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mand has been served and request additional time in which to receive such instructions.

(2) Action in event of adverse ruling. If the court or other authority declines to stay the effect of the demand in response to a request made in accordance with subparagraph (1) of this paragraph pending receipt of instructions from the Secretary of Labor, or if the court or other authority rules that the demand must be complied with irrespective of the instructions from the Secretary of Labor not to produce the material or disclose the information sought, the employee upon whom the demand has been made shall respectfully decline to comply with the demand (United States ex rel Touhy v. Ragen, 340 U.S. 462). This paragraph shall not apply to final decisions requiring production of records pursuant to 5 U.S.C. 552(a) (3), as the foregoing limitations are not intended to preclude compliance with lawful court orders calling for the production of records in connection with civil litigation or criminal proceedings, nor to preclude release of information from records when required by law.

[35 F.R. 1286, Jan. 31, 1970]

§ 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 FR. 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 5 U.S.C. 8116(b)

(d) Whenever a disabled person is entitled to augmented compensation because he has a dependent as set forth in 5 U.S.C. 8110 such person may receive augmented benefits irrespective of the Idate 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, as amended at 35 F.R. 1286, Jan. 31, 1970]

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Sec. 2.12

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

AUTHORITY: The provisions of this Part 2 issued under 5 U.S.C. 8145, 8149; 1946 Reorganization Plan No. 2, sec. 3, 3 CFR, 19431948 Comp., p. 1064; 60 Stat. 1095; 1950 Reorganization Plan No. 19, sec. 1, 3 CFR, 1949-1953 Comp., p. 1010; 64 Stat. 1271.

SOURCE: The provisions of this Part 2 appear at 35 F.R. 1287, Jan. 31, 1970, unless otherwise noted.

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

(a) All medical services, appliances, drugs, and supplies which in the opinion of the Bureau of Employees' Compensation (hereinafter referred to as the Bureau) are necessary for treatment of an injury as provided by 5 U.S.C. 8103 shall be furnished to employees of the United States and to others entitled by law to medical and other benefits by or upon the order of U.S. medical officers and hospitals, when available and practicable, for injuries sustained while in the performance of duty, including diseases proximately caused by the conditions of employment, whether resulting in loss of time or not, as well as the necessary means of transportation incident to the securing of such services, appliances, drugs, and supplies. An injured employee will be furnished transportation or be reimbursed for transportation expense, and shall be reimbursed for expenses incident to the securing of services, appliances and supplies necessary in the treatment of an injury related condition, when authorized by the Bureau or by his official superior. If there should be no U.S. medical officer or hospital available, medical services shall be furnished by private physicians designated by the Bureau.

(b) The Bureau's Pamphlet BEC-576, Medical Facilities, lists the U.S. medical officers and hospitals and designated physicians normally available for the care of BEC beneficiaries. Also, the medical facilities of the Army, Navy, Air Force, and Veterans Administration may be used when previous arrangements have been made on a case-by-case basis with the director of the hospital or clinic.

(c) Federal health service units or other occupational health service facilities established under the provisions of the Act of August 8, 1946, as amended (5 U.S.C. 7901), are not U.S. medical

officers and hospitals as used in this part. Under criteria established by the Bureau of the Budget (now Office of Management and Budget) in Circular No. A-72 of June 18, 1965, these health service units or occupational health service facilities can only provide emergency diagnosis and first (initial) treatment of injury or illness that become necessary during working hours and that are within the competence of the professional staff and facilities of the health service unit or facility [see paragraph 4.a of OMB Circular]. Any other treatment and medical care by these units or facilities in instances of injury or illness sustained in the performance of duty must be specifically authorized by a physician providing medical care under the specific authorization of the Bureau of Employees' Compensation [see paragraph 4.d of OMB Circular].

(d) In localities where there are no U.S. medical officers and hospitals available, or their use is not practicable, the injured employee shall be referred to one of the designated physicians in the locality as listed in Pamphlet BEC-576 (when authorizing the services of a designated physician the official superior shall give the injured employee an opportunity to select the designated physician to whom he wishes to be referred). In localities where U.S. medical officers and hospitals or designated physicians are not available or their use is not practicable, or in medical emergencies, any qualified physician in the area shall be authorized to provide medical care as appropriate. Mere convenience or personal preference of the injured employee may not be considered sufficient explanation for the selection of nondesignated physicians in those localities where U.S. medical officers and hospitals and/or designated physicians are available.

(e) The attending physician shall arrange for necessary hospital care at semiprivate rates (unless the nature of the case requires care in a private room), special nursing services, 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.

(f) The term "physician" includes surgeons and osteopathic physicians

within the scope of their practice as defined by State law. Chiropractors, naturopaths, podiatrists (chiropodists), psychologists, optometrists, faith healers, and other practitioners of the healing arts are not recognized as physicians as used in this part.

(g) The term "medical, surgical, and hospital services and supplies" as used in this part includes services and supplies by osteopathic physicians and hospitals within the scope of their practice as defined by State law.

[36 F.R. 8938, May 15, 1971]

§ 2.2 Official authorization for treat

ment.

(a) When an employee sustains an injury by accident under circumstances entitling him to compensation or medical treatment, his official superior shall promptly issue to him a request for examination and/or treatment on Form CA-16. The employee shall carry the Form CA-16, where practical for him to do so, from his place of employment to the medical officer or physician. Form CA-16 shall be used solely for an injury sustained by accident. In all instances of disease or illness, the official superior shall contact the proper office of the Bureau for instructions on authorizing treatment. In emergency situations, the office should be contacted by telephone.

(b) An injured employee does not have authority to issue an authorization for examination and/or treatment on his own behalf.

[36 F.R. 8938, May 15, 1971]

§ 2.3 Emergency treatment.

In cases of injury by accident where emergency treatment is necessary any qualified local physician may render initial treatment. If oral authorization for such treatment is given by the official superior, Form CA-16 shall be issued within 48 hours thereafter. Animal bites and eye injuries are considered medical emergencies and medical care by the nearest qualified physician is permissible. Further treatment, is necessary, shall be obtained as soon as practicable from a U.S. medical officer or hospital or local designated physician, if available. It is the duty of the official superior to authorize initial medical treatment for acute injuries, exclusive of disease or illness, and to transfer the employee to the care of a local U.S. medical officer or hospital or designated physician, when available, for any subsequent treatment

needed. If unable to comply promptly with this requirement, the official superior shall communicate with the appropriate district office of the Bureau for instructions.

[36 F.R. 8938, May 15, 1971]

$ 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 by accident recognized as compensable by the Bureau, under circumstances from which it may reasonably be inferred that such disability is the result of such injury, and the place of employment is the same as at the time of such injury, the official superior in his discretion may issue a Form CA-16 as provided by §§ 2.1 and 2.2: Provided, That not more than 6 months shall have elapsed since the final action of the Bureau upon the case. In any 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 shall communicate with the Bureau and request instructions, stating all of the pertinent facts in his communication. In all other cases the employee shall communicate with the Bureau and request such treatment.

[36 F.R. 8938, May 15, 1971] § 2.5 Medical

cases.

treatment in doubtful

Cases of a doubtful nature, so far as compensability is concerned, shall be referred by the official superior to a United States medical officer or hospital, or as otherwise provided in § 2.1, using a Form CA-16 for medical services as indicated in 6B of the form. This authorizes the necessary diagnostic studies and emergency treatment pending receipt of advice from the Bureau. A statement of all pertinent facts relating to the particular case shall also be forwarded immediately to the Bureau for consideration. If the medical examination or other information received subsequent to the issuance of authorization for treatment discloses that the condition for which 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 at the expense of the Bureau. In cases of an emergency 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 shall be given by the official superior in any case already disallowed by the Bureau.

§ 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 obtained from a U.S. medical officer or hospital or, if not available, upon authorization obtained in advance from the Bureau.

§ 2.7 Medical examinations.

(a) An injured employee shall be required to submit to examination by a U.S. medical officer or by a designated physician or a 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 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 the examination on the part of the United States and the injured employee's physician, the Bureau shall appoint a third physi

cian, qualified in the appropriate specialty, who shall make an examination. The physician appointed shall be one not previously connected with the

case.

§ 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 an artificial denture is necessary in such cases, application therefor may similarly be made.

§ 2.10 Recording and submission of medical reports.

(a) Medical officers, designated physicians, other physicians and hospitals shall keep adequate records of all 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 X-ray findings if X-ray examination has been made, the nature of the treatment rendered, and the degree of impairment arising from the injury.

(b) Form CA-16 provides for the furnishing of the initial medical report. Form CA-20 may also be used for the initial report and for subsequent report. The medical report on the back of Form CA-8 is to be utilized in instances where continued compensation is claimed on such form. These reports shall be forwarded promptly to the Bureau.

(c) Detailed supplementary reports in narrative form shall be made by the physician at approximately monthly intervals in all cases of serious injury, especially injuries of the head and back, and including all cases requiring hospital treatment or prolonged care. The supplementary report shall show the date the employee was first examined or treated, the patient's complaint, the condition found on examination, the diagnosis, medical opinion as to any relationship between the impairment and the injury alleged, report as to any other impairments found not due to injury, the treatment given or recommended for the

injury alleged, the extent of impairment affecting the 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 the employee, a report of his findings upon examination, his diagnosis, his opinion as to the relationship between the impairment and the injury, the medical rationale for his opinion, the treatment recommended by him, a statement of the extent of impairment as a result of the injury and the prognosis shall be forwarded to the Bureau for consideration in conjunction with other reports. The requirement 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.

[36 F.R. 8938, May 15, 1971]

§ 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, supported by medical evidence as provided in § 2.10, shall be itemized on the physician's billhead stationery and shall be forwarded promptly to the Bureau for consideration. Charges may also be submitted at the time of submission of the initial report by completing item 14 on the back of Form CA-16. A separate bill shall be submitted when the employee is discharged from treatment, except when treatment extends for more than 30 days, in which event, bills shall be submitted at the end of each 30-day period..

§ 2.12 Reimbursement for medical expenses, 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, together with a medical report as provided in § 2.10, may be submitted to the Bureau for consideration. If payment has been made to a hospital, corporation or firm, the receipted bill shall bear the signature or initials of the person acting for the payee. If receipted

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