Consistent with § 32.1, this subpart contains provisions applicable to claims made under the Act—
(a) At 34 U.S.C. 10281(b); or
(b) At 34 U.S.C. 10286 or Public Law 107-37, with respect to a public safety officer's disability.
[71 FR 46037, Aug. 10, 2016, as amended at 83 FR 22385, 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 the later of—
(1) Three years after the injury date; 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 § 32.25(a)(1)(i); or
(ii) The receipt of the certification described in § 32.25(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 22386, May 15, 2018]
Direct result of an injury —A disability results directly from an injury if the injury is a substantial factor in bringing the disability about.
Gainful work means full-or part-time activity that actually is compensated or commonly is compensated.
Medical certainty —A fact exists to a degree of medical certainty, when, pursuant to a medical assessment, the fact is demonstrated by convincing evidence.
Permanently disabled —An individual is permanently disabled only if there is a degree of medical certainty (given the current state of medicine in the United States) that his disabled condition—
(1) Will progressively deteriorate or remain constant, over his expected lifetime; or
(2) Otherwise has reached maximum medical improvement.
Product of an injury —Permanent and total disability is produced by a catastrophic injury suffered as a direct and proximate result of a personal injury if the disability is a direct result of the personal injury.
Residual functional capacity means that which an individual still is capable of doing, as shown by medical (and, as appropriate, vocational) assessment, despite a disability.
Totally disabled —An individual is totally disabled only if there is a degree of medical certainty (given the current state of medicine in the United States) that his residual functional capacity is such that he cannot perform any gainful work.
(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—
(i) Requesting a Hearing Officer determination; or
(ii) As applicable, moving to reconsider a negative disability finding.
(b) Upon a claimant's failure (without reasonable justification or excuse) to pursue in timely fashion the determination 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.
[71 FR 46037, Aug. 10, 2018, as amended at 83 FR 22386, 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 paragraph (b) of this section, a certification from the public safety officer's public safety agency (as of the injury date) that he was permanently and totally disabled as a direct result of a line of duty injury, and either—
(i) That he has received (or legally is entitled to receive) the maximum disability benefits (including workers' compensation) legally payable by the agency with respect to disabled 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; and
(2) A copy of—
(i) Each State, local, and federal income tax return filed by or on behalf of the public safety officer from the year before the injury date to the date of determination by the PSOB determining official; and
(ii) Any rulings or findings made by any public agency (or public safety agency) that relate to the claimed disability.
(b) The provisions of paragraph (a)(1) of this section shall also apply with respect to every public agency (or public safety agency) that legally is authorized to pay disability benefits with respect to the agency described in that paragraph.
(c) No certification described in paragraph (a)(1)(ii) of this section shall be deemed complete unless it—
(1) Lists every public agency (other than BJA), and every public safety agency, that legally is authorized to pay disability 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 disability benefits with respect to the certifying agency.
[71 FR 46037, Aug. 10, 2018, as amended at 83 FR 22386, May 15, 2018]
A claimant whose claim is denied in whole or in part on the ground that he has not shown that his claimed disability is total and permanent may move for reconsideration, under § 32.28, of the specific finding as to the total and permanent character of the claimed disability (in lieu of his requesting a Hearing Officer determination with respect to the same).
(a) Unless, for good cause shown, the Director extends the time for filing, no negative disability finding described in § 32.27 shall be reconsidered if the motion under that section is filed with the PSOB Office later than thirty-three days after the service of notice of the denial.
(b) Notwithstanding any other provision of this section, no negative disability finding described in § 32.27 shall be reconsidered—
(1) If or after such reconsideration is rendered moot (e.g., by the final denial of the claim on other grounds, without possibility of further administrative or judicial recourse); or
(2) If a request for a Hearing Officer determination has been filed in timely fashion with respect to such finding.
(c) Unless, for good cause shown, the Director grants a waiver, upon the making of a motion under § 32.27, reconsideration of the negative disability finding described in that section shall be stayed for three years. Upon the conclusion of the stay, the claimant shall have not more than six years to file evidence with the PSOB Office in support of his claimed disability.
(d) Upon a claimant's failure (without reasonable justification or excuse) to file in timely fashion evidence pursuant to paragraph (c) of this section, the Director may, at his discretion, deem the motion for reconsideration 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.
(e) No negative disability finding described in § 32.27 shall be reversed unless a copy (which shall be necessary, but not sufficient, for such reversal) of each federal, State, and local income tax return filed by or on behalf of the claimant from the year before the date of the motion for reconsideration under that section to the date of reversal is filed with the PSOB Office.
(f) Upon its affirming or reversing a negative disability finding described in § 32.27, the PSOB Office shall serve notice of the same upon the claimant. In the event of an affirmance, such notice shall—
(1) Specify the factual findings and legal conclusions that support it; and
(2) Provide information as to requesting a Hearing Officer determination of the disability finding.
(a) 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—
(1) Of—
(i) His entire claim, if he has not moved for reconsideration of a negative disability finding under § 32.27; or
(ii) Consistent with § 32.42(c), the grounds (if any) of the denial that are not the subject of such motion, if he has moved for reconsideration of a negative disability finding under § 32.27; and
(2) Of a negative disability finding that is affirmed pursuant to his motion for reconsideration under § 32.27.
(b) Consistent with § 32.8, the following shall constitute the final agency determination:
(1) Any denial not described in § 32.27 that is not the subject of a request for a Hearing Officer determination under paragraph (a)(1)(i) of this section;
(2) Any denial described in § 32.27 that is not the subject of a request for a Hearing Officer determination under paragraph (a)(1)(ii) of this section, unless the negative disability finding is the subject of a motion for reconsideration; and
(3) Any affirmance that is not the subject of a request for a Hearing Officer determination under paragraph (a)(2) of this section.
[73 FR 76535, Dec. 17, 2008]