[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: 20CFR61.102]



[Page 141-142]

 

                      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.  61.102  Disposition of reimbursement requests.



    (a) If the Office finds that insufficient or inadequate information 

has been submitted with the claim, the carrier shall be asked to submit 

further information. Failure to supply the requested information may 

result in disallowance of items not adequately supported as properly 

reimbursable.

    (b) The Office shall not withhold payment of an approved part of a 

reimbursement request because of denial of another part of the 

reimbursement request.

    (c) The Office shall regard awards, decisions and approved 

settlement agreements under the Defense Base Act or other applicable 

workers' compensation law, that have become final, as establishing prima 

facie, the right of the beneficiary to the payment awarded or provided 

for.

    (d) The Office shall advise the carrier of the amount approved for 

reimbursement. If the reimbursement request has been denied in whole or 

in part, the Office shall provide the carrier an explanation of the 

action taken and the reasons for the action. A carrier within the United 

States may file objections with the Associate Director for Federal 

Employees' Compensation to the disallowance or reduction of a claim 

within 60 days of the Office's decision. A carrier outside the United 

States has six months within which to file objections with the Associate 

Director. The Office may consider objections filed beyond the time 

limits under unusual circumstances or when reasonable cause has been 

shown for the delay. A determination by the Office is final.

    (e) In determining whether a claim is reimbursable, the Office shall 

hold the carrier to the same degree of care and prudence as any 

individual or corporation in the protection of its interests or the 

handling of its affairs would be expected to exercise under similar 

circumstances. A part or an item of a claim may be disapproved if the 

Office finds that the carrier--

    (1) Failed to take advantage of any right accruing by assignment or 

subrogation (except against the United States, directly or indirectly, 

its employees, or members of its armed forces) due to the liability of a 

third party, unless the financial condition of the third party or the 

facts and circumstances surrounding the liability justify the failure;

    (2) Failed to take reasonable measures to contest, reduce, or 

terminate its liability by appropriate available



[[Page 142]]



procedure under workers' compensation law or otherwise; or

    (3) Failed to make reasonable and adequate investigation or injury 

as to the right of any person to any benefit or payment; or

    (4) Failed to avoid augmentation of liability by reason of delay in 

recognizing or discharging a compensation claimant's right to benefits.