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Electronic Code of Federal Regulations

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e-CFR Data is current as of September 26, 2014

Title 20Chapter ISubchapter CPart 30


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

rule

Subpart A—GENERAL PROVISIONS

Introduction

§30.0
What are the provisions of EEOICPA, in general?
§30.1
What rules govern the administration of EEOICPA and this chapter?
§30.2
In general, how have the tasks associated with the administration of EEOICPA claims process been assigned?
§30.3
What do these regulations contain?

Definitions

§30.5
What are the definitions used in this part?

Information in Program Records

§30.10
Are all OWCP records relating to claims filed under EEOICPA considered confidential?
§30.11
Who maintains custody and control of claim records?
§30.12
What process is used by a person who wants to obtain copies of or amend EEOICPA claim records?

Rights and Penalties

§30.15
May EEOICPA benefits be assigned, transferred or garnished?
§30.16
What penalties may be imposed in connection with a claim under the Act?
§30.17
Is a beneficiary who defrauds the government in connection with a claim for EEOICPA benefits still entitled to those benefits?
rule

Subpart B—FILING CLAIMS; EVIDENCE AND BURDEN OF PROOF; SPECIAL PROCEDURES FOR CERTAIN CANCER CLAIMS

Filing Claims for Benefits Under EEOICPA

§30.100
In general, how does an employee file an initial claim for benefits?
§30.101
In general, how is a survivor's claim filed?
§30.102
In general, how does an employee file a claim for additional impairment or wage-loss under Part E of EEOICPA?
§30.103
How does a claimant make sure that OWCP has the evidence necessary to process the claim?

Verification of Alleged Employment

§30.105
What must DOE do after an employee or survivor files a claim?
§30.106
Can OWCP request employment verification from other sources?

Evidence and Burden of Proof

§30.110
Who is entitled to compensation under the Act?
§30.111
What is the claimant's responsibility with respect to burden of proof, production of documents, presumptions, and affidavits?
§30.112
What kind of evidence is needed to establish covered employment and how will that evidence be evaluated?
§30.113
What are the requirements for written medical documentation, contemporaneous records, and other records or documents?
§30.114
What kind of evidence is needed to establish a compensable medical condition and how will that evidence be evaluated?

Special Procedures for Certain Radiogenic Cancer Claims

§30.115
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?
rule

Subpart C—ELIGIBILITY CRITERIA

General Provisions

§30.200
What is the scope of this subpart?

Eligibility Criteria for Claims Relating to Covered Beryllium Illness Under Part B of EEOICPA

§30.205
What are the criteria for eligibility for benefits relating to beryllium illnesses covered under Part B of EEOICPA?
§30.206
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?
§30.207
How does a claimant prove a diagnosis of a beryllium disease covered under Part B?

Eligibility Criteria for Claims Relating to Radiogenic Cancer Under Parts B and E of EEOICPA

§30.210
What are the criteria for eligibility for benefits relating to radiogenic cancer?
§30.211
How does a claimant establish that the employee has or had contracted cancer?
§30.212
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?
§30.213
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?
§30.214
How does a claimant establish that the employee is a member of the Special Exposure Cohort?
§30.215
How does a claimant establish that the employee has sustained an injury, illness, impairment or disease as a consequence of a diagnosed cancer?

Eligibility Criteria for Claims Relating to Chronic Silicosis Under Part B of EEOICPA

§30.220
What are the criteria for eligibility for benefits relating to chronic silicosis?
§30.221
How does a claimant prove exposure to silica in the performance of duty?
§30.222
How does a claimant establish that the employee has been diagnosed with chronic silicosis or has sustained a consequential injury, illness, impairment or disease?

Eligibility Criteria for Certain Uranium Employees Under Part B of EEOICPA

§30.225
What are the criteria for eligibility for benefits under Part B of EEOICPA for certain uranium employees?
§30.226
How does a claimant establish that a covered uranium employee has sustained a consequential injury, illness, impairment or disease?

Eligibility Criteria for Other Claims Under Part E of EEOICPA

§30.230
What are the criteria necessary to establish that an employee contracted a covered illness under Part E of EEOICPA?
§30.231
How does a claimant prove employment-related exposure to a toxic substance at a DOE facility or a RECA section 5 facility?
§30.232
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?
rule

Subpart D—ADJUDICATORY PROCESS

§30.300
What process will OWCP use to decide claims for entitlement and to provide for administrative review of those decisions?
§30.301
May subpoenas be issued for witnesses and documents in connection with a claim under Part B of EEOICPA?
§30.302
Who pays the costs associated with subpoenas?
§30.303
What information may OWCP request in connection with a claim under Part E of EEOICPA?

Recommended Decisions on Claims

§30.305
How does OWCP determine entitlement to EEOICPA compensation?
§30.306
What does the recommended decision contain?
§30.307
To whom is the recommended decision sent?

Hearings and Final Decisions on Claims

§30.310
What must the claimant do if he or she objects to the recommended decision or wants to request a hearing?
§30.311
What happens if the claimant does not object to the recommended decision or request a hearing within 60 days?
§30.312
What will the FAB do if the claimant objects to the recommended decision but does not request a hearing?
§30.313
How is a review of the written record conducted?
§30.314
How is a hearing conducted?
§30.315
May a claimant postpone a hearing?
§30.316
How does the FAB issue a final decision on a claim?
§30.317
Can the FAB request a further response from the claimant or return a claim to the district office?
§30.318
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?
§30.319
May a claimant request reconsideration of a final decision of the FAB?

Reopening Claims

§30.320
Can a claim be reopened after the FAB has issued a final decision?
rule

Subpart E—MEDICAL AND RELATED BENEFITS

Medical Treatment and Related Issues

§30.400
What are the basic rules for obtaining medical treatment?
§30.401
What are the special rules for the services of chiropractors?
§30.402
What are the special rules for the services of clinical psychologists?
§30.403
Will OWCP pay for the services of an attendant?
§30.404
Will OWCP pay for transportation to obtain medical treatment?
§30.405
After selecting a treating physician, may an employee choose to be treated by another physician instead?
§30.406
Are there any exceptions to these procedures for obtaining medical care?

Directed Medical Examinations

§30.410
Can OWCP require an employee to be examined by another physician?
§30.411
What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee?
§30.412
Who pays for second opinion and referee examinations?

Medical Reports

§30.415
What are the requirements for medical reports?
§30.416
How and when should medical reports be submitted?
§30.417
What additional medical information may OWCP require to support continuing payment of benefits?

Medical Bills

§30.420
How should medical bills and reimbursement requests be submitted?
§30.421
What are the time frames for submitting bills and reimbursement requests?
§30.422
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 F—SURVIVORS; PAYMENTS AND OFFSETS; OVERPAYMENTS

Survivors

§30.500
What special statutory definitions apply to survivors under EEOICPA?
§30.501
What order of precedence will OWCP use to determine which survivors are entitled to receive compensation under EEOICPA?
§30.502
When is entitlement for survivors determined for purposes of EEOICPA?

Payment of Claims and Offset for Certain Payments

§30.505
What procedures will OWCP follow before it pays any compensation?
§30.506
To whom and in what manner will OWCP pay compensation?
§30.507
What compensation will be provided to covered Part B employees who only establish beryllium sensitivity under Part B of EEOICPA?
§30.508
What is beryllium sensitivity monitoring?
§30.509
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?

Overpayments

§30.510
How does OWCP notify an individual of a payment made on a claim?
§30.511
What is an “overpayment” for purposes of EEOICPA?
§30.512
What does OWCP do when an overpayment is identified?
§30.513
Under what circumstances may OWCP waive recovery of an overpayment?
§30.514
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?
§30.515
Is a recipient responsible for an overpayment that resulted from an error made by OWCP?
§30.516
Under what circumstances would recovery of an overpayment defeat the purpose of the Act?
§30.517
Under what circumstances would recovery of an overpayment be against equity and good conscience?
§30.518
Can OWCP require the recipient of the overpayment to submit additional financial information?
§30.519
How does OWCP communicate its final decision concerning recovery of an overpayment?
§30.520
How are overpayments collected?
rule

Subpart G—SPECIAL PROVISIONS

Representation

§30.600
May a claimant designate a representative?
§30.601
Who may serve as a representative?
§30.602
Who is responsible for paying the representative's fee?
§30.603
Are there any limitations on what the representative may charge the claimant for his or her services?

Third Party Liability

§30.605
What rights does the United States have upon payment of compensation under EEOICPA?
§30.606
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?
§30.607
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?
§30.608
How does the United States calculate the amount to which it is subrogated?
§30.609
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?
§30.610
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?
§30.611
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?

Effect of Tort Suits Against Beryllium Vendors and Atomic Weapons Employers

§30.615
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?
§30.616
What happens if this type of tort suit was filed prior to October 30, 2000?
§30.617
What happens if this type of tort suit was filed during the period from October 30, 2000 through December 28, 2001?
§30.618
What happens if this type of tort suit was filed after December 28, 2001?
§30.619
Do all the parties to this type of tort suit have to take these actions?
§30.620
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?

Coordination of Part E Benefits With State Workers' Compensation Benefits

§30.625
What does “coordination of benefits” mean under Part E of EEOICPA?
§30.626
How will OWCP coordinate compensation payable under Part E of EEOICPA with benefits from state workers' compensation programs?
§30.627
Under what circumstances will OWCP waive the statutory requirement to coordinate these benefits?
rule

Subpart H—INFORMATION FOR MEDICAL PROVIDERS

Medical Records and Bills

§30.700
What kinds of medical records must providers keep?
§30.701
How are medical bills to be submitted?
§30.702
How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses?
§30.703
What are the time limitations on OWCP's payment of bills?

Medical Fee Schedule

§30.705
What services are covered by the OWCP fee schedule?
§30.706
How are the maximum fees defined?
§30.707
How are payments for particular services calculated?
§30.708
Does the fee schedule apply to every kind of procedure?
§30.709
How are payments for medicinal drugs determined?
§30.710
How are payments for inpatient medical services determined?
§30.711
When and how are fees reduced?
§30.712
If OWCP reduces a fee, may a provider request reconsideration of the reduction?
§30.713
If OWCP reduces a fee, may a provider bill the employee for the balance?

Exclusion of Providers

§30.715
What are the grounds for excluding a provider from payment under this part?
§30.716
What will cause OWCP to automatically exclude a physician or other provider of medical services and supplies?
§30.717
When are OWCP's exclusion procedures initiated?
§30.718
How is a provider notified of OWCP's intent to exclude him or her?
§30.719
What requirements must the provider's reply and OWCP's decision meet?
§30.720
How can an excluded provider request a hearing?
§30.721
How are hearings assigned and scheduled?
§30.722
How are subpoenas or advisory opinions obtained?
§30.723
How will the administrative law judge conduct the hearing and issue the recommended decision?
§30.724
How can a party request review by OWCP of the administrative law judge's recommended decision?
§30.725
What are the effects of non-automatic exclusion?
§30.726
How can an excluded provider be reinstated?
rule

Subpart I—WAGE-LOSS DETERMINATIONS UNDER PART E OF EEOICPA

General Provisions

§30.800
What types of wage-loss are compensable under Part E of EEOICPA?
§30.801
What special definitions does OWCP use in connection with Part E wage-loss determinations?

Evidence of Wage-Loss

§30.805
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?
§30.806
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?

Determinations of Average Annual Wage and Percentages of Loss

§30.810
How will OWCP calculate the average annual wage of a covered Part E employee?
§30.811
How will OWCP calculate the duration and extent of a covered Part E employee's initial period of compensable wage-loss?
§30.812
May a covered Part E employee claim for subsequent periods of compensable wage-loss?

Special Rules for Certain Survivor Claims Under Part E of EEOICPA

§30.815
Are there special rules that OWCP will use to determine the extent of a deceased covered Part E employee's compensable wage-loss?
rule

Subpart J—IMPAIRMENT BENEFITS UNDER PART E OF EEOICPA

General Provisions

§30.900
Who can receive impairment benefits under Part E?
§30.901
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?
§30.902
How will OWCP calculate the amount of the award of impairment benefits that is payable under Part E?

Medical Evidence of Impairment

§30.905
How may an impairment evaluation be obtained?
§30.906
Who will pay for an impairment evaluation?
§30.907
Can an impairment evaluation obtained by OWCP be challenged prior to issuance of the recommended decision?
§30.908
How will the FAB evaluate new medical evidence submitted to challenge the impairment determination in the recommended decision?

Ratable Impairments

§30.910
Will an impairment that cannot be assigned a numerical percentage using the AMA's Guides be included in the impairment rating?
§30.911
Does maximum medical improvement always have to be reached for an impairment to be included in the impairment rating?
§30.912
Can a covered Part E employee receive benefits for additional impairment following an award of such benefits by OWCP?


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