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