person acting on behalf of such employee shall give written notice of such disease or disability to such employee's official superior in the manner prescribed in paragraph (a) of this section, except that notice is given on Form CA-2, Federal Employees' Notice of Occupational Disease and Claim for Compensation. If for any reason it is impractical to give such notice to the employee's official superior in the case of an occupational disease or disability, notice of the disease or disability may be given to any official of the employee's employing agency or to the Office.

[40 FR 6877, Feb. 14, 1975; 40 FR 14750, Apr. 2, 1975]

§ 10.101 Report of death.

(a) Traumatic injury. When an employee dies because of a traumatic injury sustained while in the performance of duty, such employee's official superior shall immediately report such death to the Office by telephone or telegraph. As soon thereafter as is practicable such official superior shall complete and send to the Office a form CA-6, Official Superior's Report of Employees' Death.

(b) Occupational disease. When an employee dies while in the performance of duty as a result of an occupational disease such employee's official superior shall immediately report such death in the manner prescribed in paragraph (a) of this section. If for any reason it is impracticable for such employee's official superior to report such employee's death due to an occupational disease or disability, such report may be made by any official superior of the employing agency or any other person acting on behalf of the deceased employee's survivors.

§ 10.102 When a notice of injury or report of death must be given.

(a) Traumatic injury. In the case of a traumatic injury or death due to a traumatic injury notice of such injury or death must be given pursuant to 5 U.S.C. 8119, within 30 days from the date on which the injury or death occurred. The failure to give notice within the period specified by this paragraph may result in a loss of compensation rights.

(b) Occupational disease. In the case of the onset of an occupational disease or disability notice of such onset or death shall be given within 30 days from the date on which the claimant has been informed by competent medical authority or by the exercise of reasonable diligence should have been made aware that he or she is suffering from an occupational disease or disability or in the case of death, within 30 days from the date of such death. In the case of a death due to an occupational disease or disability the 30 day period specified in this section does not apply until such times as the deceased employee's survivors or official superior should by the exercise of reasonable diligence be aware that the employee's death was due to an employment related occupational disease or disability. The failure to give notice within the time period specified by this paragraph may result in a loss of compensation rights.

§ 10.103 Report of injury by official superior and physician.

(a) The official superior is required to promptly submit to the Office a written report of every injury or occupational disease when it is likely to (1) result in a medical charge against the Office, (2) result in disability for work beyond the day or shift of injury, (3) require prolonged treatment, (4) result in future disability, (5) result in permanent disability or (6) result in a continuation of pay pursuant to 5 U.S.C. 8118. Portions of Forms CA-1 or CA-2 are provided for this purpose. The official superior shall also furnish the Office with a report of any investigation made and any other statements or data which may properly relate to the circumstances of the injury. If the injury need not be reported to the Office, the Form CA-1 or CA-2 shall be retained as a permanent record in the employee's personnel folder.

(b) In all cases reported, the Office shall be furnished with an immediate medical report from the attending physician. This report may be made: (1) on Part B of Form CA-16; (2) on Form CA-20, Attending Physician's Report; or (3) by narrative report on the physician's letterhead stationery.

(c) Other reports shall be submitted by the official superior and attending physician as described elsewhere in this part or as may be required by the Office.

CLAIMS FOR COMPENSATION

§ 10.105 Time for perfecting a claim for compensation.

(a) Claim for disability compensation. An injured employee is required to file a written claim for compensation within 3 years after the injury before compensation may be paid. If, however, the official superior had actual knowledge of the injury within 30 days, or if written notice was given within 30 days, compensation is allowed regardless of whether a written claim was made within 3 years after the injury. Actual knowledge must be such as to put the official superior reasonably on notice of an on-the-job injury.

(b) Claim for death compensation. If the employee dies, a written claim for compensation by or on behalf of the survivors is required before compensation may be paid. This claim is to be filed within 3 years after the death, unless within 30 days of such death, the official superior had actual knowledge of the death, due to an employment related injury or disease or written notice of such death was given to the official superior within 30 days of such death. The timely filing of a disability claim because of an on-the-job injury will satisfy the time requirements for a death claim based on the same injury.

(c) Claim predicated upon a latent disability. In a case of latent disability, or death due to a latent disability, the time for filing a claim does not begin to run until the employee has a compensable disability or dies and is aware or his survivors are aware, or by the exercise of reasonable diligence should have been aware, of the casual relationship of the compensable disability or death to the employment. In such a case, the time for giving notice of injury or death begins to run when the employee is aware or the survivors are aware, or by the exercise of reasonable diligence should have been aware that the employee's condition

or death is casually related to his or her employment, whether or not there is a compensable disability or death.

(d) The time limitations described in this section do not begin to run against a minor until such minor reaches 21 years of age or has had a legal representative appointed; or run against an incompetent individual while such individual is incompetent and has no duly appointed legal representative; or run against any individual whose failure to comply is excused by the Secretary of Labor on the ground that notice could not be given because of exceptional circumstances.

§ 10.106 How to file a claim for disability compensation.

(a) A claim may be filed by delivering it to the Office, or to any person designated by the Office to receive claims. The employee's official superior is so designated to receive claims on behalf of the Office, and the injured employee may submit his claim to such official superior for transmission to the Office unless special circumstances require a different procedure. The official superior shall submit the injured employee's claim to the Office within 2 working days.

(b) Notwithstanding the filing of any document provided for by Paragraph (a) of this section, no disability compensation shall be payable unless the employee completes the front of a Form CA-4 and submits it to his or her official superior. The employee and the official superior shall complete the Form CA-4. The official superior also shall complete Items 1-4 on the front of the attached Form CA-20 and insert the appropriate Office address on the back thereof, and then detach the Form CA-20 and send it to the attending physician for completion and submission to the Office. The official superior shall forward the completed Form CA-4 to the Office within 2 working days.

(c) Except as provided in Subpart C of this part, 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, the official superior shall furnish to the employee a Form CA-4 for the purpose of claiming compensation, and shall advise the

employee of his or her rights under the Act.

(d) Claims for compensation for permanent disability which involve the loss, or loss of use, of a member or function of the body, or loss, or loss of use of any other important external or internal organ of the body excluding the heart, brain, and back, as listed in 5 U.S.C. 8107 (see § 10.304), shall be filed on Form CA-4 or CA-7 as appropriate which the official superior shall furnish.

(e) Claims for serious disfigurement of the face, head, or neck shall be made on Form CA-4 or CA-7 as appropriate (which shall be furnished by the official superior). If any compensation has been paid or is payable for any such prior disfigurement the date of such prior injury, the arnount of compensation and the source thereof shall be stated in the said CA-4 or CA7.

(f) Form CA-4 shall be filed with the Office upon termination of disability if the duration of disability should be less than 10 calendar days, or at the expiration of 10 calendar days from the date pay stops if disability continues beyond that date.

§ 10.107 Application for augmented compensation for disability.

(a) While the disabled employee has one or more dependents as defined in 5 U.S.C. 8110 such employee's basic compensation for disability shall be augmented as provided in said section. Form CA-4 includes an application for such augmented compensation.

(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 fulltime course of study or training as defined by the above said section of the Act.

(c) The disabled employee claiming augmented compensation under this section shall furnish, when so required by the Office, 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 shall promptly notify the Office of the happening of any event which would terminate an employee's continued entitlement 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.

§ 10.108 How to file an original claim for death benefits.

An original claim for death benefits may be filed by any survivor of a deceased employee (see section 8133 of the Act) or any other person acting on behalf of such survivor. Form CA-5 is provided by the Office for this purpose, and should be executed as provided therein. An original death claim may be filed by delivering a completed Form CA-5 to the Office, or to any person designated by the Office to receive such claim. The deceased employee's former official superior is so designated to receive such claims on behalf of the Office, and the person claiming benefits should submit the claim to such former official superior, unless special circumstances require a different procedure. The official superior shall, when it is practicable, furnish to all persons likely to be entitled to compensation for death of an employee, a Form CA-5 or CA-5b with information as to the use of the form for making claim for compensation and procedure in respect of filing such form. The furnishing of assistance in preparing such form or in obtaining evidence relating to the claim shall be without charge by the official superior. Any claim or paper purporting to claim compensation on account death, submitted to the deceased employee's former official superior, shall be transmitted promptly to the Office.

of

§ 10.109 Claims for balance of schedule due at death from other causes.

(a) If an employee files a valid claim for a scheduled loss (permanent disability which involves the loss or loss of use of a member or function of the body as provided in 5 U.S.C. 8107) in his or her lifetime and dies from causes other than the injury, before

the entire amount due for such schedule is paid, claim for such unpaid balance may be made on an application form approved by the Office as follows: By the widow, widower, or child in the proportions and upon the conditions and in the order named in 5 U.S.C. 8109(a)(3)(D). If there is no surviving widow, widower, or child, then a claim for such unpaid balance may be made pursuant to § 10.108 in the proportions and upon the conditions and in the order as follows: To the parent or parents wholly dependent for support upon the decedent. If there is no parent wholly dependent then to a partially dependent parent or parents in equal shares with any partially dependent brother, sister, grandparent or grandchild. If one or more of the brothers, sisters, grandparents, or grandchildren are wholly dependent and a parent or parents and other brothers, sisters, grandparent, or grandchildren are partially dependent, then 75 percent will be awarded to such wholly dependent person or persons equally and the balance divided equally among such partially dependent persons. In the event there is no surviving widow, widower, child, or wholly dependent parent, and the foregoing apportionment of such compensation would result in injustice, the Office may, in its discretion, make such other apportionment as justice would require.

(b) The right of any survivor referred to in paragraph (a) of this section shall be conditioned upon his or her being alive to receive any payment and any such survivor shall not have a vested right to any such payment. Claims for continuation of payments under 5 U.S.C. 8109 shall be made in like manner and governed by § 10.124.

(c) The entitlement of any survivor to payments under 5 U.S.C. 8109 shall cease upon the happening of any event which would terminate such right under 5 U.S.C. 8133. The termination of such right shall be governed by § 10.125. In the event of any reapportionment made necessary by such termination prompt notification shall be made to the Office in accordance with § 10.126.

(d) As to the disposition of any balance not paid under the foregoing paragraphs see § 10.306.

EVIDENCE

§ 10.110 Affidavit or report by employee of employment and earnings.

The Office may require a partially disabled employee to submit an affidavit or other report as to his or her earnings either from employment or self-employment. If such individual, when required, fails within a reasonable time to submit such affidavit or report or if in such affidavit or report the employee knowingly omits or understates any part of such earnings or remuneration such employee shall forfeit his or her right to compensation with respect to any period for which such affidavit or report was required to be made, and any compensation already paid may be recovered by deducting the amount thereof from compensation payable to him or her or otherwise according to law. Earnings from employment referred to in this section or elsewhere in this part means gross earnings or wages before any deductions whatsoever have been taken out of such wages, and include the value of subsistence, quarters, or other advantages received in kind as part of the wage or remuneration. In general, earnings from self-employment means the rate of pay the employee estimates it would cost him or her to have someone else perform the work the employee is performing.

§ 10.111 Submission of other evidence.

Any claimant or person acting on behalf of such claimant may submit to the Office such evidence including documentary evidence, statements of witnesses or physicians, and any other evidence, which the claimant deems pertinent to the final determination of his claim.

TERMINATION AND CONTINUATION OF ELIGIBILITY

§ 10.120 Report of termination of disability or return to work.

In all cases reported to the Office the official superior is required to notify the Office immediately when

the injured employee returns to work or when his or her disability ceases. Form CA-3, Report of Termination of Disability and/or Payment, is provided for this purpose. It shall be used unless a report of termination of disability is made to the Office on Form CA-1 or CA-2, or CA-4, or CA-7 as appropriate, or in some other manner.

§ 10.121 Recurrence of disability for work. (a) The official superior shall notify the Office if, after the employee returns to work, the same injury causes such employee to stop work again. This report shall be made on Form CA-2a, Notice of Employee's Recurrence of Disability and Claim for Pay/ Compensation. If the injured employee does not return to duty prior to the date this form is submitted to the Office, an additional report shall be made on Form CA-3 or in a similar manner when the employee returns to work or his/her disability ceases.

(b) If the employee wishes to claim compensation as a result of the recurrence, a Form CA-4, CA-7, or CA-8 is required as appropriate. All parts of the appropriate form plus a medical report on Form CA-20 (or in narrative form), must be completed.

§ 10.122 Claims for continued compensation for disability.

Form CA-8, Claim for Continuing Compensation on Account of Disability, is provided to claim compensation for additional periods of time after Form CA-4 is submitted to the Office. While disability continues, claim on this form shall be submitted every 2 weeks until the employee is otherwise instructed by the Office. The employee shall complete and sign the face of the form, and the official superior shall complete the reverse side. The official superior also shall complete items 1-6 on the front of the attached Form CA-20a and insert the appropriate Office address on the back thereof, and then detach the Form CA-20a and send it to the attending physician for completion and submission to the Office. The official superior will forward the completed Form CA-8 to the Office within 2 working days.

§ 10.123 Employee's 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, the employee must seek such suitable work as he or she is able to perform, either in Government or private employment, unless it has already been provided for such employee, and shall accept such work or offer of work secured for him or her. An employee who has not been regularly employed during the period covered by such employee's claim, and who is only partially disabled, shall state in his or her claim what efforts he or she has made to obtain suitable employment giving the names and addresses of persons or concerns to whom the employee has applied for work. If the employee has not been offered or has not been able to secure work which he or she is able to do, he or she 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 the employee, he or she shall not be entitled to any compensation.

[40 FR 6877, Feb. 14, 1975; 40 FR 14750, Apr. 2, 1975]

§ 10.124 Continuance of compensation on account of death.

(a) A beneficiary to whom an award of compensation has been made on account of an employee's death, pursuant to his or her original claim, shall submit to the Office additional claims for continuance of compensation to the Office once each year. Form CA12 is provided by the Office for this purpose, and will be sent to the beneficiary when an additional claim is required. Failure to submit the form may result in suspension of compensation.

(b) A beneficiary to whom an award of compensation has been made for a child, brother or sister, or grandchild after he or she has reached the age of 18 because he or she continues to regularly pursue a full-time course of study or training shall furnish, when so required by the Office, proof of con