Title 20

PART 725

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 Authority:5 U.S.C. 301; 28 U.S.C. 2461 note (Federal Civil Penalties Inflation Adjustment Act of 1990); Pub. L. 114-74 at sec. 701; Reorganization Plan No. 6 of 1950, 15 FR 3174; 30 U.S.C. 901 et seq., 902(f), 921, 932, 936; 33 U.S.C. 901 et seq.; 42 U.S.C. 405; Secretary's Order 10-2009, 74 FR 58834. Source:65 FR 80054, Dec. 20, 2000, unless otherwise noted.

20:4.0.2.2.8.1SUBPART A
Subpart A - General
20:4.0.2.2.8.1.83.1SECTION 725.1
   725.1 Statutory provisions.
20:4.0.2.2.8.1.83.2SECTION 725.2
   725.2 Purpose and applicability of this part.
20:4.0.2.2.8.1.83.3SECTION 725.3
   725.3 Contents of this part.
20:4.0.2.2.8.1.83.4SECTION 725.4
   725.4 Applicability of other parts in this title.
20:4.0.2.2.8.1.83.5SECTION 725.101
   725.101 Definition and use of terms.
20:4.0.2.2.8.1.83.6SECTION 725.102
   725.102 Disclosure of program information.
20:4.0.2.2.8.1.83.7SECTION 725.103
   725.103 Burden of proof.
20:4.0.2.2.8.2SUBPART B
Subpart B - Persons Entitled to Benefits, Conditions, and Duration of Entitlement
20:4.0.2.2.8.2.83SUBJGRP 83
   Conditions and Duration of Entitlement: Miner
20:4.0.2.2.8.2.83.1SECTION 725.201
   725.201 Who is entitled to benefits; contents of this subpart.
20:4.0.2.2.8.2.83.2SECTION 725.202
   725.202 Miner defined; condition of entitlement, miner.
20:4.0.2.2.8.2.83.3SECTION 725.203
   725.203 Duration and cessation of entitlement; miner.
20:4.0.2.2.8.2.84SUBJGRP 84
   Conditions and Duration of Entitlement: Miner's Dependents (Augmented Benefits)
20:4.0.2.2.8.2.84.4SECTION 725.204
   725.204 Determination of relationship; spouse.
20:4.0.2.2.8.2.84.5SECTION 725.205
   725.205 Determination of dependency; spouse.
20:4.0.2.2.8.2.84.6SECTION 725.206
   725.206 Determination of relationship; divorced spouse.
20:4.0.2.2.8.2.84.7SECTION 725.207
   725.207 Determination of dependency; divorced spouse.
20:4.0.2.2.8.2.84.8SECTION 725.208
   725.208 Determination of relationship; child.
20:4.0.2.2.8.2.84.9SECTION 725.209
   725.209 Determination of dependency; child.
20:4.0.2.2.8.2.84.10SECTION 725.210
   725.210 Duration of augmented benefits.
20:4.0.2.2.8.2.84.11SECTION 725.211
   725.211 Time of determination of relationship and dependency of spouse or child for purposes of augmentation of benefits.
20:4.0.2.2.8.2.84.12SECTION 725.212
   725.212 Conditions of entitlement; surviving spouse or surviving divorced spouse.
20:4.0.2.2.8.2.84.13SECTION 725.213
   725.213 Duration of entitlement; surviving spouse or surviving divorced spouse.
20:4.0.2.2.8.2.84.14SECTION 725.214
   725.214 Determination of relationship; surviving spouse.
20:4.0.2.2.8.2.84.15SECTION 725.215
   725.215 Determination of dependency; surviving spouse.
20:4.0.2.2.8.2.84.16SECTION 725.216
   725.216 Determination of relationship; surviving divorced spouse.
20:4.0.2.2.8.2.84.17SECTION 725.217
   725.217 Determination of dependency; surviving divorced spouse.
20:4.0.2.2.8.2.84.18SECTION 725.218
   725.218 Conditions of entitlement; child.
20:4.0.2.2.8.2.84.19SECTION 725.219
   725.219 Duration of entitlement; child.
20:4.0.2.2.8.2.84.20SECTION 725.220
   725.220 Determination of relationship; child.
20:4.0.2.2.8.2.84.21SECTION 725.221
   725.221 Determination of dependency; child.
20:4.0.2.2.8.2.84.22SECTION 725.222
   725.222 Conditions of entitlement; parent, brother, or sister.
20:4.0.2.2.8.2.84.23SECTION 725.223
   725.223 Duration of entitlement; parent, brother, or sister.
20:4.0.2.2.8.2.84.24SECTION 725.224
   725.224 Determination of relationship; parent, brother, or sister.
20:4.0.2.2.8.2.84.25SECTION 725.225
   725.225 Determination of dependency; parent, brother, or sister.
20:4.0.2.2.8.2.84.26SECTION 725.226
   725.226 “Good cause” for delayed filing of proof of support.
20:4.0.2.2.8.2.84.27SECTION 725.227
   725.227 Time of determination of relationship and dependency of survivors.
20:4.0.2.2.8.2.84.28SECTION 725.228
   725.228 Effect of conviction of felonious and intentional homicide on entitlement to benefits.
20:4.0.2.2.8.2.84.29SECTION 725.229
   725.229 Intestate personal property.
20:4.0.2.2.8.2.84.30SECTION 725.230
   725.230 Legal impediment.
20:4.0.2.2.8.2.84.31SECTION 725.231
   725.231 Domicile.
20:4.0.2.2.8.2.84.32SECTION 725.232
   725.232 Member of the same household - “living with,” “living in the same household,” and “living in the miner's household,” defined.
20:4.0.2.2.8.2.84.33SECTION 725.233
   725.233 Support and contributions.
20:4.0.2.2.8.3SUBPART C
Subpart C - Filing of Claims
20:4.0.2.2.8.3.85.1SECTION 725.301
   725.301 Who may file a claim.
20:4.0.2.2.8.3.85.2SECTION 725.302
   725.302 Evidence of authority to file a claim on behalf of another.
20:4.0.2.2.8.3.85.3SECTION 725.303
   725.303 Date and place of filing of claims.
20:4.0.2.2.8.3.85.4SECTION 725.304
   725.304 Forms and initial processing.
20:4.0.2.2.8.3.85.5SECTION 725.305
   725.305 When a written statement is considered a claim.
20:4.0.2.2.8.3.85.6SECTION 725.306
   725.306 Withdrawal of a claim.
20:4.0.2.2.8.3.85.7SECTION 725.307
   725.307 Cancellation of a request for withdrawal.
20:4.0.2.2.8.3.85.8SECTION 725.308
   725.308 Time limits for filing claims.
20:4.0.2.2.8.3.85.9SECTION 725.309
   725.309 Additional claims; effect of prior denial of benefits.
20:4.0.2.2.8.3.85.10SECTION 725.310
   725.310 Modification of awards and denials.
20:4.0.2.2.8.3.85.11SECTION 725.311
   725.311 Communications with respect to claims; time computations.
20:4.0.2.2.8.4SUBPART D
Subpart D - Adjudication Officers; Parties and Representatives
20:4.0.2.2.8.4.85.1SECTION 725.350
   725.350 Who are the adjudication officers
20:4.0.2.2.8.4.85.2SECTION 725.351
   725.351 Powers of adjudication officers.
20:4.0.2.2.8.4.85.3SECTION 725.352
   725.352 Disqualification of adjudication officer.
20:4.0.2.2.8.4.85.4SECTION 725.360
   725.360 Parties to proceedings.
20:4.0.2.2.8.4.85.5SECTION 725.361
   725.361 Party amicus curiae.
20:4.0.2.2.8.4.85.6SECTION 725.362
   725.362 Representation of parties.
20:4.0.2.2.8.4.85.7SECTION 725.363
   725.363 Qualification of representative.
20:4.0.2.2.8.4.85.8SECTION 725.364
   725.364 Authority of representative.
20:4.0.2.2.8.4.85.9SECTION 725.365
   725.365 Approval of representative's fees; lien against benefits.
20:4.0.2.2.8.4.85.10SECTION 725.366
   725.366 Fees for representatives.
20:4.0.2.2.8.4.85.11SECTION 725.367
   725.367 Payment of a claimant's attorney's fee by responsible operator or fund.
20:4.0.2.2.8.5SUBPART E
Subpart E - Adjudication of Claims by the District Director
20:4.0.2.2.8.5.85.1SECTION 725.401
   725.401 Claims development - general.
20:4.0.2.2.8.5.85.2SECTION 725.402
   725.402 Approved State workers' compensation law.
20:4.0.2.2.8.5.85.3SECTION 725.403
   725.403 [Reserved]
20:4.0.2.2.8.5.85.4SECTION 725.404
   725.404 Development of evidence - general.
20:4.0.2.2.8.5.85.5SECTION 725.405
   725.405 Development of medical evidence; scheduling of medical examinations and tests.
20:4.0.2.2.8.5.85.6SECTION 725.406
   725.406 Medical examinations and tests.
20:4.0.2.2.8.5.85.7SECTION 725.407
   725.407 Identification and notification of responsible operator.
20:4.0.2.2.8.5.85.8SECTION 725.408
   725.408 Operator's response to notification.
20:4.0.2.2.8.5.85.9SECTION 725.409
   725.409 Denial of a claim by reason of abandonment.
20:4.0.2.2.8.5.85.10SECTION 725.410
   725.410 Submission of additional evidence.
20:4.0.2.2.8.5.85.11SECTION 725.411
   725.411 Initial adjudication in Trust Fund cases.
20:4.0.2.2.8.5.85.12SECTION 725.412
   725.412 Operator's response.
20:4.0.2.2.8.5.85.13SECTION 725.413
   725.413 Disclosure of medical information.
20:4.0.2.2.8.5.85.14SECTION 725.414
   725.414 Development of evidence.
20:4.0.2.2.8.5.85.15SECTION 725.415
   725.415 Action by the district director after development of evidence.
20:4.0.2.2.8.5.85.16SECTION 725.416
   725.416 Conferences.
20:4.0.2.2.8.5.85.17SECTION 725.417
   725.417 Action at the conclusion of conference.
20:4.0.2.2.8.5.85.18SECTION 725.418
   725.418 Proposed decision and order.
20:4.0.2.2.8.5.85.19SECTION 725.419
   725.419 Response to proposed decision and order.
20:4.0.2.2.8.5.85.20SECTION 725.420
   725.420 Initial determinations.
20:4.0.2.2.8.5.85.21SECTION 725.421
   725.421 Referral of a claim to the Office of Administrative Law Judges.
20:4.0.2.2.8.5.85.22SECTION 725.422
   725.422 Legal assistance.
20:4.0.2.2.8.5.85.23SECTION 725.423
   725.423 Extensions of time.
20:4.0.2.2.8.6SUBPART F
Subpart F - Hearings
20:4.0.2.2.8.6.85.1SECTION 725.450
   725.450 Right to a hearing.
20:4.0.2.2.8.6.85.2SECTION 725.451
   725.451 Request for hearing.
20:4.0.2.2.8.6.85.3SECTION 725.452
   725.452 Type of hearing; parties.
20:4.0.2.2.8.6.85.4SECTION 725.453
   725.453 Notice of hearing.
20:4.0.2.2.8.6.85.5SECTION 725.454
   725.454 Time and place of hearing; transfer of cases.
20:4.0.2.2.8.6.85.6SECTION 725.455
   725.455 Hearing procedures; generally.
20:4.0.2.2.8.6.85.7SECTION 725.456
   725.456 Introduction of documentary evidence.
20:4.0.2.2.8.6.85.8SECTION 725.457
   725.457 Witnesses.
20:4.0.2.2.8.6.85.9SECTION 725.458
   725.458 Depositions; interrogatories.
20:4.0.2.2.8.6.85.10SECTION 725.459
   725.459 Witness fees.
20:4.0.2.2.8.6.85.11SECTION 725.460
   725.460 Consolidated hearings.
20:4.0.2.2.8.6.85.12SECTION 725.461
   725.461 Waiver of right to appear and present evidence.
20:4.0.2.2.8.6.85.13SECTION 725.462
   725.462 Withdrawal of controversion of issues set for formal hearing; effect.
20:4.0.2.2.8.6.85.14SECTION 725.463
   725.463 Issues to be resolved at hearing; new issues.
20:4.0.2.2.8.6.85.15SECTION 725.464
   725.464 Record of hearing.
20:4.0.2.2.8.6.85.16SECTION 725.465
   725.465 Dismissals for cause.
20:4.0.2.2.8.6.85.17SECTION 725.466
   725.466 Order of dismissal.
20:4.0.2.2.8.6.85.18SECTION 725.475
   725.475 Termination of hearings.
20:4.0.2.2.8.6.85.19SECTION 725.476
   725.476 Issuance of decision and order.
20:4.0.2.2.8.6.85.20SECTION 725.477
   725.477 Form and contents of decision and order.
20:4.0.2.2.8.6.85.21SECTION 725.478
   725.478 Filing and service of decision and order.
20:4.0.2.2.8.6.85.22SECTION 725.479
   725.479 Finality of decisions and orders.
20:4.0.2.2.8.6.85.23SECTION 725.480
   725.480 Modification of decisions and orders.
20:4.0.2.2.8.6.85.24SECTION 725.481
   725.481 Right to appeal to the Benefits Review Board.
20:4.0.2.2.8.6.85.25SECTION 725.482
   725.482 Judicial review.
20:4.0.2.2.8.6.85.26SECTION 725.483
   725.483 Costs in proceedings brought without reasonable grounds.
20:4.0.2.2.8.7SUBPART G
Subpart G - Responsible Coal Mine Operators
20:4.0.2.2.8.7.85.1SECTION 725.490
   725.490 Statutory provisions and scope.
20:4.0.2.2.8.7.85.2SECTION 725.491
   725.491 Operator defined.
20:4.0.2.2.8.7.85.3SECTION 725.492
   725.492 Successor operator defined.
20:4.0.2.2.8.7.85.4SECTION 725.493
   725.493 Employment relationship defined.
20:4.0.2.2.8.7.85.5SECTION 725.494
   725.494 Potentially liable operators.
20:4.0.2.2.8.7.85.6SECTION 725.495
   725.495 Criteria for determining a responsible operator.
20:4.0.2.2.8.7.85.7SECTION 725.496
   725.496 Special claims transferred to the fund.
20:4.0.2.2.8.7.85.8SECTION 725.497
   725.497 Procedures in special claims transferred to the fund.
20:4.0.2.2.8.8SUBPART H
Subpart H - Payment of Benefits
20:4.0.2.2.8.8.85SUBJGRP 85
   General Provisions
20:4.0.2.2.8.8.85.1SECTION 725.501
   725.501 Payment provisions generally.
20:4.0.2.2.8.8.85.2SECTION 725.502
   725.502 When benefit payments are due; manner of payment.
20:4.0.2.2.8.8.85.3SECTION 725.503
   725.503 Date from which benefits are payable.
20:4.0.2.2.8.8.85.4SECTION 725.504
   725.504 Payments to a claimant employed as a miner.
20:4.0.2.2.8.8.85.5SECTION 725.505
   725.505 Payees.
20:4.0.2.2.8.8.85.6SECTION 725.506
   725.506 Payment on behalf of another; “legal guardian” defined.
20:4.0.2.2.8.8.85.7SECTION 725.507
   725.507 Guardian for minor or incompetent.
20:4.0.2.2.8.8.85.8SECTION 725.510
   725.510 Representative payee.
20:4.0.2.2.8.8.85.9SECTION 725.511
   725.511 Use and benefit defined.
20:4.0.2.2.8.8.85.10SECTION 725.512
   725.512 Support of legally dependent spouse, child, or parent.
20:4.0.2.2.8.8.85.11SECTION 725.513
   725.513 Accountability; transfer.
20:4.0.2.2.8.8.85.12SECTION 725.514
   725.514 Certification to dependent of augmentation portion of benefit.
20:4.0.2.2.8.8.85.13SECTION 725.515
   725.515 Assignment and exemption from claims of creditors.
20:4.0.2.2.8.8.86SUBJGRP 86
   Benefit Rates
20:4.0.2.2.8.8.86.14SECTION 725.520
   725.520 Computation of benefits.
20:4.0.2.2.8.8.86.15SECTION 725.521
   725.521 Commutation of payments; lump sum awards.
20:4.0.2.2.8.8.86.16SECTION 725.522
   725.522 Payments prior to final adjudication.
20:4.0.2.2.8.8.87SUBJGRP 87
   Special Provisions for Operator Payments
20:4.0.2.2.8.8.87.17SECTION 725.530
   725.530 Operator payments; generally.
20:4.0.2.2.8.8.87.18SECTION 725.531
   725.531 Receipt for payment.
20:4.0.2.2.8.8.87.19SECTION 725.532
   725.532 Suspension, reduction, or termination of payments.
20:4.0.2.2.8.8.88SUBJGRP 88
   Increases and Reductions of Benefits
20:4.0.2.2.8.8.88.20SECTION 725.533
   725.533 Modification of benefits amounts; general.
20:4.0.2.2.8.8.88.21SECTION 725.534
   725.534 Reduction of State benefits.
20:4.0.2.2.8.8.88.22SECTION 725.535
   725.535 Reductions; receipt of State or Federal benefit.
20:4.0.2.2.8.8.88.23SECTION 725.536
   725.536 Reductions; excess earnings.
20:4.0.2.2.8.8.88.24SECTION 725.537
   725.537 Reductions; retroactive effect of an additional claim for benefits.
20:4.0.2.2.8.8.88.25SECTION 725.538
   725.538 Reductions; effect of augmentation of benefits based on subsequent qualification of individual.
20:4.0.2.2.8.8.88.26SECTION 725.539
   725.539 More than one reduction event.
20:4.0.2.2.8.8.89SUBJGRP 89
   Overpayments; Underpayments
20:4.0.2.2.8.8.89.27SECTION 725.540
   725.540 Overpayments.
20:4.0.2.2.8.8.89.28SECTION 725.541
   725.541 Notice of waiver of adjustment or recovery of overpayment.
20:4.0.2.2.8.8.89.29SECTION 725.542
   725.542 When waiver of adjustment or recovery may be applied.
20:4.0.2.2.8.8.89.30SECTION 725.543
   725.543 Standards for waiver of adjustment or recovery.
20:4.0.2.2.8.8.89.31SECTION 725.544
   725.544 Collection and compromise of claims for overpayment.
20:4.0.2.2.8.8.89.32SECTION 725.545
   725.545 Underpayments.
20:4.0.2.2.8.8.89.33SECTION 725.546
   725.546 Relation to provisions for reductions or increases.
20:4.0.2.2.8.8.89.34SECTION 725.547
   725.547 Applicability of overpayment and underpayment provisions to operator or carrier.
20:4.0.2.2.8.8.89.35SECTION 725.548
   725.548 Procedures applicable to overpayments and underpayments.
20:4.0.2.2.8.9SUBPART I
Subpart I - Enforcement of Liability; Reports
20:4.0.2.2.8.9.90.1SECTION 725.601
   725.601 Enforcement generally.
20:4.0.2.2.8.9.90.2SECTION 725.602
   725.602 Reimbursement of the fund.
20:4.0.2.2.8.9.90.3SECTION 725.603
   725.603 Payments by the fund on behalf of an operator; liens.
20:4.0.2.2.8.9.90.4SECTION 725.604
   725.604 Enforcement of final awards.
20:4.0.2.2.8.9.90.5SECTION 725.605
   725.605 Defaults.
20:4.0.2.2.8.9.90.6SECTION 725.606
   725.606 Security for the payment of benefits.
20:4.0.2.2.8.9.90.7SECTION 725.607
   725.607 Payments of additional compensation.
20:4.0.2.2.8.9.90.8SECTION 725.608
   725.608 Interest.
20:4.0.2.2.8.9.90.9SECTION 725.609
   725.609 Enforcement against other persons.
20:4.0.2.2.8.9.90.10SECTION 725.620
   725.620 Failure to secure benefits; other penalties.
20:4.0.2.2.8.9.90.11SECTION 725.621
   725.621 Reports.
20:4.0.2.2.8.10SUBPART J
Subpart J - Medical Benefits and Vocational Rehabilitation
20:4.0.2.2.8.10.90.1SECTION 725.701
   725.701 What medical benefits are available
20:4.0.2.2.8.10.90.2SECTION 725.702
   725.702 Who is considered a physician
20:4.0.2.2.8.10.90.3SECTION 725.703
   725.703 How is treatment authorized
20:4.0.2.2.8.10.90.4SECTION 725.704
   725.704 How are arrangements for medical care made
20:4.0.2.2.8.10.90.5SECTION 725.705
   725.705 Is prior authorization for medical services required
20:4.0.2.2.8.10.90.6SECTION 725.706
   725.706 What reports must a medical provider give to OWCP
20:4.0.2.2.8.10.90.7SECTION 725.707
   725.707 At what rate will fees for medical services and treatments be paid
20:4.0.2.2.8.10.90.8SECTION 725.708
   725.708 How are payments for professional medical services and medical equipment determined
20:4.0.2.2.8.10.90.9SECTION 725.709
   725.709 How are payments for prescription drugs determined
20:4.0.2.2.8.10.90.10SECTION 725.710
   725.710 How are payments for outpatient medical services determined
20:4.0.2.2.8.10.90.11SECTION 725.711
   725.711 How are payments for inpatient medical services determined
20:4.0.2.2.8.10.90.12SECTION 725.712
   725.712 When and how are fees reduced
20:4.0.2.2.8.10.90.13SECTION 725.713
   725.713 If a fee is reduced, may a provider bill the claimant for the balance
20:4.0.2.2.8.10.90.14SECTION 725.714
   725.714 How do providers enroll with OWCP for authorizations and billing
20:4.0.2.2.8.10.90.15SECTION 725.715
   725.715 How do providers submit medical bills
20:4.0.2.2.8.10.90.16SECTION 725.716
   725.716 How should a miner prepare and submit requests for reimbursement for covered medical expenses and transportation costs
20:4.0.2.2.8.10.90.17SECTION 725.717
   725.717 What are the time limitations for requesting payment or reimbursement for covered medical services or treatments
20:4.0.2.2.8.10.90.18SECTION 725.718
   725.718 How are disputes concerning medical benefits resolved
20:4.0.2.2.8.10.90.19SECTION 725.719
   725.719 What is the objective of vocational rehabilitation
20:4.0.2.2.8.10.90.20SECTION 725.720
   725.720 How does a miner request vocational rehabilitation assistance