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needed. If unable to comply promptly immediately notify the physician or hoswith this requirement, the official supe pital that no further treatment shall be rior shall communicate with the appro rendered at the expense of the Bureau. priate district office of the Bureau for In cases of an emergency or cases ininstructions.
volving unusual circumstances, the 136 F.R. 8938, May 15, 1971]
Bureau may, in the exercise of its dis
cretion, authorize treatment otherwise $ 2.4 Medical treatment for recurrence
than as provided for in this part, or it of disability,
may approve payment for medical exIf an injured employee complains of penses incurred otherwise than as aua recurrence of disability (whether or thorized in this section. No authority for not he is disabled for work), after hav examination or for medical or other ing recently been discharged from medi treatment shall be given by the official cal treatment, on account of an injury superior in any case already disallowed by accident recognized as compensable by the Bureau. by the Bureau, under circumstances from which it may reasonably be inferred that
§ 2.6 Authority for dental treatment. such disability is the result of such in All necessary dental treatment, includjury, and the place of employment is the ing repairs to fixed false teeth or to na Usame as at the time of such injury, the ral teeth, needed to repair damage done official superior in his discretion may by an injury will be obtained from a U.S. issue a Form CA-16 as provided by
medical officer or hospital or, if not avail$ $ 2.1 and 2.2: Provided, That not more able, upon authorization obtained in than 6 months shall have elapsed since
advance from the Bureau. the final action of the Bureau upon the
§ 2.7 Medical examinations. case. In any case in which the employee complains of a recurrence of disability
(a) An injured employee shall be rewith respect to which there may be doubt
quired to submit to examination by a that the disability is the result of the
U.S. medical officer or by a designated injury or in any case in which the final
physician or a qualified physician apaction of the Bureau shall have been proved by the Bureau, as frequently and taken more than 6 months prior to com
at such times and places as in the plaint, the official superior shall commu
opinion of the Bureau may be reasonably nicate with the Bureau and request in
necessary. The injured employee may structions, stating all of the pertinent
have a qualified physician, paid by him, facts in his communication. In all other
present at the time of such examinacases the employee shall communi
tion. For any examination required by cate with the Bureau and request such
the Bureau an injured employee shall be treatment.
paid all expenses incident to such ex
amination which, in the opinion of the [36 F.R. 8938, May 15, 1971)
Bureau, are necessary and reasonable, § 2.5 Medical treatment in doubtful
including transportation and actual loss
of wages incurred in order to submit to Cases of a doubtful nature, so far as
the examination authorized by the compensability is concerned, shall be re
Bureau. ferred by the official superior to a United (b) If the employee refuses to submit States medical officer or hospital, or as
himself for or in any way obstructs any otherwise provided in $ 2.1, using a Form examination, his right to claim compenCA-16 for medical services as indicated
sation under said Act shall be susin 6B of the form. This authorizes the pended until such refusal or obstruction necessary diagnostic studies and emer ceases. No compensation shall be paygency treatment pending receipt of ad able while such refusal or obstruction vice from the Bureau. A statement of all continues, and the period of such refusal pertinent facts relating to the particular
or obstruction shall be deducted from case shall also be forwarded immediately the period for which compensation is to the Bureau for consideration. If the
payable to him. medical examination or other informa § 2.8 Medical referee examination. tion received subsequent to the issuance If there should be a disagreement beof authorization for treatment discloses tween the physician making the examthat the condition for which treatment ination on the part of the United States was rendered is not due to an injury, the and the injured employee's physician, person issuing the authorization shall the Bureau shall appoint a third physi
cian, qualified the appropriate injury alleged, the extent of impairment specialty, who shall make an examina affecting the employment as a result tion. The physician appointed shall be of the injury, the actual degree of loss one not previously connected with the of active or passive motion of an injured case.
member, the amount of atrophy or de$ 2.9 Furnishing of orthopedic and pros.
formity in a member, the decrease, if thetic appliances, and dental work.
any, in strength, the disturbance of sen
sation, the prognosis for recovery, and When an orthopedic or prosthetic ap all other material facts. If the services pliance, such as an artificial eye or limb, of a specialist are required in the examiis deemed to be necessary by the attend nation or treatment of the employee, a ing physician by reason of an injury report of his findings upon examination, which has been found by the Bureau to his diagnosis, his opinion as to the relahave occurred while in the performance tionship between the impairment and the of duty, application therefor may be injury, the medical rationale for his opinmade to the Bureau, stating the necessity ion, the treatment recommended by him, therefor, the approximate cost of such a statement of the extent of impairment appliance, and a brief description there as a result of the injury and the prognosis of. Applications for repairs to such an shall be forwarded to the Bureau for conappliance furnished by the Bureau will sideration in conjunction with other rebe made in the same manner. Where an ports. The requirement of this section or artificial denture is necessary in such of any section in this part with respect cases, application therefor may similar to the form of medical, dental, hospital ly be made.
or other reports may be waived by the
Bureau. $ 2.10 Recording and submission of medical reports.
[36 F.R. 8938, May 15, 1971) (a) Medical officers, designated physi
§ 2.11 Submission of bills for medical cians, other physicians and hospitals
services, appliances, and supplies. shall keep adequate records of all cases All charges for medical, hospital, surtreated by them sufficient to supply the gical, or other treatment or care of inBureau with a history of the employee's jured employees, supported by medical accident, the exact description, nature, evidence as provided in $ 2.10, shall be location, and extent of injury, the X-ray itemized on the physician's billhead stafindings if X-ray examination has been tionery and shall be forwarded promptly made, the nature of the treatment ren to the Bureau for consideration. Charges dered, and the degree of impairment may also be submitted at the time of subarising from the injury.
mission of the initial report by complet(b) Form CA-16 provides for the ing item 14 on the back of Form CA-16. furnishing of the initial medical report. A separate bill shall be submitted when Form CA-20 may also be used for the the employee is discharged from treatinitial report and for subsequent report. ment, except when treatment extends The medical report on the back of Form for more than 30 days, in which event, CA-8 is to be utilized in instances where bills shall be submitted at the end of each continued compensation is claimed on 30-day period.. such form. These reports shall be forwarded promptly to the Bureau.
8 2.12 Reimbursement for medical ex. (c) Detailed supplementary reports in penses, transportation costs, loss of narrative form shall be made by the
wages, and incidental expenses. physician at approximately monthly in If bills for medical, surgical, nursing, tervals in all cases of serious injury, es dental, or hospital services or supplies, pecially injuries of the head and back, or appliances, have been paid by an inand including all cases requiring hospital jured employee on account of an injury treatment or prolonged care. The sup incurred while in the performance of plementary report shall show the date
duty, an itemized bill, receipted and the employee was first examined or signed by the person who has received treated, the patient's complaint, the con payment, together with a medical redition found on examination, the diagno port as provided in g 2.10, may be subsis, medical opinion as to any relation mitted to the Bureau for consideration. If ship between the impairment and the payment has been made to a hospital, injury alleged, report as to any other im corporation or firm, the receipted bill pairments found not due to injury, the shall bear the signature or initials of the treatment given or recommended for the person acting for the payee. If receipted
by a mechanical stamp or device, which representative by an attorney of the shows clearly its intent and purpose, the beneficiary's choice. usual formalities attendant to the re
(36 F.R. 11432, June 12, 1971) ceipting of bills may be dispensed with.
§ 3.2 Assignment of third party. Where the means of transportation is not furnished by the Government, a claim If an injury or death for which comfor reimbursement of the cost of neces pensation is payable under said act is sary transportation, and of necessary caused under circumstances creating a incidental expenses incurred by an in legal liability upon some person other jured employee for travel for the pur than the United States to pay damages pose of securing medical or hospital therefor, the beneficiary shall, if required treatment, appliances or supplies, or for by the Bureau, assign any right of action medical examinations, should be sub he may have to the United States. AU mitted promptly to the Bureau for con such assignments shall be in writing and sideration. Standard Forms 1012 and no such cause of action shall vest in the 1012a, properly executed, shall be used United States unless and until the asfor this purpose. Where transportation by signment is accepted by the Bureau. automobile is used, reimbursement may
3.3 Refusal to assign or prosecute be made at the rate per mile fixed by law,
claim when required; effect. Executive, administrative, or other order for employees of the United States au Refusal on the part of a beneficiary to thorized to
Government assign his right of action to the United expense.
States or to prosecute said action in his
own name when required by the Bureau PART 3-CASES INVOLVING THE
shall deprive the employee of all rights LIABILITY OF A THIRD PARTY
§ 3.4 Distribution of damages recovered Sec.
by beneficiary. 3.1 Prosecution of third party action by beneficiary.
If an injury or death for which com8.2 Assignment of third party.
pensation is payable under the Act is 3.3 Refusal to assiga or prosecute claim caused under circumstances creating a when required; effect.
legal liability upon some person other 3.4 Distribution of damages recovered by
than the United States to pay damages beneficiary.
therefor, and, as a result of suit brought 8.6 Distribution of damages where cause of action is assigned.
by the beneficiary or by someone on his 8.6 Bureau may require beneficiary to settle
behalf, or as a result of settlement made or compromise third party suit.
by him or on his behalf in satisfaction
of the liability of such other person, the AUTHORITY: The provisions of this Part 3
beneficiary shall recover damages or reIssued under sec. 32.39 Stat. 749, as amended; 6 U.S.C. 8145, 8149, 1946 Reorg. Plan No. 2,
ceive any money or other property in sat$ 3, 3 CFR, 1943-1948 Comp., p. 1064; 60 isfaction of the liability of such other Stat. 1095; 1950 Reorg. Plan No. 19, § 1, 3 person on account of such injury or CFR 1949-1953 Comp., p. 1010; 64 Stat. 1271. death, the proceeds of such recovery shall SOURCE: The provisions of this Part 3 con
be applied as follows: tained in Regulations under the United (a) If an attorney is employed, a reaStates Employees' Compensation Act, June sonable attorney's fee and the cost of 1, 1938, unless otherwise noted.
collection, if any, shall first be deducted $ 3.1 Prosecution of third party action
from the gross amount of the settlement; by beneficiary.
(b) The beneficiary is entitled to re
tain one-fifth of the net amount of the If an injury or death for which com
money or other property remaining after pensation is payable under the Act is
the expenses of a suit or settlement have caused under circumstances creating a
been deducted, plus an amount equivalent legal liability upon some person other to a reasonable attorney's fee proportionthan the United States to pay damages ate to any refund to the United States; therefor, the Bureau may require the (c) There shall then be remitted to the beneficiary to prosecute an action for Bureau the compensation which has been damages against such third person. When paid on account of the injury, which shall required by the Bureau, such cause of include payments made on account of action shall be prosecuted in the name medical or hospital treatment, funeral of the injured employee or of his personal expense, and any other payments that
have been made by the Bureau on ac PART 25—COMPENSATION FOR DIScount of the injury or death;
ABILITY AND DEATH OF NON(d) Any surplus then remaining may
CITIZENS OUTSIDE THE UNITED be retained by the injured employee or his dependents, and the net amount of
STATES damages received by the beneficiary
Subpart A-General Provisions shall be credited against future payments Sec. of compensation to which the beneficiary 25.1 General statement. may be entitled under the Act on account 25.2 General adoption of local law.
25.3 of the same injury.
General provisions relating to special
schedule. (36 F.R. 11432, June 12, 1971)
25.4 Authority to settle and pay claims. $ 3.5 Distribution of damages where 25.5 Applicable criteria. cause of action is assigned.
Subpart B-Special Schedule of Compensation If the Bureau realizes upon a cause of
25.11 Compensation for disability. action assigned to the United States pur 25.12 Compensation for death. suant to 5 U.S.C. 8131, it shall apply the 25.13 General provisions. money or other property so received in
Subpart C-Extensions of Special Schedule of the following manner; namely: After
Compensation deducting the amount of any compensa
25.21 Republic of the Philippines. tion paid in respect of the injury or
25.22 Australia. death on account of which the cause of
25.23 [Reserved] action arose, and the expense of such
25.24 Territory of the Pacific Islands. realization or collection, which sum shall
25.25 Republic of Korea. be placed to the credit of the proper fund 25.26 Japanese seamen. of the Bureau, the surpius, if any, of such 25.27 Territory
of Guam (nonresident amount received shall be paid to the ben
aliens). eficiary and credited pro tanto upon any AUTHORITY: The provisions of this Part 25 future payments of compensation pay
issued under sec. 32, 39 Stat. 749, as amended; able to him on account of the same
5 U.S.C. 8145, 8149; 1946 Reorg. Plan No. 2.
sec. 3, 3 CFR, 1943-1948 Comp., p. 1064; 60 injury. However, the beneficiary is en
Stat. 1095; 1950 Reorg. Plan No. 19, sec. l. titled to not less than one-fifth of the
3 CFR, 1949–1953 Comp. p. 1010; 64 Stat. net amount of a settlement or recovery
1271, unless otherwise noted. remaining after the expenses of such
SOURCE: The provisions of this Part 25. realization or collection have been
appear at 13 F.R. 3112, June 10, 1948, unless deducted.
otherwise noted. (36 F.R. 11433, June 12, 1971)
Subpart A-General Provisions § 3.6 Bureau may require beneficiary to settle or compromise third party suit.
General statement. Where a beneficiary under said act has The provisions of this part shall apply commenced an action in his own name in respect to compensation, under the or has initiated such action through an Federal Employees' Compensation Act, administrator of a deceased person to re payable only to employees of the United cover damages against the third party States who are neither citizens nor resiliable for the injury or death, the Bureau dents of the United States, any territory, shall, at all times, have authority to re or Canada, or payable to any dependents, quire the beneficiary or such adminis of such employees. It has previously been trator to settle or compromise such action determined, pursuant to 5 U.S.C. 8137. whenever it shall appear to the Bureau that the amount of compensation, as that further prosecution of the cause of provided under such Act, is substantially action is not warranted. Refusal on the disproportionate to the compensation for part of such beneficiary or other person disability or death which is payable in acting in the interest of the beneficiary similar cases under local law, regulation, to make such settlement or to effect such custom, or otherwise, in areas outside the compromise when so directed by the Bu United States, any territory, or Canada. reau shall be deemed to be sufficient Therefore, in respect to cases of such cause for refusal on the part of the Bu employees whose injury (or injury rereau to pay compensation on account of
sulting in death) has occurred subse-. the same injury or death, or the Bureau quent to December 7, 1941, or may occur, may suspend compensation during the the following provisions shall be period of such refusal.
applicable. (4 F.R. 4558, Nov. 11, 1989)
136 F.R. 11433, June 15, 1971)
§ 25.2 General adoption of local law.
(a) Pursuant to the provisions of 5 U.S.C. 8137, the benefit features of local workmen's compensation laws, or provisions in the nature of workmen's compensation, in effect in the areas referred to in $ 25.1, shall, effective as of December 7, 1941, by adoption and adaptation, as recognized by the Director, Bureau of Employees' Compensation, apply in the cases of the employees specified in § 25.1: Provided, however, That there is not established and promulgated under this part, for the particular locality, or for a class of employees in the particular locality, a special schedule of compensatiori for injury or death.
(b) The benefit provisions as thus adopted or adapted are those dealing with the money payments for injury and death (including provisions dealing with medical, surgical, hospital and similar treatment and care), as well as those dealing with services and purposes forming an integrai part of the local plan, provided they are of a kind or character similar to services and purposes authorized by the Federal Employees' Compensation Act. Procedural provisions, designations of classes of beneficiaries in death cases, limitations (except those affecting amounts of benefit payments), and any other provisions not directly affecting the amounts of the benefit payments, in such local plans, shall not apply, but in lieu thereof the pertinent provisions of the Federal Employees' Compensation Act shall apply, unless modified by further specification in this section. However, the Director may at any time modify, limit or redesignate the class or classes of beneficiaries entitled to death benefits, including the designation of persons, representatives, or groups entitled to payment under local statute or custom whether or not included in the classes of beneficiaries otherwise specified by this subchapter.
c) Compensation in all cases of such employees paid and closed prior to the effective date of the regulations in this part shall be deemed compromised and paid under section 42 of such act; in all other cases compensation may be adjusted to conform with the regulations in this part, or the beneficiary may by compromise or agreement with the Bureau have compensation continued on the basis of a previous adjustment of the claim 113 F.R. 3112, June 10, 1948, as amended at 36 F.R. 11433, June 12, 1971)
General provisions relating to special schedule. The special schedule established by Subpart B of this part is intended as the vehicle of general basic provisions, to be adapted, with such modifications as may be necessary, and as local conditions outside the United States require. The application of this special schedule will be by specific and appropriate provi. sion in the regulations in this part, such provision specifying the locality to which applied, and the particular modifications of or additions to the schedule, as may be made. § 25.4 Authority to settle and pay claims.
In addition to the authority to receive, process and pay claims, when delegated such representative or agency receiving delegation of authority shall, in respect to cases adjudicated under this part, and when so authorized by the Director, have authority (a) to make lump sum awards (in the manner prescribed by 5 U.S.C. 8135) whenever such authorized representative shall deem such settlement to be for the best interest of the United States, and (b) to compromise and pay claims for any benefits provided for under this part, including claims in which there is a dispute as to jurisdiction or other facts, or questions of law. The Director shall, in administrative instructions to the particular representative concerned, estabiish such procedures in respect to action under this section as may be deemed necessary, and may specify the scope of any administrative review of such action. (36 F.R. 11433, June 12, 1971) § 25.5 Applicable criteria.
The following criteria shall apply to cases of employees specified in $ 25.1 and such cases, if otherwise compensable, shall be approved only upon evidence of the following nature without regard to the date of the injury or death for which claim is made:
(a) Appropriate certification by the Federal employing establishment, or:
(b) An Armed Services casualty or medical record, or;
(c) Verification of the employment and casualty by military personnel, or;
(d) Recommendation of an Armed Services "Claim Service" based on investigations conducted by it. (79 Stat. 592) (31 F.R. 2376. Feb. 4, 1966, as amended at 33 F.R. 12090. Aug. 27, 1968)