Part 725 — Claims for Benefits Under Part C of Title IV of the Federal Mine Safety and Health Act, as Amended
Subpart A — General
Subpart B — Persons Entitled to Benefits, Conditions, and Duration of Entitlement
- § 725.201— Who is entitled to benefits; contents of this subpart.
- § 725.202— Miner defined; condition of entitlement, miner.
- § 725.203— Duration and cessation of entitlement; miner.
- § 725.204— Determination of relationship; spouse.
- § 725.205— Determination of dependency; spouse.
- § 725.206— Determination of relationship; divorced spouse.
- § 725.207— Determination of dependency; divorced spouse.
- § 725.208— Determination of relationship; child.
- § 725.209— Determination of dependency; child.
- § 725.210— Duration of augmented benefits.
- § 725.211— Time of determination of relationship and dependency of spouse or child for purposes of augmentation of benefits.
- § 725.212— Conditions of entitlement; surviving spouse or surviving divorced spouse.
- § 725.213— Duration of entitlement; surviving spouse or surviving divorced spouse.
- § 725.214— Determination of relationship; surviving spouse.
- § 725.215— Determination of dependency; surviving spouse.
- § 725.216— Determination of relationship; surviving divorced spouse.
- § 725.217— Determination of dependency; surviving divorced spouse.
- § 725.218— Conditions of entitlement; child.
- § 725.219— Duration of entitlement; child.
- § 725.220— Determination of relationship; child.
- § 725.221— Determination of dependency; child.
- § 725.222— Conditions of entitlement; parent, brother, or sister.
- § 725.223— Duration of entitlement; parent, brother, or sister.
- § 725.224— Determination of relationship; parent, brother, or sister.
- § 725.225— Determination of dependency; parent, brother, or sister.
- § 725.226— “Good cause” for delayed filing of proof of support.
- § 725.227— Time of determination of relationship and dependency of survivors.
- § 725.228— Effect of conviction of felonious and intentional homicide on entitlement to benefits.
- § 725.229— Intestate personal property.
- § 725.230— Legal impediment.
- § 725.231— Domicile.
- § 725.232— Member of the same household—“living with,” “living in the same household,” and “living in the miner's household,” defined.
- § 725.233— Support and contributions.
Subpart C — Filing of Claims
- § 725.301— Who may file a claim.
- § 725.302— Evidence of authority to file a claim on behalf of another.
- § 725.303— Date and place of filing of claims.
- § 725.304— Forms and initial processing.
- § 725.305— When a written statement is considered a claim.
- § 725.306— Withdrawal of a claim.
- § 725.307— Cancellation of a request for withdrawal.
- § 725.308— Time limits for filing claims.
- § 725.309— Additional claims; effect of prior denial of benefits.
- § 725.310— Modification of awards and denials.
- § 725.311— Communications with respect to claims; time computations.
Subpart D — Adjudication Officers; Parties and Representatives
- § 725.350— Who are the adjudication officers?
- § 725.351— Powers of adjudication officers.
- § 725.352— Disqualification of adjudication officer.
- § 725.360— Parties to proceedings.
- § 725.361— Party amicus curiae.
- § 725.362— Representation of parties.
- § 725.363— Qualification of representative.
- § 725.364— Authority of representative.
- § 725.365— Approval of representative's fees; lien against benefits.
- § 725.366— Fees for representatives.
- § 725.367— Payment of a claimant's attorney's fee by responsible operator or fund.
Subpart E — Adjudication of Claims by the District Director
- § 725.401— Claims development—general.
- § 725.402— Approved State workers' compensation law.
- § 725.404— Development of evidence—general.
- § 725.405— Development of medical evidence; scheduling of medical examinations and tests.
- § 725.406— Medical examinations and tests.
- § 725.407— Identification and notification of responsible operator.
- § 725.408— Operator's response to notification.
- § 725.409— Denial of a claim by reason of abandonment.
- § 725.410— Submission of additional evidence.
- § 725.411— Initial adjudication in Trust Fund cases.
- § 725.412— Operator's response.
- § 725.413— Disclosure of medical information.
- § 725.414— Development of evidence.
- § 725.415— Action by the district director after development of evidence.
- § 725.416— Conferences.
- § 725.417— Action at the conclusion of conference.
- § 725.418— Proposed decision and order.
- § 725.419— Response to proposed decision and order.
- § 725.420— Initial determinations.
- § 725.421— Referral of a claim to the Office of Administrative Law Judges.
- § 725.422— Legal assistance.
- § 725.423— Extensions of time.
Subpart F — Hearings
- § 725.450— Right to a hearing.
- § 725.451— Request for hearing.
- § 725.452— Type of hearing; parties.
- § 725.453— Notice of hearing.
- § 725.454— Time and place of hearing; transfer of cases.
- § 725.455— Hearing procedures; generally.
- § 725.456— Introduction of documentary evidence.
- § 725.457— Witnesses.
- § 725.458— Depositions; interrogatories.
- § 725.459— Witness fees.
- § 725.460— Consolidated hearings.
- § 725.461— Waiver of right to appear and present evidence.
- § 725.462— Withdrawal of controversion of issues set for formal hearing; effect.
- § 725.463— Issues to be resolved at hearing; new issues.
- § 725.464— Record of hearing.
- § 725.465— Dismissals for cause.
- § 725.466— Order of dismissal.
- § 725.475— Termination of hearings.
- § 725.476— Issuance of decision and order.
- § 725.477— Form and contents of decision and order.
- § 725.478— Filing and service of decision and order.
- § 725.479— Finality of decisions and orders.
- § 725.480— Modification of decisions and orders.
- § 725.481— Right to appeal to the Benefits Review Board.
- § 725.482— Judicial review.
- § 725.483— Costs in proceedings brought without reasonable grounds.
Subpart G — Responsible Coal Mine Operators
- § 725.490— Statutory provisions and scope.
- § 725.491— Operator defined.
- § 725.492— Successor operator defined.
- § 725.493— Employment relationship defined.
- § 725.494— Potentially liable operators.
- § 725.495— Criteria for determining a responsible operator.
- § 725.496— Special claims transferred to the fund.
- § 725.497— Procedures in special claims transferred to the fund.
Subpart H — Payment of Benefits
- § 725.501— Payment provisions generally.
- § 725.502— When benefit payments are due; manner of payment.
- § 725.503— Date from which benefits are payable.
- § 725.504— Payments to a claimant employed as a miner.
- § 725.505— Payees.
- § 725.506— Payment on behalf of another; “legal guardian” defined.
- § 725.507— Guardian for minor or incompetent.
- § 725.510— Representative payee.
- § 725.511— Use and benefit defined.
- § 725.512— Support of legally dependent spouse, child, or parent.
- § 725.513— Accountability; transfer.
- § 725.514— Certification to dependent of augmentation portion of benefit.
- § 725.515— Assignment and exemption from claims of creditors.
- § 725.520— Computation of benefits.
- § 725.521— Commutation of payments; lump sum awards.
- § 725.522— Payments prior to final adjudication.
- § 725.530— Operator payments; generally.
- § 725.531— Receipt for payment.
- § 725.532— Suspension, reduction, or termination of payments.
- § 725.533— Modification of benefits amounts; general.
- § 725.534— Reduction of State benefits.
- § 725.535— Reductions; receipt of State or Federal benefit.
- § 725.536— Reductions; excess earnings.
- § 725.537— Reductions; retroactive effect of an additional claim for benefits.
- § 725.538— Reductions; effect of augmentation of benefits based on subsequent qualification of individual.
- § 725.539— More than one reduction event.
- § 725.540— Overpayments.
- § 725.541— Notice of waiver of adjustment or recovery of overpayment.
- § 725.542— When waiver of adjustment or recovery may be applied.
- § 725.543— Standards for waiver of adjustment or recovery.
- § 725.544— Collection and compromise of claims for overpayment.
- § 725.545— Underpayments.
- § 725.546— Relation to provisions for reductions or increases.
- § 725.547— Applicability of overpayment and underpayment provisions to operator or carrier.
- § 725.548— Procedures applicable to overpayments and underpayments.
Subpart I — Enforcement of Liability; Reports
- § 725.601— Enforcement generally.
- § 725.602— Reimbursement of the fund.
- § 725.603— Payments by the fund on behalf of an operator; liens.
- § 725.604— Enforcement of final awards.
- § 725.605— Defaults.
- § 725.606— Security for the payment of benefits.
- § 725.607— Payments of additional compensation.
- § 725.608— Interest.
- § 725.609— Enforcement against other persons.
- § 725.620— Failure to secure benefits; other penalties.
- § 725.621— Reports.
Subpart J — Medical Benefits and Vocational Rehabilitation
- § 725.701— What medical benefits are available?
- § 725.702— Who is considered a physician?
- § 725.703— How is treatment authorized?
- § 725.704— How are arrangements for medical care made?
- § 725.705— Is prior authorization for medical services required?
- § 725.706— What reports must a medical provider give to OWCP?
- § 725.707— At what rate will fees for medical services and treatments be paid?
- § 725.708— How are payments for professional medical services and medical equipment determined?
- § 725.709— How are payments for prescription drugs determined?
- § 725.710— How are payments for outpatient medical services determined?
- § 725.711— How are payments for inpatient medical services determined?
- § 725.712— When and how are fees reduced?
- § 725.713— If a fee is reduced, may a provider bill the claimant for the balance?
- § 725.714— How do providers enroll with OWCP for authorizations and billing?
- § 725.715— How do providers submit medical bills?
- § 725.716— How should a miner prepare and submit requests for reimbursement for covered medical expenses and transportation costs?
- § 725.717— What are the time limitations for requesting payment or reimbursement for covered medical services or treatments?
- § 725.718— How are disputes concerning medical benefits resolved?
- § 725.719— What is the objective of vocational rehabilitation?
- § 725.720— How does a miner request vocational rehabilitation assistance?