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CHAPTER 6-200 - USES

1. Purpose and Scope. This Chapter describes the uses of the Special Fund, procedures for authorizing use of the Fund and provides references to other Procedure Manual Chapters which contain specific procedures pertaining to use of the Fund.

2. Uses of the Special Fund. The Fund is used for payment of individual amounts as specified under various sections of the Act. The sections providing for benefits or other payments from the Special Fund are:

a. Medical Examination under Section 7(e). The cost of medical examinations ordered by the DD may be charged to the EC or, in certain specific instances, to the Special Fund. (See PM 5-200.11.)

b. Payment under Section 8(f). The liability for payment by an EC may be limited if certain requirements have been met. (See PM 6-201.)

c. Payment under Section 10(h). Adjustments for pre-1972 PTD and death cases to bring benefits to post-1972 levels are paid from the Special Fund. (See PM 3-203.)

d. Payments under Section 18(b). This section of the Act provides for payments where the insolvency of the EC or other circumstances would otherwise preclude payment of benefits. (See PM 6-202.)

e. Maintenance Payments under Section 8(g). This section of the Act provides for payment of those extra expenses that a disabled claimant incurs as a result of participation in an approved vocational rehabilitation program. These payments may not exceed $25 per week and are authorized by a rehabilitation specialist. Questions regarding such payments should be directed to the DO Rehabilitation Specialist. (See Chapter 3-500 of the OWCP Rehabilitation Procedure Manual.)

f. Rehabilitation Services under Section 39(c). The Special Fund may be utilized to provide rehabilitation services for permanently disabled workers where such services are not otherwise available. Present practice is to pay for most such services, other than for medical rehabilitation, from the Special Fund. The development and implementation of rehabilitation plans are the responsibility of the Rehabilitation Specialist. (See PM 3-301.3g and OWCP Rehabilitation Procedure Manual Chapters 3-200 and 3-300.)

g. Prosthetic Appliances under Section 39(c)(2).

(1) Purchase or repair of prosthetic devices under section 39(c)(2) at the expense of the Special Fund may be provided in the following situations: if the file shows that OWCP (or its predecessor) had previously purchased or repaired the prosthesis under authority of this subsection (see LHWCA MEMO No. 9, March 4. 1965, a copy of which may be obtained from the National Office, if needed); and if, because of unusual circumstances such as the EC being out of business or bankrupt, the service cannot be provided otherwise. In a case coming under section 8(f) requiring a prosthetic appliance, if the EC obtains the initial device, replacements may be authorized by the DD at the expense of the Special Fund, after obtaining approval of the NO.

(2) The following procedures for authorizing the purchase or repair of prosthetic appliances must be used:

(a) Obtain a written statement from the injured employee requesting repair or replacement of the prosthesis.

(b) On receipt of the request, refer the claimant for examination, if indicated, to an appropriate physician for advice as to the need for replacement or repair of the prosthesis. An estimate of the cost should be obtained and submitted for the DD's approval.

(c) The DD will notify the parties to proceed with the repair or replacement of the prosthesis.

(d) After completion of the authorized services, the employee should furnish a statement of satisfaction. The vendor should submit a bill on its regular billing form or government voucher.

(e) The DD refers copies of the request, authorization, certification of satisfaction, and bill for payment to the Director, DLHWC.