[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: 20CFR10.105]



[Page 19-20]

 

                      TITLE 20--EMPLOYEES' BENEFITS

 

                      CHAPTER I--OFFICE OF WORKERS'

                         COMPENSATION PROGRAMS,

                           DEPARTMENT OF LABOR

 

PART 10_CLAIMS FOR COMPENSATION UNDER THE FEDERAL EMPLOYEES' COMPENSATION 

ACT, AS AMENDED--Table of Contents

 

        Subpart B_Filing Notices and Claims; Submitting Evidence

 

Sec.  10.105  How and when is a notice of death and claim for benefits 

filed?



    (a) If an employee dies from a work-related traumatic injury or an 

occupational disease, any survivor may file a claim for death benefits 

using Form CA-5 or CA-5b, which may be obtained from the employer or 

from the Internet at www.dol.gov./dol/esa/owcp.htm. The survivor must 

provide this notice in writing and forward it to the employer.



[[Page 20]]



Another person, including the employer, may do so on the survivor's 

behalf. The survivor may also submit the completed Form CA-5 or CA-5b 

directly to OWCP. The survivor shall disclose the SSNs of all survivors 

on whose behalf claim for benefits is made in addition to the SSN of the 

deceased employee. The survivor may withdraw his or her claim (but not 

the notice of death) by so requesting in writing to OWCP at any time 

before OWCP determines eligibility for benefits.

    (b) For deaths that occur on or after September 7, 1974, a notice of 

death must be filed within three years of the death. The form contains 

the necessary words of claim. The requirements for timely filing are 

described in Sec.  10.100(b)(1) through (3).

    (c) However, in cases of death due to latent disability, the time 

for filing the claim does not begin to run until the survivor is aware, 

or reasonably should have been aware, of the causal relationship between 

the death and the employment (see 5 U.S.C. 8122(b)).

    (d) The filing of a notice of injury or occupational disease will 

satisfy the time requirements for a death claim based on the same injury 

or occupational disease. If an injured employee or someone acting on the 

employee's behalf does not file a claim before the employee's death, the 

right to claim compensation for disability other than medical expenses 

ceases and does not survive.

    (e) A survivor must be alive to receive any payment; there is no 

vested right to such payment. A report as described in Sec.  10.414 of 

this part must be filed once each year to support continuing payments of 

compensation.



  Notices and Claims for Injury, Disease, and Death--Employer's Actions