Part 30 — Claims for Compensation Under the Energy Employees Occupational Illness Compensation Program Act of 2000, as Amended
Subpart A — General Provisions
- § 30.0— What are the provisions of EEOICPA, in general?
- § 30.1— What rules govern the administration of EEOICPA and this chapter?
- § 30.2— In general, how have the tasks associated with the administration of EEOICPA claims process been assigned?
- § 30.3— What do these regulations contain?
- § 30.5— What are the definitions used in this part?
- § 30.10— Are all OWCP records relating to claims filed under 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?
- § 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
- § 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?
- § 30.105— What must DOE do after an employee or survivor files a claim?
- § 30.106— Can OWCP request employment verification from other sources?
- § 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 compensable medical condition and how will that evidence be evaluated?
- § 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
- § 30.200— What is the scope of this subpart?
- § 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?
- § 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?
- § 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?
- § 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?
- § 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 administrative process will OWCP use to decide claims for entitlement, and how can claimants obtain judicial review of final decisions on their claims?
- § 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?
- § 30.305— How does OWCP determine entitlement to EEOICPA compensation?
- § 30.306— What does the recommended decision include?
- § 30.307— Can one recommended decision address the entitlement of multiple claimants?
- § 30.308— To whom is the recommended decision sent?
- § 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— How will FAB consider objections to NIOSH's reconstruction of a radiation dose, or to OWCP's calculation of the recommended probability of causation, in a Part B claim for radiogenic cancer?
- § 30.319— May a claimant request reconsideration of a final decision of the FAB?
- § 30.320— Can a claim be reopened after the FAB has issued a final decision?
Subpart E — Medical and Related Benefits
- § 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 home health care, nursing home, and assisted living services?
- § 30.404— Will OWCP pay for transportation to obtain medical treatment?
- § 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?
- § 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?
- § 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?
- § 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
- § 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?
- § 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?
- § 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
- § 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?
- § 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 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?
- § 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?
- § 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
- § 30.700— In general, what responsibilities do providers have with respect to enrolling with OWCP, seeking authorization to provide services, billing, and retaining medical records?
- § 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?
- § 30.705— What services are covered by the OWCP fee schedule?
- § 30.706— How are the maximum fees for professional medical services defined?
- § 30.707— How are payments to providers 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— How are payments for outpatient medical services determined?
- § 30.712— When and how are fees reduced?
- § 30.713— If OWCP reduces a fee, may a provider request reconsideration of the reduction?
- § 30.714— If OWCP reduces a fee, may a provider bill the employee for the balance?
- § 30.715— What are the grounds for excluding a provider from 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 response 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 does a recommended decision become final?
- § 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
- § 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?
- § 30.805— What are the criteria for eligibility for wage-loss benefits under Part E?
- § 30.806— What kind of medical evidence must the claimant submit to prove that he or she lost wages due to a covered illness?
- § 30.807— What factual evidence does OWCP use to determine a covered Part E employee's average annual wage?
- § 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?
- § 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
- § 30.900— Who can receive impairment benefits under Part E?
- § 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?
- § 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?
- § 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?