(a) Upon his or her own initiative, or upon the request of any
party on grounds of a change in conditions or because of a mistake in a
determination of fact, the district director may, at any time before
one year from the date of the last payment of benefits, or at any time
before one year after the denial of a claim, reconsider the terms of an
award or denial of benefits.
(b) Modification proceedings shall be conducted in accordance with
the provisions of this part as appropriate, except that the claimant
and the operator, or group of operators or the fund, as appropriate,
shall each be entitled to submit no more than one additional chest X-
ray interpretation, one additional pulmonary function test, one
additional arterial blood gas study, and one additional medical report
in support of its affirmative case along with such rebuttal evidence
and additional statements as are authorized by paragraphs (a)(2)(ii)
and (a)(3)(ii) of Sec. 725.414. Modification proceedings shall not be
initiated before an administrative law judge or the Benefits Review
Board.
(c) At the conclusion of modification proceedings before the
district director, the district director may issue a proposed decision
and order (Sec. 725.418) or, if appropriate, deny the claim by reason
of abandonment (Sec. 725.409). In any case in which the district
director has initiated modification proceedings on his own initiative
to alter the terms of an award or denial of benefits issued by an
administrative law judge, the district director shall, at the
conclusion of modification proceedings, forward the claim for a hearing
(Sec. 725.421). In any case forwarded for a hearing, the administrative
law judge assigned to hear such case shall consider whether any
additional evidence submitted by the parties demonstrates a change in
condition and, regardless of whether the parties have submitted new
evidence, whether the evidence of record demonstrates a mistake in a
determination of fact.
(d) An order issued following the conclusion of modification
proceedings may terminate, continue, reinstate, increase or decrease
benefit payments or award benefits. Such order shall not affect any
benefits previously paid, except that an order increasing the amount of
benefits payable based on a finding of a mistake in a determination of
fact may be made effective on the date from which benefits were
determined payable by the terms of an earlier award. In the case of an
award which is decreased, no payment made in excess of the decreased
rate prior to the date upon which the party requested reconsideration
under paragraph (a) of this section shall be subject to collection or
offset under subpart H of this part, provided the claimant is without
fault as defined by Sec. 725.543. In the case of an award which is
decreased following the initiation of modification by the district
director, no payment made in excess of the decreased rate prior to the
date upon which the district director initiated modification
proceedings under paragraph (a) shall be subject to collection or
offset under subpart H of this part, provided the claimant is without
fault as defined by Sec. 725.543. In the case of an award which has
become final and is thereafter terminated, no payment made prior to the
date upon which the party requested reconsideration under paragraph (a)
shall be subject to collection or offset under subpart H of this part.
In the case of an award which has become final and is thereafter
terminated following the initiation of modification by the district
director, no payment made prior to the date upon which the district
director initiated modification proceedings
under paragraph (a) shall be subject to collection or offset under
subpart H of this part.
