Page images
PDF
EPUB

tracted with the United States or with of the United States using the same or the United States directly, under which similar plan, or reimbursement is rethe United States ultimately would bear quested under an agreement or contract the cost of such expense.

providing a method for determining re

imbursable claims expense, in lieu of $ 62.6 Claims for reimbursement of

listing of items of expense, reference claims expense.

should be made to the policy of insurance (a) Claims for reimbursement of and rating plan endorsement, or other reasonable and necessary claims expense agreement as referred to above, under incurred in connection with the adjust which benefit payments have been made, ment of claims by an employer, insur and the amount of reimbursement of ance carrier or compensation fund as claims expense for the cases listed in the provided for in section 104(a) of such schedule may be obtained by applying Public Law No. 784, and $ 62.5, may be the same factor (as is contained in such included in the claim for reimbursement rating plan endorsement for determinof benefit payments, shall be signed and ing claims expense or applying such sworn to by the person entitled to re other factor or method of determining imbursement or his duly authorized rep reimbursement for such expense) to the resentative, and shall be filed with the sum of all paid losses (benefits paid) as Bureau of Employees' Compensation, approved by the Bureau under the United States Department of Labor, claim filed with it for reimbursement of Washington 25, D.C. Such claims shall benefits paid, where such losses have occontain a schedule of cases with respect curred under policies providing a method to which reimbursement of claims ex of determining claims expense. There pense is sought.

may also be set forth any allowable items (b) Except where reimbursement is to of claims expense not included in such be made by the application of a factor factor. under an endorsement applying a com (d) Claims for reimbursement of prehensive insurance rating plan, or claims expense shall be filed quarterly; similar plan, as provided for in § 62.5, that is, as of the first of January, April, in the schedule of cases there shall be July, and October, unless otherwise aulisted the items of claims expense for thorized by the Bureau. which reimbursement is claimed, sufi- (Sec. 104, 56 Stat. 1031; 42 U.S.C. 1704; ciently describing the nature of each 1950 Reorg. Plan No. 19, Sec. 1, 3 CFR, 1949– such item. Only items of claims ex 1953 Comp., p. 1010; 64 Stat. 1271) 18 FR. pense allowable under $ 62.5 will be con.

6811, May 25, 1943, as amended at 25 F.R. sidered. If necessary in specific cases

10795, Nov. 15, 1960) listed in such schedule (where pay § 62.7 Same; approval of claims. ments have been made to numerous

(a) If upon examination and audit of payees), a supplementary sheet identified as a case exhibit may be used to show

a claim for reimbursement of claims ex

pense the Bureau finds that insufficient items and payees in the particular case.

or inadequate information or proof has Each item in excess of $10 with respect to which reimbursement is claimed shall

been supplied with the claim, further be supported by a suficient receipt signed

information or proof shall be submitted

as required by the Bureau, and failure to by the payee thereof showing that the

supply available information and proof, amount claimed has been paid and the date of payment and nature of the serv

upon request, may result in disallowance

of items not adequately supported as ice rendered. The regulations governing the matter of receipts or other

justly reimbursable.

(b) No item shall be approved for evidences of payment applicable to reimbursement of benefit payments, as

reimbursement with respect to which contained in 62.2 (c), shall apply with

there has been failure by the claimant to respect to claims expense items.

justify any such item as a reasonable (c) Where reimbursement for claims and necessary claims expense, or where expense relates to cases in which pay the Bureau finds that an item of exments have been made by an insurance pense was incurred unnecessarily or carrier under a policy of insurance to without reasonable cause. Claims for which is attached an endorsement under such reimbursement shall be approved the comprehensive insurance rating plan, only to the extent that the Bureau finds or similar plan, of the Army or Navy De- the claim to be reasonable, and unreapartment, or other department or agency sonable or excessive items shall be re

luced accordingly for the purpose of for direct payment may be recommended uch reimbursement. The claimant by an employer, carrier, or fund whenhall be advised of the action taken upon ever it believes that such transfer propthe claim filed and the amount approved erly may be effected within these regulafor reimbursement. Where a claim has tions. Whenever the Bureau determines been denied in whole or in part, or where that under these regulations the transfer reimbursement as to any item has been of a case for direct payment should be efreduced from the amount claimed, the fected, the employer, insurance carrier claimant shall be advised thereof to or compensation fund shall transfer the gether with the reasons for the action case to the Bureau at its principal ofice taken. Claimants within the United for such purpose, together with the parStates shall be allowed 60 days and ticular case file of such employer, carrier claimants outside the United States 6 or fund, or such other records or papers months, unless unusual circumstances in as may be necessary to enable the Bureau either case are found to require a longer to complete payments in the case; failure time, from the date of the Bureau's ac to transfer such case when requested tion, within which to file objections to may result in denial of further reimthe disallowance of any claim or part bursement. The file in such transferred thereof, or reduction in any item of a case shall become part of the official recclaim. Such objections, properly filed, ords of the Bureau and shall remain in will be considered by the Bureau. After its custody. such period of time objections shall not (d) Medical and other treatment and be considered, unless the Bureau for rea care with respect to any disabled person sonable cause shown shall consider such entitled to such treatment, whose case objections. Where objections are timely is transferred to the Bureau as herein filed, review of the claim and action provided, when practicable may be furthereon by the Bureau will be made upon nished in a manner consistent with the the basis of such objections.

regulations in Part 2 of this chapter, goy(c) The provisions of $ 62.4 relating to erning the furnishing of medical treatexamination of records of a claimant and ment under such Act of September 7. submission of records and papers shall 1916, as amended. In furnishing such apply with respect to claims under this treatment or care the Bureau may use section.

any private facilities, or such Govern

ment facilities as may be available. § 62.8 Direct payment of benefits.

(e) Whenever it shall appear advisa(a) The Bureau may pay benefits, as ble to the Bureau, any such case may they accrue, directly to any person en be referred to any oficer or agent identitled thereto under any applicable work tified in $ 61.8 of this subchapter for such men's compensation law or agreement as purpose as the Bureau may direct. referred to in $ 62.1(a), in lieu of reim

(f) Where any person entitled to benbursement of an employer, insurance efits, whose case has been transferred carrier or compensation fund under the under these regulations, has the right provisions of these regulations, under to have his claim for workmen's comsuch indemnity agreement as the Bureau pensation or other benefits, or continumay provide.

ation of benefits, heard before or con(b) The Bureau will not accept a case sidered or reviewed by any deputy comfor direct payment until such time as missioner, compensation board or agency, the right of the person or persons en- or other tribunal or where th

or other tribunal, or where the employer, titled to benefits has been established

insurance carrier or compensation fund and it finds the case to be one in which

has similar rights with respect to furthe employer, carrier, or fund would

ther hearings or adjudicatory processes otherwise be entitled to reimbursement for benefits thereafter paid.

with respect to a claim or case, the trans(c) The Bureau will not accept such

fer of such case to the Bureau shall not cases for direct payment until such time affect such rights. Wheever further as the rate of compensation or benefit adjudicatory processes before such depand the period of payment have become uty commissioner, board or agency, or relatively fixed and known, unless under tribunal are necessary, the Bureau will the circumstances in a particular case retransfer such case to the employer, the Bureau should determine that the carrier, or fund for completion of such case should be accepted prior thereto. processes. The Bureau may retransfer The transfer of any case to the Bureau any case to an employer, carrier or fund either for the purpose of completion of such adjudicatory processes or for continuation of payments of benefits, when ever the Bureau deems such course advisable or necessary; failure to take necessary steps in the further adjudication of a case, either when necessary, when requested by the Bureau, or pursuant to notice received by the employer, carrier or fund from a person entitled to benefits, his representative, or any party in interest, or the adjudicating agency concerned, may result in refusal by the Bureau to continue the direct payment of benefits in such case and refusal to

reimburse such employer, carrier or fund with respect to any future accruing benefits which it may have liability to pay. unless the circumstances justified such failure.

(g) Claims expense incident to the further handling of such a claim, retransferred to an employer, carrier or fund, will be processed by reimbursement under the provisions of the regulations in this part, or, in lieu of such manner of reimbursement, may be paid pursuant to a contract with an insurance carrier as provided for by § 61.22 of this subchapter. (Sec. 104, 66 Stat. 1031; 42 U. 8. C. 1704)

SUBCHAPTER G-COMPENSATION FOR INJURY, DISABILITY OR

DEATH OF CIVILIAN AMERICAN CITIZENS INCURRED WHILE DETAINED BY OR IN HIDING FROM THE IMPERIAL JAPANESE GOVERNMENT

PART 71-GENERAL PROVISIONS subject, however, to all of the provisions

of said act and the regulations in this Sec. 71.1 General administrative provisions.

subchapter. 71.2 Computation of benefits.

(b) The regulations in Part 61 of Sub71.8 Deductions from benefits.

chapter F of this chapter governing the 71.4 Limitation upon benefits.

administration of the benefits provided 71.5 Payment of benefits.

under Titles I and II of the said act of 71.6 Notice of injury or death.

December 2, 1942, as amended, shall, 71.7 Claim filing, processing, adjudication

insofar as they are applicable and are and time limits.

not inconsistent with any of the proAUTHORITY: The provisions of this Part visions of this subchapter, govern the 71 issued under sec. 32, 39 Stat. 749, as

administration of the benefits payable amended, sec. 106, 56 Stat. 1033, as amended,

under this subchapter. Provisions of sec. 5, 62 Stat. 1242, as amended; 5 U.S.C. 8145, 8149, 42 U.S.C. 1706, 50 U.S.C. App., 2004.

such regulations relating to benefits for

detention by the enemy, reimbursement SOURCE: The provisions of this Part 71

to an employer or insurance carrier, and appear at 16 F.R. 2933, Apr. 4, 1951, unless

limitations on benefits in cases where otherwise noted.

workmen's compensation is payable are $71.1 General administrative provisions. not applicable to the benefits provided in (a) Section 5 (f) of the War Claims

this subchapter nor are they within the Act of 1948 (act of July 3, 1948;

purview of this subchapter. The pro

visions of sections 101 (b), 104 and 105 Public Law 896, 80th Cong., 62 Stat. 1240)

of such act of December 2, 1942, and the makes provision for the payment of benefits with respect to the injury, dis

various provisions of Part 61 of this ability or death resulting from injury of

chapter relating to such provisions, ac

cordingly, are not applicable to the payany civilian American citizen occurring

ment of benefits under this subchapter. while he was held by or in hiding from

(c) All rights or benefits under this the Imperial Japanese Government to

subchapter which are determinable with the same extent as if such civilian Amer

reference to other provisions of law other ican citizen were an employee within the than the said War Claims Act of 1948, purview of the act of December 2, 1942 shall be determined with reference to (Public Law 784, 77th Cong., 56 Stat. such provisions as they existed and were 1028, 42 U. S. C. 1701, et seq.). Under in force on January 3, 1948. section 5 (f) of the said War Claims Act (d) As used in this subchapter: of 1948, the rights of individuals to bene. (1) The term "Bureau" means the Aits payable under this subchapter shall Bureau of Employees' Compensation, accrue from and after December 7, 1941, United States Department of Labor.

(2) The term "civilian American citi termined by the percentage which the zen" means any person who, being then degree of partial disability bears to total a citizen of the United States, was cap disability, and shall not be determined tured by the Imperial Japanese Govern with respect to the extent of loss of wagement on or after December 7, 1941, at earning capacity. Midway, Guam, Wake Island, the Philip. (b) Notwithstanding any of the provipine Islands, or any Territory or posses sions of Part 61 of this chapter, total sion of the United States attacked or maximum aggregate compensation for invaded by such government or while in disability payable under this subchapter transit to or from any such place, or is limited to $7,500 in case of injury and who went into hiding at any such place $7,500 in case of death, such sum being in order to avoid capture or internment exclusive of medical costs and funeral by such government; except (i) a person and burial expenses. who at any time voluntarily gave aid

$ 71.3 Deductions from benefits. to, collaborated with, or in any manner served such government, or (ii) a per If a civilian American citizen or his deson who at the time of his capture or pendents receives or has received from entrance into hiding was within the pur the United States any payments on acview of the Federal Employees' Compen count of the same injury or death, or sation Act of September 7, 1916, as from his employer in the form of wages amended and extended, or the said act or payments in lieu of wages, or in any of December 2, 1942, as amended, or the form of support or compensation (includMissing Persons Act of March 7, 1942 ing workmen's compensation) in respect (56 Stat. 143), as amended, or who was to the same objects, the benefits under a regularly appointed, enrolled, en this subchapter shall be diminished in the listed, or inducted member of any mili case of an injured person by the amount tary or naval force.

of payments such injured person received (3) The terms "held by the Imperial on account of the same injury or disabilJapanese Government” or “captured by ity, or in the case of dependents, by the the Imperial Japanese Government" amount of payments such dependents of mean a holding of such person as a the deceased civilian American citizen prisoner, internee, hostage or in any received on account of the same death, other capacity.

as the case may be. (4) The terms "compensation", "phy

871.4 Limitation upon benefits. sician” and “medical, surgical and hospital services and supplies" shall be No person, except a widow or a child, construed and applied as defined in the shall be entitled to benefits under this Federal Employees' Compensation Act subchapter for disability with respect to of September 7, 1916, as amended.

himself and to death benefits on account (5) The term “benefit” is construed of the death of another. as synonymous with the term “compen

§ 71.5 Payment of benefits. sation". (6) The terms "disability", "wages",

(a) Benefits under this subchapter "child", "grandchild”, “brother”, “sis

payable for disability or death shall be ter", "parent", "widow", "widower”, paid only to the person entitled thereto, "adoption" or "adopted" shall be con

or to his legal or natural guardian of he strued and applied as defined in the has one, and shall not upon death of the Longshoremen's and Harbor Workers' person so entitled survive for the benefit Compensation Act, as amended.

of his estate or any other person.

(b) The benefit of a minor or an in$ 71.2 Computation of benefits.

competent person who has no natural or (a) For the purpose of determining legal guardian may, in the discretion of the benefits under this subchapter, the the Bureau be paid in whole or in such average weekly wage of any such civilian part as the Bureau may determine, for American citizen, whether employed, and on behalf of such minor or incomself-employed, or not employed, shall be petent directly to the person or institudeemed to have been $37.50. The pro- tion caring for, supporting or having visions of this subchapter are applicable custody of such minor or incompetent. and benefits are payable whether or not (c) In any case in which benefits are such civilian American citizen was em- payable under this subchapter to any ployed. Monthly compensation in cases person who is prevented from accepting involving partial disability shall be de- such benefits by the rules, regulations

or customs of the church or the religious order or organization of which he is a member, such benefits will be paid, upon the request of such person, to such church or to such religious order or organization. $ 71.6 Notice of injury or death.

Notwithstanding any of the provisions in Part 61 of this chapter, no notice or report of injury or death shall be required for claims filed under this subchapter. $ 71.7 Claim filing, processing, adju

dication and time limits. (a) Claims for injury, disability or death benefits payable under section 5 (f) of the said War Claims Act of 1948, origi

nating in the United States or in its Territories or possessions, shall be filed by mailing to the Bureau of Employees' Compensation, United States Department of Labor, Washington 25, D.C. All claims originating in the Philippine Islands may be filed by mailing to the Bureau of Employees' Compensation, United States Department of Labor, Manila, P.I. All claims will be finally processed and adjudicated by the Bureau at essed and adiudica its principal office in Washington, D.C.

(b) The limitation provisions for the filing of claims for disability or death benefits, as prescribed by applicable provisions of statute, shall not begin to run earlier than July 3, 1948.

SUBCHAPTER H-EXTENSION OF THE LONGSHOREMEN'S AND

HARBOR WORKERS' COMPENSATION ACT TO PERSONS EMPLOYED IN CERTAIN OPERATIONS CONDUCTED ON THE OUTER CONTINENTAL SHELF

PART 81-GENERAL ADMINISTRA

TIVE PROVISIONS Sec. 81.1 General administrative provisions; def

initions; interpretation of statute. 81.2 Establishment of compensation dis

tricts. AUTHORITY: The provisions of this part 81 issued under sec. 39, 44 Stat. 1442, as amended, secs. 2–15, 67 Stat. 462-470; 83 U.S.C. 939, 43 U.S.C. 1331-1943. & 81.1 General administrative provi

sions; definitions; interpretation of

statute. (a) General. Section 4(c) of the Outer Continental Shelf Lands Act (67 Stat. 463; 43 U.S.C. 1333) extends the provisions of the Longshoremen's and Harbor Workers' Compensation Act (44 Stat. 1424, as amended; 33 U.S.C. 901, et seq.), the latter hereinafter in this subchapter referred to as “the Longshoremen's Act," to cases of disability or death of employees resulting from certain operations conducted on the Outer Continental Shelf. The regulations in Subchapter C of this chapter governing the administration of the Longshoremen's Act, insofar as they are applicable and are not inc insistent with any of the provisions of this subchapter, shall govern the administration of the Longshoremen's Act as extended by the Outer Continental Shelf Lands Act. Every person subject to claiming benefits under, or acting un

der the Longshoremen's Act as thus extended shall conform to the procedure prescribed in the Longshoremen's Act, in the regulations in Subchapter C and in this subchapter. The term “Bureau" as used in this subchapter means the Bureau of Employees' Compensation, Department of Labor. The Bureau of Employees' Compensation was transferred from the Federal Security Agency to the Department of Labor by Reorganization Plan No. 19 of 1950 (3 CFR, 1949– 53 Comp., p. 1010, 64 Stat. 1271), effective May 24, 1950. The Bureau of Employees' Compensation, when formerly in the Federal Security Agency, had been established to perform the functions theretofore performed by the United States Employees' Compensation Commission, which was abolished and its functions transferred to the Federal Security Agency by Reorganization Plan No. 2 of 1946 (3 CFR, 1943-1948 Comp., p. 1064; 60 Stat. 1095) effective July 16, 1946.

(b) Coverage. The Outer Continental Shelf Lands Act applies in respect to the disability or death of an employee resulting from any injury occurring as & result of operations conducted on the outer Continental Shelf for the purpose of exploring for, developing, removing or transporting by pipeline the natural resources of the subsoil and seabed of the outer Continental Shelf.

« PreviousContinue »