PART 335—SICKNESS BENEFITS Authority: 45 U.S.C. 362(i) and 362(l). Source: 54 FR 43057, Oct. 20, 1989, unless otherwise noted. § 335.1 General. (a) Statutory basis. (b) Day of sickness. (c) Period of continuing sickness. (i) He or she has any number of “consecutive” days of sickness based on one or more infirmities; or (ii) He or she has any number of “successive” days of sickness based on a single infirmity and there is no interruption of more than 90 “consecutive” days which are not days of sickness. (2) Days of sickness are “consecutive” when they occur one after another continuously and without interruption by any day that is not a day of sickness. Days of sickness are “successive” when one or more days of sickness follow any day of sickness with an interval of one or more days that are not days of sickness. Example: An employee is sick for 11 “consecutive” days from October 1 through October 11, meaning that each day in the period October 1 through October 11 is a day of sickness and there is no day in that period that is not a day of sickness. If the employee also had days of sickness on October 16, 17, 18, 21 and 22, those five days are considered “successive” days of sickness. (3) A period of continuing sickness with respect to any employee begins with the first day of a number of consecutive days of sickness or with the first day of a number of successive days of sickness attributable to a single cause with no interval of more than 90 days that are not days of sickness. In the example given in paragraph (c)(2) of this section, October 1 begins a period of continuing sickness. The days October 16, 17, 18, 21, and 22 are in the period of continuing sickness beginning October 1, and benefits are payable for them, provided that the employee's inability to work on those five days is due to one or more of the same infirmities that caused the employee to be unable to work on the days from October 1 through October 11. Otherwise, October 16 begins another period of continuing sickness. (4) A period of continuing sickness ends when either of these circumstances occurs: (i) 91 consecutive days have elapsed none of which is a day of sickness resulting from the infirmity that was the basis for the preceding days of sickness; or (ii) One or more days that are not days of sickness have elapsed and a statement of sickness is filed with respect to a day of sickness based on an infirmity other than any infirmity causing inability on the preceding days of sickness. The end of a benefit year, generally the 12-month period beginning July 1 of any year and ending June 30 of the next year (see 45 U.S.C. 351(m)), does not end a period of continuing sickness. In the example in paragraph (c)(2) of this section, if the inability to work on October 16 was not due to an infirmity or infirmities that caused the inability to work on October 11, then a period of continuing sickness ends on October 11. A new application and statement of sickness would be required in order for the employee to be paid sickness benefits for days beginning October 16. See § 335.2 of this part. (5) A period of continuing sickness can be interrupted, provided that: (i) The interruption is for not more than 90 consecutive days; and (ii) The days of sickness after the interruption are due to one or more of the same causes as the days of sickness before the interruption. A period of continuing sickness can be interrupted any number of times so long as each interruption is not more than 90 days and the days of sickness are all due to the same cause. If a period of continuing sickness is caused by more than one infirmity, any one of the infirmities can be considered as the single continuing cause that will permit the interruption of the period of continuing sickness for not more than 90 days without ending it. (d) Registration period. (1) The thirteenth day thereafter; or (2) The day immediately preceding the day with respect to which a statement of sickness for a new period of continuing sickness is filed in his or her behalf. However, each of the successive 14-day periods in an extended sickness benefit period shall constitute a registration period. (e) Liability for infirmity. § 335.2 Manner of claiming sickness benefits. (a) Forms required for claiming benefits. (1) An application for sickness benefits at the beginning of each period of continuing sickness; (2) A statement of sickness to accompany the employee's application; (3) A claim for sickness benefits for each 14-day registration period during the employee's period of continuing sickness; and (4) A supplemental doctor's statement, if the adjudicating office requests additional proof of the employee's inability to work. (b) Mailing or delivering the forms. (Approved by the Office of Management and Budget under control numbers 3220-0034, 3220-0039 and 3220-0045) § 335.3 Execution of statement of sickness and supplemental doctor's statement. (a) Who may execute. (1) A licensed medical doctor; (2) A licensed dentist if the infirmity relates to the teeth or gums; (3) A licensed podiatrist or chiropodist if the infirmity relates to the feet or toes; (4) A licensed chiropractor; (5) A clinical psychologist; (6) A certified nurse mid-wife; (7) The superintendent or other supervisory official of a hospital, clinic, or group health association, or similar organization, in which all examinations and treatment are conducted under the supervision of licensed medical doctors or under the supervision of licensed chiropractors, and in which medical records are maintained for each patient; (8) A physician assistant-certified (PAC); (9) An accredited Christian Science Practitioner; (10) A substance-abuse professional as defined in 49 CFR part 40.3, if the infirmity involves alcohol or controlled substances-related disorders; or (11) A nurse practitioner. (b) Use of Board form or other form. [54 FR 43057, Oct. 20, 1989, as amended at 60 FR 40073, Aug. 7, 1995; 62 FR 44408, Aug. 21, 1997; 65 FR 66499, Nov. 6, 2000] § 335.4 Filing statement of sickness and claim for sickness benefits. (a) General requirement. (b) Statement of sickness. (c) Claim for sickness benefits. Example: If a form for claiming sickness benefits is mailed to an employee on July 13, for the period from July 1 to July 14, the employee must file the claim within 30 days after July 14 [on or before August 13], to be paid benefits for the period July 1 to July 14. If the claim form was not mailed to the employee until July 16, the claim must be filed within 30 days after July 16 [on or before August 15]. (d) When form considered timely filed. (1) The statement or form was received in a Board office within the prescribed time; or (2) The statement or form was mailed to a Board office in accordance with instructions printed on the form and was received at such office; or (3) The employee made a reasonable effort to file the statement of sickness or claim form within the prescribed time but was prevented from doing so by circumstances beyond his or her control, and such statement or claim was received at a Board office within a reasonable time following the removal of the circumstances that prevented the employee from filing the form. The phrase “circumstances beyond his or her control” shall not include an employee's forgetfulness or lack of knowledge of the sickness benefit program or the time limit for filing for sickness benefits or any other lack of diligence by the employee. For the purposes of this provision, if a statement of sickness is not received within the prescribed time but is received within 30 days of the first day that an employee intends to claim as a day of sickness, the Board will consider that the employee made a reasonable effort to file the statement within the prescribed time, unless it is clear on the basis of affirmative evidence that the delay was not the result of circumstances beyond the employee's control; or (4) The employee mistakenly registered for unemployment benefits when he or she should have applied for sickness benefits for the day or days claimed and the appropriate statement of sickness was then received at an office of the Board within a reasonable time after unemployment benefits were denied; or (5) Notwithstanding the foregoing, any claim that is not filed within two years of the day or days claimed shall not be considered as timely filed, and such day or days shall not be considered as days of sickness. (e) Days for which no statement of sickness deemed filed. [54 FR 43057, Oct. 20, 1989, as amended at 57 FR 807, Jan. 9, 1992; 60 FR 40073, Aug. 7, 1995] § 335.5 Death of employee. If an employee dies before filing one or more of the required forms, the form or forms may be filed by or in behalf of the person or persons to whom benefits would be payable pursuant to section 2(g) of the Railroad Unemployment Insurance Act. Such form or forms shall be filed within the time prescribed in § 335.4 of this part. Under these circumstances, the word “employee” as used in § 335.4(b) of this part and as used in § 335.4(d)(3) of this part shall include the individual or individuals by or in behalf of whom the form is filed. The order of distribution for benefits due but unpaid as of the date of an employee's death is the same as the order of distribution for annuities unpaid at death under the Railroad Retirement Act and may be found at § 234.31 of this title. § 335.6 Payment of sickness benefits. (a) General rule. (b) Waiting period. (c) Computation of compensable days Example 1. (2) Example 2. (3) Example 3. (d) Amount payable. [65 FR 19649, Apr. 12, 2000]