Part 10 — Claims for Compensation Under the Federal Employees' Compensation Act, as Amended
Subpart A — General Provisions
- § 10.0— What are the provisions of the FECA, in general?
- § 10.1— What rules govern the administration of the FECA and this chapter?
- § 10.2— What do these regulations contain?
- § 10.3— Have the collection of information requirements of this part been approved by the Office of Management and Budget (OMB)?
- § 10.5— What definitions apply to the regulations in this subchapter?
- § 10.6— What special statutory definitions apply to dependents and survivors?
- § 10.7— What forms are needed to process claims under the FECA?
- § 10.10— Are all documents relating to claims filed under the FECA considered confidential?
- § 10.11— Who maintains custody and control of FECA records?
- § 10.12— How may a FECA claimant or beneficiary obtain copies of protected records?
- § 10.13— What process is used by a person who wants to correct FECA-related documents?
- § 10.15— May compensation rights be waived?
- § 10.16— What criminal and civil penalties may be imposed in connection with a claim under the FECA?
- § 10.17— Is a beneficiary who defrauds the Government in connection with a claim for benefits still entitled to those benefits?
- § 10.18— Can a beneficiary who is incarcerated based on a felony conviction still receive benefits?
Subpart B — Filing Notices and Claims; Submitting Evidence
- § 10.100— How and when is a notice of traumatic injury filed?
- § 10.101— How and when is a notice of occupational disease filed?
- § 10.102— How and when is a claim for wage loss compensation filed?
- § 10.103— How and when is a claim for permanent impairment filed?
- § 10.104— How and when is a claim for recurrence filed?
- § 10.105— How and when is a notice of death and claim for benefits filed?
- § 10.110— What should the employer do when an employee files a notice of traumatic injury or occupational disease?
- § 10.111— What should the employer do when an employee files an initial claim for compensation due to disability or permanent impairment?
- § 10.112— What should the employer do when an employee files a claim for continuing compensation due to disability?
- § 10.113— What should the employer do when an employee dies from a work-related injury or disease?
- § 10.115— What evidence is needed to establish a claim?
- § 10.116— What additional evidence is needed in cases based on occupational disease?
- § 10.117— What happens if, in any claim, the employer contests any of the facts as stated by the claimant?
- § 10.118— Does the employer participate in the claims process in any other way?
- § 10.119— What action will OWCP take with respect to information submitted by the employer?
- § 10.120— May a claimant submit additional evidence?
- § 10.121— What happens if OWCP needs more evidence from the claimant?
- § 10.125— How does OWCP determine entitlement to benefits?
- § 10.126— What does the decision contain?
- § 10.127— To whom is the decision sent?
Subpart C — Continuation of Pay
- § 10.200— What is continuation of pay?
- § 10.205— What conditions must be met to receive COP?
- § 10.206— May an employee who uses leave after an injury later decide to use COP instead?
- § 10.207— May an employee who returns to work, then stops work again due to the effects of the injury, receive COP?
- § 10.210— What are the employee's responsibilities in COP cases?
- § 10.211— What are the employer's responsibilities in COP cases?
- § 10.215— How does OWCP compute the number of days of COP used?
- § 10.216— How is the pay rate for COP calculated?
- § 10.217— Is COP charged if the employee continues to work, but in a different job that pays less?
- § 10.220— When is an employer not required to pay COP?
- § 10.221— How is a claim for COP controverted?
- § 10.222— When may an employer terminate COP which has already begun?
- § 10.223— Are there other circumstances under which OWCP will not authorize payment of COP?
- § 10.224— What happens if OWCP finds that the employee is not entitled to COP after it has been paid?
Subpart D — Medical and Related Benefits
- § 10.300— What are the basic rules for authorizing emergency medical care?
- § 10.301— May the physician designated on Form CA-16 refer the employee to another medical specialist or medical facility?
- § 10.302— Should the employer authorize medical care if he or she doubts that the injury occurred, or that it is work-related?
- § 10.303— Should the employer use a Form CA-16 to authorize medical testing when an employee is exposed to a workplace hazard just once?
- § 10.304— Are there any exceptions to these procedures for obtaining medical care?
- § 10.310— What are the basic rules for obtaining medical care?
- § 10.311— What are the special rules for the services of chiropractors?
- § 10.312— What are the special rules for the services of clinical psychologists?
- § 10.313— Will OWCP pay for preventive treatment?
- § 10.314— Will OWCP pay for the services of an attendant?
- § 10.315— Will OWCP pay for transportation to obtain medical treatment?
- § 10.316— After selecting a treating physician, may an employee choose to be treated by another physician instead?
- § 10.320— Can OWCP require an employee to be examined by another physician?
- § 10.321— What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee?
- § 10.322— Who pays for second opinion and referee examinations?
- § 10.323— What are the penalties for failing to report for or obstructing a second opinion or referee examination?
- § 10.324— May an employer require an employee to undergo a physical examination in connection with a work-related injury?
- § 10.330— What are the requirements for medical reports?
- § 10.331— How and when should the medical report be submitted?
- § 10.332— What additional medical information will OWCP require to support continuing payment of benefits?
- § 10.333— What additional medical information will OWCP require to support a claim for a schedule award?
- § 10.335— How are medical bills submitted?
- § 10.336— What are the time frames for submitting bills?
- § 10.337— 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 E — Compensation and Related Benefits
- § 10.400— What is total disability?
- § 10.401— When and how is compensation for total disability paid?
- § 10.402— What is partial disability?
- § 10.403— When and how is compensation for partial disability paid?
- § 10.404— When and how is compensation for a schedule impairment paid?
- § 10.405— Who is considered a dependent in a claim based on disability or impairment?
- § 10.406— What are the maximum and minimum rates of compensation in disability cases?
- § 10.410— Who is entitled to compensation in case of death, and what are the rates of compensation payable in death cases?
- § 10.411— What are the maximum and minimum rates of compensation in death cases?
- § 10.412— Will OWCP pay the costs of burial and transportation of the remains?
- § 10.413— May a schedule award be paid after an employee's death?
- § 10.414— What reports of dependents are needed in death cases?
- § 10.415— What must a beneficiary do if the number of beneficiaries decreases?
- § 10.416— How does a change in the number of beneficiaries affect the amount of compensation paid to the other beneficiaries?
- § 10.417— What reports are needed when compensation payments continue for children over age 18?
- § 10.420— How are cost-of-living adjustments applied?
- § 10.421— May a beneficiary receive other kinds of payments from the Federal Government concurrently with compensation?
- § 10.422— May compensation payments be issued in a lump sum?
- § 10.423— May compensation payments be assigned to, or attached by, creditors?
- § 10.424— May someone other than the beneficiary be designated to receive compensation payments?
- § 10.425— May compensation be claimed for periods of restorable leave?
- § 10.430— How does OWCP notify an individual of a payment made?
- § 10.431— What does OWCP do when an overpayment is identified?
- § 10.432— How can an individual present evidence to OWCP in response to a preliminary notice of an overpayment?
- § 10.433— Under what circumstances can OWCP waive recovery of an overpayment?
- § 10.434— 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?
- § 10.435— Is an individual responsible for an overpayment that resulted from an error made by OWCP or another Government agency?
- § 10.436— Under what circumstances would recovery of an overpayment defeat the purpose of the FECA?
- § 10.437— Under what circumstances would recovery of an overpayment be against equity and good conscience?
- § 10.438— Can OWCP require the individual who received the overpayment to submit additional financial information?
- § 10.439— What is addressed at a pre-recoupment hearing?
- § 10.440— How does OWCP communicate its final decision concerning recovery of an overpayment, and what appeal right accompanies it?
- § 10.441— How are overpayments collected?
Subpart F — Continuing Benefits
- § 10.500— What are the basic rules governing continuing receipt of compensation benefits and return to work?
- § 10.501— What medical evidence is necessary to support continuing receipt of compensation benefits?
- § 10.502— How does OWCP evaluate evidence in support of continuing receipt of compensation benefits?
- § 10.503— Under what circumstances may OWCP reduce or terminate compensation benefits?
- § 10.505— What actions must the employer take?
- § 10.506— May the employer monitor the employee's medical care?
- § 10.507— How should the employer make an offer of suitable work?
- § 10.508— May relocation expenses be paid for an employee who would need to move to accept an offer of reemployment?
- § 10.509— If an employee's light duty job is eliminated due to downsizing, what is the effect on compensation?
- § 10.510— When may a light duty job form the basis of a loss of wage-earning capacity determination?
- § 10.511— How may a loss of wage-earning capacity determination be modified?
- § 10.515— What actions must the employee take with respect to returning to work?
- § 10.516— How will an employee know if OWCP considers a job to be suitable?
- § 10.517— What are the penalties for refusing to accept a suitable job offer?
- § 10.518— Does OWCP provide services to help employees return to work?
- § 10.519— What action will OWCP take if an employee refuses to undergo vocational rehabilitation?
- § 10.520— How does OWCP determine compensation after an employee completes a vocational rehabilitation program?
- § 10.521— If an employee elects to receive retirement benefits instead of FECA benefits, what effect may such an election have on that employee's entitlement to FECA compensation?
- § 10.525— What information must the employee report?
- § 10.526— Must the employee report volunteer activities?
- § 10.527— Does OWCP verify reports of earnings?
- § 10.528— What action will OWCP take if the employee fails to file a report of activity indicating an ability to work?
- § 10.529— What action will OWCP take if the employee files an incomplete report?
- § 10.535— How are dependents defined, and what information must the employee report?
- § 10.536— What is the penalty for failing to submit a report of dependents?
- § 10.537— What reports are needed when compensation payments continue for children over age 18?
- § 10.540— When and how is compensation reduced or terminated?
- § 10.541— What action will OWCP take after issuing written notice of its intention to reduce or terminate compensation?
Subpart G — Appeals Process
- § 10.600— How can final decisions of OWCP be reviewed?
- § 10.605— What is reconsideration?
- § 10.606— How does a claimant request reconsideration?
- § 10.607— What is the time limit for requesting reconsideration?
- § 10.608— How does OWCP decide whether to grant or deny the request for reconsideration?
- § 10.609— How does OWCP decide whether new evidence requires modification of the prior decision?
- § 10.610— What is a review by the Director?
- § 10.615— What is a hearing?
- § 10.616— How does a claimant obtain a hearing?
- § 10.617— How is an oral hearing conducted?
- § 10.618— How is a review of the written record conducted?
- § 10.619— May subpoenas be issued for witnesses and documents?
- § 10.620— Who pays the costs associated with subpoenas?
- § 10.621— What is the employer's role when an oral hearing has been requested?
- § 10.622— May a claimant or representative withdraw a request for or postpone a hearing?
- § 10.625— What kinds of decisions may be appealed?
- § 10.626— Who has jurisdiction of cases on appeal to the ECAB?
Subpart H — Special Provisions
- § 10.700— May a claimant designate a representative?
- § 10.701— Who may serve as a representative?
- § 10.702— How are fees for services paid?
- § 10.703— How are fee applications approved?
- § 10.704— What penalties apply to representatives who collect a fee without approval?
- § 10.705— When must an employee or other FECA beneficiary take action against a third party?
- § 10.706— How will a beneficiary know if OWCP or SOL has determined that action against a third party is required?
- § 10.707— What must a FECA beneficiary who is required to take action against a third party do to satisfy the requirement that the claim be “prosecuted”?
- § 10.708— Can a FECA beneficiary who refuses to comply with a request to assign a claim to the United States or to prosecute the claim in his or her own name be penalized?
- § 10.709— What happens if a beneficiary directed by OWCP or SOL to take action against a third party does not believe that a claim can be successfully prosecuted at a reasonable cost?
- § 10.710— Under what circumstances must a recovery of money or other property in connection with an injury or death for which benefits are payable under the FECA be reported to OWCP or SOL?
- § 10.711— How is the amount of the recovery of the FECA beneficiary determined?
- § 10.712— How much of any settlement or judgment must be paid to the United States?
- § 10.713— 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 gross recovery?
- § 10.714— What amounts are included in the refundable disbursements?
- § 10.715— Is a beneficiary required to pay interest on the amount of the refund due to the United States?
- § 10.716— If the required refund is not paid within 30 days of the request for repayment, can it be collected from payments due under the FECA?
- § 10.717— Is a settlement or judgment received as a result of allegations of medical malpractice in treating an injury covered by the FECA a gross recovery that must be reported to OWCP or SOL?
- § 10.718— Are payments to a beneficiary as a result of an insurance policy which the beneficiary has purchased a gross recovery that must be reported to OWCP or SOL?
- § 10.719— If a settlement or judgment is received for more than one wound or medical condition, can the refundable disbursements paid on a single FECA claim be attributed to different conditions for purposes of calculating the refund or credit owed to the United States?
- § 10.725— When is a Federal grand or petit juror covered under the FECA?
- § 10.726— When does a juror's entitlement to disability compensation begin?
- § 10.727— What is the pay rate of jurors for compensation purposes?
- § 10.730— What are the conditions of coverage for Peace Corps volunteers and volunteer leaders injured while serving outside the United States?
- § 10.731— What is the pay rate of Peace Corps volunteers and volunteer leaders for compensation purposes?
- § 10.735— When is a non-Federal law enforcement officer (LEO) covered under the FECA?
- § 10.736— What are the time limits for filing a LEO claim?
- § 10.737— How is a LEO claim filed, and who can file a LEO claim?
- § 10.738— Under what circumstances are benefits payable in LEO claims?
- § 10.739— What kind of objective evidence of a potential Federal crime must exist for coverage to be extended?
- § 10.740— In what situations will OWCP automatically presume that a law enforcement officer is covered by the FECA?
- § 10.741— How are benefits calculated in LEO claims?
Subpart I — Information for Medical Providers
- § 10.800— How do providers enroll with OWCP for authorizations and billing?
- § 10.801— How are medical bills to be submitted?
- § 10.802— How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses?
- § 10.803— What are the time limitations on OWCP's payment of bills?
- § 10.805— What services are covered by the OWCP fee schedule?
- § 10.806— How are the maximum fees defined?
- § 10.807— How are payments for particular services calculated?
- § 10.808— Does the fee schedule apply to every kind of procedure?
- § 10.809— How are payments for medicinal drugs determined?
- § 10.810— How are payments for inpatient medical services determined?
- § 10.811— When and how are fees reduced?
- § 10.812— If OWCP reduces a fee, may a provider request reconsideration of the reduction?
- § 10.813— If OWCP reduces a fee, may a provider bill the claimant for the balance?
- § 10.815— What are the grounds for excluding a provider from payment under the FECA?
- § 10.816— What will cause OWCP to automatically exclude a physician or other provider of medical services and supplies?
- § 10.817— How are OWCP's exclusion procedures initiated?
- § 10.818— How is a provider notified of OWCP's intent to exclude him or her?
- § 10.819— What requirements must the provider's answer and OWCP's decision meet?
- § 10.820— How can an excluded provider request a hearing?
- § 10.821— How are hearings assigned and scheduled?
- § 10.822— How are subpoenas or advisory opinions obtained?
- § 10.823— How will the administrative law judge conduct the hearing and issue the recommended decision?
- § 10.824— How does the recommended decision become final?
- § 10.825— What are the effects of exclusion?
- § 10.826— How can an excluded provider be reinstated?
Subpart J — Death Gratuity
- § 10.900— What is the death gratuity under this subpart?
- § 10.901— Which employees are covered under this subpart?
- § 10.902— Does every employee's death due to injuries incurred in connection with his or her service with an Armed Force in a contingency operation qualify for the death gratuity?
- § 10.903— Is the death gratuity payment applicable retroactively?
- § 10.904— Does a death as a result of occupational disease qualify for payment of the death gratuity?
- § 10.905— If an employee incurs a covered injury in connection with his or her service with an Armed Force in a contingency operation but does not die of the injury until years later, does the death qualify for payment of the death gratuity?
- § 10.906— What special statutory definitions apply to survivors under this subpart?
- § 10.907— What order of precedence will OWCP use to determine which survivors are entitled to receive the death gratuity payment under this subpart?
- § 10.908— Can an employee designate alternate beneficiaries to receive a portion of the death gratuity payment?
- § 10.909— How does an employee designate a variation in the order or percentage of gratuity payable to survivors and how does the employee designate alternate beneficiaries?
- § 10.910— What if a person entitled to a portion of the death gratuity payment dies after the death of the covered employee but before receiving his or her portion of the death gratuity?
- § 10.911— How is the death gratuity payment process initiated?
- § 10.912— What is required to establish a claim for the death gratuity payment?
- § 10.913— In what situations will OWCP consider that an employee incurred injury in connection with his or her service with an Armed Force in a contingency operation?
- § 10.914— What are the responsibilities of the employing agency in the death gratuity payment process?
- § 10.915— What are the responsibilities of OWCP in the death gratuity payment process?
- § 10.916— How is the amount of the death gratuity calculated?