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thereto, unless liability to pay benefits is controverted by the employer or insurer, including provisions requiring, except where the State agency for reasonable cause determines otherwise,

(1) That the first installment of compensation is due and payable no later than 15 days after the employer has knowledge of the disability or death;

(2) That, after payment of the first installment, compensation becomes due and payable not less often than semimonthly; and

(3) Providing, except where compensation is payable from a State fund, penalties for failure to pay compensation with or without an award within 15 days after it becomes due;

(d) In any case in which payments of benefits are being made without an award by an employer or insurer, and in any case where the right to benefits is controverted or payments of compensation have been stopped or suspended, the State agency is required to make such investigations, to cause such medical examinations to be made, to hold such hearings, and to take such further actions as will adequately protect the rights of all parties concerned;

(e) (1) Any assignment or release of compensation or benefits due and payable under the law is declared invalid;

(2) Such compensation or benefits are exempt from all claims of creditors and from levy, execution, attachment, garnishment, or any other remedy for recovery or collection of a debt, which exemption may not be waived; and

(3) Except where compensation is payable from a State fund, any person entitled to compensation has a lien against the assets of the insurer or employer for such compensation, and, upon insolvency, bankruptcy, or reorganization in bankruptcy, of the insurer or employer, or both, is entitled to preference and priority in the distribution of the assets of the insurer or employer, or both;

(f) The standards for determining death or total disability due to pneumoconiosis are substantially equivalent to those established by section 411 of the act, and by regulations of the Secretary of Health, Education, and Welfare promulgated thereunder (see Part 410, Subpart D of this title);

(g) A claim for benefits on account of total disability or death of a miner, due to pneumoconiosis, is deemed to be timely

filed if such claim is filed within 3 years of the discovery of the total disability or the date of such death, as the case may be;

(h) In any proceeding for the enforcement of a claim for compensation under the law, it is presumed, in the absence of substantial evidence to the contrary that the claim comes within the provisions of the law;

(i) If compensation liability may be discharged by payment of a lump sum, such discharge is subject to the following conditions:

(1) The lump sum is equal to or greater than, the present value of future compensation payments otherwise payable under the law, computed at no more than 4 percent true discount compounded annually. The probabilities of the death of a disabled worker or of the remarriage of a widow must be determined in accordance with the American Experience Tables of Mortality and the Remarriage Tables of the Dutch Royal Insurance Institution respectively; and

(2) The lump sum settlement is approved by the State agency on the basis of a finding that the settlement is in the interests of the claimant;

(j) Any agreement by an employee to pay any portion of the workmen's compensation insurance premium to be paid by his employer to an insurer, or to contribute to a fund maintained for the purpose of providing compensation or other benefits required by the law, or to waive his right to compensation and other benefits is prohibited and/or declared invalid;

(k) There are in effect provisions requiring each operator of an underground coal mine, where one or more miners are employed, to secure the payment of benefits by qualifying as a self-insurer or by insuring and keeping insured with an insurer as defined in this part;

(1) A coal mine operator who has acquired such mine, or substantially all of the assets thereof, from a person (prior operator) who was an operator of such mine on or after December 30, 1969, is liable for, and must secure the payment of, all benefits which would have been payable by that person with respect to miners previously employed in such mine if the acquisition had not occurred and that person had continued to operate such mine; and that person is not relieved of any liability under the law:

(m) Provisions are made for such methods of administration as are found by the Secretary of Labor, or his designee, to be reasonably calculated to insure full payment of compensation when due, including provisions

(1) For the administration of the law by a State agency, with powers to make or cause to be made all necessary investigations, inquiries, and examinations, and to conduct hearings, in connection with claims for compensation for death or total disability due to pneumoconiosis;

(2) Requiring the State agency and State courts to approve fees for legal services rendered to a claimant in connection with such a claim;

(3) Requiring the substitution of the insurer for any coal mine operator who is not a self-insurer in order that liability for compensation be discharged, and regulating the cancellation of insurance with respect to total disability or death due to pneumoconiosis;

(4) Requiring the posting by the employer of conspicuous notices showing compliance with the provisions of the law; and

(5) Requiring that coal mine employees with pneumoconiosis be offered vocational rehabilitation in all cases, where it is feasible;

(n) (1) With respect to any claim for benefits for death or total disability due to pneumoconiosis, there must be afforded: (i) An opportunity for a fair hearing to the employer or insurer and the claimant before final administrative decision is made on such claim; and (ii) An opportunity for judicial review of such administrative decision.

(2) If a proper court determines that proceedings in respect of a claim for compensation or a compensation order have been instituted or continued without reasonable grounds, the cost of the proceedings must be assessed against the party who has instituted or continued the proceedings;

(0) There are in effect provisions for the payment, after December 31, 1972, of benefits for total disability or death due to pneumoconiosis, to claimants whose claims were filed during the calendar year 1972 under Title IV, Part B, of the Act, which provisions shall: (1) Accord recognition to the filing and any adjudication under Part B as satisfying the requirements of the State law in respect of the filing of a claim for such benefits and adjudication of the issues, if any, previously adjudicated under Part B; and (2) Provide for adjudication of any issues not so previously adjudicated and, where the issue of liability of any mine operator to pay or secure such benefits is presented for determination, afford the mine operator an opportunity to be heard on the relationship between the pneumoconiosis and employment in a mine operated by him; and

(p) Any reduction, after the date of enactment of the Act, of benefits previously paid to persons, for total disability or death due to pneumoconiosis under the State's laws which are applicable to its general work force with regard to workmen's compensation, unemployment compensation, or disability insurance, is prohibited even though the amount of the reduced benefits equals or exceeds the amount prescribed in paragraph (a) of this section.



CROSS REFERENCES: Social Security Administration, Department of Health, Education, and

Welfare: See Chapter III of this title; Rules of Procedure, National Railroad Adjustment Board: See 29 CFR, Chapter III.


Part 200

Procedures and forms.


201 202


204 205


209 210 214 216 217 220 222 225 232 234 236 237 238

Employers under the act.
Employees under the act.
Employment relation.
Employee representative.
Eligibility for an annuity.
Military service.
Execution and filing of an application for an annuity.
Annuity beginning date.
Relinquishment of rights.
Months annuities not payable by reason of work.
Definition and creditability of service.
Definition and creditability of compensation.
Computation of annuity.
Spouse's annuities.
Annuities due but unpaid at death.
Payments of benefits of $1,000 or less.
Insurance annuities and lump sums for survivors.
Residual lump-sum payments.
Proofs required in support of claims for benefits,
Reports, information, hearings and witnesses.

240 250

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INSURANCE ACT 300 Definitions. 301 Employers under the act. 319 Procedure for determining liability for contributions or repayments of

benefits. 320 Initial determinations under the Railroad Unemployment Insurance Act

and reviews of and appeals from such determinations. 322 Remuneration. 325 Registration and claims for benefits. 327 Available for work. 330 Determination of daily benefit rates. 332

Mileage or work restrictions and stand-by or lay-over rules. 335 Sickness benefits and maternity benefits. 336 Exhaustion of rights to benefits. 340 Recovery of benefits. 345 Employers' contributions and contribution reports. 370 Miscellaneous.

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PART 200-PROCEDURES AND $ 200.1 The general course and method FORMS

by which the Board's functions are

channeled and determined. 200.1 The general course and method by (a) Retirement and death benefits. which the Board's functions are

Retirement and death benefits must be channeled and determined. 2002 Designation of forms and instructions.

applied for by filing application therefor. 200.3 Availability of information to public.

(For details as to application, see Parts

210 and 237 of this chapter.) The Bureau AUTHORITY: The provisions of this part 200 issued under sec. 10, 50 Stat. 814, as

of Retirement Claims considers the ap. amended, sec. 12, 52 Stat. 1107, as amended;

plication and the evidence and informa45 U.S.C. 228). 362.

tion submitted with it. Wage and service

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