Consistent with § 32.1, this subpart contains provisions applicable to claims made under the Act—
(a) At 34 U.S.C. 10281(a); or
(b) At 34 U.S.C. 10286 or Public Law 107-37, with respect to a public safety officer's death.
[71 FR 46037, Aug. 10, 2006, as amended at 83 FR 22383, May 15, 2018]
(a) Unless, for good cause shown, the Director extends the time for filing, no claim shall be considered if it is filed with the PSOB Office after whichever of the following is latest:
(1) Three years after the public safety officer's death; or
(2) One year after the later of—
(i) A final determination of entitlement to receive, or of denial of, the benefits, if any, described in § 32.15(a)(1)(i); or
(ii) The receipt of the certification described in § 32.15(a)(1)(ii); or
(3) The end of the supporting-evidence collection period.
(b) Unless, for good cause shown, the Director extends the time for filing, no individual may file a notice of intention to file a claim after the later of—
(1) The period described in paragraph (a)(1) of this section; or
(2) The period described in paragraph (a)(2) of this section.
(c) In the event that a claim is filed that fails to identify and provide foundational evidence as to status and injury, the Director shall deny the claim for lack of that foundational evidence. Not less than thirty-three days prior to such denial, the PSOB Office shall serve the claimant with notice of the date on which the Director will deny for that lack of evidence. Upon the claimant's request, filed prior to the date specified for the denial, the Director shall, in lieu of the denial—
(1) Allow the claimant to withdraw his claim; and
(2) Deem (as of the date of the request to withdraw) the claimant to have filed a notice of intention to file a claim, if a notice of intention otherwise filed by the claimant on that date would be timely under paragraph (b) of this section.
(d) Notwithstanding paragraph (a) of this section, unless, for good cause shown, the Director extends the time for filing, no claim based on an injury sustained by a WTC responder and resulting from the September 11, 2001, attacks shall be considered if it is filed with the PSOB Office after the later of—
(1) The time provided in paragraph (a) of this section; or
(2) Two years after the earlier of—
(i) The date on which the WTC-related physical health condition, if any, is determined by the September 11th Victim Compensation Fund, for the WTC responder, to meet the definition at section 104.2(i) of this title (as in effect on January 17, 2017); or
(ii) The date on which the WTC-related health condition, if any, is certified, for the WTC responder, under (as applicable) 42 U.S.C. 300mm-22(b)(1)(B)(ii) or 42 U.S.C. 300mm-22(b)(2)(A)(ii).
[83 FR 22384, May 15, 2018]
Adoptive parent of a public safety officer means any individual who (not being a step-parent), as of the injury date, was the legally-adoptive parent of the public safety officer, or otherwise was in a child-parent relationship with him.
Beneficiary of a life insurance policy of a public safety officer —An individual (living or deceased on the date of death of the public safety officer) is designated as beneficiary of a life insurance policy of such officer as of such date, only if the designation is, as of such date, legal and valid (as a designation of beneficiary of a life insurance policy) and unrevoked (by such officer or by operation of law) or otherwise unterminated, except that—
(1) Any designation of an individual (including any designation of the biological or adoptive offspring of such individual) made in contemplation of such individual's marriage (or purported marriage) to such officer shall be considered to be revoked by such officer as of such date of death if the marriage (or purported marriage) did not take place, unless preponderant evidence demonstrates that—
(i) It did not take place for reasons other than personal differences between the officer and the individual; or
(ii) No such revocation was intended by the officer; and
(2) Any designation of a spouse (or purported spouse) made in contemplation of or during such spouse's (or purported spouse's) marriage (or purported marriage) to such officer (including any designation of the biological or adoptive offspring of such spouse (or purported spouse)) shall be considered to be revoked by such officer as of such date of death if the spouse (or purported spouse) is divorced from such officer after the date of designation and before such date of death, unless preponderant evidence demonstrates that no such revocation was intended by the officer.
Beneficiary under the Act, at 34 U.S.C. 10281(a)(4)(A) —An individual (living or deceased on the date of death of the public safety officer) is designated, by such officer (and as of such date), as beneficiary under the Act, at 34 U.S.C. 10281(a)(4)(A), only if the designation is, as of such date, legal and valid and unrevoked (by such officer or by operation of law) or otherwise unterminated, except that—
(1) Any designation of an individual (including any designation of the biological or adoptive offspring of such individual) made in contemplation of such individual's marriage (or purported marriage) to such officer shall be considered to be revoked by such officer as of such date of death if the marriage (or purported marriage) did not take place, unless preponderant evidence demonstrates that—
(i) It did not take place for reasons other than personal differences between the officer and the individual; or
(ii) No such revocation was intended by the officer; and
(2) Any designation of a spouse (or purported spouse) made in contemplation of or during such spouse's (or purported spouse's) marriage (or purported marriage) to such officer (including any designation of the biological or adoptive offspring of such spouse (or purported spouse)) shall be considered to be revoked by such officer as of such date of death if the spouse (or purported spouse) is divorced from such officer subsequent to the date of designation and before such date of death, unless preponderant evidence demonstrates that no such revocation was intended by the officer.
Cardiovascular disease includes heart attack and stroke.
Child-parent relationship means a relationship between a public safety officer and another individual, in which the individual (other than the officer's biological or legally-adoptive parent) has the role of parent, as shown by convincing evidence.
Competent medical evidence means evidence that indicates a fact to a degree of medical probability.
Designation on file —A designation of beneficiary under the Act, at 34 U.S.C. 10281(a)(4)(A), is on file with a public safety agency, -organization, or -unit, only if it is deposited with the same by the public safety officer making the designation, for it to maintain with its personnel or similar records pertaining to him.
Direct and proximate result of a heart attack or stroke —A death results directly and proximately from a heart attack or stroke if the heart attack or stroke is a substantial factor in bringing it about.
Engagement in a situation involving law enforcement, fire suppression, rescue, hazardous material response, emergency medical services, prison security, disaster relief, or other emergency response activity —A public safety officer is so engaged only when, within his line of duty—
(1) He is in the course of actually—
(i) Engaging in law enforcement;
(ii) Suppressing fire;
(iii) Responding to a hazardous-material emergency;
(iv) Performing rescue activity;
(v) Providing emergency medical services;
(vi) Performing disaster relief activity; or
(vii) Otherwise engaging in emergency response activity; and
(2) His public safety agency (or the relevant government) legally recognizes him to have been in such course at the time of such engagement (or, at a minimum, does not deny (or has not denied) him so to have been).
Event includes occurrence, but does not include any engagement or participation described in the Act, at 34 U.S.C. 10281(k)(1).
Execution of a designation of beneficiary under the Act, at 34 U.S.C. 10281(a)(4)(A) means the legal and valid execution, by the public safety officer, of a writing that, designating a beneficiary, expressly, specifically, or unmistakably refers to—
(1) The Act (or the program it creates); or
(2) All the death benefits with respect to which such officer lawfully could designate a beneficiary (if there be no writing that satisfies paragraph (1) of this definition).
Execution of a life insurance policy means, with respect to a life insurance policy, the legal and valid execution, by the individual whose life is insured thereunder, of—
(1) The approved application for coverage;
(2) A designation of beneficiary; or
(3) A designation of the mode of benefit.
Life insurance policy on file —A life insurance policy is on file with a public safety agency, -organization, or -unit, only if—
(1) It is issued through (or on behalf of) the same; or
(2) The original (or a copy) of one of the following is deposited with the same by the public safety officer whose life is insured under the policy, for it to maintain with its personnel or similar records pertaining to him:
(i) The policy (itself);
(ii) The declarations page or -statement from the policy's issuer;
(iii) A certificate of insurance (for group policies);
(iv) Any instrument whose execution constitutes the execution of a life insurance policy; or
(v) The substantial equivalent of any of the foregoing.
Medical probability —A fact is indicated to a degree of medical probability, when, pursuant to a medical assessment, the fact is indicated by a preponderance of such evidence as may be available.
Most recently executed designation of beneficiary under the Act, at 34 U.S.C. 10281(a)(4)(A) means the most recently executed such designation that, as of the date of death of the public safety officer, designates a beneficiary.
Most recently executed life insurance policy of a public safety officer means the most recently executed policy insuring the life of a public safety officer that, being legal and valid (as a life insurance policy) upon its execution, as of the date of death of such officer—
(1) Designates a beneficiary; and
(2) Remains legally unrevoked (by such officer or by operation of law) or otherwise unterminated.
Nonroutine strenuous physical activity means line of duty activity that—
(1) Is not excluded by the Act, at 34 U.S.C. 10281(l);
(2) Is not performed as a matter of routine; and
(3) Entails an unusually-high level of physical exertion.
Nonroutine stressful or strenuous physical activity means nonroutine stressful physical activity or nonroutine strenuous physical activity.
Nonroutine stressful physical activity means line of duty activity that—
(1) Is not excluded by the Act, at 34 U.S.C. 10281(l);
(2) Is not performed as a matter of routine;
(3) Entails non-negligible physical exertion; and
(4) Occurs—
(i) With respect to a situation in which a public safety officer is engaged, under circumstances that objectively and reasonably—
(A) Pose (or appear to pose) significant dangers, threats, or hazards (or reasonably-foreseeable risks thereof), not faced by similarly-situated members of the public in the ordinary course; and
(B) Provoke, cause, or occasion an unusually-high level of alarm, fear, or anxiety; or
(ii) With respect to a training exercise in which a public safety officer participates, under circumstances that objectively and reasonably—
(A) Simulate in realistic fashion situations that pose significant dangers, threats, or hazards; and
(B) Provoke, cause, or occasion an unusually-high level of alarm, fear, or anxiety.
Parent of a public safety officer means a public safety officer's surviving—
(1) Biological or adoptive parent whose parental rights have not been terminated, as of the injury date; or
(2) Step-parent.
Participation in a training exercise —A public safety officer participates (as a trainer or trainee) in a training exercise only when actually taking formal part in a structured activity that itself is—
(1) Within an official training (or -fitness) program of his public safety agency; and
(2) Mandatory, rated (i.e., officially tested, -graded, -judged, -timed, etc.), or directly supervised, -proctored, or -monitored.
Public safety organization or unit means—
(1) The component of a public agency, in which component—
(i) An individual described in the Act, at 34 U.S.C. 10284(9)(A), serves in an official capacity; or
(ii) An employee described in the Act, at 34 U.S.C. 10284(9)(B) or (C) performs official duties; or
(2) The component of an agency or entity, under the authority (or by the license) of which component a member of a rescue squad or ambulance crew engages in activity (or in the provision of services) described in the Act, at 34 U.S.C. 10284(9)(D).
Routine —Neither of the following shall be dispositive in determining whether an activity or action shall be understood to have been performed as a matter of routine:
(1) Being generally described by the public safety agency as routine or ordinary; or
(2) The frequency with which it may be performed.
Something other than the mere presence of cardiovascular disease risk factors means—
(1) Ingestion of controlled substances included on Schedule I of the drug control and enforcement laws (see 21 U.S.C. 812(a)); or
(2) Abuse of controlled substances included on Schedule II, III, IV, or V of the drug control and enforcement laws (see 21 U.S.C. 812(a)).
Step-parent of a public safety officer means a current or former spouse of the legally-adoptive or biological parent (living or deceased) of a public safety officer conceived (or legally adopted) by that parent before the marriage of the spouse and the parent, which spouse (not being a legally-adoptive parent of the officer), as of the injury date,
(1) Received over half of his support from the officer;
(2) Had as his principal place of abode the home of the officer and was a member of the officer's household; or
(3) Was in a child-parent relationship with the officer.
[61 FR 50213, Sept. 24, 1996, as amended at 73 FR 76832, Dec. 17, 2008; 83 FR 22384, May 15, 2018]
(a) Upon its approving or denying a claim, the PSOB Office shall serve notice of the same upon the claimant (and upon any other claimant who may have filed a claim with respect to the same public safety officer). Such notice shall—
(1) Specify the factual findings and legal conclusions that support it; and
(2) In the event of a denial, provide information as to requesting a Hearing Officer determination.
(b) Upon a claimant's failure (without reasonable justification or excuse) to pursue in timely fashion the determination, by the PSOB Office, of his filed claim, the Director may, at his discretion, deem the same to be abandoned, as though never filed. Not less than thirty-three days prior thereto, the PSOB Office shall serve the claimant with notice of the Director's intention to exercise such discretion.
[73 FR 76534, Dec. 17, 2008, as amended at 83 FR 22385, May 15, 2018]
(a) Except as provided in the Act, at 34 U.S.C. 10286 or Public Law 107-37, and unless, for good cause shown, the Director grants a waiver, no claim shall be approved unless the following (which shall be necessary, but not sufficient, for such approval) are filed with the PSOB Office:
(1) Subject to paragraphs (b) and (d) of this section, a certification from the public safety officer's public safety agency (as of the injury date) that he died as a direct and proximate result of a line of duty injury, and either—
(i) That his survivors (listed by name, address, relationship to him, and amount received) have received (or legally are entitled to receive) the maximum death benefits legally payable by the agency with respect to deaths of public safety officers of his kind, rank, and tenure; or
(ii) Subject to paragraph (c) of this section, that the agency is not legally authorized to pay—
(A) Any benefits described in paragraph (a)(1)(i) of this section, to any person; or
(B) Any benefits described in paragraph (a)(1)(i) of this section, to public safety officers of the kind, rank, and tenure described in such paragraph;
(2) A copy of any findings or rulings made by any public agency (or public safety agency) that relate to the officer's death; and
(3) A certification from the claimant listing every individual known to him who is or might be the officer's child, spouse, or parent.
(b) The provisions of paragraphs (a)(1) and (d) of this section shall also apply with respect to every public agency (or public safety agency) that legally is authorized to pay death benefits with respect to the agency described in such paragraph (a)(1).
(c) No certification described in paragraph (a)(1)(ii) of this section shall be deemed complete for purposes of this section unless it—
(1) Lists every public agency (other than BJA), and every public safety agency, that legally is authorized to pay death benefits with respect to the certifying agency; or
(2) States that no public agency (other than BJA), or public safety agency, legally is authorized to pay death benefits with respect to the certifying agency.
(d) Subject to paragraphs (b) and (c) of this section, if the Director finds that the conditions specified in the Act, at 34 U.S.C. 10281(k), are satisfied with respect to a particular public safety officer's death, and that no circumstance specified in the Act, at 34 U.S.C. 10282(a)(1), (2), or (3), applies with respect thereto—
(1) The certification as to death, described in paragraph (a)(1) of this section, shall not be required; and
(2) The certification as to benefits, described in paragraph (a)(1)(ii) of this section, shall be deemed complete for purposes of this section if it—
(i) Describes the public agency's (or public safety agency's) understanding of the circumstances (including such causes of which it may be aware) of the officer's death; and
(ii) States that, in connection with deaths occurring under the circumstances described in paragraph (d)(2)(i) of this section, the public agency (or public safety agency's) is not legally authorized to pay any benefits described in paragraph (a)(1)(i) of this section.
[73 FR 76534, Dec. 17, 2008, as amended at 83 FR 22385, May 15, 2018]
(a) No payment shall be made to (or on behalf of) more than one individual, on the basis of being a public safety officer's parent as his mother, or on that basis as his father. If more than one parent qualifies as the officer's mother, or as his father, payment shall be made to the one with whom the officer considered himself, as of the injury date, to have the closest relationship, except that any biological or legally adoptive parent whose parental rights have not been terminated as of the injury date shall be presumed rebuttably to be such one.
(b) Any amount payable with respect to a minor or incompetent shall be paid to his legal guardian, to be expended solely for the benefit of such minor or incompetent.
[73 FR 76535, Dec. 17, 2008, as amended at 83 FR 22385, May 15, 2018]
In order to exhaust his administrative remedies, a claimant seeking relief from the denial of his claim shall request a Hearing Officer determination under subpart E of this part. Consistent with § 32.8, any denial that is not the subject of such a request shall constitute the final agency determination.