application for the disability retirement of an employee, the agency shall establish an employee retirement file separate from the Official Personnel Folder. The agency shall file in the employee retirement file all documents pertinent to the application, including any notice to report for fitness-for-duty examination, medical reports, notice of determination that filing of an application for disability retirement appears to be justified, the employee's answer together with any documentary evidence or affidavits he submits with his answer, the written summary of any oral answer together with any amendment or supplement to the summary, and the decision of the agency as to whether or not it will file an application for disability retirement.

(d) This subpart does not change basic requirements to comply with applicable laws, regulations, and executive orders intended to protect information involving the national security. § 831.1203 Agency action.

(a) Fitness-for-duty examination. When the agency has reason to believe an employee may be totally disabled within the meaning of paragraph (c) (1) of this section, and satisfactory medical evidence is not otherwise available, the agency may direct the employee to report for a fitness-for-duty examination. However, in the case of an employee with a suspected mental or emotional illness when the fitness-for-duty examination being considered is psychiatric, two of three agency officials (including a manager or supervisor, a personnel official, and a medical officer if available) must agree in the light of all available facts of the case that such an examination appears to be necessary. The employee is entitled to an advance written notice of the examination. The notice shall set forth the reasons for the examination and the general scope and character of the examination. An employee has the right to participate in the selection of another medical examiner if he objects to the first. When the refusal to submit to the examination appears to be the result of a mental, emotional, or nervous condition, and the employee does not want to participate in the selection of another medical examiner, the agency shall make a finding to this effect and continue to process the application for retirement on the basis of other available evidence.

(b) Notice of proposed determination and answer. When an agency determines that filing of an application for the disability retirement of an employee appears to be justified, it shall notify him in writing of:

(1) Its determination;

(2) The reasons for this determination;

(3) His right, or the right of his physician or representative to review the case file; and

(4) His right to answer orally or in writing or both, and to submit affidavits or documentary evidence or both, within a reasonable time to an official designated to receive the answer.

The reasonable time required depends on the facts and circumstances in each case but may not be less than 15 calendar days. The official designated to receive the answer shall have authority either to make the decision or to recommend the decision. An oral reply to the previously designated agency official must be summarized in writing and included in the case file. A copy, approved or supplemented by the employee, must also be included in the case file. The employee has 5 calendar days from the day he received the summary within which to amend and supplement the summary.

(c) Disability standards. An agency shall file an application for the disability retirement of an employee only when it certifies that:

(1) In its opinion the employee is totally disabled for useful and efficient service in the grade or class of position occupied (as shown by his performance or by a job-related factor) because of disease or injury not due to vicious habits, intemperance, or wilfull misconduct on his part within 5 years before becoming so disabled; and

(2) There is no suitable position vacant for which the employee is qualified and which he is willing to accept instead of retirement.

(d) Decision. The employee is entitled to a written decision from the agency at the earliest practicable date. The decision shall include a statement of findings and conclusions. When the decision is to file an application for disability retirement, the agency shall file the application and retirement file with the regional office of the Commission or the Bureau as appropriate.

[33 F.R. 12498, Sept. 4, 1968, as amended at 34 F.R. 17618, Oct. 31, 1969]

§ 831.1204 Notice of receipt of application.

(a) The Commission office that receives the application first reviews it for compliance with the procedures in § 831.1203. If there has not been compliance, the Commission office remands the application to the agency and notifies the employee of the remand. If there has been compliance with the required procedures, the Commission office notifies the agency and the employee in writing that it has received the application. The same notice informs the employee that he is entitled to:

(1) Participate in the selection of a medical examiner when the Commission determines under § 831.502(a) that a medical examination is necessary;

(2) Be examined without cost to him; and

(3) Submit further relevant evidence as provided in the notice. A regional medical officer will forward the file to the Bureau upon completion of his action.

(b) Decision: After considering the employee's retirement file, the Bureau either approves or disapproves the application. The Bureau's decision shall be in writing and a copy shall be given to the employee and the agency concerned. The decision shall set forth the Bureau's findings and conclusions and shall inform the employee and the agency of the right of appeal and hearing provided by § 831.1205.

[34 F.R. 17618, Oct. 31, 1969]

§ 831.1205 Appeal and hearing.

(a) Right of appeal and hearing. An agency or an employee may appeal the decision of the Bureau that involves an application for disability retirement filled by an employee or by an agency to the Appeals Examining Office or a regional office of the Commission as appropriate. The appeal shall be in writing, set forth the reasons for the appeal, request a hearing if the appellant desires a hearing, and be filed with the appropriate office within 15 calendar days after receipt of the decision of the Bureau. The Appeals Examining Office or regional office of the Commission may extend this time limit for good cause shown.

(b) Subpart C of Part 772 of this chapter applies to appeals to the Commission from decisions of the Bureau involving applications for disability retirement.

[34 F.R. 17618, Oct. 31, 1969]

An agency shall retain an employee in an active duty status until it receives the decision of the Bureau on an agency application for disability retirement, except that the agency on the basis of medical evidence may place an employee on leave with his consent, or without his consent when the circumstances are such that his retention in an active duty status may result in damage to Government property, or may be detrimental to the interests of the Government, or injurious to the employee, his fellow workers, or the general public. If the leave account of the employee is or becomes exhausted, any suspension or involuntary leave without pay shall be affected in accordance with applicable laws, Executive orders, and regulations. [34 F.R. 17618, Oct. 31, 1969]

Life and accidental death and dismemberment benefits (referred to in this part as "regular insurance") shall be payable in accordance with a policy or policies purchased by the Commission from the Metropolitan Life Insurance Co., 1 Madison Avenue, New York, N.Y. 10010, pursuant to section 8709 of title 5, United States Code. Actions at law or in equity to recover on an insurance policy, in which there is not alleged any breach of any obligation undertaken by the United States, should be brought against the insurance company.

Except as provided in § 870.202, each employee as defined by section 8701 of title 5, United States Code, shall, at the time and subject to the conditions prescribed in this part, be insured for an amount of regular insurance as specified in §§ 870.301, 870.602, and 870.702. § 870.202 Exclusions.

(a) Employees, as defined by section 8701 of title 5, United States Code, in the following groups are excluded from the application of this part:

(1) An employee serving under appointment limited to one year or less, except an employee so appointed for fulltime employment or part-time employment with a regular tour of duty without break in service or after a separation of 3 days or less, following service in which he was insured, an acting postmaster, and a Presidential appointee appointed to fill an unexpired term.

(2) An employee whose employment is of uncertain or purely temporary dura

tion, or who is employed for brief periods at intervals and an employee who is expected to work less than 6 months in each year, except an employee who is employed under a cooperative work-study program of at least 1 year's duration which requires the employee to be in pay status during not less than one-third of the total time required for completion of the program.

(3) An intermittent employee-a nonfull-time employee without a prearranged regular tour of duty, except when the employee enters into such a status without break in service or after a separation of 3 days or less, following service in a position in which he was insured and to which he is expected to return.

(4) An employee whose pay on an annual basis is $12 a year or less.

(5) A beneficiary or patient employee in a government hospital or home.

(6) An employee paid on a contract or fee basis, except an employee who is a citizen of the United States who is appointed by a contract between the employee and the Federal employing authority which requires his personal service and is paid on the basis of units of time.

(7) An employee paid on a piecework basis, except one whose work schedule provides for full-time service or parttime service with a regular tour of duty.

(b) The Commission shall make final determination regarding applicability of the above classifications to a specific employee or group of employees.

[33 F.R. 12506, Sept. 4, 1968, as amended at 34 F.R. 19967, Dec. 20, 1969]

(a) (1) An employee appointed, or transferred from a position wherein he is not insured, is insured at the time he actually enters on duty on his first day in a pay status, unless before the end of his first pay period he files with his employing office a waiver of regular insurance coverage, or had previously filed such a waiver which remains uncanceled.

(2) An employee transferring from a position wherein he is insured to another position wherein he is not excluded from coverage is insured at the beginning of the effective date of his transfer, unless before the end of his first pay period in the new position he files with his new employing office a waiver of regular insurance coverage.

(b) An employee who returns to duty and is in a pay status after a period of more than 12 months of nonpay status is insured at the time he actually enters on duty on his first day in a pay status, unless before the end of the first pay period he files with his employing office a waiver of regular insurance coverage, or had previously filed such waiver which remains uncanceled.

(c) An employee serving in cooperation with a non-Federal agency paid in whole or in part from non-Federal funds may not be insured before the date that the Commission prescribes for the group of which he is a member following Commission approval of arrangements which are placed into effect and provide (1) that the required withholdings and contributions will be made from federally controlled funds and timely deposited into the Employees' Life Insurance Fund, or (2) that the cooperating non-Federal agency will, by written agreement with the Federal agency, make the required withholdings and contributions from non-Federal funds and will transmit the total of such amounts to the Federal agency for timely deposit into the Employees' Life Insurance Fund.

§ 870.204

Cancellation of waiver of insurance coverage.

(a) An insured employee may at any time cancel his regular insurance by filing with his employing office a waiver of insurance coverage. The waiver shall be effective and the employee's insurance ceases at the end of the pay period in which the waiver is received in the employing office.

(b) An employee who has filed a waiver of regular insurance coverage may cancel the waiver and become insured if (1) he is under age 50, (2) at least 1 year has elapsed since the effective date of such waiver, and (3) he furnishes satisfactory evidence of insurability.

(c) An employee who has complied with paragraph (b) of this section is insured at the time he actually enters on duty on his first day in a pay status in a position wherein he is not excluded from insurance by law or regulation, following the approval of his Request for Insurance by the Office of Federal Employees Group Life Insurance. The approval is revoked automatically and the employee is not insured unless he acquires such a duty and pay status effective within 31 days following the date of such approval.

(d) An employee who has filed a waiver of regular insurance coverage may cancel the waiver and become insured by filing Standard Form 176, completed to show that he wants the regular insurance, with his employing office during the period March 1 to March 31, 1970. The effective date of the regular insurance in such case is the first day the employee actually enters on duty in a pay status on or after April 1, 1970.

[33 F.R. 12506, Sept. 4, 1968, as amended at 34 F.R. 19543, Dec. 11, 1969] § 870.205 Appeals.

(a) A person may appeal an action of his employing office denying regular insurance coverage to the Bureau of Retirement, Insurance, and Occupational Health, U.S. Civil Service Commission, Washington, D.C. 20415.

(b) An appeal may be taken to the Commission's Board of Appeals and Review from the final action or order of the Bureau of Retirement, Insurance, and Occupational Health denying regular insurance coverage.

(c) The time for filing an appeal is not later than 6 months from the date of mailing notice of the final action or order of which complaint is made.

[33 F.R. 12506, Sept. 4, 1968, as amended at 34 F.R. 19543, Dec. 11, 1969]

Subpart C-Amount of Insurance § 870.301

ance.

Amount of employee's insur

(a) An insured employee's annual pay is his annual basic pay rate as fixed by law or regulation.

(b) A pay rate of other than annual is converted to an annual rate by multiplying the prescribed rate by the number of pay units in a 52-week work year.

(c) The annual pay for a part-time employee is his basic pay applicable to his tour of duty in a 52-week work year. (d) The annual pay for an employee who legally and concurrently serves in

(a) During any period in any part of which an insured employee is in a pay status there shall be withheld from the biweekly pay of such employee the sum of 272 cents for each $1,000 of his regular insurance. The amount withheld from the pay of an employee who is paid on other than a biweekly basis is determined at a proportionate rate, adjusted to the nearest cent.

(b) The amount withheld from the pay of an insured employee whose annual pay is paid during a period shorter than 52 workweeks is the sum obtained by converting the biweekly rate of 271⁄2 cents for each $1,000 of his regular insurance to an annual rate and prorating the annual rate over the number of installments of pay regularly paid during the year.

(c) The amount withheld from the pay of an insured employee whose amount of insurance changes during a pay period is based on the last amount of insurance in force during the pay period.

(d) For each period in which an employee is insured there shall be contributed from the respective appropriation or fund which is used for the payment of his pay (or, in the case of an elected official, from such appropriation or fund as may be available for payment of other pay of the same office or establishment) an amount equal to onehalf the amount withheld from the employee's pay.

Subpart E-Termination and
Conversion

he is excluded from regular insurance stops on his last day on the roll in the former position, subject to a 31-day extension of regular life insurance coverage.

(c) Except as provided in paragraph (e) of this section and in §§ 870.601 and 870.701, the regular insurance of an insured employee continues without cost to the employee while he is in nonpay status for up to 12 months at which time it stops, subject to a 31-day extension of regular life insurance coverage. The 12 months nonpay status may be continuous or broken by periods of less than 4 consecutive months in pay status. If an employee has at least 4 consecutive months in pay status after a period of nonpay status he is entitled to begin the 12 months continuation of regular insurance anew. If after a return to duty he is not entitled to any further continuation of regular insurance in nonpay status because he has not had 4 consecutive months of pay status since exhausting his 12 months continuation in nonpay status, his regular insurance stops the last day of his last pay period in pay status. For the purposes of this paragraph, 4 consecutive months in pay status means any 4-month period during which the employee is in pay status for at least part of each pay period.

(d) The regular insurance of an insured person who enters on active duty or active duty for training as a member of a uniformed service stops, subject to a 31-day extension of regular life insurance coverage, on the day preceding his entrance on such duty, unless the period of such duty is covered by military leave with pay from his civilian position. This stopping of regular insurance coverage does not operate with respect to regular insurance granted before January 1, 1957, to commissioned officers of the Coast and Geodetic Survey or of the Regular or Reserve Corps of the Public Health Service.

(e) During the 31-day extension of regular life insurance coverage under this section a person may, upon application and without medical examination, convert all or any part of his regular life insurance to an individual policy of life insurance at rates applicable to his attained age and class of risk unless. within 3 calendar days after the date his regular insurance stopped, he returns to a position wherein he is not excluded from coverage.