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 re

ceipt 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, or other evidence, shall be marked with the case number appearing in the schedule (as provided in paragraph (d) of this section), the case name, as listed in such schedule, and identified as exhibits to the respective cases and lettered alphabetically with respect to each case.

(d) Where claim for reimbursement includes more than one case, the schedule attached thereto (referred to in paragraph (b) of this section) shall be arranged alphabetically and cases shall be numbered consecutively in the schedule. Each separate claim of an employer, insurance carrier, or compensation fund shall be numbered consecutively for prompt identification. Claimants shall make and retain a copy of the claim and accompanying schedule.

(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, sufficiently 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 applicable law, a copy of the award or agreement 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. Sufficient 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 as a case exhibit. In all cases where an insurance carrier is a claimant, it shall attach as a case exhibit a copy of the insurance contract under which its liability or obligation has accrued. Where payment was made pursuant to a contract or agreement between the United States and the contractor, a copy of such contract, or a sufficient excerpt therefrom or information sufficient to enable the Bureau to obtain a copy or excerpt thereof, including a copy of the applicable insurance contract issued 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 liability of the claimant for the payinent with respect to which reimbursement is claimed is not otherwise clearly apparent. Where liability of an employer, 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 sufficiently 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, § 1, 3 CFR, 1949-1953 Comp., p. 1010; 64 Stat. 1271)

[8 FR 6811, May 25, 1943, as amended at 25 FR 10795, Nov. 15, 1960]

§ 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 sup

plied 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 unreasonable 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 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 investigation 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 prudence 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 under similar circumstances.

§ 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.

§ 62.5 Reimbursement of claims expense.

(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 claims expense of employers (other than claims expense arising under insurance policies), reimbursement of reasonable and necessary claims expense will he made on the basis of item reimbursement. Items of such expense which will be recognized by the Bureau are only those items which can be directly allocated to claims, when necessary to determine liability. If in the adjustment of such claims expense, allocation thereof to a specific claim is impracticable, reimbursement of such expense or part thereof may be made by the Bureau on the basis of agreement with the claimant, or on such other equitable basis as will accomplish reimbursement for reasonable and necessary claims expense.

(c) The adjustment of claims expense arising under insurance policies to which are attached endorsements under the comprehensive insurance rating plan, or similar plan, of the Army or Navy Department, or other department or agency of the United States using the same or similar plan, shall be consistent with the method provided under such plan for deter

mining payment of claims expense. In addition to reimbursement for allocated claims expense, as provided for and defined in such endorsement the Bureau may apply the same factor as is contained in such endorsement for determining claims expense, by applying such factor to the sum of paid losses arising under the policy containing such endorsement, as may be approved for reimbursement by the Bureau under the particular claim filed under § 62.2 to which such claims expense relates. In such situations the reimbursement of claims expense shall be upon the basis of such allocated claims expense plus the application of such factor, as provided. If the application of such factor would not result in reimbursement of reasonable and necessary claims expense, the Bureau may apply such methods of determining such claims expense, or may adjust such expense upon such basis with the claimant, as will result in fair and equitable reimbursement. In cases in which no benefit payments have been made, but claims expense has been necessarily incurred, reimbursement of reasonable and necessary claims expense will be made with respect to proper items thereof as established by the claimant and approved by the Bureau, or upon such other equitable basis as may be agreed upon by the Bureau and the claimant. The adjustment of claims expense arising under other insurance policies or agreements shall be consistent with the plan or method, if any, provided for therein in the determination of reimbursable claims expense, if the application of such plan or method in relation to the amount of benefit reimbursement results in reimbursement of reasonable and necessary claims expense; otherwise, the manner of determining such reimbursable expense, as provided above with respect to cases in which no benefit payments have been made, shall be applied.

(d) In the adjustment of claims expense the Bureau will not in any case consider as a claims expense any distribution of administrative, general office maintenance, rent, insurance, taxes, or other similar general expenses. Except as defined otherwise by an applied endorsement, plan or

method, the term "allocated claims expense", when considered as such by the Bureau, shall include payments made for reasonable attorneys' fees, court and litigation costs, expenses of witnesses and expert testimony, examinations, autopsies and such other items of expense as can be directly allocated to specific claims, when necessary to determine liability. The term "unallocated claims expense", when considered as such by the Bureau, shall mean that expense which can properly and definitely be allocated to claims, where necessary to determine liability, but cannot be directly allocated to specific claims.

(e) No employer, insurance carrier or compensation fund shall be entitled to reimbursement under this section for any claims expense where it has been paid such expense, or has been paid for any service which included or contemplated payment of the expense for which reimbursement hereunder is sought, the cost of which has been or will be borne by the United States. Any charge made or paid, contemplating expenses other than allocated or unallocated claims expense shall not be considered as a claims expense within the meaning of this subsection. Every claimant applying for reimbursement of claims expense shall in his claim expressly disclaim and waive any right to claim allocated or unallocated claims expense, as defined above or as defined in any such plan or endorsement, or to claim a service or other charge which would include or contemplate the inclusion of such expense, to the extent to which reimbursement thereof is made under his claim, where such right may arise by reason of any agreement or contract with a contractor who has contracted with the United States or with the United States directly, under which the United States ultimately would bear the cost of such expense.

§ 62.6 Claims for reimbursement of claims expense.

(a) Claims for reimbursement of reasonable and necessary claims expense incurred in connection with the adjustment of claims by an employer, insurance carrier or compensation fund as provided for in section 104(a) of

such Public Law No. 784, and § 62.5, may be included in the claim for reimbursement of benefit payments, shall be signed and sworn to by the person entitled to reimbursement or his duly authorized representative, and shall be filed with the Bureau of Employees' Compensation, United States Department of Labor, Washington, D.C. 20211. Such claims shall contain a schedule of cases with respect to which reimbursement of claims expense is sought.

(b) Except where reimbursement is to be made by the application of a factor under an endorsement applying rating

a

comprehensive insurance

plan, or similar plan, as provided for in § 62.5, in the schedule of cases there shall be listed the items of claims expense for which reimbursement is claimed, sufficiently describing the nature of each such item. Only items of claims expense allowable under § 62.5 will be considered. If necessary in specific cases listed in such schedule (where payments have been made to numerous payees), a supplementary sheet identified as a case exhibit may be used to show items and payees in the particular case. Each item in excess of $10 with respect to which reimbursement is claimed shall be supported by a sufficient receipt signed by the payee thereof showing that the amount claimed has been paid and the date of payment and nature of the service rendered. The regulations governing the matter of receipts or other evidences of payment applicable to reimbursement of benefit payments, as contained in § 62.2(c), shall apply with respect to claims expense items.

(c) Where reimbursement for claims expense relates to cases in which payments have been made by an insurance carrier under a policy of insurance to which is attached an endorsement under the comprehensive insurance rating plan, or similar plan, of the Army or Navy Department, or other department or agency of the United States using the same or similar plan, or reimbursement is requested under an agreement or contract providing a method for determining reimbursable claims expense, in lieu of listing of items of expense, reference should be made to the policy of insur

ance and rating plan endorsement, or other agreement as referred to above, under which benefit payments have been made, and the amount of reimbursement of claims expense for the cases listed in the schedule may be obtained by applying the same factor (as is contained in such rating plan endorsement for determining claims expense or applying such other factor or method of determining reimbursement for such expense) to the sum of all paid losses (benefits paid) as approved by the Bureau under the claim filed with it for reimbursement of benefits paid, where such losses have occurred under policies providing a method of determining claims expense.

There

may also be set forth any allowable items of claims expense not included in such factor.

(d) Claims for reimbursement of claims expense 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, Sec. 1, 3 CFR, 1949-1953 Comp., p. 1010; 64 Stat. 1271)

[8 FR 6811, May 25, 1943, as amended at 25 FR 10795, Nov. 15, 1960]

§ 62.7 Same; approval of claims.

(a) If upon examination and audit of a claim for reimbursement of claims expense 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 any such item as a reasonable and necessary claims expense, or where the Bureau finds that an item of expense was incurred unnecessarily or without reasonable cause. Claims for such reimbursement shall be approved only to the extent that the Bureau finds the claim to be reasonable, and unreasonable or excessive items shall be reduced accordingly for the purpose of such reimbursement.