Subpart F-Reimbursable Insurance Claims SOURCE: The provisions of this Subpart F appear at 11 F.R. 177A-527, Sept. 11, 1946, unless otherwise noted. Redesignated at 13 F.R. 7668, Dec. 10, 1948. § 01.51 General procedures. Reimbursement of employers, insurance carriers, and compensation funds, for losses resulting from hazards of the war, is provided for in such act of December 2, 1942 (42 U.S.C. 1704). The procedure in respect to reimbursement and the prerequisites of claims are set forth in detail by regulations in Subchapter F of this chapter. Under such regulations claims may be filed directly with the Bureau. They are examined by the Audit and Accounting Division of the Bureau after verification by the Employees' Compensation Division of the Solicitor's Office, United States Department of Labor. Hearings upon such claims are not authorized by applicable statute. The final authority in the Bureau in the approval of such claims is the Director or Acting Director thereof. [11 F.R. 177A-528, Sept. 11, 1946, as amended at 13 F.R. 7668, Dec. 10, 1948; 25 F.R. 10793, Nov. 15, 1960] except claims originating in the Philippine Islands which may however be filed with the field representative of the Bureau in Manila, P. I. All claims are processed directly by the Bureau through its Claims Branch with supplementary actions by other Branches of the Bureau as a particular case may require, including final audit by the Audit and Accounting Branch. The final authority in the Bureau in the approval or rejection 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 Federal Employees' Compensation Act of September 7, 1916. § 01.62 Forms. Forms used in connection with the administration of benefits provided by section 5(f) of the said War Claims Act of 1948 are as follows: WC-3-Claim for Injury or Disability Benefits by Civilian American Citizen. WC-3A-Medical Report of Attending Physician. WC-3B Claim for Continuance of Disability Benefits by Civilian American Citizen. WC-4 Claim for Death Benefits by Survivors of Deceased Civilian American Citizens. CA 12-Same as under the Federal Employees' Compensation Act. CA-13-Same as under the Federal Employees' Compensaton Act. CA-13A-Same as under the Federal Employees' Compensation Act. CA-14-Same as under the Federal Employees' Compensation Act. CA-42-Same as under the Federal Employees' Compensation Act. CA-43-Same as under the Federal Employees' Compensation Act. Std. 69-Same as under the Federal Employees' Compensation Act. Std. 1012-Same as under the Federal Employees' Compensaton Act. Std. 1034-Same as under the Federal Employees' Compensation Act. Subpart H-Outer Continental Shelf Lands Act SOURCE: The provisions of this Subpart H appear at 19 F.R. 6220, Sept. 28, 1954, unless otherwise noted. Except as herein modified, review of compensation cases arising under the Longshoremen's and Harbor Workers' Compensation Act, as extended by the Outer Continental Shelf Lands Act, is governed by § 01.12 of Subpart B of this subchapter. Application for judicial review of a decision in a compensation case arising under the Longshoremen's and Harbor Workers' Compensation Act, as extended by the Outer Continental Shelf Lands Act, is required to be instituted in the judicial district in which any defendant resides or may be found or in the judicial district of the adjacent State nearest the place where the injury or injury causing death occurred. (Interpret or apply sec. 2, 67 Stat. 462; 43 U.S.C. 1331) The same forms prescribed for use in connection with the administration of the Longshoremen's Act are used in the administration of the Outer Continental Shelf Lands Act, except that they are modified by a stamped or typed legend to indicate that they relate to the Outer Continental Shelf Lands Act. (Interpret or apply sec. 2, 67 Stat. 462; 43 U.S.C. 1331) Subpart I-Compensation for Civilian Employees of Nonappropriated Fund Instrumentalities SOURCE: The provisions of this Subpart I appear at 23 F.R. 8958, Nov. 18, 1958, unless otherwise noted. 01.81 Processing of claims. The processing of claims of employees and dependents for compensation benefits payable according to the Longshoremen's and Harbor Workers' Compensation Act, as amended (44 Stat. 1424, 33 U.S.C. 901 et seq.) as extended by the act of July 18, 1958 (72 Stat. 397; 5 U.S.C. 150k-1), to civilian employees of nonappropriated fund instrumentalities of the Armed Forces, is governed by § 01.11. (Interpret or apply 72 Stat. 397; 5 U.S.C. 8171, 8172, 8173) Except as herein modified, review of compensation cases arising under the Longshoremen's and Harbor Workers' Compensation Act as extended by the act of July 18, 1958 (72 Stat. 397; 5 U.S.C. 150k-1) to civilian employees of nonappropriated fund instrumentalities of the Armed Forces, is governed by § 01.12. Proceedings for judicial review (or for enforcement of payment of compensation in case of default as authorized under section 18 of the Longshoremen's Act), of a decision in a compensation case arising under the Longshoremen's Act, as thus extended, are required to be instituted with respect to any injury or death occurring outside the continental limits of the United States, in the District Court of the United States within the territorial jurisdiction of which is located the office of the deputy commissioner having jurisdiction in respect of such injury or death (or in the United States District Court for the District of Columbia if such office is located in such district). In all other cases the provisions of section 21 (b) (33 U. S. C. 921 (b)) of the Longshoremen's Act apply and they require judicial proceedings to be instituted in the United States District Court for the judicial district in which the injury occurred (or the United States District Court for the District of Columbia, if the injury occurred in the District of Columbia). (Interpret or apply 72 Stat. 397; 5 U.S.C. 8171, 8172, 8173) § 01.83 Forms. The same forms prescribed for use in connection with the administration of the Longshoremen's Act are used in the administration of said act of July 18, 1958, providing for payment of workmen's compensation benefits to civilian employees of nonappropriated fund instrumentalities of the Armed Forces as follows: US-201 Employee's first notice to Deputy Commissioner of accident or occupational disease. US-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.) US-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-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. US-209 Request to employee that he reply to the employer's objection to his right to compensation. US-210-11 Employer's supplementary report of accident or occupational disease. US-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 (disability 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-226 Subpoena. US-226A Subpoena Duces Tecum. 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). US-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. Decision granting authority to Act US-242 Notice (compliance with Act by self-insurance). (Interpret or apply 72 Stat. 397; 5 U.S.C. 8171, 8172, 8173) PART 02-STATEMENT RELATIVE TO SUBSTANTIVE RULES § 02.1 Statement relative to substantive rules. (a) The principal function of the Bureau and its subordinate parts is that of adjudicating claims for workmen's compensation. This function is quasi judicial in character and involves the application of statutes and principles of law to resolved factual situations. The field of activity is within the specialized branch of the law generally referred to as "workmen's compensation". This branch of the law has its own particularized principles which have general applicability to workmen's compensation statutes (State and Federal), as such statutes have certain common or underlying similarity in respect to the meaning of terms and phrases, and in respect to scope, jurisdiction, and general basic concepts of employers liability. (b) In the administration of the several workmen's compensation laws within its jurisdiction, the Bureau has one general policy, which is to follow and to adhere to the principles of workmen's compensation law as stated in the opinions of the Supreme Court, the Federal Circuit Courts of Appeal, and the District Courts of the United States, as they may appropriately be applied in like situations arising under the laws administered by the Bureau. In addition, decisions and opinions of the judicial tribunals of the several States and Territories furnish principles of law of general applicability in the specialized field of workmen's compensation, which form part of the foundation of general principles relied upon in the application and interpretation of the several acts administered by the Bureau. The Bureau applies the statute, applicable in respect to a particular case or situation, to the extent that the statute can readily be applied without extrinsic aid, but where such aid is necessary, the source thereof is the body of principles embodied in authoritative decisions of the courts within such wellrecognized branch of the law. (c) Certain statutes administered by the Bureau (relating to military or quasi military establishments) contain as the amended; 5 U.S.C. 8145, 8149; 1946 Reorg. Plan No. 2, § 3, 3 CFR 1943-1948 Comp., p. 1064; 60 Stat. 1095; 1950 Reorg. Plan No. 19, § 1, 3 CFR, 1949-1953 Comp., p. 1010; 64 Stat. 1271, unless otherwise noted. § 1.1 General provisions: definitions. (a) The administration of the Federal Employees' Compensation Act, as codified in 5 U.S.C. Ch. 81, is placed in the Department of Labor, under the direction and supervision of the Secretary of Labor or his designees in the Department. The Bureau of Employees' Compensation is authorized by the Secretary of Labor to decide all questions arising under the act. The Bureau is authorized under such act, upon consideration of a claim presented by a beneficiary and official reports pertaining to injury or death sustained by a civil employee of the United States while in the performance of duty and upon completion of such investigation as it may deem necessary, to determine the facts and make an award for or against payment of the compensation provided for in said act. The Bureau has power, under the provisions of the said act to issue subpoenas for and compel the attendance of witnesses within a radius of 100 miles, to require the production of books, papers, documents, and other evidence, to administer oaths, and to examine witnesses, upon any matter within the jurisdiction of the Bureau. (b) [Reserved] (c) All employees of the United States and other persons who may claim or be entitled to claim benefits under the said act, and the official superiors of all such persons, shall be bound by the regulations in this subchapter and shall conform to the procedure prescribed in said act and in the regulations under this subchapter. The term "official superior," as used in this subchapter, includes all officers and employees having responsible supervision, direction or control of civil employees, others employed in the service of the Federal Government or the government of the District of Columbia, and other persons performing service for the United States within the purview of said act and all acts in amendments, substitution or extension thereof. For the purposes of the regulations in this subchapter the term "employee" as used in this subchapter shall include all civil officers and employees of all branches of the Government of the United States (including officers and employees of instrumentalities of the United States wholly owned by the United States), employees of the government of the District of Columbia (except members of the Police and Fire Departments of the District of Columbia), members of the Reserve Officers' Training Corps, an individual appointed to the staff of a former President, Civil Air Patrol volunteers, Peace Corps volunteers, Job Corps enrollees, Youth Conservation Corps enrollees, Volunteers in Service to America, members of the National Teachers' Corps, members of the Neighborhood Youth Corps, student employees as defined in 5 U.S.C. 5351, employees of the Canal Zone and the Alaskan Railroad, law enforcement officers not employees of the United States killed or injured under certain circumstances involving a crime against the United States, and other persons performing service for the United States within the purview of said act and all acts in amendments, substitution or extension thereof. (d) The term "einployee" shall also include persons rendering personal services of a kind similar to those of civilian officers or employees of the United States to any department, independent establishment, or agency thereof (including instrumentalities of the United States wholly owned by it), without compensation or for nominal compensation, in any case in which acceptance or use of such services is authorized by an act of Congress or in which provision is made by law for payment of the travel or other expenses of such person. (e) All definitions appearing in the act are applicable with respect to the regulations promulgated under this subchapter. (f) In the case of employees of the Canal Zone Government and the Panama Canal Company, the Federal Employees' Compensation Act is administered by the Governor of the Canal Zone; and inquiries pertaining to such cover (a) Whenever any injury is sustained by an employee of the United States while in the performance of his duty, he shall immediately give written notice to his official superior. If the injured employee is unable to give such notice, it may be given by someone in his behalf. Form CA-1 and 2 (Front), Employee's Notice of Injury and Occupational Disease, is provided by the Bureau for this purpose. Unless written notice of injury is given within 48 hours or unless the immediate superior has actual knowledge of the injury within that time, compensation may be refused. For reasonable cause the Bureau may accept written notice of injury given later than 48 hours, but not later than 1 year after the injury. (See § 1.13 for waiver of limitation provision.) (b) Whenever such an injury comes to the knowledge of the injured employee's official superior, a record of the cause, nature, and extent of the injury shall be made by the official superior, who shall call to the attention of the employee or his immediate family (if the employee is unable to do so) the necessity of submitting, within 48 hours, or as soon after injury as practicable, a Notice of Injury or Occupational Disease on Form CA-1 and 2 (Front). The official superior shall complete the receipt on the bottom of the instruction sheet attached to the Form CA-1 and 2, and give the receipt to the employee. He also shall secure the signed statements of witnesses to the occurrence and shall retain the Form CA-1 and 2 until the injury is reported to the Bureau as required in § 1.3. [36 F.R. 8936, May 15, 1971] § 1.3 Reports by official superiors and physicians. (a) The official superior is required to promptly submit to the Bureau a written report of every injury or occupational disease when it is likely to (1) result in a medical charge against the Bureau, (2) result in disability for work beyond the day of injury, (3) require prolonged treatment, (4) result in future disability, or (5) result in permanent disability. Form CA-1 and 2 (Back), Official Superior's Report of Injury, is |