Page images
PDF
EPUB

districts established pursuant to such act. The deputy commissioner performs the quasi-judicial function of deciding the rights of private parties, the employee, or his dependents (as the claimant or claimants), and the employer, or employer and his insurance carrier (as respondent or respondents).

(b) Claims for compensation or for reimbursement of medical expenses (where the employer has failed or neglected to furnish medical care) are processed by the deputy commissioner, with or without the assistance of claims examiners in his office, by the verification of payments, and informal adjudicatory processes, in uncontested cases. Claims not subject to informal adjustment are processed by the deputy commissioner after pre-hearing conference (to afford amicable disposition of controversies, to narrow issues, and to simplify subsequent methods of proof), or after formal hearing provided for by the act, implemented by $ $ 31.9, 31.10, 41.8, 41.9, 51.1 and 51.4 of this chapter.

(c) Formal proceedings are terminated by the filing of a compensation order containing findings of fact and award, or other order of the deputy commissioner $$ 31.12, 31.13, 31.14, 41.11, 41.12, 41.13, and 51.1 of this chapter. (Sec. 19, 44 Stat. 1435, as amended; 38 U.S. C. 919)

01.12 Review of decisions.

Review of a compensation case by the deputy commissioner may be had as prescribed by the act. The procedure outlined in the regulations requires an application to be filed in duplicate with the deputy commissioner stating the ground for review, which shall be supported by appropriate evidence ($$ 31.16, 41.15, and 51.1 of this chapter). The procedure in respect to such application for review is the same as is prescribed for claims by the act and regulations. The act does not authorize review by the Bureau of the action upon a claim by the deputy commissioner; judicial review of such action is however authorized, and the manner thereof is specified. (Secs. 21 (b), 22, 44 Stat. 1436, 1437, as amended; 33 U. S. C. 921 (b), 922) $ 01.13 Forms.

Forms for use under the Longshoremen's Act are as follows:

US-201 Employee's first notice to Deputy Commissioner of accident or occupational disease.

U8–202 Employer's first report to Deputy Commissioner of accident or occupational disease.

US-202A Employer's first report of injury (No time lost by employee).

U8–203 Employee's claim for compensation.

US–204 Attending Physician's report.

US-205 Physician's report on permanent eye disabilities.

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

US-206–8 Notice to the Deputy Commissioner that the payment of compensation has begun without awaiting award by him.

U8–207 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.

08–209 Request to employee that he reply to the employer's objection to his right to compensation.

US-210 Employer's supplementary report of subsequent disability.

U8–211 Employer's supplementary report of accident or occupational disease.

U8-212 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 (disabil. ity or death claim).

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

US-215 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-224 Application to determine reason. ableness of physician's bill or medical charges under section 7.

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

US-227 Attending Physician's supplementary report.

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).

U8–264 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 hae secured payment of compensation (by obtaining insurance policy).

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

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

US-242 Notice (compliance with Act by self-insurance). Subpart C—District of Columbia

Workmen's Compensation Act SOURCE: The provisions of this Subpart C

pea at 11 F.R. 177A-527, Sept. 11, 1946, unless otherwise noted. Redesignated at 13 F.R. 7668, Dec. 10, 1948. § 01.21 Processing of claims.

(See $ 01.11.) & 01.22 Review of decisions.

(See § 01.12.) Proceedings for judicial review of the decision of the deputy commissioner are filed in the United States District Court for the District of Columbia. 8 01.23 Forms.

The following forms are used in the administration of the District of Columbia workmen's compensation law: DCCA-301 Employee's

first notice to Deputy Commissioner of accident or occupational disease.

DCCA-302 Employer's first report to Deputy Commissioner of accident or occupational disease.

DCCA-303 Employee's claim for compensation.

DCCA-304 Attending physician's report.

DCCA-305 Physician's report on permanent eye disabilities.

DCCA-306 Notice to the Deputy Commissioner that the payment of compensation has begun without awaiting award.

DCCA-306–8 Notice to the Deputy Commissioner that the payment of compensa

tion has begun without awaiting award by him.

DCCA-307 Notice to the Deputy Commissioner that claim will be controverted.

DCCA-308 Notice to the Deputy Commissioner that the payment, of compensation has been stopped or suspended.

DCCA-309 Request to employee that he reply to the employer's objection to his right to compensation.

DCCA-310 Employer's supplementary report of subsequent disability.

DCCA-311 Employer's supplementary report of accident or occupational disease.

DCCA-312 Notice to injured employee that case will be closed unless payments made are shown to be incorrect.

DCCA-313 Notice of election to sue (disability or death claim).

DCCA-314 Request for medical examination under District of Columbia Workmen's Compensation Act.

DCCA-315 Answer of employer or insurance carrier to employee's claim for compensation.

DCCA-315A Notice to employer and insurance carrier that answer to claim for compensation should be made.

DCCA-321 Application for lump sum award (disability or death).

DCCA-326 Subpoena.
DCCA-326A Subpoena Duces Tecum.
DCCA-326B Notice of Hearing.

DCCA-360 Notice to Deputy Commissioner of Death.

DCCA-361 Supplemental report of employer in death case.

DCCA-362 Claim for compensation in death case by widow and/or children under the age of eighteen.

DCCA-363 Claim for compensation in death cases by dependents other than widow and children of deceased (each dependent or representative must file individual claim).

DCCA-364 Proof of Death (by Physician last in attendance on deceased).

DCCA-365 Proof of Burial and Funeral expenses-by undertaker.

DCCA-402 Application for self-insurance.

DCCA-403 Decision granting application of employer to pay compensation as a selfinsurer.

DCCA-404 Agreement and Undertaking of employer granted the privilege of paying compensation as self-insurer,

DCCA-405 Indemnity Bond given by selfinsurer.

DCCA-411 Certificate of Authority.

DCCA-439 Certificate that employer has secured payment of compensation (by obtaining insurance policy).

DCCA 440 Certificate that employer has secured payment of compensation (by selfinsurance).

DCCA-441 Notice (compliance with Act by insuring with).

DCCA-442 Notice (compliance with Act by self-insurance).

Subpart D-Defense Bases Act

SOURCE: The provisions of this Subpart D appear at 11 F.R. 177A-527, Sept. 11, 1946, unless otherwise noted. Redesignated at 13 F.R. 7668, Dec. 10, 1948. 8 01.31 Processing of claims.

(See : 01.11.) 801.32 Review of decisions.

(See § 01.12.) Application for judicial review is required to be instituted in the United States district court for the judicial district wherein is located the office of the deputy commissioner whose compensation order is involved, if his office is located in a judicial district, and if not so located, such judicial proceedings are required to be instituted in the judicial district nearest the place at which the injury or death occurs. (Sec. 8, 55 Stat. 623; 42 U. S. C. 1663) $ 01.33 Forms.

The same forms prescribed for use in the administration of the Longshoremen's Act are used in the administration of the act of August 16, 1941 (the socalled Defense Bases Act) except that they are modified by a typed or stamped insertion to show that they relate to such act of August 16, 1941. (See § 01.13.) Subpart E-Disability, Death and De

tention Benefits; Employees of Contractors SOURCE: The provisions of this Subpart E appear at 11 F.R. 177A-527, Sept. 11, 1946, unless otherwise noted. Redesignated at 13 F.R. 7668, Dec. 10, 1948. & 01.41

General procedures. The procedure in respect to the benefit provisions, in so far as administration of the act of December 2, 1942 (56 Stat. 1028, as amended; 42 U.S.C. 1701 et seq.) is concerned, is stated by regulations in detail in Subchapter F, of this chapter. Under such regulations claims may be filed directly with the Bureau

with a deputy commissioner or other designated officer and may be processed completely by the Bureau or completely or partially by the authorized field officers. In practice most claims are processed directly by the Bureau through its Claims Division, with supplementary actions by other divisions of the Bureau as a particular case may require, including final audit by the Audit and Accounting Division. The final au

thority in the Bureau in the approval of claims is the Director or Acting Director thereof. Hearings are not authorized by the applicable statute, and the adjudication of cases is upon written evidence as in other cases under the Employees' Compensation Act of Sept abe 1916. (For further statement of procedures see 8 01.1.) 01.42 Forms.

Forms used in connection with the benefit provisions of the act of December 2, 1942, are as follows:

CAEA-5 Dependent's Claim for Disbursement of Detention Benefits.

CAEA-12 Wife or Husband's Claim for Continued Disbursement of Detention BeneAts.

CAEA-13 Claim of Guardian of Minor for Continued Disbursement of Detention Benefits.

CAEA-14 Dependent Parent's Claim for Continued Disbursement of Detention Benefits.

CA-12 Same as under United States Employees' Compensation Act.

CA-13 Same as under United States Employees' Compensation Act.

CA-13A Same as under United States Employees' compensation Act.

CA-14 Same as under United States Employees' Compensation Act.

CA-16 Same as under United States Em. ployees' Compensation Act.

CA-17 Same as under United States Em. ployees' Compensation Act.

CA-20 Same as under United States Employees' Compensation Act.

CA-32 Same as under United States Employees' Compensation Act.

CA-42 Same as under United States Employees' Compensation Act.

CA-43 Same as under United States Employees' Compensation Act.

CA-96 Same as under United States Em. ployees' Compensation Act.

Std. 69 Same as under United States Em. ployees' Compensation Act.

Std. 1012 Same as under United States Employees' Compensation Act.

Std. 1034 Same as under United States Einployees' Compensation Act.

US-205 Same as under United States Em. ployees' Compensation Act.

US-203 Employee's Notice of Injury and Original Claim for Compensation and Medical Treatinent.

US-202 Employer's First Report to Bureau of Detention, Accident or Occupational Illness,

US-261 Eniployer's Supplemental Report in Death Case.

US-262 Claim of Widow or Children for Compensation for Death.

US-263 Dependent's (other than widow or children) Claim for Compensation for Death.

or

or

Subpart F-Reimbursable Insurance pine Islands which may however be Claims

filled with the field representative of

the Bureau in Manila, P. I. All claims SOURCE: The provisions of this Subpart F

are processed directly by the Bureau appear at 11 F.R. 177A-527, Sept. 11, 1946,

through its Claims Branch with suppleunless otherwise noted. Redesignated at

mentary actions by other Branches of 13 F.R. 7668, Dec. 10, 1948.

the Bureau as a particular case may re801.51 General procedures.

quire, including final audit by the Audit Reimbursement of employers, insur

and Accounting Branch. The final auance carriers, and compensation funds,

thority in the Bureau in the approval or for losses resulting from hazards of the

rejection of claims is the Director or war, is provided for in such act of De- Acting Director thereof. Hearings are cember 2, 1942 (42 U.S.C. 1704). The

not authorized by the applicable statute, procedure in respect to reimbursement

and the adjudication of cases is upon and the prerequisites of claims are set

written evidence as in other cases under forth in detail by regulations in Sub

the Federal Employees' Compensation chapter F of this chapter. Under such

Act of September 7, 1916. regulations claims may be filed directly § 01.62 Forms. with the Bureau. They are examined

Forms used in connection with the by the Audit and Accounting Division of

administration of benefits provided by the Bureau after verification by the Em

section 5 (f) of the said War Claims Act ployees' Compensation Division of the

of 1948 are as follows: Solicitor's Office, United States Department of Labor. Hearings upon such

WC-3—Claim for Injury Disability claims are not authorized by applicable

Benefits by Civilian American Citizen.

WC-3A-Medical Report of Attending statute. The final authority in the Bu

Physician. reau in the approval of such claims is

WC-3B-Claim for Continuance of Disthe Director or Acting Director thereof. ability Benefits by Civilian American (11 F.R. 177A-528, Sept. 11, 1946, as amended Citizen. at 13 F.R. 7668, Dec. 10, 1948; 25 F.R. 10793, WC-4-Claim for Death Benefits by SurNov. 15, 1960)

vivors of Deceased Civilian American

Citizens. 8 01.52 Form.

CA 12-Same as under the Federal EmThe form used in connection with the

ployees' Compensation Act.

CA-13-Same as under the Federal Em. reimbursement provisions of the act of

ployees' Compensaton Act. December 2, 1942, is as follows:

CA-13A-Same as under the Federal EmU. S. R-1 Claim for Reimbursement of ployees' Compensation Act. Benefit Payments and Claims Expense.

CA-14-Same as under the Federal Em

ployees' Compensation Act. Subpart G-Compensation for Injury, CA 42-Same as under the Federal EmDisability or Death of Civilian ployees' Compensation Act.

CA-43–Same as under the Federal Em. American Citizens Incurred While

ployees' Compensation Act. Detained By or in Hiding From the Std. 69—Same as under the Federal Em. Imperial Japanese Government ployees' Compensation Act.

Std. 1012-Same as under the Federal SOURCE: The provisions of this Subpart G appear at 16 F.R. 2932, Apr. 4, 1951, unless

Employees' Compensaton Act. otherwise noted.

Std. 1034-Same as under the Federal

Employees' Compensation Act. & 01.61 General procedures. The procedure in respect to the ad

Subpart H-Outer Continental Shelf ministration of the benefit provisions of

Lands Act section 5(f) of the War Claims Act of

SOURCE: The provisions of this Subpart H 1948 (Act of July 3, 1948, Public Law

appear at 19 F.R. 6220, Sept. 28, 1954, unless 896, 80th Congress, 62 Stat. 1240) is

otherwise noted. set forth in detail by regulations in Subchapter G of this chapter and, by

§ 01.71 Processing of claims. reference therein, to pertinent regula- The processing of claims of employees tions in Subchapter F of this chapter. for compensation benefits arising under Under such regulations claims must the Longshoremen's and Harbor Workbe filed directly with the Bureau, ers' Compensation Act, as amended (44 except claims originating in the Philip- Stat. 1442, 33 U.S.C. 901, et seq.), as ex

tended by the Outer Continental Shelf § 01.82 Review of decisions. Lands Act (67 Stat. 462, 43 U.S.C. 1331

Except as herein modified, review of et seq.), is governed by $ 01.11 of Sub

compensation cases arising under the part B of this subchapter.

Longshoremen's and Harbor Workers' (Interpret or apply sec. 2, 67 Stat. 462; 43

Compensation Act as extended by the U.S.C. 1331)

act of July 18, 1958 (72 Stat. 397; § 01.72 Review of decisions.

5 U.S.C. 150k-1) to civilian employees Except as herein modified, review of

of nonappropriated fund instrumentali

ties of the Armed Forces, is governed compensation cases arising under the

by $ 01.12. Proceedings for judicial Longshoremen's and Harbor Workers'

review (or for enforcement of payment Compensation Act, as extended by the Outer Continental Shelf Lands Act, is

of compensation in case of default as

authorized under section 18 of the governed by $ 01.12 of Subpart B of this

Longshoremen's Act), of a decision subchapter. Application for judicial re

in a compensation case arising under view of a decision in a compensation

the Longshoremen's Act, as thus excase arising under the Longshoremen's and Harbor Workers' Compensation Act,

tended, are required to be instituted with

respect to any jur or death occurring as extended by the Outer Continental

outside the continental limits of the Shelf Lands Act, is required to be insti

United States, in the District Court of tuted in the judicial district in which any

the United States within the territorial defendant resides or may be found or in

jurisdiction of which is located the office the judicial district of the adjacent State

of the deputy commissioner having jurisnearest the place where the injury or

diction in respect of such injury or injury causing death occurred.

death (or in the United States District (Interpret or apply sec. 2, 67 Stat. 462; 43

Court for the District of Columbia if U.S.C. 1331)

such office is located in such district). $ 01.73 Forms.

In all other cases the provisions of sec

tion 21 (b) (33 U. S. C. 921 (b)) of the The same forms prescribed for use in

Longshoremen's Act apply and they reconnection with the administration of

quire judicial proceedings to be instituted the Longshoremen's Act are used in the

in the United States District Court for administration of the Outer Continental

the judicial district in which the injury Shelf Lands Act, except that they are

occurred (or the United States District modified by a stamped or typed legend

Court for the District of Columbia, if to indicate that they relate to the Outer

the injury occurred in the District of Continental Shelf Lands Act.

Columbia). (Interpret or apply sec. 2, 67 Stat. 462; 43 U.S.C. 1331)

(Interpret or apply 72 Stat. 397; 5 U.S.C.

8171, 8172, 8173) Subpart 1-Compensation for Civilian

$ 01.83

Forms. Employees of Nonappropriated

The same forms prescribed for use in Fund Instrumentalities

connection with the administration of SOURCE: The provisions of this Subpart I the Longshoremen's Act are used in the appear at 23 F.R. 8958, Nov. 18, 1958, unless administration of said act of July 18, otherwise noted.

1958, providing for payment of work8 01.81 Processing of claims.

men's compensation benefits to civilian

employees of nonappropriated fund The processing of claims of employees instrumentalities of the Armed Forces as and dependents for compensation bene- follows: fits payable according to the Longshore

US-201 Employee's first notice to Deputy men's and Harbor Workers' Compensa- Commissioner of accident or occupational tion Act, as amended (44 Stat. 1424, 33

disease. U.S.C. 901 et seq.) as extended by the

US-202 Employer's first report to Deputy act of July 18, 1958 (72 Stat. 397; 5

Commissioner of accident or occupational

disease.
50k-1), to civilian employees of US-202A Employer's first report of injury.

riated fund instrumentalities (No time lost by employee.)
d Forces, is governed by

US-203 Employee's claim for compensation.

US–204 Attending Physician's report. ply 72 Stat. 397; 5 U.S.C. US-205 Physician's report on permanent

eye disabilities.

« PreviousContinue »