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Code of Federal Regulations (Last Updated: November 8, 2024) |
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Title 20 - Employees' Benefits |
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Chapter VI - Office of Workers' Compensation Programs, Department of Labor |
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SubChapter B - Federal Coal Mine Health and Safety Act of 1969, as Amended |
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Part 725 - Claims for Benefits Under Part C of Title Iv of the Federal Mine Safety and Health Act, as Amended |
Part 725 - Claims for Benefits Under Part C of Title Iv of the Federal Mine Safety and Health Act, as Amended
| Subpart A - General |
| § 725.1 - Statutory provisions. |
| § 725.2 - Purpose and applicability of this part. |
| § 725.3 - Contents of this part. |
| § 725.4 - Applicability of other parts in this title. |
| § 725.101 - Definition and use of terms. |
| § 725.102 - Disclosure of program information. |
| § 725.103 - Burden of proof. |
| Subpart B - Persons Entitled to Benefits, Conditions, and Duration of Entitlement |
| § 725.201 - Who is entitled to benefits; contents of this subpart. |
| Conditions and Duration of Entitlement |
| Conditions and Duration of Entitlement: Miner'S Dependents (Augmented Benefits) |
| § 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. |
| Terms Used in This Subpart |
| Survivors’ Entitlement |
| Conditions and Duration of Entitlement: Miner |
| § 725.202 - Miner defined; condition of entitlement, miner. |
| § 725.203 - Duration and cessation of entitlement; miner. |
| Benefits on Account of Living Dependents (Augmented Benefits) |
| Subpart C—Filing of Claims |
| 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. |
| Adjudication by the Deputy Commissioner |
| Parties and Representatives |
| Subpart E - Adjudication of Claims by the District Director |
| § 725.401 - Claims development - general. |
| § 725.402 - Approved State workers' compensation law. |
| § 725.403 - [Reserved] |
| § 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. |
| § 725.453A - Time and place of hearing. |
| § 725.459A - Oral argument and written allegations. |
| 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. |
| General Provisions |
| 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. |
| Benefit Rates |
| Increases and Reductions of Benefits |
| Special Provisions for Operator Payments |
| Overpayments; Underpayments |
| § 725.503A - Payments to a claimant employed as a miner. |
| Subpart H - Payment of Benefits |
| Overpayments; Underpayments |
| § 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. |
| Increases and Reductions of Benefits |
| § 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. |
| Benefit Rates |
| § 725.520 - Computation of benefits. |
| § 725.521 - Commutation of payments; lump sum awards. |
| § 725.522 - Payments prior to final adjudication. |
| Special Provisions for Operator Payments |
| § 725.530 - Operator payments; generally. |
| § 725.531 - Receipt for payment. |
| § 725.532 - Suspension, reduction, or termination of payments. |
| General Provisions |
| § 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. |
| 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. |
| § 725.701A - Claims for medical benefits only under section 11 of the Reform Act. |
| 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? |