pensation Act, United States Employees' Compensation Commission, effective June 1, 1938. 1.2 Notice of injury by employee. (a) Whenever any injury is sustained by an employee of the United States while in the performance of his duty, he shall immediately give written notice to his official superior. If the injured employee is unable to give such notice, it may be given by someone in his behalf. Form C. A. 1, Notice of Injury, is provided by the Commission for such purpose. Unless written notice of injury is given within 48 hours or unless the immediate superior has actual knowledge of the injury, compensation may be refused. For reasonable cause the Commission may accept written notice of injury given later than 48 hours, but not later than 1 year after the injury. (b) Whenever such an injury comes to the knowledge of the injured employee's official superior, a record of the cause, nature, and extent of the injury shall be made by the official superior, who should call to the attention of the employee the necessity of submitting, within 48 hours, or as soon after injury as practicable, a notice of the injury on Form C. A. 1. The official superior shall secure the signed statements of witnesses to the occurrence, and shall retain the employee's notice of injury until the injury is reported to the Commission as required by Š 1.3.** 1.3 Reports by official superiors of injuries to employees. Every injury which is likely to result in any medical charge against the compensation fund or in any disability for work beyond the day, shift, or turn of the occurrence, or which appears likely to require prolonged treatment or to result in future disability, shall be reported by the official superior on Form C. A. 2, Report of Injury, provided by the Commission for this purpose, which shall be transmitted to the Commission without delay. The employee's original Notice of Injury, on Form C. A. 1, or otherwise, should accompany the Report of Injury together with report of any investigation made and such statements or other data as may properly relate to the circumstances surrounding the injury. If the disability is likely not to exceed three days, the report may be withheld until the employee has returned to work. + 1.4 Claim for compensation for disability. Compensation for disability under said Act will not be paid unless written claim therefor is made by the employee or by someone in his behalf within the time limit prescribed by the said Act. If such claim is not submitted within 60 days after the injury, an explanation of the delay must accompany the claim. Form C. A. 4 is provided by the Commission for making the original claim. Such claim may be filed by delivering it at the offices of the Commission, or to any Commissioner or to any person designated by the Commission to receive it. The employee's Official superior is so designated to receive claims on behalf of the Commission, and the injured employee should submit his claim to his official superior for transmission to the Commission unless special circumstances require different procedure. Any claim or paper pur- , porting to claim compensation submitted by an employee to his official superior shall be transmitted promptly to the Commission. Whenever an employee, as a result of an injury in the performance of duty, is disabled with loss of pay for more than 3 days, his official superior when practicable should furnish to him Form C. A. 4 for the purpose of claiming compensation, and should advise him of his rights under the said Act. Form C. A. 4 should be filed with the Commission upon termination of disability if the duration of disability should be less than 18 days, or at the expiration of 18 days from the date pay stops, if disability continues beyond that date. If no claim is filed by an injured employee or by someone on his behalf prior to his death, the right to claim compensation for disability ceases and does not survive.** (Sec. 18, 39 Stat. 746; 5 U.S.C. 768) **For statutory and source citations, see note to 8 1.1. Page 3 **For statutory and source citations, see note to s 1.1, 5 1.5 Waiver not authorized. No official superior is authorized to require an employee to enter into any agreement, either before or after an injury, to waive his right to claim compensation.** 1.6 Report of termination of disability or return to work. Whenever an injured employee is able to return to work after a period of disability caused by an injury, his official superior shall immediately report that fact to the Commission on Form C. A. 3, which is provided by the Commission for this purpose, unless such report has been made on Form C. A. 2, or otherwise. Such report shall show the period of absence from work and shall show specifically the part of such period for which the employee has been or will be paid on account of leave or for any other reason, stating the basis of such wage payment.** 1.7 Recurrence of disability for work. When an injured employee, after returning to work, is again disabled and stops work as a result of the same injury, the official superior shall report the recurrence of disability promptly to the Commission, showing clearly when the employee again stopped work and for what part of the new absence he has been or will be paid on account of leave or for any other reason. If the recurrent disability has ended when the report is made, the date and hour of return to duty should be stated; if not, an additional report should be made when the employee returns to work or his disability ceases. If the employee has been examined or attended by a physician in connection with such recurrence of disability, a medical report, as required by $ 2.10 should accompany the official superior's report of the recurrence, unless the physician has made his report to the Commission.* * 1.8 Claims for continued compensation for disability. An employee whose injury results in disability with loss of pay continuing beyond the time covered by the original claim on Form C. A. 4, may claim compensation for further periods of disability on Form C. A. 8, which is provided by the Commission for that purpose. Compensation will not be paid unless such claim for further compensation, properly executed, is received by the Commission. The certification of the attending physician as to the further disability should be obtained on the form and it should be submitted to the employee's official superior, who shall complete his portion of the certification thereon and forward the claim promptly to the Commission. Claims on Form C. A. 8 should be submitted semi-monthly if disability is continuous. An employee whose disability is such that medical evi Page 4 dence of continuation thereof is not immediately necessary may be provided by the Commission with Form C. A. 69 or Form C. A. 95 for use in submitting claim for continued compensation in lieu of Form C. A. 8.** 1.9 Employee's obligation to return to work or to seek work when able. When total disability to perform work ceases and the employee is able to perform a part of his usual duties, or to perform work of a different nature, he must seek such suitable work as he is able to perform, either in Government or private employment, unless it has already been provided for him, and shall accept such work or offer of work secured for him. If a partially disabled employee refuses to seek suitable work or refuses or neglects to work after suitable work is offered to, procured by, or secured for him, he shall not be entitled to any compensation.** 1.10 Report by employee of employment and earnings. An employee claiming compensation on account of disability shall show in his claim any and all amounts which he has earned during the period covered by the claim, stating separately for each calendar month or part of a calendar month the amounts thereof, with the names and addresses of his employers, the nature of the work performed, and the rate or rates of pay. He shall include in his statement of earnings, as separate items, the value of housing, board, lodging, and other advantages he may have received as a part of his remuneration. Whenever required by the Commission, he shall make affidavit of his earnings and employment.** 1.11 Report of efforts to obtain employment. An employee who has not been regularly employed during the period covered by his claim, and who is only partially disabled, shall state in his claim what efforts he has made to obtain suitable employment, giving the names and addresses of persons or concerns to whom he has applied for work. If he has not been offered or has not been able to secure work which he is able to do, he shall so state. The Commission may require the employee to make affidavit with respect to his statements. If the employee, when required, fails to make such affidavit, he shall not be entitled to any compensation while such failure continues, and period of such failure shall be deducted from the period during which compensation is payable to him.** 1.12 Report of death. If an injury to an employee results in death, the official superior shall immediately report that fact to the Commission by telegraph. If a report of injury has not previously been submitted on Form C. A. 2, such form, together with a copy of the death certificate and a report of death on Form C. A. 3, provided by the Commission for such purpose, shall be forwarded to the Commission. If the death does not immediately follow the injury, the report on Form C. A. 3 should also show, on the upper half, the exact period of absence from work prior to the date and hour of death, and the part of such period, if any, during which the employee's wages have accrued, or for which they will be payable to his estate, on account of leave or for any other reason.** 1.13 Original claims for death benefits. If the death of an employee results from an injury within 6 years, any person entitled **For statutory and source citations, see note to § 1.1. Page 5 to claim compensation as one of the beneficiaries enumerated in section 10 of the said Act (39 Stat. 744; 5 U.S.C. 760) may file a claim for compensation, within the limit of time of 1 year after death prescribed in the said Act. Form C. A. 5 is provided by the Commission for that purpose, and should be executed as provided therein. Under said Act no compensation is payable if the death takes place more than 1 year after the cessation of disability, resulting from such injury, or, if there has been no disability preceding death, more than 1 year after the injury. Such claim may be filed by delivering it at the office of the Commission, or to any Commissioner or to any person designated by the Commission to receive it. The deceased employee's former official superior is so designated to receive such claims on behalf of the Commission, and the person claiming benefits should submit the claim to such former Official superior, unless special circumstances require a different procedure. The official superior should when it is practicable furnish to all persons likely to be entitled to compensation for death of an employee Form C. A. 5 with information as to the use of the form for making claim for compensation and the procedure in respect of filing such form, advising the Commission of such fact. The furnishing of assistance in preparing such form or in obtaining evidence relating to the claim shall be without charge by the official superior. Any claim or paper purporting to claim compensation on account of death, submitted to the deceased employee's former official superior, shall be transmitted promptly to the Commission. No compensation shall be paid on account of death if it is not so claimed within one year after the death.** (Sec. 18, 39 Stat. 746; 5 U.S.C. 768) 1.14 Claims for continuance of compensation on account of death. A beneficiary to whom an award of compensation has been made on account of an employee's death, pursuant to his original claim, shall submit direct to the Commission additional claims for continuance of compensation to be filed on the first day of January, April, July and October of each year while the award continues. Failure to submit such forms may result in suspension of compensation. For this purpose Form C. A. 12 is provided by the Commission for the use of a widow or widower; Form C. A. 13 is provided for the use of a guardian or other person receiving compensation on behalf of minor or incapacitated beneficiaries; Form C. A. 13A is provided for the use of incapacitated beneficiaries, other than widows, widowers, parents or grandparents, who are not minors and have no guardians; and Form C. A. 14 is provided for the use of depend. ent parents or grandparents.*+ 1.15 Termination of the right to compensation for death. When a beneficiary who is receiving compensation on account of death ceases to be entitled to such compensation by reason of marrying, reaching the age of 18, ceasing to be dependent, or becoming capable of self-support, he or someone in his behalf shall immediately notify the Commission of the fact. If such a beneficiary receives a check which includes payment of compensation for any period after the date when he ceased to be entitled to it, for any of the above reasons, he shall promptly return it to the office from which it was received.*ť Page 6 **For statutory and source citations, see note to $ 1.1. **For statutory and source citations, see note to 8 1.1. 1.16 Change in status of beneficiaries affecting compensation for death. When two or more beneficiaries are receiving compensation on account of the death of an employee and any event occurs which may require a reapportionment of the amount of compensation payable to one or more of them, such beneficiaries, or someone on their behalf, shall promptly notify the Commission, giving the date of the event and all essential facts. Such reapportionment may become necessary when any such beneficiary dies or marries, when & child, grandchild, brother or sister of the decedent becomes 18 years old, or, if over 18, becomes capable of self support, or when a parent or grandparent of the decedent ceases to be dependent, or when a posthumous child of the decedent is born.*+ 1.17 Burial expenses. When the death of an employee results from an injury occurring within the time limitations prescribed in said Act, the Commission may in its discretion pay reasonable burial expenses in an amount not to exceed $200, provided that if any part of the burial expenses has been paid by another department of the Government, the amount paid by the Commission shall not exceed the difference between the amount so paid by the other department and $200. Payment will be made to the duly appointed executor or administrator of the estate on the submission of competent evidence of his appointment as such. If there is no legal representative of the estate, the Commission may upon application pay to the undertaker the amount of any burial expenses remaining unpaid, not exceeding the amount payable by the Commission, or may upon application reimburse the person who has paid such burial expenses and is entitled to such reimbursement.** 1.18 Embalming and transportation of bodies of deceased employees. In the case of an employee whose home is within the United States, if such death occurs away from his home office or outside the United States, and if the relatives desire that the body be embalmed and transported in a hermetically sealed casket to the home of the employee, the Commission may upon application pay the reasonable and necessary expenses of such embalming and transportation, in addition to the allowance for burial expense.** 1.19 Payments by mistake. If any compensation is paid under a mistake of law or of fact, the Commission shall immediately cancel any award under which such compensation has been paid and shall recover, so far as practicable, any amount which has been so paid. Any person who has received any payment from the Commission, or on whose behalf the Commission has made any payment, under a mistake of law or of fact shall, as soon as the mistake is discovered or his attention is called to the same, refund to the Commission any amount so paid. If the payee of any check covering any payment made under the provisions of said Act shall die before the check is presented for payment, the check shall be returned to the office from which it was received, with a statement of the reason for its return.** 1.20 Injuries to members of the Naval Reserve. If any officer or enlisted man of the Naval Reserve is physically injured in the line of duty while performing active duty, authorized training duty with 1 Page 7 |