filed under the FECA considered
confidential?
All records relating to claims for
benefits, including copies of such
records maintained by an employer, are
considered confidential and may not be
released, inspected, copied or otherwise
disclosed except as provided in the
Freedom of Information Act and the
Privacy Act of 1974 or under the routine
uses provided by DOL/GOVT–1 if such
release is consistent with the purpose
for which the record was created.
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§ 10.11 Who maintains custody and
control of 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
the government-wide Privacy Act
system of records entitled DOL/GOVT–
1 (Office of Workers’ Compensation
Programs, Federal Employees’
Compensation Act File). This system of
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records is maintained by and under the
control of OWCP, and, as such, all
records covered by DOL/GOVT–1 are
official records of OWCP. The
protection, release, inspection and
copying of records covered by DOL/
GOVT–1 shall be accomplished in
accordance with the rules, guidelines
and provisions of this part, as well as
those contained in 29 CFR parts 70 and
71, and with the notice of the system of
records and routine uses published in
the Federal Register. All questions
relating to access/disclosure, and/or
amendment of FECA records
maintained by OWCP or the employing
agency, are to be resolved in accordance
with this section.
§ 10.12 How may a FECA claimant or
beneficiary obtain 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 office having custody of the file.
A claimant seeking copies of FECArelated documents in the custody of the
employer should follow the procedures
established by that agency.
(b)(1) While an employing agency
may establish procedures that an
injured employee or beneficiary should
follow in requesting access to
documents it maintains, any decision
issued in response to such a request
must comply with the rules and
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regulations of the Department of Labor
which govern all other aspects of
safeguarding these records.
(2) No employing agency has the
authority to issue determinations with
respect to requests for the correction or
amendment of records contained in or
covered by DOL/GOVT–1. That
authority is within the exclusive control
of OWCP. Thus, any request for
correction or amendment received by an
employing agency must be referred to
OWCP for review and decision.
(3) Any administrative appeal taken
from a denial issued by the employing
agency or OWCP shall be filed with the
Solicitor of Labor in accordance with 29
CFR 71.7 and 71.9.
§ 10.13 What process is used by a person
who 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 file. No employer
has the authority to issue
determinations with regard to requests
for the correction of records contained
in or covered by DOL/GOVT–1. Any
request for correction received by an
employer must be referred to OWCP for
review and decision.
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§ 10.18 Can a beneficiary who is
incarcerated based on a felony conviction
still receive benefits?
Rights and Penalties
§ 10.15 May compensation rights be
waived?
No employer or other person may
require an employee or other claimant
to enter into any agreement, either
before or after an injury or death, to
waive his or her right to claim
compensation under the FECA. No
waiver of compensation rights shall be
valid.
§ 10.16 What criminal and civil penalties
may be imposed in 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
under the FECA, or to wrongfully
impede a FECA claim. Included among
these provisions are sections 287, 1001,
1920, and 1922 of title 18, United States
Code. Enforcement of these and other
provisions that may apply to claims
under the FECA are within the
jurisdiction of the Department of Justice.
(b) In addition, administrative
proceedings may be initiated under the
Program Fraud Civil Remedies Act of
1986 (PFCRA), 31 U.S.C. 3801–12, to
impose civil penalties and assessments
against persons who make, submit, or
present, or cause to be made, submitted
or presented, false, fictitious or
fraudulent claims or written statements
to OWCP in connection with a claim
under the FECA. The Department of
Labor’s regulations implementing the
PFRCA are found at 29 CFR part 22.
Furthermore, a civil action to recover
benefits paid erroneously under the
FECA may be maintained under the
False Claims Act, 31 U.S.C. 3729–3733.
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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?
When a beneficiary either pleads
guilty to or is found guilty on either
Federal or State criminal charges of
defrauding the Federal Government in
connection with a claim for benefits, the
beneficiary’s entitlement to any further
compensation benefits will terminate
effective the date of conviction, which
is the date of the verdict or, in the case
of a plea bargain, the date the claimant
made the plea in open court (not the
date of sentencing or the date court
papers were signed). The employing
agency may, upon request, be required
to provide the documentation needed
for termination under this section.
Termination of entitlement under this
section is not affected by any
subsequent change in or recurrence of
the beneficiary’s medical condition.
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Notices and Claims for Injury, Disease,
and Death—Employee or Survivor’s
Actions
injury. (The form contains the necessary
words of claim.) The requirements for
filing notice are further described in 5
U.S.C. 8119. Also see § 10.205
concerning time requirements for filing
claims for continuation of pay.
(1) If the claim is not filed within
three years, compensation may still be
allowed if notice of injury was given
within 30 days or the employer had
actual knowledge of the injury or death
within 30 days after occurrence. This
knowledge may consist of written
records or verbal notification. An entry
into an employee’s medical record may
also satisfy this requirement if it is
sufficient to place the employer on
notice of a possible work-related injury
or disease.
(2) OWCP may excuse failure to
comply with the three-year time
requirement because of truly
exceptional circumstances (for example,
being held prisoner of war).
(3) The claimant may withdraw his or
her claim (but not the notice of injury)
by so requesting in writing to OWCP at
any time before OWCP determines
eligibility for benefits. Any continuation
of pay (COP) granted to an employee
after a claim is withdrawn must be
charged to sick or annual leave, or
considered an overpayment of pay
consistent with 5 U.S.C. 5584, at the
employee’s option.
(c) However, in cases of latent
disability, the time for filing claim does
not begin to run until the employee has
a compensable disability and is aware,
or reasonably should have been aware,
of the causal relationship between the
disability and the employment (see 5
U.S.C. 8122(b)).
§ 10.100 How and when is a notice of
traumatic injury filed?
§ 10.101 How and when is a notice of
occupational disease filed?
(a) To claim benefits under the FECA,
an employee who sustains a workrelated traumatic injury must give
notice of the injury in writing on Form
CA–1, which may be obtained from the
employer or from the Internet at
www.dol.gov under forms. The
employee must forward this notice to
the employer. Another person,
including the employer, may give notice
of injury on the employee’s behalf. The
person submitting a notice shall include
the Social Security Number (SSN) of the
injured employee. All such notices
should be submitted electronically
wherever feasible to facilitate processing
of such claims. All employers that
currently do not have such capability
should create such a method by
December 31, 2012.
(b) For injuries sustained on or after
September 7, 1974, a notice of injury
must be filed within three years of the
(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 the condition in
writing on Form CA–2, which may be
obtained from the employer or from the
Internet at www.dol.gov under forms.
The employee must forward this notice
to the employer. Another person,
including the employer, may do so on
the employee’s behalf. The person
submitting a notice shall include the
Social Security Number (SSN) of the
injured employee. All such notices
should be submitted electronically
wherever feasible to facilitate processing
of such claims. All employers that
currently do not have such capability
should create such a method by
December 31, 2012. The claimant may
withdraw his or her claim (but not the
notice of occupational disease) by so
requesting in writing to OWCP at any
(a) Whenever a beneficiary is
incarcerated in a State or Federal jail,
prison, penal institution or other
correctional facility due to a State or
Federal felony conviction, he or she
forfeits all rights to compensation
benefits during the period of
incarceration. A beneficiary’s right to
compensation benefits for the period of
his or her incarceration is not restored
after such incarceration ends, even
though payment of compensation
benefits may resume. A beneficiary has
an affirmative duty to provide notice of
any conviction and imprisonment. The
employing agency shall provide OWCP
any information or documentation they
may have concerning such matters.
(b) If the beneficiary has eligible
dependents, OWCP will pay
compensation to such dependents at a
reduced rate during the period of his or
her incarceration, by applying the
percentages of 5 U.S.C. 8133(a)(1)
through (5) to the beneficiary’s gross
current entitlement rather than to the
beneficiary’s monthly pay.
(c) If OWCP’s decision on entitlement
is pending when the period of
incarceration begins, and compensation
is due for a period of time prior to such
incarceration, payment for that period
will only be made to the beneficiary
following his or her release.
Subpart B—Filing Notices and Claims;
Submitting Evidence
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time before OWCP determines eligibility
for benefits.
(b) For occupational diseases
sustained as a result of exposure to
injurious work factors that occurs on or
after September 7, 1974, a notice of
occupational disease must be filed
within three years of the onset of the
condition. (The form contains the
necessary words of claim.) The
requirements for timely filing are
described in § 10.100(b)(1) through (3).
(c) However, in cases of latent
disability, the time for filing claim does
not begin to run until the employee has
a compensable disability and is aware,
or reasonably should have been aware,
of the causal relationship between the
disability and the employment (see 5
U.S.C. 8122(b)).
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§ 10.102 How and when is a claim 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
loss of pay for more than three calendar
days due to an injury, or someone acting
on his or her behalf, must file Form CA–
7 before compensation can be paid.
(2) The employee shall complete the
front of Form CA–7 and submit the form
to the employer for completion and
transmission to OWCP. The form should
be completed as soon as possible, but no
more than 14 calendar days after the
date pay stops due to the injury or
disease. All such notices should be
submitted electronically wherever
feasible to facilitate processing of such
claims. All employers that currently do
not have such capability should create
such a method by December 31, 2012.
(3) The requirements for filing claims
are further described in 5 U.S.C. 8121.
(b) Form CA–7 is also used to claim
compensation for additional periods of
disability following the initial injury.
(1) It is the employee’s responsibility
to submit Form CA–7. Without receipt
of such claim, OWCP has no knowledge
of continuing wage loss. Therefore,
while disability continues, the
employee should submit a claim on
Form CA–7 each two weeks until
otherwise instructed by OWCP.
(2) The employee shall complete the
front of Form CA–7 and submit the form
to the employer for completion and
transmission to OWCP.
(3) The employee is responsible for
submitting, or arranging for the
submittal of, medical evidence to OWCP
which establishes both that disability
continues and that the disability is due
to the work-related injury. Form CA–20a
is submitted with Form CA–7 for this
purpose.
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§ 10.103 How and when is a claim 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. All such
notices should be submitted
electronically wherever feasible to
facilitate processing of such claims. All
employers that currently do not have
such capability should create such a
method by December 31, 2012. If Form
CA–7 has already been filed to claim
disability compensation, an employee
may file a claim for such impairment by
sending a letter to OWCP which
specifies the nature of the benefit
claimed. OWCP may create a form
specifically for schedule award claims;
if that form is created, only that form
may be used to file a claim under 5
U.S.C. 8107.
§ 10.104 How and when is a claim 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 employee
experiences a renewed need for
treatment after previously being
released from care. However, a notice of
recurrence should not be filed when a
new injury, new occupational disease,
or new event contributing to an alreadyexisting occupational disease has
occurred. In these instances, the
employee should file Form CA–1 or
CA–2.
(b) The employee has the burden of
establishing by the weight of reliable,
probative and substantial evidence that
the recurrence of disability is causally
related to the original injury.
(1) The employee must include a
detailed factual statement as described
on Form CA–2a. The employer may
submit comments concerning the
employee’s statement.
(2) The employee should arrange for
the submittal of a detailed medical
report from the attending physician as
described on Form CA–2a. The
employee should also submit, or arrange
for the submittal of, similar medical
reports for any examination and/or
treatment received after returning to
work following the original injury.
(c) A claim for recurrence of disability
is not available where OWCP has issued
a loss of wage-earning capacity
determination. Under that circumstance,
the only method for claiming additional
wage loss compensation is through a
request to modify that determination.
However, OWCP is not precluded from
adjudicating a limited period of
disability following the issuance of a
loss of wage-earning capacity decision,
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i.e., where an employee has a
demonstrated need for surgery.
§ 10.105 How and when is a notice of
death and claim for benefits filed?
(a) If an employee dies from a workrelated traumatic injury or an
occupational disease, any survivor may
file a claim for death benefits using
Form CA–5 or CA–5b, which may be
obtained from the employer or from the
Internet at https://www.dol.gov under
forms. The survivor must provide this
notice in writing and forward it to the
employer. Another person, including
the employer, may do so on the
survivor’s behalf. The survivor may also
submit the completed Form CA–5 or
CA–5b directly to OWCP. The survivor
shall disclose the SSNs of all survivors
on whose behalf claim for benefits is
made in addition to the SSN of the
deceased employee. All such notices
should be submitted electronically
wherever feasible to facilitate processing
of such claims. All employers that
currently do not have such capability
should create such a method by
December 31, 2012. The survivor may
withdraw his or her claim (but not the
notice of death) by so requesting in
writing to OWCP at any time before
OWCP determines eligibility for
benefits.
(b) For deaths that occur on or after
September 7, 1974, a notice of death
must be filed within three years of the
death. The form contains the necessary
words of claim. The requirements for
timely filing are described in
§ 10.100(b)(1) through (3).
(c) However, in cases of death due to
latent disability, the time for filing the
claim does not begin to run until the
survivor is aware, or reasonably should
have been aware, of the causal
relationship between the death and the
employment (see 5 U.S.C. 8122(b)).
(d) The filing of a notice of injury or
occupational disease will satisfy the
time requirements for a death claim
based on the same injury or
occupational disease. If an injured
employee or someone acting on the
employee’s behalf does not file a claim
before the employee’s death, the right to
claim compensation for disability other
than medical expenses ceases and does
not survive.
(e) A survivor must be alive to receive
any payment; there is no vested right to
such payment. A report as described in
§ 10.414 of this part must be filed once
each year to support continuing
payments of compensation.
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Notices and Claims for Injury, Disease,
and Death—Employer’s Actions
§ 10.110 What should the employer do
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 injury) or CA–2 (for
occupational disease) no more than 10
working days after receipt of notice from
the employee. The employer shall also
complete the Receipt of Notice and give
it to the employee, along with copies of
both sides of Form CA–1 or Form CA–
2.
(b) The employer must complete and
transmit the form to OWCP within 10
working days after receipt of notice from
the employee if the injury or disease
will likely result in:
(1) A medical charge against OWCP;
(2) Disability for work beyond the day
or shift of injury;
(3) The need for more than two
appointments for medical examination
and/or treatment on separate days,
leading to time loss from work;
(4) Future disability;
(5) Permanent impairment; or
(6) Continuation of pay pursuant to 5
U.S.C. 8118.
(c) The employer should not wait for
submittal of supporting evidence before
sending the form to OWCP.
(d) If none of the conditions in
paragraph (b) of this section applies, the
Form CA–1 or CA–2 shall be retained as
a permanent record in the Employee
Medical Folder in accordance with the
guidelines established by the Office of
Personnel Management.
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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?
(a) Except for employees covered by
paragraph (d) of this section, when an
employee is disabled by a work-related
injury and loses pay for more than three
calendar days, or has a permanent
impairment or serious disfigurement as
described in 5 U.S.C. 8107, the
employer shall furnish the employee
with Form CA–7 for the purpose of
claiming compensation.
(b) If the employee is receiving
continuation of pay (COP), the employer
should give Form CA–7 to the employee
by the 30th day of the COP period and
submit the form to OWCP by the 40th
day of the COP period. If the employee
has not returned the form to the
employer by the 40th day of the COP
period, the employer should ask him or
her to submit it as soon as possible.
(c) Upon receipt of Form CA–7 from
the employee, or someone acting on his
or her behalf, the employer shall
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complete the appropriate portions of the
form. As soon as possible, but no more
than five working days after receipt
from the employee, the employer shall
forward the completed Form CA–7 and
any accompanying medical report to
OWCP.
(d) Postal Service employees are not
entitled to compensation or
continuation of pay for the waiting
period, the first three days of disability.
Such employees may use annual leave,
sick leave or leave without pay during
that period; however, if the disability
exceeds 14 days, the employee may
have their sick leave or annual leave
reinstated or receive pay for the time
spent on leave without pay. This
waiting period does not apply to the
provision of medical care, and days of
time loss for medical treatment only
with no work-related disability do not
count as part of the waiting period. A
Postal Service employee seeking wage
loss compensation for this period
should utilize Form CA–7 to claim such
benefits.
§ 10.112 What should the employer do
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 workrelated injury after the period of
compensation initially claimed on Form
CA–7, the employer shall furnish the
employee with another Form CA–7 for
the purpose of claiming continuing
compensation.
(b) Upon receipt of Form CA–7 from
the employee, or someone acting on his
or her behalf, the employer shall
complete the appropriate portions of the
form. As soon as possible, but no more
than five working days after receipt
from the employee, the employer shall
forward the completed Form CA–7 and
any accompanying medical report to
OWCP.
§ 10.113 What should the employer do
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 occupational disease
to OWCP by telephone, telegram, or
facsimile (fax). No more than 10
working days after notification of the
death, the employer shall complete and
send Form CA–6 to OWCP.
(b) When possible, the employer shall
furnish a Form CA–5 or CA–5b to all
persons likely to be entitled to
compensation for death of an employee.
The employer should also supply
information about completing and filing
the form.
(c) The employer shall promptly
transmit Form CA–5 or CA–5b to
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OWCP. The employer shall also
promptly transmit to OWCP any other
claim or paper submitted which appears
to claim compensation on account of
death.
Evidence and Burden of Proof
§ 10.115 What evidence is needed to
establish a claim?
Forms CA–1, CA–2, CA–5 and CA–5b
describe the basic evidence required.
OWCP may send a request for additional
evidence to the claimant and to his or
her representative, if any; however the
burden of proof still remains with the
claimant. Evidence should be submitted
in writing. The evidence submitted
must be reliable, probative and
substantial. Each claim for
compensation must meet five
requirements before OWCP can accept
it. These requirements, which the
employee must establish to meet his or
her burden of proof, are as follows:
(a) The claim was filed within the
time limits specified by the FECA;
(b) The injured person was, at the
time of injury, an employee of the
United States as defined in 5 U.S.C.
8101(1) and § 10.5(h) of this part;
(c) The fact that an injury, disease or
death occurred;
(d) The injury, disease or death
occurred while the employee was in the
performance of duty; and
(e) The medical condition for which
compensation or medical benefits is
claimed is causally related to the
claimed injury, disease or death. Neither
the fact that the condition manifests
itself during a period of Federal
employment, nor the belief of the
claimant that factors of employment
caused or aggravated the condition, is
sufficient in itself to establish causal
relationship.
(f) In all claims, the claimant is
responsible for submitting, or arranging
for submittal of, a medical report from
the attending physician. For wage loss
benefits, the claimant must also submit
medical evidence showing that the
condition claimed is disabling. The
rules for submitting medical reports are
found in §§ 10.330 through 10.333.
§ 10.116 What additional evidence is
needed in cases based on occupational
disease?
(a) The employee must submit the
specific detailed information described
on Form CA–2 and should submit any
checklist (Form CA–35, A–H) provided
by the employer. OWCP has developed
these checklists to address particular
occupational diseases. The medical
report should also include the
information specified on the checklist
for the particular disease claimed.
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(b) The employer should submit the
specific detailed information described
on Form CA–2 and on any checklist
pertaining to the claimed disease.
§ 10.117 What happens if, in 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 submit a
statement to OWCP that specifically
describes the factual allegation or
argument with which it disagrees and
provide evidence or argument to
support its position. The employer may
include supporting documents such as
witness statements, medical reports or
records, or any other relevant
information.
(b) Any such statement shall be
submitted to OWCP with the notice of
traumatic injury or death, or within 30
calendar days from the date notice of
occupational disease or death is
received from the claimant. If the
employer does not submit a written
explanation to support the
disagreement, OWCP may accept the
claimant’s report of injury as
established. The employer may not use
a disagreement with an aspect of the
claimant’s report to delay forwarding
the claim to OWCP or to compel or
induce the claimant to change or
withdraw the claim.
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§ 10.118 Does the employer participate 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 its possession, or which it may
acquire through investigation or other
means. Such evidence may be submitted
at any time.
(b) The employer may ascertain the
events surrounding an injury and the
extent of disability where it appears that
an employee who alleges total disability
may be performing other work, or may
be engaging in activities which would
indicate less than total disability. This
authority is in addition to that given in
§ 10.118(a). However, the provisions of
the Privacy Act apply to any endeavor
by the employer to ascertain the facts of
the case (see §§ 10.10 and 10.11).
(c) The employer does not have the
right, except as provided in subpart C of
this part, to actively participate in the
claims adjudication process.
§ 10.119 What action will OWCP take with
respect to information submitted by the
employer?
OWCP will consider all evidence
submitted appropriately, and OWCP
will inform the employee, the
employee’s representative, if any, and
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the employer of any action taken. Where
an employer contests a claim within 30
days of the initial submittal and the
claim is later approved, OWCP will
notify the employer of the rationale for
approving the claim.
§ 10.120 May a claimant submit additional
evidence?
A claimant or a person acting on his
or her behalf may submit to OWCP at
any time any other evidence relevant to
the claim.
§ 10.121 What happens if OWCP needs
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 the burden of
proof, OWCP will inform the claimant
of the additional evidence needed. The
claimant will be allowed at least 30 days
to submit the evidence required. OWCP
is not required to notify the claimant a
second time if the evidence submitted
in response to its first request is not
sufficient to meet the burden of proof.
Decisions on Entitlement to Benefits
§ 10.125 How does OWCP determine
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 by
the employer, and the results of such
investigation as OWCP may deem
necessary.
(b) OWCP claims staff apply the law,
the regulations, and its procedures to
the facts as reported or obtained upon
investigation. They also apply decisions
of the Employees’ Compensation
Appeals Board and administrative
decisions of OWCP as set forth in FECA
Program Memoranda.
§ 10.126
What does the decision contain?
The decision shall contain findings of
fact and a statement of reasons. It is
accompanied by information about the
claimant’s appeal rights, which may
include the right to a hearing, a
reconsideration, and/or a review by the
Employees’ Compensation Appeals
Board. (See subpart G of this part.)
§ 10.127
To whom is the decision sent?
A copy of the decision shall be mailed
to the employee’s last known address. If
the employee has a designated
representative before OWCP, a copy of
the decision will also be mailed to the
representative. A copy of the decision
will also be sent to the employer.
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Subpart C—Continuation of Pay
§ 10.200
What is continuation of pay?
(a) For most employees who sustain a
traumatic injury, the FECA provides
that the employer must continue the
employee’s regular pay during any
periods of resulting disability, up to a
maximum of 45 calendar days. This is
called continuation of pay, or COP. The
employer, not OWCP, pays COP. Unlike
wage loss benefits, COP is subject to
taxes and all other payroll deductions
that are made from regular income.
(b) The employer must continue the
pay of an employee, except for Postal
Service employees pursuant to 5 U.S.C.
8117 and as provided below in
paragraph (c) of this section, who is
eligible for COP, and may not require
the employee to use his or her own sick
or annual leave, unless the provisions of
§§ 10.200(c), 10.220, or 10.222 apply.
However, while continuing the
employee’s pay, the employer may
controvert the employee’s COP
entitlement pending a final
determination by OWCP. OWCP has the
exclusive authority to determine
questions of entitlement and all other
issues relating to COP.
(c) Postal Service employees are not
entitled to continuation of pay for the
first 3 days of temporary disability and
may use annual, sick or leave without
pay during that period, except that if the
disability exceeds 14 days or is followed
by permanent disability, the Postal
Service employee may have that leave
restored.
(d) The FECA excludes certain
persons from eligibility for COP. COP
cannot be authorized for members of
these excluded groups, which include
but are not limited to: Persons rendering
personal service to the United States
similar to the service of a civil officer or
employee of the United States, without
pay or for nominal pay; volunteers (for
instance, in the Civil Air Patrol and
Peace Corps); Job Corps and Youth
Conservation Corps enrollees;
individuals in work- study programs,
and grand or petit jurors (unless
otherwise Federal employees).
Eligibility for COP
§ 10.205 What conditions must be met to
receive COP?
(a) To be eligible for COP, a person
must:
(1) Have a ‘‘traumatic injury’’ as
defined at § 10.5(ee) which is job-related
and the cause of the disability, and/or
the cause of lost time due to the need
for medical examination and treatment;
(2) File Form CA–1 within 30 days of
the date of the injury (but if that form
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is not available, using another form
would not alone preclude receipt); and
(3) Begin losing time from work due
to the traumatic injury within 45 days
of the injury.
(b) OWCP may find that the employee
is not entitled to COP for other reasons
consistent with the statute (see
§ 10.220).
§ 10.206 May an employee who uses leave
after 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 of electing COP. The employee
can change the election between leave
and COP for prospective periods at any
point while eligibility for COP remains.
The employee may also change the
election for past periods and request
COP in lieu of leave already taken for
the same period. In either situation, the
following provisions apply:
(a) The request must be made to the
employer within one year of the date the
leave was used or the date of the written
approval of the claim by OWCP (if
written approval is issued), whichever
is later.
(b) Where the employee is otherwise
eligible, the agency shall restore leave
taken in lieu of any of the 45 COP days.
Where any of the 45 COP days remain
unused, the agency shall continue pay
prospectively.
(c) The use of leave may not be used
to delay or extend the 45-day COP
period or to otherwise affect the time
limitation as provided by 5 U.S.C. 8117.
Therefore, any leave used during the
period of eligibility counts towards the
45-day maximum entitlement to COP.
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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?
If the employee recovers from
disability and returns to work, then
becomes disabled again and stops work,
the employer shall pay any of the 45
days of entitlement to COP not used
during the initial period of disability
where:
(a) The employee completes Form
CA–2a and elects to receive regular pay;
(b) OWCP did not deny the original
claim for disability;
(c) The disability recurs and the
employee stops work within 45 days of
the time the employee first returned to
work following the initial period of
disability; and
(d) Pay has not been continued for the
entire 45 days.
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Responsibilities
Calculation of COP
§ 10.210 What are the employee’s
responsibilities in COP cases?
§ 10.215 How does OWCP compute the
number of days of COP used?
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 the following actions to
ensure continuing eligibility for COP.
The employee must:
(a) Complete and submit Form CA–1
to the employing agency as soon as
possible, but no later than 30 days from
the date the traumatic injury occurred.
(b) Ensure that medical evidence
supporting disability resulting from the
claimed traumatic injury, including a
statement as to when the employee can
return to his or her date of injury job,
is provided to the employer within 10
calendar days after filing the claim for
COP.
(c) Ensure that relevant medical
evidence is submitted to OWCP, and
cooperate with OWCP in developing the
claim.
(d) Ensure that the treating physician
specifies work limitations and provides
them to the employer and/or
representatives of OWCP.
(e) Provide to the treating physician a
description of any specific alternative
positions offered the employee, and
ensure that the treating physician
responds promptly to the employer and/
or OWCP, with an opinion as to whether
and how soon the employee could
perform that or any other specific
position.
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 on the day or shift of the
injury does not count toward COP.
(Instead, the agency must keep the
employee in a pay status for that
period);
(b) The first COP day is the first day
disability begins following the date of
injury (providing it is within the 45
days following the date of injury),
except where the injury occurs before
the beginning of the work day or shift,
in which case the date of injury is
charged to COP;
(c) Any part of a day or shift (except
for the day of the injury) counts as a full
day toward the 45 calendar day total;
(d) Regular days off are included if
COP has been used on the regular work
days immediately preceding or
following the regular day(s) off, and
medical evidence supports disability;
and
(e) Leave used during a period when
COP is otherwise payable is counted
toward the 45-day COP maximum as if
the employee had been in a COP status.
(f) For employees with part-time or
intermittent schedules, all calendar days
on which medical evidence indicates
disability are counted as COP days,
regardless of whether the employee was
or would have been scheduled to work
on those days. The rate at which COP
is paid for these employees is calculated
according to § 10.216(b).
§ 10.211 What are the employer’s
responsibilities in 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 care in
accordance with § 10.300. Failure to do
so may mean that OWCP will not
uphold any termination of COP by the
employer.
(b) Advise the employee of the right
to receive COP, and the need to elect
among COP, annual or sick leave or
leave without pay, for any period of
disability.
(c) Inform the employee of any
decision to controvert COP and/or
terminate pay, and the basis for doing
so.
(d) Complete Form CA–1 and transmit
it, along with all other available
pertinent information, (including the
basis for any controversion), to OWCP
within 10 working days after receiving
the completed form from the employee.
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§ 10.216 How is the pay rate for COP
calculated?
The employer shall calculate COP
using the period of time and the weekly
pay rate.
(a) The pay rate for COP purposes is
equal to the employee’s regular
‘‘weekly’’ pay (the average of the weekly
pay over the preceding 52 weeks).
(1) The pay rate excludes overtime
pay, but includes other applicable extra
pay except to the extent prohibited by
law.
(2) Changes in pay or salary (for
example, promotion, demotion, withingrade increases, termination of a
temporary detail, etc.) which would
have otherwise occurred during the 45day period are to be reflected in the
weekly pay determination.
(b) The weekly pay for COP purposes
is determined according to the following
formulas:
(1) For full or part-time workers
(permanent or temporary) who work the
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same number of hours each week of the
year (or of the appointment), the weekly
pay rate is the hourly pay rate (A) in
effect on the date of injury multiplied by
(×) the number of hours worked each
week (B): A × B = Weekly Pay Rate.
(2) For part-time workers (permanent
or temporary) who do not work the
same number of hours each week, but
who do work each week of the year (or
period of appointment), the weekly pay
rate is an average of the weekly
earnings, established by dividing (÷) the
total earnings (excluding overtime) from
the year immediately preceding the
injury (A) by the number of weeks (or
partial weeks) worked in that year (B):
A ÷ B = Weekly Pay Rate.
(3) For intermittent and seasonal
workers, whether permanent or
temporary, who do not work either the
same number of hours or every week of
the year (or period of appointment), the
weekly pay rate is the average weekly
earnings established by dividing (÷) the
total earnings during the full 12-month
period immediately preceding the date
of injury (excluding overtime) (A), by
the number of weeks (or partial weeks)
worked during that year (B) (that is, A
÷ B); or 150 times the average daily
wage earned in the employment during
the days employed within the full year
immediately preceding the date of
injury divided by 52 weeks, whichever
is greater.
§ 10.217 Is COP charged if the employee
continues 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 with
different duties with no loss in pay,
then COP is not chargeable. COP must
be paid and the days counted against
the 45 days authorized by law whenever
an actual reduction of pay results from
the injury, including a reduction of pay
for the employee’s normal
administrative workweek that results
from a change or diminution in his or
her duties following an injury. However,
this does not include a reduction of pay
that is due solely to an employer being
prohibited by law from paying extra pay
to an employee for work he or she does
not actually perform.
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Controversion and Termination of COP
§ 10.220 When is an employer not required
to 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:
(a) The disability was not caused by
a traumatic injury;
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(b) The employee is not a citizen of
the United States or Canada;
(c) No written claim was filed within
30 days from the date of injury;
(d) The injury was not reported until
after employment has been terminated;
(e) The injury occurred off the
employing agency’s premises and was
otherwise not within the performance of
official duties;
(f) The injury was caused by the
employee’s willful misconduct, intent to
injure or kill himself or herself or
another person, or was proximately
caused by intoxication by alcohol or
illegal drugs; or
(g) Work did not stop until more than
45 days following the injury.
§ 10.221 How is a claim for COP
controverted?
When the employer stops an
employee’s pay for one of the reasons
cited in § 10.220, the employer must
controvert the claim for COP on Form
CA–1, explaining in detail the basis for
the refusal. The final determination on
entitlement to COP always rests with
OWCP.
§ 10.222 When may an employer terminate
COP 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 is present:
(1) Medical evidence which on its
face supports disability due to a workrelated injury is not received within 10
calendar days after the claim is
submitted (unless the employer’s own
investigation shows disability to exist).
Where the medical evidence is later
provided, however, COP shall be
reinstated retroactive to the date of
termination;
(2) The medical evidence from the
treating physician shows that the
employee is not disabled from his or her
regular position;
(3) Medical evidence from the treating
physician shows that the employee is
not totally disabled, and the employee
refuses a written offer of a suitable
alternative position which is approved
by the attending physician. If OWCP
later determines that the position was
not suitable, OWCP will direct the
employer to grant the employee COP
retroactive to the termination date.
(4) The employee returns to work
with no loss of pay;
(5) The employee’s period of
employment expires or employment is
otherwise terminated (as established
prior to the date of injury);
(6) OWCP directs the employer to stop
COP; and/or
(7) COP has been paid for 45 calendar
days.
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(b) An employer may not interrupt or
stop COP to which the employee is
otherwise entitled because of a
disciplinary action, unless a preliminary
notice was issued to the employee
before the date of injury and the action
becomes final or otherwise takes effect
during the COP period.
(c) An employer cannot otherwise
stop COP unless it does so for one of the
reasons found in this section or
§ 10.220. Where an employer stops COP,
it must file a controversion with OWCP,
setting forth the basis on which it
terminated COP, no later than the
effective date of the termination.
§ 10.223 Are there other circumstances
under 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 OWCP, the right to COP is
suspended until the refusal or
obstruction ceases. COP already paid or
payable for the period of suspension is
forfeited. If already paid, the COP may
be charged to annual or sick leave or
considered an overpayment of pay
consistent with 5 U.S.C. 5584.
§ 10.224 What happens if OWCP finds that
the 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 have
the time charged to annual or sick leave,
or considered an overpayment of pay
under 5 U.S.C. 5584. The employer
must correct any deficiencies in COP as
directed by OWCP.
Subpart D—Medical and Related
Benefits
Emergency Medical Care
§ 10.300 What are the basic rules for
authorizing emergency medical care?
(a) When an employee sustains a
work-related traumatic injury that
requires medical examination, medical
treatment, or both, the employer shall
authorize such examination and/or
treatment by issuing a Form CA–16.
This form may be used for occupational
disease or illness only if the employer
has obtained prior permission from
OWCP.
(b) The employer shall issue Form
CA–16 within four hours of the claimed
injury. If the employer gives verbal
authorization for such care, he or she
should issue a Form CA–16 within 48
hours. The employer is not required to
issue a Form CA–16 more than one
week after the occurrence of the claimed
injury. The employer may not authorize
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examination or medical or other
treatment in any case that OWCP has
disallowed.
(c) Form CA–16 must contain the full
name and address of the qualified
physician or qualified medical facility
authorized to provide service. The
authorizing official must sign and date
the form and must state his or her title.
Form CA–16 authorizes treatment for 60
days from the date of injury, unless
OWCP terminates the authorization
sooner.
(d) The employer should advise the
employee of the right to his or her initial
choice of physician. The employer shall
allow the employee to select a qualified
physician, after advising him or her of
those physicians excluded under
subpart I of this part. The physician may
be in private practice, including a health
maintenance organization (HMO), or
employed by a Federal agency such as
the Department of the Army, Navy, Air
Force, or Veterans Affairs. Any qualified
physician may provide initial treatment
of a work-related injury in an
emergency. See also § 10.825(b).
as a result of that exposure. OWCP will
authorize preventive treatment only
under certain well-defined
circumstances (see § 10.313).
(b) Employers may be required under
other statutes or regulations to provide
their employees with medical testing
and/or other services in situations
described in paragraph (a) of this
section. For example, regulations issued
by the Occupational Safety and Health
Administration at 29 CFR chapter XVII
require employers to provide their
employees with medical consultations
and/or examinations when they either
exhibit symptoms consistent with
exposure to a workplace hazard, or
when an identifiable event such as a
spill, leak or explosion occurs and
results in the likelihood of exposure to
a workplace hazard. In addition, 5
U.S.C. 7901 authorizes employers to
establish health programs whose staff
can perform tests for workplace hazards,
counsel employees for exposure or
feared exposure to such hazards, and
provide health care screening and other
associated services.
§ 10.301 May the physician designated on
Form CA–16 refer the employee to another
medical specialist or medical facility?
§ 10.304 Are there any exceptions to these
procedures for obtaining medical care?
The physician designated on Form
CA–16 may refer the employee for
further examination, testing, or medical
care. OWCP will pay this physician or
facility’s bill on the authority of Form
CA–16. The employer should not issue
a second Form CA–16.
In cases involving emergencies or
unusual circumstances, OWCP may
authorize treatment in a manner other
than as stated in this subpart.
§ 10.302 Should the employer authorize
medical care if he or she doubts that the
injury occurred, or that it is work-related?
(a) The employee is entitled to receive
all medical services, appliances or
supplies which a qualified physician
prescribes or recommends and which
OWCP considers necessary to treat the
work-related injury. Billing for these
services is described in subpart I of this
part. The employee need not be disabled
to receive such treatment. If there is any
doubt as to whether a specific service,
appliance or supply is necessary to treat
the work-related injury, the employee
should consult OWCP prior to obtaining
it through the automated authorization
process described in § 10.800. OWCP
may also utilize the services of a field
nurse to facilitate and coordinate
medical care for the employee. OWCP
may contract with a specific provider or
providers to supply such services or
appliances, including durable medical
equipment and prescribed medications.
(b) Any qualified physician or
qualified hospital may provide such
services, appliances and supplies. Nonphysician providers such as physicians’
assistants, nurse practitioners and
physical therapists may also provide
authorized services for injured
If the employer doubts that the injury
occurred, or that it is work-related, he
or she should authorize medical care by
completing Form CA–16 and checking
block 6B of the form. If the medical and
factual evidence sent to OWCP shows
that the condition treated is not workrelated, OWCP will notify the employee,
the employer, and the physician or
hospital that OWCP will not authorize
payment for any further treatment.
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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?
(a) Simple exposure to a workplace
hazard, such as an infectious agent, does
not constitute a work-related injury
entitling an employee to medical
treatment under the FECA. The
employer therefore should not use a
Form CA–16 to authorize medical
testing for an employee who has merely
been exposed to a workplace hazard,
unless the employee has sustained an
identifiable injury or medical condition
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Medical Treatment and Related Issues
§ 10.310 What are the basic rules for
obtaining medical care?
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employees to the extent allowed by
applicable Federal and State law.
(c) Where OWCP has not contracted
for the provision of appliances or
supplies, only a supplier of durable
medical equipment, which is a provider
that is registered in Medicare’s Durable
Medical Equipment, Prosthetics,
Orthotics and Supplies Competitive
Bidding Process, may furnish such
appliances and supplies. OWCP may
apply a test of cost-effectiveness to
appliances and supplies, may offset the
cost of prior rental payments against a
future purchase price, and may provide
refurbished appliances where
appropriate.
§ 10.311 What are the special rules for 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 of physical and
related laboratory tests performed by or
required by a chiropractor to diagnose
such a subluxation are also payable.
(b) In accordance with 5 U.S.C.
8101(3), a diagnosis of spinal
‘‘subluxation as demonstrated by X-ray
to exist’’ must appear in the
chiropractor’s report before OWCP can
consider payment of a chiropractor’s
bill.
(c) A chiropractor may interpret his or
her x-rays to the same extent as any
other physician. To be given any weight,
the medical report must state that x-rays
support the finding of spinal
subluxation. OWCP will not necessarily
require submittal of the x-ray, or a
report of the x-ray, but the report must
be available for submittal on request.
(d) A chiropractor may also provide
services in the nature of physical
therapy under the direction of, and as
prescribed by, a qualified physician.
§ 10.312 What are the special rules for 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, a clinical psychologist may
not serve as a physician for conditions
that include a physical component
unless the applicable State law allows
clinical psychologists to treat physical
conditions. A clinical psychologist may
also perform testing, evaluation and
other services under the direction of a
qualified physician.
§ 10.313 Will OWCP pay for preventive
treatment?
The FECA does not authorize
payment for preventive measures such
as vaccines and inoculations, and in
general, preventive treatment may be a
responsibility of the employing agency
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under the provisions of 5 U.S.C. 7901
(see § 10.303). However, OWCP can
authorize treatment for the following
conditions, even though such treatment
is designed, in part, to prevent further
injury:
(a) Complications of preventive
measures which are provided or
sponsored by the agency, such as an
adverse reaction to prophylactic
immunization.
(b) Actual or probable exposure to a
known contaminant due to an injury,
thereby requiring disease-specific
measures against infection. Examples
include the provision of tetanus
antitoxin or booster toxoid injections for
puncture wounds; administration of
rabies vaccine for a bite from a rabid or
potentially rabid animal; or appropriate
measures where exposure to human
immunodeficiency virus (HIV) has
occurred.
(c) Conversion of tuberculin reaction
from negative to positive following
exposure to tuberculosis in the
performance of duty. In this situation,
the appropriate therapy may be
authorized.
(d) Where injury to one eye has
resulted in loss of vision, periodic
examination of the uninjured eye to
detect possible sympathetic
involvement of the uninjured eye at an
early stage.
sroberts on DSKD5P82C1PROD with PROPOSALS
§ 10.314 Will OWCP pay for the services of
an attendant?
Yes, OWCP will pay for the services
of an attendant where the need for such
services has been medically
documented. In the exercise of the
discretion afforded by 5 U.S.C. 8111(a),
the Director has determined that, except
where attendant service payments were
being made prior to January 4, 1999,
direct payments to the claimant to cover
such services will no longer be made.
Rather, the cost of providing attendant
services will be paid under section 8103
of the Act, and medical bills for these
services will be considered under
§ 10.801, so long as the personal care
services have been determined to be
medically necessary and are provided
by a home health aide, licensed
practical nurse, or similarly trained
individual, subject to requirements
specified by OWCP. By paying for the
services under section 8103, OWCP can
better determine whether the services
provided are necessary, and what type
of provider is most qualified to provide
adequate care to meet the needs of the
injured employee. In addition, a system
requiring the personal care provider to
submit a bill to OWCP, where the
amount billed will be subject to OWCP’s
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fee schedule, will result in greater fiscal
accountability.
§ 10.315 Will OWCP pay for transportation
to obtain medical treatment?
(a) The employee is entitled to
reimbursement of reasonable and
necessary expenses, including
transportation needed to obtain
authorized medical services, appliances
or supplies. To determine what is a
reasonable distance to travel, OWCP
will consider the availability of services,
the employee’s condition, and the
means of transportation. Generally, a
roundtrip distance of up to 100 miles is
considered a reasonable distance to
travel. Travel should be undertaken by
the shortest route, and if practical, by
public conveyance. If the medical
evidence shows that the employee is
unable to use these means of
transportation, OWCP may authorize
travel by taxi or special conveyance.
(b) For non-emergency medical
treatment, if roundtrip travel of more
than 100 miles is contemplated, or air
transportation or overnight
accommodations will be needed, the
employee must submit a written request
to OWCP for prior authorization with
information describing the
circumstances and necessity for such
travel expenses. OWCP will approve the
request if it determines that the travel
expenses are reasonable and necessary,
and are incident to obtaining authorized
medical services, appliances or
supplies. Requests for travel expenses
that are often approved include those
resulting from referrals to a specialist for
further medical treatment, and those
involving air transportation of an
employee who lives in a remote
geographical area with limited local
medical services.
(c) If a claimant disagrees with the
decision of OWCP that requested travel
expenses are either not reasonable or
necessary, or are not incident to
obtaining authorized medical services or
supplies, he or she may utilize the
appeals process described in subpart G
of this part.
(d) The standard form designated for
medical travel refund requests is Form
OWCP–957 and must be used to seek
reimbursement under this section. This
form can be obtained from OWCP.
§ 10.316 After selecting a treating
physician, may an employee choose to be
treated by another physician instead?
(a) When the physician originally
selected to provide treatment for a workrelated injury refers the employee to a
specialist for further medical care, the
employee need not consult OWCP for
approval. In all other instances,
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49619
however, the employee must submit a
written request to OWCP with his or her
reasons for desiring a change of
physician.
(b) OWCP will approve the request if
it determines that the reasons submitted
are sufficient. Requests that are often
approved include those for transfer of
care from a general practitioner to a
physician who specializes in treating
conditions like the work-related one, or
the need for a new physician when an
employee has moved. The employer
may not authorize a change of
physicians.
Directed Medical Examinations
§ 10.320 Can OWCP require an employee
to 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 as often and at
such times and places as OWCP
considers reasonably necessary. The
employee may have a qualified
physician, paid by him or her, present
at such examination. However, the
employee is not entitled to have anyone
else present at the examination unless
there is rationalized medical evidence
that establishes that someone else is
needed in the room or OWCP decides
that exceptional circumstances exist.
Where an employee requires an
accommodation, such as where a
hearing-impaired employee needs an
interpreter, the presence of an
interpreter will be allowed. Also, OWCP
may send a case file for second opinion
review where actual examination is not
needed, or where the employee is
deceased.
§ 10.321 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 more
probative value, OWCP will base its
determination of entitlement on that
medical conclusion (see § 10.502). A
difference in medical opinion sufficient
to be considered a conflict occurs when
two reports of virtually equal weight
and rationale reach opposing
conclusions (see James P. Roberts, 31
ECAB 1010 (1980)).
(b) If a conflict exists between the
medical opinion of the employee’s
physician and the medical opinion of
either a second opinion physician or an
OWCP medical adviser or consultant,
OWCP shall appoint a third physician to
make an examination (see § 10.502).
This is called a referee or impartial
examination. OWCP will select a
physician who is qualified in the
appropriate specialty and who has had
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no prior connection with the case. The
employee is not entitled to have anyone
present at the examination unless
OWCP decides that exceptional
circumstances exist. For example, where
a hearing-impaired employee needs an
interpreter, the presence of an
interpreter would be allowed. Also, a
case file may be sent for referee or
impartial medical review where there is
no need for an actual examination, or
where the employee is deceased.
§ 10.322 Who pays for second opinion and
referee examinations?
OWCP will pay second opinion and
referee medical specialists directly.
OWCP will reimburse the employee all
necessary and reasonable expenses
incident to such an examination,
including transportation costs and
actual wages lost for the time needed to
submit to an examination required by
OWCP.
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§ 10.323 What are the penalties for failing
to report for or obstructing a second
opinion or referee examination?
(a) If an employee refuses to submit to
or in any way obstructs an examination
required by OWCP, including testing
such as functional capacity
determinations conducted in connection
with an OWCP-directed medical
examination, his or her right to
compensation under the FECA is
suspended under 5 U.S.C. 8123(d) until
such refusal or obstruction stops. The
action of the employee’s representative
is considered to be the action of the
employee for purposes of this section.
The employee will forfeit compensation
otherwise paid or payable under the
FECA for the period of the refusal or
obstruction, and any compensation
already paid for that period will be
declared an overpayment and will be
subject to recovery pursuant to 5 U.S.C.
8129.
(b) If the employee does not report for
an OWCP-directed examination or in
any way obstructs this examination, he
or she may provide an explanation to
OWCP within 14 days. If this
explanation does not establish good
cause for the employee’s actions,
entitlement to compensation will be
suspended in accordance with 5 U.S.C.
8123(d). Should the employee
subsequently agree to attend the
examination or cease the obstruction (as
expressed in writing or by telephone
documented on Form CA–110), OWCP
will restore any periodic benefits to
which the employee is entitled when
the employee actually reports for and
cooperates with the examination.
Payment is retroactive to the date the
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employee agreed to attend or cease
obstruction of the examination.
§ 10.324 May an employer require an
employee to undergo a physical
examination in connection with a workrelated injury?
The employer may have authority
independent of the FECA to require the
employee to undergo a medical
examination to determine whether he or
she meets the medical requirements of
the position held or can perform the
duties of that position. Nothing in the
FECA or in this part affects such
authority. However, no agency-required
examination or related activity shall
interfere with the employee’s initial
choice of physician or the provision of
any authorized examination or
treatment, including the issuance of
Form CA–16.
Medical Reports
§ 10.330 What are the requirements for
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 and
treatment;
(b) History given by the employee;
(c) Physical findings;
(d) Results of diagnostic tests;
(e) Diagnosis;
(f) Course of treatment;
(g) A description of any other
conditions found but not due to the
claimed injury;
(h) The treatment given or
recommended for the claimed injury;
(i) The physician’s opinion, with
medical reasons, as to causal
relationship between the diagnosed
condition(s) and the factors or
conditions of the employment;
(j) The extent of disability affecting
the employee’s ability to work due to
the injury;
(k) The prognosis for recovery; and
(l) All other material findings.
§ 10.331 How and when should the
medical report be submitted?
(a) Form CA–16 may be used for the
initial medical report; Form CA–20 may
be used for the initial report and for
subsequent reports; and Form CA–20a
may be used where continued
compensation is claimed. Use of
medical report forms is not required,
however. The report may also be made
in narrative form on the physician’s
letterhead stationery. The report should
bear the physician’s signature or
signature stamp. OWCP may require an
original signature on the report.
(b) The report shall be submitted
directly to OWCP as soon as possible
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after medical examination or treatment
is received, either by the employee or
the physician. (See also § 10.210.) The
employer may request a copy of the
report from OWCP. The employer
should use Form CA–17 to obtain
interim reports concerning the duty
status of an employee with a disabling
injury.
§ 10.332 What additional medical
information will OWCP require to support
continuing payment of benefits?
In all cases of serious injury or
disease, especially those requiring
hospital treatment or prolonged care,
OWCP will request detailed narrative
reports from the attending physician at
periodic intervals. The physician will be
asked to describe continuing medical
treatment for the condition accepted by
OWCP, a prognosis, a description of
work limitations, if any, and the
physician’s opinion as to the continuing
causal relationship between the
employee’s condition and factors of his
or her Federal employment.
§ 10.333 What additional medical
information will 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 the function
of the organ or member, in accordance
with the American Medical
Association’s Guides to the Evaluation
of Permanent Impairment as described
in § 10.404. These measurements may
include: the actual degree of loss of
active or passive motion or deformity;
the amount of atrophy; the decrease, if
any, in strength; the disturbance of
sensation; pain due to nerve
impairment; the diagnosis of the
condition; and functional impairment
ratings.
Medical Bills
§ 10.335
How are medical bills submitted?
Usually, medical providers submit
bills directly to OWCP or to a bill
processing agent designated by OWCP.
The rules for submitting and paying
bills are stated in subpart I of this part.
An employee claiming reimbursement
of medical expenses should submit an
itemized bill as described in § 10.802.
§ 10.336 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 was incurred, or by the end of
the calendar year after the year when
OWCP first accepted the claim as
compensable, whichever is later.
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§ 10.337 If an employee is only partially
reimbursed 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 the amounts
payable for many services (see § 10.805).
The employee may be only partially
reimbursed for medical expenses
because the amount he or she paid to
the medical provider for a service
exceeds the maximum allowable charge
set by the OWCP fee schedule.
(b) If this happens, OWCP shall advise
the employee of the maximum
allowable charge for the service in
question and of his or her responsibility
to ask the provider to refund to the
employee, or credit to the employee’s
account, the amount he or she paid
which exceeds the maximum allowable
charge. The provider may request
reconsideration of the fee determination
as set forth in §§ 10.812 and 10.813.
(c) If the provider does not refund to
the employee or credit to his or her
account the amount of money paid in
excess of the charge which OWCP
allows, the employee should submit
documentation of the attempt to obtain
such refund or credit to OWCP. OWCP
may make reasonable reimbursement to
the employee after reviewing the facts
and circumstances of the case.
Subpart E—Compensation and Related
Benefits
Compensation for Disability and
Impairment
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§ 10.400
What is total disability?
(a) Permanent total disability is
presumed to result from the loss of use
of both hands, both arms, both feet, or
both legs, or the loss of sight of both
eyes. 5 U.S.C. 8105(b). However, the
presumption of permanent total
disability as a result of such loss may be
rebutted by evidence to the contrary,
such as evidence of continued ability to
work and to earn wages despite the loss.
(b) Temporary total disability is
defined as the inability to return to the
position held at the time of injury or
earn equivalent wages, or to perform
other gainful employment, due to the
work-related injury. Except as presumed
under paragraph (a) of this section, an
employee’s disability status is always
considered temporary pending return to
work.
§ 10.401 When and how is compensation
for total disability paid?
(a) Compensation is payable when an
employee starts to lose pay if the injury
causes permanent disability or if pay
loss continues for more than 14 calendar
days. Otherwise, compensation is
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payable on the fourth day after pay
stops pursuant to 5 U.S.C. 8117.
Compensation may not be paid while an
injured employee is in a continuation of
pay status or receives pay for leave or,
for Postal Service employees, for the
first three days of temporary disability,
except for medical or vocational
rehabilitation benefits.
(b) Compensation for total disability is
payable at the rate of 662⁄3 percent of the
pay rate if the employee has no
dependents, or 75 percent of the pay
rate if the employee has at least one
dependent. (‘‘Dependents’’ are defined at
5 U.S.C. 8110(a).)
§ 10.402
What is partial disability?
An injured employee who cannot
return to the position held at the time
of injury (or earn equivalent wages) due
to the work-related injury, but who is
not totally disabled for all gainful
employment, is considered to be
partially disabled.
§ 10.403 When and how is compensation
for 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 and reasonably
represent his or her wage-earning
capacity, those earnings will form the
basis for payment of compensation for
partial disability. (See §§ 10.500 through
10.521 concerning return to work.) If the
employee’s actual earnings do not fairly
and reasonably represent his or her
wage-earning capacity, or if the
employee has no actual earnings, OWCP
uses the factors stated in 5 U.S.C. 8115
to select a position which represents his
or her wage-earning capacity, which
include the nature of the injury, the
degree of physical impairment, the
usual employment, the age of the
employee, the employee’s qualifications
for other employment and the
availability of suitable employment.
However, OWCP will not secure
employment for the employee in the
position selected for establishing a
wage-earning capacity.
(b) Compensation for partial disability
is payable as a percentage of the
difference between the employee’s pay
rate for compensation purposes and the
employee’s wage-earning capacity. The
percentage is 662⁄3 percent of this
difference if the employee has no
dependents, or 75 percent of this
difference if the employee has at least
one dependent.
(c) The formula which OWCP uses to
compute the compensation payable for
partial disability employs the following
terms: Pay rate for compensation
purposes, which is defined in § 10.5(s)
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of this part; current pay rate, which
means the salary or wages for the job
held at the time of injury at the time of
the determination; and earnings, which
means the employee’s actual earnings,
or the salary or pay rate of the position
selected by OWCP as representing the
employee’s wage-earning capacity.
(d) The employee’s wage-earning
capacity in terms of percentage is
computed by dividing the employee’s
earnings by the current pay rate. The
comparison of earnings and ‘‘current’’
pay rate for the job held at the time of
injury need not be made as of the
beginning of partial disability. OWCP
may use any convenient date for making
the comparison as long as both wage
rates are in effect on the date used for
comparison.
(e) The employee’s wage-earning
capacity in terms of dollars is computed
by first multiplying the pay rate for
compensation purposes by the
percentage of wage-earning capacity.
The resulting dollar amount is then
subtracted from the pay rate for
compensation purposes to obtain the
employee’s loss of wage-earning
capacity.
§ 10.404 When and how is compensation
for 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 of the
body. Such loss or loss of use is known
as permanent impairment.
Compensation for proportionate periods
of time is payable for partial loss or loss
of use of each member, organ or
function. 5 U.S.C. 8107(b)(19). OWCP
evaluates the degree of impairment to
schedule members, organs and
functions as defined in 5 U.S.C. 8107
according to the standards set forth in
the specified (by OWCP) edition of the
American Medical Association’s Guides
to the Evaluation of Permanent
Impairment.
(a) 5 U.S.C. 8107(c) provides
compensation for loss to the following
list of schedule members:
Member
Arm ...................................................
Leg ....................................................
Hand .................................................
Foot ...................................................
Eye ....................................................
Thumb ...............................................
First Finger lost .................................
Great toe ...........................................
Second finger ...................................
Third finger .......................................
Toe other than great toe ..................
Fourth finger .....................................
Hearing, one ear ...............................
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312
288
244
205
160
75
46
38
30
25
16
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Member
Weeks
Hearing, both ears ............................
200
(b) Pursuant to the authority provided
by 5 U.S.C. 8107(c)(22), the Secretary
has added the following organs to the
compensation schedule for injuries that
were sustained on or after September 7,
1974, except that a schedule award for
the skin may be paid for injuries on or
after September 11, 2001:
Member
Weeks
Breast (one) ......................................
Kidney (one) .....................................
Larynx ...............................................
Lung (one) ........................................
Penis .................................................
Testicle (one) ....................................
Tongue ..............................................
Ovary (one) .......................................
Uterus/cervix and vulva/vagina ........
Skin ...................................................
52
156
160
156
205
52
160
52
205
205
(c) Compensation for schedule awards
is payable at 662⁄3 percent of the
employee’s pay, or 75 percent of the pay
when the employee has at least one
dependent.
(d) The period of compensation
payable under 5 U.S.C. 8107(c) shall be
reduced by the period of compensation
paid or payable under the schedule for
an earlier injury if:
(1) Compensation in both cases is for
impairment of the same member or
function or different parts of the same
member or function, or for
disfigurement; and
(2) OWCP finds that compensation
payable for the later impairment in
whole or in part would duplicate the
compensation payable for the preexisting impairment.
(e) Compensation not to exceed
$3,500 may be paid for serious
disfigurement of the face, head or neck
which is likely to handicap a person in
securing or maintaining employment.
Under 5 U.S.C. 8107(21), a
disfigurement award may be paid
concurrently with schedule awards.
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§ 10.405 Who is considered a dependent in
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 is incapable of self-support; a
student, until he or she reaches 23 years
of age or completes four years of school
beyond the high school level; or a
wholly dependent parent.
(b) Augmented compensation payable
for an unmarried child, which would
otherwise terminate when the child
reached the age of 18, may be continued
while the child is a student as defined
in 5 U.S.C. 8101(17).
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§ 10.406 What are the maximum and
minimum 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 of grade 15 of the General
Schedule. (Basic monthly pay does not
include locality adjustments.) However,
this limit does not apply to disability
sustained in the performance of duty
which was due to an assault which
occurred during an attempted
assassination of a Federal official
described under 18 U.S.C. 351(a) or
1751(a).
(b) Compensation for total disability
may not be less than 75 percent of the
basic monthly pay of the first step of
grade 2 of the General Schedule or
actual pay, whichever is less. (Basic
monthly pay does not include locality
adjustments.)
Compensation for Death
§ 10.410 Who is entitled to compensation
in case of death, and what are the rates of
compensation payable in death cases?
(a) Pursuant to 5 U.S.C. 8133, benefits
may be paid to eligible dependents of an
employee whose death results from an
injury sustained in the performance of
duty. This benefit is separate and
distinct from a death gratuity benefit
under 5 U.S.C. 8102a and subpart J of
these regulations.
(b) If there is no child entitled to
compensation, the employee’s surviving
spouse will receive compensation equal
to 50 percent of the employee’s monthly
pay until death or remarriage before
reaching age 55. Upon remarriage, the
surviving spouse will be paid a lump
sum equal to 24 times the monthly
compensation payment (excluding
compensation payable on account of
another individual) to which the
surviving spouse was entitled
immediately before the remarriage. If
remarriage occurs at age 55 or older, the
lump-sum payment will not be paid and
compensation will continue until death.
(c) If there is a child entitled to
compensation, the compensation for the
surviving spouse will equal 45 percent
of the employee’s monthly pay plus 15
percent for each child, but the total
percentage may not exceed 75 percent.
(d) If there is a child entitled to
compensation and no surviving spouse,
compensation for one child will equal
40 percent of the employee’s monthly
pay. Fifteen percent will be awarded for
each additional child, not to exceed 75
percent, the total amount to be shared
equally among all children.
(e) If there is no child or surviving
spouse entitled to compensation, the
parents will receive compensation equal
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to 25 percent of the employee’s monthly
pay if one parent was wholly dependent
on the employee at the time of death
and the other was not dependent to any
extent, or 20 percent each if both were
wholly dependent on the employee, or
a proportionate amount in the discretion
of the Director if one or both were
partially dependent on the employee. If
there is a child or surviving spouse
entitled to compensation, the parents
will receive so much of the
compensation described in the
preceding sentence as, when added to
the total percentages payable to the
surviving spouse and children, will not
exceed a total of 75 percent of the
employee’s monthly pay.
(f) If there is no child, surviving
spouse or dependent parent entitled to
compensation, the brothers, sisters,
grandparents and grandchildren will
receive compensation equal to 20
percent of the employee’s monthly pay
to such dependent if one was wholly
dependent on the employee at the time
of death; or 30 percent if more than one
was wholly dependent, divided among
such dependents equally; or 10 percent
if no one was wholly dependent but one
or more was partly dependent, divided
among such dependents equally. If there
is a child, surviving spouse or
dependent parent entitled to
compensation, the brothers, sisters,
grandparents and grandchildren will
receive so much of the compensation
described in the preceding sentence as,
when added to the total percentages
payable to the children, surviving
spouse and dependent parents, will not
exceed a total of 75 percent of the
employee’s monthly pay.
(g) A child, brother, sister or
grandchild may be entitled to receive
death benefits until death, marriage, or
reaching age 18. Regarding entitlement
after reaching age 18, refer to § 10.417.
§ 10.411 What are the maximum and
minimum 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 grade 15 of the General
Schedule, except that compensation
may exceed the employee’s basic
monthly pay if such excess is created by
authorized cost-of-living increases.
(Basic monthly pay does not include
locality adjustments.) However, the
maximum limit does not apply when
the death occurred during an
assassination of a Federal official
described under 18 U.S.C. 351(a) or 18
U.S.C. 1751(a).
(b) Compensation for death is
computed on a minimum pay rate equal
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to the basic monthly pay of an employee
at the first step of grade 2 of the General
Schedule. (Basic monthly pay does not
include locality adjustments.)
§ 10.412 Will OWCP pay the costs 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 within the United
States and the employee dies outside
the United States, or away from home or
the official duty station, an additional
amount may be paid for transporting the
remains to the employee’s home as set
forth in 5 U.S.C. 8134. An additional
amount of $200 is paid to the personal
representative of the decedent for
reimbursement of the costs of
terminating the decedent’s status as an
employee of the United States in
accordance with 5 U.S.C. 8133.
§ 10.413 May a schedule award be paid
after an employee’s death?
For a schedule award to be paid
following the death of an employee, the
employee must have filed a valid claim
specifically for a schedule award prior
to death; in addition, the employee must
have died from a cause other than the
injury before the end of the period
specified in the schedule. The balance
of the schedule award may be paid to
an employee’s survivors pursuant to the
proportions and order of precedence
described in 5 U.S.C. 8109.
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§ 10.414 What reports of dependents are
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 each
year on Form CA–12. The report
requires the beneficiary to note changes
in marital status and dependents. If the
beneficiary fails to submit the form (or
an equivalent written statement) within
30 days of the date of request, OWCP
shall suspend compensation until the
requested form or equivalent written
statement is received. The suspension
will include compensation payable for
or on behalf of another person (for
example, compensation payable to a
widow on behalf of a child). When the
form or statement is received,
compensation will be reinstated at the
appropriate rate retroactive to the date
of suspension, provided the beneficiary
is entitled to such compensation.
§ 10.415 What must a beneficiary do 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). A beneficiary in a claim for
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death benefits should promptly notify
OWCP of any event which would affect
his or her entitlement to continued
compensation. The terms ‘‘marriage’’
and ‘‘remarriage’’ include common-law
marriage as recognized and defined by
State law in the State where the
beneficiary resides. If a beneficiary, or
someone acting on his or her behalf,
receives a check or electronic payment
which includes payment of
compensation for any period after the
date when entitlement ended, he or she
must promptly return such funds to
OWCP.
§ 10.416 How does a change in the number
of beneficiaries affect the amount of
compensation paid to the other
beneficiaries?
If compensation to a beneficiary is
terminated, the amount of compensation
payable to one or more of the remaining
beneficiaries may be reapportioned.
Similarly, the birth of a posthumous
child may result in a reapportionment of
the amount of compensation payable to
other beneficiaries. The parent, or
someone acting on the child’s behalf,
shall promptly notify OWCP of the birth
and submit a copy of the birth
certificate.
§ 10.417 What reports are needed when
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 the
person reaches 18 years of age, shall be
continued if and for so long as he or she
is not married and is either a student as
defined in 5 U.S.C. 8101(17), or
physically or mentally incapable of selfsupport.
(b) At least once each year, OWCP
will ask a beneficiary receiving
compensation based on the student
status of a dependent to provide proof
of continuing entitlement to such
compensation, including certification of
school enrollment. The beneficiary is
required to report any changes to
student status in the interim.
(c) Likewise, at least once each year
unless otherwise provided in paragraph
(d) of this section, OWCP will ask a
beneficiary or legal guardian receiving
compensation based on a dependent’s
physical or mental inability to support
himself or herself to submit a medical
report verifying that the dependent’s
medical condition persists and that it
continues to preclude self-support. If
there is a change in that condition, the
beneficiary or legal guardian is required
to immediately report that change to
OWCP.
(d) In the case of a dependent
incapable of self support due to that
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dependant’s physical or mental
disability where the status of that
dependent is unlikely to change, a
beneficiary or legal guardian may
establish the permanency of that
condition by submitting a well
rationalized medical report which
describes that condition and the
ongoing prognosis of that condition. If
the permanency of that condition is
established by such a report, OWCP will
not seek further information regarding
that condition; however, if there is a
change in that condition, the beneficiary
or legal guardian is required to
immediately report that change to
OWCP.
Adjustments to Compensation
§ 10.420 How are cost-of-living
adjustments applied?
(a) In cases of disability, a beneficiary
is eligible for cost-of-living adjustments
under 5 U.S.C. 8146a where injuryrelated disability began more than one
year prior to the date the cost-of-living
adjustment took effect. The employee’s
use of continuation of pay as provided
by 5 U.S.C. 8118, or of sick or annual
leave, during any part of the period of
disability does not affect the
computation of the one-year period.
(b) Where an injury does not result in
disability but compensation is payable
for permanent impairment of a covered
member, organ or function of the body,
a beneficiary is eligible for cost-of-living
adjustments under 5 U.S.C. 8146a where
the award for such impairment began
more than one year prior to the date the
cost-of-living adjustment took effect.
(c) In cases of recurrence of disability,
where the pay rate for compensation
purposes is the pay rate at the time
disability recurs, a beneficiary is eligible
for cost-of-living adjustments under 5
U.S.C. 8146a where the effective date of
that pay rate began more than one year
prior to the date the cost-of living
adjustment took effect.
(d) In cases of death, entitlement to
cost-of-living adjustments under 5
U.S.C. 8146a begins with the first such
adjustment occurring more than one
year after the date of death. However, if
the death was preceded by a period of
injury-related disability, compensation
payable to the survivors will be
increased by the same percentages as
the cost-of-living adjustments paid or
payable to the deceased employee for
the period of disability, as well as by
subsequent cost-of-living adjustments to
which the survivors would otherwise be
entitled.
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§ 10.421 May a beneficiary receive other
kinds of payments from the Federal
Government concurrently with
compensation?
(a) 5 U.S.C. 8116(a) provides that a
beneficiary may not receive wage-loss
compensation concurrently with a
Federal retirement or survivor annuity.
The beneficiary must elect the benefit
that he or she wishes to receive, and the
election, once made, is revocable.
(b) An employee may receive
compensation concurrently with
military retired pay, retirement pay,
retainer pay or equivalent pay for
service in the Armed Forces or other
uniformed services.
(c) An employee may not receive
compensation for total disability
concurrently with severance pay or
separation pay. However, an employee
may concurrently receive compensation
for partial disability or permanent
impairment to a schedule member,
organ or function with severance pay or
separation pay.
(d) Pursuant to 5 U.S.C. 8116(d), a
beneficiary may receive compensation
under the FECA for either the death or
disability of an employee concurrently
with benefits under title II of the Social
Security Act on account of the age or
death of such employee. However, this
provision of the FECA also requires
OWCP to reduce the amount of any such
compensation by the amount of any
Social Security Act benefits that are
attributable to the Federal service of the
employee.
(e) To determine the employee’s
entitlement to compensation, OWCP
may require an employee to submit an
affidavit or statement as to the receipt of
any federally funded or federally
assisted benefits. If an employee fails to
submit such affidavit or statement
within 30 days of the date of the
request, his or her right to compensation
shall be suspended until such time as
the requested affidavit or statement is
received. At that time, compensation
will be reinstated retroactive to the date
of suspension provided the employee is
entitled to such compensation.
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§ 10.422 May compensation payments be
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
entitled to wage-loss benefits (that is,
those payable under 5 U.S.C. 8105 and
8106). Therefore, when OWCP receives
requests for lump-sum payments for
wage-loss benefits, OWCP will not
exercise further discretion in the matter.
This determination is based on several
factors, including:
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(1) The purpose of the FECA, which
is to replace lost wages;
(2) The prudence of providing wageloss benefits on a regular, recurring
basis; and
(3) The high cost of the long-term
borrowing that is needed to pay out
large lump sums.
(b) However, a lump-sum payment
may be made to an employee entitled to
a schedule award under 5 U.S.C. 8107
where OWCP determines that such a
payment is in the employee’s best
interest. Lump-sum payments of
schedule awards generally will be
considered in the employee’s best
interest only where the employee does
not rely upon compensation payments
as a substitute for lost wages (that is, the
employee is working or is receiving
annuity payments). An employee
possesses no absolute right to a lumpsum payment of benefits payable under
5 U.S.C. 8107.
(c) Lump-sum payments to surviving
spouses are addressed in 5 U.S.C.
8135(b); payments to beneficiaries
under 5 U.S.C. 8137 payable as a lump
sum pursuant to 5 U.S.C. 8135 are
addressed in part 25 of this title.
§ 10.423 May compensation payments be
assigned to, or attached by, creditors?
(a) As a general rule, compensation
and claims for compensation are exempt
from the claims of private creditors.
Further, any attempt by a FECA
beneficiary to assign his or her claim is
null and void. However, pursuant to
provisions of the Social Security Act, 42
U.S.C. 659, and regulations issued by
the Office of Personnel Management
(OPM) at 5 CFR part 581, FECA benefits,
including survivor’s benefits, may be
garnished to collect overdue alimony
and child support payments.
(b) Garnishment for child support and
alimony may be requested by providing
a copy of the State agency or court order
to the district office handling the FECA
claim.
§ 10.424 May someone other than the
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 a
mental or physical disability, or because
of legal incompetence, or because he or
she is under 18 years of age. In this
situation, absent the appointment of a
guardian or other party to manage the
financial affairs of the claimant by a
court or administrative body authorized
to do so, OWCP in its sole discretion
may approve a person to serve as the
representative payee for funds due the
beneficiary. Where a guardian or other
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party has been appointed by a court or
administrative body authorized to do so
to manage the financial affairs of the
claimant, OWCP will recognize that
individual as the representative payee.
§ 10.425 May compensation be claimed for
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
employing agency. Forms CA–7a and
CA–7b are used for this purpose. Leave
donated to an employee by an
employing agency leave bank is not
restorable leave.
Overpayments
§ 10.430 How does OWCP notify an
individual 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 clear indication of
the period for which payment is being
made. A form is sent to the recipient
with each supplemental check which
states the date and amount of the
payment and the period for which
payment is being made. For payments
sent by electronic funds transfer (EFT),
a notification of the date and amount of
payment appears on the statement from
the recipient’s financial institution.
(b) By these means, OWCP puts the
recipient on notice that a payment was
made and the amount of the payment.
If the amount received differs from the
amount indicated on the written notice
or bank statement, the recipient is
responsible for notifying OWCP of the
difference. Absent affirmative evidence
to the contrary, the beneficiary will be
presumed to have received the notice of
payment, whether mailed or transmitted
electronically. For EFT payments,
OWCP is entitled to presume receipt
and acceptance of that payment once a
recipient has had an opportunity to
receive a statement from their financial
institution.
§ 10.431 What does OWCP do when an
overpayment is identified?
Before seeking to recover an
overpayment or adjust benefits, OWCP
will advise the beneficiary in writing
that:
(a) The overpayment exists, and the
amount of overpayment;
(b) A preliminary finding shows
either that the individual was or was not
at fault in the creation of the
overpayment;
(c) He or she has the right to inspect
and copy Government records relating
to the overpayment; and
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(d) He or she has the right to present
evidence which challenges the fact or
amount of the overpayment, and/or
challenges the preliminary finding that
he or she was at fault in the creation of
the overpayment. He or she may also
request that recovery of the
overpayment be waived.
§ 10.432 How can an individual present
evidence to OWCP in response to a
preliminary notice of an overpayment?
The individual may present this
evidence to OWCP in writing or at a prerecoupment hearing. The evidence must
be presented or the hearing requested
within 30 days of the date of the written
notice of overpayment. Failure to
request the hearing within this 30-day
time period shall constitute a waiver of
that right.
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§ 10.433 Under what circumstances can
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 or creating the overpayment.
Each recipient of compensation benefits
is responsible for taking all reasonable
measures to ensure that payments he or
she receives from OWCP are proper. The
recipient must show good faith and
exercise a high degree of care in regard
to receipt of their benefits. Such care
includes reporting events which may
affect entitlement to or the amount of
benefits, including reviewing their
accounts and related statements
(including electronic statements and
records from their financial institutions
involving EFT payments). A recipient
who has done any of the following will
be found to be at fault with respect to
creating an overpayment:
(1) Made an incorrect statement as to
a material fact which he or she knew or
should have known to be incorrect; or
(2) Failed to provide information
which he or she knew or should have
known to be material; or
(3) Accepted a payment which the
recipient knew or should have known to
be incorrect. (This provision applies
only to the overpaid individual.)
(b) Whether or not OWCP determines
that an individual was at fault with
respect to the creation of an
overpayment depends on the
circumstances surrounding the
overpayment. The degree of care
expected may vary with the complexity
of those circumstances and the
individual’s capacity to realize that he
or she is being overpaid.
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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?
If OWCP finds that the recipient of an
overpayment was not at fault,
repayment will still be required unless:
(a) Adjustment or recovery of the
overpayment would defeat the purpose
of the FECA (see § 10.436), or
(b) Adjustment or recovery of the
overpayment would be against equity
and good conscience (see § 10.437).
§ 10.435 Is an individual responsible for 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 the overpayment may have resulted
from an error by another Government
agency, does not by itself relieve the
individual who received the
overpayment from liability for
repayment if the individual also was at
fault in accepting the overpayment.
(b) However, OWCP may find that the
individual was not at fault if failure to
report an event affecting compensation
benefits, or acceptance of an incorrect
payment, occurred because:
(1) The individual relied on
misinformation given in writing by
OWCP (or by another Government
agency which he or she had reason to
believe was connected with the
administration of benefits) as to the
interpretation of a pertinent provision of
the FECA or its regulations; or
(2) OWCP erred in calculating cost-ofliving increases, schedule award length
and/or percentage of impairment, or loss
of wage-earning capacity.
§ 10.436 Under what circumstances would
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 a
currently or formerly entitled
beneficiary because:
(a) The beneficiary from whom OWCP
seeks recovery needs substantially all of
his or her current income (including
compensation benefits) to meet current
ordinary and necessary living expenses;
and
(b) The beneficiary’s assets do not
exceed a specified amount as
determined by OWCP from data
furnished by the Bureau of Labor
Statistics. A higher amount is specified
for a beneficiary with one or more
dependents.
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§ 10.437 Under what circumstances would
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 any individual
who received an overpayment would
experience severe financial hardship in
attempting to repay the debt.
(b) Recovery of an overpayment is
also considered to be against equity and
good conscience when any individual,
in reliance on such payments or on
notice that such payments would be
made, gives up a valuable right or
changes his or her position for the
worse. In making such a decision,
OWCP does not consider the
individual’s current ability to repay the
overpayment.
(1) To establish that a valuable right
has been relinquished, it must be shown
that the right was in fact valuable, that
it cannot be regained, and that the
action was based chiefly or solely in
reliance on the payments or on the
notice of payment. Donations to
charitable causes or gratuitous transfers
of funds to other individuals are not
considered relinquishments of valuable
rights.
(2) To establish that an individual’s
position has changed for the worse, it
must be shown that the decision made
would not otherwise have been made
but for the receipt of benefits, and that
this decision resulted in a loss.
§ 10.438 Can OWCP require the individual
who received the overpayment to submit
additional financial information?
(a) The individual who received the
overpayment is responsible for
providing information about income,
expenses and assets as specified by
OWCP. This information is needed to
determine whether or not recovery of an
overpayment would defeat the purpose
of the FECA, or be against equity and
good conscience. This information will
also be used to determine the repayment
schedule, if necessary.
(b) Failure to submit the requested
information within 30 days of the
request shall result in denial of waiver,
and no further request for waiver shall
be considered until the requested
information is furnished.
§ 10.439 What is addressed at a prerecoupment 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
hearing will thus fulfill OWCP’s
obligation to provide pre-recoupment
rights and a hearing under 5 U.S.C.
8124(b). Pre-recoupment hearings shall
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be conducted in exactly the same
manner as provided in § 10.615 through
§ 10.622.
§ 10.440 How does OWCP communicate
its 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 whom
recovery is sought; his or her
representative, if any; and the
employing agency.
(b) The only review of a final decision
concerning an overpayment is to the
Employees’ Compensation Appeals
Board. The provisions of 5 U.S.C.
8124(b) (concerning hearings) and 5
U.S.C. 8128(a) (concerning
reconsiderations) do not apply to such
a decision. The pendency of an appeal
with ECAB has no effect on the finality
of the order being appealed; in the event
ECAB reverses the final overpayment
decision, any monies collected will be
restored to the beneficiary.
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§ 10.441
How are overpayments collected?
(a) When an overpayment has been
made to an individual who is entitled to
further payments, the individual shall
refund to OWCP the amount of the
overpayment as soon as the error is
discovered or his or her attention is
called to same. If no refund is made,
OWCP shall decrease later payments of
compensation, taking into account the
probable extent of future payments, the
rate of compensation, the financial
circumstances of the individual, and
any other relevant factors, so as to
minimize any hardship. Should the
individual die before collection has
been completed, collection shall be
made by decreasing later payments, if
any, payable under the FECA with
respect to the individual’s death. If no
further benefits are payable with respect
to the individual’s death, OWCP may
also file a claim with the estate of the
individual or seek repayment of the
overpayment through other means
including referral of the debt to the
Treasury Department.
(b) When an overpayment has been
made to an individual who is not
entitled to further payments, the
individual shall refund to OWCP the
amount of the overpayment as soon as
the error is discovered or his or her
attention is called to same. The
overpayment is subject to the provisions
of the Federal Claims Collection Act of
1966 (as amended) and may be reported
to the Internal Revenue Service as
income. If the individual fails to make
such refund, OWCP may recover the
same through any available means,
including offset of salary, annuity
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benefits, or other Federal payments,
including tax refunds as authorized by
the Tax Refund Offset Program, or
referral of the debt to a collection
agency or to the Department of Justice.
Subpart F—Continuing Benefits
Rules and Evidence
§ 10.500 What are the basic rules
governing continuing receipt of
compensation benefits and return to work?
(a) Benefits are available only while
the effects of a work-related condition
continue. Compensation for wage loss
due to disability is available only for
any periods during which an
employee’s work-related medical
condition prevents him or her from
earning the wages earned before the
work-related injury. If the evidence
establishes that light duty within an
employee’s work restrictions is available
and that the employee was made aware
that such duty was available, the
employee was not prevented from
earning the wages earned before the
work-related injury for the hours such
work was available. Payment of medical
benefits is available for all treatment
necessary due to a work-related medical
condition.
(b) Each disabled employee is
obligated to perform such work as he or
she can, and OWCP’s goal is to return
each disabled employee to work as soon
as he or she is medically able. In
determining what constitutes
appropriate work under 5 U.S.C. 8115
for determining the wage-earning
capacity for a particular disabled
employee, OWCP considers the
employee’s current physical limitations,
whether the work is available within the
employee’s demonstrated commuting
area, the employee’s qualifications to
perform such work, and other relevant
factors. (See § 10.508 with respect to the
payment of relocation expenses and
§ 10.509.)
§ 10.501 What medical evidence is
necessary to support continuing receipt of
compensation benefits?
(a) The employee is responsible for
providing sufficient medical evidence to
justify payment of any compensation
sought.
(1) To support payment of continuing
compensation where an employee has
been found entitled to periodic benefits,
narrative medical evidence must be
submitted whenever OWCP requests it
but ordinarily not less than once a year
and with any filing of a form CA–1032.
It must contain a physician’s
rationalized opinion as to whether the
specific period of alleged disability is
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causally related to the employee’s
accepted injury or illness.
(2) For those employees with more
serious conditions not likely to improve
and for employees over the age of 65,
OWCP may require less frequent
documentation, but ordinarily not less
than once every three years.
(3) The physician’s opinion must be
based on the facts of the case and the
complete medical background of the
employee, must be one of reasonable
medical certainty and must include
objective findings in support of its
conclusions. Subjective complaints of
pain are not sufficient, in and of
themselves, to support payment of
continuing compensation. Likewise,
medical limitations based solely on the
fear of a possible future injury are also
not sufficient to support payment of
continuing compensation. See § 10.330
for a fuller discussion of medical
evidence.
(b) OWCP may require any kind of
non-invasive testing to determine the
employee’s functional capacity. Failure
to undergo such testing will result in a
suspension of benefits. In addition,
OWCP may direct the employee to
undergo a second opinion or referee
examination in any case it deems
appropriate (see §§ 10.320 and 10.321).
§ 10.502 How does OWCP evaluate
evidence in support of continuing receipt of
compensation benefits?
In considering the medical and factual
evidence, OWCP will weigh the
probative value of the attending
physician’s report, any second opinion
physician’s report, any other medical
reports, or any other evidence in the
file. If OWCP determines that the
medical evidence supporting one
conclusion is more consistent, logical,
and well-reasoned than evidence
supporting a contrary conclusion,
OWCP will use the conclusion that is
supported by the weight of the medical
evidence as the basis for awarding or
denying further benefits. If medical
reports that are equally well-reasoned
support inconsistent determinations of
an issue under consideration, OWCP
will direct the employee to undergo a
third, impartial referee examination to
resolve the issue, which will be given
special weight in determining the issue.
§ 10.503 Under what circumstances may
OWCP 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 medical benefits or
compensation, benefits will not be
terminated or reduced unless the weight
of the evidence establishes that:
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(a) The disability for which
compensation was paid has ceased;
(b) The disabling condition is no
longer causally related to the
employment;
(c) The employee is only partially
disabled;
(d) The employee has returned to
work;
(e) The beneficiary was convicted of
fraud in connection with a claim under
the FECA, or the beneficiary was
incarcerated based on any felony
conviction; or
(f) OWCP’s initial decision was in
error.
Return to Work—Employer’s
Responsibilities
§ 10.505
take?
What actions must the employer
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
§ 10.210 and as defined in this subpart.
The term ‘‘return to work’’ as used in
this subpart is not limited to returning
to work at the employee’s normal
worksite or usual position, but may
include returning to work at other
locations and in other positions. In
general, the employer should make all
reasonable efforts to place the employee
in his or her former or an equivalent
position, in accordance with 5 U.S.C.
8151(b)(2), if the employee has fully
recovered after one year. The Office of
Personnel Management (not OWCP)
administers this provision.
(a) Where the employer has specific
alternative positions available for
partially disabled employees, the
employer should advise the employee in
writing of the specific duties and
physical requirements of those
positions.
(b) Where the employer has no
specific alternative positions available
for an employee who can perform
restricted or limited duties, the
employer should advise the employee of
any accommodations the agency can
make to accommodate the employee’s
limitations due to the injury.
possible job assignments. (However, the
employer shall not contact the
physician by telephone or through
personal visit.) When such contact is
made, the employer shall send a copy of
any such correspondence to OWCP and
the employee, as well as a copy of the
physician’s response when received.
The employer may also contact the
employee at reasonable intervals to
request periodic medical reports
addressing his or her ability to return to
work.
§ 10.507 How should the employer make
an offer 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 some
work but not return to the position held
at date of injury), the employer should
act as follows:
(a) If the employee can perform in a
specific alternative position available in
the agency, and the employer has
advised the employee in writing of the
specific duties and physical
requirements, the employer shall notify
the employee in writing immediately of
the date of availability.
(b) If the employee can perform
restricted or limited duties, the
employer should determine whether
such duties are available or whether an
existing job can be modified. If so, the
employer shall advise the employee in
writing of the duties, their physical
requirements and availability.
(c) The employer must make any job
offer in writing. However, the employer
may make a job offer verbally as long as
it provides the job offer to the employee
in writing within two business days of
the verbal job offer.
(d) The offer must include a
description of the duties of the position,
the physical requirements of those
duties, and the date by which the
employee is either to return to work or
notify the employer of his or her
decision to accept or refuse the job offer.
The employer must send a complete
copy of any job offer to OWCP when it
is sent to the employee.
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§ 10.506 May the employer monitor the
employee’s medical 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 this purpose.
To aid in returning an injured
employee to suitable employment, the
employer may also contact the
employee’s physician in writing
concerning the work limitations
imposed by the effects of the injury and
§ 10.508 May relocation expenses be paid
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 employee currently resides. If
this is not practical, the employer may
offer suitable reemployment at the
employee’s former duty station or other
location. Where the distance between
the location of the offered job and the
location where the employee currently
resides is at least 50 miles, OWCP may
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pay such relocation expenses as are
considered reasonable and necessary if
the employee has been terminated from
the agency’s employment rolls and
would incur relocation expenses by
accepting the offered reemployment.
OWCP may also pay such relocation
expenses when the new employer is
other than a Federal employer. OWCP
will notify the employee that relocation
expenses are payable if it makes a
finding that the job is suitable. To
determine whether a relocation expense
is reasonable and necessary, OWCP
shall use as a guide the Federal travel
regulations for permanent changes of
duty station.
§ 10.509 If an employee’s light duty job is
eliminated due to downsizing, what is the
effect on compensation?
In general, an employee will not be
considered to have experienced a
compensable recurrence of disability as
defined in § 10.5(x) merely because his
or her employer has eliminated the
employee’s light-duty position in a
reduction-in-force or some other form of
downsizing. When this occurs, OWCP
will determine the employee’s wageearning capacity based on his or her
actual earnings in such light-duty
position if this determination is
appropriate on the basis that such
earnings fairly and reasonably represent
the employee’s wage-earning capacity
and such a determination has not
already been made and the employing
agency has stated, in writing, that no
other employment is available.
§ 10.510 When may a light duty job form
the basis of a loss of wage-earning capacity
determination?
A light-duty position may form the
basis of a loss of wage-earning capacity
determination if that light duty position
is a classified position to which the
injured employee has been formally
reassigned. The position must conform
to the established physical limitations of
the injured employee; the employer
must have a written position description
outlining the duties and physical
requirements; and the position must
correlate to the type of appointment
held by the injured employee at the time
of injury. If these circumstances are
present, a determination may be made
that the position constitutes ‘‘regular’’
Federal employment. In the absence of
a ‘‘light-duty position’’ as described in
this paragraph, OWCP will assume that
the employee was instead engaged in
non-competitive, makeshift or odd lot
employment which does not represent
the employee’s wage-earning capacity,
i.e., work of the type provided to injured
employees who cannot otherwise be
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employed by the Federal Government or
in any well-known branch of the general
labor market.
§ 10.511 How may a loss of wage-earning
capacity determination be modified?
If OWCP issues a formal loss of wageearning capacity determination,
including a finding of no loss of wageearning capacity, that determination and
rate of compensation, if applicable,
remains in place until that
determination is modified by OWCP.
Modification of such a determination
is only warranted where the party
seeking the modification establishes
either that there is a material change in
the nature and extent of the injuryrelated condition, the employee has
been retrained or otherwise vocationally
rehabilitated, or the original
determination was erroneous. However,
OWCP is not precluded from
adjudicating a limited period of
disability following the issuance of a
loss of wage-earning capacity decision,
i.e., where an employee has a
demonstrated need for surgery.
Return to Work—Employee’s
Responsibilities
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§ 10.515 What actions must the employee
take 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 once the employee has
recovered from the work-related injury
to the extent that he or she can perform
the duties of the position held at the
time of injury, or earn equivalent wages.
(b) If an employee cannot return to the
job held at the time of injury due to
partial disability from the effects of the
work-related injury, but has recovered
enough to perform some type of work,
he or she must seek work. In the
alternative, the employee must accept
suitable work offered to him or her. (See
§ 10.500 for a definition of ‘‘suitable
work’’.) This work may be with the
original employer or through job
placement efforts made by or on behalf
of OWCP.
(c) If the employer has advised an
employee in writing that specific
alternative positions exist within the
agency, the employee shall provide the
description and physical requirements
of such alternate positions to the
attending physician and ask whether
and when he or she will be able to
perform such duties.
(d) If the employer has advised an
employee that it is willing to
accommodate his or her work
limitations, the employee shall so
advise the attending physician and ask
him or her to specify the limitations
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imposed by the injury. The employee is
responsible for advising the employer
immediately of these limitations.
(e) From time to time, OWCP may
require the employee to report his or her
efforts to obtain suitable employment,
whether with the Federal Government,
State and local Governments, or in the
private sector.
§ 10.516 How will an employee know if
OWCP considers 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 or present any
reasons to counter OWCP’s finding of
suitability. If the employee presents
such reasons, and OWCP determines
that the reasons are unacceptable, it will
notify the employee of that
determination and that he or she has 15
days in which to accept the offered
work without penalty. At that point in
time, OWCP’s notification need not state
the reasons for finding that the
employee’s reasons are not acceptable.
§ 10.517 What are the penalties for
refusing to 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 work after suitable work is
offered to or arranged for him or her, is
not entitled to compensation. An
employee who refuses or neglects to
work after suitable work has been
offered or secured for him or her has the
burden to show that this refusal or
failure to work was reasonable or
justified.
(b) After providing the two notices
described in § 10.516, OWCP will
terminate the employee’s entitlement to
further compensation under 5 U.S.C.
8105, 8106, and 8107 on all claims
where the injury occurred prior to the
termination decision, as provided by 5
U.S.C. 8106(c)(2). However, the
employee remains entitled to medical
benefits as provided by 5 U.S.C. 8103.
§ 10.518 Does OWCP provide services to
help employees return to work?
OWCP may, in its discretion, provide
vocational rehabilitation services as
authorized by 5 U.S.C. 8104. Vocational
rehabilitation services may include
vocational evaluation, testing, training,
and placement services with either the
original employer or a new employer,
when the injured employee cannot
return to the job held at the time of
injury. These services also include
functional capacity evaluations, which
help to tailor individual rehabilitation
programs to employees’ physical
reconditioning and behavioral
modification needs, and help employees
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to meet the demands of current or
potential jobs.
§ 10.519 What action will OWCP take if 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. To
ensure that vocational rehabilitation
services are available to all who might
be entitled to benefit from them, an
injured employee who has a loss of
wage-earning capacity shall be
presumed to be ‘‘permanently disabled,’’
for purposes of this section only, unless
and until the employee proves that the
disability is not permanent. If an
employee without good cause fails or
refuses to apply for, undergo, participate
in, or continue to participate in a
vocational rehabilitation effort when so
directed, OWCP will act as follows:
(a) Where a suitable job has been
identified, OWCP will reduce the
employee’s future monetary
compensation based on the amount
which would likely have been his or her
wage-earning capacity had he or she
undergone vocational rehabilitation.
OWCP will determine this amount in
accordance with the job identified
through the vocational rehabilitation
planning process, which includes
meetings with the OWCP nurse and the
employer. The reduction will remain in
effect until such time as the employee
acts in good faith to comply with the
direction of OWCP.
(b) Where a suitable job has not been
identified, because the failure or refusal
occurred in the early but necessary
stages of a vocational rehabilitation
effort (that is, interviews, testing,
counseling, functional capacity
evaluations, and work evaluations),
OWCP cannot determine what would
have been the employee’s wage-earning
capacity.
(c) Under the circumstances identified
in paragraph (b) of this section, in the
absence of evidence to the contrary,
OWCP will assume that the vocational
rehabilitation effort would have resulted
in a return to work with no loss of wageearning capacity, and OWCP will reduce
the employee’s monetary compensation
accordingly (that is, to zero). This
reduction will remain in effect until
such time as the employee acts in good
faith to comply with the direction of
OWCP.
§ 10.520 How does OWCP determine
compensation after an employee completes
a vocational rehabilitation program?
After completion of a vocational
rehabilitation program, OWCP may
adjust compensation to reflect the
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injured worker’s wage-earning capacity.
Actual earnings will be used if they
fairly and reasonably reflect the earning
capacity. The position determined to be
the goal of a training plan is assumed to
represent the employee’s earning
capacity if it is suitable and performed
in sufficient numbers so as to be
reasonably available, whether or not the
employee is placed in such a position.
§ 10.521 If an employee elects to receive
retirement benefits instead of FECA
benefits, what effect may such an election
have on that employee’s entitlement to
FECA compensation?
Where an employee is undergoing
vocational rehabilitation, or where
OWCP is attempting to otherwise place
that employee in a suitable job, and that
employee elects to receive retirement
benefits from the Office of Personnel
Management instead of benefits under
the FECA, the OWCP may proceed with
a loss of wage-earning capacity
determination which may reduce FECA
entitlement as long as the determination
is based on the evidence of record at the
time of such election.
Reports of Earnings From Employment
and Self-Employment
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§ 10.525 What information must the
employee report?
(a) An employee who is receiving
compensation for partial or total
disability must advise OWCP
immediately of any return to work,
either part-time or full-time. An
employee must report all outside
employment, including any concurrent
dissimilar employment held at the time
of injury, even if the injury did not
result in any lost time in that position.
In addition, an employee who is
receiving compensation for partial or
total disability will periodically be
required to submit a report of earnings
from employment or self-employment,
either part-time or full-time. (See
§ 10.5(g) for a definition of ‘‘earnings.’’)
(b) The employee must report even
those earnings which do not seem likely
to affect his or her level of benefits.
Many kinds of income, though not all,
will result in reduction of compensation
benefits. While earning income will not
necessarily result in a reduction of
compensation, failure to report income
may result in forfeiture of all benefits
paid during the reporting period.
§ 10.526 Must the employee report
volunteer activities?
An employee who is receiving
compensation for partial or total
disability is periodically required to
report volunteer activity or any other
kind of activity which shows that the
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employee is no longer totally disabled
for work. The fact that the employee did
not receive any salary for this work is
not a basis for failing to report this
activity; instead the employee must
report the cost if any to have someone
else do the work or activity.
§ 10.527 Does OWCP verify reports of
earnings?
To make proper determinations of an
employee’s entitlement to benefits,
OWCP may verify the earnings reported
by the employee through a variety of
means, including but not limited to
computer matches with the Office of
Personnel Management and inquiries to
the Social Security Administration.
Also, OWCP may perform computer
matches with records of State agencies,
including but not limited to workers’
compensation administrations, to
determine whether private employers
are paying workers’ compensation
insurance premiums for recipients of
benefits under the FECA.
§ 10.528 What action will OWCP take if the
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 an
affidavit as to any work, or activity
indicating an ability to work, which the
employee has performed for the prior 15
months. If an employee who is required
to file such a report fails to do so within
30 days of the date of the request, his
or her right to compensation for wage
loss under 5 U.S.C. 8105 or 8106 is
suspended until OWCP receives the
requested report. At that time, OWCP
will reinstate compensation retroactive
to the date of suspension if the
employee remains entitled to
compensation.
§ 10.529 What action will OWCP take if the
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 right to compensation
with respect to any period for which the
report was required. A false or evasive
statement, omission, concealment, or
misrepresentation with respect to
employment activity or earnings in a
report may also subject an employee to
criminal prosecution.
(b) Where the right to compensation is
forfeited, OWCP shall recover any
compensation already paid for the
period of forfeiture pursuant to 5 U.S.C.
8129 and other relevant statutes.
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Reports of Dependents
§ 10.535 How are dependents defined, and
what information must the employee
report?
(a) Dependents in disability cases are
defined in § 10.405. While the employee
has one or more dependents, the
employee’s basic compensation for wage
loss or for permanent impairment shall
be augmented as provided in 5 U.S.C.
8110. (The rules for death claims are
found in § 10.414.)
(b) An employee who is receiving
augmented compensation on account of
dependents must advise OWCP
immediately of any change in the
number or status of dependents. The
employee should also promptly refund
to OWCP any amounts received on
account of augmented compensation
after the right to receive augmented
compensation has ceased. Any
difference between actual entitlement
and the amount already paid beyond the
date entitlement ended is an
overpayment of compensation and may
be recovered pursuant to 5 U.S.C. 8129
and other relevant statutes.
(c) An employee who is receiving
augmented compensation shall be
periodically required to submit a
statement as to any dependents, or to
submit supporting documents such as
birth or marriage certificates or court
orders, to determine if he or she is still
entitled to augmented compensation.
§ 10.536 What is the penalty for failing to
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 suspend his or
her right to augmented compensation
until OWCP receives the requested
statement or supporting document. At
that time, OWCP will reinstate
augmented compensation retroactive to
the date of suspension, provided that
the employee is entitled to receive
augmented compensation.
§ 10.537 What reports are needed when
compensation payments 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 will
continue if and for so long as he or she
is not married and is either a student as
defined in 5 U.S.C. 8101(17), or
physically or mentally incapable of selfsupport.
(b) At least once each year, OWCP
will ask an employee who receives
compensation based on the student
status of a child to provide proof of
continuing entitlement to such
compensation, including certification of
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school enrollment. The employee is
required to report any changes to
student status in the interim as soon as
they occur.
(c) Likewise, at least once each year,
OWCP will ask an employee who
receives compensation based on a
child’s physical or mental inability to
support himself or herself, and who is
not covered by § 10.417(d) of this part,
to submit a medical report verifying that
the child’s medical condition persists
and that it continues to preclude selfsupport. The employee is required to
report any changes to that status in the
interim.
(d) If an employee fails to submit
proof within 30 days of the date of the
request, OWCP will suspend the
employee’s right to compensation until
the requested information is received.
At that time OWCP will reinstate
compensation retroactive to the date of
suspension, provided the employee is
entitled to such compensation.
Reduction and Termination of
Compensation
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§ 10.540 When and how is compensation
reduced or terminated?
(a) Except as provided in paragraphs
(c), (d), and (e) of this section, where the
evidence establishes that compensation
should be either reduced or terminated,
OWCP will provide the beneficiary with
written notice of the proposed action
and give him or her 30 days to submit
relevant evidence or argument to
support entitlement to continued
payment of compensation.
(b) Notice provided under this section
will include a description of the reasons
for the proposed action and a copy of
the specific evidence upon which
OWCP is basing its determination.
Payment of compensation will continue
until any evidence or argument
submitted has been reviewed and an
appropriate decision has been issued, or
until 30 days have elapsed if no
additional evidence or argument is
submitted.
(c) OWCP will not provide such
written notice when the beneficiary has
no reasonable basis to expect that
payment of compensation will continue.
For example, when a claim has been
made for a specific period of time and
that specific period expires, no written
notice will be given.
(d) Written notice will also not be
given when a beneficiary dies, when
OWCP either reduces or terminates
compensation upon an employee’s
return to work, when OWCP terminates
only medical benefits after a physician
indicates that further medical treatment
is not necessary or has ended, or when
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OWCP denies payment for a particular
medical expense.
(e) OWCP will also not provide such
written notice when compensation is
terminated, suspended or forfeited due
to one of the following: A beneficiary’s
conviction for fraud in connection with
a claim under the FECA; a beneficiary’s
incarceration based on any felony
conviction; an employee’s failure to
report earnings from employment or
self-employment; an employee’s failure
or refusal to either continue performing
suitable work or to accept an offer of
suitable work; or an employee’s refusal
to undergo or obstruction of a directed
medical examination or treatment for
substance abuse.
§ 10.541 What action will OWCP take after
issuing 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, OWCP will evaluate it in light
of the proposed action and undertake
such further development as it may
deem appropriate, if any. Evidence or
argument which is repetitious,
cumulative, or irrelevant will not
require any further development. If the
beneficiary does not respond within 30
days of the written notice, OWCP will
issue a decision consistent with its prior
notice. OWCP will not grant any request
for an extension of this 30-day period.
(b) Evidence or argument which
refutes the evidence upon which the
proposed action was based will result in
the continued payment of
compensation. If the beneficiary submits
evidence or argument which fails to
refute the evidence upon which the
proposed action was based but which
requires further development, OWCP
will not provide the beneficiary with
another notice of its proposed action
upon completion of such development.
Once any further development of the
evidence is completed, OWCP will
either continue payment or issue a
decision consistent with its prior notice.
Subpart G—Appeals Process
§ 10.600 How can final decisions of OWCP
be reviewed?
There are three methods for reviewing
a formal decision of the OWCP
(§§ 10.125 through 10.127 discuss how
decisions are made). These methods are:
reconsideration by the district office; a
hearing before an OWCP hearing
representative; and appeal to the
Employees’ Compensation Appeals
Board (ECAB). For each method there
are time limitations and other
restrictions which may apply, and not
all options are available for all
decisions, so the employee should
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consult the requirements set forth
below. Further rules governing appeals
to the ECAB are found at part 501 of this
title.
Reconsiderations and Reviews by the
Director
§ 10.605
What is reconsideration?
The FECA provides that the Director
may review an award for or against
compensation upon application by an
employee (or his or her representative)
who receives an adverse decision. The
employee shall exercise this right
through a request to the district office.
The request, along with the supporting
statements and evidence, is called the
‘‘application for reconsideration.’’
§ 10.606 How does a claimant request
reconsideration?
(a) An employee (or representative)
seeking reconsideration should send the
application for reconsideration to the
address as instructed by OWCP in the
final decision.
(b) The application for
reconsideration, including all
supporting documents, must:
(1) Be submitted in writing;
(2) Be signed and dated by the
claimant or the authorized
representative; and
(3) Set forth arguments and contain
evidence that either:
(i) Shows that OWCP erroneously
applied or interpreted a specific point of
law;
(ii) Advances a relevant legal
argument not previously considered by
OWCP; or
(iii) Constitutes relevant and pertinent
new evidence not previously considered
by OWCP.
§ 10.607 What is the time limit for
requesting reconsideration?
(a) An application for reconsideration
must be received by OWCP within one
year of the date of the OWCP decision
for which review is sought.
(b) OWCP will consider an untimely
application for reconsideration only if
the application demonstrates clear
evidence of error on the part of OWCP
in its most recent merit decision. The
application must establish, on its face,
that such decision was erroneous.
(c) The year in which a claimant has
to timely request reconsideration shall
not include any period subsequent to an
OWCP decision for which the claimant
can establish through probative medical
evidence that he or she is unable to
communicate in any way and that his or
her testimony is necessary in order to
obtain modification of the decision.
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§ 10.608 How does OWCP decide whether
to grant or deny the request for
reconsideration?
(a) A timely request for
reconsideration may be granted if
OWCP determines that the employee
has presented evidence and/or argument
that meets at least one of the standards
described in § 10.606(b)(3). If
reconsideration is granted, the case is
reopened and the case is reviewed on its
merits (see § 10.609).
(b) Where the request is timely but
fails to meet at least one of the standards
described in § 10.606(b)(3), or where the
request is untimely and fails to present
any clear evidence of error, OWCP will
deny the application for reconsideration
without reopening the case for a review
on the merits. A decision denying an
application for reconsideration cannot
be the subject of another application for
reconsideration. The only review for
this type of non-merit decision is an
appeal to the ECAB (see § 10.625), and
OWCP will not entertain a request for
reconsideration or a hearing on this
decision denying reconsideration.
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§ 10.609 How does OWCP decide whether
new evidence requires modification of the
prior decision?
When application for reconsideration
is granted, OWCP will review the
decision for which reconsideration is
sought on the merits and determine
whether the new evidence or argument
requires modification of the prior
decision.
(a) After OWCP decides to grant
reconsideration, but before undertaking
the review, OWCP will send a copy of
the reconsideration application to the
employer, which will have 20 days from
the date sent to comment or submit
relevant documents. OWCP will provide
any such comments to the employee,
who will have 20 days from the date the
comments are sent to him or her within
which to comment. If no comments are
received from the employer, OWCP will
proceed with the merit review of the
case. Where a reconsideration request
pertains only to a medical issue (such as
disability or a schedule award) not
requiring comment from the employing
agency, the employing agency will be
notified that a request for
reconsideration has been received, but
OWCP is not required to wait 20 days
for comment before reaching a
determination, except when that
claimant is deployed in an area of
armed conflict.
(b) A claims examiner who did not
participate in making the contested
decision will conduct the merit review
of the claim. When all evidence has
been reviewed, OWCP will issue a new
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merit decision, based on all the
evidence in the record. A copy of the
decision will be provided to the agency.
(c) An employee dissatisfied with this
new merit decision may again request
reconsideration under this subpart or
appeal to the ECAB. An employee may
not request a hearing on this decision.
§ 10.610
What is a review by the Director?
The FECA specifies that an award for
or against payment of compensation
may be reviewed at any time on the
Director’s own motion. Such review
may be made without regard to whether
there is new evidence or information. If
the Director determines that a review of
the award is warranted (including, but
not limited to circumstances indicating
a mistake of fact or law or changed
conditions), the Director (at any time
and on the basis of existing evidence)
may modify, rescind, decrease or
increase compensation previously
awarded, or award compensation
previously denied. A review on the
Director’s own motion is not subject to
a request or petition and none shall be
entertained.
(a) The decision whether or not to
review an award under this section is
solely within the discretion of the
Director. The Director’s exercise of this
discretion is not subject to review by the
ECAB, nor can it be the subject of a
reconsideration or hearing request.
(b) Where the Director reviews an
award on his or her own motion, any
resulting decision is subject as
appropriate to reconsideration, a
hearing and/or appeal to the ECAB.
Jurisdiction on review or on appeal to
ECAB is limited to a review of the
merits of the resulting decision. The
Director’s determination to review the
award is not reviewable.
Hearings
§ 10.615
What is a hearing?
A 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 the
discretion of the hearing representative,
an oral hearing may be conducted by
telephone, teleconference,
videoconference or other electronic
means. In addition to the evidence of
record, the employee may submit new
evidence to the hearing representative.
§ 10.616 How does a claimant obtain a
hearing?
(a) A claimant, injured on or after July
4, 1966, who has received a final
adverse decision by the district office
may obtain a hearing by writing to the
address specified in the decision. The
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hearing request must be sent within 30
days (as determined by postmark or
other carrier’s date marking) of the date
of the decision for which a hearing is
sought. The claimant must not have
previously submitted a reconsideration
request (whether or not it was granted)
on the same decision.
(b) OWCP will schedule an oral
hearing and determine whether the oral
hearing will be conducted in person,
including whether the in person hearing
will be by teleconference,
videoconference or other electronic
means. The claimant can request a
change in the format from a hearing to
a review of the written record by making
a written request to the Branch of
Hearings and Review. OWCP will grant
a request received by the Branch of
Hearings and Review within 30 days of:
The date OWCP acknowledges the
initial hearing request, or the date
OWCP issues a notice setting a date for
an oral hearing, in cases where the
initial request was for, or was treated as
a request for, an oral hearing. A request
received after those dates will be subject
to OWCP’s discretion. The decision to
grant or deny a change of format from
a hearing to a review of the written
record is not reviewable.
§ 10.617 How is an oral hearing
conducted?
(a) The hearing representative retains
complete discretion to set the time,
place and method of the hearing,
including the amount of time allotted
for the hearing, considering the issues to
be resolved. Any requests for reasonable
accommodation by individuals with
disabilities should be made through the
procedure described in the initial
acknowledgement letter.
(b) Unless otherwise directed in
writing by the claimant, the hearing
representative will mail a notice of the
time, place and method of the oral
hearing to the claimant and any
representative at least 30 days before the
scheduled date. The employer will also
be mailed a notice at least 30 days
before the scheduled date.
(c) The hearing is an informal process,
and the hearing representative is not
bound by common law or statutory rules
of evidence, by technical or formal rules
of procedure or by section 5 of the
Administrative Procedure Act, but the
hearing representative may conduct the
hearing in such manner as to best
ascertain the rights of the claimant.
During the hearing process, the claimant
may state his or her arguments and
present new written evidence in support
of the claim. Hearings are limited to one
hour; this limitation may be extended in
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the discretion of the hearing
representative.
(d) Testimony at oral hearings,
including those conducted by
teleconference, videoconference or other
electronic means, is recorded, then
transcribed and placed in the record.
Oral testimony shall be made under
oath. The transcript of the hearing is the
official record of the hearing.
(e) OWCP will furnish a transcript of
the oral hearing to the claimant and the
employer, who have 20 days from the
date it is sent to comment. The
employer shall send any comments to
OWCP and the claimant, who will have
20 more days from the date of the
agency’s certificate of service to
comment.
(f) The hearing remains open for the
submittal of additional evidence until
30 days after the hearing is held, unless
the hearing representative, in his or her
sole discretion, grants an extension.
Only one such extension may be
granted. A copy of the decision will be
mailed to the claimant’s last known
address, to any representative, and to
the employer.
(g) The hearing representative
determines the conduct of the oral
hearing and may terminate the hearing
at any time he or she determines that all
relevant evidence has been obtained, or
because of misbehavior on the part of
the claimant and/or representative.
(h) Pursuant to 5 U.S.C. 8126, if an
individual disobeys or resists a lawful
order or process in proceedings under
this part, or misbehaves during a
hearing or in a manner so as to obstruct
the hearing, OWCP may certify the facts
to the appropriate U.S. District Court,
which may, if the evidence warrants,
punish the individual in the same
manner and to the same extent as for a
contempt committed before the court, or
commit the individual on the same
conditions as if the forbidden act had
occurred with reference to the process
of or in the presence of the court.
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§ 10.618 How is a review of the written
record conducted?
(a) The hearing representative will
review the official record and any
additional evidence submitted by the
claimant and by the agency. The hearing
representative may also conduct
whatever investigation is deemed
necessary. New evidence and arguments
are to be submitted at any time up to the
time specified by OWCP, but they
should be submitted as soon as possible
to avoid delaying the hearing process.
(b) The claimant should submit, with
his or her application for review, all
evidence or argument that he or she
wants to present to the hearing
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representative. If the claimant chooses
to change the request from an oral
hearing to a review of the written
record, the claimant should submit all
evidence or argument at that time. A
copy of all pertinent material will be
sent to the employer, which will have
20 days from the date it is sent to
comment. (Medical evidence is not
considered ‘‘pertinent’’ for review and
comment by the agency, and it will
therefore not be furnished to the agency.
OWCP has sole responsibility for
evaluating medical evidence.) The
employer shall send any comments to
OWCP and the claimant, who will have
20 more days from the date of the
agency’s certificate of service to
comment.
§ 10.619 May subpoenas be issued for
witnesses and 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 hearing
representative may issue subpoenas for
the attendance and testimony of
witnesses, and for the production of
books, records, correspondence, papers
or other relevant documents. Subpoenas
are issued for documents only if they
are relevant and cannot be obtained by
other means, and for witnesses only
where oral testimony is the best way to
ascertain the facts.
(a) A claimant may request a
subpoena only as part of the hearings
process, and no subpoena will be issued
under any other part of the claims
process. To request a subpoena, the
requestor must:
(1) Submit the request in writing and
send it to the hearing representative as
early as possible but no later than 60
days (as evidenced by postmark,
electronic marker or other objective date
mark) after the date of the original
hearing request.
(2) Explain in the original request for
a subpoena why the testimony or
evidence is directly relevant to the
issues at hand, and a subpoena is the
best method or opportunity to obtain
such evidence because there are no
other means by which the documents or
testimony could have been obtained.
(b) No subpoena will be issued for
attendance of employees of OWCP
acting in their official capacities as
decision-makers or policy
administrators. For hearings taking the
form of a review of the written record,
no subpoena for the appearance of
witnesses will be considered.
(c) The hearing representative issues
the subpoena under his or her own
name. It may be served in person or by
certified mail, return receipt requested,
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addressed to the person to be served at
his or her last known principal place of
business or residence. A decision to
deny a subpoena can only be appealed
as part of an appeal of any adverse
decision which results from the hearing.
§ 10.620 Who pays the costs associated
with subpoenas?
(a) Witnesses who are not employees
or former employees of the Federal
Government shall be paid the same fees
and mileage as paid for like services in
the District Court of the United States
where the subpoena is returnable,
except that expert witnesses shall be
paid a fee not to exceed the local
customary fee for such services.
(b) Where OWCP asked that the
witness submit evidence into the case
record or asked that the witness attend,
OWCP shall pay the fees and mileage.
Where the claimant requested the
subpoena, and where the witness
submitted evidence into the record at
the request of the claimant, the claimant
shall pay the fees and mileage.
§ 10.621 What is the employer’s role when
an oral hearing has been requested?
(a) The employer may send one (or
more, if deemed appropriate by the
hearing representative) representative(s)
to observe the proceeding, but the
agency representative cannot give
testimony or argument or otherwise
participate in the hearing, except where
the claimant or the hearing
representative specifically asks the
agency representative to testify.
(b) The hearing representative may
deny a request by the claimant that the
agency representative testify where the
claimant cannot show that the
testimony would be relevant or where
the agency representative does not have
the appropriate level of knowledge to
provide such evidence at the hearing.
The employer may also comment on the
hearing transcript, as described in
§ 10.617(e).
§ 10.622 May a claimant withdraw a
request for 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 the decision
issued. Withdrawing the hearing request
means the record is returned to the
jurisdiction of the district office and no
further requests for a hearing on the
underlying decision will be considered.
(b) OWCP will entertain any
reasonable request for scheduling the
oral hearing, including whether to
participate by teleconference,
videoconference or other electronic
means, but such requests should be
made at the time of the original
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application for hearing. Scheduling is at
the sole discretion of the hearing
representative, and is not reviewable.
Once the oral hearing is scheduled and
OWCP has mailed appropriate written
notice to the claimant, the oral hearing
cannot be postponed at the claimant’s
request for any reason except those
stated in paragraph (c) of this section,
unless the hearing representative can
reschedule the hearing on the hearing
representative’s same monthly docket.
When the request to postpone a
scheduled hearing does not meet the
test of paragraph (c) of this section and
cannot be accommodated on the docket,
no further opportunity for an oral
hearing will be provided. Instead, the
hearing will take the form of a review
of the written record and a decision
issued accordingly.
(c) Where the claimant is hospitalized
for a reason which is not elective, or
where the death of the claimant’s
parent, spouse, or child prevents
attendance at the hearing, a
postponement may be granted upon
proper documentation.
(d) A claimant who fails to appear at
a scheduled hearing may request in
writing within 10 days after the date set
for the hearing that another hearing be
scheduled. Where good cause for failure
to appear is shown, another hearing will
be scheduled. The failure of the
claimant to request another hearing
within 10 days, or the failure of the
claimant to appear at the second
scheduled hearing without good cause
shown, shall constitute abandonment of
the request for a hearing. Where good
cause is shown for failure to appear at
the second scheduled hearing, review of
the matter will proceed as a review of
the written record.
Review by the Employees’
Compensation Appeals Board (ECAB)
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§ 10.625 What kinds of decisions may be
appealed?
Only final decisions of OWCP may be
appealed to the ECAB. However, certain
types of final decisions, described in
this part as not subject to further review,
cannot be appealed to the ECAB.
Decisions that are not appealable to the
ECAB include: Decisions concerning the
amounts payable for medical services,
decisions concerning exclusion and
reinstatement of medical providers,
decisions by the Director to review an
award on his or her own motion, and
denials of subpoenas independent of the
appeal of the underlying decision. In
appeals before the ECAB, attorneys from
the Office of the Solicitor of Labor shall
represent OWCP.
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§ 10.626 Who has jurisdiction of cases on
appeal 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 on
appeal. The OWCP continues to
administer the claim and retains
jurisdiction over issues unrelated to the
issue or issues on appeal and issues
which arise after the appeal as a result
of ongoing administration of the case.
Such issues would include, for example,
the ability to terminate benefits where
an individual returns to work while an
appeal is pending at the ECAB. ECAB’s
rules of procedure are found at part 501
of this title.
Subpart H—Special Provisions
Representation
§ 10.700 May a claimant designate a
representative?
(a) The claims process under the
FECA is informal. Unlike many workers’
compensation laws, the employer is not
a party to the claim, and OWCP acts as
an impartial evaluator of the evidence.
Nevertheless, a claimant may appoint
one individual to represent his or her
interests, but the appointment must be
in writing.
(b) There can be only one
representative at any one time, so after
one representative has been properly
appointed, OWCP will not recognize
another individual as representative
until the claimant withdraws the
authorization of the first individual. In
addition, OWCP will recognize only
certain types of individuals (see
§ 10.701); however if the representative
is an attorney, OWCP may communicate
with any member of that attorney’s
recognized law firm.
(c) A properly appointed
representative who is recognized by
OWCP may make a request or give
direction to OWCP regarding the claims
process, including a hearing. This
authority includes presenting or
eliciting evidence, making arguments on
facts or the law, and obtaining
information from the case file, to the
same extent as the claimant.
§ 10.701 Who may serve as a
representative?
A claimant may authorize any
individual to represent him or her in
regard to a claim under the FECA,
unless that individual’s service as a
representative would violate any
applicable provision of law (such as 18
U.S.C. 205 and 208). A Federal
employee may act as a representative
only:
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49633
(a) On behalf of immediate family
members, defined as a spouse, children,
parents, and siblings of the
representative, provided no fee or
gratuity is charged; or
(b) While acting as a union
representative, defined as any officially
sanctioned union official, and no fee or
gratuity is charged.
§ 10.702
How are fees for services paid?
(a) 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 and other charges. The
claimant will not be reimbursed by
OWCP, nor is OWCP in any way liable
for the amount of the fee. Contingency
fees are not allowed in any form.
(b) Administrative costs (mailing,
copying, messenger services, travel and
the like, but not including secretarial
services, paralegal and other activities)
need not be approved before the
representative collects them. Before any
fee for services can be collected,
however, the fee must be approved by
the Secretary.
§ 10.703 How are fee applications
approved?
(a) Fee application. The
representative must submit the fee
application to OWCP for services
rendered before OWCP. (Representative
services before ECAB must be approved
by ECAB under 20 CFR part 501.) The
application submitted to OWCP shall
contain the following:
(1) An itemized statement showing
the representative’s hourly rate, the
number of hours worked and
specifically identifying the work
performed and a total amount charged
for the representation (excluding
administrative costs).
(2) A statement of agreement or
disagreement with the amount charged,
signed by the claimant. The statement
must also acknowledge that the
claimant is aware that he or she must
pay the fees and that OWCP is not
responsible for paying the fee or other
costs.
(b) Approval where there is no
dispute. Where a fee application that
describes the services rendered in
accordance with paragraph (a)(1) of this
section is accompanied by a signed
statement indicating the claimant’s
agreement with the fee as described in
paragraph (a)(2) of this section, the
application is deemed approved except
that no contingency fee arrangement
may be considered deemed approved
through this process.
(c) Disputed requests. (1) Where the
claimant disagrees with the amount of
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the fee, as indicated in the statement
accompanying the submittal, OWCP
will evaluate the objection and decide
whether or not to approve the request.
OWCP will provide a copy of the
request to the claimant and ask him or
her to submit any further information in
support of the objection within 15 days
from the date the request is forwarded.
After that period has passed, OWCP will
evaluate the information received to
determine whether the amount of the
fee is substantially in excess of the value
of services received by looking at the
following factors:
(i) Usefulness of the representative’s
services;
(ii) The nature and complexity of the
claim;
(iii) The actual time spent on
development and presentation of the
claim; and
(iv) Customary local charges for
services for a representative of similar
background and experience.
(2) Where the claimant disputes the
representative’s request and files an
objection with OWCP, an appealable
decision will be issued.
§ 10.704 What penalties apply to
representatives who collect a fee without
approval?
Representatives who collect a fee
without proper approval from OWCP
may be charged with a misdemeanor
under 18 U.S.C. 292.
Third Party Liability
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§ 10.705 When must an employee or other
FECA 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
other than a Federal employee acting
within the scope of his or her
employment, the claimant can be
required to take action against that third
party.
(b) The Office of the Solicitor of Labor
(SOL) is hereby delegated authority to
administer the subrogation aspects of
certain FECA claims for OWCP. Either
OWCP or SOL can require a FECA
beneficiary to assign his or her claim for
damages to the United States or to
prosecute the claim in his or her own
name. All information regarding
subrogation claims administered by SOL
should be submitted to Chief,
Subrogation Unit, U.S. Department of
Labor, Office of the Solicitor, 200
Constitution Avenue, NW., Room
S4325, Washington, DC 20210.
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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?
When OWCP determines that an
employee or other FECA beneficiary
must take action against a third party, it
will notify the employee or beneficiary
in writing. If the case is transferred to
SOL, a second notification may be
issued.
§ 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’’?
At a minimum, a FECA beneficiary
must do the following:
(a) Seek damages for the injury or
death from the third party, either
through an attorney or on his or her own
behalf;
(b) Either initiate a lawsuit within the
appropriate statute of limitations period
or obtain a written release of this
obligation from OWCP or SOL unless
recovery is possible through a
negotiated settlement prior to filing suit;
(c) Refuse to settle or dismiss the case
for any amount less than the amount
necessary to repay OWCP’s refundable
disbursements, as defined in § 10.714,
without receiving permission from
OWCP or SOL;
(d) Provide periodic status updates
and other relevant information in
response to requests from OWCP or
SOL;
(e) Submit detailed information about
the amount recovered and the costs of
the suit on a ‘‘Statement of Recovery’’
form approved by OMB;
(f) Submit information regarding the
names of all plaintiffs to the suit or
settlement and their relationship to the
injured employee, if not the same as the
FECA beneficiary;
(g) If any portion of the settlement or
judgment was paid to more than one
individual, advise whether it was
indicated in the settlement or judgment
the amount each individual is to
receive, and if so, the percentage of the
total award;
(h) Advise whether any portion of the
settlement or judgment was paid in
more than one capacity, such as a joint
payment to a husband and wife for
personal injury and loss of consortium
or a payment to a spouse representing
both loss of consortium and wrongful
death; and
(i) Pay any required refund.
§ 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?
When a FECA beneficiary refuses a
request to either assign a claim or
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prosecute a claim in his or her own
name, OWCP may determine that he or
she has forfeited his or her right to all
past or future compensation for the
injury with respect to which the request
is made. Alternatively, OWCP may also
suspend the FECA beneficiary’s
compensation payments until he or she
complies with the request.
§ 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?
If a beneficiary consults an attorney
and is informed that a suit for damages
against a third party for the injury or
death for which benefits are payable is
unlikely to prevail or that the costs of
such a suit are not justified by the
potential recovery, he or she should
request that OWCP or SOL release him
or her from the obligation to proceed.
This request should be in writing and
provide evidence of the attorney’s
opinion. If OWCP or SOL agrees, the
beneficiary will not be required to take
further action against the third party.
§ 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?
Any person who has filed a FECA
claim that has been accepted by OWCP
(whether or not compensation has been
paid), or who has received FECA
benefits in connection with a claim filed
by another, is required to notify OWCP
or SOL of the receipt of money or other
property as a result of a settlement or
judgment in connection with the
circumstances of that claim. This
includes an injured employee, and in
the case of a claim involving the death
of an employee, a spouse, children or
other dependents entitled to receive
survivor’s benefits. OWCP or SOL
should be notified in writing within 30
days of the receipt of such money or
other property or the acceptance of the
FECA claim, whichever occurs later.
§ 10.711 How is the amount of the
recovery of the FECA beneficiary
determined?
(a) When a FECA beneficiary is
entitled to receive money as a result of
a judgment entered in a lawsuit or
settlement of a lawsuit or any other
settlement or recovery from a
responsible third party, the entire
amount of the award is reported as the
gross recovery. To determine the
amount of the recovery of the FECA
beneficiary, deductions are made for the
portion representing damage to real or
personal property, the portion
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representing loss of consortium, the
portion representing wrongful death and
the portion representing a survival
action. To make deductions for loss of
consortium, wrongful death and
survival action, it must be established
that:
(1) These claims were asserted in the
suit (or if there was no suit that these
claims were included in the settlement
or recovery); and
(2) That such claims are permissible
under the state law where the action
was brought.
(b) OWCP or SOL will determine the
appropriate percentage of the total
judgment or settlement that will be
allocated for loss of consortium,
wrongful death action and survival
action. FECA beneficiaries may accept
OWCP’s or SOL’s determination or
demonstrate good cause in writing for a
different allocation. Whether to accept a
specific allocation is at the discretion of
OWCP or SOL, even where it has been
incorporated into the settlement
agreement. OWCP or SOL will not
determine the appropriate percentage to
be allocated for loss of consortium,
wrongful death action and survival
action if a judge or jury specifies the
percentage to be awarded of a contested
verdict attributable to each of several
plaintiffs; in such case, OWCP or SOL
will accept that percentage allocation.
(c) The amount of the recovery of the
FECA beneficiary will be determined as
followed:
(1) If a settlement or judgment is paid
to or for one individual, the recovery is
the gross recovery less the portion
representing damage to real or personal
property. The portion representing
damage to real or personal property
must be established in writing and
approved by OWCP or SOL.
(2) In any case involving an injury to
an employee where a judgment or
settlement is paid to or on behalf of
more than one individual, the recovery
is the gross recovery less the portion
representing damage to real or personal
property and less the portion
representing loss of consortium. OWCP
or SOL will allocate up to 25% for a
spouse and up to 5% for each child not
to exceed 15% for all children for loss
of consortium.
(3) In any case involving the death of
an employee, where both wrongful
death and survival actions have been
asserted, separate statements of recovery
are completed for the deceased
employee and the surviving FECA
beneficiaries. For the deceased
employee, the recovery is the gross
recovery less the portion representing
damage to real or personal property, less
the portion representing loss of
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consortium, less the portion
representing the wrongful death action.
For the surviving spouse and children,
the recovery is the gross recovery less
the portion representing damage to real
or personal property, less the portion
representing loss of consortium, less the
portion representing the survival action.
OWCP or SOL will allocate the total
judgment or settlement as follows:
(i) For loss of consortium, OWCP or
SOL will allocate up to 15% for a
spouse and up to 5% for each child not
to exceed 10% for all children;
(ii) For the wrongful death action,
OWCP or SOL will allocate 65% of the
remainder after subtraction of the
amounts attributed to loss of
consortium;
(iii) For the survival action, OWCP or
SOL will allocate 35% percent of the
remainder after subtraction of the
amounts attributed to loss of
consortium.
(d) In any case involving an injury to
an employee where a judgment or
settlement is paid to or on behalf of
more than one individual and in any
case involving the death of an
employee, court costs will be attributed
using the same percentages as was used
for loss of consortium, wrongful death
action and survival action. Attorney fees
will be determined using the same
percentage that was used for the gross
recovery. These calculations are used
only for the purpose of determining the
amount of the refund and if applicable
the surplus.
§ 10.712 How much of any settlement or
judgment 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 a reasonable
attorney’s fee and the costs of litigation
have been deducted from the third-party
recovery. The United States shares in
the attorney fees by allowing the
beneficiary to retain, at the time of
distribution, an amount equivalent to a
reasonable attorney’s fee proportionate
to the refund due the United States.
After the refund owed to the United
States is calculated, the FECA
beneficiary retains any surplus
remaining, and this amount is credited,
dollar for dollar, against future
compensation including wage-loss
compensation, schedule award benefits
and medical benefits for the same
injury, as defined in § 10.719. OWCP
will resume the payment of
compensation only after the FECA
beneficiary has been awarded
compensation which exceeds the
amount of the surplus.
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49635
(a) The refund to the United States is
calculated as follows, using the
Statement of Recovery form approved
by OMB:
(1) Determine the amount of the
recovery of the FECA beneficiary as set
forth in § 10.711 as follows:
(i) Set out the gross recovery which is
the entire amount of the award;
(ii) Subtract the amount of award
representing damage to real or personal
property approved by OWCP or SOL
(Subtotal A);
(iii) Multiply Subtotal A by the
appropriate percentage in § 10.711(c), or
if it is a contested verdict by the
percentage allocated by the judge or
jury, and subtract this amount from
Subtotal A (Subtotal B);
(iv) If both a wrongful death action
and survival action have been asserted,
multiply Subtotal B by 65% to
determine the amount allocated to the
wrongful death case and multiply
Subtotal B by 35% to determine the
amount allocated to the survival action,
or if it is a contested verdict, by the
percentage allocated by the judge or
jury. Separate Statements of Recovery
must be completed for each cause of
action. For the wrongful death action
use the result of Subtotal B times 65%
for Subtotal C and for the survival
action use the result of Subtotal B times
35% for Subtotal C. If both a wrongful
death and survival have not been
asserted the amount in Subtotal B is
used for Subtotal C;
(v) Subtotal C is the amount of
recovery of the FECA beneficiary;
(2) Subtract the amount of attorney’s
fees actually paid, but not more than the
maximum amount of attorney’s fees
considered by OWCP or SOL to be
reasonable, from Subtotal C. This is
calculated by first determining the
attorney fee percentage which is
determined by dividing the gross
recovery into the amount of attorney’s
fees actually paid, but the attorney’s fee
amount must not be more than the
maximum amount of attorney’s fees
considered to be reasonable by OWCP or
SOL and must be approved by OWCP or
SOL. Subtotal C is multiplied by the fee
percentage and this amount is
subtracted from Subtotal C (Subtotal D);
(3) Subtract the costs of litigation, as
allowed by OWCP or SOL from Subtotal
D (Subtotal E). If loss of consortium
and/or wrongful death and survival
actions are claimed, the costs of
litigation are reduced first by the
percentage used for loss of consortium
and then by the percentage used for
wrongful death or survival action as set
forth in § 10.711;
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(4) Multiply Subtotal E by 20% and
subtract this amount from Subtotal E
(Subtotal F);
(5) Compare Subtotal F and the
refundable disbursements as defined in
§ 10.714. Subtotal G is the lower of the
two amounts;
(6) Multiply Subtotal G by the
percentage used for attorney’s fees in
paragraph (a)(2), to determine the
Government’s allowance for attorney’s
fees, and subtract this amount from
Subtotal G. This is the amount of the
refund.
(b) The credit against future benefits
(also referred to as the surplus) is
calculated as follows:
(1) If Subtotal F, as calculated
according to paragraph (a)(4) of this
section, is less than the refundable
disbursements, as defined in § 10.714,
there is no credit to be applied against
future benefits (but the remainder of the
unused disbursements must be applied
to any future recovery for the same
injury);
(2) If Subtotal F is greater than the
refundable disbursements, the credit
against future benefits (or surplus)
amount is determined by subtracting the
refundable disbursements from Subtotal
F.
(c) Examples of how these
calculations are made follows:
(1) In this example, a Federal
employee sues another party for causing
injuries for which the employee has
received $22,000 in benefits under the
FECA, subject to refund. The suit is
settled and the injured employee
receives $100,000, all of which was for
his injury. The injured worker paid
attorney’s fees of $25,000 and costs for
the litigation of $3,000.
(i) Gross Recovery ...........................................................................................................................................................................
(ii) Amount of Property Damage ......................................................................................................................................................
(iii) Subtotal A (Line a minus Line b) ...............................................................................................................................................
(iv) Amount Allocated for Loss of Consortium 0% of Line c ...........................................................................................................
(v) Subtotal B (Line c minus Line d) ...............................................................................................................................................
(vi) Amount Allocated for Wrongful Death 0% of Line e .................................................................................................................
(vii) Amount Allocated for Survival Action 0% of Line e .................................................................................................................
(viii) Subtotal C—If Wrongful Death use Line f, if survival action use Line g, otherwise use Subtotal B ......................................
(ix) Attorney’s Fees 25% (Line h × .25) ..........................................................................................................................................
(x) Subtotal D (Line h minus Line i) ................................................................................................................................................
(xi) Court costs ................................................................................................................................................................................
(xii) Subtotal E (Line j minus Line k) ...............................................................................................................................................
(xiii) One-fifth of Subtotal E (Line l × .20) .......................................................................................................................................
(xiv) Subtotal F (Line l minus Line m) .............................................................................................................................................
(xv) Refundable Disbursements ......................................................................................................................................................
(xvi) Subtotal G (lower of Subtotal F or refundable disbursements) ..............................................................................................
(xvii) Government’s allowance for attorney’s fees (attorney’s fees percentage used to determine Subtotal D multiplied by Subtotal G) .........................................................................................................................................................................................
(xviii) Refund to the United States (Line p minus Line q) ...............................................................................................................
(xix) Credit against future benefits (If Subtotal F greater than refundable disbursements, Line n minus Line o) .........................
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(2) In this example, a Federal
employee who is married sues another
party for causing injuries as a result of
car accident where she was driving her
personally owned vehicle on approved
travel and the employee received
$75,000 in disbursements. The suit
includes a claim for loss of consortium
which is permitted under the state law
and for damage to her vehicle
(documented at $50,000.00). A joint
settlement is reached where the injured
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death and survival is filed which
includes claims for loss of consortium
all of which is permitted under state
law. A joint settlement is reached for all
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5,500.00
16,500.00
35,600.00
employee and her spouse receive
$250,000 for all their claims. Attorney’s
fees were $83,325 and there were
$25,000 in approved court costs.
(i) Gross Recovery ...........................................................................................................................................................................
(ii) Amount of Property Damage ......................................................................................................................................................
(iii) Subtotal A (Line a minus Line b) ...............................................................................................................................................
(iv) Amount Allocated for Loss of Consortium (25% of Line c) ......................................................................................................
(v) Subtotal B (Line c minus Line d) ...............................................................................................................................................
(vi) Amount Allocated for Wrongful Death 0% of Line e .................................................................................................................
(vii) Amount Allocated for Survival Action 0% of Line e .................................................................................................................
(viii) Subtotal C—If Wrongful Death Use Line f, if survival action use Line g, otherwise use Subtotal B .....................................
(ix) Attorney’s Fees 33.33% (line h × .3333) ..................................................................................................................................
(x) Subtotal D (Line h minus Line i) ................................................................................................................................................
(xi) Court costs are reduced by the amount allocated for the loss of consortium (in this example, $25,000–($25,000 × .25)) ....
(xii) Subtotal E (line j minus Line k) ................................................................................................................................................
(xiii) One-fifth of Subtotal E (Line l × .20) .......................................................................................................................................
(xiv) Subtotal F (Line l minus Line m) .............................................................................................................................................
(xv) Refundable Disbursements ......................................................................................................................................................
(xvi) Subtotal G (lower of Subtotal F or refundable disbursements) ..............................................................................................
(xvii) Government’s allowance for attorney’s fees (attorney’s fees percentage used to determine Subtotal D multiplied by subtotal G) .........................................................................................................................................................................................
(xviii) Refund to the United States (Line p minus Line q) ...............................................................................................................
(xix) Credit against future benefits (If Subtotal F is greater than refundable disbursements, Line n minus Line o) .....................
(3) In this example, a Federal
employee who is married with two
minor children is killed in the
performance of duty. A suit for wrongful
$100,000.00
0.00
100,000.00
0.00
100,000.00
0.00
0.00
100,000.00
25,000.00
75,000.00
3,000.00
72,000.00
14,400.00
57,600.00
22,000.00
22,000.00
$250,000.00
50,000.00
200,000.00
50,000.00
150,000.00
0.00
0.00
150,000.00
49,995.00
100,005.00
18,750.00
81,255.00
16,251.00
65,004.00
75,000.00
65,004.00
21,665.83
43,338.17
0.00
claims and all parties in the amount of
$1,000,000. There were court costs of
$48,000 and attorney’s fees of $300,000.
Two Statements of Recovery are
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completed one for the wrongful death
claim and the other for the survival
action. Disbursements in this case were
$30,000 for the deceased employee and
$100,000 for the surviving spouse and
children.
49637
(i) For the wrongful death claim the
calculation is as follows:
(A) Gross Recovery .........................................................................................................................................................................
(B) Amount of Property Damage .....................................................................................................................................................
(C) Subtotal A (Line a minus Line b) ..............................................................................................................................................
(D) Amount Allocated for Loss of Consortium (25% (15% for spouse, 5% for each child) of Line c) ...........................................
(E) Subtotal B (Line c minus Line d) ...............................................................................................................................................
(F) Amount Allocated for Wrongful Death 65% of Line e ...............................................................................................................
(G) Amount Allocated for Survival Action 35% of Line e ................................................................................................................
(H) Subtotal C—If Wrongful Death Use Line f, if survival action use Line g, otherwise use Subtotal B .......................................
(I) Attorney’s Fees 30% (Line h × .30) ............................................................................................................................................
(J) Subtotal D (Line h minus Line i) ................................................................................................................................................
(K) Court costs are reduced by the amount allocated for the loss of consortium (in this example, .25 × $48,000 = 12,000) and
then by the amount allocated for survivor action, [(48,000–12,000) × .35 = 12,600], [48,000–12,000–12,600]) .......................
(L) Subtotal E (Line j minus Line k) ................................................................................................................................................
(M) One-fifth of Subtotal E (Line l × .20) .........................................................................................................................................
(N) Subtotal F (Line l minus Line m) ...............................................................................................................................................
(O) Refundable Disbursements .......................................................................................................................................................
(P) Subtotal G (lower of Subtotal F or refundable disbursements) ................................................................................................
(Q) Government’s allowance for attorney’s fees (attorney’s fees percentage used to determine Subtotal D multiplied by subtotal G) .........................................................................................................................................................................................
(R) Refund to the United States (Line p minus Line q) ..................................................................................................................
(S) Credit against future benefits (If Subtotal F is greater than refundable disbursements, Line n minus Line o) .......................
$1,000,000.00
0.00
1,000,000.00
250,000.00
750,000.00
487,500.00
262,500.00
487,500.00
146,250.00
341,250.00
23,400.00
317,850.00
63,570.00
254,280.00
100,000.00
100,000.00
30,000.00
70,000.00
154,280.00
(ii) For the survival claim the
calculation is as follows:
(A) Gross Recovery .........................................................................................................................................................................
(B) Amount of Property Damage .....................................................................................................................................................
(C) Subtotal A (Line a minus Line b) ..............................................................................................................................................
(D) Amount Allocated for Loss of Consortium (25% (15% for spouse, 5% for each child) of Line c) ...........................................
(E) Subtotal B (Line c minus Line d) ...............................................................................................................................................
(F) Amount Allocated for Wrongful Death 65% of Line e ...............................................................................................................
(G) Amount Allocated for Survival Action 35% of Line e ................................................................................................................
(H) Subtotal C—If Wrongful Death Use Line f, if survival action use Line g, otherwise use Subtotal B .......................................
(I) Attorney’s Fees 30% (line h × .30) .............................................................................................................................................
(J) Subtotal D (Line h minus Line i) ................................................................................................................................................
(K) Court costs are reduced by the amount allocated for the loss of consortium (in this example, .25 × $48,000 = 12,000) and
then by the amount allocated for wrongful death, [(48,000–12,000) × .65 = 23,400], [48,000–12,000–23,400]) ......................
(L) Subtotal E (Line j minus Line k) ................................................................................................................................................
(M) One-fifth of Subtotal E (Line l × .20) .........................................................................................................................................
(N) Subtotal F (Line l minus Line m) ...............................................................................................................................................
(O) Refundable Disbursements .......................................................................................................................................................
(P) Subtotal G (lower of Subtotal F or refundable disbursements) ................................................................................................
(Q) Government’s allowance for attorney’s fees (attorney’s fees percentage used to determine Subtotal D multiplied by subtotal G) .........................................................................................................................................................................................
(R) Refund to the United States (Line p minus Line q) ..................................................................................................................
(S) Credit against future benefits (If Subtotal F is greater than refundable disbursements, Line n minus Line o) .......................
sroberts on DSKD5P82C1PROD with PROPOSALS
§ 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?
In this situation, the gross recovery to
be reported is the present value of the
right to receive all of the payments
included in the structured settlement,
allocated in the case of multiple
recipients in the same manner as single
payment recoveries.
§ 10.714 What amounts are included in the
refundable disbursements?
The refundable disbursements of a
specific claim consist of the total money
paid by OWCP from the Employees’
Compensation Fund with respect to that
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claim to or on behalf of a FECA
beneficiary including charges for field
nurses, vocational rehabilitation, and
second opinion and referee physicians,
less charges for any medical file review
(i.e., the physician does not examine the
employee) done at the request of OWCP.
Charges for medical examinations also
may be subtracted if the FECA
beneficiary establishes that the
examinations were required to be made
available to the employee under a
statute other than the FECA by the
employing agency or at the employing
agency’s cost. Requests for
disbursements can be made to SOL or
OWCP.
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$1,000,000.00
0.00
1,000,000.00
250,000.00
750,000.00
487,500.00
262,500.00
262,500.00
78,750.00
183,750.00
12,600.00
171,150.00
34,230.00
136,920.00
30,000.00
30,000.00
9,000.00
21,000.00
106,920.00
§ 10.715 Is a beneficiary required to pay
interest 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 from
SOL or OWCP, interest shall accrue on
the refund due to the United States from
the date of the request. The rate of
interest assessed shall be the rate of the
current value of funds to the United
States Treasury as published in the
Federal Register (as of the date the
request for payment is sent). Waiver of
the collection of interest shall be in
accordance with the provisions of the
Department of Labor regulations on
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Federal Claims Collection governing
waiver of interest, 29 CFR 20.61.
§ 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?
If the required refund is not paid
within 30 days of the request for
payment, OWCP can, in its discretion,
collect the refund by withholding all or
part of any payments currently payable
to the beneficiary under the FECA with
respect to any injury. The waiver
provisions of §§ 10.432 through 10.440
do not apply to such determinations.
§ 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?
Since an injury caused by medical
malpractice in treating an injury
covered by the FECA is also an injury
covered under the FECA, any recovery
in a suit alleging such an injury is
treated as a gross recovery that must be
reported to OWCP or SOL.
§ 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?
Since payments received by a FECA
beneficiary pursuant to an insurance
policy purchased by someone other than
a liable third party are not payments in
satisfaction of liability for causing an
injury covered by the FECA, they are
not considered a gross recovery covered
by section 8132 that requires filing a
Statement of Recovery and paying any
required refund.
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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?
(a) All wounds, diseases or other
medical conditions accepted by OWCP
in connection with a single claim are
treated as the same injury for the
purpose of computing any required
refund and any credit against future
benefits in connection with the receipt
of a recovery from a third party, except
that an injury caused by medical
malpractice in treating an injury
covered under the FECA will be treated
as a separate injury for purposes of
section 8132.
(b) If an injury covered under the
FECA is caused under circumstances
creating a legal liability in more than
one person, other than the United
States, to pay damages, OWCP or SOL
will determine whether recoveries
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received from one or more third parties
should be attributed to separate
conditions for which compensation is
payable in connection with a single
FECA claim. If such an attribution is
both practicable and equitable, as
determined by OWCP or SOL, in its
discretion, the conditions will be treated
as separate injuries for purposes of
calculating the refund and credit owed
to the United States under section 8132.
Federal Grand and Petit Jurors
§ 10.725 When is a Federal grand or petit
juror 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 a juror is:
(1) In attendance at court pursuant to
a summons;
(2) In deliberation;
(3) Sequestered by order of a judge; or
(4) At a site, by order of the court, for
the taking of a view.
(b) A juror is not considered to be in
the performance of duty while traveling
to or from home in connection with the
activities enumerated in paragraphs (a)
(1) through (4) of this section.
§ 10.726 When does a juror’s entitlement
to 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 service as a
juror.
§ 10.727 What is the pay rate of jurors for
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
the General Schedule unless his or her
actual pay as an ‘‘employee’’ of the
United States while serving on court
leave is higher, in which case the pay
rate for compensation purposes is
determined in accordance with 5 U.S.C.
8114.
Peace Corps Volunteers
§ 10.730 What are the conditions of
coverage for 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
or she is located abroad is deemed
proximately caused by Peace Corps
employment and will be found by
OWCP to have been sustained in the
performance of duty, and any illness
contracted while that volunteer is
located abroad will be found by OWCP
to be proximately caused by the
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employment unless the evidence
establishes:
(1) The injury or illness was caused
by the claimant’s willful misconduct,
intent to bring about the injury or death
of self or another, or was proximately
caused by the intoxication by alcohol or
illegal drugs of the injured claimant; or
(2) The illness is shown to have preexisted the period of service abroad; or
(3) The injury or illness claimed is a
manifestation of symptoms of, or
consequent to, a pre-existing congenital
defect or abnormality.
(b) If the OWCP finds that the
evidence indicates that the injury or
illness may not have been sustained in
the performance of duty due to the
circumstances enumerated in paragraph
(a)(2) and (3) of this section, the
claimant may still prove his claim by
the submittal of substantial and
probative evidence that such injury or
illness was sustained in the
performance of duty with the Peace
Corps.
(c) If an injury or illness, or episode
thereof, comes within one of the
exceptions described in paragraph (a)(2)
or (3) of this section, the claimant may
nonetheless be entitled to
compensation. This will be so provided
he or she meets the burden of proving
by the submittal of substantial,
probative and rationalized medical
evidence that the illness or injury was
proximately caused by factors or
conditions of Peace Corps service, or
that it was materially aggravated,
accelerated or precipitated by factors of
Peace Corps service; if the injury or
illness was temporarily aggravated by
factors of Peace Corps service, disability
compensation is payable for the period
of such aggravation.
§ 10.731 What is the pay rate of Peace
Corps 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 separation, provided that
the rate equals or exceeds the pay rate
on the date of injury. It is defined in
accordance with 5 U.S.C. 8142(a), not
8101(4).
Non-Federal Law Enforcement Officers
§ 10.735 When is a non-Federal law
enforcement officer (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.
possessions and territories, or an
employee of the United States
pensioned or pensionable under
sections 521–535 of Title 4, D.C. Code,
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whose functions include the activities
listed in 5 U.S.C. 8191.
(b) Benefits are available to officers
who are not ‘‘employees’’ under 5 U.S.C.
8101, and who are determined in the
discretion of OWCP to have been
engaged in the activities listed in 5
U.S.C. 8191 with respect to the
enforcement of crimes against the
United States. Individuals who only
perform administrative functions in
support of officers are not considered
officers.
(c) Except as provided by 5 U.S.C.
8191 and 8192 and elsewhere in this
part, the provisions of the FECA and of
subparts A, B, and D through I of this
part apply to officers.
§ 10.736 What are the time limits for filing
a LEO claim?
OWCP must receive a claim for
benefits under 5 U.S.C. 8191 within five
years after the injury or death. This fiveyear limitation is not subject to waiver.
The tolling provisions of 5 U.S.C.
8122(d) do not apply to these claims.
§ 10.737 How is a LEO claim filed, and who
can 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
submitted to the officer’s employer for
completion and forwarding to OWCP. A
claim may be filed by the officer, the
officer’s survivor, or any person or
association authorized to act on behalf
of an officer or an officer’s survivors.
sroberts on DSKD5P82C1PROD with PROPOSALS
§ 10.738 Under what circumstances are
benefits payable 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 Federal crime.
However, either an actual Federal crime
must be in progress or have been
committed, or objective evidence (of
which the officer is aware at the time of
injury) must exist that a potential
Federal crime was in progress or had
already been committed. The actual or
potential Federal crime must be an
integral part of the criminal activity
toward which the officer’s actions are
directed. The fact that an injury to an
officer is related in some way to the
commission of a Federal crime does not
necessarily bring the injury within the
coverage of the FECA. The FECA is not
intended to cover officers who are
merely enforcing local laws.
(b) For benefits to be payable when an
officer is injured preventing, or
attempting to prevent, a Federal crime,
there must be objective evidence that a
Federal crime is about to be committed.
An officer’s belief, unsupported by
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objective evidence, that he or she is
acting to prevent the commission of a
Federal crime will not result in
coverage. Moreover, the officer’s
subjective intent, as measured by all
available evidence (including the
officer’s own statements and testimony,
if available), must have been directed
toward the prevention of a Federal
crime. In this context, an officer’s own
statements and testimony are relevant
to, but do not control, the determination
of coverage.
§ 10.739 What kind of objective evidence
of 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 sufficient information
which would lead a reasonable officer,
under the circumstances, to conclude
that a Federal crime was in progress, or
was about to occur. This awareness
need not extend to the precise
particulars of the crime (the section of
Title 18, United States Code, for
example), but there must be sufficient
evidence that the officer was in fact
engaged in actual or attempted
apprehension of a Federal criminal or
prevention of a Federal crime.
§ 10.740 In what situations will OWCP
automatically presume 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 law enforcement
authority in the protection of the
President of the United States, or any
other person actually provided or
entitled to U.S. Secret Service
protection, coverage will be extended.
(b) Coverage for officers of the U.S.
Park Police and those officers of the
Uniformed Division of the U.S. Secret
Service who participate in the District of
Columbia Retirement System is
adjudicated under the principles set
forth in paragraph (a) of this section,
and does not extend to numerous
tangential activities of law enforcement
(for example, reporting to work,
changing clothes). However, officers of
the Non-Uniformed Division of the U.S.
Secret Service who participate in the
District of Columbia Retirement System
are covered under the FECA during the
performance of all official duties.
§ 10.741 How are benefits calculated in
LEO 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. 8101. However, such benefits
may be reduced or adjusted as OWCP in
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49639
its discretion may deem appropriate to
reflect comparable benefits which the
officer or survivor received or would
have been entitled to receive by virtue
of the officer’s employment.
(b) For the purpose of this section, a
comparable benefit includes any benefit
that the officer or survivor is entitled to
receive because of the officer’s
employment, including pension and
disability funds, State workers’
compensation payments, Public Safety
Officers’ Benefits Act payments, and
State and local lump-sum payments.
Health benefits coverage and proceeds
of life insurance policies purchased by
the employer are not considered to be
comparable benefits.
(c) The FECA provides that, where an
officer receives comparable benefits,
compensation benefits are to be reduced
proportionally in a manner that reflects
the relative percentage contribution of
the officer and the officer’s employer to
the fund which is the source of the
comparable benefit. Where the source of
the comparable benefit is a retirement or
other system which is not fully funded,
the calculation of the amount of the
reduction will be based on a per capita
comparison between the contribution by
the employer and the contribution by all
covered officers during the year prior to
the officer’s injury or death.
(d) The non-receipt of compensation
during a period where a dual benefit
(such as a lump-sum payment on the
death of an officer) is being offset
against compensation entitlement does
not result in an adjustment of the
respective benefit percentages of
remaining beneficiaries because of a
cessation of compensation under 5
U.S.C. 8133(c).
Subpart I—Information for Medical
Providers
Medical Records and Bills
§ 10.800 How do providers enroll with
OWCP for authorizations and billing?
(a) All providers must enroll with
OWCP or its designated bill processing
agent (hereinafter OWCP in this subpart)
to have access to the automated
authorization system and to submit
medical bills to OWCP. To enroll, the
provider must complete and submit a
Form OWCP–1168 to the appropriate
location noted on that form. By
completing and submitting this form,
providers certify that they satisfy all
applicable Federal and State licensure
and regulatory requirements that apply
to their specific provider or supplier
type. The provider must maintain
documentary evidence indicating that it
satisfies those requirements. The
provider is also required to notify
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OWCP immediately if any information
provided to OWCP in the enrollment
process changes. Agency medical
officers, private physicians and
hospitals are also required to keep
records of all cases treated by them
under the FECA so they can supply
OWCP with a history of the injury, a
description of the nature and extent of
injury, the results of any diagnostic
studies performed, the nature of the
treatment rendered and the degree of
any impairment and/or disability arising
from the injury.
(b) Where a medical provider intends
to bill for a procedure where prior
authorization is required, that provider
must request such authorization from
OWCP.
(c) After enrollment, a provider must
submit all medical bills to OWCP
through its bill processing portal and
include the Provider Number/ID
obtained through enrollment or other
identifying number required by OWCP.
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§ 10.801 How are medical bills to be
submitted?
(a) All charges for medical and
surgical treatment, appliances or
supplies furnished to injured
employees, except for treatment and
supplies provided by nursing homes,
shall be supported by medical evidence
as provided in § 10.800. OWCP may
withhold payment for services until
such report or evidence is provided. The
physician or provider shall itemize the
charges on Form OWCP–1500 or CMS–
1500 (for professional services or
medicinal drugs dispensed in the
office), Form OWCP–04 or UB–04 (for
hospitals), an electronic or paper-based
bill that includes required data elements
(for pharmacies) or other form as
warranted and accepted by OWCP, and
submit the form promptly to OWCP.
(b) The provider shall identify each
service performed using the Physician’s
Current Procedural Terminology (CPT)
code, the Healthcare Common
Procedure Coding System (HCPCS)
code, the National Drug Code (NDC), or
the Revenue Center Code (RCC) with a
brief narrative description; OWCP has
discretion to determine which of these
codes may be utilized in the billing
process. The Director also has the
authority to create and supply specific
procedure codes that will be used by
OWCP to better describe and allow
specific payments for special services.
These OWCP-created codes will be
issued to providers by OWCP as
appropriate and may only be used as
authorized by OWCP. For example, a
physician conducting a referee or
second opinion examination under 5
U.S.C. 8123 will be furnished an OWCP-
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created code; a provider may not use
such an OWCP-created code for other
types of medical examinations or
services. Where no appropriate code is
submitted to identify the services
performed, the bill will be returned to
the provider and/or denied.
(c) For professional charges billed on
Form OWCP–1500 or CMS–1500, the
provider shall also state each diagnosed
condition and furnish the corresponding
diagnostic code using the ‘‘International
Classification of Disease, 9th Edition,
Clinical Modification’’ (ICD–9–CM), or
as revised. A separate bill shall be
submitted when the employee is
discharged from treatment or monthly,
if treatment for the work-related
condition is necessary for more than 30
days.
(1) (i) Hospitals shall submit charges
for inpatient medical and surgical
treatment or supplies promptly to
OWCP on Form OWCP–04 or UB–04.
(ii) For outpatient billing, the provider
shall identify each service performed,
using Revenue Center Codes (RCCs) and
HCPCS/CPT codes as warranted. The
charge for each individual service, or
the total charge for all identical services,
should also appear on the form. OWCP
may adopt an Outpatient Prospective
Payment System (OWCP OPPS) (as
developed and implemented by the
Center for Medicare and Medicaid
services (CMS) for Medicare, while
modifying the allowable costs under
Medicare to account for deductibles and
other additional costs which are covered
by FECA). Once adopted, hospital
providers shall submit outpatient
hospital bills on the current version of
the Universal Billing Form (UB) and use
HCPCS codes and other coding schemes
in accordance with the OWCP OPPS.
(2) Pharmacies shall itemize charges
for prescription medications,
appliances, or supplies on electronic or
paper-based bills and submit them
promptly to OWCP. Bills for
prescription medications must include
the NDC assigned to the product, the
generic or trade name of the drug
provided, the prescription number, the
quantity provided, and the date the
prescription was filled.
(3) Nursing homes shall itemize
charges for appliances, supplies or
services on the provider’s billhead
stationery and submit them promptly to
OWCP. Such charges shall be subject to
any applicable OWCP fee schedule.
(d) By submitting a bill and/or
accepting payment, the provider
signifies that the service for which
reimbursement is sought was performed
as described, necessary, appropriate and
properly billed in accordance with
accepted industry standards. For
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example, accepted industry standards
preclude upcoding billed services for
extended medical appointments when
the employee actually had a brief
routine appointment, or charging for the
services of a professional when a
paraprofessional or aide performed the
service; industry standards prohibit
unbundling services to charge
separately for services that should be
billed as a single charge. In addition, the
provider thereby agrees to comply with
all regulations set forth in this subpart
concerning the rendering of treatment
and/or the process for seeking
reimbursement for medical services,
including the limitation imposed on the
amount to be paid for such services.
(e) In summary, bills submitted by
providers must: be itemized on the
Health Insurance Claim Form (for
physicians) or the OWCP–04 (for
hospitals); contain the signature or
signature stamp of the provider; and
identify the procedures using HCPCS/
CPT codes, RCCs, or NDCs. Otherwise,
OWCP may deny the bill, and the
provider must correct and resubmit the
bill.
§ 10.802 How should an employee prepare
and submit requests for reimbursement for
medical expenses, transportation costs,
loss of wages, and incidental expenses?
(a) If an employee has paid bills for
medical, surgical or dental services,
supplies or appliances due to an injury
sustained in the performance of duty
and seeks reimbursement for those
expenses, he or she may submit a
request for reimbursement on Form
OWCP–915, together with an itemized
bill on Form OWCP–1500, CMS–1500,
OWCP–04 or UB–04 prepared by the
provider and a medical report as
provided in § 10.800, to OWCP.
(1) The provider of such service shall
state each diagnosed condition and
furnish the applicable ICD–9–CM code,
or as revised, and identify each service
performed using the applicable HCPCS/
CPT code, with a brief narrative
description of the service performed, or,
where no code is applicable, a detailed
description of that service. If no code or
description is received, OWCP will
deny the reimbursement request and
correction and resubmission will be
required.
(2) The reimbursement request must
be accompanied by evidence that the
provider received payment for the
service from the employee and a
statement of the amount paid.
Acceptable evidence that payment was
received includes, but is not limited to,
a signed statement by the provider, a
mechanical stamp or other device
showing receipt of payment, a copy of
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the employee’s canceled check (both
front and back) or a copy of the
employee’s credit card receipt or a form
indicating a balance of zero to the
provider.
(b) If services were provided by a
hospital, pharmacy or nursing home, the
employee should submit the bill in
accordance with the provisions of
§ 10.801(a). Any request for
reimbursement must be accompanied by
evidence, as described in paragraph (a)
of this section, that the provider
received payment for the service from
the employee and a statement of the
amount paid.
(c) OWCP may waive the
requirements of paragraphs (a) and (b) of
this section if extensive delays in the
filing or the adjudication of a claim
make it unusually difficult for the
employee to obtain the required
information.
(d) OWCP will not accept copies of
bills for reimbursement unless they bear
the signature of the provider, with
evidence of payment. Payment for
medical and surgical treatment,
appliances or supplies shall in general
be no greater than the maximum
allowable charge for such service
determined by the Director, as set forth
in § 10.805.
(e) An employee will be only partially
reimbursed for a medical expense if the
amount he or she paid to a provider for
the service exceeds the maximum
allowable charge set by the Director’s
schedule. If this happens, OWCP shall
advise the employee of the maximum
allowable charge for the service in
question and of his or her responsibility
to ask the provider to refund to the
employee, or credit to the employee’s
account, the amount he or she paid
which exceeds the maximum allowable
charge. The provider may request
reconsideration of the fee determination
as set forth in § 10.812.
(f) If the provider fails to make
appropriate refund to the employee, or
to credit the employee’s account, within
60 days after the employee requests a
refund of any excess amount, or the date
of a subsequent reconsideration
decision which continues to disallow all
or a portion of the appealed amount, the
provider shall be subject to exclusion
procedures as provided by § 10.815.
(g) If the provider does not refund to
the employee or credit to his or her
account the amount of money paid in
excess of the charge which OWCP
allows, the employee should submit
documentation of the attempt to obtain
such refund or credit to OWCP. OWCP
may make reasonable reimbursement to
the employee after reviewing the facts
and circumstances of the case.
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(h) If an employee seeks
reimbursement for transportation costs,
loss of wages or incidental expenses
related to medical treatment under this
part, that employee may submit such
reimbursement request on the Medical
Travel Refund Request OWCP–957 form
to OWCP along with all proof of
payment. Requests for reimbursement
for lost wages under this subsection
must include an official statement from
the employing agency indicating the
amount of wage loss.
§ 10.803 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 a timely manner. However, no bill
will be paid for expenses incurred if the
bill is submitted more than one year
beyond the end of the calendar year in
which the expense was incurred or the
service or supply was provided, or more
than one year beyond the end of the
calendar year in which the claim was
first accepted as compensable by OWCP,
whichever is later.
Medical Fee Schedule
§ 10.805 What services are covered by the
OWCP fee schedule?
(a) Payment for medical and other
health services, devices and supplies
furnished by physicians, hospitals, and
other providers for work-related injuries
shall not exceed a maximum allowable
charge for such service as determined by
the Director, except as provided in this
section.
(b) The schedule of maximum
allowable charges does not apply to
charges for services provided in a
nursing home for employees admitted to
that nursing home prior to [EFFECTIVE
DATE OF FINAL RULE], but does apply
to all charges for services provided by
a nursing home where the employee
was admitted to that nursing home after
that date. The schedule does apply to
charges for treatment furnished in a
nursing home by a physician or other
medical professional at any time.
(c) The schedule of maximum
allowable charges also does not apply to
charges for appliances, supplies,
services or treatment furnished by
medical facilities of the U.S. Public
Health Service or the Departments of the
Army, Navy, Air Force and Veterans
Affairs.
§ 10.806 How are the maximum fees
defined?
For professional medical services, the
Director shall maintain a schedule of
maximum allowable fees for procedures
performed in a given locality. The
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schedule shall consist of: An assignment
of Relative Value Units (RVU) to
procedures identified by Healthcare
Common Procedure Coding System/
Current Procedural Terminology
(HCPCS/CPT) code which represents the
relative skill, effort, risk and time
required to perform the procedure, as
compared to other procedures of the
same general class; an assignment of
Geographic Practice Cost Index (GPCI)
values which represent the relative
work, practice expenses and malpractice
expenses relative to other localities
throughout the country; and a monetary
value assignment (conversion factor) for
one unit of value for each coded service.
§ 10.807 How are payments for particular
services calculated?
Payment for a procedure, service or
device identified by a HCPCS/CPT code
shall not exceed the amount derived by
multiplying the Relative Value Units
(RVU) values for that procedure by the
Geographic Practice Cost Index (GPCI)
values for services in that area and by
the conversion factor to arrive at a dollar
amount assigned to one unit in that
category of service.
(a) The ‘‘locality’’ which serves as a
basis for the determination of cost is
defined by the Office of Management
and Budget Metropolitan Statistical
Areas. The Director shall base the
determination of the relative per capita
cost of medical care in a locality using
information about enrollment and
medical cost per county, provided by
the Centers for Medicare and Medicaid
Services (CMS).
(b) The Director shall assign the RVUs
published by CMS to all services for
which CMS has made assignments,
using the most recent revision. Where
there are no RVUs assigned to a
procedure, the Director may develop
and assign any RVUs that he or she
considers appropriate. The geographic
adjustment factor shall be that
designated by GPCI for Metropolitan
Statistical Areas as devised for CMS and
as updated or revised by CMS from time
to time. The Director will devise
conversion factors for each category of
service as appropriate using OWCP’s
processing experience and internal data.
(c) For example, if the RVUs for a
particular surgical procedure are 2.48
for physician’s work (W), 3.63 for
practice expense (PE), and 0.48 for
malpractice insurance (MP), and the
conversion factor assigned to one unit in
that category of service (surgery) is
$61.20, then the maximum allowable
charge for one performance of that
procedure is the product of the three
RVUs times the corresponding GPCI
values for the locality times the
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conversion factor. If the GPCI values for
the locality are 0.988 (W), 0.948 (PE),
and 1.174 (MP), then the maximum
payment calculation is:
[(2.48)(0.988) + (3.63)(0.948) +
(0.48)(1.174)] × $61.20
[2.45 + 3.44 + .56] × $61.20
6.45 × $61.20 = $394.74
§ 10.808 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 the next, the Director may
choose not to assign a relative value to
that procedure. In this case the
allowable charge for the procedure will
be set individually based on
consideration of a detailed medical
report and other evidence. At its
discretion, OWCP may set fees without
regard to schedule limits for specially
authorized consultant examinations, for
examinations performed under 5 U.S.C.
8123, and for other specially authorized
services.
§ 10.809 How are payments for medicinal
drugs determined?
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Payment for medicinal drugs
prescribed by physicians shall not
exceed the amount derived by
multiplying the average wholesale price,
or as otherwise specified by OWCP, of
the medication by the quantity or
amount provided, plus a dispensing fee.
OWCP may, in its discretion, contract
for or require the use of specific
providers for certain medications.
(a) All prescription medications
identified by National Drug Code (NDC)
will be assigned an average wholesale
price representing the product’s
nationally recognized wholesale price as
determined by surveys of manufacturers
and wholesalers, or by other method
designated by OWCP. The Director will
establish the dispensing fee, which will
not be affected by the location or type
of provider dispensing the medication.
(b) The NDCs, the average wholesale
prices, and the dispensing fee shall be
reviewed from time to time and updated
as necessary.
(c) With respect to prescribed
medications, OWCP may require the use
of generic equivalents where they are
available.
§ 10.810 How are payments for inpatient
medical services determined?
(a) OWCP will pay for inpatient
medical services according to predetermined, condition-specific rates
based on the Inpatient Prospective
Payment System (IPPS) devised by CMS
(42 CFR parts 412, 413, 424, 485, and
489). Using this system, payment is
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derived by multiplying the diagnosisrelated group (DRG) weight assigned to
the hospital discharge by the providerspecific factors.
(1) All inpatient hospital discharges
will be classified according to the DRGs
prescribed by the CMS in the form of
the DRG Grouper software program.
Each DRG represents the average
resources necessary to provide care in a
case in that DRG relative to the national
average of resources consumed per case.
(2) The provider-specific factors will
be provided by CMS in the form of their
PPS Pricer software program. The
software takes into consideration the
type of facility, census division, actual
geographic location (MSA) of the
hospital, case mix cost per discharge,
number of hospital beds, intern/beds
ratio, operating cost to charge ratio, and
other factors used by CMS to determine
the specific rate for a hospital discharge
under their PPS. The Director may
devise price adjustment factors as
appropriate using OWCP’s processing
experience and internal data.
(3) OWCP will base payments to
facilities excluded from CMS’ IPPS on
consideration of detailed medical
reports and other evidence.
(4) The Director shall review the predetermined hospital rates at least once
a year, and may adjust any or all
components when he or she deems it
necessary or appropriate.
(b) The Director shall review the
schedule of fees at least once a year, and
may adjust the schedule or any of its
components when he or she deems it
necessary or appropriate.
§ 10.811
When and how are fees reduced?
(a) OWCP accepts a provider’s
designation of the code used to identify
a billed procedure or service if the code
is consistent with the medical and other
evidence, and will pay no more than the
maximum allowable fee for that
procedure. If the code is not consistent
with the medical evidence or where no
code is supplied, the bill will be
returned to the provider for correction
and resubmission.
(b) If the charge submitted for a
service supplied to an injured employee
exceeds the maximum amount
determined to be reasonable according
to the schedule, OWCP shall pay the
amount allowed by the schedule for that
service and shall notify the provider in
writing that payment was reduced for
that service in accordance with the
schedule. OWCP shall also notify the
provider of the method for requesting
reconsideration of the balance of the
charge.
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§ 10.812 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 paid because it exceeds a
maximum allowable amount set by the
Director may, within 30 days, request
reconsideration of the fee
determination.
(1) The provider should make such a
request to the OWCP district office with
jurisdiction over the employee’s claim.
The request must be accompanied by
documentary evidence that the
procedure performed was incorrectly
identified by the original code, that the
presence of a severe or concomitant
medical condition made treatment
especially difficult, or that the provider
possessed unusual qualifications. In
itself, board-certification in a specialty
is not sufficient evidence of unusual
qualifications to justify an exception.
These are the only three circumstances
which will justify reevaluation of the
paid amount.
(2) A list of OWCP district offices and
their respective areas of jurisdiction is
available upon request from the U.S.
Department of Labor, Office of Workers’
Compensation Programs, Washington,
DC 20210, or from the Internet at https://
www.dol.gov./owcp. Within 30 days of
receiving the request for
reconsideration, the OWCP district
office shall respond in writing stating
whether or not an additional amount
will be allowed as reasonable,
considering the evidence submitted.
(b) If the OWCP district office issues
a decision which continues to disallow
a contested amount, the provider may
apply to the Regional Director of the
region with jurisdiction over the OWCP
district office. The application must be
filed within 30 days of the date of such
decision, and it may be accompanied by
additional evidence. Within 60 days of
receipt of such application, the Regional
Director shall issue a decision in writing
stating whether or not an additional
amount will be allowed as reasonable,
considering the evidence submitted.
This decision shall be final, and shall
not be subject to further review.
§ 10.813 If OWCP reduces a fee, may 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 tests for reasonableness in
accordance with this part shall not
request reimbursement from the
employee for additional amounts.
(a) Where a provider’s fee for a
particular service or procedure is lower
to the general public than as provided
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by the schedule of maximum allowable
charges, the provider shall bill at the
lower rate. A fee for a particular service
or procedure which is higher than the
provider’s fee to the general public for
that same service or procedure will be
considered a charge ‘‘substantially in
excess of such provider’s customary
charges’’ for the purposes of § 10.815(d).
(b) A provider whose fee for service
is partially paid by OWCP as the result
of the application of the schedule of
maximum allowable charges and who
collects or attempts to collect from the
employee, either directly or through a
collection agent, any amount in excess
of the charge allowed by OWCP, and
who does not cease such action or make
appropriate refund to the employee
within 60 days of the date of the
decision of OWCP, shall be subject to
the exclusion procedures provided by
§ 10.815(h).
Exclusion of Providers
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§ 10.815 What are the grounds for
excluding a provider from payment under
the FECA?
A physician, hospital, or provider of
medical services, appliances or supplies
shall be excluded from payment under
the FECA if such physician, hospital or
provider has:
(a) Been convicted under any criminal
statute of fraudulent activities in
connection with any Federal or State
program for which payments are made
to providers for similar medical,
surgical or hospital services, appliances
or supplies;
(b) Been excluded or suspended, or
has resigned in lieu of exclusion or
suspension, from participation in any
Federal or State program referred to in
paragraph (a) of this section;
(c) Knowingly made, or caused to be
made, any false statement or
misrepresentation of a material fact in
connection with a determination of the
right to reimbursement under the FECA,
or in connection with a request for
payment;
(d) Submitted, or caused to be
submitted, three or more bills or
requests for payment within a 12-month
period under this subpart containing
charges which OWCP finds to be
substantially in excess of such
provider’s customary charges, unless
OWCP finds there is good cause for the
bills or requests containing such
charges;
(e) Knowingly failed to timely
reimburse employees for treatment,
services or supplies furnished under
this subpart and paid for by OWCP;
(f) Failed, neglected or refused on
three or more occasions during a 12month period to submit full and
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accurate medical reports, or to respond
to requests by OWCP for additional
reports or information, as required by
the FECA and § 10.800;
(g) Knowingly furnished treatment,
services or supplies which are
substantially in excess of the employee’s
needs, or of a quality which fails to meet
professionally recognized standards; or
(h) Collected or attempted to collect
from the employee, either directly or
through a collection agent, an amount in
excess of the charge allowed by OWCP
for the procedure performed, and has
failed or refused to make appropriate
refund to the employee, or to cease such
collection attempts, within 60 days of
the date of the decision of OWCP.
(i) Failed to inform OWCP of any
change in their provider status as
required in section 10.800 of this title.
(j) Engaged in conduct related to care
of an employee’s FECA covered injury
that OWCP finds to be misleading,
deceptive or unfair.
§ 10.816 What will cause OWCP to
automatically exclude a physician or other
provider of medical services and supplies?
(a) OWCP shall automatically exclude
a physician, hospital, or provider of
medical services or supplies who has
been convicted of a crime described in
§ 10.815(a), or has been excluded or
suspended, or has resigned in lieu of
exclusion or suspension, from
participation in any program as
described in § 10.815(b).
(b) The exclusion applies to
participating in the program and to
seeking payment under the FECA for
services performed after the date of the
entry of the judgment of conviction or
order of exclusion, suspension or
resignation, as the case may be, by the
court or agency concerned. Proof of the
conviction, exclusion, suspension or
resignation may consist of a copy
thereof authenticated by the seal of the
court or agency concerned.
(c) A provider may be excluded on a
voluntary basis at any time.
§ 10.817 How are OWCP’s exclusion
procedures initiated?
(a) Upon receipt of information
indicating that a physician, hospital or
provider of medical services or supplies
(hereinafter the provider) has or may
have engaged in activities enumerated
in § 10.815(c) through (j) OWCP will
forward that information to the
Department of Labor’s Office of
Inspector General (DOL OIG) for its
consideration. If the information was
provided directly to DOL OIG, DOL OIG
will notify OWCP of its receipt and
implement the appropriate action
within its authority, unless such
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49643
notification will or may compromise the
identity of confidential sources, or
compromise or prejudice an ongoing or
potential criminal investigation.
(b) DOL OIG will conduct such action
as it deems necessary, and, when
appropriate, provide a written report as
described in paragraph (c) of this
section to OWCP. OWCP will then
determine whether to initiate
procedures to exclude the provider from
participation in the FECA program. If
DOL OIG determines not to take any
further action, it will promptly notify
OWCP.
(c) If DOL OIG discovers reasonable
cause to believe that violations of
§ 10.815 have occurred, it shall, when
appropriate, prepare a written report,
i.e., investigative memorandum, and
forward that report along with
supporting evidence to OWCP. The
report shall be in the form of a single
memorandum in narrative form with
attachments.
(1) The report should contain all of
the following elements:
(i) A brief description and explanation
of the subject provider or providers;
(ii) A concise statement of the DOL
OIG’s findings upon which exclusion
may be based;
(iii) A summary of the events that
make up the DOL OIG’s findings;
(iv) A discussion of the
documentation supporting the DOL
OIG’s findings;
(v) A discussion of any other
information that may have bearing upon
the exclusion process; and
(vi) The supporting documentary
evidence including any expert opinion
rendered in the case.
(2) The attachments to the report
should be provided in a manner that
they may be easily referenced from the
report.
§ 10.818 How is a provider notified of
OWCP’s intent to exclude him or her?
Following receipt of the investigative
report, OWCP will determine if there
exists a reasonable basis to exclude the
provider or providers. If OWCP
determines that such a basis exists,
OWCP shall initiate the exclusion
process by sending the provider a letter,
by certified mail and with return receipt
requested, which shall contain the
following:
(a) A concise statement of the grounds
upon which exclusion shall be based;
(b) A summary of the information,
with supporting documentation, upon
which OWCP has relied in reaching an
initial decision that exclusion
proceedings should begin;
(c) An invitation to the provider to:
(1) Resign voluntarily from eligibility
for providing services under this part
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without admitting or denying the
allegations presented in the letter; or
(2) Request a decision on exclusion
based upon the existing record and any
additional documentary information the
provider may wish to furnish;
(d) A notice of the provider’s right, in
the event of an adverse ruling by the
deciding official, to request a formal
hearing before an administrative law
judge;
(e) A notice that should the provider
fail to answer (as described in § 10.819)
the letter of intent within 60 days of
receipt, the deciding official may deem
the allegations made therein to be true
and may order exclusion of the provider
without conducting any further
proceedings; and
(f) The address to where the answer
from the provider should be sent.
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§ 10.819 What requirements must the
provider’s answer 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 the provider does not offer to resign,
he or she shall request that a
determination be made upon the
existing record and any additional
information provided.
(b) Should the provider fail to answer
the letter of intent within 60 days of
receipt, the deciding official may deem
the allegations made therein to be true
and may order exclusion of the
provider.
(c) The provider may inspect or
request copies of information in the
record at any time prior to the deciding
official’s decision by making such
request to OWCP within 20 days of
receipt of the letter of intent.
(d) Any response from the provider
will be forwarded to DOL OIG, which
shall have 30 days to answer the
provider’s response. That answer will be
forwarded to the provider, who shall
then have 15 days to reply.
(e) The deciding official shall be the
Regional Director in the region in which
the provider is located unless otherwise
specified by the Director of the Division
of Federal Employees’ Compensation.
(f) The deciding official shall issue his
or her decision in writing, and shall
send a copy of the decision to the
provider by certified mail, return receipt
requested. The decision shall advise the
provider of his or her right to request,
within 30 days of the date of an adverse
decision, a formal hearing before an
administrative law judge under the
procedures set forth in §§ 10.820
through 10.823. The filing of a request
for a hearing within the time specified
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shall stay the effectiveness of the
decision to exclude.
§ 10.820 How can an excluded provider
request a hearing?
A request for a hearing shall be sent
to the deciding official and shall
contain:
(a) A concise notice of the issues on
which the provider desires to give
evidence at the hearing;
(b) Any request for the presentation of
oral argument or evidence; and
(c) Any request for a certification of
questions concerning professional
medical standards, medical ethics or
medical regulation for an advisory
opinion from a competent recognized
professional organization or Federal,
State or local regulatory body.
§ 10.821 How are hearings assigned and
scheduled?
(a) If the deciding official receives a
timely request for hearing, the OWCP
representative shall refer the matter to
the Chief Administrative Law Judge of
the Department of Labor, who shall
assign it for an expedited hearing. The
administrative law judge assigned to the
matter shall consider the request for
hearing, act on all requests therein, and
issue a Notice of Hearing and Hearing
Schedule for the conduct of the hearing.
A copy of the hearing notice shall be
served on the provider by certified mail,
return receipt requested. The Notice of
Hearing and Hearing Schedule shall
include:
(1) A ruling on each item raised in the
request for hearing;
(2) A schedule for the prompt
disposition of all preliminary matters,
including requests for the certification
of questions to advisory bodies; and
(3) A scheduled hearing date not less
than 30 days after the date the schedule
is issued, and not less than 15 days after
the scheduled conclusion of preliminary
matters, provided that the specific time
and place of the hearing may be set on
10 days’ notice.
(b) The provider is entitled to be
heard on any matter placed in issue by
his or her response to the Notice of
Intent to Exclude, and may designate
‘‘all issues’’ for purposes of hearing.
However, a specific designation of
issues is required if the provider wishes
to interpose affirmative defenses, or
request the issuance of subpoenas or the
certification of questions for an advisory
opinion.
§ 10.822 How are subpoenas or advisory
opinions obtained?
(a) The provider may apply to the
administrative law judge for the
issuance of subpoenas upon a showing
of good cause therefor.
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(b) A certification of a request for an
advisory opinion concerning
professional medical standards, medical
ethics or medical regulation to a
competent recognized or professional
organization or Federal, State or local
regulatory agency may be made:
(1) As to an issue properly designated
by the provider, in the sound discretion
of the administrative law judge,
provided that the request will not
unduly delay the proceedings;
(2) By OWCP on its own motion either
before or after the institution of
proceedings, and the results thereof
shall be made available to the provider
at the time that proceedings are
instituted or, if after the proceedings are
instituted, within a reasonable time after
receipt. The opinion, if rendered by the
organization or agency, is advisory only
and not binding on the administrative
law judge.
§ 10.823 How will the administrative law
judge conduct the hearing and issue the
recommended decision?
(a) To the extent appropriate,
proceedings before the administrative
law judge shall be governed by 29 CFR
part 18.
(b) The administrative law judge shall
receive such relevant evidence as may
be adduced at the hearing. Parties to the
hearing are the provider and OWCP.
Evidence shall be presented under oath,
orally or in the form of written
statements. The administrative law
judge shall consider the Notice and
Response, including all pertinent
documents accompanying them, and
may also consider any evidence which
refers to the provider or to any claim
with respect to which the provider has
provided medical services, hospital
services, or medical services and
supplies, and such other evidence as the
administrative law judge may determine
to be necessary or useful in evaluating
the matter.
(c) All hearings shall be recorded and
the original of the complete transcript
shall become a permanent part of the
official record of the proceedings.
(d) Pursuant to 5 U.S.C. 8126 and 29
CFR Part 18, the administrative law
judge may issue subpoenas, administer
oaths, and examine witnesses with
respect to the proceedings.
(e) At the conclusion of the hearing,
the administrative law judge shall issue
a recommended decision and cause it to
be served on all parties to the
proceeding, their representatives and
the Director of OWCP.
§ 10.824 How does the recommended
decision become final?
(a) Within 30 days from the date the
recommended decision is issued, each
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party may state, in writing, whether the
party objects to the recommended
decision. This written statement should
be filed with the Director of OWCP.
(b) For purposes of determining
whether the written statement referred
to in paragraph (a) of this section has
been timely filed with the Director, the
statement will be considered to be
‘‘filed’’ on the date that the provider
mails it to the Director, as determined
by postmark or the date that such
written statement is actually received by
the Director, whichever is earlier.
(c) Written statements objecting to the
recommended decision may be filed
upon one or more of the following
grounds:
(1) A finding or conclusion of material
fact is not supported by substantial
evidence;
(2) A necessary legal conclusion is
erroneous;
(3) The decision is contrary to law or
to the duly promulgated rules or
decisions of the Director;
(4) A substantial question of law,
policy, or discretion is involved; or
(5) A prejudicial error of procedure
was committed.
(d) Each issue shall be separately
numbered and plainly and concisely
stated, and shall be supported by
detailed citations to the record when
assignments of error are based on the
record, and by statutes, regulations or
principal authorities relied upon.
Except for good cause shown, no
assignment of error by any party shall
rely on any question of fact or law upon
which the administrative law judge had
not been afforded an opportunity to
pass.
(e) If a written statement of objection
is filed within the allotted period of
time, the Director will review the
objection. The Director will forward the
written objection to the DOL OIG, which
will have 14 calendar days from that
date to respond. Any response from
DOL OIG will be forwarded to the
provider, which will have 14 calendar
days from that date to reply.
(f) The Director of OWCP will
consider the recommended decision, the
written record and any response or
reply received and will then issue a
written, final decision either upholding
or reversing the exclusion.
(g) If no written statement of objection
is filed within the allotted period of
time, the Director of OWCP will issue a
written, final decision accepting the
recommendation of the administrative
law judge.
(h) The decision of the Director of
OWCP shall be final with respect to the
provider’s participation in the program,
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and shall not be subject to further
review by any court or agency.
§ 10.825
What are the effects of exclusion?
(a) OWCP may give notice of the
exclusion of a physician, hospital or
provider of medical services or supplies:
(1) All OWCP district offices;
(2) All Federal employers;
(3) The CMS;
(4) The State or local authority
responsible for licensing or certifying
the excluded party.
(b) Notwithstanding any exclusion of
a physician, hospital, or provider of
medical services or supplies under this
subpart, OWCP shall not refuse an
employee reimbursement for any
otherwise reimbursable medical
treatment, service or supply if:
(1) Such treatment, service or supply
was rendered in an emergency by an
excluded physician; or
(2) The employee could not
reasonably have been expected to have
known of such exclusion.
(c) An employee who is notified that
his or her attending physician has been
excluded shall have a new right to select
a qualified physician.
§ 10.826 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
§ 10.816, the provider excluded will
automatically be reinstated upon notice
to OWCP that the conviction or
exclusion which formed the basis of the
automatic exclusion has been reversed
or withdrawn. However, an automatic
reinstatement shall not preclude OWCP
from instituting exclusion proceedings
based upon the underlying facts of the
matter.
(b) A physician, hospital, or provider
of medical services or supplies excluded
from participation as a result of an order
issued pursuant to this subpart may
apply for reinstatement one year after
the entry of the order of exclusion,
unless the order expressly provides for
a shorter period. An application for
reinstatement shall be addressed to the
Director for Federal Employees’
Compensation, and shall contain a
concise statement of the basis for the
application. The application should be
accompanied by supporting documents
and affidavits.
(c) A request for reinstatement may be
accompanied by a request for an oral
presentation. Oral presentations will be
allowed only in unusual circumstances
where it will materially aid the decision
process.
(d) The Director of OWCP shall order
reinstatement only in instances where
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such reinstatement is clearly consistent
with the goal of this subpart to protect
the FECA program against fraud and
abuse. To satisfy this requirement the
provider must provide reasonable
assurances that the basis for the
exclusion will not be repeated.
Subpart J—Death Gratuity
§ 10.900 What is the death gratuity under
this subpart?
(a) The death gratuity authorized by 5
U.S.C. 8102a and payable pursuant to
the provisions of this subpart is a
payment to a claimant who is an eligible
survivor (as defined in §§ 10.906 and
10.907) or a designated alternate
beneficiary (as defined in §§ 10.908 and
10.909) of an employee who dies of
injuries incurred in connection with the
employee’s service with an Armed
Force in a contingency operation. This
payment was authorized by section
1105 of Public Law 110–181 (2008). For
the purposes of this subchapter, the
term ‘‘Armed Force’’ means the Army,
Navy, Air Force, Marine Corps, and
Coast Guard.
(b) This death gratuity payment is a
FECA benefit, as defined by § 10.5(a) of
this part. All the provisions and
definitions in this part apply to claims
for payment under this subpart unless
otherwise specified.
§ 10.901 Which employees are covered
under this subpart?
For purposes of this subpart, the term
‘‘employee’’ means all employees
defined in 5 U.S.C. 8101 and § 10.5(h)
of this part and all non-appropriated
fund instrumentality employees as
defined in section 1587(a)(1) of title 10
of the United States Code.
§ 10.902 Does every employee’s death due
to injuries incurred in connection with his
or her service with an Armed Force in a
contingency operation qualify for the death
gratuity?
Yes. All such deaths that occur on or
after January 28, 2008 (the date of
enactment of Public Law 110–181
(2008)) qualify for the death gratuity
administered by this subpart.
§ 10.903 Is the death gratuity payment
applicable retroactively?
An employee’s death qualifies for the
death gratuity if the employee died on
or after October 7, 2001, and before
January 28, 2008, if the death was a
result of injuries incurred in connection
with the employee’s service with an
Armed Force in the theater of operations
of Operation Enduring Freedom or
Operation Iraqi Freedom.
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§ 10.904 Does a death as a result of
occupational disease qualify for payment of
the death gratuity?
Yes—throughout this subpart, the
word ‘‘injury’’ is defined as it is in 5
U.S.C. 8101(5), which includes a disease
proximately caused by employment. If
an employee’s death results from an
occupational disease incurred in
connection with the employee’s service
in a contingency operation, the death
qualifies for payment of the death
gratuity under this subpart.
§ 10.905 If an employee incurs a covered
injury in connection with his or her service
with an Armed Force in a contingency
operation but does not die of the injury until
years later, does the death qualify for
payment of the death gratuity?
Yes—as long as the employee’s death
is a result of injuries incurred in
connection with the employee’s service
with an Armed Force in a contingency
operation, the death qualifies for the
death gratuity of this subpart regardless
of how long after the injury the
employee’s death occurs.
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§ 10.906 What special statutory definitions
apply to survivors under this subpart?
For the purposes of paying the death
gratuity to eligible survivors under this
subpart, OWCP will use the following
definitions:
(a) ‘‘Surviving spouse’’ means the
person who was legally married to the
deceased employee at the time of his or
her death.
(b) ‘‘Children’’ means, without regard
to age or marital status, the deceased
employee’s natural children and
adopted children. It also includes any
stepchildren who were a part of the
decedent’s household at the time of
death.
(1) A stepchild will be considered
part of the decedent’s household if the
decedent and the stepchild share the
same principal place of abode in the
year prior to the decedent’s death. The
decedent and stepchild will be
considered as part of the same
household notwithstanding temporary
absences due to special circumstances
such as illness, education, business
travel, vacation travel, military service,
or a written custody agreement under
which the stepchild is absent from the
employee’s household for less than 180
days of the year.
(2) A natural child who is an
illegitimate child of a male decedent is
included in the definition of ‘‘children’’
under this subpart if:
(i) The child has been acknowledged
in writing signed by the decedent;
(ii) The child has been judicially
determined, before the decedent’s death,
to be his child;
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(iii) The child has been otherwise
proved, by evidence satisfactory to the
employing agency, to be the decedent’s
child; or
(iv) The decedent had been judicially
ordered to contribute to the child’s
support.
(c) ‘‘Parent’’ or ‘‘parents’’ mean the
deceased employee’s natural father and
mother or father and mother through
adoption. It also includes persons who
stood in loco parentis to the decedent
for a period of not less than one year at
any time before the decedent became an
employee.
(1) A person stood in loco parentis
when the person assumed the status of
parent toward the deceased employee.
(Any person who takes a child of
another into his or her home and treats
the child as a member of his her family,
providing parental supervision, support,
and education as if the child were his
or her own child, will be considered to
stand in loco parentis.)
(2) Only one father and one mother,
or their counterparts in loco parentis,
may be recognized in any case.
(3) Preference will be given to those
who exercised a parental relationship
on the date, or most nearly before the
date, on which the decedent became an
employee.
(d) ‘‘Brother’’ and ‘‘sister’’ mean any
person, without regard to age or marital
status, who is a natural brother or sister
of the decedent, a half-brother or halfsister, or a brother or sister through
adoption. Step-brothers or step-sisters of
the decedent are not considered a
‘‘brother’’ or a ‘‘sister.’’
§ 10.907 What order of precedence will
OWCP use to determine which survivors
are entitled to receive the death gratuity
payment under this subpart?
If OWCP determines that an
employee’s death qualifies for the death
gratuity, the FECA provides that the
death gratuity payment will be
disbursed to the living survivor(s)
highest on the following list:
(a) The employee’s surviving spouse.
(b) The employee’s children, in equal
shares.
(c) The employee’s parents, brothers,
and sisters, or any combination of them,
if designated by the employee pursuant
to the designation procedures in
§ 10.909.
(d) The employee’s parents, in equal
shares.
(e) The employee’s brothers and
sisters, in equal shares.
§ 10.908 Can an employee designate
alternate beneficiaries to receive a portion
of the death gratuity payment?
An employee may designate another
person or persons to receive not more
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than 50 percent of the death gratuity
payment pursuant to the designation
procedures in § 10.909. Only living
persons, rather than trusts, corporations
or other legal entities, may be
designated under this subsection. The
balance of the death gratuity will be
paid according to the order of
precedence described in § 10.907.
§ 10.909 How does an employee designate
a variation in the order or percentage of
gratuity payable to survivors and how does
the employee designate alternate
beneficiaries?
(a) Form CA–40 must be used to make
a variation in the order or percentages
of survivors under § 10.907 and/or to
make an alternate beneficiary
designation under § 10.908. A
designation may be made at any time
before the employee’s death, regardless
of the time of injury. The form will not
be valid unless it is signed by the
employee and received and signed prior
to the death of the employee by the
supervisor of the employee or by
another official of the employing agency
authorized to do so.
(b) Alternatively, any paper executed
prior to the effective date of this
regulation that specifies an alternate
beneficiary of the death gratuity
payment will serve as a valid
designation if it is in writing, completed
before the employee’s death, signed by
the employee, and signed prior to the
death of the employee by the supervisor
of the employee or by another official of
the employing agency authorized to do
so.
(c) If an employee makes a survivor
designation under § 10.907(c), but does
not designate the portions to be received
by each designated survivor, the death
gratuity will be disbursed to the
survivors in equal shares.
(d) An alternate beneficiary
designation made under § 10.908 must
indicate the percentage of the death
gratuity, in 10 percent increments up to
the maximum of 50 percent, that the
designated person(s) will receive. No
more than five alternate beneficiaries
may be designated. If the designation
fails to indicate the percentage to be
paid to an alternate beneficiary, the
designation to that person will be
invalid.
§ 10.910 What if a person entitled to a
portion of the death gratuity payment dies
after the death of the covered employee but
before receiving his or her portion of the
death gratuity?
(a) If a person entitled to all or a
portion of the death gratuity due to the
order of precedence for survivors in
§ 10.907 dies after the death of the
covered employee but before the person
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receives the death gratuity, the portion
will be paid to the living survivors
otherwise eligible according to the order
of precedence prescribed in that
subsection.
(b) If a survivor designated under the
survivor designation provision in
§ 10.907(c) dies after the death of the
covered employee but before receiving
his or her portion of the death gratuity,
the survivor’s designated portion will be
paid to the next living survivors
according to the order of precedence.
(c) If a person designated as an
alternate beneficiary under § 10.908 dies
after the death of the covered employee
but before the person receives his or her
designated portion of the death gratuity,
the designation to that person will have
no effect. The portion designated to that
person will be paid according to the
order of precedence prescribed in
§ 10.907.
(d) If there are no living survivors or
alternate beneficiaries, the death
gratuity will not be paid.
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§ 10.911 How is the death gratuity
payment process initiated?
(a) Either the employing agency or a
living claimant (survivor or alternate
beneficiary) may initiate the death
gratuity payment process. If the death
gratuity payment process is initiated by
the employing agency notifying OWCP
of the employee’s death, each claimant
must file a claim with OWCP in order
to receive payment of the death gratuity.
The legal representative or guardian of
any minor child may file on the child’s
behalf. Alternatively, if a claimant
initiates the death gratuity payment
process by filing a claim, the employing
agency must complete a death
notification form and submit it to
OWCP. Other claimants must also file a
claim for their portion of the death
gratuity.
(b) The employing agency must notify
OWCP immediately upon learning of an
employee’s death that may be eligible
for benefits under this subpart, by
submitting form CA–42 to OWCP. The
agency must also submit to OWCP any
designation forms completed by the
employee, and the agency must provide
as much information as possible about
any living survivors or alternate
beneficiaries of which the agency is
aware.
(1) OWCP will then contact any living
survivor(s) or alternate beneficiary(ies)
it is able to identify.
(2) OWCP will furnish claim form
CA–41 to any identified survivor(s) or
alternate beneficiary(ies) and OWCP
will provide information to them
explaining how to file a claim for the
death gratuity.
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(c) Alternatively, any claimant may
file a claim for death gratuity benefits
with OWCP. Form CA–41 may be used
for this purpose. The claimant will be
required to provide any information that
he or she has regarding any other
beneficiaries who may be entitled to the
death gratuity payment. The claimant
must disclose, in addition to the Social
Security number (SSN) of the deceased
employee, the SSNs (if known) and all
known contact information of all other
possible claimants who may be eligible
to receive the death gratuity payment.
The claimant must also identify, if
known, the agency that employed the
deceased employee when he or she
incurred the injury that caused his or
her death. OWCP will then contact the
employing agency and notify the agency
that it must complete and submit form
CA–42 for the employee. OWCP will
also contact any other living survivor(s)
or alternate beneficiary(ies) it is able to
identify, furnish to them claim form
CA–41, and provide information
explaining how to file a claim for the
death gratuity.
(d) If a claimant submits a claim for
the death gratuity to an employing
agency, the agency must promptly
transmit the claim to OWCP. This
includes both claim forms CA–41 and
any other claim or paper submitted
which appears to claim compensation
on account of the employee’s death.
§ 10.912 What is required to establish a
claim for the death gratuity payment?
Claim form CA–41 describes the basic
requirements. Much of the required
information will be provided by the
employing agency when it completes
notification form CA–42. However, the
claimant bears the burden of proof to
ensure that OWCP has the evidence
needed to establish the claim. OWCP
may send any request for additional
evidence to the claimant and to his or
her representative, if any. Evidence
should be submitted in writing. The
evidence submitted must be reliable,
probative, and substantial. Each claim
for the death gratuity must establish the
following before OWCP can pay the
gratuity:
(a) That the claim was filed within the
time limits specified by the FECA, as
prescribed in 5 U.S.C. 8122 and this
part. Timeliness is based on the date
that the claimant filed the claim for the
death gratuity under § 10.911, not the
date the employing agency submitted
form CA–42. As procedures for
accepting and paying retroactive claims
were not available prior to the
publication of the interim final rule, the
applicable statute of limitations began to
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run for a retroactive payment under this
subpart on August 18, 2009.
(b) That the injured person, at the
time he or she incurred the injury or
disease, was an employee of the United
States as defined in 5 U.S.C. 8101(1) and
§ 10.5(h) of this part, or a nonappropriated fund instrumentality
employee, as defined in 10 U.S.C.
1587(a)(1).
(c) That the injury or disease occurred
and that the employee’s death was
causally related to that injury or disease.
The death certificate of the employee
must be provided. Often, the employing
agency will provide the death certificate
and any needed medical
documentation. OWCP may request
from the claimant any additional
documentation that may be needed to
establish the claim.
(d) That the employee incurred the
injury or disease in connection with the
employee’s service with an Armed
Force in a contingency operation. This
will be determined from evidence
provided by the employing agency or
otherwise obtained by OWCP and from
any evidence provided by the claimant.
(1) Section 8102a defines
‘‘contingency operation’’ to include
humanitarian operations, peacekeeping
operations, and similar operations.
(‘‘Similar operations’’ will be determined
by OWCP.)
(i) A ‘‘contingency operation’’ is
defined by 10 U.S.C. 101(a)(13) as a
military operation that—
(A) Is designated by the Secretary of
Defense as an operation in which
members of the armed forces are or may
become involved in military actions,
operations, or hostilities against an
enemy of the United States or against an
opposing military force; or
(B) Results in the call or order to, or
retention on, active duty of members of
the uniformed services under section
688, 12301(a), 12302, 12304, 12305, or
12406 of Title 10, chapter 15 of Title 10,
or any other provision of law during a
war or during a national emergency
declared by the President or Congress.
(ii) A ‘‘humanitarian or peacekeeping
operation’’ is defined by 10 U.S.C.
2302(8) as a military operation in
support of the provision of
humanitarian or foreign disaster
assistance or in support of a
peacekeeping operation under chapter
VI or VII of the Charter of the United
Nations. The term does not include
routine training, force rotation, or
stationing.
(iii) ‘‘Humanitarian assistance’’ is
defined by 10 U.S.C. 401(e) to mean
medical, surgical, dental, and veterinary
care provided in areas of a country that
are rural or are underserved by medical,
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surgical, dental, and veterinary
professionals, respectively, including
education, training, and technical
assistance related to the care provided;
construction of rudimentary surface
transportation systems; well drilling and
construction of basic sanitation
facilities; rudimentary construction and
repair of public facilities.
(2) A contingency operation may take
place within the United States or
abroad. However, operations of the
National Guard are only considered
‘‘contingency operations’’ for purposes
of this subpart when the President,
Secretary of the Army, or Secretary of
the Air Force calls the members of the
National Guard into service. A
‘‘contingency operation’’ does not
include operations of the National
Guard when called into service by a
Governor of a State.
(3) To show that the injury or disease
was incurred ‘‘in connection with’’ the
employee’s service with an Armed
Force in a contingency operation, the
claim must show that the employee
incurred the injury or disease while in
the performance of duty as that phrase
is defined for the purposes of otherwise
awarding benefits under FECA.
(4)(i) When the contingency operation
occurs outside of the United States,
OWCP will find that an employee’s
injury or disease was incurred ‘‘in
connection with’’ the employee’s service
with an Armed Force in a contingency
operation if the employee incurred the
injury or disease while performing
assignments in the same region as the
operation, unless there is conclusive
evidence that the employee’s service
was not supporting the Armed Force’s
operation.
(ii) Economic or social development
projects, including service on Provincial
Reconstruction Teams, undertaken by
covered employees in regions where an
Armed Force is engaged in a
contingency operation will be
considered to be supporting the Armed
Force’s operation.
(5) To show that an employee’s injury
or disease was incurred ‘‘in connection
with’’ the employee’s service with an
Armed Force in a contingency
operation, the claimant will be required
to establish that the employee’s service
was supporting the Armed Force’s
operation. The death gratuity does not
cover federal employees who are
performing service within the United
States that is not supporting activity
being performed by an Armed Force.
(e) The claimant must establish his or
her relationship to the deceased
employee so that OWCP can determine
whether the claimant is the survivor
entitled to receive the death gratuity
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payment according to the order of
precedence prescribed in § 10.907.
§ 10.913 In what situations will OWCP
consider that an employee incurred injury
in connection with his or her service with
an Armed Force in a contingency
operation?
(a) OWCP will consider that an
employee incurred injury in connection
with service with an Armed Force in a
contingency operation if:
(1) The employee incurred injury
while serving under the direction or
supervision of an official of an Armed
Force conducting a contingency
operation; or
(2) The employee incurred injury
while riding with members of an Armed
Force in a vehicle or other conveyance
deployed to further an Armed Force’s
objectives in a contingency operation.
(b) An employee may incur injury in
connection with service with an Armed
Force in a contingency operation in
situations other than those listed above.
Additional situations will be
determined by OWCP on a case-by-case
basis.
§ 10.914 What are the responsibilities of
the employing agency in the death gratuity
payment process?
Because some of the information
needed to establish a claim under this
subpart will not be readily available to
the claimants, the employing agency of
the deceased employee has significant
responsibilities in the death gratuity
claim process. These responsibilities are
as follows:
(a) The agency must completely fill
out form CA–42 immediately upon
learning of an employee’s death that
may be eligible for benefits under this
subpart. The agency must complete
form CA–42 as promptly as possible if
notified by OWCP that a survivor filed
a claim based on the employee’s death.
The agency should provide as much
information as possible regarding the
circumstances of the employee’s injury
and his or her assigned duties at the
time of the injury, so that OWCP can
determine whether the injury was
incurred in the performance of duty and
whether the employee was performing
service in connection with an Armed
Force in a contingency operation at the
time.
(b) The employing agency must
promptly transmit any form CA–41’s
received from claimants to OWCP. The
employer must also promptly transmit
to OWCP any other claim or paper
submitted that appears to claim
compensation on account of the
employee’s death.
(c) The employing agency must
maintain any designations completed by
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the employee and signed by a
representative of the agency in the
employee’s official personnel file or a
related system of records. The agency
must forward any such forms to OWCP
if the agency submits form CA–42
notifying OWCP of the employee’s
death. The agency must also forward
any other paper signed by the employee
and employing agency that appears to
make designations of the death gratuity.
(d) If requested by OWCP, the
employing agency must determine
whether a survivor, who is claiming the
death gratuity based on his or her status
as an illegitimate child of a deceased
male employee, has offered satisfactory
evidence to show that he or she is in fact
the employee’s child.
(e) The employing agency must notify
OWCP of any other death gratuity
payments under any other law of the
United States for which the employee’s
death qualifies. The employing agency
also must notify OWCP of any other
death gratuity payments that have been
paid based on the employee’s death.
(f) Non-appropriated fund
instrumentalities must fulfill the same
requirements under this subpart as any
other employing agency.
§ 10.915 What are the responsibilities of
OWCP in the death gratuity payment
process?
(a) If the death gratuity payment
process is initiated by the employing
agency’s submission of form CA–42,
OWCP will identify living potential
claimants. OWCP will make a
reasonable effort to provide claim form
CA–41’s to any known potential
claimants and provide instructions on
how to file a claim for the death gratuity
payment.
(b) If the death gratuity payment
process is initiated by a claimant’s
submission of a claim, OWCP will
contact the employing agency and
prompt it to submit form CA–42. OWCP
will then review the information
provided by both the claim and form
CA–42, and OWCP will attempt to
identify all living survivors or alternate
beneficiaries who may be eligible for
payment of the gratuity.
(c) If OWCP determines that the
evidence is not sufficient to meet the
claimant’s burden of proof, OWCP will
notify the claimant of the additional
evidence needed. The claimant will be
allowed at least 30 days to submit the
additional evidence required. OWCP
may also request additional information
from the employing agency.
(d) OWCP will review the information
provided by the claimant and
information provided by the employing
agency to determine whether the claim
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satisfies all the requirements listed in
§ 10.912.
(e) OWCP will calculate the amount of
the death gratuity payment and pay the
beneficiaries as soon as possible after
accepting the claim.
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§ 10.916 How is the amount of the death
gratuity calculated?
The death gratuity payment under
this subpart equals $100,000 minus the
amount of any death gratuity payments
that have been paid under any other law
of the United States based on the same
death. A death gratuity payment is a
payment in the nature of a gift, beyond
reimbursement for death and funeral
expenses, relocation costs, or other
similar death benefits. Only other death
gratuity payments will reduce the
amount of the death gratuity provided
in this subpart. For this reason, death
benefits provided to the same
employee’s survivors such as those
under 5 U.S.C. 8133 as well as benefits
paid under 5 U.S.C. 8134 are not death
gratuity payments, and therefore have
no effect on the amount of the death
gratuity provided under this subpart.
(a) A payment provided under section
413 of the Foreign Service Act of 1980
(22 U.S.C. 3973), is a death gratuity
payment, and if a deceased employee’s
survivors received that payment for the
employee’s death, the amount of the
death gratuity paid to the survivors
under this subpart would be reduced by
the amount of the Foreign Service Act
death gratuity. Other death gratuities
that would affect the calculation of the
amount payable include but are not
limited to: the gratuity provision in
section 1603 of the Emergency
Supplemental Appropriations Act for
Defense, the Global War on Terror, and
Hurricane Recovery, 2006 (Pub. L. 109–
234, June 15, 2006); the $10,000 death
gratuity to the personal representative of
civilian employees, at Title VI, Section
651 of the Omnibus Consolidated
Appropriations Act of 1996 (Pub. L.
104–208, September 30, 1996); the death
gratuity for members of the Armed
Forces or any employee of the
Department of Defense dying outside
the United States while assigned to
intelligence duties, at 10 U.S.C. 1489;
and the death gratuity for employees of
the Central Intelligence Agency, at 50
U.S.C. 403k.
(b) The amount of the death gratuity
under this section will be calculated
before it is disbursed to the employee’s
survivors or alternate beneficiaries, by
taking into account any death gratuities
paid by the time of disbursement.
Therefore, any designations made by the
employee under § 10.909 are only
applicable to the amount of the death
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gratuity as described in paragraph (a) of
this section. The following examples are
intended to provide guidance in this
administration of this subpart.
(1) Example One. An employee’s survivors
are entitled to the Foreign Service Act death
gratuity; the employee’s spouse received
payment in the amount of $80,000 under that
Act. A death gratuity is also payable under
FECA; the amount of the FECA death gratuity
that is payable is a total of $20,000. That
employee, using Form CA–40 had designated
50% of the death gratuity under this subpart
to be paid to his neighbor John Smith who
is still living. So, 50% of the death gratuity
will be paid to his spouse and the remaining
50% of the death gratuity paid under this
subpart would be paid to John Smith. This
means the surviving spouse will receive
$10,000 and John Smith will receive $10,000.
(2) Example Two. Employee dies in
circumstances that would qualify her for
payment of the gratuity under this subpart;
her agency has paid the $10,000 death
gratuity pursuant to Public Law 104–208.
The employee had not completed any
designation form. The FECA death gratuity is
reduced by the $10,000 death gratuity and
employee’s spouse receives $90,000.
(3) Example Three. An employee of the
Foreign Service whose annual salary is
$75,000 dies in circumstances that would
qualify for payment of both the Foreign
Service Act death gratuity and the death
gratuity under this subpart. Before his death,
the employee designated that 40% of the
death gratuity under this subpart be paid to
his cousin Jane Smith, pursuant to the
alternate beneficiary designation provision at
§ 10.908 and that 10% be paid to his uncle
John Doe who has since died. At the time of
his death, the employee had no surviving
spouse, children, parents, or siblings.
Therefore, the Foreign Service Act death
gratuity will not be paid, because no eligible
survivors according to the Foreign Service
Act provision exist. The death gratuity under
this subpart would equal $100,000, because
no other death gratuity has been paid, and
Jane would receive $40,000 according to the
employee’s designation. As John Doe is
deceased, no death gratuity may be paid
pursuant to the designation of a share of the
death gratuity to him.
3. Part 25 is revised to read as follows:
PART 25—COMPENSATION FOR
DISABILITY AND DEATH OF
NONCITIZEN FEDERAL EMPLOYEES
OUTSIDE THE UNITED STATES
Subpart A—General Provisions
Sec.
25.1 How are claims of Federal employees
who are neither citizens nor residents
adjudicated?
25.2 In general, what is the Director’s policy
regarding such claims?
25.3 What is the authority to settle and pay
such claims?
25.4 What type of evidence is required to
establish a claim under this part?
25.5 How does OWCP adjudicate claims of
non-citizen residents of possessions or
territories?
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Subpart B—The Special Schedule of
Compensation
25.100 What general provisions does OWCP
apply to the Special Schedule?
25.101 How is compensation for disability
paid?
25.102 How is compensation for death of a
non-citizen non-resident employee paid?
Subpart C—Extensions of the Special
Schedule of Compensation
25.200 How is the Special Schedule applied
for employees in the Republic of the
Philippines?
25.201 How is the Special Schedule applied
for employees in Australia?
25.202 How is the Special Schedule applied
for Japanese seamen?
25.203 How is the Special Schedule applied
to non-resident aliens in the Territory of
Guam?
Authority: 5 U.S.C. 301, 8137, 8145 and
8149; 1946 Reorganization Plan No. 2, sec. 3,
3 CFR 1943–1948 Comp., p. 1064; 60 Stat.
1095; Reorganization Plan No. 19 of 1950,
sec. 1, 3 CFR 1943–1953 Comp., p. 1010; 64
Stat. 1271; Secretary of Labor’s Order No. 10–
2009, 74 FR 218.
Subpart A—General Provisions
§ 25.1 How are claims of Federal
employees who are neither citizens nor
residents adjudicated?
This part describes how OWCP pays
compensation under the FECA to
employees of the United States who are
neither citizens nor residents of the
United States, any territory or Canada,
as well as to any dependents of such
employees. It has been determined that
the compensation provided under the
FECA is substantially disproportionate
to the compensation for disability or
death which is payable in similar cases
under local law, regulation, custom or
otherwise, in areas outside the United
States, any territory or Canada and
therefore a special schedule should
apply to such cases This special
schedule applies to any non-citizen
non-resident federal employee who is
neither hired nor employed in the
United States, Canada or in a possession
or territory of the United States.
Therefore, with respect to the claims of
such employees whose injury (or injury
resulting in death) has occurred
subsequent to [DATE 60 DAYS AFTER
DATE OF PUBLICATION OF FINAL
RULE IN THE FEDERAL REGISTER], or
may occur, the regulations in this part
shall apply.
§ 25.2 In general, what is the Director’s
policy regarding such claims?
(a) Pursuant to 5 U.S.C. 8137(a)(2), a
special schedule is established by
subpart B of this part that applies to any
non-citizen non-resident federal
employee who is neither hired nor
employed in the United States, Canada
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or in a possession or territory of the
United States (hereinafter non-citizen
non-resident employees). The special
schedule in subpart B of this part is
subject to the exceptions set forth in
paragraph (b) of this section. The special
schedule set forth in subpart B of this
part applies to claims of such employees
whose injury (or injury resulting in
death) occurred on or after [DATE 60
DAYS AFTER DATE OF PUBLICATION
OF FINAL RULE IN THE FEDERAL
REGISTER].
(b) This special schedule of
compensation established by subpart B
of this part shall apply to non-citizen
non-resident employees outside of the
United States unless:
(1) The injured employee receives
compensation pursuant to a specific
separate agreement between the United
States and another government (or
similar compensation from another
sovereign government);
(2) The employee receives
compensation pursuant to the special
schedule under subpart C for the
particular locality, or for a class of
employees in that particular locality; or
(3) The employee otherwise
establishes entitlement to compensation
under local law pursuant to § 25.100(e).
(c) Compensation in all cases of such
employees paid and closed prior to
[DATE 60 DAYS AFTER DATE OF
PUBLICATION OF FINAL RULE IN
THE FEDERAL REGISTER] shall be
deemed compromised and paid under 5
U.S.C. 8137. In all other cases,
compensation may be adjusted to
conform with the regulations in this
part, or the beneficiary may by
compromise or agreement with the
Director have compensation continued
on the basis of a previous adjustment of
the claim.
(d) Compensation received by
beneficiaries pursuant to 5 U.S.C. 8137
and the special schedule set forth in
subpart B or as otherwise specified in
paragraph (b) of this section is the
exclusive measure of compensation in
cases of injury (or death from injury) to
non-citizen non-resident employees of
the United States as specified in
paragraph (a) of this section.
(e) Compensation for disability and
death of non-citizen non-resident
employees outside the United States
under this part shall in no event exceed
that generally payable under the FECA.
§ 25.3 What is the authority to settle and
pay such claims?
In addition to the authority to receive,
process and pay claims, when delegated
such representative or agency receiving
delegation of authority shall, in respect
to cases adjudicated under this part, and
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when so authorized by the Director,
have authority to make lump-sum
awards (in the manner prescribed by 5
U.S.C. 8135) whenever such authorized
representative shall deem such
settlement to be for the best interest of
the United States, and to compromise
and pay claims for any benefits
provided for under this part, including
claims in which there is a dispute as to
questions of fact or law. The Director
shall, in instructions to the particular
representative concerned, establish such
procedures in respect to action under
this section as he or she may deem
necessary, and may specify the scope of
any administrative review of such
action.
§ 25.4 What type of evidence is required to
establish a claim under this part?
Claims of non-citizen non-resident
employees of the United States as
specified in § 25.2(a), if otherwise
compensable, shall be approved only
upon evidence of the following nature
without regard to the date of injury or
death for which the claim is made:
(a) Appropriate certification by the
Federal employing establishment; or
(b) An armed service’s casualty or
medical record; or
(c) Verification of the employment
and casualty by Department of Defense
personnel; or
(d) Recommendation of an armed
service’s ‘‘Claim Service’’ based on
investigations conducted by it.
§ 25.5 How does OWCP adjudicate claims
of non-citizen residents of possessions or
territories?
An employee who is a bona fide
permanent resident of any United States
possession, territory, commonwealth, or
trust territory will receive the full
benefits of the FECA, as amended,
except that the application of the
minimum benefit provisions provided
therein shall be governed by the
restrictions set forth in 5 U.S.C. 8138.
Subpart B—The Special Schedule of
Compensation
§ 25.100 What general 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) The provisions of the FECA,
unless modified by this subpart or
otherwise inapplicable, shall be applied
whenever possible in the application of
this subpart.
(c) The provisions of the regulations
for the administration of the FECA, as
amended or supplemented from time to
time by instructions applicable to this
subpart, shall apply in the
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administration of compensation under
this subpart, whenever they can
reasonably be applied.
§ 25.101 How is compensation for
disability paid?
Compensation for disability shall be
paid to the non-citizen non-resident
employee as follows:
(a) Temporary total disability. Where
the injured employee is disabled and
unable to earn wages equivalent to those
earned at the time of injury for a period
of time less than two years, the
employee shall receive 50 percent of the
monthly pay during the period of such
disability.
(b) Temporary partial disability.
Where the injured employee is disabled
and unable to earn equivalent wages to
those earned at the time of injury, but
who is not totally disabled for work, the
injured employee shall receive during
the period of disability, that proportion
of compensation for temporary total
disability, as determined under
paragraph (a) of this section, which is
equal in percentage to the degree or
percentage of physical impairment
caused by the disability.
(c) Permanent total disability. Where
it is found that the injured employee is
disabled and will be or has been unable
to earn equivalent wages to those earned
at the time of injury for greater than two
years, the employee is deemed
permanently disabled. Such employee
shall receive a lump sum settlement
based on compensation equaling 50
percent of the monthly pay or a
percentage proportionate to the extent of
disability. The lump sum award shall be
made by the manner prescribed by 5
U.S.C. 8135.
(d) Permanent partial disability.
Where there is permanent disability
(impairment) involving the loss, or loss
of use, of a member or function of the
body, the injured employee is entitled to
schedule compensation at 50 percent of
the monthly pay to be paid in a lump
sum according to 5 U.S.C. 8135, for the
following losses and periods:
(1) Arm lost: 312 weeks’
compensation.
(2) Leg lost: 288 weeks’ compensation.
(3) Hand lost: 244 weeks’
compensation.
(4) Foot lost: 205 weeks’
compensation.
(5) Eye lost: 160 weeks’
compensation.
(6) Thumb lost: 75 weeks’
compensation.
(7) First finger lost: 46 weeks’
compensation.
(8) Great toe lost: 38 weeks’
compensation.
(9) Second finger lost: 30 weeks’
compensation.
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(10) Third finger lost: 25 weeks’
compensation.
(11) Toe, other than great toe, lost: 16
weeks’ compensation.
(12) Fourth finger lost: 15 weeks’
compensation.
(13) Loss of hearing: One ear, 52
weeks’ compensation; both ears, 200
weeks’ compensation.
(14) Breast (one) lost: 52 weeks’
compensation.
(15) Kidney (one) lost: 156 weeks’
compensation.
(16) Larynx lost: 160 weeks’
compensation.
(17) Lung (one) lost: 156 weeks’
compensation.
(18) Penis lost: 205 weeks’
compensation.
(19) Testicle (one) lost: 52 weeks’
compensation.
(20) Tongue lost: 160 weeks’
compensation.
(21) Ovary (one) lost: 52 weeks’
compensation.
(22) Uterus/cervix and vulva/vagina
lost: 205 weeks’ compensation.
(23) Skin: 205 weeks’ compensation.
(24) Phalanges: Compensation for loss
of more than one phalanx of a digit shall
be the same as for the loss of the entire
digit. Compensation for loss of the first
phalanx shall be one-half of the
compensation for the loss of the entire
digit.
(25) Amputated arm or leg:
Compensation for an arm or a leg, if
amputated at or above the elbow or the
knee, shall be the same as for the loss
of the arm or leg; but, if amputated
between the elbow and the wrist, or
between the knee and the ankle, the
compensation shall be the same as for
the loss of the hand or the foot.
(26) Binocular vision or percent of
vision: Compensation for loss of
binocular vision, or for 80 percent or
more of the vision of an eye shall be the
same as for the loss of the eye.
(27) Two or more digits:
Compensation for loss of two or more
digits, one or more phalanges of two or
more digits of a hand or foot may be
proportioned to the loss of use of the
hand or foot occasioned thereby, but
shall not exceed the compensation for
the loss of a hand or a foot.
(28) Total loss of use: Compensation
for a permanent total loss of use of a
member shall be the same as for loss of
the member.
(29) Partial loss or partial loss of use:
Compensation for permanent partial
loss or loss of use of a member may be
for proportionate loss of use of the
member.
(30) Consecutive awards: In any case
in which there occurs a loss or loss of
use of more than one member or parts
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of more than one member set forth in
paragraph (d) of this section, but not
amounting to permanent total disability,
the award of compensation shall be for
the loss or loss of use of each such
member or part thereof, which awards
shall run consecutively.
(31) Other cases: In all other cases
within this class of disability the
compensation during the continuance of
disability shall be that proportion of
compensation for permanent total
disability, as determined under
paragraph (c) of this section, which is
equal in percentage to the degree or
percentage of physical impairment
caused by the disability.
(32) Compensation under paragraph
(d) of this section for permanent partial
disability shall be in addition to any
compensation for temporary total or
temporary partial disability under this
section, and awards for temporary total,
temporary partial, and permanent
partial disability shall run
consecutively.
(e) In the event a beneficiary covered
under subpart B can demonstrate that
the amount payable under the special
schedule would result in a payment that
would be demonstrably less than the
amount payable under the law of his
home country, the Director retains the
discretion to pay that amount of
compensation under 5 U.S.C.
8137(a)(2)(A), not to exceed the amount
payable under FECA. To request
benefits under this paragraph, the
beneficiary must submit the following:
(1) Translated copies of the applicable
local statute as well as any regulations,
policies and procedures the beneficiary
avers are applicable; and
(2) A translated copy of an opinion
rendered by an attorney licensed in that
jurisdiction or an advisory opinion from
a court or administrative tribunal that
explains the benefits payable to the
beneficiary.
§ 25.102 How is compensation for death of
a non-citizen non-resident employee 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 the undertaker or person
entitled to reimbursement, reasonable
funeral expenses not exceeding $800.
(b) To the surviving spouse, if there is
no child, 30 percent of the monthly pay
until his or her death or remarriage
subject to the lump sum provisions of 5
U.S.C. 8135.
(c) To the surviving spouse, if there is
a child, the compensation payable
under paragraph (b) of this section, and
in addition thereto 10 percent of the
monthly wage for each child, not to
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49651
exceed a total of 50 percent of the
monthly pay for such surviving spouse
and children subject to the lump sum
provisions of 5 U.S.C. 8135. If a child
has a guardian other than the surviving
spouse, the compensation payable on
account of such child shall be paid to
such guardian. The compensation
entitlement of any child shall cease
when he or she dies, marries or reaches
the age of 18 years, or if over such age
and incapable of self-support, becomes
capable of self-support.
(d) To the children, if there is no
surviving spouse, 25 percent of the
monthly pay for one child and 10
percent thereof for each additional
child, not to exceed a total of 50 percent
of the monthly pay thereof, divided
among such children share and share
alike subject to the lump sum provisions
of 5 U.S.C. 8135. The compensation
entitlement of each child shall cease
when he or she dies, marries or reaches
the age of 18, or if over such age and
incapable of self-support, becomes
capable of self-support. The
compensation of a child under legal age
shall be paid to its guardian, if there is
one, otherwise to the person having the
custody or care of such child, for such
child, as the Director in his or her
discretion shall determine.
(e) To the parents, if one is wholly
dependent for support upon the
deceased employee at the time of his or
her death and the other is not
dependent to any extent, 20 percent of
the monthly pay; if both are wholly
dependent, 10 percent thereof to each;
if one is or both are partly dependent,
a proportionate amount in the discretion
of the Director. The compensation to a
parent or parents in the percentages
specified shall be paid if there is no
surviving spouse or child, but if there is
a surviving spouse or child, there shall
be paid so much of such percentages for
a parent or parents as, when added to
the total of the percentages of the
surviving spouse and children, will not
exceed a total of 50 percent of the
monthly pay. These payments are
subject to the lump sum provision of 5
U.S.C. 8135.
(f) To the brothers, sisters,
grandparents and grandchildren, if one
is wholly dependent upon the deceased
employee for support at the time of his
or her death, 20 percent of the monthly
pay to such dependent; if more than one
are wholly dependent, 30 percent of
such pay, divided among such
dependents share and share alike; if
there is no one of them wholly
dependent, but one or more are partly
dependent, 10 percent of such pay
divided among such dependents share
and share alike. The compensation to
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such beneficiaries shall be paid if there
is no surviving spouse, child or
dependent parent. If there is a surviving
spouse, child or dependent parent, there
shall be paid so much of the above
percentages as, when added to the total
of the percentages payable to the
surviving spouse, children and
dependent parents, will not exceed a
total of 50 percent of such pay. These
payments are subject to the lump sum
provision of 5 U.S.C. 8135.
(g) The compensation entitlement of
each beneficiary under paragraphs (e)
and (f) of this section shall be paid until
he or she, if a parent or grandparent,
dies, marries or ceases to be dependent,
or, if a brother, sister or grandchild,
dies, marries or reaches the age of 18
years, or if over such age and incapable
of self-support, becomes capable of selfsupport. The compensation of a brother,
sister or grandchild under legal age shall
be paid to his or her guardian, if there
is one, otherwise to the person having
the custody or care of such person, for
such person, as the Director in his or her
discretion shall determine.
(h) Upon the cessation of any person’s
compensation for death under this
subpart, the compensation of any
remaining person entitled to continuing
compensation in the same case shall
remain the same so that the continuing
compensation shall be at the same rate
each person previously received.
(i) In cases where there are two or
more classes of persons entitled to
compensation for death under this
subpart, and the apportionment of such
compensation as provided in this
section would result in injustice, the
Director may in his or her discretion
modify the apportionments to meet the
requirements of the case.
(j) Compensation for death shall be
paid where practicable in a lump sum
pursuant to section 8135.
(k) In the event a beneficiary eligible
for death benefits covered under subpart
B can demonstrate that the amount
payable under the special schedule
would result in a payment that would
be demonstrably less than the amount
payable under the law of his home
country, the Director retains the
discretion to pay that amount of
compensation under 5 U.S.C.
8137(a)(2)(A), not to exceed the amount
payable under FECA. To request
benefits under this paragraph, the
beneficiary must submit the following:
(1) Translated copies of the applicable
local statute as well as any regulations,
policies and procedures the beneficiary
asserts are applicable; and
(2) A translated copy of an opinion
rendered by an attorney licensed in that
jurisdiction or an advisory opinion from
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a court or administrative tribunal that
explains the benefits payable to the
beneficiary.
(l) A FECA death gratuity of $65,000
may be payable for the death of a noncitizen non-resident employee should
the death be a result of injury incurred
in connection with service with an
Armed Force in a contingency operation
as set forth in subpart J of Part 10.
Subpart C—Extensions of the Special
Schedule of Compensation
§ 25.200 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 of direct-hire employees of the
U.S. Military Forces covered by the
Philippine Medical Care Program and
the Employees’ Compensation Program
pursuant to the agreement signed by the
United States and the Republic of the
Philippines on March 10, 1982 who are
also members of the Philippine Social
Security System, the special schedule of
compensation established in subpart B
of this part shall apply, with the
modifications or additions specified in
paragraphs (b) through (k) of this
section, in the Republic of the
Philippines, to injury or death occurring
on or after July 1, 1968, with the
following limitations:
(1) Temporary disability. Benefits for
payments accruing on and after July 1,
1969, for injuries causing temporary
disability and which occurred on and
after July 1, 1968, shall be payable at the
rates in the special schedule as modified
in this section.
(2) Permanent disability and death.
Benefits for injuries occurring on and
after July 1, 1968, which cause
permanent disability or death, shall be
payable at the rates specified in the
special schedule as modified in this
section for all awards not paid in full
before July 1, 1969, and any award paid
in full prior to July 1, 1969: Provided,
that application for adjustment is made,
and the adjustment will result in
additional benefits of at least $10. In the
case of injuries or death occurring on or
after December 8, 1941 and prior to July
1, 1968, the special schedule as
modified in this section may be applied
to prospective awards for permanent
disability or death, provided that the
monthly and aggregate maximum
provisions in effect at the time of injury
or death shall prevail. These maxima are
$50 and $4,000, respectively.
(b) Death benefits. 400 weeks’
compensation at two-thirds of the
weekly wage rate, shared equally by the
eligible survivors in the same class.
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(c) Death beneficiaries. Benefits are
payable to the survivors in the following
order of priority (all beneficiaries in the
highest applicable classes are entitled to
share equally):
(1) Surviving spouse and unmarried
children under 18, or over 18 and totally
incapable of self-support.
(2) Dependent parents.
(3) Dependent grandparents.
(4) Dependent grandchildren, brothers
and sisters who are unmarried and
under 18, or over 18 and totally
incapable of self-support.
(d) Burial allowance. 14 weeks’ wages
or $400, whichever is less, payable to
the eligible survivor(s), regardless of the
actual expense. If there is no eligible
survivor, actual burial expenses may be
paid or reimbursed, in an amount not to
exceed what would be paid to an
eligible survivor.
(e) Permanent total disability. 400
weeks’ compensation at two-thirds of
the weekly wage rate.
(f) Permanent partial disability.
Where applicable, the compensation
provided in § 25.100(c)(1) through (19)
subject to an aggregate limitation of 400
weeks’ compensation. In all other cases,
provided for permanent total disability
that proportion of the compensation
(paragraph (e) of this section) which is
equivalent to the degree or percentage of
physical impairment caused by the
disability.
(g) Temporary partial disability. Twothirds of the weekly loss of wageearning capacity.
(h) Compensation period for
temporary disability. Compensation for
temporary disability is payable for a
maximum period of 80 weeks.
(i) Maximum compensation. The total
aggregate compensation payable in any
case, for injury or death or both, shall
not exceed $8,000, exclusive of medical
costs and burial allowance. The weekly
rate of compensation for disability or
death shall not exceed $35.
(j) Method of payment. Only
compensation for temporary disability
shall be payable periodically.
Compensation for permanent disability
and death shall be payable in full at the
time the extent of entitlement is
established.
(k) Exceptions. The Director in his or
her discretion may make exceptions to
the regulations in this section by:
(1) Reapportioning death benefits, for
the sake of equity.
(2) Excluding from consideration
potential death beneficiaries who are
not available to receive payment.
(3) Paying compensation for
permanent disability or death on a
periodic basis, where this method of
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payment is considered to be in the best
interest of the beneficiary.
§ 25.201 How is 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
the modifications or additions specified
in paragraph (b) of this section, as of
December 8, 1941, in all cases of injury
(or death from injury) which occurred
between December 8, 1941 and
December 31, 1961, inclusive, and shall
be applied retrospectively in all such
cases of injury (or death from injury).
Compensation in all such cases pending
as of July 15, 1946, shall be readjusted
accordingly, with credit taken in the
amount of compensation paid prior to
such date. Refund of compensation shall
not be required if the amount of
compensation paid in any such case,
otherwise than through fraud,
misrepresentation or mistake, and prior
to July 15, 1946, exceeds the amount
provided for under this paragraph, and
such case shall be deemed compromised
and paid under 5 U.S.C. 8137.
(b) The total aggregate compensation
payable in any case under paragraph (a)
of this section, for injury or death or
both, shall not exceed the sum of
$4,000, exclusive of medical costs. The
maximum monthly rate of
compensation in any such case shall not
exceed the sum of $50.
(c) The benefit amounts payable
under the provisions of the
Commonwealth Employees’
Compensation Act of 1930–1964,
Australia, shall apply as of January 1,
1962, in Australia, as the exclusive
measure of compensation in cases of
injury (or death from injury) according
on and after January 1, 1962, and shall
be applied retrospectively in all such
cases, occurring on and after such date:
Provided, that the compensation
payable under the provisions of this
paragraph shall in no event exceed that
payable under the FECA.
sroberts on DSKD5P82C1PROD with PROPOSALS
§ 25.202 How is the Special Schedule
applied for Japanese seamen?
(a) General. The special schedule of
compensation established by subpart B
of this part shall apply as of November
1, 1971, with the modifications or
additions specified in paragraphs (b)
through (i) of this section, to injuries
VerDate Mar<15>2010
16:31 Aug 12, 2010
Jkt 220001
sustained outside the continental
United States or Canada by direct-hire
Japanese seamen who are neither
citizens nor residents of the United
States or Canada and who are employed
by the Military Sealift Command in
Japan.
(b) Temporary total disability. Weekly
compensation shall be paid at 75
percent of the weekly wage rate.
(c) Temporary partial disability.
Weekly compensation shall be paid at
75 percent of the weekly loss of wageearning capacity.
(d) Permanent total disability.
Compensation shall be paid in a lump
sum equivalent to 360 weeks’ wages.
(e) Permanent partial disability. (1)
The provisions of § 25.101 of this part
shall apply to the types of permanent
partial disability listed in paragraphs
(d)(1) through (13) and (d)(24) through
(29) of that section: Provided that
weekly compensation shall be paid at 75
percent of the weekly wage rate and that
the number of weeks allowed for
specified losses shall be changed as
follows:
(i) Arm lost: 312 weeks.
(ii) Leg lost: 288 weeks.
(iii) Hand lost: 244 weeks.
(iv) Foot lost: 205 weeks.
(v) Eye lost: 160 weeks.
(vi) Thumb lost: 75 weeks.
(vii) First finger lost: 46 weeks.
(viii) Second finger lost: 30 weeks.
(ix) Third finger lost: 25 weeks.
(x) Fourth finger lost: 15 weeks.
(xi) Great toe lost: 38 weeks.
(xii) Toe, other than great toe lost: 16
weeks.
(2) In all other cases, that proportion
of the compensation provided for
permanent total disability in paragraph
(d) of this section which is equivalent to
the degree or percentage of physical
impairment caused by the injury.
(f) Death. If there are two or more
eligible survivors, compensation
equivalent to 360 weeks’ wages shall be
paid to the survivors, share and share
alike. If there is only one eligible
survivor, compensation equivalent to
300 weeks’ wages shall be paid. The
following survivors are eligible for death
benefits:
(1) Spouse who lived with or was
dependent upon the employee.
(2) Unmarried children under 21 who
lived with or were dependent upon the
employee.
PO 00000
Frm 00059
Fmt 4701
Sfmt 9990
49653
(3) Adult children who were
dependent upon the employee by reason
of physical or mental disability.
(4) Dependent parents, grandparents
and grandchildren.
(g) Burial allowance. $1,000 payable
to the eligible survivor(s), regardless of
actual expenses. If there are no eligible
survivors, actual expenses may be paid
or reimbursed, up to $1,000.
(h) Method of payment. Only
compensation for temporary disability
shall be payable periodically, as
entitlement accrues. Compensation for
permanent disability and death shall be
payable in a lump sum.
(i) Maxima. In all cases, the maximum
weekly benefit shall be $130. Also,
except in cases of permanent total
disability and death, the aggregate
maximum compensation payable for
any injury shall be $51,000. This
amount will be adjusted annually on
March 1 in accordance with the
percentage amount determined by the
cost of living adjustment under 5 U.S.C.
8146a.
(j) Prior injury. In cases where injury
or death occurred prior to November 1,
1971, benefits will be paid in
accordance with regulations
promulgated, contained in 20 CFR parts
1–399, edition revised as of January 1,
1971.
§ 25.203 How is the Special Schedule
applied to non-resident aliens in the
Territory of Guam?
The special schedule of compensation
established by subpart B of this part
shall apply to an injury or death
occurring on or after [DATE 60 DAYS
FROM DATE OF PUBLICATION OF
FINAL RULE] in the Territory of Guam
to non-resident alien employees
recruited in foreign countries for
employment by the military
departments in the Territory of Guam.
This schedule shall not apply to any
employee who becomes a bona fide
permanent resident as such claims will
be decided in accordance with § 25.5.
Signed at Washington, DC, this 28th of July
2010.
Shelby Hallmark,
Director, Office of Workers’ Compensation
Programs.
[FR Doc. 2010–18965 Filed 8–12–10; 8:45 am]
BILLING CODE 4510–CH–P
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Agencies
[Federal Register Volume 75, Number 156 (Friday, August 13, 2010)]
[Proposed Rules]
[Pages 49596-49653]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2010-18965]
[[Page 49595]]
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Part III
Department of Labor
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Office of Workers' Compensation Programs
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20 CFR Parts 1, 10, and 25
Performance of Functions; Claims for Compensation Under the Federal
Employees' Compensation Act; Compensation for Disability and Death of
Noncitizen Federal Employees Outside the United States; Proposed Rule
Federal Register / Vol. 75 , No. 156 / Friday, August 13, 2010 /
Proposed Rules
[[Page 49596]]
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DEPARTMENT OF LABOR
Office of Workers' Compensation Programs
20 CFR Parts 1, 10, and 25
RIN 1240-AA03
Performance of Functions; Claims for Compensation Under the
Federal Employees' Compensation Act; Compensation for Disability and
Death of Noncitizen Federal Employees Outside the United States
AGENCY: Office of Workers' Compensation Programs, Department of Labor.
ACTION: Notice of proposed rulemaking.
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SUMMARY: The Department of Labor proposes to amend the regulations
governing the administration of the Federal Employees' Compensation Act
(FECA), which provides benefits to all civilian Federal employees and
certain other groups of employees and individuals who are injured or
killed while performing their jobs. The Department of Labor also
proposes to revise the regulations establishing the authority of the
Office of Workers' Compensation Programs (OWCP) which administers the
FECA.
The existing rules have been amended to acknowledge a change in the
organization of the OWCP and amendments to the FECA which have occurred
since the last time the regulations were amended in 1999. These changes
also update the regulations by taking into account changes in
technology and other changes to improve administrative efficiency. As
many FECA claimants are not represented, the regulations are revised to
insert FECA statutory references as a frame of reference for clarity
and ease of use. The regulations include adding the skin as an organ
pursuant to 5 U.S.C. 8107(c)(22). The regulations also create a new
special schedule covering injuries to non-citizen non-resident Federal
employees outside the United States. Finally, the regulations covering
the processing of medical bills have been updated to provide for
greater use of technology in that process to reduce costs and to
clarify requirements for such submissions.
DATES: Written comments must be submitted on or before October 12,
2010.
ADDRESSES: You may submit comments on the proposed rule, identified by
Regulatory Information Number (RIN) 1240-AA03, by one of the following
methods:
Federal e-Rulemaking Portal: The Internet address to
submit comments on the rule is https://www.regulations.gov. Follow the
Web site instructions for submitting comments.
Mail: Submit written comments to Shelby Hallmark,
Director, Office of Workers' Compensation Programs, U.S. Department of
Labor, Room S-3524, 200 Constitution Avenue, NW., Washington, DC 20210.
Because of security measures, mail directed to Washington, DC is
sometimes delayed. We will only consider comments postmarked by the
U.S. Postal Service or other delivery service on or before the deadline
for comments.
Instructions: All comments must include the RIN 1240-AA03 for this
rulemaking. Receipt of any comments, whether by mail or Internet, will
not be acknowledged. Because DOL continues to experience delays in
receiving postal mail in the Washington, DC area, commenters are
encouraged to submit any comments by mail early.
Comments on the proposed rule will be available for public
inspection during normal business hours at the address listed above for
mailed comments. Persons who need assistance to review the comments
will be provided with appropriate aids such as readers or print
magnifiers. Copies of this proposed rule may be obtained in alternative
formats (e.g., large print, audiotape or disk) upon request. To
schedule an appointment to review the comments and/or to obtain the
proposed rule in an alternative format, contact OWCP at 202-693-0031
(this is not a toll-free number).
Written comments on the information collection requirements
described in this proposed rule should be sent to the Office of
Information and Regulatory Affairs, Office of Management and Budget,
Attention: Desk Officer for Office of Workers' Compensation Programs,
Washington, DC 20503.
FOR FURTHER INFORMATION CONTACT: Shelby Hallmark, Director, Office of
Workers' Compensation Programs, U.S. Department of Labor, Room S-3524,
200 Constitution Avenue, NW., Washington, DC 20210, Telephone: 202-693-
0031 (this is not a toll-free number).
Individuals with hearing or speech impairments may access this
telephone number via TTY by calling the toll-free Federal Information
Relay Service at 1-800-877-8339.
SUPPLEMENTARY INFORMATION:
I. Background
The FECA provides compensation for wage loss, medical care, and
vocational rehabilitation to Federal employees and certain other
individuals who are injured in the performance of their duties, or who
develop illnesses as a result of factors of their Federal employment.
It also provides monetary benefits to the survivors of employees who
are killed in the performance of duty or die as the result of factors
of their Federal employment.
II. Overview of the Regulations
The program's regulations were last substantially revised in 1999.
Since then, the organization and authority of OWCP has changed.
Furthermore, new provisions have been added to the statute, and
experience has shown that certain parts of the regulations need
clarification or revision to promote fairness and efficiency in the
claims process. In addition, technological advances that may help
preserve administrative resources and improve efficiency in the claims
process have been made since the last update of the regulations.
Accordingly, OWCP has determined that the regulations governing the
administration of claims under FECA require updating.
As many sections of the regulations are based on longstanding
interpretations and program practice and do not require revision, this
is not a wholesale revision of the existing regulations. However,
consistent with past practice on FECA regulatory revisions, the entire
regulation is being republished for ease of use. A detailed listing of
the regulations changed and a description of those changes follows.
20 CFR Part 1
This part has been amended to reflect the change in organization at
the Department of Labor that occurred on November 8, 2009, when the
Employment Standards Administration (ESA) was dissolved and the
authority that the Secretary of Labor had previously delegated under
the FECA to ESA was delegated by the Secretary to the Director, OWCP.
20 CFR Part 10
Subpart A--General Provisions
This subpart is substantially the same as current subpart A
(Sec. Sec. 10.0 through 10.18). The majority of the changes to this
subpart involve updating the regulations as a result of the addition of
the new death gratuity benefit which was added to the FECA by 5 U.S.C.
8102a and by adding clarification language in a number of sections, as
described below.
[[Page 49597]]
Definitions and Forms
Section 10.1 has been modified by deleting the references to the
Assistant Secretary for Employment Standards, as that position no
longer exists.
Section 10.2 now includes the new subpart J of this part which
administers the new death gratuity benefit that was added to the FECA
in 2008 by 5 U.S.C. 8102a.
Section 10.3 has been revised to update the list of OMB control
numbers to include the new death gratuity forms and the subrogation
forms.
Section 10.5 has been revised to restore statutory definitions and
citations, as experience has shown that the absence of these citations
caused confusion regarding what definitions were applicable and to
clarify the definition of a recurrence of disability in paragraph (x).
Section 10.6 now includes a reference to the special definitions
for survivorship and dependency that apply only to the new death
gratuity benefit to promote clarity.
Section 10.7 has been updated to list all new forms described above
and to eliminate forms that are no longer in use.
Information in Program Records
Section 10.10 has been amended to state that information may be
released under the Privacy Act through the routine uses that apply to
the records if such release is consistent with the purpose for which
the records were created. This change has been made to clarify that
there are certain situations where release of claim files is not
appropriate under the Privacy Act.
Rights and Penalties
These sections have been updated to reflect current provisions that
impose civil penalties on false claims under the FECA and to
affirmatively require submission of documentation where appropriate.
Section 10.16 has been revised to note that a civil action may be
maintained under the False Claims Act to recover erroneous payments
under the FECA.
Section 10.17 has been revised to clarify when benefits are
terminated for defrauding the Federal Government to eliminate confusion
concerning what day should be used when a guilty plea has been entered.
The addition specifies what date to use in such a situation. This
section has also been revised to provide an affirmative duty for the
employing agency (which may be fulfilled by the employing agency's
Office of Inspector General (OIG) in a case where the agency OIG is
actively involved) to submit this information to OWCP.
Section 10.18 has been revised to provide an affirmative duty for a
beneficiary to report to OWCP any incarceration based on a felony
conviction that would result in forfeiture of that beneficiary's right
to compensation during incarceration.
Subpart B--Filing Notices and Claims; Submitting Evidence
This subpart is substantially the same as the current subpart B
(Sec. Sec. 10.100 through 10.127). Most changes involve the electronic
submission of forms, a method of submission that was not feasible when
the regulations were last changed. Other changes include the
administration of the change to the waiting period for employees of the
United States Postal Service necessitated by a statutory amendment in 5
U.S.C. 8117.
Notices and Claims for Injury, Disease, and Death--Employee or
Survivor's Actions
Sections 10.100, 10.101, 10.102, 10.103 and 10.105 all have been
revised by an identical provision that allows for electronic submission
of notices and claims forms. This change includes a provision that all
agencies should create a method to submit such forms electronically by
December 31, 2012, by which time OWCP will have implemented a method to
enhance the agencies' ability to file forms electronically. Electronic
filing will speed OWCP's processing of claim forms.
Section 10.102 was also revised to clarify the language specifying
that CA-7 should be used to claim compensation for additional periods
of disability.
Section 10.103 has been revised to provide authority to create a
separate form for schedule award claims under 5 U.S.C. 8107.
Section 10.104 was revised to make clear what constitutes a
recurrence of disability and to explain the basis for a modification of
a loss of wage-earning capacity determination. The addition of
paragraph (c) to this section clarifies the distinction by
incorporating longstanding case law from the Employees' Compensation
Appeals Board.
Notices and Claims for Injury, Disease, and Death--Employer's Actions
Section 10.111 has been amended to reflect the change in law
regarding waiting periods and Postal Service employees incorporated in
the amendment to 5 U.S.C. 8117.
Evidence and Burden of Proof
Section 10.115 has been revised to clearly state that the burden of
proof remains with the claimant even when OWCP requests additional
information, as provided by ECAB case law.
Section 10.116 has been amended to reflect current OWCP practice,
in that OWCP does not require the submission of the checklist in all
situations.
Decisions on Entitlement to Benefits
Section 10.127 has been amended to remove the language stating that
service of a decision on either the claimant or the representative
would count as service to both, as this no longer reflects current
practice of the OWCP. OWCP serves decisions on entitlement on both the
claimant and the representative.
Subpart C--Continuation of Pay
Subpart C (Sec. Sec. 10.200 through 10.224) continues unchanged
from the previous regulations, except for a change to Sec. 10.200. The
change to this section reflects the change to continuation of pay to
Postal Service employees as a result of the statutory change to 5
U.S.C. 8117 which provides that Postal Service employees are not
entitled to continuation of pay for the first 3 days of temporary
disability unless that disability exceeds 14 days or is followed by
permanent disability.
Subpart D--Medical and Related Benefits
Subpart D (Sec. Sec. 10.300 through 10.337) is mostly unchanged.
Most of the changes involve technological advances since the last
update of the regulations; these advances caused procedures to be
changed. Other changes clarify the prior regulations or codify current
practice. Additionally, OWCP seeks to codify authority to make changes
to the manner in which durable medical equipment and other non-
physician services are provided.
Emergency Medical Care
Section 10.300 has been amended to clarify that the Form CA-16,
which provides authorization for initial medical treatment, authorizes
treatment from the date of injury, not the date the form is signed.
This change corrects situations where this form has not been signed
immediately--this posed difficulties for employees obtaining treatment
at the time of injury.
Medical Treatment and Related Issues
Section 10.310 has been amended in a number of places. First, this
section was amended to cross-reference the sections of this part that
provide for medical billing and authorization. This
[[Page 49598]]
section has also been modified to codify OWCP's authority to utilize
field nurses in facilitating and coordinating medical care.
Furthermore, this section has been modified to codify OWCP's authority
to contract with specific providers to provide services and appliances;
OWCP has determined that providing such services in this method may aid
in delivering such benefits as well as controlling medical costs. This
section has also been amended to clearly state that certain non-
physician providers provide authorized services to injured employees,
to the extent allowed under Federal and state law including licensure
by any appropriate regulating body for that profession. This change was
made to clarify that OWCP pays for such services.
Section 10.310 has also been amended to add a new paragraph (c)
that covers durable medical equipment. This paragraph provides first
that any provider of such equipment must be registered in Medicare's
Durable Medical Equipment, Prosthetics, Orthotics and Supplies
Competitive Bidding Process. This requirement provides OWCP a measure
of reliability (including financial security) in such providers, while
helping OWCP avoid using scarce program resources to police all such
providers. Furthermore, this paragraph allows OWCP, when purchasing
such equipment, to offset the costs of prior rental payments against a
future purchase and provide refurbished equipment when appropriate.
Both of these additions were done to help control the cost of providing
this equipment.
Section 10.311(d) has been amended to clarify that, for a
chiropractor's service to be under the direction of a qualified
physician, that physician must prescribe those services.
Section 10.314 relating to attendant services has been
substantially shortened from the prior regulation. As the number of
attendant services provided in cases prior to January 4, 1999 has
decreased and since the current policy has been successfully in place
for over a decade, the extended discussion is no longer necessary.
Section 10.315 has been substantially modified, increasing the
reasonable distance of travel up to a roundtrip distance of 100 miles.
OWCP encountered situations where employees no longer had doctors
within the old distance of 25 miles and determined that such an
increase is needed. This section has also been amended to explain
procedures regarding types and manner of transport allowed.
Directed Medical Examinations
Section 10.320 has been amended to add language allowing another
person to be present at an OWCP directed examination where there is
rationalized medical evidence demonstrating that such a person is
needed in addition to situations such as where a translator or sign
language interpreter is needed to aid communication. This change is in
response to a number of claims where such a person may be needed. This
language sets forth one method to meet the ``exceptional
circumstances'' test for allowing an additional person in the
examination where medically indicated.
Section 10.321 has been updated to add the word ``impartial'' to
the referee medical review to conform with terminology normally used by
OWCP and ECAB.
Section 10.323 has been amended by expressly noting that
examinations required by OWCP includes testing such as functional
capacity evaluations and by adding a new paragraph (b) which details
the process of how OWCP suspends compensation for obstructing a medical
examination, as well as to explain how the employee can end that
obstruction. This paragraph was added to provide additional guidance to
claimants and to consolidate all such information in one location.
Medical Reports
Section 10.333 has been amended to provide a cross reference to the
information necessary to support an award for loss to a scheduled
member and to include additional language used in the AMA Guides.
Medical Bills
Section 10.335 has been amended to bring this section in line with
current OWCP procedures, and to provide notice that OWCP may contract
with a third party for bill payment processing.
Section 10.337 has been amended to update the cross-references
contained in that section.
Subpart E--Compensation and Related Benefits
Subpart E (Sec. Sec. 10.400 through 10.441) also is largely
unchanged. Of the changes made to this subpart, most are to clarify the
prior regulation by codifying ECAB case law or promoting administrative
efficiency by changing practices that experience has shown waste
program resources. A few additions have been made, including the
addition of the skin as a scheduled member and including language
regarding electronic payments and their effect on overpayments.
Section 10.400 has been amended to include the statutory citation
for when permanent total disability is presumed to clarify the origin
of that definition.
Section 10.401 has been amended to reflect the change in when the
waiting period begins for Postal Service employees after the amendment
to 5 U.S.C 8117 as described above.
Section 10.403 has been amended to restore the factors used in
determining wage-earning capacity where actual earnings do not fairly
and reasonably represent that capacity as described in 5 U.S.C. 8115 to
facilitate ease of use of that section.
Section 10.404, which describes how compensation is paid for loss
to scheduled members under 5 U.S.C. 8107, has been revised to include
the statutory scheduled members as well as those that have been added
by regulation. Furthermore, Section 10.404 has been amended to include
the skin as a schedule member, for up to 205 weeks of compensation, for
injuries sustained on or after September 11, 2001. In determining
compensation payable for the skin, OWCP considered a number of factors,
including relative percentage impairments of the other scheduled
members under the AMA Guides, as well as the length of compensation
that had been previously given for members added by regulation. After
considering these factors, OWCP determined that the skin should be
given the maximum amount of compensation that had been previously given
when adding new members. As to the date of applicability of this
section, OWCP determined that use of September 11, 2001 would allow
individuals who had sustained severe burns or other skin conditions on
or after September 11, 2001 to file schedule award claims. OWCP further
determined that use of an earlier date would create problems of proof
and eligibility under Sec. 10.413 of this section.
Compensation for Death
Section 10.410 has been amended to clarify that survivor's benefits
under 5 U.S.C. 8133 are separate and distinct from the death gratuity
benefits under 5 U.S.C. 8102a.
Section 10.412 has been amended to include statutory citations to
the amounts provided for burial and related expenses.
Section 10.413 has been amended to codify in the regulations the
requirement of 5 U.S.C. 8109 and ECAB case law which states a claim for
a schedule award must be filed while the claimant is still alive in
order for the claim to be paid.
[[Page 49599]]
Section 10.415 has been amended to modernize the regulation to
provide additional detail on handling the increasing number of
governmental payments made by electronic fund transfer (EFT).
Section 10.417 has been revised to streamline the process by which
employees establish the dependency for adult children who are incapable
of self-support. In this section, OWCP has reduced the reporting
requirements in those instances to once each year, while placing an
affirmative duty on the employee to report any change in the conditions
to OWCP. This change will promote efficiency for OWCP when, in a number
of instances, the circumstance of such dependency will not change more
than annually. Furthermore, this section was amended to add a new
section allowing an employee to establish the permanency of an adult
child's mental or physical disability; such a change will save OWCP
administrative resources while eliminating an employee's burden to
continuously submit reports for an adult child with permanent mental or
physical disabilities.
Adjustments to Compensation
Section 10.421 has been amended to reflect the change in language
to 5 U.S.C. 8116 made after the repeal of 5 U.S.C. 5532.
Section 10.422 has been amended to note that the availability of
lump sum payments for non-citizen non-resident employees will be
addressed in Part 25 of this title.
Section 10.423 has been amended to delete the discussion that
suggests claims for compensation are subject to garnishment from claims
from other Federal agencies. The authority for this language is unclear
and has not been used.
Section 10.425 has been amended to clarify that leave donated to an
employee through an employing agency's leave program is not leave that
may be restored through the leave buy back process.
Overpayments
Since the last time the regulations were updated, most recipients
of FECA benefits have been moved to electronic payment (EFT). This has
created questions as to when an employee has knowledge of receipt of
their FECA benefits. Accordingly, Sec. 10.430 has been amended to
reflect a growing concern regarding when a claimant receives, or has
knowledge of, an electronic payment. This section has been amended to
add the normal business transaction definition of such receipt, where a
payee is presumed to have knowledge of any payment once the payee has
had the opportunity to receive a bank statement from the payee's
financial institution.
Section 10.433 was likewise amended to reflect that an employee is
required to review such bank statements in order to ensure proper
receipt of FECA benefits.
Section 10.440 was amended to include District Court and ECAB case
law which allow OWCP to pursue collection of a debt while any such
determination is pending before ECAB.
Section 10.441 was amended to describe the process used by OWCP to
collect overpayment debts following the death of an employee.
Subpart F--Continuing Benefits
Subpart F (Sec. Sec. 10.500 through 10.541) is largely unchanged.
Most changes clarify the prior regulations by further describing the
procedures and policies of OWCP and by including ECAB case law
explaining those prior regulations.
Section 10.500 was amended to clarify the difference between light
duty work and a suitable work determination and to restore statutory
citations to the regulations.
Section 10.501 was amended to include a new subparagraph (2), which
allows OWCP to require less medical documentation for continuing
benefits where circumstances merit such reduced documentation, reducing
the burden on those employees and the OWCP in administering their
claims.
Section 10.502 was revised to update the language used to describe
the impartial referee examination to bring the terminology in line with
OWCP and ECAB usage.
Return to Work--Employer's Responsibilities
Section 10.509 was also modified by splitting that section into two
sections, Sec. Sec. 10.509 and 10.510. Section 10.509 now covers only
situations involving the effect of downsizing of a light duty position
on compensation. New Sec. 10.510 describes when a light duty job may
be used as a basis for a loss of wage-earning capacity determination.
Section 10.511 is a new section that codifies longstanding ECAB
case law which delineates the only circumstances under which a loss of
wage-earning capacity determination may be modified.
Return to Work--Employee's Responsibilities
Section 10.517 has been modified to make clear that, when an
employee refuses to seek or accept suitable work, the resulting
termination of compensation applies to any prior injuries in which
compensation may be payable as well as the claim under which
compensation has ended. Consistent with longstanding program practice,
medical benefits remain payable in all cases following such
termination.
Sections 10.518 and 10.519 have been modified to delete references
to registered nurses under the vocational rehabilitation of employees,
as ECAB ruled that the sanctions for failing to cooperate with
vocational rehabilitation do not apply to nurse services.
New Sec. 10.521 has been added to explain the process followed by
OWCP when an employee that is involved in the vocational rehabilitation
process or other return to work effort elects to receive benefits from
the Office of Personnel Management instead of FECA benefits, and is no
longer participating in the vocational rehabilitation process. In such
instances, OWCP may use the evidence of file to perform a loss of wage-
earning capacity determination.
Reports of Earnings From Employment and Self-Employment
Section 10.525 has been amended to clarify that an employee must
report all employment activities, including all outside employment, as
such employment is material to a disability determination. This is so
even where such earnings from concurrent dissimilar employment held at
the time of injury do not reduce compensation payable but may still
assist OWCP in assessing disability for work.
Section 10.526 has been amended to clarify that, in reporting
volunteer activities, the fact that the employee received no monetary
compensation for those activities is not a basis for not reporting
those activities to OWCP under ECAB case law.
Reports of Dependents
Section 10.537 was amended to reflect the change in reporting for
non-minor children to once a year as described above in the discussion
regarding Sec. 10.417.
Reduction and Termination of Compensation
Section 10.540 has been reorganized by splitting paragraph (a) into
new paragraphs (a) and (b), to promote clarity and ease of use of the
section.
Subpart G--Appeals Process
Subpart G (Sec. Sec. 10.600 through 10.626) also continues largely
unchanged; the changes that have been made were made to promote clarity
and update the
[[Page 49600]]
regulations to reflect changes in practice and technology that have
taken place since the regulations were last updated.
Reconsiderations and Reviews by the Director
Section 10.606 has been modified to add language requiring that
reconsideration requests be signed and dated. This change has been made
to clarify when such requests have been made and to allow OWCP to
ascertain that the person (such as a representative) requesting
reconsideration is authorized to do so at the time such request is
made.
Section 10.607 has been modified by changing the date of the
reconsideration request for timeliness purposes from the date mailed to
the date received by OWCP. This change has been made to promote
efficiency in administering these requests; current electronic case
files and associated scanning procedures and resources would be
unnecessarily strained by the requirement to scan in every envelope
from every letter sent to OWCP. Accordingly, the prior regulation which
referenced the date of mailing on the envelope led to some uncertainty
regarding when a request was filed. Rather than reduce the amount of
time given to file the reconsideration request, OWCP has chosen simply
to require that the request must have been received by OWCP within the
one year period, a period which provides more than ample time to obtain
the necessary evidence or make the legal arguments in support of a
reconsideration request.
Section 10.609 has been modified to note that OWCP will not wait
for comments from an employing agency regarding a request for
reconsideration when comments from the agency are not germane to the
issue being resolved on reconsideration.
Hearings
The sections governing hearings before the OWCP's Branch of
Hearings and Review (BHR) have been modified to reference that
procedures are available for reasonable accommodation in the hearing
process. The sections include procedures for BHR to conduct hearings by
teleconference and videoconference. Such methods although permissible
under the regulations were not in active use at the time of the last
regulation update. These sections have also been modified to clarify
certain policies related to such processes and to provide discretion to
utilize other technology to conduct hearings as it may become
available. OWCP has found that use of teleconferences and
videoconferences allows hearings to be held more quickly.
Section 10.616 has been modified to accommodate the alternative
types of hearings as described above.
Section 10.617 has been amended to cover a number of policies that
were previously not contained in the regulation. First, this section
has been amended to note how an employee may request accommodations
from BHR. This section has also been amended to note that hearings are
generally limited to one hour, and to note that the transcript is the
official record of the hearing. This section has also been modified to
clarify the time limits for submitting comments following a hearing.
Finally, a new paragraph (h) has been inserted as a reference to a
statutory section that allows an OWCP hearing representative to certify
any misconduct to a District Court for appropriate handling.
Section 10.618 has been amended to clarify that when an employee
requests that a hearing be changed to a review of the written record,
all evidence should be submitted with that request.
Section 10.619 has been amended to clarify that, if a request for a
subpoena has been made, the requestor must explain why that subpoena is
necessary at the time the request is made.
Section 10.621 has been amended to clarify that it is in the
discretion of the hearing representative whether the employing agency
may be allowed to have more than one representative attend the hearing.
Section 10.622 has been amended to accommodate the alternative
forms of hearings discussed above and to explain how these types of
hearings are handled with a monthly docket. Furthermore, this section
has been amended to add new paragraph (d) which restores prior
regulatory language addressing abandonment of hearings, as experience
since that language was removed has shown that this section is
necessary.
Review by the Employees' Compensation Appeals Board (ECAB)
Section 10.626 has been amended to cross reference ECAB's rules of
procedure to promote ease of use of these regulations.
Subpart H--Special Provisions
While a majority of the provisions in subpart H (Sec. Sec. 10.700
through 10.741) remain unchanged, some extensive changes have been made
to certain portions of this subpart. This subpart has been changed to
reference that an attorney associated with a law firm may represent
claimants and to explicitly state that OWCP will communicate with the
law firm. The regulation clarifies OWCP policy that contingency fees
are not allowed under any circumstances. The FECA subrogation sections
have been expanded to codify current practice; to promote transparency
and clarity where a third party is responsible for an injury or death;
and to better explain how subsequent FECA subrogation claims are
handled. Finally, the provision relating to coverage of Peace Corps
volunteers has been amended to restore statutory language concerning
such coverage.
Representation
Section 10.700 has been amended to clarify that where a claimant's
representative is an attorney, OWCP may communicate with any attorney
or employee in the attorney's law firm. This change has been made to
comport with the normal practice of law firms, and to promote efficient
administration of the program.
Section 10.702 has been amended to clearly state that contingency
fees are not allowed when representing beneficiaries under the FECA.
This explicit language addressing contingency fees was removed during
the last regulatory update; however, experience since that update has
shown that the removal of this language caused some to believe that the
ban on contingency fees had been removed as well.
Section 10.703 has been amended to make clear that OWCP can only
approve representative's fees for services that have been performed
before OWCP and references that ECAB must approve fees for services
performed in front of ECAB. This section has also been amended to
clarify that contingency fees will not be approved for any reason.
Contingency fees are not subject to the deemed approved process where a
fee may be approved if a claimant concurs with such a fee. If the fee
is disputed, the regulations provide that OWCP will consider the
customary local charge for a representative with similar qualifications
in considering what constitutes a reasonable fee.
New Sec. 10.704 takes a sentence that was formerly the last
sentence of Sec. 10.702 and makes that language its own section in the
regulations to highlight that a person who collects a fee without OWCP
approval may be charged with a misdemeanor. OWCP believes that adding
this section is useful to provide notice of the potential consequences
for failing to comport with the OWCP fee approval process.
[[Page 49601]]
Third Party Liability
Section 10.705 has been amended to give the full address where
information on subrogation claims may be sent.
Section 10.707 has been amended to require that certain information
be submitted in circumstances where the employee is not the only
plaintiff in a suit.
The provisions in 10.711 have been moved to 10.712 and the
provisions in 10.712 have been moved to 10.711. The new order reflects
the process of calculating the refund and surplus in accordance with
the statement of recovery form CA-1108. New section 10.711
substantially revises existing 10.712 by setting out in greater detail
the manner in which the amount of recovery of the employee is
determined including situations where property loss is part of the
recovery or where loss of consortium or wrongful death and survival
actions have been asserted. New section 10.711 reflects the procedures
that have been in place for a number of years. New section 10.712
clarifies that the crediting of a surplus is done against both wage-
loss compensation and medical benefits, sets out in greater detail the
steps to follow in calculating the refund and surplus, and provides
additional examples of how these calculations are made, including cases
where loss of consortium and wrongful death and survival actions have
been asserted.
Section 10.714 has been amended to clarify that OWCP may seek
reimbursement for all types of benefits paid to an employee when that
employee has successfully sued a third party for that injury. This
section was also amended to clarify how that employee may obtain a copy
of the disbursements made by OWCP in their claim.
Peace Corps Volunteers
Section 10.730 has been amended to restore the statutory language
applicable to coverage of claims involving Peace Corps volunteers. The
statutory language is a recognition of the difficulties for such
volunteers to establish that certain injuries or illness are related to
their covered activities. The change in language allows OWCP to
consider evidence that controverts coverage, while still allowing the
volunteer to establish the claim, and clarifies that a temporary
aggravation of a preexisting condition may be paid without the
necessity of accepting all disability related to that condition.
Subpart I--Information for Medical Providers
A number of changes have been made to subpart I. The majority of
these changes have been made to address OWCP's electronic bill
processing system and to comport this processing with that done in
other compensation programs administered by OWCP. This subpart has also
been revised to modify the process by which OWCP excludes medical
providers by including the Department of Labor's Office of Inspector
General (DOL OIG) in the process.
Medical Records and Bills
Section 10.800 has been amended to describe OWCP's provider
enrollment process and automated bill processing and authorization
system, which has been substantially revised since the last time the
regulations were updated.
Section 10.801 has been amended to clarify how medical bills are
currently processed. In addition to those changes, this section has
been amended to codify that OWCP may require nursing homes to abide by
a fee schedule for admissions made after the effective date of the
regulations, which will standardize billing practices and promote cost
containment. This change was made to allow additional modifications to
restrain medical costs. This section has also been amended to provide
language making it clear that providers must adhere to accepted
industry standards when billing. Since the advent of the automated bill
processing system, OWCP wishes to make clear that billing practices
such as upcoding and unbundling are not in accord with industry
standards and such attempts to circumvent the fee schedule through
practices described in that language are prohibited under the
regulations.
Section 10.802 has been amended to clarify how an injured employee
currently seeks reimbursement for out of pocket expenses.
Medical Fee Schedule
Section 10.805 has been revised in order to give the Director of
OWCP the express authority to determine a fee schedule for services
provided by nursing homes.
Sections 10.806, 10.807 and 10.810 have been revised to update the
indices used in determining maximum fees.
Section 10.809 has been revised to clarify that the fee schedule
regarding medicinal drugs applies whether the drugs are dispensed by a
pharmacy or by a doctor in his office. This section has also been
modified by providing OWCP the authority to require the use of a
specific contract provider for medicinal drugs. This language has been
added so that OWCP may explore the use of such providers to contract
for better prices on such drugs. Finally, the authority to require the
use of generic drugs has been moved to this section as new paragraph
(c).
Section 10.811 has been amended to clarify that OWCP will not
correct procedure or diagnosis codes on submitted bills. Instead those
bills will be returned to the provider for correction as the
responsibility for proper submission lies with the provider.
Exclusion of Providers
Section 10.815 has been amended by adding new sections (i) and (j)
which set out additional reasons for excluding providers. These new
reasons are failure to update a change in provider status and having
engaged in conduct found by OWCP to be misleading, deceptive or unfair.
Experience has shown that a number of ambiguities existed in the
exclusion process. These new reasons for exclusion are meant to address
any perceived loopholes.
Section 10.816 has been amended to add new section (c), which
clarifies that a provider may be voluntarily excluded without the
exclusion procedures being initiated. This clarification is meant to
address situations where providers agree to be excluded, for example,
where a provider may be faced with criminal charges.
Section 10.817 has been amended to provide that the DOL OIG is
primarily responsible for investigating possible exclusions of
providers. This duty was previously handled by OWCP; OWCP has no
investigatory arm and lacks resources to carry out this responsibility.
Accordingly, this change in the exclusion process has been made in an
effort to improve administrative efficiency of this process.
Sections 10.818 through 10.821 have been revised to change the
deciding official in exclusion matters from just the Regional Director
to the Regional Director or any other official specified by the
Director of the Division of Federal Employees' Compensation. This
change has been made in recognition of the fact that there may be
instances (such as where more than one region is involved) where the
Regional Director should not be the deciding official. These sections
have also been modified to recognize the role of DOL OIG.
Sections 10.823 through 10.824 have been modified to change the
manner in which the administrative law judge's recommended decision
becomes final.
[[Page 49602]]
Previously, the decision became final if no objection was filed, which
could lead to confusion regarding the finality of this decision.
Accordingly, these sections were changed to reflect that no recommended
decision regarding exclusion will become final until the Director of
OWCP issues the decision in final form.
Section 10.825 has been amended to reflect current practices of
OWCP, as OWCP may use discretion in determining who should receive the
notice of exclusion.
Section 10.826 has been modified to correct terminology and to
clarify that the Director of OWCP can order reinstatement of excluded
providers.
Subpart J--Death Gratuity
Subpart J (Sec. Sec. 10.900 through 10.916) is unchanged.
20 CFR Part 25
Section 8137 provides the conditions and parameters for FECA
coverage for non-citizen non-resident employees of the United States,
any territory, or Canada. Part 25 describes how benefits will be paid
to such employees. Since the last time the regulations were revised in
1999, OWCP encountered a number of situations where the current
regulatory scheme proved difficult to administer. Although payment of
FECA compensation across the board in all such cases remains
substantially disproportionate, benefits payable under local law may be
insufficient. Moreover, many of the distinctions and definitions such
as those for third country and fourth country nationals do not comport
with the current governmental hiring realities for non-citizen non-
resident employees. In conducting the comparison required by the
current regulations between compensation payable under local law and
that paid under FECA, OWCP encountered situations where the families of
employees who were killed received very limited compensation under
local law. However, payment of ongoing FECA benefits in such cases
would result in disproportionately high payments and would pose
administrative challenges in managing such cases on an ongoing basis.
Under the statute, the Director has authority to create a special
schedule. In the interests of fairness, the Director has created a new
more comprehensive special schedule for disability that will pay
benefits on an ongoing basis for up to two years and will pay a lump
sum thereafter for cases of permanent total disability. Payment for
death benefits will also be paid in a lump sum to facilitate benefit
delivery and to ease administrative burdens.
Subpart A--General Provisions
Section 25.1 has been revised to reflect a change in policy in the
payment of compensation under the FECA to employees of the United
States who are neither citizens nor residents of the United States, any
territory or Canada, as well as any dependents of such employees. The
proposed revision would modify the benefit structure for foreign
nationals by using the authority under section 8137 to create a special
schedule of compensation for foreign nationals to provide a reduced
percentage of FECA benefits.
Section 25.2(a) has been revised to provide that the special
schedule set forth in subpart B would apply to any non-citizen non-
resident federal employee who is neither hired nor employed in the
United States, Canada or in a possession or territory of the United
States, with respect to any injury (or injury resulting in death)
occurring subsequent to the effective date of the publication of the
final rule in the Federal Register. This paragraph has also been
amended to provide that the benefit provisions adopted under this
paragraph shall apply to injuries that occur on or after 60 days after
the publication of the final rule in the Federal Register.
Section 25.2(b) has been revised to provide that the special
schedule in subpart B shall apply to cases unless the injured non-
citizen non-resident employee receives compensation pursuant to a
specific separate agreement between the United States and another
government (or similar compensation from another sovereign government);
or the employee receives compensation pursuant to the special schedule
under subpart C; or the employee otherwise establishes entitlement to
compensation under local law pursuant to section 25.100(e) of this
part.
Section 25.2(c) has been revised to provide that compensation in
all cases of such non-citizen non-resident employees paid and closed
prior to 60 days after the publication of the final rule in the Federal
Register are deemed paid in full under 5 U.S.C. 8137.
Section 25.2(d) has been revised to provide that the compensation
received under the special schedule set forth in subpart B or as
otherwise specified in 25.2(b) is the exclusive measure of compensation
in cases of injury (or death from injury) to non-citizen non- resident
employees of the United States.
Section 25.2(e) was revised to clarify the information in former
section 25.2(e) that compensation for disability and death of non-
citizen non-resident employees outside the United States under this
part shall in no event exceed that generally payable under the FECA.
Section 25.3 remains unchanged, providing that the Director has the
authority to make lump-sum awards (in the manner prescribed by 5 U.S.C.
8135) to settle claims pursuant to section 8137 of the FECA.
Section 25.4 remains unchanged except for section (c) which is
revised to read ``Verification of the employment and casualty by
Department of Defense personnel'' instead of military personnel to
reflect the responsibility for providing the type of evidence necessary
to make a claim under this section resides with that department.
Section 25.5 has been renumbered but otherwise remains unchanged,
providing that an employee who is a permanent resident of any United
States possession, territory, commonwealth or trust territory will
receive full FECA benefits.
Subpart B--the Special Schedule of Compensation
Section 25.100 has been amended to provide that the definitions
under this subpart are generally the same as those provided under the
rest of the FECA statute and regulations.
25.101 has been modified to describe how compensation for temporary
total and partial disability, and permanent total and permanent partial
disability are paid to non-citizen non-resident employees. Provisions
under the former section 25.101 for death benefits have been revised
and currently appear in section 25.102.
Section 25.101(a) has been amended to provide for temporary total
disability, where the injured employee is disabled for less than two
years. Under this provision, the employee receives 50 percent of the
monthly pay during the period of such disability.
Section 25.101(b) has been amended to provide for temporary partial
disability, where the injured employee is unable to earn equivalent
wages to those earned at the time of injury, but is not totally
disabled for work. Under this section, the injured employee receives a
proportional amount of compensation for the period of disability. The
compensation amount is that portion of compensation for temporary total
disability, as determined under paragraph (a) of this section, which is
equal in percentage to the degree or percentage of physical impairment
caused by the disability.
Section 25.101(c) has been amended to provide for permanent total
[[Page 49603]]
disability, where the injured employee will be disabled for greater
than two years. This section provides that the injured employee will
receive a lump sum settlement, made by the manner prescribed under 5
U.S.C. 8135, based on compensation equaling 50 percent of the monthly
pay.
Section 25.101(d) has been amended to provide for permanent partial
disability, where there is permanent impairment involving the loss, or
loss of use, of a member or function of the body. This section
describes how compensation is paid for loss to scheduled members, and
has been revised to be consistent with the time periods listed under 5
U.S.C. 8107 and the regulations listed in 20 CFR 10.404. In addition to
the revision of the time periods, this section has been amended to
include the skin as a schedule member, for up to 205 weeks of
compensation. This change is consistent with changes made under Part
10. The employee will be paid in a lump sum according to 5 U.S.C. 8135,
at 50 percent of the monthly pay.
Section 25.101(e) has been amended to provide that if a beneficiary
can show that the amount payable under the special schedule would be
demonstrably less than the amount payable under the law of his home
country, the Director has the discretion to pay an amount in excess of
the special schedule of compensation under 5 U.S.C. 8137(a)(2)(A), not
to exceed the amount payable under FECA. This section provides that to
request such benefits, the beneficiary must submit the following
information: translated copies of the applicable local statute as well
as any regulations, policies and procedures the beneficiary asserts are
applicable; and a translated copy of an opinion rendered by an attorney
licensed in that jurisdiction or an advisory opinion from a court or
administrative tribunal that explains the benefits payable to the
beneficiary.
Section 25.102 has been amended to describe how compensation for
death of a non-citizen non-resident employee is paid. Section 25.102(a)
has been amended to provide for burial expenses not to exceed $800.
Sections 25.102(b)-(i) remain similar in the distribution of death
benefits (as delineated in former sections 25.101(a)-(i)) but have been
limited to a total of 50 percent of monthly pay. Section 25.102(j) has
been added to provide that death benefits should be paid in a lump sum
where practicable pursuant to 5 U.S.C. 8135.
Section 25.102(k) has been added to provide if a beneficiary can
show that the amount payable under the special schedule would be
demonstrably less than the amount payable under the law of his home
country, the Director has the discretion to pay an amount in excess of
the special schedule under 5 U.S.C. 8137(a)(2)(A), not to exceed the
amount payable under FECA. This section provides that the beneficiary
must submit the same information as noted in section 25.101(e).
Section 25.102(l) has been added to inform claimants that a FECA
death gratuity of $65,000 may be payable for the death of a non-citizen
non-resident employee should the death be a result of injury incurred
in connection with service with an Armed Force in a contingency
operation as set forth in subpart J of part 10.
Subpart C
The provisions of subpart C are largely unchanged in this
regulatory revision. Section 25.202 has been amended to adjust the
maximum amount of compensation payable under that section for
inflation, and to provide an automatic, yearly escalator to that
amount.
Section 25.203 has been amended to apply the special schedule
created by subpart B to non-citizen, non-resident employees in the
Territory of Guam, without the modifications contained in the prior
regulations.
III. Administrative Requirements for the Proposed Rulemaking
Executive Order 12866
This proposed regulatory action constitutes a ``significant'' rule
within the meaning of Executive Order 12866 in that any executive
agency could be required to participate in the development of claims
for benefits under this regulatory action. The Department believes,
however, that as this regulatory action merely updates existing
regulations, this regulatory action will not have a significant
economic impact on the economy, or any person or organization subject
to the proposed changes. The Department has projected that the addition
of the skin as an organ under the schedule award provision as well as
the revision of the part 25 compensation for non-citizen non-resident
employees will result in additional expenditures of $10,893,434 over
ten years.
This projection is based on a very limited amount of data and a
single significant event could result in substantially higher than
projected expenditures. This has been reviewed by the Office of
Management and Budget for consistency with the President's priorities
and the principles set forth in Executive Order 12866.
Regulatory Flexibility Act of 1980
This proposed rule has been reviewed in accordance with the
Regulatory Flexibility Act of 1980, as amended by the Small Business
Regulatory Enforcement Fairness Act of 1996, 5 U.S.C. 601-612. The
Department has concluded that the rule does not involve regulatory and
informational requirements regarding businesses, organizations, and
governmental jurisdictions subject to regulation.
Paperwork Reduction Act (PRA)
This rule contains information collection requirements subject to
the Paperwork Reduction Act (PRA) of 1995, 44 U.S.C. 3501, et seq. The
requirements set out in this rule were both submitted to and approved
by the OMB under the OMB Control Numbers 1240-0001, 1240-0007, 1240-
0008, 1240-0009, 1240-0012, 1240-0013, 1240-0015, 1240-0016, 1240-0017,
1240-0018, 1240-0019, 1240-0022, 1240-0044, 1240-0045, 1240-0046, 1240-
0047, 1240-0049, 1240-0050 and 1240-0051.
The National Environmental Policy Act of 1969
The Department certifies that this proposed rule has been assessed
in accordance with the requirements of the National Environmental
Policy Act of 1969, 42 U.S.C. 4321 et seq. (NEPA). The Department
concludes that NEPA requirements do not apply to this rulemaking
because this proposed rule includes no provisions impacting the
maintenance, preservation, or enhancement of a healthful environment.
Federal Regulations and Policies on Families
The Department has reviewed this proposed rule in accordance with
the requirements of section 654 of the Treasury and General Government
Appropriations Act of 1999, 5 U.S.C. 601 note. These proposed
regulations were not found to have a potential negative effect on
family well-being as it is defined thereunder.
Executive Order 13045: Protection of Children From Environmental Health
Risks and Safety Risks
The Department certifies that this proposed rule has been assessed
regarding environmental health risks and safety risks that may
disproportionately affect children. These proposed regulations were not
found to have a potential negative effect on the health or safety of
children.
[[Page 49604]]
Unfunded Mandates Reform Act of 1995 and Executive Order 13132
The Department has reviewed this proposed rule in accordance with
the requirements of Executive Order 13132, 64 FR 43225 (Aug. 10, 1999),
and the Unfunded Mandates Reform Act of 1995, 2 U.S.C. 1501 et seq.,
and has found no potential or substantial direct effects on the States,
on the relationship between the national government and the States, or
on the distribution of power and responsibilities among the various
levels of government. As there is no Federal mandate contained herein
that could result in increased expenditures by State, local, or tribal
governments or by the private sector, the Department has not prepared a
budgetary impact statement.
Executive Order 13175: Consultation and Coordination With Indian Tribal
Governments
The Department has reviewed this proposed rule in accordance with
Executive Order 13175, 65 FR 67249 (Nov. 9, 2000), and has determined
that it does not have ``tribal implications.'' The proposed rule does
not ``have substantial direct effects on one or more Indian tribes, on
the relationship between the Federal government and Indian tribes, or
on the distribution of power and responsibilities between the Federal
government and Indian tribes.''
Executive Order 12630: Governmental Actions and Interference With
Constitutionally Protected Property Rights
The Department has reviewed this proposed rule in accordance with
Executive Order 12630, 53 FR 8859 (Mar. 15, 1988), and has determined
that it does not contain any ``policies that have takings
implications'' in regard to the ``licensing, permitting, or other
condition requirements or limitations on private property use, or that
require dedications or exactions from owners of private property.''
Executive Order 13211: Energy Supply, Distribution, or Use
The Department has reviewed this proposed regulation and has
determined that the provisions of Executive Order 13211, 66 FR 28355
(May 18, 2001), are not applicable as there are no direct or implied
effects on energy supply, distribution, or use.
The Privacy Act of 1974, 5 U.S.C. 552a, as Amended
Claims filed under these regulations are subject to the current
Privacy Act System of Records, DOL/GOVT-1, Office of Workers'
Compensation Programs, Federal Employees' Compensation Act File, 67 FR
16826 (April 8, 2002).
Clarity of This Regulation
Executive Order 12866, 58 FR 51735 (September 30, 1993), and the
President's memorandum of June 1, 1998, require each agency to write
all rules in plain language. The Department invites comments on how to
make this proposed rule easier to understand.
List of Subjects in 20 CFR Parts 1, 10, and 25
Administrative practice and procedure, Claims, Government
employees, Labor, Workers' compensation.
For reasons set forth in the preamble, the Office of Workers'
Compensation Programs, Department of Labor, amends 20 CFR chapter I as
follows:
1. Part 1 is revised to read as follows:
PART 1--PERFORMANCE OF FUNCTIONS
Sec.
1.1 Under what authority does the Office of Workers' Compensation
Programs operate?
1.2 What functions are assigned to OWCP?
1.3 What rules are contained in this chapter?
1.4 Where are other rules concerning OWCP functions found?
1.5 When was the former Bureau of Employees' Compensation abolished?
1.6 How were many of OWCP's current functions administered in the
past?
Authority: 5 U.S.C. 301, 8145 and 8149 (Reorganization Plan No.
6 of 1950, 15 FR 3174, 3 CFR, 1949-1953 Comp., p. 1004, 64 Stat.
1263); 42 U.S.C. 7384d and 7385s-10; E.O. 13179, 65 FR 77487, 3 CFR,
2000 Comp., p. 321; Secretary of Labor's Order No. 13-71, 36 FR
8155; Employment Standards Order No. 2-74, 39 FR 34722; Secretary of
Labor's Order No. 10-2009, 74 FR 218.
Sec. 1.1 Under what authority does the Office of Workers'
Compensation Programs operate?
(a) The Assistant Secretary of Labor for Employment Standards, by
authority vested in him by the Secretary of Labor in Secretary's Order
No. 13-71 (36 FR 8755), established in the Employment Standards
Administration (ESA) an Office of Workers' Compensation Programs (OWCP)
by Employment Standards Order No. 2-74 (39 FR 34722). The Assistant
Secretary subsequently designated as the head thereof a Director who,
under the general supervision of the Assistant Secretary, administered
the programs assigned to OWCP by the Assistant Secretary.
(b) Effective November 8, 2009, ESA was dissolved into its four
component parts, including OWCP. Secretary of Labor's Order 10-2009 (74
FR 218) cancelled or modified all prior orders and directives
referencing ESA, devolved certain authorities and responsibilities of
ESA to OWCP, and delegated authority to the Director, OWCP, to
administer the programs now assigned directly to OWCP.
Sec. 1.2 What functions are assigned to OWCP?
The Secretary of Labor has delegated authority and assigned
responsibility 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
extended (5 U.S.C. 8101 et seq.), except 5 U.S.C. 8149 as it pertains
to the Employees' Compensation Appeals Board.
(b) The War Hazards Compensation Act, as amended (42 U.S.C. 1701 et
seq.).
(c) The War Claims Act of 1948, as amended (50 U.S.C. App. 2003 et
seq.).
(d) The Energy Employees Occupational Illness Compensation Program
Act of 2000, as amended (42 U.S.C. 7384 et seq.), except 42 U.S.C.
7385s-15 as it pertains to the Office of the Ombudsman, and activities,
pursuant to Executive Order 13179 (``Providing Compensation to
America's Nuclear Weapons Workers'') of December 7, 2000, assigned to
the Secretary of Health and Human Services, the Secretary of Energy and
the Attorney General.
(e) The Longshore and Harbor Workers' Compensation Act, as amended
and extended (33 U.S.C. 901 et seq.), except: 33 U.S.C. 919(d) with
respect to administrative law judges in the Office of Administrative
Law Judges; 33 U.S.C. 921(b) as it pertains to the Benefits Review
Board; and activities, pursuant to 33 U.S.C. 941, assigned to the
Assistant Secretary of Labor for Occupational Safety and Health.
(f) The Black Lung Benefits Act, as amended (30 U.S.C. 901 et
seq.)., including 26 U.S.C. 9501, except: 33 U.S.C. 919(d) as
incorporated by 30 U.S.C. 932(a), with respect to administrative law
judges in the Office of Administrative Law Judges; and 33 U.S.C. 921(b)
as incorporated by 30 U.S.C. 932(a), as it applies to the Benefits
Review Board.
Sec. 1.3 What rules are contained in this chapter?
The rules in this chapter are those governing the OWCP functions
under the Federal Employees' Compensation Act, the War Hazards
Compensation
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Act, the War Claims Act and the Energy Employees Occupational Illness
Compensation Program Act of 2000.
Sec. 1.4 Where are other rules concerning OWCP functions found?
(a) The rules of OWCP governing its functions under the Longshore
and Harbor Workers' Compensation Act and its extensions are set forth
in subchapter A of chapter VI of this title.
(b) The rules of OWCP governing its functions under the Black Lung
Benefits Act program are set forth in subchapter B of chapter VI of
this title.
(c) The rules and regulations of the Employees' Compensation
Appeals Board are set forth in chapter IV of this title.
(d) The rules and regulations of the Benefits Review Board are set
forth in Chapter VII of this title.
Sec. 1.5 When was the former Bureau of Employees' Compensation
abolished?
By Secretary of Labor's Order issued September 23, 1974 (39 FR
34723), issued con