[Code of Federal Regulations]
[Title 20, Volume 1]
[Revised as of April 1, 2005]
From the U.S. Government Printing Office via GPO Access
[CITE: 20CFR61.101]

[Page 122]
 
                      TITLE 20--EMPLOYEES' BENEFITS
 
CHAPTER I--OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR
 
PART 61_CLAIMS FOR COMPENSATION UNDER THE WAR HAZARDS COMPENSATION ACT, 
AS AMENDED--Table of Contents
 
                   Subpart B_Reimbursement of Carriers
 
Sec. 61.101  Filing a request for reimbursement.

    (a) A carrier or employer may file a request for reimbursement. The 
request shall be submitted to the U.S. Department of Labor, Office of 
Workers' Compensation Programs, Branch of Special Claims, P.O. Box 
37117, Washington, DC 20013-7117;
    (b) Each request for reimbursement shall include documentation 
itemizing the payments for which reimbursement is claimed. The 
documentation shall be sufficient to establish the purpose of the 
payment, the name of the payee, the date(s) for which payment was made, 
and the amount of the payment. Copies of any medical reports and bills 
related to medical examination or treatment for which reimbursement is 
claimed shall also be submitted. If the carrier cannot provide copies of 
the payment drafts or receipts, the Office may accept a certified 
listing of payments which includes payee name, description of services 
rendered, date of services rendered, amount paid, date paid check or 
draft number, and signature of certifier.
    (c) When filing an initial request for reimbursement under the Act, 
the carrier shall submit copies of all available documents related to 
the workers' compensation case, including--
    (1) Notice and claim forms;
    (2) Statements of the employee or employer;
    (3) Medical reports;
    (4) Compensation orders; and
    (5) Proof of liability (e.g., insurance policy or other 
documentation).