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US-242 Notice (compliance with Act by self-insurance). (Interpret or apply 72 Stat. 397; 5 U.S.C. 8171, 8172, 8173)

US-206 Notice to the Deputy Commissloner that the payment of compensation has begun without awaiting award.

US-207 Notice to the Deputy Commissioner that claim will be controverted.

US-208 Notice to the Deputy Commissioner that the payment of compensation has been stopped or suspended.

US-209 Request to employee that he reply to the employer's objection to his right to compensation.

US-210–11 Employer's supplementary report of accident or occupational disease.

US-212 Notice to injured employee that case will be closed unless reports now on file are shown to be incorrect.

US-213 Notice of election to sue (disability or death claim).

US-214 Request for medical examination under United States Longshoremen's and Harbor Workers' Compensation Act.

US-216 Answer of employer or insurance carrier to employee's claim for compensation.

US-215A Notice to employer and insurance carrier that answer to claim for compensation should be made.

US-216 Request for additional reports. US-221 Application for lump sum award (disability or death).

US-226 Subpoena.
US-226A Subpoena Duces Tecum.
US-226B Notice of Hearing.

US-260 Notice to Deputy Commissioner of Death (by dependents or on their behalf).

US-261 Supplemental report of employer in death case.

US-262 Claim for compensation in death case by widow and/or children under the age of eighteen.

US-263 Claim for compensation in death cases by dependents other than widow and children of deceased (each dependent or representative must file individual claim).

US-264 Proof of death (by Physician last in attendance on Deceased).

US-265 Proof of Burial and Funeral expenses—by Undertaker.

LSI-2 Application for Self-Insurance.

LSI-3 Decision granting authority to Act as Self-insurer.

LSI 4 Agreement and Undertaking of employer granted the privilege of paying compensation as self-insurer.

LSI-5c Indemnity Bond given by Selfinsurer.

LSI-8 Pay-roll report. LSI-9 Report of compensation payments. LSI-10 Report of employer's injury experience.

LSI-11 Certificate of Authority.

US-239 Certificate that employer has secured payment of compensation (by obtaining insurance policy).

US-240 Certificate that employer has secured payment of compensation (by selfinsurance).

US-241 Notice (compliance with Act by Insuring with).


SUBSTANTIVE RULES $ 02.1 Statement relative to substantive

rules. (a) The principal function of the Bureau and its subordinate parts is that of adjudicating claims for workmen's compensation. This function is quasi judicial in character and involves the application of statutes and principles of law to resolved factual situations. The field of activity is within the specialized branch of the law generally referred to as "workmen's compensation". This branch of the law has its own particularized principles which have general applicability to workmen's compensation statutes (State and Federal), as such statutes have certain common or underlying similarity in respect to the meaning of terms and phrases, and in respect to scope, jurisdiction, and general basic concepts of employers liability.

(b) In the administration of the several workmen's compensation laws within its jurisdiction, the Bureau has one general policy, which is to follow and to adhere to the principles of workmen's compensation law as stated in the opinions of the Supreme Court, the Federal Circuit Courts of Appeal, and the District Courts of the United States, as they may appropriately be applied in like situations arising under the laws administered by the Bureau. In addition, decisions and opinions of the judicial tribunals of the several States and Territories furnish principles of law of general applicability in the specialized field of workmen's compensation, which form part of the foundation of general principles relied upon in the application and interpretation of the several acts administered by the Bureau. The Bureau applies the statute, applicable in respect to a particular case or situation, to the extent that the statute can readily be applied without extrinsic aid, but where such aid is necessary, the source thereof is the body of principles embodied in authoritative decisions of the courts within such wellrecognized branch of the law.

(c) Certain statutes administered by the Bureau (relating to military or quasi military establishments) contain as the fundamental prerequisite to compensation that injury or death shall have occurred in the “line of duty”—a phrase not having a counterpart in workmen's compensation statutes. The policy of the Bureau in respect to such phrase is to follow the principles and interpretations in respect thereto as may be ap

plied by the particular service in which the disabled or deceased individual served.

(d) To the extent that any rule of substantive nature may appear in the published regulations of the Bureau, such regulations are made part of this section. [13 F.R. 7668, Dec. 10, 1948]






CEDURE Sec. 1.1 General provisions: definitions. 1.2 Notice of injury by employee. 1.3 Reports by official superiors of injuries

to employees.

Claim for compensation for disability. 1.5 Application for augmented compensa

sation for disability. Report of termination of disability or

return to work. 1.7 Recurrence of disability for work. 1.8 Claims for continued compensation for

disability. 1.9 Employee's obligation to return to work

or to seek work when able. 1.10 Affidavit or report by employee of em

ployment and earnings. 1.11 Claims for balance of schedule due at

death from other causes.

Report of death. 1.13 Original claims for death benefits. 1.14 Continuance of compensation on ac

count of death, 1.15 Termination of the right to compensa

tion for death. 1.16 Change in status of beneficiaries affect

ing compensation for death. 1.17 Burial expenses. 1.18 Embalming and transportation of bod

ies of deceased employees. 1.19 Overpayments by mistake. 1.20 Injuries to members of the Officers'

Reserve Corps, Enlisted Reserve

Corps, and Naval Reserve. 1.21 Records relating to Federal Employees'

Compensation Act matters as records of Bureau of Employees' Compensa

tion. 1.22 Inspection of records of Bureau re

lating to FECA matters. 1.23 Waiver not authorized. 1.24 Representation of claimants and ap

proval of claims for legal and other

services. 1.25 Retroactive effective dates and pro

cedures under Federal Employees'
Compensation Act Amendments of
TY: The provisions of this Part 1

sec. 32, 39 Stat. 749, as
S.C. 8145, 8149; 1946 Reorg.

3 CFR 1943–1948 Comp.,

p. 1064; 60 Stat. 1095; 1950 Reorg. Plan No. 19, § 1, 3 CFR, 1949–1953 Comp., p. 1010; 64 Stat. 1271, unless otherwise noted. § 1.1 General provisions: definitions.

(a) The administration of the Federal Employees' Compensation Act, as codified in 5 U.S.C. Ch. 81, is placed in the Department of Labor, under the direction and supervision of the Secretary of Labor or his designees in the Department. The Bureau of Employees' Compensation is authorized by the Secretary of Labor to decide all questions arising under the act. The Bureau is authorized under such act, upon consideration of a claim presented by a beneficiary and official reports pertaining to injury or death sustained by a civil employee of the United States while in the performance of duty and upon completion of such investigation as it may deem necessary, to determine the facts and make an award for or against payment of the compensation provided for in said act. The Bureau has power, under the provisions of the said act to issue subpoenas for and compel the attendance of witnesses within a radius of 100 miles, to require the production of books, papers, documents, and other evidence, to administer oaths, and to examine witnesses, upon any matter within the jurisdiction of the Bureau.

(b) [Reserved]

(c) All employees of the United States and other persons who may claim or be entitled to claim benefits under the said act, and the official superiors of all such persons, shall be bound by the regulations in this subchapter and shall conform to the procedure prescribed in said act and in the regulations under this subchapter. The term “official superior,” as used in this subchapter, includes all officers and employees having responsi supervision, direction or control of civil employees, others employed in the service of the Federal Government or the gov

135 F.R. 1284, Jan. 31, 1970.

ernment of the District of Columbia, and other persons performing service for the United States within the purview of said act and all acts in amendments, substitution or extension thereof. For the purposes of the regulations in this subchapter the term "employee" as used in this subchapter shall include all civil officers and employees of all branches of the Government of the United States (including officers and employees of instrumentalities of the United States wholly owned by the United States), employees of the government of the District of Columbia (except members of the Police and Fire Departments of the District of Columbia), members of the Reserve Oficers' Training Corps, an individual appointed to the staff of a former President, Civil Air Patrol volunteers, Peace Corps volunteers, Job Corps enrollees, Volunteers in Service to America, members of the National Teacher's Corps, members of the Neighborhood Youth Corps, student employees as defined in 5 U.S.C. 5351, employees of the Canal Zone and the Alaskan Railroad, law enforcement officers not employees of the United States killed or injured under certain circumstances involving a crime against the United States, and other persons performing service for the United States within the purview of said act and all acts in amendments, substitution or extension thereof.

(d) The term "einployee" shall also include persons rendering personal services of a kind similar to those of civilian oficers or employees of the United States to any department, independent establishment, or agency thereof (including Instrumentalities of the United States wholly owned by it), without compensation or for nominal compensation, in any case in which acceptance or use of such services is authorized by an act of Congress or in which provision is made by law for payment of the travel or other expenses of such person.

(e) All definitions appearing in the act are applicable with respect to the regulations promulgated under this subchapter [18 F.R. 7668, Dec. 10, 1948, as amended at 14 F.R. 7874, Dec. 9, 1949; 95 F.R. 1284, Jan, 81, 1970) $ 1.2 Notice of injury by employee.

(a) Whenever any injury is sustained by an employee of the United States while in the performance of his duty, he

shall immediately give written notice to his official superior. If the injured employee is unable to give such notice, it may be given by someone in his behalf. Form C.A. 1, Notice of Injury, is provided by the Bureau for such purpose. Unless written notice of injury is given within 48 hours or unless the immediate superior has actual knowledge of the injury, compensation may be refused. For reasonable cause the Bureau may accept written notice of injury given later than 48 hours, but not later than 1 year after the injury. (See $ 1.13 for waiver of limitation provision.)

(b) Whenever such an injury comes to the knowledge of the injured employee's oficial superior, a record of the cause, nature, and extent of the injury shall be made by the official superior, who should call to the attention of the employee the necessity of submitting, within 48 hours, or as soon after injury as practicable, a notice of the injury on Form C.A. 1. The official superior shall secure the signed statements of witnesses to the occurrence, and shall retain the employee's notice of injury until the injury is reported to the Bureau as required in g 1.3. Regulations under the United States Employees' Compensation Act, June 1, 1938] 8 1.3 Reports by official superiors of

injuries to employees. Every injury which is likely to result in any medical charge against the Compensation Fund or in any disability for work beyond the day, shift, or turn of the occurrence or which appears likely to require prolonged treatment or to result in future disability, or to result in any permanent disability, including the total or partial loss or loss of use of a member of the body, or serious disfigurement of the face, head or neck, shall be reported by the official superior on Form CA-2, Report of Injury, provided by the Bureau for this purpose, which shall be transmitted to the Bureau without delay. The employee's original Notice of Injury, on Form CA-1, or otherwise, should accompany the Report of Injury together with report of Investigation made and such stat or other data as may properly r the circumstances surrounding Jury. If the disability is likely exceed 3 days, the report may be held until the employee has returi work. [14 F.R. 7874, Dec. 9, 1949)


8 1.4 Claim for compensation for dig.

ability. (a) Compensation for disability under said act will not be paid unless written claim therefor is made by the employee or by someone in his behalf within the time limit prescribed by the said act. If such claim is not submitted within 60 days after the injury, an explanation of the delay must accompany the claim. For any reasonable cause shown the Bureau may allow claims for compensation for disability to be made at any time within 1 year. (For further waiver of limitation provisions see $ 1.13). Form CA4 is provided by the Bureau for making the original claim. Such claim may be filed by delivering it at the offices of the Bureau, or to any person designated by the Bureau to receive it. The employee's oficial superior is so designated to receive claims on behalf of the Bureau, and the injured employee should submit his claim to his official superior for transmission to the Bureau unless special circumstances require different procedure. Any claim or paper purporting to claim compensation submitted by an employee to his official superior shall be transmitted promptly to the Bureau. Whenever an employee, as a result of an injury in the performance of duty, is disabled with loss of pay for more than 3 days or sustains permanent disability which involves the total or partial loss, or loss of use, of a member of the body, or serious disfigurement of the face, head or neck, his official superior, when practicable, should furnish to him Form CA-4 for the purpose of claiming compensation, and should advise him of his rights under the said act Form CA-4 should be filled with the Bureau upon termination of disability it the duration of disability should be less than 14 days, or at the expiration of 14 days from the date pay stops, if disability continues beyond that date. If no claim is filed by an injured employee or by someone on his behalf prior to his death, the right to claim compensation for disability ceases and does not survive.

(b) Claims for compensation for permanent disability which involve solely the loss, or loss of use, of a member of the body, should be filed on Form CA-4, and if any compensation has been paid or is payable for a prior injury to the same member the date of such prior injury, the amount of such compensation and the source thereof shall be set forth in

the said CA-4 and filed in accordance with paragraph (a) of this section.

(c) Claims for serious disfigurement of the face, head, or neck should be made on Form CA-4, supplemented by Form CA-4B when required. If any compensation has been paid or is payable for any such prior disfigurement the date of such prior injury, the amount of compensation and the source thereof shall be stated in the said CA-4, or as supplemented by Form CA-4B. (Sec. 18, 39 Stat. 746; 5 U.S.C. 8121) (14 F.R. 7374, Dec. 9, 1949, as amended at 35 F.R. 1285, Jan. 31, 1970) $ 1.5 Application for augmented com

pensation for disability. (a) While the disabled employee has one or more dependents as defined in 5 U.S.C. 8110, his basic compensation for disability shall be augmented as provided in said section. The Bureau may require application for such augmented compensation to be made on Form CA-4A in accordance with $ 1.4. The Bureau may, however, pending the making of such application on such form, pay compensation under 5 U.S.C. 8110 upon other satisfactory proof.

(b) Augmented compensation payable while a disabled employee has an unmarried child as defined by 5 U.S.C. 8110, which would otherwise terminate because the child reaches the age of 18, may be continued while the child is a student regularly pursuing a full-time course of study or training as defined by $ 1.14(c).

(c) The disabled employee claiming augmented compensation under this section shall furnish, when so required by the Bureau, proof of continuing entitlement to augmented compensation as set forth in paragraph (a) of this section.

(d) The disabled employee receiving augmented compensation under this section shali promptly notify the Bureau of the happening of any event which would no longer entitle him to augmented compensation under the provisions of 5 U.S.C. 8110. Any checks or payments received after the occurrence of such event shall be returned promptly to the office from which it was received. (32 F.R. 2699, Feb. 9, 1967) § 1.6 Report of termination of disability

or return to work. Whenever an injured employee is able to return to work after a nerind

of disability caused by an injury, his official superior shall immediately report that fact to the Bureau on Form CA-3, which is provided by the Bureau for this purpose, unless such report has been made on Form CA-2, or otherwise. Such report shall show the period of absence from work and shall show specifically the part of such period for which the employee has been or will be paid on account of leave or for any other reason, stating the basis of such wage payment. If when disability begins the employee has annual or sick leave to his credit, he may use such leave until it is exhausted, solely at the discretion of such employee. (14 F.R. 7375, Dec. 9, 1949) § 1.7 Recurrence of disability for work.

When an injured employee, after returning to work, is again disabled and stops work as a result of the same injury, the official superior shall report the recurrence of disability promptly to the Bureau, showing clearly when the employee again stopped work and for what part of the new absence he has been or will be paid on account of leave or for any other reason. If the recurrent disability has ended when the report is made, the date and hour of return to duty should be stated; if not, an additional report should be made when the employee returns to work or his disability ceases. If the employee has been examined or attended by a physician in connection with such recurrence of disability, a medical report, as required by $ 2.10 of this subchapter should accompany the official superior's report of the recurrence, unless the physician has made his report to the Bureau.

Regulations under the United States Employees' Compensation Act, June 1, 1938] $ 1.8 Claims for continued compensa

tion for disability. An employee whose injury results in disability with loss of pay continuing beyond the time covered by the original claim on Form CA-4, may claim com

sation for further periods of disability on Form CA-8 which is provided by the Bureau for that purpose. Compensation will not be paid unless such claim for further compensation, properly executed, is received by the Bureau. The certification of the attending physician as to the further disability should be obtained on the form and it should be submitted to the employee's

official superior, who shall complete his portion of the certification thereon and forward the claim promptly to the Bureau. Claims on Form CA-8 should be submitted semi-monthly if disability is continuous. However, a Form CA-8 should not be submitted for continuing payments payable under a scheduled loss as provided in section 5 of the act. An employee whose disability is such that medical evidence of continuation thereof is not immediately necessary may be provided by the Bureau with Form CA-96 for use in submitting claim for continued compensation in lieu of Form CA-8. (14 F.R. 7375, Dec. 9, 1949] $ 1.9 Employees' obligation to return to

work or to seek work when able. When total disability to perform work ceases and the employee is able to perform a part of his usual duties, or to perform work of a different nature, he must seek such suitable work as he is able to perform, either in Government or private employment, unless it has already been provided for him, and shall accept such work or offer of work secured for: him. An employee who has not been regularly employed during the period covered by his claim, and who is only partially disabled, shall state in his claim what efforts he has made to obtain suitable employment, giving the names and addresses of persons or concerns to whom he has applied for work. If he has not been offered or has not been able to secure work which he is able to do, he shall so state. If a partially disabled employee refuses to seek suitable work or refuses or neglects to work after suitable work is offered to, procured by, or secured for him, he shall not be entitled to any compensation. (14 F.R. 7375, Dec. 9, 19491 1.10 Affidavit or report by employee

of employment and earnings. The Bureau may require a partially disabled employee to file a Form CA-96 or to submit an affidavit or other report as to his earnings either from employment or self-employment. If such individual, when required, fails to submit such form or affidavit or other report or if in such form, affidavit or report the employee knowingly omits or understates any part of such earnings or remunera.tion he shall forfeit his right to compensation with respect to any period for which such report was required to be made, and any compensation already


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