Title 20, Part 30 — Claims for Compensation Under the Energy Employees Occupational Illness Compensation Program Act of 2000, as Amended

What are the provisions of EEOICPA, in general?

What rules govern the administration of EEOICPA and this chapter?

In general, how have the tasks associated with the administration of EEOICPA claims process been assigned?

What do these regulations contain?

What are the definitions used in this part?

Are all OWCP records relating to claims filed under EEOICPA considered confidential?

Who maintains custody and control of claim records?

What process is used by a person who wants to obtain copies of or amend EEOICPA claim records?

May EEOICPA benefits be assigned, transferred or garnished?

What penalties may be imposed in connection with a claim under the Act?

Is a beneficiary who defrauds the government in connection with a claim for EEOICPA benefits still entitled to those benefits?

In general, how does an employee file an initial claim for benefits?

In general, how is a survivor's claim filed?

In general, how does an employee file a claim for additional impairment or wage-loss under Part E of EEOICPA?

How does a claimant make sure that OWCP has the evidence necessary to process the claim?

What must DOE do after an employee or survivor files a claim?

Can OWCP request employment verification from other sources?

Who is entitled to compensation under the Act?

What is the claimant's responsibility with respect to burden of proof, production of documents, presumptions, and affidavits?

What kind of evidence is needed to establish covered employment and how will that evidence be evaluated?

What are the requirements for written medical documentation, contemporaneous records, and other records or documents?

What kind of evidence is needed to establish a compensable medical condition and how will that evidence be evaluated?

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?

What is the scope of this subpart?

What are the criteria for eligibility for benefits relating to beryllium illnesses covered under Part B of EEOICPA?

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?

How does a claimant prove a diagnosis of a beryllium disease covered under Part B?

What are the criteria for eligibility for benefits relating to radiogenic cancer?

How does a claimant establish that the employee has or had contracted cancer?

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?

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?

How does a claimant establish that the employee is a member of the Special Exposure Cohort?

How does a claimant establish that the employee has sustained an injury, illness, impairment or disease as a consequence of a diagnosed cancer?

What are the criteria for eligibility for benefits relating to chronic silicosis?

How does a claimant prove exposure to silica in the performance of duty?

How does a claimant establish that the employee has been diagnosed with chronic silicosis or has sustained a consequential injury, illness, impairment or disease?

What are the criteria for eligibility for benefits under Part B of EEOICPA for certain uranium employees?

How does a claimant establish that a covered uranium employee has sustained a consequential injury, illness, impairment or disease?

What are the criteria necessary to establish that an employee contracted a covered illness under Part E of EEOICPA?

How does a claimant prove employment-related exposure to a toxic substance at a DOE facility or a RECA section 5 facility?

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?

What administrative process will OWCP use to decide claims for entitlement, and how can claimants obtain judicial review of final decisions on their claims?

May subpoenas be issued for witnesses and documents in connection with a claim under Part B of EEOICPA?

Who pays the costs associated with subpoenas?

What information may OWCP request in connection with a claim under Part E of EEOICPA?

How does OWCP determine entitlement to EEOICPA compensation?

What does the recommended decision include?

Can one recommended decision address the entitlement of multiple claimants?

To whom is the recommended decision sent?

What must the claimant do if he or she objects to the recommended decision or wants to request a hearing?

What happens if the claimant does not object to the recommended decision or request a hearing within 60 days?

What will the FAB do if the claimant objects to the recommended decision but does not request a hearing?

How is a review of the written record conducted?

How is a hearing conducted?

May a claimant postpone a hearing?

How does the FAB issue a final decision on a claim?

Can the FAB request a further response from the claimant or return a claim to the district office?

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?

May a claimant request reconsideration of a final decision of the FAB?

Can a claim be reopened after the FAB has issued a final decision?

What are the basic rules for obtaining medical treatment?

What are the special rules for the services of chiropractors?

What are the special rules for the services of clinical psychologists?

Will OWCP pay for home health care, nursing home, and assisted living services?

Will OWCP pay for transportation to obtain medical treatment?

After selecting a treating physician, may an employee choose to be treated by another physician instead?

Are there any exceptions to these procedures for obtaining medical care?

Can OWCP require an employee to be examined by another physician?

What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee?

Who pays for second opinion and referee examinations?

What are the requirements for medical reports?

How and when should medical reports be submitted?

What additional medical information may OWCP require to support continuing payment of benefits?

How should medical bills and reimbursement requests be submitted?

What are the time frames for submitting bills and reimbursement requests?

If an employee is only partially reimbursed for a medical expense, must the provider refund the balance of the amount paid to the employee?

What special statutory definitions apply to survivors under EEOICPA?

What order of precedence will OWCP use to determine which survivors are entitled to receive compensation under EEOICPA?

When is entitlement for survivors determined for purposes of EEOICPA?

What procedures will OWCP follow before it pays any compensation?

To whom and in what manner will OWCP pay compensation?

What compensation will be provided to covered Part B employees who only establish beryllium sensitivity under Part B of EEOICPA?

What is beryllium sensitivity monitoring?

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?

How does OWCP notify an individual of a payment made on a claim?

What is an “overpayment” for purposes of EEOICPA?

What does OWCP do when an overpayment is identified?

Under what circumstances may OWCP waive recovery of an overpayment?

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?

Is a recipient responsible for an overpayment that resulted from an error made by OWCP?

Under what circumstances would recovery of an overpayment defeat the purpose of the Act?

Under what circumstances would recovery of an overpayment be against equity and good conscience?

Can OWCP require the recipient of the overpayment to submit additional financial information?

How does OWCP communicate its final decision concerning recovery of an overpayment?

How are overpayments collected?

May a claimant designate a representative?

Who may serve as a representative?

Who is responsible for paying the representative's fee?

Are there any limitations on what the representative may charge the claimant for his or her services?

What rights does the United States have upon payment of compensation under EEOICPA?

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?

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?

How does the United States calculate the amount to which it is subrogated?

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?

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?

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?

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?

What happens if this type of tort suit was filed prior to October 30, 2000?

What happens if this type of tort suit was filed during the period from October 30, 2000 through December 28, 2001?

What happens if this type of tort suit was filed after December 28, 2001?

Do all the parties to this type of tort suit have to take these actions?

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?

What does “coordination of benefits” mean under Part E of EEOICPA?

How will OWCP coordinate compensation payable under Part E of EEOICPA with benefits from state workers' compensation programs?

Under what circumstances will OWCP waive the statutory requirement to coordinate these benefits?

In general, what responsibilities do providers have with respect to enrolling with OWCP, seeking authorization to provide services, billing, and retaining medical records?

How are medical bills to be submitted?

How should an employee prepare and submit requests for reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses?

What are the time limitations on OWCP's payment of bills?

What services are covered by the OWCP fee schedule?

How are the maximum fees for professional medical services defined?

How are payments to providers calculated?

Does the fee schedule apply to every kind of procedure?

How are payments for medicinal drugs determined?

How are payments for inpatient medical services determined?

How are payments for outpatient medical services determined?

When and how are fees reduced?

If OWCP reduces a fee, may a provider request reconsideration of the reduction?

If OWCP reduces a fee, may a provider bill the employee for the balance?

What are the grounds for excluding a provider from payment under this part?

What will cause OWCP to automatically exclude a physician or other provider of medical services and supplies?

When are OWCP's exclusion procedures initiated?

How is a provider notified of OWCP's intent to exclude him or her?

What requirements must the provider's response and OWCP's decision meet?

How can an excluded provider request a hearing?

How are hearings assigned and scheduled?

How are subpoenas or advisory opinions obtained?

How will the administrative law judge conduct the hearing and issue the recommended decision?

How does a recommended decision become final?

What are the effects of non-automatic exclusion?

How can an excluded provider be reinstated?

What types of wage-loss are compensable under Part E of EEOICPA?

What special definitions does OWCP use in connection with Part E wage-loss determinations?

What are the criteria for eligibility for wage-loss benefits under Part E?

What kind of medical evidence must the claimant submit to prove that he or she lost wages due to a covered illness?

What factual evidence does OWCP use to determine a covered Part E employee's average annual wage?

How will OWCP calculate the average annual wage of a covered Part E employee?

How will OWCP calculate the duration and extent of a covered Part E employee's initial period of compensable wage-loss?

May a covered Part E employee claim for subsequent periods of compensable wage-loss?

Are there special rules that OWCP will use to determine the extent of a deceased covered Part E employee's compensable wage-loss?

Who can receive impairment benefits under Part E?

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?

How will OWCP calculate the amount of the award of impairment benefits that is payable under Part E?

How may an impairment evaluation be obtained?

Who will pay for an impairment evaluation?

Can an impairment evaluation obtained by OWCP be challenged prior to issuance of the recommended decision?

How will the FAB evaluate new medical evidence submitted to challenge the impairment determination in the recommended decision?

Will an impairment that cannot be assigned a numerical percentage using the AMA's Guides be included in the impairment rating?

Does maximum medical improvement always have to be reached for an impairment to be included in the impairment rating?

Can a covered Part E employee receive benefits for additional impairment following an award of such benefits by OWCP?