[Congressional Bills 104th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3205 Introduced in House (IH)]


104th CONGRESS
  2d Session
                                H. R. 3205

 To change the appeals process in the workers' compensation provisions 
                    of title 5, United States Code.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 29, 1996

  Mr. Bilbray (for himself and Ms. Dunn of Washington introduced the 
  following bill; which was referred to the Committee on Economic and 
                       Educational Opportunities

_______________________________________________________________________

                                 A BILL


 
 To change the appeals process in the workers' compensation provisions 
                    of title 5, United States Code.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. APPEALS PROCESS.

    (a) Reference.--Whenever in this section an amendment or repeal is 
expressed in terms of an amendment to, or repeal of, a section or other 
provision, the reference shall be considered to be made to a section or 
other provision of title 5, United States Code.
    (b) Time Period for Decision.--Section 8118 is amended by adding at 
the end the following:
    ``(f) An initial decision by the Secretary of Labor shall be made 
within 90 days of the date the claim is filed by the employee. If an 
initial decision is not made within such 90 days, the claimant shall be 
authorized further payment of full and normal salary until at such time 
an initial decision is reached. An employer may not hold or delay the 
filing of the claim. An agency may not withhold the filing of a claim, 
deny forms to file a claim, or obstruct, threaten, or induce a claimant 
to forego filing a claim. An agent of an agency may not falsify, 
induce, or compel false testimony to deny or controvert a claim.''.
    (c) Claimant's Physician.--Section 8123(a) is amended to read as 
follows:
    ``(a) An employee shall submit to an actual physical examination by 
a physician designated or approved by the Secretary of Labor, when so 
ordered by the administrative law judge. In cases of surgery, a second 
opinion examination shall be required before such surgery, except in 
life threatening circumstances or where additional disability will 
result if there is a delay. A medical report from a treating physician 
is predominant and sufficient for a case unless there are serious and 
legal reasons to suspect the medical evidence. Legal and medical 
examinations and reports, ordered by administrative law judges, will 
only be required where there are legal questions to be resolved with 
regard to the nature of the injury or with regard to whether the event 
that caused the injury was work-related or work-caused. The claimant 
shall have the right to have the claimant's own physician or a witness 
or representative present during the exam. The employee may have a 
physician designated and paid by the employee present to participate in 
the examination. If there is any disagreement between the physician for 
the Secretary and the claimant's physician, a list of 3 physicians of 
the appropriate Board Certified Specialty shall be tendered to the 
claimant who shall choose the physician to conduct the final 
examination with respect to the medical and legal issues in 
disagreement. The Secretary shall provide the claimant's physician with 
the same opportunity and information as is provided to the physician 
acting for the Secretary, including the statement of accepted facts and 
all medical information in the claimant's file.''.
    (d) Physician Fees.--Section 8123(c) is amended to read as follows:
    ``(c) The Secretary shall fix the fees for physicians under this 
section such that the physicians representing the Secretary shall be 
limited to the same structure and amounts allowed to claimants' 
physicians. All medical bills shall be paid within 60 days of billing, 
except during the initial claims processing, and in that case they 
shall be paid within 60 days of acceptance of the claim.''.
    (e) Hearing Date.--Section 8124(b)(1) is amended to read as 
follows:
    ``(b)(1) Administrative review of an initial decision of which the 
claimant is not satisfied may be appealed for an oral hearing before 
the administrative law judges of the Department of Labor. A request for 
an oral hearing must be made within 180 days of the date of the initial 
decision being appealed. A hearing must be held within 90 days of the 
date requested, or compensation denied or reduced shall be reinstated 
until such time as the hearing is given and a decision reached. 
Decisions regarding the issues brought on appeal shall be rendered 
within 30 days of the hearing or benefits will be reinstated if denied 
or reduced until a decision is reached.''.
    (f) Claimant's Authority.--Section 8124(b)(2) is amended to read as 
follows:
    ``(2) In conducting the hearing, the Secretary shall follow the 
requirements of chapter 5. The claimant shall have the right to 
confront and cross examine all adverse witnesses and present such 
evidence as the claimant feels necessary for consideration of the 
claim. The claimant's employer shall not be present at the hearing but 
shall be provided an opportunity to comment on the transcript of the 
hearing.''.
    (g) Representation; Representative Fees.--Section 8127 is amended 
by adding at the end the following:
    ``(c) Except as provided in subsection (d), claimant's attorney or 
representative shall be entitled to receive a fee of 15 percent of the 
benefits awarded to the claimant.
    ``(d) If the claimant prevails in a decision of a Federal court 
under chapter 7, the claimant's attorney shall be paid by the 
Secretary, but not from the claimant's award for the work of such 
attorney if the position of the Secretary with respect to such claimant 
was found under section 2412(c) of title 28 to be not substantially 
justified.''.
    (h) Review of Award.--Section 8128 is amended by striking 
subsections (a) and (b) and insert the following:
    ``Once a claim for compensation has been accepted, the Secretary 
may only end, decrease, or increase compensation by meeting a burden of 
proof standard that there was sufficient cause to perform a review. The 
claimant shall have the right to petition for review of adverse 
decisions at any time upon the submission of a new legal argument or 
new factual evidence not previously considered. Any denial of a 
petition for review or adverse decision arising out of a petition for 
review shall be reviewable under section 8124. Decisions on petitions 
for review shall be rendered no later than 90 days from the date 
received by the Secretary or his designee.''.
    (i) Reemployment and Vocational Rehabilitation.--(1) Section 8104 
is amended to read as follows:
``Sec. 8104. Reemployment and vocational rehabilitation
    ``(a) The Secretary of Labor shall provide vocational 
rehabilitation services to any permanently disabled claimant who 
requests or whose physician requests such services. The claimant shall 
choose the vocational service provider, and insofar as practicable use 
the State services already funded by the Secretary of Health and Human 
Services. If a private counselor is used, the claimant shall have sole 
right to pick the provider and the fees shall be paid out of the 
Employees' Compensation Fund.
    ``(b) Federal employers shall give first priority of placement to 
injured Federal workers in positions commensurate with their pay at 
time of injury and disability. Such positions include any positions for 
which the claimant may already have experience or ones that they can be 
trained in. No person may retaliate, punish, deny work, deny promotion, 
or carry out any other discriminatory act against a claimant for filing 
a claim for compensation.''.
    (2) The table of sections for chapter 81 of title 5, United States 
Code, is amended by striking the item relating to section 8104 and 
inserting the following:

``8104. Reemployment and vocational rehabilitation.''.
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