Title 20, Part 725 — Claims for Benefits Under Part C of Title Iv of the Federal Mine Safety and Health Act, as Amended
185 sections
Section 725.1
Statutory provisions.
Section 725.2
Purpose and applicability of this part.
Section 725.3
Contents of this part.
Section 725.4
Applicability of other parts in this title.
Section 725.101
Definition and use of terms.
Section 725.102
Disclosure of program information.
Section 725.103
Burden of proof.
Section 725.201
Who is entitled to benefits; contents of this subpart.
Section 725.202
Miner defined; condition of entitlement, miner.
Section 725.203
Duration and cessation of entitlement; miner.
Section 725.204
Determination of relationship; spouse.
Section 725.205
Determination of dependency; spouse.
Section 725.206
Determination of relationship; divorced spouse.
Section 725.207
Determination of dependency; divorced spouse.
Section 725.208
Determination of relationship; child.
Section 725.209
Determination of dependency; child.
Section 725.210
Duration of augmented benefits.
Section 725.211
Time of determination of relationship and dependency of spouse or child for purposes of augmentation of benefits.
Section 725.212
Conditions of entitlement; surviving spouse or surviving divorced spouse.
Section 725.213
Duration of entitlement; surviving spouse or surviving divorced spouse.
Section 725.214
Determination of relationship; surviving spouse.
Section 725.215
Determination of dependency; surviving spouse.
Section 725.216
Determination of relationship; surviving divorced spouse.
Section 725.217
Determination of dependency; surviving divorced spouse.
Section 725.218
Conditions of entitlement; child.
Section 725.219
Duration of entitlement; child.
Section 725.220
Determination of relationship; child.
Section 725.221
Determination of dependency; child.
Section 725.222
Conditions of entitlement; parent, brother, or sister.
Section 725.223
Duration of entitlement; parent, brother, or sister.
Section 725.224
Determination of relationship; parent, brother, or sister.
Section 725.225
Determination of dependency; parent, brother, or sister.
Section 725.226
“Good cause” for delayed filing of proof of support.
Section 725.227
Time of determination of relationship and dependency of survivors.
Section 725.228
Effect of conviction of felonious and intentional homicide on entitlement to benefits.
Section 725.229
Intestate personal property.
Section 725.230
Legal impediment.
Section 725.231
Domicile.
Section 725.232
Member of the same household—“living with,” “living in the same household,” and “living in the miner's household,” defined.
Section 725.233
Support and contributions.
Section 725.301
Who may file a claim.
Section 725.302
Evidence of authority to file a claim on behalf of another.
Section 725.303
Date and place of filing of claims.
Section 725.304
Forms and initial processing.
Section 725.305
When a written statement is considered a claim.
Section 725.306
Withdrawal of a claim.
Section 725.307
Cancellation of a request for withdrawal.
Section 725.308
Time limits for filing claims.
Section 725.309
Additional claims; effect of prior denial of benefits.
Section 725.310
Modification of awards and denials.
Section 725.311
Communications with respect to claims; time computations.
Section 725.350
Who are the adjudication officers?
Section 725.351
Powers of adjudication officers.
Section 725.352
Disqualification of adjudication officer.
Section 725.360
Parties to proceedings.
Section 725.361
Party amicus curiae.
Section 725.362
Representation of parties.
Section 725.363
Qualification of representative.
Section 725.364
Authority of representative.
Section 725.365
Approval of representative's fees; lien against benefits.
Section 725.366
Fees for representatives.
Section 725.367
Payment of a claimant's attorney's fee by responsible operator or fund.
Section 725.401
Claims development—general.
Section 725.402
Approved State workers' compensation law.
Section 725.403
[Reserved]
Section 725.404
Development of evidence—general.
Section 725.405
Development of medical evidence; scheduling of medical examinations and tests.
Section 725.406
Medical examinations and tests.
Section 725.407
Identification and notification of responsible operator.
Section 725.408
Operator's response to notification.
Section 725.409
Denial of a claim by reason of abandonment.
Section 725.410
Submission of additional evidence.
Section 725.411
Initial adjudication in Trust Fund cases.
Section 725.412
Operator's response.
Section 725.413
Disclosure of medical information.
Section 725.414
Development of evidence.
Section 725.415
Action by the district director after development of evidence.
Section 725.416
Conferences.
Section 725.417
Action at the conclusion of conference.
Section 725.418
Proposed decision and order.
Section 725.419
Response to proposed decision and order.
Section 725.420
Initial determinations.
Section 725.421
Referral of a claim to the Office of Administrative Law Judges.
Section 725.422
Legal assistance.
Section 725.423
Extensions of time.
Section 725.450
Right to a hearing.
Section 725.451
Request for hearing.
Section 725.452
Type of hearing; parties.
Section 725.453
Notice of hearing.
Section 725.454
Time and place of hearing; transfer of cases.
Section 725.455
Hearing procedures; generally.
Section 725.456
Introduction of documentary evidence.
Section 725.457
Witnesses.
Section 725.458
Depositions; interrogatories.
Section 725.459
Witness fees.
Section 725.460
Consolidated hearings.
Section 725.461
Waiver of right to appear and present evidence.
Section 725.462
Withdrawal of controversion of issues set for formal hearing; effect.
Section 725.463
Issues to be resolved at hearing; new issues.
Section 725.464
Record of hearing.
Section 725.465
Dismissals for cause.
Section 725.466
Order of dismissal.
Section 725.475
Termination of hearings.
Section 725.476
Issuance of decision and order.
Section 725.477
Form and contents of decision and order.
Section 725.478
Filing and service of decision and order.
Section 725.479
Finality of decisions and orders.
Section 725.480
Modification of decisions and orders.
Section 725.481
Right to appeal to the Benefits Review Board.
Section 725.482
Judicial review.
Section 725.483
Costs in proceedings brought without reasonable grounds.
Section 725.490
Statutory provisions and scope.
Section 725.491
Operator defined.
Section 725.492
Successor operator defined.
Section 725.493
Employment relationship defined.
Section 725.494
Potentially liable operators.
Section 725.495
Criteria for determining a responsible operator.
Section 725.496
Special claims transferred to the fund.
Section 725.497
Procedures in special claims transferred to the fund.
Section 725.501
Payment provisions generally.
Section 725.502
When benefit payments are due; manner of payment.
Section 725.503
Date from which benefits are payable.
Section 725.504
Payments to a claimant employed as a miner.
Section 725.505
Payees.
Section 725.506
Payment on behalf of another; “legal guardian” defined.
Section 725.507
Guardian for minor or incompetent.
Section 725.510
Representative payee.
Section 725.511
Use and benefit defined.
Section 725.512
Support of legally dependent spouse, child, or parent.
Section 725.513
Accountability; transfer.
Section 725.514
Certification to dependent of augmentation portion of benefit.
Section 725.515
Assignment and exemption from claims of creditors.
Section 725.520
Computation of benefits.
Section 725.521
Commutation of payments; lump sum awards.
Section 725.522
Payments prior to final adjudication.
Section 725.530
Operator payments; generally.
Section 725.531
Receipt for payment.
Section 725.532
Suspension, reduction, or termination of payments.
Section 725.533
Modification of benefits amounts; general.
Section 725.534
Reduction of State benefits.
Section 725.535
Reductions; receipt of State or Federal benefit.
Section 725.536
Reductions; excess earnings.
Section 725.537
Reductions; retroactive effect of an additional claim for benefits.
Section 725.538
Reductions; effect of augmentation of benefits based on subsequent qualification of individual.
Section 725.539
More than one reduction event.
Section 725.540
Overpayments.
Section 725.541
Notice of waiver of adjustment or recovery of overpayment.
Section 725.542
When waiver of adjustment or recovery may be applied.
Section 725.543
Standards for waiver of adjustment or recovery.
Section 725.544
Collection and compromise of claims for overpayment.
Section 725.545
Underpayments.
Section 725.546
Relation to provisions for reductions or increases.
Section 725.547
Applicability of overpayment and underpayment provisions to operator or carrier.
Section 725.548
Procedures applicable to overpayments and underpayments.
Section 725.601
Enforcement generally.
Section 725.602
Reimbursement of the fund.
Section 725.603
Payments by the fund on behalf of an operator; liens.
Section 725.604
Enforcement of final awards.
Section 725.605
Defaults.
Section 725.606
Security for the payment of benefits.
Section 725.607
Payments of additional compensation.
Section 725.608
Interest.
Section 725.609
Enforcement against other persons.
Section 725.620
Failure to secure benefits; other penalties.
Section 725.621
Reports.
Section 725.701
What medical benefits are available?
Section 725.702
Who is considered a physician?
Section 725.703
How is treatment authorized?
Section 725.704
How are arrangements for medical care made?
Section 725.705
Is prior authorization for medical services required?
Section 725.706
What reports must a medical provider give to OWCP?
Section 725.707
At what rate will fees for medical services and treatments be paid?
Section 725.708
How are payments for professional medical services and medical equipment determined?
Section 725.709
How are payments for prescription drugs determined?
Section 725.710
How are payments for outpatient medical services determined?
Section 725.711
How are payments for inpatient medical services determined?
Section 725.712
When and how are fees reduced?
Section 725.713
If a fee is reduced, may a provider bill the claimant for the balance?
Section 725.714
How do providers enroll with OWCP for authorizations and billing?
Section 725.715
How do providers submit medical bills?
Section 725.716
How should a miner prepare and submit requests for reimbursement for covered medical expenses and transportation costs?
Section 725.717
What are the time limitations for requesting payment or reimbursement for covered medical services or treatments?
Section 725.718
How are disputes concerning medical benefits resolved?
Section 725.719
What is the objective of vocational rehabilitation?
Section 725.720
How does a miner request vocational rehabilitation assistance?