§ 1.22 Inspection of records of Bureau.

An employee or his beneficiary in case of death, or the agent of such employee or beneficiary, may, at the discretion of the Bureau, be permitted to examine the records of the case in which he is an interested party. In any request for such permission the Bureau shall be the judge of 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 beneficiary or to any person, or which will not be inimical to the interests of the Bureau or of the United States. [4 F.R. 1613, Apr. 14, 1939]

§ 1.23 Waiver not authorized.

No official superior is authorized to require an employee to enter into any agreement, either before or after an injury, to waive his right to claim compensation.

[Regulations under the United States Employees' Compensation Act, June 1, 1938. Redesignated at 14 F.R. 7375, Dec. 9, 1949] § 1.24 Representation of claimants and approval of claims for legal and other services.

(a) A claimant may be represented before the Bureau in any proceeding under the act by any duly authorized person. (A former member of the Employees' Compensation Appeals Board or a former Director of the Bureau shall not be considered a duly authorized person within the meaning of this section for a period of two years following termination of his services as a Board member or as Directors. The Bureau shall require satisfactory proof of the representative's authorization.

(b) No claim for legal services or for other services rendered in respect of a case, claim, or award for compensation, to or on account of any person shall be valid unless approved by the Bureau. Any person who receives any fee, other consideration, or gratuity on account of services so rendered, unless such fee, consideration or gratuity is approved by the Bureau, or who solicits employment for himself or another in respect of any case, claim, or award for compensation under (or to be brought under) this act shall be guilty of a misdemeanor and upon conviction thereof, for each offense, be punished by a fine of not more than $1,000 or by imprisonment not to exceed one year, or by both such fine and imprisonment. The Bureau cannot pay

any claim so approved by it nor can it assist in the collection of any sum so approved.

(c) No fee for services shall be approved except upon an application to the Bureau supported by an itemized statement of the necessary work done on behalf of a claimant. Should such statement be deemed insufficient by the Bureau, further details may be required and the Bureau may require the person for whom such services were rendered to certify to the correctness thereof. Except where it has been established that representation was to be rendered gratuitously, the fee approved by the Bureau shall be reasonably commensurate with the actual necessary work performed by such representative. The Bureau will consider for approval only the necessary services performed by applicant on behalf of the claimant, taking into account the capacity in which the representative has served and the circumstances of the claimant.

(d) The Bureau will not recognize any contract for the payment of an agreed sum, or any contingent contract, with respect to legal or other services rendered in respect of a claim or award for compensation.

[14 F.R. 7376, Dec. 9, 1949, as amended at 24 F.R. 1157, Feb. 14, 1959]

§ 1.25 Retroactive effective dates and procedures under Federal Employees' Compensation Act Amendments of 1949.

(a) The amendments classifying the loss or loss of use of both hands, or both arms, or both feet or both legs or both eyes, or the sight thereof, as prima facie constituting permanent total disability, is applicable to injuries sustained before October 14, 1949, but only with respect to any period of disability beginning on or after the first of November 1949.

(b) The amendments apply retroactively for injuries which occurred on or after January 1, 1940, involving the total loss or loss of use of an arm, leg, hand, foot or eye or total and permanent loss of hearing of both ears or serious disfigurement of the face, head or neck, on or after January 1, 1940.

(c) If an employee has sustained the permanent partial loss or loss of use of an arm, leg, foot, hand, eye or hearing or the total or partial loss or loss of use of any other member of the body on or after October 14, 1948, he is required to

make an election as provided in section 5 of the act.

(d) Whenever a disabled person is entitled to augmented compensation because he has a dependent as set forth in section 105 of the act such person may receive augmented benefits irrespective of the date of his injury. However, such payments shall not commence prior to November 1, 1949; see § 1.5.

(e) The amendments with respect to increasing the rate of compensation are applicable to cases of injury or death which occurred before enactment of these amendments but only with respect to any period beginning the first of November 1949.

(f) Whenever a person is entitled to compensation by virtue of the amendment broadening the scope of the term "employee", such entitlement shall apply to injuries or deaths which occurred on or after December 7, 1941: Provided, however, That no payments for medical expenses or compensation shall be payable for any period prior to November 1, 1949, and shall be limited to cases involving permanent partial or permanent total disability or death; see §§ 1.4, 1.5 and 1.12. [14 F.R. 7376, Dec. 9, 1949]

2.5

2.6

2.7

2.8

2.9

Medical treatment in doubtful cases.
Authority for dental treatment.
Medical examinations.

Medical referee examination.

Furnishing of orthopedic and prosthetic appliances, and dental work. 2.10 Recording and submission of medical reports.

2.11 Submission of bills for medical services, appliances and supplies. 2.12 Reimbursement for medical expense, transportation costs, loss of wages, and incidental expenses.

AUTHORITY: The provisions of this Part 2 issued under sec. 32, 39 Stat. 749, as 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.

SOURCE: The provisions of this Part 2 contained in Regulations under the United States Employees' Compensation Act, June 1, 1938, unless otherwise noted.

§ 2.1 Medical treatment, hospital service, transportation, etc.

(a) All medical services, appliances, drugs and supplies which in the opinion of the Bureau are necessary for the treatment of an injury as provided by section 9 of said act (39 Stat. 743; 5 U.S.C. 759), shall be furnished to employees of the United States and to others by law entitled to medical and other benefits, by or upon the order of United States medical officers and hospitals, when available and practicable, for injuries sustained while in the performance of duty, including, where not excluded by law, diseases proximately caused by the conditions of employment, whether resulting in loss of time or not, as well as necessary transportation incident to the securing of such services, appliances, drugs and supplies. An injured employee will be furnished with the means of obtaining transportation, and shall be entitled to reimbursement for expenses incident to to the securing of services, appliances, and supplies necessary in the treatment of a condition the result of injury, when authorized by the Bureau or by his official superior. If there should be no United States medical officer or hospital available, medical services shall be furnished by designated private physicians listed in the Bureau's Form C. A. 76. If there should be no United States medical officer or hospital or designated physician available, such services shall be furnished by a duly qualified physician. Authorization for prolonged treatment from such a physician should be obtained from the Bureau. The attending physician may arrange for necessary hospital care at general ward rates, unless the nature of the case requires care in a private room, special nursing services (if indicated by the nature of the case), X-ray examinations, and consultations by specialists. In cases of an emergency nature or cases involving unusual circumstances the Bureau may in the exercise of its discretion authorize treatment otherwise than as provided for in this part, or it may approve payment for medical expenses incurred otherwise than as authorized in this part.

(b) The term "physician" as used in the regulations in this subchapter includes surgeons and osteopathic practitioners within the scope of their practice as defined by State law. The term "medical, surgical, and hospital services and

supplies" as used in the regulations in this subchapter includes services and supplies by osteopathic practitioners and hospitals within the scope of their practice as defined by State law.

§ 2.2 Emergency medical treatment.

In all cases of injury where emergency treatment is necessary, any duly qualified physician may render first aid treatment. Further treatment, if necessary, should be obtained as soon as practicable from a medical officer of the United States or from a designated physician, where available. It shall be the duty of the official superior to authorize initial adequate medical treatment and thereafter to follow up the matter of such treatment to see that the employee is placed under the care of a medical officer of the United States or a designated physician, if practicable, for any treatment subsequently needed. If unable to comply promptly with this requirement, the official superior shall communicate immediately with the Bureau for instructions, giving full information not only as to the nature and cause of the injury, but as to any treatment that has been rendered with respect thereto. § 2.3

Official authorization for treat

ment.

(a) When an employee is injured under circumstances entitling him to compensation or medical treatment, his official superior shall issue promptly to him a request for treatment which shall be authorization for treatment by a United States medical officer or hospital or by a designated physician. Form C. A. 16 has been provided by the Bureau for use in cases in which there is no doubt concerning the right of the employee to receive medical care. Form C. A. 17 has been provided by the Bureau for use in cases in which there may be doubt whether the disability of the employee is due to an injury coming within the purview of said act; also see § 2.5.

(b) Authorization may be given for emergency treatment before the issuance of Form C. A. 16: Provided, That this form is issued within 48 hours thereafter.

(c) In every case in which Form C. A. 16 or Form C. A. 17 is used, a copy of such form shall be transmitted to the Bureau together with the reports required by § 1.3 of this subchapter.

§ 2.4 Medical treatment for recurrence of disability.

If an injured employee complains of a recurrence of disability (whether or not he is disabled for work), after having recently been discharged from medical treatment, on account of an injury recognized as compensable by the Bureau, under circumstances from which it may reasonably be inferred that such disability is the result of such injury, the official superior in his discretion may issue Form C. A. 16 for treatment by a medical officer of the United States or a Government hospital, or a designated physician provided that not more than 6 months shall have elapsed since the final action of the Bureau upon the case. In any other case in which the employee complains of a recurrence of disability with respect to which there may be doubt that the disability is the result of the injury or in any case in which the final action of the Bureau shall have been taken more than 6 months prior to complaint, the official superior should communicate with the Bureau and request instructions, stating all of the pertinent facts in his communication. In all other cases the employee should communicate with the Bureau and request such treatment. § 2.5 Medical treatment in doubtful

cases.

Cases of a doubtful nature, so far as compensability in concerned, should be referred by the official superior to a medical officer of the United States, a Government hospital, or a designated physician for treatment, using Form C. A. 17 for this purpose in lieu of Form C. A. 16. Where such form has been furnished, a statement of all pertinent. facts relating to the particular case, together with a statement of the reason for such doubt, shall be forwarded immediately to the Bureau for consideration. Form C. A. 17 authorizes only necessary emergency treatment pending receipt of advice from the Bureau, and shall be used only in cases where prima facie there is a causal relation between the alleged disability and the employment, and shall not be used as authority for operations in hernia cases unless the hernia is strangulated or incarcerated. If the medical examination or other information received subsequent to the issuance of authorization for treatment discloses that the condition for which the treatment was rendered is not due

to an injury, the person issuing the authorization shall immediately notify the physician or hospital that no further treatment shall be rendered for the account of the Bureau. In cases of an emergency nature or cases involving unusual circumstances, the Bureau may in the exercise of its discretion authorize treatment otherwise than as provided for in this part, or it may approve payment for medical expenses incurred otherwise than as authorized in this section. No authority for examination or for medical or other treatment should be given in any case already disallowed by the Bureau. (For cases requiring emergency treatment, see § 2.2.)

§ 2.6 Authority for dental treatment.

All necessary dental treatment, including repairs to fixed false teeth or to natural teeth, needed to repair damage done by an injury will be furnished by the Bureau. Such treatment shall be rendered by or upon the order of a United States dental officer or United States medical establishment, when available and practicable. If such facilities are not available, or treatment by such facilities is not practicable, no dental work should be authorized without obtaining in advance the approval of the Bureau. (For cases requiring emergency treatment see § 2.2.) (For cases requiring artificial denture see § 2.9.) [6 F.R. 5305, Oct. 18, 1941]

§ 2.7

Medical examinations.

(a) An injured employee shall be required to submit to examination by a medical officer of the United States or by a designated physician or a duly qualified physician approved by the Bureau, as frequently and at such times and places as in the opinion of the Bureau may be reasonably necessary. The injured employee may have a duly qualified physician, paid by him, present at the time of such examination. For any examination required by the Bureau an injured employee shall be paid all expenses incident to such examination which, in the opinion of the Bureau, are necessary and reasonable, including transportation and actual loss of wages incurred in order to submit to the examination authorized by the Bureau.

(b) If the employee refuses to submit himself for or in any way obstructs any examination, his right to claim compensation under said act shall be suspended until such refusal or obstruction ceases.

No compensation shall be payable while such refusal or obstruction continues, and the period of such refusal or obstruction shall be deducted from the period for which compensation is payable to him.

§ 2.8

Medical referee examination.

If there should be a disagreement between the physician making an examination on the part of the United States and the injured employee's physician, application may be made to the Bureau for the appointment of a third physician, duly qualified, who shall make an examination.

§ 2.9 Furnishing of orthopedic and prosthetic appliances, and dental work.

When an orthopedic or prosthetic appliance, such as an artificial eye or limb, is deemed to be necessary by the attending physician by reason of an injury which has been found by the Bureau to have occurred while in the performance of duty, application therefor may be made to the Bureau, stating the necessity therefor, the approximate cost of such appliance, and a brief description thereof. Applications for repairs to such an appliance furnished by the Bureau will be made in the same manner. Where artificial denture is necessary in such cases, application therefor may similarly be made.

§ 2.10 Recording and submission of medical reports.

Medical officers, designated physicians, other physicians and hospitals shall keep adequate records of all injury cases treated by them sufficient to supply the Bureau with a history of the employee's accident, the exact description, nature, location and extent of injury, the degree of disability arising therefrom, the X-ray findings if X-ray examination has been made, the nature of the treatment rendered, and the degree of disability arising from the injury. A medical officer or such physicians shall forward to the Bureau a full report with respect to each injury case treated by him under the provisions of the Compensation Act which results in charge for treatment or supplies against the Bureau, or involves any loss of time beyond the day, shift, turn or working period during which it occurs. Form C. A. 20 has been provided by the Bureau for use in submitting the initial medical report. Form

C. A. 78 has been provided by the Bureau for use in forwarding initial report of operation. In hernia cases, Form C. A. 32 similarly has been provided. These reports should be forwarded promptly to the Bureau. Detailed supplementary report in the form of a letter should be made by the medical officer or such physician in all cases of serious injury, especially injuries of the head and back, including cases requiring hospital treatment or prolonged care. The supplementary report should show the date when case was first examined or treated, the patient's complaint, the condition found on examination, the diagnosis, medical opinion as to any relationship between the disability and the injury alleged, report as to any other disabilities found not due to injury, the treatment given or recommended for the industrial injury, the degree of disability for usual or other employment as a result of the injury, the actual degree of loss of active or passive motion of an injured member, the amount of atrophy or deformity in a member, the decrease, if any, in strength, the disturbance of sensation, the prognosis for recovery, and all other material facts. If the services of a specialist are required in the examination or treatment of a beneficiary, a report of his findings upon examination, his diagnosis, his opinion as to the relationship of disability to injury, the treatment recommended by him, a statement of the degree of disability for work as a result of injury and the prognosis should be forwarded to the Bureau for consideration in conjunction with other reports. The requirements of this section or of any section in this part with respect to the form of medical, dental, hospital or other reports may be waived by the Bureau.

§ 2.11 Submission of bills for medical services, appliances and supplies.

All charges for medical, hospital, surgical, or other treatment or care of injured employees shall be itemized on Form S-69 provided by the Bureau, and this form properly executed shall be forwarded promptly to the Bureau for consideration. A separate Form S-69 shall be submitted by each payee for services to each injured employee. Vouchers should be submitted when the employee is discharged from treatment, except when treatment extends for more than 30 days, in which event Form S-69 should

be submitted at the end of each 30-day period. Vouchers shall be verified by the signature of the injured employee, and if such signature cannot be obtained, a concise explanation of the reason for the failure to secure such verification must be stated.

§ 2.12

Reimbursement for medical expense, transportation costs, loss of wages, and incidental expenses.

If bills for medical, surgical, nursing, dental or hospital services or supplies, or appliances, have been paid by an injured employee on account of an injury incurred while in the performance of duty, an itemized bill, receipted and signed by the person who has received payment, may be submitted to the Bureau for consideration. If payment has been made to a hospital, corporation or firm, the receipted bill should bear the signature or initials of the person acting for the payee. If receipted by mechanical stamp or device, which shows clearly its intent and purpose, the usual formalities attendant to the receipting of bills may be dispensed with. Where the means of transportation is not furnished by the Government, a claim for reimbursement of the cost of necessary transportation, and of necessary incidental expenses incurred by an injured employee who has been authorized to travel for the purpose of securing medical or hospital treatment, appliances or supplies or for medical examinations, may be submitted promptly to the Bureau for consideration. Standard Form 1012 properly executed should be used for this purpose. Where transportation by automobile is furnished by an employee of the United States or by a relative of the injured employee, reimbursement may be made at the rate per mile fixed by law, Executive, administrative or other order for employees of the United States authorized to travel at Government expense. [13 F.R. 7669, Dec. 10, 1948]