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Electronic Code of Federal Regulations

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e-CFR Data is current as of April 23, 2014

TITLE 20—Employees' Benefits

CHAPTER I—OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR

SUBCHAPTER B—FEDERAL EMPLOYEES' COMPENSATION ACT

PART 10—CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION ACT, AS AMENDED

rule

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?
rule

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?
rule

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?
rule

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?
rule

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?
rule

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?
rule

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?
rule

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?
rule

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?
rule

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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