ans' Administration, and United States Public Health Service, and any other medical officers or hospital designated as a United States medical officer or hospital by the Secretary. (b) Statutory terms. The definitions contained in this part shall not be considered to derogate from the terms of the Act as amended. (c) Dependents and survivors. In addition to basic disability benefits for employees the Act provides in section 8133 that certain monthly benefits shall be payable to certain enumerated survivors of employees who have died from an injury sustained in the performance of duty. Section 8110 of the Act provides that any employee who is found eligible for a basic benefit shall be entitled to have such basic benefit augmented at a specified rate for certain persons living in the beneficiary's household or who are dependent upon the beneficiary for support. The provisions of 5 U.S.C. 8101, 8110, and 8133 defining the nature of such survivorship or dependency necessary to qualify a beneficiary for a survivor's benefit or augmented benefit shall be applicable as appropriate to the provisions of this part. (d) Inclusive terms. As used in this part, the singular case includes the plural. INFORMATION IN PROGRAM RECORDS § 10.10 Custody of records relating to Federal Employees' Compensation Act matters. All records, medical and other reports, statements of witnesses and other papers relating to the injury or death of a civil employee of the United States or other persons entitled to compensation or benefits from the United States under the Act and all amendments and extensions thereof, are the official records of the Office and are not records of the agency, establishment or department making or having the care or use of such records. [52 FR 10504, Apr. 1, 1987] EFFECTIVE DATE NOTE: Section 10.10 was revised at 52 FR 10504, Apr. 1, 1987, effective June 1, 1987. For the convenience of the user, the superseded text is set forth below. § 10.10 Custody of records relating to Federal Employees' Compensation Act matters. All records, medical and other reports, statements of witnesses and other papers relating to the injury or death of a civil employee of the United States or other person entitled to compensation or benefits from the United States under the Act and all amendments or extensions thereof, are the official records of the Office and are not records of the agency, establishment or department making or having the care or use of such records. Such records and papers pertaining to any such injury or death are confidential and no official or employee of a Government establishment who has investigated or secured statements from witnesses and others pertaining to a claim for benefits, or any person having the care or use of such reports, shall disclose information from or pertaining to such records to any person, except upon the written approval of the Office. § 10.11 Confidentiality of records relating to Federal Employees' Compensation Act matters. Records of the Office pertaining to an injury or death are confidential, and are exempt from disclosure to the public under section 552(b)(6) of Title 5, United States Code. No official or employee of an agency, establishment or department who has investigated or secured statements from witnesses and others pertaining to a claim for benefits, or any person having the care or use of such reports, shall disclose information from or pertaining to such records to any person, except in accordance with applicable regulations (see 29 CFR 70 and 70a). [52 FR 10505, Apr. 1, 1987] EFFECTIVE DATE NOTE: Section 10.11 was revised at 52 FR 10505, Apr. 1, 1987, effective June 1, 1987. For the convenience of the user, the superseded text is set forth below. § 10.11 Inspection and copying of records. (a) Confidentiality of records. Records of the Office pertaining to an injury or death are confidential, and are generally exempt from disclosure to the public under section 552(b)(6) of Title 5 U.S.C., the terms of which are applied in this section. (See also Part 70 of Title 29, Code of Federal Regulations regarding Department of Labor documents exempt from disclosure.) (b) Release to the employee or to his/her beneficiary. If an employee or, in the case of death, such employee's beneficiary or the authorized representative of an employee or beneficiary requests information from the Officer's records, such individual shall at the discretion of the Office be permitted to examine the records of the case in which such employee is an interested party or representative of such party. In considering any request for such information the Office shall judge 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 employee or beneficiary. Where the Office determines the release of information to the employee or to the employee's beneficiary is not in the best interest of the employee or his beneficiary, the Office may release the information to the employee's or beneficiary's representative or personal physician upon receipt of written authorization from the employee or beneficiary. If the individual concerned is mentally incompetent, insane or deceased, the next of kin or legal representative must authorize in writing the release of records to the representative. (c) Release to other United States Government departments and agencies. (1) Information may be released to other departments and agencies which have proper need for the information upon request stating the specific purpose for which it will be used. (2) In appropriate cases, the requesting department will be advised that the information will be withheld until the Department obtains the written request of the employee or beneficiary concerned. (3) In honoring requests, the Office shall disclose only that information which is germane to the request. (d) Release to medical research or scientific organizations. Information shall be released, upon the request of medical research or scientific organizations or other qualified researchers when the Office finds that the release of the requested information will not constitute a clearly unwarranted invasion of personal privacy. Where feasible, the Office shall delete identifying detail to prevent a clearly unwarranted invasion of personal privacy. The requesting organization or individual shall be advised that the information must be held in confidence and that any published reports resulting from such study shall not identify in any way the individuals whose records were examined. (e) Release to parties involved in actions brought under 5 U.S.C. 8131. When an employee or beneficiary is prosecuting an action for damages under 5 U.S.C. 8131, records shall be released as provided for in paragraph (b) of this section. Information from such records requested by other parties in interest in said action for damages may be released only upon the written authorization of the employee or beneficiary, or of the authorized representative, and all such requests shall be directed to the Office. [40 FR 6877, Feb. 14, 1975, as amended at 46 FR 49543, Oct. 6, 1981] § 10.12 Protection, release, inspection and copying of records. (a) The protection, release, inspection and copying of records of the Office pertaining to an injury or death shall be accomplished in accordance with the rules, guidelines and provisions contained in Part 70 and Part 70a of Title 29 of the Code of Federal Regulations and the annual notice of systems of records and routine uses as published in the FEDERAL REGISTER. However, since the records of the Office are contained within a government-wide system of records under the control of the Department of Labor, § 70a.1(b)(3) of Title 29 of the Code of Federal Regulations provides that the regulations of the agency in possession of such records shall govern the procedure for requesting access to, or amendment of the records, including initial determinations on such requests, while the Department of Labor regulations shall govern all other aspects of safeguarding these records established by the Privacy Act. Where requested to amend such records in possession of the agency is received, the agency shall so advise the Office and shall provide the Office with a copy of any amended record. (b) Records of the Office pertaining to an employee or beneficiary which are in the possession of the employing agency may be released by the employing agency to that employee or beneficiary, or their representative, in accordance with the provisions contained in Part 70a of Title 29 of the Code of Federal Regulations. This includes copies retained by the employing agency of records previously submitted to and in the possession of the Office. (c) When an employee or beneficiary is prosecuting an action for damages under 5 U.S.C. 8131, records may be released as provided for in Part 70a of Title 29 of the Code of Federal Regulations. [52 FR 10505, Apr. 1, 1987] EFFECTIVE DATE NOTE: Section 10.12 was added at 52 FR 10505, Apr. 1, 1987, effective June 1, 1987. (8) CA-6.. Title Form No. (1) CA-1 (2) CA-2. (3) CA-2a (4) CA-3 (5) CA-5. (6) CA-5b.. (7) CA-6 (8) CA-7 (9) CA-8 (10) CA-12.. (11) CA-16. (12) CA-17. (13) CA-20.. (14) CA-20a.. Title Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation. Notice of Occupational Disease and Claim for Compensation. Notice of Employee's Recurrence of Disability and Claim for Pay/ Compensation. Report of Termination of Disability and/or Payment. Claim for Compensation by Widow, ents, Brothers, Sisters, Grandparents, or Grandchildren. Official Superior's Report of Employee's Death. Claim for Compensation Due to Traumatic Injury of Occupational Disease. Claim for Continuing Compensation on Account of Disability. Claim for Continuance of Compensation. Authorization of Examination and/ or Treatment. Duty Status Report. Attending Physician's Report. Attending Physician's Supplemental Report. (c) Copies of the forms enumerated in this paragraph are available for public inspection at the Office of Workers' Compensation Programs, Employment Standards Administration, U.S. Department of Labor, Washington, D.C. 20211. [40 FR 6877, Feb. 14, 1975, as amended at 41 FR 2, Jan. 2, 1976; 52 FR 10505, Apr. 1, 1987] EFFECTIVE DATE NOTE: Section 10.20(b) table was amended by revising entry (2) and entries (5) through (14) at 52 FR 10505, (9) CA-7. Federal Employee's Notice of Occupational Disease and Claim for Compensation. Claim for Compensation on Account of Occupational Disease. Claim for Compensation by Widow, Widower and/or Children. Claim for Compensation by Parents, Broth- Official Superior's Report of Employee's Claim for Compensation on Account of (10) CA-8... Claim for Continuing Compensation on Account of Disability. knowingly certifies to, any false statement, misrepresentation, concealment of fact, or any other act of fraud with respect to a claim under the Act, or who knowingly accepts compensation to which that person is not entitled, is subject to criminal prosecution and may, under appropriate U.S. Criminal Code provisions (e.g., 18 U.S.C. 287 and 1001), be punished by a fine of not more than $10,000 or imprisonment for not more than five years, or both. (b) Any employee, beneficiary, official superior, representative, or other person who, with respect to a claim under the Act, enters into any agreement, combination, or conspiracy to defraud the United States by obtaining or aiding to obtain the payment or allowance of any false, fictitious or fraudulent claim is subject to criminal prosecution and may, under appropriate U.S. Criminal Code provisions (e.g., 18 U.S.C. 286), be punished by a fine of not more than $10,000 or imprisonment for not more than ten years, or both. (c) Any person charged with the responsibility of making reports in connection with an injury who willfully fails, neglects, or refuses to do so; induces, compels, or directs an injured employee to forego filing a claim; or willfully retains any notice, report, or paper required in connection with an injury, is subject to a fine of not more than $500 or imprisonment for not more than one year, or both. [52 FR 10505, Apr. 1, 1987] EFFECTIVE DATE NOTE: Section 10.23 was revised at 52 FR 10505, Apr. 1, 1987, effective June 1, 1987. For the convenience of the user, the superseded text is set forth below. in connection with an injury, is subject to a fine of no more than $500 or imprisonment for no more than one year, or both. Subpart B-Notice of Injury and Claim for Compensation, Administrative Procedures NOTICE OF INJURY OR DEATH EFFECTIVE DATE NOTE: Former section 10.100 was revised, §§ 10.101 through 10.103 were redesignated and revised, § 10.104 was added at 52 FR 10505-10506, Apr. 1, 1987, effective June 1, 1987. For the convenience of the user, the superseded text follows the new text. § 10.100 How to file a notice of injury or death. (a) Traumatic injury. An employee who sustains a traumatic injury which the employee believes occurred while in the performance of duty shall give written notice of the injury on Form CA-1 to the official superior. If the employee is unable to give written notice, it may be given by any person acting on the employee's behalf. (b) Occupational disease or illness. An employee who has a disease or illness which the employee believes to be employment-related shall give written notice of the condition on Form CA-2 to the official superior. If the employee is unable to give written notice, it may be given by any person acting on the employee's behalf. If it is impractical to give written notice to the employee's official superior, it may be given to any official of the employing agency, or directly to the Office. Form CA-2 must be accompanied by a statement from the employee to include: (1) A detailed history of the disease or illness with identification of part(s) of the body affected; (2) Complete details of types of substances or conditions of employment believed responsible for the disease or illness; (3) A description of specific exposures to substances or stressful conditions including locations, frequency and duration, and (4) Whether the employee ever suffered a similar condition and, if so, full details of onset, history and medical care received with names and addresses of physicians rendering treatment. (c) Death. If an employee dies because of a traumatic injury believed to have been sustained in the performance of duty or because of a disease or illness believed to have been employment-related, the employee's survivor(s), or any person acting on behalf of the survivor(s), shall notify the official superior of the death. If it is impractical to give notice to the employee's official superior, it may be given to any official of the employing agency, or directly to the Office. [52 FR 10505, Apr. 1, 1987] § 10.101 When a notice of injury or death must be given. (a) Traumatic injury. Written notice of a traumatic injury or death due to a traumatic injury shall be given as soon as possible but, pursuant to 5 U.S.C. 8119, no later than 30 days from the date on which the injury or death occurred. Given the provisions of 5 U.S.C. 8122 and § 10.105 of this part concerning the timely filing of a claim for compensation, the failure to give notice within 30 days may result in a loss of compensation rights. (b) Occupational disease or illness. Written notice of disease or illness believed to be employment related shall be given as soon as possible but no later than 30 days from the date on which the employee was first aware, or by the exercise of reasonable diligence should have been aware, of a possible relationship between the disease or illness and the conditions or factors of employment. Given the provisions of 5 U.S.C. 8122 and § 10.105 of this part concerning the timely filing of a claim for compensation, the failure to give notice within 30 days may result in a loss of compensation rights. (c) Death. In the case of death, notice shall be given as soon as possible but no later than 30 days from the date of death or the date the employee's survivor first became aware, or by the exercise of reasonable diligence should have been aware, of a possible relationship between the death and the conditions or factors of employment. Given the provisions of 5 U.S.C. 8122 and § 10.105 of this part concerning the timely filing of a claim for compensation, the failure to give notice within 30 days may result in a loss of compensation rights. [52 FR 10506, Apr. 1, 1987] § 10.102 Report of injury by the official superior. (a) As soon as possible but no later than 10 working days after receipt of written notice of injury from the employee, the official superior shall submit to the Office a written report of every injury or occupational disease or illness which is likely to: (1) Result in a medical charge against the Office; (2) Result in disability for work beyond the day or shift of injury; (3) Require prolonged treatment (i.e., more than two instances of medical examination and/or treatment); (4) Result in future disability; (5) Result in permanent impairment or; (6) Result in a continuation of pay pursuant to 5 U.S.C 8118. Portions of Forms CA-1 or CA-2 are provided for this purpose. If the injury does not come under any of the categories enumerated in this paragraph, the Form CA-1 or CA-2 need not be submitted to the Office but shall be retained as a permanent record in the Employee Medical Folder in accordance with the guidelines established by the Office of Personnel Management. Regardless of whether the Form CA-1 of CA-2 is forwarded to the Office or retained by the employing agency, immediately upon receipt of the written notice of injury the official superior shall complete the "Receipt of Notice of Injury" and return it to the employee. (b) If the official superior has reason to disagree with any particular of the injury as reported by the employee, the official superior or other agency official shall explore the circumstances of the injury and submit to the Office a full written explanation specifying the areas of disagreement and the findings upon which the disagreement is based. The report may be accompanied by supporting documentation such as witness statements, medical reports or records, or any other relevant information. Any written explanation of disagreement shall |