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Home Page > Executive Branch > Code of Federal Regulations > Electronic Code of Federal Regulations
e-CFR Data is current as of February 4, 2010
TITLE 20--Employees' Benefits
CHAPTER I--OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR
SUBCHAPTER C--ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000
PART 30--CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000, AS AMENDED
Subpart A--GENERAL PROVISIONS
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| What are the provisions of EEOICPA, in general? |
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| What rules govern the administration of EEOICPA and this chapter? |
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| In general, how have the tasks associated with the administration of EEOICPA claims process been assigned? |
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| What do these regulations contain? |
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| What are the definitions used in this part? |
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| Are all OWCP records relating to claims filed under EEOICPA considered confidential? |
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| Who maintains custody and control of claim records? |
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| What process is used by a person who wants to obtain copies of or amend EEOICPA claim records? |
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| May EEOICPA benefits be assigned, transferred or garnished? |
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| What penalties may be imposed in connection with a claim under the Act? |
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| Is a beneficiary who defrauds the government in connection with a claim for EEOICPA benefits still entitled to those benefits? |
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Subpart B--FILING CLAIMS; EVIDENCE AND BURDEN OF PROOF; SPECIAL PROCEDURES FOR CERTAIN CANCER CLAIMS
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| In general, how does an employee file an initial claim for benefits? |
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| In general, how is a survivor's claim filed? |
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| In general, how does an employee file a claim for additional impairment or wage-loss under Part E of EEOICPA? |
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| How does a claimant make sure that OWCP has the evidence necessary to process the claim? |
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| What must DOE do after an employee or survivor files a claim? |
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| Can OWCP request employment verification from other sources? |
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| Who is entitled to compensation under the Act? |
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| What is the claimant's responsibility with respect to burden of proof, production of documents, presumptions, and affidavits? |
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| What kind of evidence is needed to establish covered employment and how will that evidence be evaluated? |
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| What are the requirements for written medical documentation, contemporaneous records, and other records or documents? |
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| What kind of evidence is needed to establish a compensable medical condition and how will that evidence be evaluated? |
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| For those radiogenic cancer claims that do not seek benefits under Part B of the Act pursuant to the Special Exposure Cohort provisions, what will OWCP do once it determines that an employee contracted cancer? |
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Subpart C--ELIGIBILITY CRITERIA
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| What is the scope of this subpart? |
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| What are the criteria for eligibility for benefits relating to beryllium illnesses covered under Part B of EEOICPA? |
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| How does a claimant prove that the employee was a ''covered beryllium employee'' exposed to beryllium dust, particles or vapor in the performance of duty? |
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| How does a claimant prove a diagnosis of a beryllium disease covered under Part B? |
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| What are the criteria for eligibility for benefits relating to radiogenic cancer? |
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| How does a claimant establish that the employee has or had contracted cancer? |
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| How does a claimant establish that the employee contracted cancer after beginning employment at a DOE facility, an atomic weapons employer facility or a RECA section 5 facility? |
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| How does a claimant establish that the radiogenic cancer was at least as likely as not related to employment at the DOE facility, the atomic weapons employer facility, or the RECA section 5 facility? |
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| How does a claimant establish that the employee is a member of the Special Exposure Cohort? |
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| How does a claimant establish that the employee has sustained an injury, illness, impairment or disease as a consequence of a diagnosed cancer? |
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| What are the criteria for eligibility for benefits relating to chronic silicosis? |
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| How does a claimant prove exposure to silica in the performance of duty? |
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| How does a claimant establish that the employee has been diagnosed with chronic silicosis or has sustained a consequential injury, illness, impairment or disease? |
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| What are the criteria for eligibility for benefits under Part B of EEOICPA for certain uranium employees? |
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| How does a claimant establish that a covered uranium employee has sustained a consequential injury, illness, impairment or disease? |
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| What are the criteria necessary to establish that an employee contracted a covered illness under Part E of EEOICPA? |
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| How does a claimant prove employment-related exposure to a toxic substance at a DOE facility or a RECA section 5 facility? |
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| How does a claimant establish that the employee has been diagnosed with a covered illness, or sustained an injury, illness, impairment or disease as a consequence of a covered illness? |
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Subpart D--ADJUDICATORY PROCESS
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| What process will OWCP use to decide claims for entitlement and to provide for administrative review of those decisions? |
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| May subpoenas be issued for witnesses and documents in connection with a claim under Part B of EEOICPA? |
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| Who pays the costs associated with subpoenas? |
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| What information may OWCP request in connection with a claim under Part E of EEOICPA? |
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| How does OWCP determine entitlement to EEOICPA compensation? |
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| What does the recommended decision contain? |
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| To whom is the recommended decision sent? |
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| What must the claimant do if he or she objects to the recommended decision or wants to request a hearing? |
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| What happens if the claimant does not object to the recommended decision or request a hearing within 60 days? |
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| What will the FAB do if the claimant objects to the recommended decision but does not request a hearing? |
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| How is a review of the written record conducted? |
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| How is a hearing conducted? |
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| May a claimant postpone a hearing? |
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| How does the FAB issue a final decision on a claim? |
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| Can the FAB request a further response from the claimant or return a claim to the district office? |
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| Can the FAB consider objections to HHS's reconstruction of a radiation dose or to the guidelines OWCP uses to determine if a claimed cancer was at least as likely as not related to employment? |
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| May a claimant request reconsideration of a final decision of the FAB? |
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| Can a claim be reopened after the FAB has issued a final decision? |
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Subpart E--MEDICAL AND RELATED BENEFITS
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| What are the basic rules for obtaining medical treatment? |
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| What are the special rules for the services of chiropractors? |
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| What are the special rules for the services of clinical psychologists? |
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| Will OWCP pay for the services of an attendant? |
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| Will OWCP pay for transportation to obtain medical treatment? |
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| After selecting a treating physician, may an employee choose to be treated by another physician instead? |
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| Are there any exceptions to these procedures for obtaining medical care? |
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| Can OWCP require an employee to be examined by another physician? |
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| What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee? |
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| Who pays for second opinion and referee examinations? |
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| What are the requirements for medical reports? |
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| How and when should medical reports be submitted? |
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| What additional medical information may OWCP require to support continuing payment of benefits? |
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| How should medical bills and reimbursement requests be submitted? |
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| What are the time frames for submitting bills and reimbursement requests? |
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| If an employee is only partially reimbursed for a medical expense, must the provider refund the balance of the amount paid to the employee? |
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Subpart F--SURVIVORS; PAYMENTS AND OFFSETS; OVERPAYMENTS
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| What special statutory definitions apply to survivors under EEOICPA? |
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| What order of precedence will OWCP use to determine which survivors are entitled to receive compensation under EEOICPA? |
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| When is entitlement for survivors determined for purposes of EEOICPA? |
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| What procedures will OWCP follow before it pays any compensation? |
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| To whom and in what manner will OWCP pay compensation? |
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| What compensation will be provided to covered Part B employees who only establish beryllium sensitivity under Part B of EEOICPA? |
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| What is beryllium sensitivity monitoring? |
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| Under what circumstances may a survivor claiming under Part E of the Act choose to receive the benefits that would otherwise be payable to a covered Part E employee who is deceased? |
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| How does OWCP notify an individual of a payment made on a claim? |
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| What is an ''overpayment'' for purposes of EEOICPA? |
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| What does OWCP do when an overpayment is identified? |
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| Under what circumstances may OWCP waive recovery of an overpayment? |
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| If OWCP finds that the recipient of an overpayment was not at fault, what criteria are used to decide whether to waive recovery of it? |
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| Is a recipient responsible for an overpayment that resulted from an error made by OWCP? |
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| Under what circumstances would recovery of an overpayment defeat the purpose of the Act? |
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| Under what circumstances would recovery of an overpayment be against equity and good conscience? |
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| Can OWCP require the recipient of the overpayment to submit additional financial information? |
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| How does OWCP communicate its final decision concerning recovery of an overpayment? |
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| How are overpayments collected? |
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Subpart G--SPECIAL PROVISIONS
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| May a claimant designate a representative? |
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| Who may serve as a representative? |
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| Who is responsible for paying the representative's fee? |
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| Are there any limitations on what the representative may charge the claimant for his or her services? |
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| What rights does the United States have upon payment of compensation under EEOICPA? |
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| Under what circumstances must a recovery of money or other property in connection with an illness for which benefits are payable under EEOICPA be reported to OWCP? |
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| How is a structured settlement (that is, a settlement providing for receipt of funds over a specified period of time) treated for purposes of reporting the recovery? |
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| How does the United States calculate the amount to which it is subrogated? |
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| Is a settlement or judgment received as a result of allegations of medical malpractice in treating an illness covered by EEOICPA a recovery that must be reported to OWCP? |
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| Are payments to a covered Part B employee, a covered Part E employee or an eligible surviving beneficiary as a result of an insurance policy which the employee or eligible surviving beneficiary has purchased a recovery that must be reported to OWCP? |
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| If a settlement or judgment is received for more than one medical condition, can the amount paid on a single EEOICPA claim be attributed to different conditions for purposes of calculating the amount to which the United States is subrogated? |
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| What type of tort suits filed against beryllium vendors or atomic weapons employers may disqualify certain claimants from receiving benefits under Part B of EEOICPA? |
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| What happens if this type of tort suit was filed prior to October 30, 2000? |
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| What happens if this type of tort suit was filed during the period from October 30, 2000 through December 28, 2001? |
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| What happens if this type of tort suit was filed after December 28, 2001? |
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| Do all the parties to this type of tort suit have to take these actions? |
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| How will OWCP ascertain whether a claimant filed this type of tort suit and if he or she has been disqualified from receiving any benefits under Part B of EEOICPA? |
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| What does ''coordination of benefits'' mean under Part E of EEOICPA? |
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| How will OWCP coordinate compensation payable under Part E of EEOICPA with benefits from state workers' compensation programs? |
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| Under what circumstances will OWCP waive the statutory requirement to coordinate these benefits? |
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Subpart H--INFORMATION FOR MEDICAL PROVIDERS
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| What kinds of medical records must providers keep? |
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| How are medical bills to be submitted? |
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| How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses? |
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| What are the time limitations on OWCP's payment of bills? |
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| What services are covered by the OWCP fee schedule? |
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| How are the maximum fees defined? |
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| How are payments for particular services calculated? |
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| Does the fee schedule apply to every kind of procedure? |
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| How are payments for medicinal drugs determined? |
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| How are payments for inpatient medical services determined? |
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| When and how are fees reduced? |
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| If OWCP reduces a fee, may a provider request reconsideration of the reduction? |
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| If OWCP reduces a fee, may a provider bill the employee for the balance? |
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| What are the grounds for excluding a provider from payment under this part? |
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| What will cause OWCP to automatically exclude a physician or other provider of medical services and supplies? |
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| When are OWCP's exclusion procedures initiated? |
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| How is a provider notified of OWCP's intent to exclude him or her? |
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| What requirements must the provider's reply and OWCP's decision meet? |
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| How can an excluded provider request a hearing? |
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| How are hearings assigned and scheduled? |
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| How are subpoenas or advisory opinions obtained? |
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| How will the administrative law judge conduct the hearing and issue the recommended decision? |
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| How can a party request review by OWCP of the administrative law judge's recommended decision? |
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| What are the effects of non-automatic exclusion? |
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| How can an excluded provider be reinstated? |
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Subpart I--WAGE-LOSS DETERMINATIONS UNDER PART E OF EEOICPA
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| What types of wage-loss are compensable under Part E of EEOICPA? |
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| What special definitions does OWCP use in connection with Part E wage-loss determinations? |
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| What evidence does OWCP use to determine a covered Part E employee's average annual wage and whether he or she experienced compensable wage-loss under Part E of EEOICPA? |
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| May a claimant submit factual evidence in support of a different determination of average annual wage and/or wage-loss than that found by OWCP? |
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| How will OWCP calculate the average annual wage of a covered Part E employee? |
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| How will OWCP calculate the duration and extent of a covered Part E employee's initial period of compensable wage-loss? |
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| May a covered Part E employee claim for subsequent periods of compensable wage-loss? |
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| Are there special rules that OWCP will use to determine the extent of a deceased covered Part E employee's compensable wage-loss? |
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Subpart J--IMPAIRMENT BENEFITS UNDER PART E OF EEOICPA
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| Who can receive impairment benefits under Part E? |
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| How does OWCP determine the extent of an employee's impairment that is due to a covered illness contracted through exposure to a toxic substance at a DOE facility or a RECA section 5 facility, as appropriate? |
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| How will OWCP calculate the amount of the award of impairment benefits that is payable under Part E? |
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| How may an impairment evaluation be obtained? |
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| Who will pay for an impairment evaluation? |
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| Can an impairment evaluation obtained by OWCP be challenged prior to issuance of the recommended decision? |
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| How will the FAB evaluate new medical evidence submitted to challenge the impairment determination in the recommended decision? |
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| Will an impairment that cannot be assigned a numerical percentage using the AMA's Guides be included in the impairment rating? |
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| Does maximum medical improvement always have to be reached for an impairment to be included in the impairment rating? |
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| Can a covered Part E employee receive benefits for additional impairment following an award of such benefits by OWCP? |
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