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Code of Federal Regulations Pertaining to U.S. Department of Labor |
| Employees' Benefits |
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| Office of Workers' Compensation Programs, Department of Labor |
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| Claims for Compensation Under the Federal Employees' Compensation Act, As Amended |
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| General Provisions |
20 CFR 10.5 - What definitions apply to these regulations?
- Section Number: 10.5
- Section Name: What definitions apply to these regulations?
Certain words and phrases found in this part are defined in this
section or in the FECA. Some other words and phrases that are used only
in limited situations are defined in the later subparts of these
regulations.
(a) Benefits or Compensation means the money OWCP pays to or on
behalf of a beneficiary from the Employees' Compensation Fund for lost
wages, a loss of wage-earning capacity or a permanent physical
impairment, as well as the money paid to beneficiaries for an employee's
death. These two terms also include any other amounts paid out of the
Employees' Compensation Fund for such things as medical treatment,
medical examinations conducted at the request of OWCP as part of the
claims adjudication process, vocational rehabilitation services,
services of an attendant and funeral expenses, but does not include
continuation of pay.
(b) Beneficiary means an individual who is entitled to a benefit
under the FECA and this part.
(c) Claim means a written assertion of an individual's entitlement
to benefits under the FECA, submitted in a manner authorized by this
part.
(d) Claimant means an individual whose claim has been filed.
(e) Director means the Director of OWCP or a person designated to
carry out his or her functions.
(f) Disability means the incapacity, because of an employment
injury, to earn the wages the employee was receiving at the time of
injury. It may be partial or total.
(g) Earnings from employment or self-employment means:
(1) Gross earnings or wages before any deductions and includes the
value of subsistence, quarters, reimbursed expenses and any other goods
or services received in kind as remuneration; or
(2) A reasonable estimate of the cost to have someone else perform
the duties of an individual who accepts no remuneration. Neither lack of
profits, nor the characterization of the duties as a hobby, removes an
unremunerated individual's responsibility to report the estimated cost
to have someone else perform his or her duties.
(h) Employee means, but is not limited to, an individual who fits
within one of the following listed groups:
(1) A civil officer or employee in any branch of the Government of
the United States, including an officer or employee of an
instrumentality wholly owned by the United States;
(2) An individual rendering personal service to the United States
similar to the service of a civil officer or employee of the United
States, without pay or for nominal pay, when a statute
authorizes the acceptance or use of the service, or authorizes payment
of travel or other expenses of the individual;
(3) An individual, other than an independent contractor or an
individual employed by an independent contractor, employed on the
Menominee Indian Reservation in Wisconsin in operations conducted under
a statute relating to tribal timber and logging operations on that
reservation;
(4) An individual appointed to a position on the office staff of a
former President; or
(5) An individual selected and serving as a Federal petit or grand
juror.
(i) Employer or Agency means any civil agency or instrumentality of
the United States Government, or any other organization, group or
institution employing an individual defined as an ``employee'' by this
section. These terms also refer to officers and employees of an employer
having responsibility for the supervision, direction or control of
employees of that employer as an ``immediate superior,'' and to other
employees designated by the employer to carry out the functions vested
in the employer under the FECA and this part, including officers or
employees delegated responsibility by an employer for authorizing
medical treatment for injured employees.
(j) Entitlement means entitlement to benefits as determined by OWCP
under the FECA and the procedures described in this part.
(k) FECA means the Federal Employees' Compensation Act, as amended.
(l) Hospital services means services and supplies provided by
hospitals within the scope of their practice as defined by State law.
(m) Impairment means any anatomic or functional abnormality or loss.
A permanent impairment is any such abnormality or loss after maximum
medical improvement has been achieved.
(n) Knowingly means with knowledge, consciously, willfully or
intentionally.
(o) Medical services means services and supplies provided by or
under the supervision of a physician. Reimbursable chiropractic services
are limited to physical examinations (and related laboratory tests), x-
rays performed to diagnose a subluxation of the spine and treatment
consisting of manual manipulation of the spine to correct a subluxation.
(p) Medical support services means services, drugs, supplies and
appliances provided by a person other than a physician or hospital.
(q) Occupational disease or Illness means a condition produced by
the work environment over a period longer than a single workday or
shift.
(r) OWCP means the Office of Workers' Compensation Programs.
(s) Pay rate for compensation purposes means the employee's pay, as
determined under 5 U.S.C. 8114, at the time of injury, the time
disability begins or the time compensable disability recurs if the
recurrence begins more than six months after the injured employee
resumes regular full-time employment with the United States, whichever
is greater, except as otherwise determined under 5 U.S.C. 8113 with
respect to any period.
(t) Physician means an individual defined as such in 5 U.S.C.
8101(2), except during the period for which his or her license to
practice medicine has been suspended or revoked by a State licensing or
regulatory authority.
(u) Qualified hospital means any hospital licensed as such under
State law which has not been excluded under the provisions of subpart I
of this part. Except as otherwise provided by regulation, a qualified
hospital shall be deemed to be designated or approved by OWCP.
(v) Qualified physician means any physician who has not been
excluded under the provisions of subpart I of this part. Except as
otherwise provided by regulation, a qualified physician shall be deemed
to be designated or approved by OWCP.
(w) Qualified provider of medical support services or supplies means
any person, other than a physician or a hospital, who provides services,
drugs, supplies and appliances for which OWCP makes payment, who
possesses any applicable licenses required under State law, and who has
not been excluded under the provisions of subpart I of this part.
(x) Recurrence of disability means an inability to work after an
employee has returned to work, caused by a spontaneous change in a
medical condition
which had resulted from a previous injury or illness without an
intervening injury or new exposure to the work environment that caused
the illness. This term also means an inability to work that takes place
when a light-duty assignment made specifically to accommodate an
employee's physical limitations due to his or her work-related injury or
illness is withdrawn (except when such withdrawal occurs for reasons of
misconduct, non-performance of job duties or a reduction-in-force), or
when the physical requirements of such an assignment are altered so that
they exceed his or her established physical limitations.
(y) Recurrence of medical condition means a documented need for
further medical treatment after release from treatment for the accepted
condition or injury when there is no accompanying work stoppage.
Continuous treatment for the original condition or injury is not
considered a ``need for further medical treatment after release from
treatment,'' nor is an examination without treatment.
(z) Representative means an individual properly authorized by a
claimant in writing to act for the claimant in connection with a claim
or proceeding under the FECA or this part.
(aa) Student means an individual defined at 5 U.S.C. 8101(17). Two
terms used in that particular definition are further defined as follows:
(1) Additional type of educational or training institution means a
technical, trade, vocational, business or professional school accredited
or licensed by the United States Government or a State Government or any
political subdivision thereof providing courses of not less than three
months duration, that prepares the individual for a livelihood in a
trade, industry, vocation or profession.
(2) Year beyond the high school level means:
(i) The 12-month period beginning the month after the individual
graduates from high school, provided he or she had indicated an
intention to continue schooling within four months of high school
graduation, and each successive 12-month period in which there is school
attendance or the payment of compensation based on such attendance; or
(ii) If the individual has indicated that he or she will not
continue schooling within four months of high school graduation, the 12-
month period beginning with the month that the individual enters school
to continue his or her education, and each successive 12-month period in
which there is school attendance or the payment of compensation based on
such attendance.
(bb) Subluxation means an incomplete dislocation, off-centering,
misalignment, fixation or abnormal spacing of the vertebrae which must
be demonstrable on any x-ray film to an individual trained in the
reading of x-rays.
(cc) Surviving spouse means the husband or wife living with or
dependent for support upon a deceased employee at the time of his or her
death, or living apart for reasonable cause or because of the deceased
employee's desertion.
(dd) Temporary aggravation of a pre-existing condition means that
factors of employment have directly caused that condition to be more
severe for a limited period of time and have left no greater impairment
than existed prior to the employment injury.
(ee) Traumatic injury means a condition of the body caused by a
specific event or incident, or series of events or incidents, within a
single workday or shift. Such condition must be caused by external
force, including stress or strain, which is identifiable as to time and
place of occurrence and member or function of the body affected.
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