20 cfr 61.101

§ 61.101

20 CFR Ch. I (4–1–10 Edition)

has been reimbursed, paid, or compensated for the loss for which reimbursement is requested.
(c) Reimbursement under this section
with respect to benefits shall be limited to the amounts which will discharge the liability of the carrier under
the applicable workers’ compensation
law.

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§ 61.101 Filing a request for reimbursement.
(a) A carrier or employer may file a
request for reimbursement. The request shall be submitted to the U.S.
Department of Labor, Office of Workers’ Compensation Programs, Branch of
Special Claims, P.O. Box 37117, Washington, DC 20013–7117;
(b) Each request for reimbursement
shall include documentation itemizing
the payments for which reimbursement
is claimed. The documentation shall be
sufficient to establish the purpose of
the payment, the name of the payee,
the date(s) for which payment was
made, and the amount of the payment.
Copies of any medical reports and bills
related to medical examination or
treatment for which reimbursement is
claimed shall also be submitted. If the
carrier cannot provide copies of the
payment drafts or receipts, the Office
may accept a certified listing of payments which includes payee name, description of services rendered, date of
services rendered, amount paid, date
paid check or draft number, and signature of certifier.
(c) When filing an initial request for
reimbursement under the Act, the carrier shall submit copies of all available
documents related to the workers’
compensation case, including—
(1) Notice and claim forms;
(2) Statements of the employee or
employer;
(3) Medical reports;
(4) Compensation orders; and
(5) Proof of liability (e.g., insurance
policy or other documentation).
§ 61.102 Disposition of reimbursement
requests.
(a) If the Office finds that insufficient or inadequate information has
been submitted with the claim, the carrier shall be asked to submit further
information. Failure to supply the re-

quested information may result in disallowance of items not adequately supported as properly reimbursable.
(b) The Office shall not withhold payment of an approved part of a reimbursement request because of denial of
another part of the reimbursement request.
(c) The Office shall regard awards,
decisions and approved settlement
agreements under the Defense Base Act
or other applicable workers’ compensation law, that have become final, as establishing prima facie, the right of the
beneficiary to the payment awarded or
provided for.
(d) The Office shall advise the carrier
of the amount approved for reimbursement. If the reimbursement request
has been denied in whole or in part, the
Office shall provide the carrier an explanation of the action taken and the
reasons for the action. A carrier within
the United States may file objections
with the Associate Director for Federal
Employees’ Compensation to the disallowance or reduction of a claim within 60 days of the Office’s decision. A
carrier outside the United States has
six months within which to file objections with the Associate Director. The
Office may consider objections filed beyond the time limits under unusual circumstances or when reasonable cause
has been shown for the delay. A determination by the Office is final.
(e) In determining whether a claim is
reimbursable, the Office shall hold the
carrier to the same degree of care and
prudence as any individual or corporation in the protection of its interests
or the handling of its affairs would be
expected to exercise under similar circumstances. A part or an item of a
claim may be disapproved if the Office
finds that the carrier—
(1) Failed to take advantage of any
right accruing by assignment or subrogation (except against the United
States, directly or indirectly, its employees, or members of its armed
forces) due to the liability of a third
party, unless the financial condition of
the third party or the facts and circumstances surrounding the liability
justify the failure;
(2) Failed to take reasonable measures to contest, reduce, or terminate
its liability by appropriate available

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