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Law, pursuant to section 207 thereof, is not transferable or assignable at law or in equity except to the United States. and none of the moneys paid or payable (except money paid as reimbursement for funeral expenses), or rights existing under such title, are subject to execution, levy, attachment, garnishment, or other legal process or to the operation of any bankruptcy or insolvency law. $61.22 Contracts for service facilities
of insurance carriers. (a) Under the provisions of section 106(a) of such Public Law the Bureau is authorized to contract with insurance carriers for the use of the service facilities of such carriers for the purpose of facilitating administration. The Bureau under this authority may enter into contracts for the use of service facilities which may be available and can be utilized in the processing of claims arising directly under section 101 and under section 104, Title I of such Public Law.
(b) Contracts for the use of service facilities will be arranged directly with insurance carriers or carrier groups as the Bureau finds to be necessary to facilitate administration.
(c) Compensation for the use of sery. ice facilities shall be based upon the services rendered for the Bureau with reimbursement for such items of claims expense (see $ 62.6 of this subchapter) as may be necessarily incurred or authorized by the Bureau, unless the serv. ice charge agreed upon includes all items of the carriers expense. The compensation for services shall be such amount as the Bureau and the carrier shall agree upon as reasonable for services rendered.
SOURCE: The provisions of this Part 62 appear at 8 F.R. 6811, May 25, 1943, unless Otherwise noted. $ 62.1 General reimbursement provi
sions. (a) Where any employer or his insurance carrier or compensation fund pays or is required to pay benefits:
(1) To any person or fund on account of injury or death of any person coming within the purview of Title I of Public Law No. 784, 77th Congress, entitled "An Act to provide benefits for the injury, disability, death, or enemy detention of employees of contractors with the United States, and for other purposes," approved December 2, 1942, or of Public Law No. 208, 77th Congress, extending the Longshoremen's and Harbor Workers' Compensation Act to certain persons employed at military, air, and naval bases, and upon Federal public works, outside the continental United States, approved August 16, 1941, as amended, if such injury or death arose from a war risk hazard (as defined in section 201 (b), Title II of such Public Law No. 784), which are payable under any workmen's compensation law of the United States or of any State, Territory, or possession of the United States, or other jurisdiction.
(2) To any person by reason of any agreement outstanding on the date of enactment of such Public Law No. 784 (such date being December 2, 1942) made in accordance with a contract between the United States and any contractor therewith (including any subcontractor or subordinate contractor with respect to the contract of such contractor), (i) to pay benefits with respect to the death of any employee of such contractor occurring under circumstances not entitling such person to benefits under any workmen's compensation law, or (11) to pay benefits with respect to the failure of the United States or its contractor to furnish transportation, upon the completion of the employment of any employee of such contractor, to his home or to the place where he was employed.
(3) To any person by reason of an agreement approved or authorized by the United States under which a contractor with the United States has agreed to pay workmen's compensation benefits or benefits in the nature of workmen's compensation benefits to an injured employee or his dependents on
PART 62-REIMBURSEMENT OF EM
PLOYERS, INSURANCE CARRIERS,
OR COMPENSATION FUNDS Sec. 62.1 General reimbursement provisions. 62.2 Claims for reimbursement. 62.3 Approval of claims. 62.4 Examination of records of claimant. 62.5 Reimbursement of claims expense. 82.6 Claims for reimbursement of claims
expense. 62.7 Same; approval of claims. 62.8 Direct payment of benefits.
AUTHORITY: The provisions of this part 62 issued under sec. 106, 56 Stat. 1088; 42 US.C. 1706, unless otherwise noted.
account of detention by the enemy or on account of injury or death arising from a war-risk hazard; such employer, carrier, or fund shall be entitled to be reimbursed for all benefits so paid or payable, including funeral and burial expenses, medical, hospital, or other similar costs for treatment and care; and reasonable and necessary claims expense in connection therewith.
(b) No reimbursement shall be made in any case in which the Bureau finds that the benefits paid or payable were on account of injury, detention, or death which arose from a war-risk hazard for which a premium (which included an additional charge or loading for such hazard) was charged; or where an insurance carrier has been compensated by its premium charge for the risk which it has assumed; or where the claimant has been reimbursed, paid, or compensated for the loss for which reimbursement is claimed.
(c) Reimbursement under this section, with respect to benefits, shall be made only of amounts which will discharge such liability or obligation as arises under applicable workmen's compensation law or pursuant to the terms of the applicable contract. $ 62.2 Claims for reimbursement.
(a) Claims for reimbursement of benefits and expense shall be made upon a form which the Bureau has prescribed, shall be signed and sworn to by the person, firm, or corporation entitled to reimbursement or the duly authorized representative of such person, firm, or corporation, and shall be filed with the Bu reau of Employees' Compensation, United States Department of Labor, Washington 25, D.C. Where the claimant is a corporation, or an agency authorized by the law of a State or other political jurisdiction, such corporation or agency shall advise the Bureau of the name and designation of its officer or officers authorized to execute such claims.
(b) Such claims shall contain a schedule showing the names and addresses of the persons to whom or on whose account benefits, payments, or expenses have been paid. In such schedule with respect to such persons there shall be stated the nature of the payment made; that is, whether for workmen's compensation benefits paid under any applicable law or for benefits under such agreements as are referred
to in $ 62.1. In the cases of such persons as are named in such schedule, the purpose of such payments shall be stated; that is, whether for compensation or benefits for disability or death, for medical, hospital or other similar costs for treatment and care, for funeral and burial expenses, for failure of the United States or the contractor to furnish transportation, for detention of an employee by the enemy, or for such other purpose within the purview of $ 62.1. Expenses classed as reasonable and necessary claims expense in connection with the handling of such cases may be included in such claim, as provided for by $ 62.5. With respect to each case listed in such schedule, where injury or death is involved, the cause thereof shall be stated; if payment is on account of detention or failure to furnish such transportation, the facts in relation thereto shall be stated.
(c) All payments as listed in such schedule shall be itemized, with identity of the payee shown. If necessary in specific cases listed in such schedule, where payments have been made to numerous payees, a supplementary sheet, properly identified, as an exhibit to the case or cases, may be used to show items and payees. Each item in excess of $10, with respect to which reimbursement is claimed in any claim shall be supported by a sufficient receipt signed by the payee showing that the amount claimed has been paid and the date thereof and the purpose of payment. Where a payee fails or refuses to furnish such receipt upon request therefor, in lieu of such receipt the Bureau may accept the certificate of the person claiming reimbursement that the item has been paid as claimed (such certificate identifying the payee and service rendered or benefit paid) and that receipt has been requested, but that the payee has failed or refused to furnish same, and that a canceled check covering the payment is in the claimant's possession. The Bureau may also accept such certificate where for other satisfactory reason such receipt can not be obtained; or the Bureau may accept other satisfactory evidence of payment. The Bureau reserves the right, when satisfactory receipts have not been furnished, to examine the vouchers, canceled checks, and other evidence of payment in the possession of the claimant. All supplementary sheets, as above referred to, receipts for items paid, and certificates in lieu of receipts,
18 de other evidence, shall be marked with ue le case number appearing in the schedmele (as provided in paragraph (d) of fc is section), the case name, as listed in
ich schedule, and identified as exhibits othed the respective cases and lettered alre habetically with respect to each case. af (d) Where claim for reimbursement accacludes more than one case, the scheder de attached thereto (referred to in parugraph (b) of this section) shall be
rranged alphabetically and cases shall se numbered consecutively in the schedmoule. Each separate claim of an employter, insurance carrier, or compensation
und shall be numbered consecutively for prompt identification. Claimants drshall make and retain a copy of the claim
and accompanying schedule. mg (e) In the schedule provided for in
paragraph (b) of this section, there shall be set forth, in relation to each case as listed, a reference to the workmen's compensation law or agreement under which payment was made, suficiently identifying the applicable law and section thereof pertaining to the separate amounts listed for reimbursement. Where payment was made pursuant to an award or settlement agreement under such appli
cable law, a copy of the award or agree"ment shall be attached as an exhibit to
the case. Where continued payments have been made under an award or agreement, copy of which has been furnished by the claimant in connection with a prior claim, further copy thereof need not be furnished in connection with a later claim for reimbursement involving the same case. Suficient reference thereto should be given to facilitate identification. Where an award or agreement has been modified, evidence of such modification should be submitted in applicable cases. Copies of awards under any law administered by the Bureau need not be attached, but reference thereto may be made in the schedule or in a separate sheet marked e a case exhibit. In all cases where I insurance carrier is a claimant, it
attach as a case exhibit a copy of surance contract under which its
or obligation has accrued. ayment was made pursuant to
greement between the
e contractor, a copy 4 sufficient excerpt
ion suficient to ibtain a copy or Ung & copy of
thereunder, if any, shall be furnished as a case exhibit to the case or cases to which it applies. Such contract or excerpt should be supplemented by an explanatory statement of the claimant, or by other supporting papers, if the 11ability of the claimant for the payment with respect to which reimbursement is claimed is not otherwise clearly apparent. Where liability of an employex, insurance carrier or compensation fund has accrued in more than one case, copies of insurance contracts, awards or settlement agreements, or other agreements or contracts (or excerpts) relied upon as basis for reimbursement need be furnished to the Bureau only once as a case exhibit; thereafter, in other cases in the same reimbursement claim, or in future reimbursement claims, reference thereto may be made suficiently identifying the case name, number upon claim schedule, and number and date of the claim (if the exhibit accompanied an earlier claim).
(f) Claims for reimbursement shall be filed quarterly; that is, as of the first of January, April, July, and October, unless otherwise authorized by the Bureau. (Sec. 104, 56 Stat. 1031; 42 U.S.C. 1704; 1950 Reorg. Plan No. 19, 81, 3 CFR, 1949–1958 Comp., p. 1010; 64 Stat, 1271) 18 F.R. 6811, May 25, 1943, as amended at 25 F.R. 10795, Nov. 15, 1960] 8 62.3 Approval of claims.
(a) If upon examination and audit of a claim under this part the Bureau finds that insufficient or inadequate information or proof has been supplied with the claim, further information or proof shall be submitted as required by the Bureau, and failure to supply available information and proof, upon request, may result in disallowance of items not adequately supported as justly reimbursable.
(b) No item shall be approved for reimbursement with respect to which there has been failure by the claimant to justify such item as a liability or obligation of such claimant arising under the provisions of applicable workmen's compensation law or under the provisions of an agreement or contract relied upon as basis for such liability. Claims for reimbursement for funeral and burial expenses, medical, hospital, or other similar costs for treatment and care, or other necessary expenses, shall be approved only to the extent that they have been shown to be reasonable, and unreasongble or excessive items shall be reduced accordingly for purpose of such reimbursement. The Bureau will not withhold payment of any part of a claim approved, because of denial of any part of such claim. The Bureau will regard awards, decisions, and approved settlement agreements of workmen's compensation jurisdictions, which have become final in the cases to which they pertain, as establishing, prima facie, the right of the beneficiary named therein to the payment awarded or provided for.
(c) The claimant shall be advised of the action taken upon the claim filed and the amount approved for reimbursement. Where the claim has been denied in whole or in part, or where reimbursement as to any item has been reduced from the amount claimed, the claimant shall be advised thereof together with the reasons for the action taken. Claimants within the United States shall be allowed sixty days, and claimants outside the United States six months, unless unusual circumstances in either case are found to require a longer time, from date of the Bureau's action, within which to file objections to the disallowance of any claim or part thereof, or reduction in any item of a claim. Such objections properly filed will be considered by the Bureau. After such period of time, objections shall not be considered, unless the Bureau for reasonable cause shown shall consider such objections.
(d) A part or an item of a claim may be disapproved if the Bureau should find that the claimant or those whom he represented or those who represent him by contract or otherwise (1) failed to contest, reasonably questionable liability; or (2) failed to take advantage of set-off against the claim of any person whose case is referred to in such schedule; or (3) failed to take advantage of any right accruing by assignment, subrogation or otherwise (except as against the United States, directly or indirectly, its employees, or members of its armed forces) because of the liability of a third party, unless the financial condition of such third party or facts and circumstances in respect of such liability justified such failure; or (4) failed to take reasonable measures to reduce or terminate his liability by appropriate available procedures under workmen's compensation law or otherwise; or (5) failed to make reasonable and adequate investi gation or inquiry as to the right of any
person to any benefit or payment, or the continuation thereof. In considering whether there has been a failure to do any of the foregoing things, the Bureau will have regard for and weigh such matters as bona fides, good judgment, unusual circumstances, reasonable cause, or such similar basis for justification as may be relied upon to avoid the effect of any such failure. Claimants will be held to the same degree of care and pru. dence in respect of the matters set forth in this paragraph, as under the law any individual or corporation in the protection of its interests or the handling of its affairs would be expected to exercise un. der similar circumstances. 8 62.4 Examination of records of
claimant. (a) Whenever it shall be deemed necessary, the Bureau or its representative may request submission of case records or may inspect the records and accounts of a claimant (or any party whom he represents or who represents him, by contract or otherwise) for the purpose of verifying any allegation, fact or payment stated in his claim or papers in support thereof, and such claimant shall furnish such record and permit or authorize any such inspection as the Bureau shall require. Such right of inspection shall also relate to records and data used for rate making or premium establishing purposes kept by a claimant or supplied by him to any rate making or similar agency or authority to determine whether any premium or other charge has been made with respect to the reimbursement claimed.
(b) If required by the Bureau, a claimant shall furnish copies of drafts, vouchers, releases, or other instruments relating to payments on account of which reimbursement is claimed, by photostat or other means of facsimile reproduction. 8 62.5 Reimbursement of claims ex
pense. (a) Under the provisions of section 104 (a) Title I, of such Public Law No. 784, the Bureau is authorized to reimburse an employer, carrier, or compensation fund for reasonable and necessary claims expense in connection with cases within the purview of such section, for which reimbursement is claimed.
(b) In the adjustment of claim pense of employers (other than expense arising under insurance cies), reimbursement of reasonable
necessary claims expense will be made for therein in the determination of reon the basis of item reimbursement. imbursable claims expense, if the appliItems of such expense which will be rec cation of such plan or method in relaognized by the Bureau are only thosetion to the amount of benefit reimburseitems which can be directly allocated to ment results in reimbursement of reaclaims, when necessary to determine lia sonable and necessary claims expense; bility. If in the adjustment of such otherwise, the manner of determining claims expense, allocation thereof to a such reimbursable expense, as provided specific claim is impracticable, reim- above with respect to cases in which no bursement of such expense or part benefit payments have been made, shall thereof may be made by the Bureau on the basis of agreement with the claim (d) In the adjustment of claims exant, or on such other equitable basis as pense the Bureau will not in any case will accomplish reimbursement for rea consider as a claims expense any distrisonable and necessary claims expense. bution of administrative, general office
(c) The adjustment of claims expense maintenance, rent, insurance, taxes, arising under insurance policies to which or other similar general expenses. Exare attached endorsements under the cept as defined otherwise by an applied comprehensive insurance rating plan, or endorsement, plan or method, the term similar plan, of the Army or Navy De "allocated claims expense”, when conpartment, or other department or agency sidered as such by the Bureau, shall inof the United States using the same or clude payments made for reasonable atsimilar plan, shall be consistent with the torneys' fees, court and litigation costs, method provided under such plan for de expenses of witnesses and expert testitermining payment of claims expense. mony, examinations, autopsies and such In addition to reimbursement for allo other items of expense as can be directly cated claims expense, as provided for and allocated to specific claims, when necesdefined in such endorsement the Bu- sary to determine liability. The term reau may apply the same factor as is "unallocated claims expense”, when concontained in such endorsement for de- sidered as such by the Bureau, shall mean termining claims expense, by applying that expense which can properly and such factor to the sum of paid losses aris- definitely be allocated to claims, where ing under the policy containing such en necessary to determine liability, but can dorsement, as may be approved for re not be directly allocated to specific imbursement by the Bureau under the claims. particular claim filed under $ 62.2 to (e) No employer, insurance carrier or which such claims expense relates. In compensation fund shall be entitled to such situations the reimbursement of reimbursement under this section for any claims expense shall be upon the basis of claims expense where it has been paid such allocated claims expense plus the such expense, or has been paid for any application of such factor, as provided service which included or contemplated If the application of such factor would payment of the expense for which reimnot result in reimbursement of reason bursement hereunder is sought, the cost able and necessary claims expense, the of which has been or will be borne by Bureau may apply such method of deter- the United States. Any charge made or mining such claims expense, or may paid, contemplating expenses other than adjust such expense upon such basis with allocated or unallocated claims expense the claimant, as will result in fair and shall not be considered as a claims exequitable reimbursement. In cases in pense within the meaning of this subwhich no benefit payments have been section. Every claimant applying for remade, but claims expense has been neces imbursement of claims expense shall in sarily incurred, reimbursement of rea his claim expressly disclaim and waive sonable and necessary claims expense any right to claim allocated or unallowill be made with respect to proper items cated claims expense, as defined above thereof as established by the claimant or as defined in any such plan or endorseand approved by the Bureau, or upon ment, or to claim a service or other such other equitable basis as may be charge which would include or contemagreed upon by the Bureau and the plate the inclusion of such expense, to the claimant. The adjustment of claims ex- extent to which reimbursement thereof is pense arising under other insurance poli- made under his claim, where such right cies or agreements shall be consistent may arise by reason of any agreement or with the plan or method, if any, provided contract with a contractor who has con