Page images
PDF
EPUB

with respect to certain previously approved claims.

(d) Subpart C of this part describes special procedures applicable to the continuation of pay provisions contained in 5 U.S.C. 8118 as amended by Pub. L. 93-416, 88 Stat. 1146.

(e) Subpart D of this part contains provisions relating to the procedures governing the payment of dollar benefits for disability or death and further contains additions to the compensation schedule mandated by the new paragraph 22 of 5 U.S.C. 8107(c), Pub. L. 93-416, 88 Stat. 1145.

(f) Subpart E of this part contains the rules governing an employee's rights to obtain medical evidence in support of such employee's claim and further contains information describing the rights of a beneficiary to medical benefits under the Act.

(g) Subpart F of this part is reserved.

(h) Subpart G of this part contains the rules governing the adjustment and recovery from a third person under 5 U.S.C. 8132.

[blocks in formation]

(4) "Office" or "OWCP" means the Office of Workers Compensation Programs, Employment Standards Administration, of the Department.

(5) "Director" means the Director of OWCP or a person designated by him or her to carry out his or her functions under the Act.

(6) "Benefits" or "Compensation" means benefits or compensation paid or payable under the Act and includes money paid on account of a loss of wages, ability to earn wages, money paid in the form of scheduled compensation, medical diagnostic and treatment services supplied pursuant to the Act and this part, money paid on account of death, and certain payments to individuals participating in an approved vocational rehabilitation program.

(7) "Claim" means an assertion in writing of an individual's entitlement to benefits under or pursuant to the Act, submitted in a form and manner authorized by the provisions of this part.

(8) "Claimant" means an individual whose claim for entitlement to benefits under the Act has been filed in accordance with the Act and the provisions of this part.

(9) "Beneficiary" means an individual who is entitled to a benefit under the Act and this part.

(10) "Entitlement" means entitlement to benefits as determined pursuant to the provisions of the Act and the procedures set forth in this part. A beneficiary is entitled to benefits as so determined when the determination is final.

(11) "Employee" means:

(i) A civil officer or employee in any branch of the Government of the United States, including an officer or employee of an instrumentality wholly owned by the United States;

(ii) An individual rendering personal service to the United States similar to the service of a civil officer or employee of the United States, without pay or for nominal pay, when a statute authorizes the acceptance or use of the service, or authorizes payment of travel or other expenses of the individual;

(iii) An individual, other than an independent contractor or an individual

employed by an independent contractor, employed on the Menominee Indian Reservation in Wisconsin in operations conducted under a statute relating to tribal timber and logging operations on that reservation;

(iv) An individual employed by the government of the District of Columbia;

(v) An individual appointed to a position on the office staff of a former President under section 1(b) of the Act of August 25, 1958 (72 Stat. 838);

(vi) An individual selected pursuant to Chapter 121 of Title 28, United States Code, and serving as a petit or grand juror and who is otherwise an employee for the purposes of this part as defined by paragraphs (a)(11)(i), (ii), (iii), (iv), and (v) of this section;

(vii) Members of the Reserve Officers Training Corps;

(viii) Civil Air Patrol Volunteers;

(ix) Peace Corps Volunteers, volunteer leaders and volunteers with one or more minor children as defined in Secccection 2504 of Title 22, United States Code;

(x) Job Corps enrollees;

(xi) Youth Conservation Corps enrollees;

(xii) Volunteers In Service To America;

(xiii) Members of the National Teachers Corps;

(xiv) Members of the Neighborhood Youth Corps;

(xv) Student employees as defined in 5 U.S.C. 5351;

(xvi) Employees of the Canal Zone; (xvii) Employees of the Alaska Railroad;

(xviii) Law enforcement officers not employees of the United States killed or injured under certain circumstances involving a crime against the United States; and,

(xix) Other persons performing service for the United States within the purview of the Act and all acts in amendments, substitution or extension thereof;

(xx) But does not include.

(A) A commissioned officer of the Regular Corps of the Public Health Service;

(B) A commissioned officer of the Reserve Corps of the Public Health Service on active duty;

(C) A commissioned officer of the Environmental Science Services. Administration;

(D) A member of the Metropolitan Police or the Fire Department of the District of Columbia who is pensioned or pensionable under Sections 521-535 of Title 4, District of Columbia Code.

(12) "Official Superior" means officers and employees having responsibility for the supervision, direction control of employees.

or

or

(13) "Employing Agency" "agency" means any civil agency or instrumentality of the United States Government or any other organization, group or institution employing any individual defined as an “employee" by this section.

(14) “Injury" means injury induced by accident or trauma and includes a disease or latent disabling condition proximately caused by the employment for which benefits are provided under the Act. The term "injury" includes damage or destruction of medical braces, artificial limbs, and other prosthetic devices which shall be replaced or repaired; except that eyeglasses and hearing aids would not be replaced, repaired, or otherwise compensated for, unless the damage or destruction is incident to a personal injury requiring medical services.

a

(15) "Traumatic Injury" means wound or other condition of the body caused by external force, including stress or strain. The injury must be identifiable as to time and place of occurrence and member or function of the body affected, and be caused by a specific event or incident or series of events or incidents within a single day or work shift. Traumatic injuries are distinguished from occupational diseases or illnesses in that the latter are produced by systemic infections; continued or repeated stress or strain; exposure to toxins, poisons, fumes, etc., or other continued and repeated exposure to conditions of the work environment over a longer period of time. Traumatic injuries also include damage or destruction to prosthetic devices or appliances, exclusive of eyeglasses and hearing aids unless the eyeglasses and hearing aids were damaged incidental to a personal injury requiring medical services.

the

(16) "Monthly pay" means monthly pay at the time of injury, or the monthly pay at the time disability begins, or the monthly pay at the time compensable disability recurs, if the recurrence begins more than 6 months after the injured employee resumes regular full-time employment with the United States, whichever is greater, except when otherwise determined under section 8113 of the Act with respect to any period.

(17) "Price index" means the Consumer Price Index (all items U Sasc ty average) published monthly by the Bureau of Labor Statistics.

(18) "Base month" means the month of July 1966 and each later month which is used as a basis for calculating an increase under 5 U.S.C. 8146a.

(19) "Organ" means a part of the body that performs a special function, and for purposes of this part excludes the brain, heart and back.

(20) "United States Medical Officers and Hospitals" means medical officers and hospitals of the Army, Navy, Air Force, Veterans' Administration, and United States Public Health Service, and any other medical officers or hospital designated as a United States medical officer or hospital by the Secretary.

(b) Statutory terms. The definitions contained in this part shall not be considered to derogate from the terms of the Act as amended.

(c) Dependents and survivors. In addition to basic disability benefits for employees the Act provides in section 8133 that certain monthly benefits shall be payable to certain enumerated survivors of employees who have died from an injury sustained in the performance of duty. Section 8110 of the Act provides that any employee who is found eligible for a basic benefit shall be entitled to have such basic benefit augmented at a specified rate for certain persons living in the beneficiary's household or who are dependent upon the beneficiary for support. The provisions of 5 U.S.C. 8101, 8110, and 8133 defining the nature of such survivorship or dependency necessary to qualify a beneficiary for a survivor's benefit or augmented benefit shall be applicable as appropriate to the provisions of this part.

(d) Inclusive terms. As used in this part, the singular case includes the plural.

INFORMATION IN PROGRAM RECORDS

§ 10.10 Custody of records relating to Federal Employees' Compensation Act

matters.

All records, medical and other reports, statements of witnesses and other papers relating to the injury or death of a civil employee of the United States or other person entitled to compensation or benefits from the United States under the Act and all amendments or extensions thereof, are the official records of the Office and are not records of the agency, establishment or department making or having the care or use of such records. Such records and papers pertaining to any such injury or death are confidential and no official or employee of a Government establishment who has investigated or secured statements from witnesses and others pertaining to a claim for benefits, or any person having the care or use of such reports, shall disclose information from or pertaining to such records to any person, except upon the written approval of the Office.

§ 10.11 Inspection and copying of records.

(a) Confidentiality of records. Records of the Office pertaining to an injury or death are confidential, and are generally exempt from disclosure to the public under Section 552(b)(6) of Title 5 U.S.C., the terms of which are applied in this section. (See also Part 70 of Title 29, Code of Federal Regulations regarding Department of Labor documents exempt from disclosure.)

(b) Release to the employee or to his/ her beneficiary. If an employee or, in the case of death, such employee's beneficiary or the authorized representative of an employee or beneficiary requests information from the Officer's records, such individual shall at the discretion of the Office be permitted to examine the records of the case in which such employee is an interested party or representative of such party. In considering any request for such information the Office shall

judge the reasonableness thereof, and may in its discretion permit inspection of such record or part thereof, which in its opinion, will not result in damage or harm to the employee or beneficiary. Where the Office determines the release of information to the employee or to the employee's beneficiary is not in the best interest of the employee or his beneficiary, the Office may release the information to the employee's or beneficiary's representative or personal physician upon receipt of written authorization from the employee or beneficiary. If the individual concerned is mentally incompetent, insane or deceased, the next of kin or legal representative must authorize in writing the release of records to the representative.

(c) Release to other United States Government departments and agencies. (1) Information may be released to other departments and agencies which have proper need for the information upon request stating the specific purpose for which it will be used.

(2) In appropriate cases, the requesting department will be advised that the information will be withheld until the Department obtains the written request of the employee or beneficiary concerned.

(3) In honoring requests, the Office shall disclose only that information which is germane to the request.

(d) Release to medical research or scientific organizations. Information shall be released, upon the request of medical research or scientific organizations or other qualified researchers when the Office finds that the release of the requested information will not constitute a clearly unwarranted invasion of personal privacy. Where feasible, the Office shall delete identifying detail to prevent a clearly unwarranted invasion of personal privacy. The requesting organization or individual shall be advised that the information must be held in confidence and that any published reports resulting from such study shall not identify in any way the individuals whose records were examined.

(e) Release to Federal or State courts or other administrative bodies. Any officer or employee of the United States who is served with a demand for rec

ords or information relating to Federal Employees' Compensation Act matters, the disclosure of which has not been authorized, regardless of whether it may or may not be authorized by this section or Part 70 of Title 29, Code of Federal Regulations, shall promptly, and without awaiting appearance before the court or other authority, communicate through established channels the contents of the demand to the Solicitor of Labor. Such officer or employee shall await instructions concerning the response to the demand. If it is determined that the demand should be opposed, the United States attorney, his or her assistant or other appropriate legal representative shall be requested respectfully to inform the court or other authority that the Secretary of Labor has instructed the officer or employee to refuse to disclose the records or information sought. If instructions have not been received at the time when the officer or employee is required to appear before the court or other authority in response to the demand, the United States attorney, his or her assistant, or other appropriate legal representative shall be requested to appear with the officer or employee upon whom the demand has been served and request additional time in which to receive such instructions.

(f) Release to parties involved in actions brought under 5 U.S.C. 8131. When an employee or beneficiary is prosecuting an action for damages under 5 U.S.C. 8131, records shall be released as provided for in paragraph (b) of this section. Information from such records requested by other parties in interest in said action for damages may be released only upon the written authorization of the employee or beneficiary, or of the authorized representative, and all such requests shall be directed to the Office.

MISCELLANEOUS PROVISIONS

§ 10.20 Forms.

(a) Notice of injury, claims and certain specified reports required to be made with respect to any claim shall be made on approved forms as are prescribed by the Office. Supervisors are expected to maintain an adequate

[blocks in formation]

Treatment.

Duty Status Report.

Attending Physician's Report.

Attending Physician's Supplemental
Report.

(c) Copies of the forms enumerated in this paragraph are available for public inspection at the Office of Workers' Compensation Programs, Employment Standards Administration, U.S. Department of Labor, Washington, D.C. 20211.

FR 2, Jan. 2, 1976]

Act constitute the exclusive remedy against the United States for employment related injuries or deaths. The injury or death of an employee gives rise to no right to recover damages from the United States exclusive of the Act.

§ 10.23 Penalties.

(a) Any person who makes a false statement to obtain Federal employees' compensation or who accepts compensation payments to which he or she is not entitled is subject to a fine of no more than $2,000 or imprisonment for no more than one year, or both.

(b) Any person charged with the responsibility of making reports in connection with an injury who willfully fails, neglects, or refuses to do so; knowingly files a false report; induces compels, or directs an injured employ ee to forego filing a claim; or willfully retains any notice, report, or paper re quired in connection with an injury, is subject to a fine of no more than $500 or imprisonment for no more than one year, or both.

Subpart B-Notice of Injury and
Claim for Compensation, Adminis
trative Procedures

NOTICE OF INJURY OR DEATH
$10.100 How to file a notice of injury.

(B) Traumatic injury. Whenever an employee sustains a traumatic injur which he or she believes to have a curred while in the performance of duty, such employee shall immediately

[ocr errors]

[40 FR 6877, Feb. 14, 1975, as amended at 41 give written notice of the injury to his
or her official superior. If the employ
able to give such notice for any
Son, such notice may be give by ans
person with knowledge of the
on behalf of the intrayer.
Form CA-1

§ 10.21 Waiver of Compensation rights in-
valid.

[ocr errors]
[ocr errors]

No official superior or other sin is authorized to require an employee or other claimant to enter how any Notice of Dramas Ornam agreement, either before utter n for Cansinuation & P/ Compre injury or death, to waiverter on approved the Cite right to claim compensator under theÉSECCH DUCKY

Act. No waiver of compasstION: TE shall be valid.

§10.22 Exclusiveness of emmy

The benefits providedempt and to survivors of oyees cy

[ocr errors]
[ocr errors]

4

ty

ess

f a

or

yee

om

su

on

-20

ad

n

« PreviousContinue »