20 CFR Part 10
PART 10—CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED
- PART 10—CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED
- Chapter I—Office of Workers' Compensation Programs, Department of Labor › Subchapter B—Federal Employees' Compensation Act
- Subpart A—General Provisions
- 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 the regulations in this subchapter?
- § 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?
- 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?
- Calculation of COP
- § 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?
- 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?
- Subpart D—Medical and Related Benefits
- Emergency Medical Care
- § 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 work-related?
- § 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?
- 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 work-related injury?
- Medical Reports
- § 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?
- 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
- Compensation for Disability and Impairment
- § 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?
- 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?
- § 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 pre-recoupment 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?
- 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?
- 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?
- § 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 or representative 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?
- § 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 How 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?
- § 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?
- 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 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?
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