[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: 20CFR30.0] [Page 77-82] TITLE 20--EMPLOYEES' BENEFITS CHAPTER I--OFFICE OF WORKERS' COMPENSATION PROGRAMS, DEPARTMENT OF LABOR PART 30_CLAIMS FOR COMPENSATION UNDER THE ENERGY EMPLOYEES OCCUPATIONAL ILLNESS COMPENSATION PROGRAM ACT OF 2000, AS AMENDED--Table of Contents Subpart A_General Provisions Sec. 30.0 What are the provisions of the EEOICPA, in general? Subpart A_General Provisions Introduction Sec. 30.0 What are the provisions of the EEOICPA, in general? 30.1 What rules govern the administration of the EEOICPA and this chapter? 30.2 In general, how have the tasks associated with the administration of the EEOICPA claims process been assigned? 30.3 What do these regulations contain? Definitions 30.5 What are the definitions used in this part? Information in Program Records 30.10 Are all OWCP records relating to claims filed under the EEOICPA considered confidential? 30.11 Who maintains custody and control of claim records? 30.12 What process is used by a person who wants to obtain copies of or amend EEOICPA claim records? Rights and Penalties 30.15 May EEOICPA benefits be assigned, transferred or garnished? 30.16 What penalties may be imposed in connection with a claim under the Act? 30.17 Is a beneficiary who defrauds the government in connection with a claim for EEOICPA benefits still entitled to those benefits? Subpart B_Filing Claims; Evidence and Burden of Proof; Special Procedures for Certain Cancer Claims Filing Claims for Benefits Under EEOICPA 30.100 In general, how does an employee file an initial claim for benefits? 30.101 In general, how is a survivor's claim filed? 30.102 In general, how does an employee file a claim for additional impairment or wage-loss under Part E of EEOICPA? 30.103 How does a claimant make sure that OWCP has the evidence necessary to process the claim? Verification of Alleged Employment 30.105 What must DOE do after an employee or survivor files a claim? 30.106 Can OWCP request employment verification from other sources? Evidence and Burden of Proof 30.110 Who is entitled to compensation under the Act? 30.111 What is the claimant's responsibility with respect to burden of proof, production of documents, presumptions, and affidavits? 30.112 What kind of evidence is needed to establish covered employment and how will that evidence be evaluated? 30.113 What are the requirements for written medical documentation, contemporaneous records, and other records or documents? 30.114 What kind of evidence is needed to establish a covered medical condition and how will that evidence be evaluated? Special Procedures for Certain Radiogenic Cancer Claims 30.115 For those radiogenic cancer claims that do not seek benefits under Part B of the Act pursuant to the Special Exposure Cohort provisions, what will OWCP do once it determines that an employee contracted cancer? Subpart C_Eligibility Criteria General Provisions 30.200 What is the scope of this subpart? Eligibility Criteria for Claims Relating to Covered Beryllium Illness Under Part B of EEOICPA 30.205 What are the criteria for eligibility for benefits relating to beryllium illnesses covered under Part B of EEOICPA? 30.206 How does a claimant prove that the employee was a ``covered beryllium employee'' exposed to beryllium dust, particles or vapor in the performance of duty? 30.207 How does a claimant prove a diagnosis of a beryllium disease covered under Part B? [[Page 78]] Eligibility Criteria for Claims Relating to Radiogenic Cancer Under Parts B and E of EEOICPA 30.210 What are the criteria for eligibility for benefits relating to radiogenic cancer? 30.211 How does a claimant establish that the employee has or had contracted cancer? 30.212 How does a claimant establish that the employee contracted cancer after beginning employment at a DOE facility, an atomic weapons employer facility or a RECA section 5 facility? 30.213 How does a claimant establish that the radiogenic cancer was at least as likely as not related to employment at the DOE facility, the atomic weapons employer facility, or the RECA section 5 facility? 30.214 How does a claimant establish that the employee is a member of the Special Exposure Cohort? 30.215 How does a claimant establish that the employee has sustained an injury, illness, impairment or disease as a consequence of a diagnosed cancer? Eligibility Criteria for Claims Relating to Chronic Silicosis Under Part B of EEOICPA 30.220 What are the criteria for eligibility for benefits relating to chronic silicosis? 30.221 How does a claimant prove exposure to silica in the performance of duty? 30.222 How does a claimant establish that the employee has been diagnosed with chronic silicosis or has sustained a consequential injury, illness, impairment or disease? Eligibility Criteria for Certain Uranium Employees Under Part B of EEOICPA 30.225 What are the criteria for eligibility for benefits under Part B of EEOICPA for certain uranium employees? 30.226 How does a claimant establish that a covered uranium employee has sustained a consequential injury, illness, impairment or disease? Eligibility Criteria for Other Claims Under Part E of EEOICPA 30.230 What are the criteria necessary to establish that an employee contracted a covered illness under Part E of EEOICPA? 30.231 How does a claimant prove employment-related exposure to a toxic substance at a DOE facility or a RECA section 5 facility? 30.232 How does a claimant establish that the employee has been diagnosed with a covered illness, or sustained an injury, illness, impairment or disease as a consequence of a covered illness? Subpart D_Adjudicatory Process 30.300 What process will OWCP use to decide claims for entitlement and to provide for administrative review of those decisions? 30.301 May subpoenas be issued for witnesses and documents in connection with a claim under Part B of EEOICPA? 30.302 Who pays the costs associated with subpoenas? 30.303 What information may OWCP request in connection with a claim under Part E of EEOICPA? Recommended Decisions on Claims 30.305 How does OWCP determine entitlement to EEOICPA compensation? 30.306 What does the recommended decision contain? 30.307 To whom is the recommended decision sent? Hearings and Final Decisions on Claims 30.310 What must the claimant do if he or she objects to the recommended decision or wants to request a hearing? 30.311 What happens if the claimant does not object to the recommended decision or request a hearing within 60 days? 30.312 What will the FAB do if the claimant objects to the recommended decision but does not request a hearing? 30.313 How is a review of the written record conducted? 30.314 How is a hearing conducted? 30.315 May a claimant postpone a hearing? 30.316 How does the FAB issue a final decision on a claim? 30.317 Can the FAB request a further response from the claimant or return a claim to the district office? 30.318 Can the FAB consider objections to HHS's reconstruction of a radiation dose or to the guidelines OWCP uses to determine if a claimed cancer was at least as likely as not related to employment? 30.319 May a claimant request reconsideration of a final decision of the FAB? Reopening Claims 30.320 Can a claim be reopened after the FAB has issued a final decision? Subpart E_Medical and Related Benefits Medical Treatment and Related Issues 30.400 What are the basic rules for obtaining medical treatment? 30.401 What are the special rules for the services of chiropractors? 30.402 What are the special rules for the services of clinical psychologists? 30.403 Will OWCP pay for the services of an attendant? 30.404 Will OWCP pay for transportation to obtain medical treatment? [[Page 79]] 30.405 After selecting a treating physician, may an employee choose to be treated by another physician instead? 30.406 Are there any exceptions to these procedures for obtaining medical care? Directed Medical Examinations 30.410 Can OWCP require an employee to be examined by another physician? 30.411 What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee? 30.412 Who pays for second opinion and referee examinations? Medical Reports 30.415 What are the requirements for medical reports? 30.416 How and when should medical reports be submitted? 30.417 What additional medical information may OWCP require to support continuing payment of benefits? Medical Bills 30.420 How should medical bills and reimbursement requests be submitted? 30.421 What are the time frames for submitting bills and reimbursement requests? 30.422 If an employee is only partially reimbursed for a medical expense, must the provider refund the balance of the amount paid to the employee? Subpart F_Survivors; Payments and Offsets; Overpayments Survivors 30.500 What special statutory definitions apply to survivors under EEOICPA? 30.501 What order of precedence will OWCP use to determine which survivors are entitled to receive compensation under EEOICPA? 30.502 When is entitlement for survivors determined for purposes of EEOICPA? Payment of Claims and Offset for Certain Payments 30.505 What procedures will OWCP follow before it pays any compensation? 30.506 To whom and in what manner will OWCP pay compensation? 30.507 What compensation will be provided to covered Part B employees who only establish beryllium sensitivity under Part B of EEOICPA? 30.508 What is beryllium sensitivity monitoring? 30.509 Under what circumstances may a survivor claiming under Part E of the Act choose to receive the benefits that would otherwise be payable to a covered Part E employee who is deceased? Overpayments 30.510 How does OWCP notify an individual of a payment made on a claim? 30.511 What is an ``overpayment'' for purposes of EEOICPA? 30.512 What does OWCP do when an overpayment is identified? 30.513 Under what circumstances may OWCP waive recovery of an overpayment? 30.514 If OWCP finds that the recipient of an overpayment was not at fault, what criteria are used to decide whether to waive recovery of it? 30.515 Is a recipient responsible for an overpayment that resulted from an error made by OWCP? 30.516 Under what circumstances would recovery of an overpayment defeat the purpose of the Act? 30.517 Under what circumstances would recovery of an overpayment be against equity and good conscience? 30.518 Can OWCP require the recipient of the overpayment to submit additional financial information? 30.519 How does OWCP communicate its final decision concerning recovery of an overpayment? 30.520 How are overpayments collected? Subpart G_Special Provisions Representation 30.600 May a claimant designate a representative? 30.601 Who may serve as a representative? 30.602 Who is responsible for paying the representative's fee? 30.603 Are there any limitations on what the representative may charge the claimant for his or her services? Third Party Liability 30.605 What rights does the United States have upon payment of compensation under EEOICPA? 30.606 Under what circumstances must a recovery of money or other property in connection with an illness for which benefits are payable under EEOICPA be reported to OWCP? 30.607 How is a structured settlement (that is, a settlement providing for receipt of funds over a specified period of time) treated for purposes of reporting the recovery? 30.608 How does the United States calculate the amount to which it is subrogated? 30.609 Is a settlement or judgment received as a result of allegations of medical malpractice in treating an illness covered by EEOICPA a recovery that must be reported to OWCP? 30.610 Are payments to a covered Part B employee, a covered Part E employee or [[Page 80]] an eligible surviving beneficiary as a result of an insurance policy which the employee or eligible surviving beneficiary has purchased a recovery that must be reported to OWCP? 30.611 If a settlement or judgment is received for more than one medical condition, can the amount paid on a single EEOICPA claim be attributed to different conditions for purposes of calculating the amount to which the United States is subrogated? Effect of Tort Suits Against Beryllium Vendors and Atomic Weapons Employers 30.615 What type of tort suits filed against beryllium vendors or atomic weapons employers may disqualify certain claimants from receiving benefits under Part B of EEOICPA? 30.616 What happens if this type of tort suit was filed prior to October 30, 2000? 30.617 What happens if this type of tort suit was filed during the period from October 30, 2000 through December 28, 2001? 30.618 What happens if this type of tort suit was filed after December 28, 2001? 30.619 Do all the parties to this type of tort suit have to take these actions? 30.620 How will OWCP ascertain whether a claimant filed this type of tort suit and if he or she has been disqualified from receiving any benefits under Part B of EEOICPA? Coordination of Part E Benefits With State Workers' Compensation Benefits 30.625 What does ``coordination of benefits'' mean under Part E of EEOICPA? 30.626 How will OWCP coordinate compensation payable under Part E of EEOICPA with benefits from state workers' compensation programs? 30.627 Under what circumstances will OWCP waive the statutory requirement to coordinate these benefits? Subpart H_Information for Medical Providers Medical Records and Bills 30.700 What kind of medical records must providers keep? 30.701 How are medical bills to be submitted? 30.702 How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses? 30.703 What are the time limitations on OWCP's payment of bills? Medical Fee Schedule 30.705 What services are covered by the OWCP fee schedule? 30.706 How are the maximum fees defined? 30.707 How are payments for particular services calculated? 30.708 Does the fee schedule apply to every kind of procedure? 30.709 How are payments for medicinal drugs determined? 30.710 How are payments for inpatient medical services determined? 30.711 When and how are fees reduced? 30.712 If OWCP reduces a fee, may a provider request reconsideration of the reduction? 30.713 If OWCP reduces a fee, may a provider bill the employee for the balance? Exclusion of Providers 30.715 What are the grounds for excluding a provider for payment under this part? 30.716 What will cause OWCP to automatically exclude a physician or other provider of medical services and supplies? 30.717 When are OWCP's exclusion procedures initiated? 30.718 How is a provider notified of OWCP's intent to exclude him or her? 30.719 What requirements must the provider's reply and OWCP's decision meet? 30.720 How can an excluded provider request a hearing? 30.721 How are hearings assigned and scheduled? 30.722 How are subpoenas or advisory opinions obtained? 30.723 How will the administrative law judge conduct the hearing and issue the recommended decision? 30.724 How can a party request review by OWCP of the administrative law judge's recommended decision? 30.725 What are the effects of non-automatic exclusion? 30.726 How can an excluded provider be reinstated? Subpart I_Wage-Loss Determinations Under Part E of EEOICPA General Provisions 30.800 What types of wage-loss are compensable under Part E of EEOICPA? 30.801 What special definitions does OWCP use in connection with Part E wage-loss determinations? Evidence of Wage-Loss 30.805 What evidence does OWCP use to determine a covered Part E employee's average annual wage and whether he or she experienced compensable wage-loss under Part E of EEOICPA? 30.806 May a claimant submit factual evidence in support of a different determination of average annual wage and/or wage-loss than that found by OWCP? [[Page 81]] Determinations of Average Annual Wage and Percentages of Loss 30.810 How will OWCP calculate the average annual wage of a covered Part E employee? 30.811 How will OWCP calculate the duration and extent of a covered Part E employee's initial period of compensable wage-loss? 30.812 May a covered Part E employee claim for subsequent periods of compensable wage-loss? Special Rules for Certain Survivor Claims Under Part E of EEOICPA 30.815 Are there special rules that OWCP will use to determine the extent of a deceased covered Part E employee's compensable wage-loss? Subpart J_Impairment Benefits Under Part E of EEOICPA General Provisions 30.900 Who can receive impairment benefits under Part E of EEOICPA? 30.901 How does OWCP determine the extent of an employee's impairment that is due to a covered illness contracted through exposure to a toxic substance at a DOE facility or a RECA section 5 facility, as appropriate? 30.902 How will OWCP calculate the amount of the award of impairment benefits that is payable under Part E? Medical Evidence of Impairment 30.905 How may an impairment evaluation be obtained? 30.906 Who will pay for an impairment evaluation? 30.907 Can an impairment evaluation obtained by OWCP be challenged prior to issuance of the recommended decision? 30.908 How will the FAB evaluate new medical evidence submitted to challenge the impairment determination in the recommended decision? Ratable Medical Impairments 30.910 Will an impairment that cannot be assigned a numerical percentage using the AMA's Guides be included in the impairment rating? 30.911 Does maximum medical improvement always have to be reached for an impairment to be included in the impairment rating? 30.912 Can a covered Part E employee receive benefits for additional impairment following an award of such benefits by OWCP? Authority: 5 U.S.C. 301; 31 U.S.C. 3716 and 3717; 42 U.S.C. 7384d, 7384t, 7384u and 7385s-10; Executive Order 13179, 65 FR 77487, 3 CFR, 2000 Comp., p. 321; Secretary of Labor's Order No. 4-2001, 66 FR 29656. Source: 70 FR 33605, June 8, 2005, unless otherwise noted. Introduction Part B of the Energy Employees Occupational Illness Compensation Program Act of 2000, as amended (EEOICPA or Act), 42 U.S.C. 7384 et seq., provides for the payment of compensation benefits to covered Part B employees and, where applicable, survivors of such employees, of the United States Department of Energy (DOE), its predecessor agencies and certain of its contractors and subcontractors. Part B also provides for the payment of supplemental compensation benefits to other covered Part B employees who have already been found eligible for benefits under section 5 of the Radiation Exposure Compensation Act, as amended (RECA), 42 U.S.C. 2210 note, and where applicable, survivors of such persons. Part E of the Act provides for the payment of compensation benefits to covered Part E employees and, where applicable, survivors of such employees. The regulations in this part describe the rules governing filing, processing, and paying claims for benefits under both Part B and Part E of EEOICPA. (a) Part B of EEOICPA provides for the payment of either lump-sum monetary compensation for the disability of a covered Part B employee due to an occupational illness or for monitoring for beryllium sensitivity, as well as for medical and related benefits for such illness. Part B also provides for the payment of monetary compensation for the disability of a covered Part B employee to specified survivors if the employee is deceased at the time of payment. (b) Part E of EEOICPA provides for the payment of monetary compensation for the established wage-loss and/or impairment of a covered Part E employee due to a covered illness, and for medical and related benefits for such covered illness. Part E also provides for [[Page 82]] the payment of monetary compensation for the death (and established wage-loss, where applicable) of a covered Part E employee to specified survivors if the covered Part E employee is deceased at the time of payment. (c) All types of benefits and conditions of eligibility listed in this section are subject to the provisions of EEOICPA and this part.