CA810 Revised 2009 CA 801 810

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Injury Compensation for Federal Employees
Publication CA-810

U.S. Department of Labor
Hilda L. Solis, Secretary

CA-810
Revised 2009
This material was prepared by the Office of Workers’ Compensation
Programs (OWCP), U.S. Department of Labor. It is meant to serve as a
handbook for Federal agency personnel specialists, compensation
specialists, and supervisors. The term “supervisor” is used generically
to refer to individuals in all of these roles.
For information concerning any aspect of the program which is not
addressed in this manual, contact the OWCP district office serving your
agency. These offices are listed in Chapter 1-4 and Appendix D.
Material contained in this publication is in the public domain and may be
reproduced, fully or partially, without permission of the Federal
Government. Source credit is requested but not required. Permission is
required only to reproduce any copyrighted material contained herein.

Table of Contents
Chapter 1, Overview
1-1 Purpose
1-2 Exclusiveness of Remedy
1-3 OWCP Structure
1-4 Jurisdiction
1-5 Information and Records
1-6 Penalties
1-7 Forms
1-8 References
1-9 Training

Chapter 2, Initiating Claims
2-1 Exposure to Infectious Agents
2-2 Traumatic Injury
2-3 Occupational Disease
2-4 Recurrences
2-5 Death

Chapter 3, Conditions of Coverage
3-1 Time
3-2 Civil Employee
3-3 Fact of Injury
3-4 Performance of Duty
3-5 Causal Relationship
3-6 Statutory Exclusions

Chapter 4, Processing Claims
4-1 Administrative Matters
4-2 Burden of Proof
4-3 Questionable Cases
4-4 Decisions and Notification

Chapter 5, Continuation of Pay (COP)
5-1, Definition and Entitlement
5-2 Use of Leave Instead of COP
5-3 Controversion
5-4 Pay Rate for COP Purposes
5-5 Computation
5-6 Light- or Limited-Duty Assignments
5-7 Recurrences
5-8 Terminating COP
5-9 Reporting COP
Chapter 6, Medical Benefits and Care
6-1 Entitlement
6-2 Definition of Physician
6-3 Choice of Physician
6-4 Medical Treatment and Evaluation
6-5 Exclusion of Providers
6-6 Payment of Bills
Chapter 7, Compensation Benefits
7-1 Disability Benefits
7-2 Death Benefits
7-3 Dual Benefits
7-4 Computing Compensation
Chapter 8, Managing Disability Claims
8-1 Initial Actions by OWCP
8-2 Retention Rights
8-3 Nurse Services
8-4 Reemployment with the Agency
8-5 Vocational Rehabilitation Services
8-6 Assisted Reemployment
8-7 Payment of Relocation Expenses
8-8 Employees in Light- or Limited-Duty Status
8-9 Separation from Employment

Chapter 9, Agency Management of Compensation Claims
9-1 Obtaining Information
9-2 Inspection and Protection of Records
9-3 Managing Compensation Programs
9-4 Chargeback
Appendix A.

Basic Forms

Appendix B.

Injury/Illness Type and Source Codes

Appendix C.

Occupational Disease Checklists

Appendix D.

Address List and Jurisdictional Map

Chapter 1. Overview
This chapter provides basic information about the administration of the
Federal Employees’ Compensation Act (FECA).
1-1
1-2
1-3
1-4
1-5
1-6
1-7
1-8
1-9

Purpose
Exclusiveness of Remedy
OWCP Structure
Jurisdiction
Information and Records
Penalties
Forms
References
Training

1-1. Purpose
The FECA (5 U.S.C. 8101 et seq.) provides compensation benefits to
civilian employees of the United States for disability due to personal
injury or disease sustained while in the performance of duty. The FECA
also provides for payment of benefits to dependents if a work-related
injury or disease causes an employee’s death. The FECA is intended to
be remedial in nature, and proceedings under it are non-adversarial.

1-2. Exclusiveness of Remedy
Benefits provided under the FECA constitute the sole remedy against
the United States for work-related injury or death. A Federal employee
or surviving dependent is not entitled to sue the United States or recover
damages for such injury or death under any other law.
1-3. OWCP Structure
The Division of Federal Employees’ Compensation (DFEC) administers
the FECA. The Director for DFEC and the various OWCP Regional

Directors have authority over the operations of the 12 district offices.
Each of these offices is headed by a District Director, who is responsible
for office functions.
In each district office are two or more Supervisory Claims Examiners, or
Claims Managers, who are responsible for the operation of individual
claims units. A number of Senior Claims Examiners and Claims
Examiners have primary responsibility for handling claims. Individuals at
each level have specific responsibilities for issuing decisions on claims.
1-4. Jurisdiction
The jurisdictions of the 12 district offices are as follows (see Appendix D
for addresses and map):
District 1 -- Boston, MA:
Connecticut, Maine,
Massachusetts, New Hampshire, Rhode Island and Vermont.
District 2 -- New York, NY:
and the Virgin Islands.

New Jersey, New York, Puerto Rico

District 3 -- Philadelphia, PA:
Delaware, Pennsylvania, West
Virginia and Maryland when the injured worker’s zip code begins 21***.
District 6 -- Jacksonville, FL:
Alabama, Florida, Georgia,
Kentucky, Mississippi, North Carolina, South Carolina and Tennessee.
District 9 -- Cleveland, OH:
Indiana, Michigan and Ohio. Also
handles claims for employees injured overseas, employees claiming
injury due to radiation or Agent Orange, Peace Corps and VISTA
volunteers, Reserve Officers’ Training Corps (ROTC) Cadets, members
of the Coast Guard Auxiliary and temporary members of the Coast
Guard Reserve and certain non-Federal claims.
District 10 -- Chicago, IL:

Illinois, Minnesota and Wisconsin.

District 11 -- Kansas City, MO:
Arkansas, Iowa, Kansas, Missouri
and Nebraska. Also handles claims for Department of Labor employees
(except employees of the OWCP Midwest Region and their relatives.

District 12 -- Denver, CO:
Colorado, Montana, New Mexico,
North Dakota, South Dakota, Utah and Wyoming.
District 13 -- San Francisco, CA:
Arizona, California, Hawaii, Nevada
and Pacific territories and possessions.
District 14 -- Seattle, WA:
Washington.

Alaska, Idaho, Oregon and

District 16 -- Dallas, TX:

Louisiana, Oklahoma and Texas.

District 25 -- Washington, DC:
District of Columbia, Virginia and
Maryland except when the injured worker’s zip code begins 21***. Also
handles Members of Congress and their staffs, White House officials
and employees, Executive Office of the President, Architect of the
Capitol, Library of Congress, employees of the Government Accounting
Office, employees of the Capitol Hill Police, employees whose cases
involve security consideration and employees of the OWCP Midwest
Region and their relatives.
1-5. Information and Records
Individual case files are protected under the Privacy Act of 1974 (5
U.S.C. 552a) and maintained in a system of records known as DOLGOVT 1. Only the employee, his or her representative (if any), and
authorized agency personnel may routinely have access to a given file.
Any of these parties may inspect the file at the district office which has
custody. An appointment should be requested ahead of time. If it is not
possible to travel to the district office, a copy of the case file may be
provided.
Employees and their representatives may have access to records,
including medical reports, which OWCP has released to the agency.
The records must be safeguarded in the same manner as other
personnel material, and the agency must determine whether such
information may properly be released in accordance with the regulations
contained in 29 CFR parts 70 and 71. Use of the record must be
consistent with the purpose for which the record was created; the record
was created for the administration of FECA and payment of FECA
benefits.

As stated in OWCP’s FECA regulations, while an employer may
establish procedures for an injured employee or beneficiary to obtain
documents, any decision issued in response to such a request must
comply with OWCP’s regulations and no employer may correct or
amend records pertaining to OWCP claims.

1-6. Penalties
A. The regulations at 20 CFR § 10.15 address waiver of
compensation rights as follows:
No employer or other person may require an employee or other
claimant to enter into any agreement, either before or after an injury or
death, to waive his or her right to claim compensation under the FECA.
No waiver of compensation rights shall be valid.
B. The regulations at 20 CFR § 10.16 address criminal penalties
in connection with a claim under the FECA as follows:
(a) A number of statutory provisions make it a crime to file a
false or fraudulent claim or statement with the government in connection
with a claim under the FECA, or to wrongfully impede a FECA claim.
Included among these provisions are sections 287, 1001, 1920, and
1922 of Title 18, United States Code. Enforcement of these and other
criminal provisions that may apply to claims under the FECA are within
the jurisdiction of the Department of Justice.
(b) In addition, administrative proceedings may be initiated
under the Program Fraud Civil Remedies Act of 1986 (PFCRA), 31
U.S.C. 3801-12, to impose civil penalties and assessments against
persons who make, submit, or present, or cause to be made, submitted
or presented, false, fictitious or fraudulent claims or written statements to
OWCP in connection with a claim under the FECA. The Department of
Labor’s regulations implementing the PFCRA are found at 29 CFR Part
22.

C. The regulations at 20 CFR § 10.17 address the effects to a
beneficiary who defrauds the government in connection with a claim for
benefits as follows:
When a beneficiary either pleads guilty to or is found guilty of
either Federal or state criminal charges of defrauding the Federal
government in connection with a claim for benefits, the beneficiary’s
entitlement to any further compensation benefits will terminate effective
the date either the guilty plea is accepted or a verdict of guilty is returned
after trial, for any injury occurring on or before the date of such guilty
plea or verdict. Termination of entitlement under this section is not
affected by any subsequent change in or recurrence of the beneficiary’s
medical condition.

1-7. Forms
Agencies should maintain an adequate supply of the basic forms
needed to process claims, as follows:
Form

Title

CA-1

Federal Employee’s Notice of Traumatic Injury
and Claim for Continuation of ay/
Compensation

CA-2

Notice of Occupational Disease and Claim for
Compensation

CA-2a

Notice of Employee’s Recurrence of Disability
and Claim for Pay/Compensation

CA-3

Report of Termination of Disability (used by
agencies in electronic format)

CA-5

Claim for Compensation by Widow, Widower,
and/or Children

CA-5b

Claim for Compensation by Parents, Brothers,
Sisters, Grandparents or Grandchildren

Form

Title

CA-6

Official Superior’s Report of Employee’s Death

CA-7

Claim for Compensation on Account of
Traumatic Injury or Occupational Disease

CA-7a

Time Analysis Form

CA-7b

Leave Buy-Back (LBB) Worksheet/Certification
and Election

CA-16

Authorization for Examination and/or Treatment

CA-17

Duty Status Report

CA-20

Attending Physician’s Report (attached to Form
CA-7; also available separately)

CA-35, a-h

Occupational Disease Checklists

CA 40, 41, 42

Death Gratuity Forms 5 U.S.C. 8102a

OWCP-915

Claim for Medical Reimbursement

OWCP-957

Medical Travel Refund Request

OWCP-1500

Health Insurance Claim Form

A chart showing the use of each form is found in Appendix A.
Many forms are available in PDF format at:
http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm
All forms available online may be completed manually via the print form
option. Some forms may be completed electronically via the electronic
fill option. Still others may be completed and submitted electronically.

Please note the CA-16 is available for download on the Agency Query
System (AQS) website at: https://aqsweb.dol-esa.gov/AQS.
Agencies may order forms from the Superintendent of Documents, U.S.
Government Printing Office, at: www.gpo.gov.

1-8. References
Several resources describing the provisions of the law and how they are
applied are available on the DFEC home page at:
http://www.dol.gov/owcp/dfec/index.htm. Some materials are also
available in printed format.
A.
The Federal Employees’ Compensation Act as amended, 5
U.S.C. 8101 et seq., is the source of entitlement to compensation
benefits for Federal workers. Most of the provisions of the FECA have
been interpreted and more fully described through OWCP directives and
decisions of the Employees’ Compensation Appeals Board (ECAB). For
this reason, the program’s Procedure Manual and ECAB decisions will
usually prove more helpful than the FECA itself. Copies of the FECA
may be obtained from the DFEC website or by contacting the National
Office.
B.
The Code of Federal Regulations, 20 CFR Part 10, more
fully describes the provisions of the law, and it contains additional
information about administration of the program. Letters and decisions
from OWCP may contain references to the regulations. Copies may
also be obtained from the DFEC website or by contacting the National
Office.
C.
The Federal (FECA) Procedure Manual describes in detail
the procedures which OWCP staff use to process claims. It is divided
into several parts by subject area; the section most likely to be useful to
agency personnel is Part 2, Claims.
D.
Questions and Answers about the Federal Employees’
Compensation Act (Publication CA-550) describes the basic provisions
of the law in non-technical language. It addresses the most common
issues about entitlement and claims processing. It is intended for use

primarily by employees who may obtain a copy from the DFEC website.
Agencies may order printed copies from the GPO.
E.
Decisions of the Employees’ Compensation Appeals Board
maybe found in most law libraries. Recent decisions are available on
line at the ECAB website: http://dol.gov/ecab/decisions.htm.

1-9. Training
OWCP provides the following courses in response to requests from
agency personnel:
A.
The FECA Seminar gives an overview of the law for firsttime supervisors as well as middle- and senior-level managers. The
seminar includes lectures and visual aids. Tailored toward the
audience, it lasts from one to six hours and is usually held at the
requesting agency’s facility. The seminar may be given to small or large
groups which are composed of one or more agencies. Also, Federal
labor unions may avail themselves of this seminar.
B.
The Basic Compensation Specialist Workshop is a formal
session in a classroom setting. It is intended for agency staff who are
primarily responsible for processing OWCP claims and for those who
spend at least 50% of their time handling OWCP claims. The training
stresses skills needed to counsel injured employees, review claim forms
for accuracy, document continuation of pay and develop record-keeping
systems.
C.
The FECA Supervisor’s Workshop is tailored to the needs of
the agency requesting training. The course covers management of pay,
deciding whether to controvert a claim, light or limited duty assignments
and reemployment. The length of this course varies and is dependent
on the type and amount of material presented.
Arrangements for these courses may be made with the district office
serving your area, or with the Branch of Technical Assistance.

Chapter 2. Initiating Claims
This chapter begins by describing the difference between exposure to
an infectious agent, which is not compensable, and actual injury. It then
outlines the forms and procedures which employees and agency
personnel use to initiate claims for traumatic injury, occupational
disease, recurrence of disability, and death. Agency personnel are
cautioned never to prevent employees from filing claims under any
circumstances.

2-1.
2-2.
2-3
2-4.
2-5

Exposure to Infectious Agents
Traumatic Injury
Occupational Disease
Recurrences
Death

2-1. Exposure to Infectious Agents
The FECA does not provide for payment of expenses associated with
simple exposure to an infectious disease without the occurrence of a
work-related injury. Infectious diseases include tuberculosis, hepatitis,
and HIV (human immuno-deficiency virus).
The Occupational Safety and Health Administration has published
regulations addressing the health risks posed by blood borne pathogens
in the work place. Under these regulations, an “exposure incident” is
defined as a “specific eye, mouth, other mucous membrane, non-intact
skin, or parenteral contact with blood or other potentially infectious
materials that results from the performance of an employee’s duties” (29
CFR §19 10.1030).
Both a work-related injury and exposure to a known carrier must occur
before OWCP can pay for diagnostic testing. For instance, a puncture
wound from a needle used to draw blood from a patient not known to be
infected with HIV would entitle the worker to benefits only for the effects
of the puncture wound, and the supervisor would not issue CA-16 to
authorize precautionary testing since no indication exists that a

communicable disease has been contracted on duty. However, a
puncture wound from a needle used to draw blood from a patient known
to be infected with HIV would entitle the worker to benefits for the effects
of the puncture wound and to payment for diagnostic studies to rule out
the presence of a more serious condition, because exposure to a known
carrier would be involved.
Similarly, fear of exposure to an infectious agent does not entitle the
worker to benefits under the FECA, since no definable injury has
occurred. For instance, the act of searching an individual known to have
hepatitis or an individual believed to belong to a high-risk group for
tuberculosis would not entitle an employee to benefits. In these
situations, the supervisor should not issue Form CA-16 as no injury or
exposure has occurred.
However, employees who have encountered persons with serious
communicable infections may suffer anxiety for their health and
employing agencies should take these concerns seriously when actual
exposure (as opposed to fear of exposure) has occurred. In such
cases, the supervisor may use the authority provided by 5 U.S.C. 7901
to authorize testing or counseling. This section of the law allows
agencies to provide screening and associated health services to their
own employees and the services offered may be geared to the particular
occupational hazards to which an agency’s employees are commonly
exposed.
It may also be helpful to arrange for surveillance testing, which monitors
a population at risk for certain conditions, as opposed to diagnostic
testing, which is performed to assess the specific nature of an
individual’s illness when a medical condition is known to exist. To
arrange for HIV testing or employee counseling, a supervisor may wish
to contact the appropriate regional office of the Public Health Service.

2-2. Traumatic Injury
A traumatic injury is defined as a wound or other condition of the body
caused by external force, including stress or strain. The injury must be
identifiable by time and place or occurrence and member of the body

affected. It must be caused by a specific event or incident or series of
events or incidents within a single day or work shift.
Traumatic injuries also include damage to or destruction of prosthetic
devices or appliances, including eyeglasses, contact lenses, and
hearing aids, if they were damaged incidental to a personal injury
requiring medical services. (Personal property claims can be made
only under the Military Personnel and Civilian Employees’ Claim Act, 31
U.S.C. § 3721.)
A. Notice of Injury - Form CA-1
When an employee sustains a traumatic injury in the performance of
duty, he or she should file a report on Form CA-1. It may be filed on the
paper form or electronically, depending on the employing agency
participation. The report should be submitted to the supervisor as soon
as possible, but not later than 30 days from the date of injury. If the
employee is incapacitated, this action may be taken by someone acting
on his or her behalf, including a family member, union official, or
representative. (The supervisor may provide such notice as well.) The
paper form must contain the original signature of the person giving
notice. Employing agencies that submit claims electronically must print
a copy of the form and retain the claimant’s or representative’s
signature. The supervisor should:
(1) Review page one of the form for completeness and accuracy,
and assist the employee in correcting any deficiencies found;
(2) Complete and sign page two of the Form CA-1, including a
telephone number in case OWCP staff has questions about the injury.
Also, the appropriate codes should be entered on the form. Include
codes for occupation, type and source of injury, agency identification
and location of duty station. (Appendix B of this publication describes
the type and source of injury codes and their use.)
(3) Sign and return to the employee the receipt attached to the
paper Form CA-1 and give a copy of the entire form to the employee.
Or, if submitted electronically, print and sign the copy of the electronic
form and give it to the employee.

(4) Authorize medical care, if needed, in accordance with
paragraph C below;
(5) Inform the employee of the right to elect continuation of pay
(COP), (discussed in detail in Chapter 5), or annual or sick leave if time
loss will occur;
(6) Advise the employee whether COP will be controverted, and if
so, whether pay will be terminated. The basis for the action must be
explained to the employee. (Controversion is discussed in Chapter 5-3;
the reason for controverting a claim must always be shown on Form CA1.)
(7) Advise the employee of his or her responsibility to submit
prima facie medical evidence of disability within ten calendar days or risk
termination of COP. (See Chapter 5-8.)
B. Disposition of Form CA-1
If the employee incurs medical expense or loses time from work beyond
the date of injury, the supervisor should send Form CA-1 to the district
office with supporting information as soon as possible but no later than
ten working days after receipt of Form CA-1 from the employee.
If the employee is examined or treated at the agency’s medical facilities
or by medical providers under contract to the agency, and this
examination or treatment occurs during working hours beyond the date
of injury, the supervisor should check “first aid” in block 39 of the
agency’s portion of the form and submit the form to OWCP. “First aid”
injuries also include those requiring two or more visits to a medical
facility for examination or treatment during non-duty hours beyond the
date of injury, as long as no leave or COP is charged and no medical
expense is incurred.
If the employee obtains no medical care, or obtains only agencysponsored care on the date of injury, and no time loss is charged to
either leave or COP, the supervisor should place Form CA-1 in the
workers’ Employee Medical Folder (EMF) instead of sending it to
OWCP.

C. Medical Treatment - Form CA-16
If an employee requires medical treatment for the injury, the supervisor
should complete the front of Form CA-16, within four hours of the
request whenever possible. If the supervisor doubts whether the
employee’s condition is related to the employment, he or she should so
indicate on the form. Where there is no time to complete a Form CA-16,
the supervisor may authorize medical treatment by telephone and send
the completed form to the medical facility within 48 hours. Retroactive
issuance of Form CA-16 is usually not permitted under other
circumstances.
(1) Delayed Report of Injury. If an employee reported an injury
several days after the fact, or did not request medical treatment within
24 hours of the injury, the supervisor may still authorize medical care
using Form CA-16. Agency personnel are encouraged to use discretion
in issuing authorizations for medical care under such circumstances, but
employees should not be penalized for short delays in reporting injuries.
The supervisor may, however, refuse to issue a CA-16 if more than a
week has passed since the injury on the basis that the need for
immediate treatment would become apparent in that period of time. An
employee may not use Form CA-16 to authorize his or her own
treatments.
(2) Choice of Physician. The employee is entitled under FECA
to select the physician who is to provide treatment. The provider must
meet the definition of “physician” under the FECA and must not have
been excluded from payment under the program. (refer to Chapter 6 for
guidance in authorizing providers.) Physicians employed by or under
contract to the agency may examine the employee at the agency’s
facility in accordance with OPM regulations. However, the employee’s
choice of physician must be honored, and treatment by the employee’s
physician must not be delayed for the purpose of obtaining an agencydirected medical examination.
(3) Obtaining Treatment. Along with Form CA-16, the
supervisor should give the employee Form OWCP-1500, which is used
for billing. (This form is discussed in Chapter 6.) The physician should
complete the reverse of Form CA-16 and the OWCP-1500 and forward
them to OWCP’s central mailroom; the supervisor may ask the physician
for a copy of the report as well. The employee may be furnished

transportation and/or reimbursed for travel and incidental expenses.
OWCP generally considers 25 miles from the agency or the employee’s
home a reasonable distance to travel for medical care unless
appropriate care is not available within that radius.
(4) Further Referral. The original treating physician may wish to
refer the employee for additional testing or specialized treatment. He or
she may do so on the basis of the Form CA-16 already issued; it is not
necessary to issue authorizations for treatment. Both the original
physician and any physician to whom the employee is referred are
guaranteed payment for 60 days from the date of issue of Form CA-16
unless OWCP terminates this authority at an earlier date. Treatment
may continue at OWCP expense if the claim is approved. Should the
employee wish to change physicians after the initial choice, he or she
must contact OWCP in writing for approval and include the reasons for
requesting the change.
D. Medical Reports - Forms CA-20 and CA-17
When OWCP is adjudicating entitlement, a medical report from the
attending physician is required. This report may be submitted on Form
CA-16 or on Form CA-20, Attending Physician’s Report, which is
attached to the Form CA-7, Claim for Compensation. Also, the report
may be submitted in narrative form on the physician’s letterhead
stationery, or in the form of a hospital or health plan summary. The
report should bear the physician’s signature or signature stamp. The
supervisor should supply Forms CA-20 to the employee as often as
needed. The original reports should be sent to OWCP.
Agency personnel should use Form CA-17, Duty Status Report, to
obtain interim medical reports about the employee’s fitness for duty; it
may be issued initially with Form CA-16. The supervisor should
complete the agency’s portion of the form by describing the physical
requirements of the employee’s job and noting the availability of any light
or limited duty. The physician should send the original Form CA-17 to
the agency and a copy to OWCP’s central mailroom. The supervisor
may send CA-17 to the physician at reasonable intervals (but not more
often than once a week) to monitor the employee’s medical status and
ability to return to light or full duty. (Agency offers of light or limited duty
during the COP period are discussed in Chapter 5.)

E. Wage Loss/Permanent Impairment - Form CA-7
If disability is anticipated at the time of injury, the employee may elect to
use leave or COP (which is discussed in chapter 5) on Form CA-1. An
employee who cannot return to work when COP ends, or who is not
entitled to receive COP, may claim compensation for wage loss on Form
CA-7. In controverted cases where pay is terminated, Form CA-7
should be submitted with Form CA-1.
(1) When to File. If it is not clear whether the employee will
remain disabled after the 45 days of COP are used, he or she should
initiate a claim for compensation. Supervisors should carry employees
who have filed claims in LWOP status. If an employee returns to work
after Form CA-7 has been filed, the supervisor should notify OWCP by
telephone, or by electronic notice through the Agency Query System
(AQS).
(2) Completion of Form. If compensation is to be claimed,
the supervisor should give Form CA-7 to the employee on the 30th day
of COP with instructions to complete the front and return the form to the
agency within one week. (This measure is used to help avoid major
interruptions in pay). If the employee has not returned it by the 40th day
of COP, the supervisor should contact him or her by telephone and ask
for its submittal as soon as possible.
When the form is returned, the supervisor should complete
the reverse of the form, including the name and the telephone number of
an agency official with direct knowledge of the claim.
The employee should arrange to provide medical evidence
to support the period of disability claimed; this evidence may be
submitted with the Form CA-7 or sent to OWCP separately.
(3) Submission of Form. After completing the form, the
supervisor should send it to OWCP, along with any new medical
evidence in the agency’s possession. OWCP will use the pay data
supplied by agency personnel to determine the rate at which
compensation is to be paid. (Submittal should not be delayed for
computation of shift differential, Sunday or holiday pay, or other
incremental pay. These elements, which are discussed in Chapter 8,
may be computed and submitted separately.) The dates of

compensation claimed should represent the period of disability
supported by the medical evidence or the interval until the employee’s
next medical appointment.
(4) Leave Repurchase. An employee who uses sick or
annual leave to avoid interruption of income may repurchase that leave,
subject to agency concurrence, if the claim is approved. Form CA-7
(along with Forms CA-7a and CA-7b) is used for this purpose. The
employee and supervisor should supply the factual and medical
evidence described above and the supervisor should also provide a
detailed breakdown of leave used, showing the number of hours
charged for each day claimed and whether sick or annual leave was
used. (The relationship between COP use and leave use is discussed
in Chapter 5-2.)
(5) Lost Wages for Medical Treatment. An employee
who has returned to work but still requires medical treatment during
work hours may claim compensation for lost wages while undergoing or
traveling to and from the treatment. For a routine medical appointment,
a maximum of four hours of compensation is usually allowed. Such a
claim should be made on Form CA-7 and it should be accompanied by a
statement from the supervisor showing the exact period of time, the total
amount of wages lost due to the treatment, the rate of pay and the
number of hours or days the employee would have worked if available.
Form CA-7 is also used to claim continuing compensation
for wage loss. During the period of disability, a new Form CA-7 should
be submitted every two weeks, absent other instructions from OWCP.
Finally, Form CA-7 is used to claim schedule awards for
permanent impairment. (Entitlement to such awards is discussed in
Chapter 7-1.)

2-3. Occupational Disease
An occupational disease is defined as a condition produced in the work
environment over a period longer than one workday or shift. It may
result from systemic infection, repeated stress or strain or conditions of
the work environment.

A. Notice of Occupational Disease - Form CA-2
The injured employee, or someone acting on his or her behalf, should
give notice of occupational disease on Form CA-2. It may be filed on
the paper form or electronically, depending on the employing agency’s
participation. (Such notice may be provided by the supervisor as well.)
The supervisor should issue to the employee two copies of the
appropriate checklist, Form CA-35, a-h, for the disease claimed. (To
facilitate submittal of evidence, specific checklists have been devised for
various conditions. See Appendix C.) The supervisor should also
explain the need for detailed information to the employee and advise
him or her to furnish supporting medical and factual information
requested on the checklist. If possible, this information should be
submitted with the form. Upon receiving Form CA-2, the supervisor
should:
(1) Review the front of paper form CA-2, or the information
submitted electronically by the employee, for completeness and
accuracy and assist the employee in correcting any errors or omissions;
(2) Complete and sign the reverse of the paper Form CA-2 or
complete the electronic form. A telephone number should be included in
case OWCP staff has questions about the claim. Also, enter the
appropriate codes on the form. Include codes for occupation, type and
source of injury, agency identification and location of duty station.
(Appendix B describes the type and source of injury codes and their
uses.);
(3) Sign and return to the employee the receipt attached to the
paper Form CA-2 and give a copy of the entire form to the employee.
Or, if submitted electronically, print a copy of the electronic form and
give it to the employee.
(4) Review the employee’s portion of the form and provide
comments on the employee’s statement;
(5) Prepare a supporting statement to include exposure data, test
results, copies of results of previous medical examinations and/or
witness statements, depending on the nature of the case. The checklist

may be used to coordinate compilation of material by agency personnel,
including compensation specialists and safety and health officers;
(6) Advise the employee of the right to elect sick or annual leave
or leave without pay, pending adjudication of the claim. The supervisor
should submit completed Form CA-2 to the district office within 10
working days of receipt from the employee. It should not be held for
receipt of supporting documentation.
B. Medical Treatment - Form CA-16
Only rarely may employers authorize medical care in occupational
disease claims. The supervisor must contact OWCP before issuing a
Form CA-16.
C. Wage Loss/Permanent Impairment - Form CA-7
Form CA-7 is used to file a claim for compensation because of pay loss.
The claim should be filed as soon as possible, but no more than 14
calendar days after the date pay stops or when the employee returns to
work, whichever comes first.
(1) Leave Repurchase. The employee may use sick or annual
leave pending adjudication of the claim. If this is done, the employee
may initiate repurchase of this leave, subject to agency concurrence,
using Form CA-7, (along with Forms CA-7a and CA-7b). The supervisor
should certify the amount and kind of leave used for each day claimed,
and the employee should arrange to submit medical evidence
supporting the period of repurchase requested.
(2) Lost Wages for Medical Treatment. An employee who has
returned to work but still needs medical treatment during work hours
may claim compensation for lost wages while undergoing or traveling to
and from the treatment. For a routine medical appointment, a maximum
of four hours of compensation is usually allowed. Such a claim should
be made on Form CA-7 and it should be accompanied by a statement
from the supervisor showing the exact period of time, the total amount of
wage lost due to the treatment, as well as the rate of pay.
Form CA-7 is also used to claim continuing compensation and to initiate
a claim for a schedule award for permanent impairment resulting from

occupational disease. Chapter 7-1 addresses entitlement to schedule
awards.

2-4. Recurrences
A recurrence of disability is defined as a spontaneous return or increase
of disability due to a previous injury or occupational disease without
intervening cause, or a return or increase of disability due to a
consequential injury (defined in Chapter 3-5). A recurrence of disability
differs from a new injury in that with a recurrence, no event other than
the previous injury accounts for the disability.
A recurrence of medical condition is defined as a documented need for
further medical treatment after release from treatment for the accepted
condition or injury when there is no accompanying work stoppage.
Continuous treatment for the original condition or injury is not considered
a “need for further medical treatment after release from treatment” nor is
an examination without treatment.
A. Claim for Recurrence of Disability - Form CA-2a
If a recurrence of disability develops, the employee and supervisor
should complete Form CA-2a and submit it to OWCP. If the employee
was entitled to use COP and the 45 calendar days of COP have not
been exhausted, he or she may elect to use the remaining days if 45
days have not elapsed since the first return to duty. (See Chapter 5-7
for detailed information.) Otherwise, the employee may elect to use sick
or annual leave pending adjudication of the claim for recurrence. The
employee should arrange for submittal of the factual and medical
evidence described in the instructions attached to the form, paying
particular attention to the need for “bridging” information which describes
his or her condition and job duties between the original injury and the
recurrence.
B. Medical Treatment
Ordinarily, no medical treatment is authorized at OWCP expense until a
claim for recurrence is accepted. At its discretion, the district office may
authorize an emergency medical examination without Form CA-2a.

C. Continuing Claim for Wage Loss - Form CA-7
Form CA-7 is used to file a claim for continuing compensation due to a
recurrence. During the period of disability, a new Form CA-7 should be
submitted every two weeks, absent other instructions from OWCP.

2-5. Death
When an employee dies because of an injury incurred in the
performance of duty, the supervisor should immediately notify the district
office by telephone or facsimile message. The supervisor should also
contact any survivors, provide them with claim forms and help them
prepare the claim. The forms should be submitted to OWCP, even if a
disability claim was previously filed and benefits were paid. Continuation
of benefits is not automatic as it must be shown that the work related
condition contributed to the death.
A. Claims for Death Benefits - Forms CA-5 and CA-5b
The survivors of a deceased employee should use Form CA-5 or CA-5b
to submit claims for death benefits. Such notice may be provided by the
supervisor as well. The survivor should complete the front of the
appropriate form, while the attending physician should complete the
medical report on the reverse. The claim form should be forwarded to
OWCP with a copy of the death certificate, a copy of the marriage
certificate if a spouse is making claim and a copy of any divorce or
annulment decree if the decedent or spouse was formerly married. The
submittal should also include copies of birth certificates of any children
for whom claim is made.
B. Agency Notice - Form CA-6
The supervisor uses this form to report the work-related death of an
employee. It should be completed by the supervisor and sent to OWCP
no more than 10 working days after notification of the death.
2-6

Death Gratuity

FECA was amended by adding a new section 8102a (5 U.S.C. §
8102a – Death Gratuity). (See section 1105 of the National Defense

Authorization Act for FY 2008, Public Law 110-181.) This new
provision creates a death gratuity for Federal employees and
employees of nonappropriated fund instrumentalities by authorizing
the United States to pay up to $100,000 to the survivors and
designated beneficiaries "an employee who dies of injuries incurred
in connection with the employee's service with an Armed Force in a
contingency operation.” This provision became effective on January
28, 2008.
A. Claim for Benefit
Any time a Federal employee is assigned to provide service to an
Armed Force in a contingency operation, as defined in 8102(a), he or
she should be informed of this death gratuity and be given the
opportunity to designate a beneficiary on the Designation of Recipient
of Death Gratuity Payment under Section 1105 of Public Law 110181 form. Employees already so assigned should also be given this
opportunity. An employee desiring to designate one or more
beneficiaries of a death gratuity payable under this provision should
complete and sign a copy of the form, retain a copy, and give the
original to his or her employer to be maintained by the employer in
the employee’s official personnel file, or a related system of records.

Chapter 3. Conditions of Coverage
Each claim for compensation must meet certain requirements before it
can be accepted. This is true whether the claim is for traumatic injury,
occupational disease or death. While the requirements are addressed
somewhat differently according to the type of claim, they are always
considered in the same order. This chapter will describe these
requirements as well as the three statutory prohibitions to payment of
compensation. It will also describe the kind of information which the
supervisor and employee should submit with respect to each issue.
3-1
3-2
3-3
3-4
3-5
3-6

Time
Civil Employee
Fact of Injury
Performance of Duty
Causal Relationship
Statutory Exclusions

3-1. Time
All cases must first satisfy the statutory time requirements of the FECA.
A. Provisions of the Law
For injuries and deaths on or after September 7, 1974, the law provides
that a claim for compensation must be filed within three years of the
injury or death. See 5 U.S.C. 8122. Even if a claim is not filed within
three years, however, compensation may still be allowed if written notice
of injury was given within 30 days or the immediate supervisor had
actual knowledge of the injury or death within 30 days after occurrence.
This knowledge may consist of written records or verbal notification; an
entry into an employee’s medical record may also satisfy this
requirement if it is sufficient to place the agency on notice of a possible
work-related injury or illness.
The law also provides that filing a disability claim because of injury will
satisfy the time requirements for a death claim based on the same
injury. OWCP may excuse failure to comply with the three-year time

requirement because of exceptional circumstances (for example, being
held prisoner of war).
For injuries and deaths occurring before September 7, 1974, different
provisions apply with respect to timeliness. Contact the district office
concerning any such situation.
B. When Time Begins to Run
For a traumatic injury, the statutory time limitation begins to run from the
date of injury. For a latent condition, it begins to run when an injured
employee who has a compensable disability becomes aware, or
reasonably should have been aware, of a possible relationship between
the medical condition and the employment. Where the exposure to the
identified factors of employment continues after this knowledge, the time
for filing begins to run on the date of the employee’s last exposure to
those factors.
Where death is due to disease, time begins to run when the beneficiary
is aware, or reasonably should have been aware, of causal relationship
between the death and the factors of employment. For a minor, the time
limitations do not being to run until he or she reaches the age of 21 or
has a legal representative. For a person who is mentally incompetent,
the time limitations do not begin to run until he or she has a legal
representative.
C. Written Notice
Form CA-1 or CA-2 constitutes notice of injury. A claim for
compensation (Form CA-7 in disability cases, CA-5 or CA-5b in death
cases) may also constitute notice of injury. OWCP will also accept as a
notice of injury or death any written statement which is signed by the
person claiming benefits, or someone acting on his or her behalf, and
which states the name of the employee; the name and address of the
person claiming benefits; the time and location of the injury or death; and
the cause and nature of injury or death.
D. Actual Knowledge
An agency official may acquire actual knowledge through firsthand
observation of the incident, from another employee or from medical
personnel at the agency’s medical facility. This knowledge must place
the employing agency reasonably on notice of an on-the-job injury or

death. An entry into the employee’s medical records may be considered
actual knowledge, as may the results of tests conducted by agency
personnel in connection with known occupational hazards. The date on
which the agency or OWCP receives written notice will be considered
the date of filing. OWCP will request information addressing the issue of
actual knowledge only where the agency did not receive written notice
within three years.

3-2. Civil Employee
If the claim is timely filed, it must be determined whether the injured or
deceased individual was an “employee” within the meaning of the law.
This is always the second requirement considered.
A. Provisions of the Law
The FECA covers all civilian Federal employees except for nonappropriated fund employees. In addition, special legislation provides
coverage to Peace Corps and VISTA volunteers; Federal petit or grand
jurors; volunteer members of the Civil Air Patrol; Reserve Officer’s
Training Corps Cadets; Job Corps and Youth Conservation Corps
enrollees; and non-Federal law enforcement officers under certain
circumstances involving crimes against the United States.
B. Other Considerations
Temporary employees are covered on the same basis as permanent
employees. Contract employees, volunteers and loaned employees are
covered under some circumstances. Such determinations must be
made on a case-by-case basis once a claim is filed. Federal employees
who are not citizens or residents of the United States or Canada are
covered subject to certain special provisions governing their pay rates
and computation of compensation payments.

3-3. Fact of Injury
If the issues of “time” and “civil employee” have been resolved
affirmatively, it must be established whether the employee in fact
sustained an injury or disease. Two factors are involved in this
determination:

A. Occurrence of Event
Whether the employee actually experienced the accident, event, or
employment factor which is alleged to have occurred. This is resolved
on the basis of factual evidence, including statements from the
employee, the supervisor, and any witnesses. An injury need not be
witnessed to be compensable. A supervisor who believes, however,
that the employee’s testimony is contrary to the facts should supply
pertinent information to support this belief.
B. Existence of Medical Condition
Whether the accident or employment factor resulted in an injury or
disease. This is determined on the basis of the attending physician’s
statement that a medical condition is present that could be related to the
incident, though the medical report need not relate the condition to the
incident. Simple exposure, for instance to a contagious condition or
dusty environment does not constitute an injury.

3-4. Performance of Duty
If the first three criteria have been met, it must be determined whether
the employee was in the performance of duty when the injury occurred.
A. Agency Premises
An employee who is injured on agency premises during working hours
has the protection of the FECA unless engaged in an activity which
removes him or her from the scope of employment. Coverage includes
injuries which occur while the employee was performing assigned duties
or engaging in an activity which was reasonably associated with the
employment. Such activities include use of facilities for the employee’s
comfort, health, and convenience as well as eating meals and snacks
provided on the premises. The premises include areas immediately
outside the building, such as steps or sidewalks, if they are federally
owned or maintained. The supervisor should document an injury
occurring in such an area by submitting a diagram showing where it
happened.

(1) Outside Working Hours. Coverage is extended to employees who
are on the premises for a reasonable time (usually considered 30
minutes) before or after working hours. It is not extended, however, to
employees who are visiting the premises for non-work-related reasons.
The supervisor should verify the time of the injury and provide any
available information about the employee’s purpose for being on the
premises at the time of injury.
(2) Representational Functions. Injuries to employees performing
representational functions entitling them to official time are covered.
Injuries to employees engaged in the internal business of a labor
organization, such as soliciting new members or collecting dues, are not
covered. The supervisor should advise whether the employee was
entitled to official time when injured.
(3) Parking Facilities. The agency’s premises include the parking
facilities which it owns, controls, or manages. An employee will usually
be covered if injured on such parking facilities. Information submitted by
the supervisor should include a statement indicating whether the agency
owns or leases the parking lot and, if the latter, the name and address of
the owner (this information may be needed to develop the third-party
aspect of the claim, which is described in Chapter 4-1). If the parking lot
is not immediately adjacent to the building, the supervisor should also
supply a diagram showing where the injury took place in relation to the
parking lot and building.
(4) Agency Housing. An employee is covered if injured during the
reasonable use of premises which he or she is required or expected to
occupy, and which are furnished or made available by the agency.
(Employees using such housing include firefighters and Job Corps
enrollees.) Any claim for injury occurring in this way should be
accompanied by a full description of the living arrangements and the
requirements and expectations surrounding them.
B. Off-Premises Injuries Coverage is extended to workers such as
letter carriers, chauffeurs and messengers who perform service away
from the agency’s premises. It is also extended to workers who are sent
on errands or special missions and workers who perform services at
home.

(1) To and From Work. Employees do not have the protection of the
FECA when injured en route between work and home except where the
agency furnishes transportation to and from work, the employee is
required to travel during a curfew or emergency or the employee is
required to use his or her vehicle during the workday. Such claims
should be accompanied by a description of the circumstances.
(2) Lunch Hour. Injuries which occur during lunch hour off the
premises are not ordinarily covered unless the employee is in travel
status or is performing regular duties off premises.
(3) Travel Status. Employees in travel status are covered 24 hours a
day for all reasonable incidents of their temporary duty. Thus, an
employee injured on a sightseeing trip in the city to which he or she was
assigned would not be covered, while an employee injured while taking
a shower in the hotel would be covered. All claims for injuries occurring
in travel status should be accompanied by a copy of the travel
authorization.
(4) Vehicle Accidents. Any claim involving a traffic accident should be
accompanied by a copy of the police report, if any, and a diagram or
map showing the location of the accident in relation to the places where
official duty was last performed and next scheduled.
C. Other Factors Some injuries occur under circumstances which are
not governed, or not completely governed, by the premises rules.
Injuries involving any of the circumstances indicated below must be
determined on a case-by-case basis.
(1) Recreation. An employee is covered while engaged in formal
recreation for which he or she is paid or is required to perform as part of
training or assigned duties. Also covered are employees engaged in
informal recreation, such as jogging, while on the agency premises.
Under other circumstances, the agency must explain what benefit it
derived from the employee’s participation, the extent to which the
agency sponsored or directed the activity and whether the employee’s
participation was mandatory or optional.
(2) Horseplay.
An employee who is injured during horseplay is
covered if the activity was one which could reasonably be expected
where a group of workers are closely associated for extended periods of

time. In this kind of case, it must be determined whether the specific
activity was a reasonable incident of the employment or whether it was
an isolated event which could not reasonably have been expected to
result from close association.
(3) Assault. An injury or death caused by the assault of another person
may be covered if it is established that the assault was accidental and
arose out of an activity directly related to the work or work environment.
Coverage may also be extended if the injury arose out of a personal
matter having no connection with the employment if it was materially and
substantially aggravated by the work associations. The supervisor
should submit copies of reports of any internal or external investigations
as well as witness statements from parties with knowledge of the
incident.
(4) Emergencies. Coverage is extended to employees who
momentarily step outside the sphere of employment to assist in an
emergency, such as to extinguish a fire or help a person hit by a car.

3-5. Causal Relationship
After the four factors described above have been considered, causal
relationship between the condition claimed and the injury or disease
sustained is examined. Unlike fact of injury, which is discussed in
paragraph (3-3) above and which involves the determination that a
medical condition is present, causal relationship involves the
establishment of a connection between the injury and the condition
found. This factor is based entirely on medical evidence provided by
physicians who have examined and treated the employee. Opinions of
the employee, supervisor or witness are not considered, nor is general
medical information contained in published articles.
A. Kinds of Causal Relationship
An injury or disease may be related to employment factors in any one of
four ways:
(1) Direct Causation. This term refers to situations where the injury or
factors of employment result in the condition claimed through a natural
and unbroken sequence.

(2) Aggravation. If a pre-existing condition is worsened, either
temporarily or permanently, by a work-related injury, that condition is
said to be aggravated.
(a) Temporary aggravation involves a limited period of medical
treatment and/or disability after which the employee returns to his or her
previous medical status. Compensation is payable only for the period of
aggravation established by the medical evidence and not for any
disability caused by the underlying disease. This is true even if the
employee cannot return to the job held at the time of injury because the
pre-existing condition may be aggravated again. For example, if
exposure to dust at work temporarily aggravates an employee’s preexisting allergy, compensation will be payable for the period of workrelated disability but not for any subsequent period even though further
exposure to the work place may cause another aggravation.
(b) Permanent aggravation occurs when a condition will persist
indefinitely due to the effects of the work-related injury or when a
condition is materially worsened by a factor of employment such that it
will not return to the pre-injury state.
(3) Acceleration. A work-related injury or disease may hasten the
development of an underlying condition. Acceleration is said to occur
when the ordinary course of the disease does not account for the speed
with which a condition develops.
(4) Precipitation. This term refers to a latent condition which would not
have manifested itself on this occasion but for the employment. For
example, an employee’s latent tuberculosis may be precipitated by
work-related exposure.
B. Medical Evidence
The issue of causal relationship almost always requires reasoned
medical opinion for resolution. This opinion must come from a physician
who has examined or treated the employee for the condition claimed.
Where a pre-existing condition involving the same part of the body is
present, the physician must provide rationalized medical opinion which
differentiates the effects of the employment-related injury or disease

from the pre-existing condition. Such evidence will permit the proper
kind of acceptance (temporary vs. permanent aggravation, for instance).
To establish causal relationship, additional medical opinion may be
requested of OWCP’s District Medical Director/Advisor or from a
specialist in the medical field pertinent to the injury or disease. In a
claim for a psychiatric condition, a report from a psychiatrist or clinical
psychologist will be required. In claims for hearing loss and pulmonary
disease, OWCP will refer the employee for examination by an
appropriate specialist after exposure to the hazardous condition or
substance has been established. Chapter 6 contains further information
about medical examinations.
C. Consequential and Intervening Injuries
Sometimes an injury occurring outside the performance of duty affects
the compensability of a work-related injury.
(1) A consequential injury is a new injury which occurs as the
result of a work-related injury (for example, because of weakness
or impairment caused by a work-related injury). Included in this
definition are injuries sustained while obtaining medical care for a
work-related injury. Consequential injuries are compensable.
(2) An intervening injury is one which occurs outside the
performance of duty to the same part of the body originally injured.
The resulting condition will be considered related to the original
injury unless the second injury, and any other factors unrelated to
the original injury, is established as its cause.
For instance, an employee with an accepted claim for back strain later
begins to have pain which suggests disc involvement. Later, while at
home, the employee suffers back pain when leaning over the tub to
clean it. Unless the incident at home is medically competent to cause
the resulting condition and it breaks the chain of causation of an earlier
injury, OWCP will consider the resulting condition to be causally related
to the original injury.

3-6. Statutory Exclusions
Sometimes the circumstances of a case raise the issues of willful
misconduct, intention to bring about the injury or death of oneself or
another, or intoxication. If any of these factors is the cause of the injury
or death, benefits are denied. Agency or OWCP staff must assert and
prove these factors.
A. Willful Misconduct
The question of deliberate willful misconduct may arise when the
employee violated a safety rule, disobeyed orders of the employer, or
violated a law. Because safety rules are established for the protection of
the worker rather than the employer, simple negligent disregard of such
rules is not sufficient to deprive an employee or beneficiary of
entitlement to compensation. Disobedience of such orders may destroy
the right to compensation only if the disobedience is deliberate and
intentional as distinguished from careless and heedless.
B. Intoxication
In any case involving intoxication, whether by alcohol or illegal drugs, the
record must establish the extent to which the employee was intoxicated
at the time of the injury and the particular manner in which the
intoxication caused the injury. It is not sufficient just to show that the
employee was intoxicated; it must be shown that the intoxication
proximately caused the injury. This requirement does not, however,
provide agency personnel with any additional authority to test
employees for drug use beyond that which may exist under other
statutes or regulations.
C. Intent to Bring About Injury or Death to Oneself or Another
Where it appears that the employee brought about his or her own injury
or death, or that of another, intent must be
established. If the factual and medical evidence show that the employee
was not in full possession of his or her faculties, the injury may be
compensable. Thus, suicide may be compensable if the injury and its
consequences directly caused a mental disturbance or physical
condition which produced a compulsion to commit suicide and
prevented the employee from exercising sound discretion or judgment
so as to control that compulsion.

Chapter 4. Processing Claims
This chapter describes procedures and responsibilities for case handling
once the proper forms and information have reached OWCP. It also
describes the steps which agency personnel should take if they believe
a claim is questionable.
4-1
4-2
4-3
4-4

Administrative Matters
Burden of Proof
Questionable Cases
Decisions and Notification

4-1. Administrative Matters
A. Initial Handling
The notice of traumatic injury, occupational disease or death should be
filed with the district office with jurisdiction over the location of the
employing agency. (After adjudication, the claim may be transferred to
the district office with jurisdiction over the location of the employee’s
residence, if different.) When possible, the notice should be
accompanied by supporting documents such as medical reports and
statements from the employee, the supervisor, and any witnesses.
However, submittal of claim forms should not be delayed pending
receipt of the supporting documents. When the notice is received,
OWCP will send the employee a Form CA14 which contains general
information and the case number. Employers receive notice of new
case numbers either through EDI transmission or by postcard
notification.
OWCP will administratively close uncontroverted claims with medical
bills totaling less than $1500, no claim for compensation benefits, and
no potential third-party liability. Claims not meeting these criteria will be
assigned to a claims examiner for formal adjudication, as will those
which exceed the $1500 threshold for medical bill payment.
The claims examiner will determine if information in addition to the initial
submittal is required to adjudicate the claim. If so, the information will be

requested of the employee and/or the supervisor with a copy to all
parties to the claim. While the requirements for accepting a claim are
considered in the order shown in the previous chapter, OWCP will
attempt to request information on all unresolved aspects of the claim at
the same time in the interest of efficient case handling.
B. Obtaining Information
Most routine requests for information are conveyed by mail. Under the
Privacy Act, the employee or representative is entitled to receive one
copy of the case file from OWCP free of charge; additional copies will be
sent at a cost of $.15 per page. It is not necessary to request the
records under the Freedom of Information Act.
Ordinarily, a complete copy of the record is sent directly to the requestor;
occasionally, if sensitive medical information is involved, OWCP will
forward the medical reports to a physician of the employee’s choice so
that the contents may be properly interpreted to the employee.
Sensitive medical information may be sent to the employee’s
representative, with the proviso that it not be disclosed to the employee
without the attending physician’s permission.
C. Conferencing
Telephone conferences conducted by a senior claims examiner may be
held in cases involving complicated adjudicatory and case management
issues. Conferences may be used to address the agency’s
controversion; the occurrence of an injury as claimed, the occurrence of
an injury in the performance of duty; occupational disease cases
involving voluminous factual evidence or complex determinations;
overpayments; and return-to-work efforts. Conferences may also be
held where the employee is not able to express himself or herself well in
writing.
A representative of the agency may be asked to participate in such a
conference, either with the claims examiner or senior claims examiner
alone or together with other parties to the claim. After the conference,
the Examiner completes a Memorandum of Conference which describes
what each party said, then asks the participant(s) to provide any
comments on this document within 15 days (except that comments are
not requested if the decision is found in favor of the party conferenced)..

The Senior Claims Examiner then makes findings on the issue for
resolution and issues a decision.
D. Representation
The FECA provides that an employee may be represented if he or she
so desires, but it is not required. A representative need not be an
attorney; a union representative, family member or friend, for example,
may act in this capacity. A Federal employee may act as a
representative only for an immediate family member or in the capacity of
a union representative. The employee must designate any
representative in writing before OWCP will recognize him or her, and
there can be only one representative at a time.
OWCP does not honor contingency fee agreements, and the law
contains no provision for OWCP to pay representatives’ fees. It does
require, however, that OWCP approve such fees before payment.
Where the representative and the employee agree on the fee charged,
the fee is deemed approved. Where a disagreement exists, OWCP will
evaluate the request. In this instance, the employee shall not pay any
fee prior to approval by OWCP, unless the fee is paid into a true escrow
account.
E. Third Party
When a party other than the injured employee or another employee of
the agency appears to be responsible for an injury or death, OWCP may
ask the employee to seek damages from that party, which may be an
individual, a company or a product manufacturer. OWCP encourages
supervisors to investigate the third-party aspect of any claim and submit
all information gathered. OWCP will contact the employee with specific
instructions about this aspect of the claim; he or she should not attempt
to settle such claim without first obtaining advice and approval from the
Solicitor of Labor through OWCP.
While a claim is pending against the third party, OWCP will pay medical
and compensation benefits to which the beneficiary is entitled. If a
recovery is made, the beneficiary must first pay outstanding legal fees
and costs. He or she is then entitled to retain 20 percent of the
remaining amount, plus an amount equivalent to a reasonable attorney’s
fee in proportion to the sum which will be owed to OWCP. The latter
amount generally includes the total medical and compensation

payments made by OWCP up to the time of settlement. The beneficiary
retains any money remaining, which is credited against future claims for
benefits. OWCP will resume payment of compensation benefits and
medical bills only after the beneficiary has submitted claims which
exceed the amount of money remaining.

4-2. Burden of Proof
The employee is responsible for establishing the essential elements of
the claim as described in Chapter 3. OWCP will help the employee to
meet this responsibility, which is termed burden of proof, by requesting
evidence needed to establish these elements if such information is not
included with the original submittal.
OWCP will try to obtain any pertinent medical evidence in the
possession of another Federal facility, including the employing agency,
but this assistance does not relieve the employee of his or her burden of
proof. Agencies are required by law to provide medical and factual
evidence requested by OWCP to adjudicate a claim. Agencies and
employees are always entitled to present information not specifically
requested by OWCP.
When information is not submitted in a timely manner, delays in
adjudicating cases and paying claims often result. To minimize such
delay, OWCP will ask the employee and supervisor to submit the
required evidence within a specific period, usually 30 days from the date
of the request. A copy of any request to the supervisor for information
will be sent to the employee, and vice versa.
A. Traumatic Injury Cases (Including Recurrence and Death)
(1) The factual evidence required from an employer in a traumatic
case often concerns the circumstances of the injury. By anticipating
the information that OWCP will need, as described in the preceding
chapter, supervisors contribute to the efficient handling of the claim.
Each submittal of forms should contain a clear description of how the
injury occurred, including the time and place, whether it happened
during working hours, the presence of witnesses, etc.

If this information is not included in the original submittal, OWCP will
request it. If the requested information is not received, OWCP will
process the case on the basis of the evidence submitted by the
employee, as follows:
(a) If the employee’s statement is sufficiently detailed and/or
credible, OWCP will accept the statement and adjudicate the case
accordingly.
(b) If the employee’s statement is not sufficient and/or credible,
the case will be denied for the reason that one or more of the five basic
elements required to approve a claim has not been established.
(2) Medical evidence in possession of the agency may also be
requested.
(a) In an unadjudicated case, the supervisor should submit copies of
medical records pertaining to the injury and any relevant pre-existing
condition, at the time of initial submittal to OWCP. OWCP will request
this evidence of the agency if it is not sent with the original submittal.
(b) In an accepted case, if the employee receives continuing care from
an agency physician (or its contract provider), the supervisor should
include supporting medical evidence for disability with claims submitted.
Otherwise, OWCP will request this evidence.
If the file contains prima facie medical evidence of disability for the
period claimed but additional support is needed, OWCP will authorize
payment for a reasonable period and request the evidence from the
employer. If another claim is received and the previously requested
evidence has not been submitted, OWCP will again authorize payment
of compensation for a reasonable period and refer the employee to a
medical specialist for examination.
(3) Information needed to make payment will usually include the
employee’s salary and the days of LWOP claimed. Agencies can
speed up payment by advising OWCP if the pay rate includes elements
of pay such as night and Sunday differential. If so, OWCP will need to
know whether the employee has received the increments regularly (in
which case the biweekly amount should be stated) or sporadically (in

which case the employee’s entire earnings in the relevant pay category
for the year preceding the injury should be stated).
Where the pay rate is in question, OWCP will begin paying
compensation using the lower salary and request clarification from the
supervisor. If a second request is necessary, OWCP will advise the
employee that documentation is needed to support the higher pay rate
and will ask for any documentation in his or her possession. If the
agency fails to reply and the employee submits adequate documentation
(e.g., pay stubs), OWCP will adjust compensation. Until sufficient
documentation is received from the supervisor or the employee,
compensation will be paid at the lower rate.
Where the days and hours of LWOP are in question, OWCP will request
clarification from the supervisor. Any follow-up request will also advise
the employee of the need for documentation and invite him or her to
submit a detailed account for the period in question. If the employee
provides such an account, OWCP will send a copy to the supervisor for
review and advise that unless OWCP is notified of any inaccuracies in a
timely manner, the employee’s accounting will be used to compute the
payment.
B. Occupational Disease Claims (Including Recurrence and Death)
(1) OWCP’s requirement for factual information varies according
to the type and severity of the medical condition involved. Simple
occupational disease claims, for example a claim for poison ivy where
the job duties involved exposure to the plant, and the medical evidence
confirmed the diagnosis, require less evidence to adjudicate.
The information specified in the instructions on Form CA-2 and on the
evidence checklist appropriate to the disease in question should be sent
with the initial submittal. If sufficiently detailed descriptions of how the
condition developed are not received, OWCP will request the
information needed for adjudication.
If the information is not received, OWCP will process the case on the
basis of the evidence submitted by the employee. As with traumatic
injury cases, if that evidence is sufficient and/or credible, OWCP will
accept the employee’s statements and adjudicate the case accordingly.

If the evidence is not sufficient and/or not credible, OWCP will deny the
case because one or more of the five basic elements required to
approve a case has not been established.
(2) An agency’s medical facility sometimes provides medical
examination and treatment.
If additional evidence about such treatment is needed from the agency,
OWCP will advise the employee that we are attempting to obtain it, but
the burden of proof still rests upon the employee and that he or she
should also try to obtain that evidence.
(3) As with traumatic injury cases, payment information needed
from the agency will likely include the employee’s pay rate and the
days of LWOP claimed, and OWCP will use the procedures
described above for obtaining such information in traumatic injury
cases. The medical evidence developed for initial adjudication should
provide sufficient information about the nature and extent of disability to
permit adjudication of the claim for wage loss. If not, OWCP will follow
the procedures for developing medical evidence for wage-loss claims in
traumatic injury claims.
Once OWCP accepts a claim, the burden of proof shifts from the
employee to OWCP. To rescind the acceptance of a condition or to
make a retroactive determination that an employee was not disabled for
a period during which compensation was paid, OWCP must
demonstrate not only that an error was made but that the weight of the
evidence supports a different conclusion about the merits of the claim.
In practice, this means that new evidence is virtually always required to
rescind an acceptance.

4-3. Questionable Cases
If the supervisor questions the validity of a claim, he or she should
investigate the circumstances and report the results to OWCP. All such
allegations must be supported by specific factual evidence. Situations
which may prompt the supervisor to conduct such an investigation, and
actions which the agency may take, are as follows:

A. Differing Versions
If the employee has given differing versions of the incident to different
people, or if several witnesses give differing accounts of the facts
surrounding the injury, the supervisor should request a written statement
from each person which details his or her knowledge of the situation.
B. Previous Injury
If the employee reported to work on the date of the claimed injury with
the appearance of a pre-existing condition or injury, the agency should
obtain statements from witnesses which detail the relevant observations.
C. Time Lags
If an injury is reported long after its alleged occurrence, and the
employee appears to be able to perform normal duties, a written
statement detailing the situation should be composed.
D. Other Employment
If an employee who has claimed injury is reported to be working at
another job, the supervisor should first ask him or her about the
requirements of the other employment. Depending on the reply, the
supervisor may wish to ask the employee for permission to contact the
other employer for information about duties and periods of work.
OWCP will consider all information submitted and correspond with the
parties if necessary. Also, OWCP may investigate the claim, whether or
not the agency has conducted an investigation. The authority to
determine any aspect of a claim rests with OWCP, and while the agency
is entitled to an explanation of the basis of OWCP’s actions, it must
accept the determination rendered.

4-4. Decisions and Notification
If disability is expected to occur or continue, OWCP will notify the
employee by letter that his or her case is accepted. The letter will state
the medical condition for which the claim is accepted and advise how to
claim compensation benefits and obtain payment or reimbursement of
medical bills.

In cases involving potential long-term disability, OWCP will notify the
employee of his or her obligation to seek work when he or she is no
longer totally disabled. The supervisor will receive a copy of this
notification and will also be asked to submit a copy of the employee’s job
description and job application (OF-612 or equivalent) to prepare for
eventual reemployment. (That process is described in Chapter 8.)
During the life of a claim, decisions may be rendered on various issues.
OWCP, through our contractor, will usually advise employees by letter
about such matters as approval or denial of surgical procedures and
other forms of medical care, and payment of medical bills. Appeal rights
are not included in such notifications, but OWCP will issue formal
decisions on such matters if requested.
Any determination that sets forth OWCP’s findings in the case and
includes a description of the employee’s appeal rights is known as a
formal decision. OWCP issues a formal decision whenever it reaches
an adverse decision about entitlement, such as denial of an initial claim
or denial of continuing benefits. Three avenues of appeal are provided
for employees (the agency is not entitled to appeal). The employee may
request only one form of appeal at a time.
A. Hearing
The employee is entitled to either an oral hearing before an OWCP
representative or a review of the written record (but not both), as long as
written request is made within 30 days of the formal decision and a
reconsideration has not already been requested. The employee may
request a change of format under certain circumstances.
The request should be sent to the Branch of Hearings and Review at the
address stated in the appeal rights; no specific form is needed.
Hearings may be held in person, by telephone or video conference at
the discretion of the hearing representative. If the hearing is held in
person, it will be held within 100 miles of the employee’s home; and the
employee may present written evidence or oral testimony in support of
the case. If a review of the written record is chosen, the employee may
not present oral testimony but he or she may submit written evidence or
argument.

If an oral hearing is requested, OWCP will advise the agency of the date
and time. The agency may have one representative (or more, where
appropriate) present at the hearing and/or request a copy of the
transcript. The agency representative may not participate in the
proceedings, however, unless specifically invited to do so by the
employee or the OWCP representative.
For either an oral hearing or a review of the written record, OWCP will
allow the agency representative 20 days to submit comments and/or
additional documents, which will be subject to review and comment by
the employee within a further 20 day period.
After the oral hearing is held or the review of the written record is
completed, OWCP will issue a formal decision, including a description of
the employee’s further appeal rights.
B. Reconsideration
The employee may ask OWCP to reconsider a formal decision made by
the district office. The request should be addressed to the district office.
No special form is required, but the request should clearly state the
grounds on which it is based. It must be accompanied by relevant
evidence not previously submitted or arguments for error in fact or law in
reaching the contested decision. A reconsideration must be requested
within one year of the date the contested formal decision was issued.
For any request which meets these criteria, OWCP will provide the
agency representative with a copy of the employee’s request, and will
allow 20 days for submittal of comments and/or documents which will in
turn be subject to the employee’s review and comment within 20 days.
Following reconsideration, OWCP will issue a new formal decision that
includes a description of the employee’s further appeal rights.
C. Review by Employees’ Compensation Appeals Board (ECAB)
An employee may request review by the ECAB, which is the highest
authority in Federal workers’ compensation claims. The employee
should file for such review directly with the ECAB at the address shown
in the formal decision. The ECAB’s review is based solely upon the
case record at the time of the formal decision; new evidence is not
considered.

Employees should file application for review by the ECAB within 180
days of the date of the decision. This rule became effective, November
19, 2008.

Chapter 5. Continuation of Pay (COP)
This chapter describes the employee’s entitlement to continuation of his
or her regular pay (COP) for periods of disability or medical care which
occur soon after a traumatic injury.
5-1
5-2
5-3
5-4
5-5
5-6
5-7
5-8
5-9

Definition and Entitlement
Use of Leave Instead of COP
Controversion
Pay Rate for COP Purposes
Computation
Light-or Limited-Duty Assignments
Recurrences
Terminating COP
Reporting COP

5-1. Definition and Entitlement
The FECA provides that an employee’s regular pay may continue for up
to 45 calendar days of wage loss due to disability and/or medical
treatment after a traumatic injury. The intent of this provision is to avoid
interruption of the employee’s income while the case is being
adjudicated. COP is not considered compensation and is therefore
subject to the usual deductions from pay, such as income tax and
retirement allotments. After entitlement to COP ends, the employee may
apply for compensation or use leave.
An employee is entitled to receive COP when he or she is absent from
work due to disability or medical treatment, or when he or she is
reassigned by formal personnel action to a position with a lower rate of
pay due to partial disability. Because informal assignment to light or
limited duties without a personnel action does not result in pay loss, time
worked in such a position may not be changed to COP. However, an
employee whose work schedule is changed so that a loss of salary or
premium pay (e.g., holiday pay or night differential, though not Sunday
pay) results, is entitled to COP for such wage loss whether or not the
schedule was changed by a formal personnel action.

Temporary employees are entitled to COP on the same basis as
permanent employees. If a termination date has been set for an
employee prior to the injury, however, COP need not be continued past
the date of termination as long as Form SF-52 showing the date of
termination has been completed. In this instance, OWCP will pay
compensation to a disabled worker after employment has ceased. Like
any other employee, a temporary worker who first reports a traumatic
injury after employment ends is not entitled to COP.
Employees of the U.S. Postal Service who request COP as a result of a
traumatic injury are not under FECA entitled to COP for the first 3 days
of temporary disability. During this 3 day waiting period, an employee
may choose to use annual leave, sick leave, or leave without pay. If
disability eventually exceeds 14 days or is followed by permanent
disability, COP will be paid for the 3 day waiting period and the USPS
will reinstate any sick or annual leave used by the employee during this
period.

5-2. Use of Leave Instead of COP
An employee may use annual or sick leave to cover all or part of an
absence due to injury. If an employee elects to use leave, each full or
partial day for which leave is taken will be counted against the 45 days
of entitlement to COP. Therefore, while an employee may use COP
intermittently along with sick or annual leave, entitlement is not extended
beyond 45 days of combined absences.
An election of sick or annual leave during the 45-day period is not
irrevocable. If an employee who has elected leave later wishes to elect
COP, the supervisor must make such a change on a prospective basis
from the date of the employee’s request. Where the employee wishes
to have leave restored retroactively, the supervisor must honor the
request provided he or she receives prima facie medical evidence of
injury-related disability for the period in question. A request to elect COP
retroactively in lieu of leave must be made within one year of the date
the leave was used or the date of written approval of the claim by
OWCP, whichever is later.

U.S. Postal Service employees may use sick or annual leave, or leave
without pay, during the three day waiting period. If disability extends
beyond 14 days, the USPS will convert the three day waiting period to
COP and restore any leave used.
5-3. Controversion
An agency’s objection to paying COP for one of the reasons provided by
regulation is called controversion. The supervisor may controvert a
claim by completing the indicated portion of Form CA-1 and submitting
detailed supporting information to OWCP. Even though a claim is
controverted, the agency must continue the employee’s regular pay
unless at least one of the following conditions applies:
A.

The disability is a result of an occupational disease or
illness;

B.
The employee comes within the exclusions of 5 U.S.C. 8101
(1)(B) or (E) (which refers to persons serving without pay or
nominal pay and to persons appointed to the staff of a former
President);
C.
The employee is neither a citizen nor a resident of the
United States or Canada;
D.
The injury occurred off the employing agency’s premises
and the employee was not engaged in official “off-premises”
duties;
E.
The employee caused the injury by his or her willful
misconduct, or the employee intended to bring about his or her
injury or death or that of another person, or the employee’s
intoxication was the proximate cause of the injury;
F.
The injury was not reported on a form approved by OWCP
(usually Form CA-1) within 30 days of the injury;
G.

Work stoppage occurred more than 45 days after the injury;

H.
The employee first reported the injury after employment was
terminated;
I.
The employee is enrolled in the Civil Air Patrol, Peace
Corps, Job Corps, Youth Conservation Corps, work study
program or other group covered by special legislation.
The agency may not continue pay under any of the above
circumstances.
The agency may dispute an employee’s right to receive COP, and/or the
validity of the claim as a whole, on other grounds, for instance on the
basis that the employee was not performing assigned duties when the
injury occurred or that the condition claimed is not the result of a workrelated injury. Any such objection should be supported by factual
evidence such as witness statements, pictures, accident investigation
reports, or time sheets. If the validity of a claim is disputed for reasons
other than the nine listed above, the agency must continue regular pay
for up to 45 calendar days. COP may not be interrupted during the 45day period unless one of the conditions in section 5-6 or 5-8 is met.

5-4. Pay Rate for COP Purposes
An employee’s regular pay is his or her average weekly earnings,
including night or shift differential and various kinds of premium pay. It
also includes other extra pay such as pay authorized by the Fair Labor
Standards Act for employees who receive annual premium pay for
standby duty and who also earn and use leave on the basis of their
entire tour of duty including periods of standby duty. Overtime pay is not
included except for administratively uncontrollable work covered under 5
U.S.C. 5545(c)(2).
A.
Standard Tour of Duty. For a full-time or part-time worker,
whether permanent or temporary, who works the same number of hours
per week, the weekly pay rate equals the number of hours regularly
worked each week times the hourly pay rate on the date of injury,
excluding overtime.

B.
Non-standard Tour of Duty. For a part-time worker, whether
permanent or temporary, who does not work the same number of hours
per week, the weekly pay rate equals the average weekly earnings for
the year prior to the date of injury, excluding overtime.
C.
Intermittent Work. For an intermittent or part-time worker,
whether permanent or temporary, who does not work each week of the
year (or the period of appointment), the weekly pay rate equals the
average of the employee’s weekly earnings during the year before the
injury. The pay rate is computed on the basis of the total earnings
divided by the number of weeks worked. Partial weeks worked are
counted as whole weeks. The annual earnings used for this
computation must not be less than 150 times the average daily wage
(hourly rate times eight) earned within one year before the date of injury.
D.
Increments of Pay. Night or shift differential, holiday or other
extra premium pay (except for Sunday pay) should be included but
overtime pay may not be considered.
E.
Changes in Pay. Changes in pay due to within-grade
increases, promotions, demotions, terminations of temporary details,
etc., which would have occurred but for the injury are included in COP
since COP represents salary and not compensation. Moreover, an
employee who moves into a higher-paying job during the COP period is
entitled to receive COP at the higher rate of pay. Where the weekly
COP rate is based on the employee’s average weekly earnings during
the year prior to the date of injury, the COP rate should be changed by
the same percentage as the change in hourly pay or salary.
F.
Lost Elements in Pay. An element is sometimes lost due
to the effects of the injury. For instance, a night shift worker may be
reassigned to the day shift to perform light duty, and thus lose night
differential. In such instances COP should be granted for the lost
element of pay. Each day for which COP is granted to cover a lost
element of pay will count as one full day of COP.
G. An employing agency is not required to include in COP
elements of pay that the agency is prohibited to pay by law.

5-5. Computation
Unless the injury occurs before the beginning of the workday, time lost
on the date of injury should be changed to administrative leave. For
non-Postal employees, the period to be charged to COP begins with the
first day or shift of disability or medical treatment after the date of injury,
provided that the absence began within 45 days after the injury. For
U.S. Postal Service employees, COP entitlement begins following the
three day waiting period, unless the period of disability exceeds 14 days.
COP should be charged for weekends and holidays if the medical
evidence shows the employee was disabled on the days in question.
For example, if the physician states that disability will continue only
through Saturday for an employee who has Saturday and Sunday off,
COP will be charged only through Saturday.
If work stoppage occurs for only a portion of a day or shift, a full day of
COP will be counted toward the 45-day entitlement even though the
employee is not entitled to COP for the entire day or shift. For example,
if an employee who has returned to work must lose three hours to obtain
physical therapy for the effects of the injury, he or she is entitled to only
three hours of COP even though one full day will be counted. If the
employee is absent for all or part of the remaining workday, the time loss
should be covered by leave, LWOP, AWOL, etc., as appropriate since
absence beyond the time needed to obtain the physical therapy cannot
be charged to COP.
If a partially disabled employee continues to work several hours a day,
each day or partial day of absence from work is chargeable against the
45-day period.

5-6. Light or Limited Duty Assignments
When the physician’s report shows that the employee is no longer totally
disabled, he or she is required to accept any reasonable offer of suitable
light or limited duty. Such an offer may be made by telephone but must
be confirmed in writing within 48 hours to be valid. The offer should

include a description of the duties and requirements of the offered
position. If a personnel action is involved, the employee must be
furnished with a copy of it prior to the effective date.
COP should be paid if the employee has been assigned light or limited
duty by formal personnel action and pay loss results (e.g., the employee
is placed in a light-duty position at lower pay). The dollar amount of
COP will be the difference between the pay rates of the job held on the
date of injury and the light- or limited-duty position. One full day of COP
should be charged for each day of light duty, even though the employee
is working a full shift. COP should also be paid if the light or limited duty
consists of work at regular duties for fewer than the usually scheduled
number of hours.
If the employee refuses to accept the work offered, COP should be
terminated as of the date of the employee’s refusal or after five
workdays from the date of the offer, whichever is earlier. OWCP will
then determine entitlement based on the medical reports and the duties
of the offered position and issue a formal decision concerning payment
of COP. A discussion of the criteria used in making such determinations
is found in Chapter 8-4.

5-7. Recurrences
In many cases, an employee will return to work without using all 45 days
of entitlement to COP. Should such an employee suffer a recurrence of
disability, he or she may use COP if no more than 45 days have elapsed
since the date of first return to work, including part-time work and light or
limited duty, and if he or she completes the Form CA-2a and elects to
receive regular pay. If the recurrence begins later than 45 days after the
first return to work, the agency should not pay COP even though some
days of entitlement remain unused. A period which begins before the
45-day deadline and continues beyond it may be charged to COP as
long as the period of time is uninterrupted.
If a third-party credit has been established, the supervisor should contact
OWCP before paying COP.

5-8. Terminating COP
COP should not be stopped unless:
A.
Medical Evidence is Not Submitted Within 10 Calendar
Days. This period should be counted from the date the employee claims
COP or the disability begins, or recurs, whichever is later. If the agency
has not received prima facie medical evidence of injury-related disability
within that period, it may stop COP.
However, the agency need not wait 10 days to request such
evidence, which is defined as medical evidence showing that the
employee is disabled because of an employment injury. Pay may be
continued without such evidence if the supervisor is satisfied that the
employee sustained a disabling traumatic injury.
For the purposes of this provision, the 10-day period begins the
day after the employee claims COP or the disability begins or recurs.
B.
The Employee is No Longer Disabled. The agency should
terminate COP if: it received medical information from the attending
physician stating that the employee is no longer disabled for regular
work; a partially disabled employee returns to full-time light or limited
duty with no pay loss; or the employee refuses a suitable offer of light-or
limited-duty work.
C.

OWCP Notifies the Agency That Pay should be terminated.

D.

The 45-Day Period Expires.

An employee who is scheduled to be separated, and who reports a
traumatic injury on or before the date of separation, is entitled to COP up
to the date of separation and to compensation thereafter.

5-9. Reporting COP
A.
Time Cards. Time loss for an employee who is receiving
COP should be recorded as “COP” on the Time and Attendance Report.
A diminishing record of the 45-day limitation is to be maintained in the
“Remarks” block.
B.
Disability Ends. If the disability ends before the 45-day
period expires, the agency should terminate COP. An employee who is
no longer disabled must return to work upon notification by the attending
physician that he or she is able to perform full regular duty or suitable
and available light or limited duty. If the employee has returned to duty
prior to the Form CA-1 being completed, that information should be
recorded on the Form CA-1. If not, the information may be obtained
telephonically by a nurse assigned to the case during the COP period. If
the employee who is no longer disabled does not return to duty, an
overpayment which is subject to collection by the agency may result.
Employing agencies who use the Agency Query System (AQS)
should complete and submit the electronic form CA-3, Report of Work
Status, to notify OWCP of an injured employee's return to work
following a work-related injury. This electronic form replaces the
previous version of form CA-3, and may only be submitted via AQS. It
may be submitted by an agency as often as necessary to report the
return to work of an employee following a period of disability.

C.
Formal Decision. In all cases OWCP has the final authority
to determine whether the agency’s action in paying or terminating COP
is correct. If entitlement is denied, OWCP will issue a formal
determination, usually conveyed by Form CA-1050. Payment made
may then be changed, at the employee’s option, to sick or annual leave
or be deemed an overpayment subject to collection by the agency.

Chapter 6. Medical Benefits and Care
This chapter addresses medical benefits under the FECA.
6-1
6-2
6-3
6-4
6-5
6-6

Entitlement
Definition of Physician
Choice of Physician
Medical Treatment and Evaluation
Exclusion of Providers
Payment of Bills

6-1. Entitlement
The FECA at 5 U.S.C. 8103 authorizes medical services for treatment of
any condition which is causally related to factors of Federal employment.
No limit is imposed on the amount of medical expenses or the length of
time for which they are paid as long as the charges represent the
reasonable and customary fees for the services involved and the need
for the treatment can be shown.
Federal employees are entitled to all services, appliances, and supplies
prescribed or recommended by qualified physicians that, in the opinion
of OWCP, are likely to cure, give relief, reduce the degree or the period
of disability or aid in lessening the amount of monthly compensation.
Medical care includes examination, treatment and related services such
as medications, hospitalization, as well as transportation needed to
secure these services. Preventative care may not be authorized,
however.

6-2. Definition of Physician
The term “physician” includes surgeons, osteopathic practitioners,
podiatrists, dentists, clinical psychologists, optometrists, and
chiropractors within the scope of their practice as defined by State law.
Naturopaths, faith healers, and other practitioners of the healing arts not
recognized as physicians within the meaning of the law.

A.
Chiropractors. Under the FECA, the services of
chiropractors may be reimbursed only for treatment consisting of manual
manipulation of the spine to correct a subluxation as demonstrated by Xray to exist. The term “subluxation” is defined as an incomplete
dislocation, off-centering, misalignment, fixation or abnormal spacing of
the vertebrae anatomically which must be demonstrable on any X-ray
film to individuals trained in the reading of X-rays. Chiropractors may
interpret their own X-rays and, if a subluxation is diagnosed, OWCP will
accept the chiropractor’s assessment of any disability caused by it.
If a Form CA-16 is issued to a chiropractor for emergency care
and the condition diagnosed is other than a subluxation, OWCP will
honor the charges incurred and terminate the authority of the Form CA16. In this situation, the employee is entitled to select another physician
who will need to submit a report substantiating the condition found in
order for the claim to be accepted.
B.
Excluded Physicians. The term “qualified physician” does
not include those whose licenses to practice medicine have been
suspended or revoked by a state licensing or regulatory authority or who
have been excluded from payment under the FECA. (See paragraph 65 below.)

6-3. Choice of Physician
A.
Initial Choice. An employee is entitled to initial choice of
physician for treatment of an injury. He or she may choose any licensed
physician in private practice who is not excluded, or he or she may
choose to be treated at a government medical facility if one is available.
Such facilities include hospitals of the Army, Navy, Air Force,
Department of Veterans Affairs and their medical officers.
Agency personnel may not interfere with the employee’s right to
choose a physician and may not require an employee to go to a
physician employed by, or under contract to, the agency before going to
the physician of the employee’s choice. Agency personnel may contact
the attending physician only in writing and only to clarify or obtain

additional information about the employee’s duty status or medical
progress.
B.
Referral by Attending Physician. The attending physician
may engage the services of facilities which provide X-ray or laboratory
services, or the services of specialists who can provide consultation.
Charges for such services will usually be paid on the basis that the
attending physician requested them.
C.
Change of Physicians. Except for a referral made by the
attending physician, any change in treating physician must be
authorized by OWCP. Otherwise, OWCP will not pay for the treatment.
The employee should request any such change in writing and explain
the reasons for the request. If a physician chosen by an employee is
later excluded from participation under the regulations, the employee
should choose another physician. Otherwise, and upon notification by
OWCP, he or she will be liable for payment of the bills from the excluded
provider.
D.
Transfer of Medical Care. The agency does not have
authority to transfer medical care from one physician to another. If
adequate medical care is not available locally or it appears that transfer
of medical care is advisable for other reasons, the agency must contact
OWCP for assistance.
E.
Provider Enrollment. In order to receive payment , all
medical providers must enroll with OWCP’s contracted authorization and
billing administrator. Instructions on enrollment procedures may be
found on the OWCP web bill processing portal. Upon submission of the
necessary enrollment information, each provider is assigned a unique
provider identification number, which must be placed on all bills and
authorization requests. An employee may view a listing of medical
providers within a geographical area who have enrolled with our vendor
by visiting the web portal.
6-4.

Medical Treatment and Evaluation

A.
Provider Requests. To guarantee payment, authorization
for some forms of medical treatment should be obtained in advance.
OWCP’s medical authorization and billing contractor processes medical

authorization requests. Whenever an injured worker is treated, the
medical provider should contact our vendor to determine whether the
service or procedure requires authorization. Eligibility may be checked
via the web portal (link to site). Providers for non-pharmacy services will
need the case file number, procedure or revenue code for the service
requested and the date(s) of service. For pharmacy services, the case
file number, date of service and NDC code is needed. A real-time
answer will be provided when this information is entered into the web
portal.
Automated information on bill payment and medical authorization status
may also be obtained via an interactive voice response telephone
system at 1-866-335-8319. A customer service representative may be
reached by calling 850-558-1818.
When a service requires prior authorization, the medical provider may
submit a request via the web portal, or the authorization request may be
faxed to 1-800-215-4901. . For faxed authorization requests, providers
should use the appropriate authorization template. These forms are
available on line at the web portal (link to site) .
The medical provider is responsible for requesting authorization of
services. Neither the injured employee nor the employing agency
should request medical authorizations.
Some services, such as non-emergency surgery, may require a second
opinion examination before they can be approved. OWCP will not
require an employee to undergo surgery or any other invasive
procedure, such as a myelogram.
B.
OWCP Requests. OWCP may ask other physicians
besides the attending physician to evaluate an employee and/or file.
OWCP may request such evaluations in connection with original or
continuing entitlement to benefits, the percentage of the employee’s
permanent impairment, the ability to return to full or light duty or other
issues. Physicians who may be asked to examine the employee and/or
file are as follows:
(1) District Medical Director/Advisor (DMD/DMA). Each
district office has one or more physicians on staff or under contract who

respond to questions raised by OWCP staff. These physicians interpret
medical issues posed by treating physicians and provide their own
opinions on medical questions. DMDs and DMAs also consider certain
requests for surgery. They do not, however, examine employees except
where a claim for disfigurement of the face, head, or neck is involved.
(2) Medical Specialist (Second Opinion Referral).
Medical issues sometimes arise which cannot be resolved on the basis
of opinions given by the attending physician and the DMD/DMA.
Opinion will then be requested from a physician who specializes in the
field of medicine pertinent to the issue. OWCP will schedule the
appointment and advise the employee of the arrangements. OWCP
pays for the examination, as well as for reasonable travel expenses and
wage loss incurred in connection with it. The employee may bring a
physician paid by him or her to the examination if desired. The
compensation of an employee who fails to attend an OWCP-scheduled
examination without good cause will be suspended until the employee
reports for examination.
(3) Referee Medical Specialist. A conflict of medical
opinion may occur when the file contains differing medical opinions of
approximately equal weight. Medical opinion from a referee specialist
will then be arranged to resolve the conflict. Such conflicts may concern
the relationship of a condition to factors of employment or the extent of
disability.
OWCP selects the referee physician on the basis of rotation
among the available specialists within a given geographical area who
practice in the pertinent field of medicine. OWCP will arrange the
appointment and advise the employee of the arrangements. As with
second opinion referrals, OWCP will pay the cost of the examination,
reasonable travel expenses and the amount of lost wages. Here again,
the compensation of an employee who fails to attend the examination
without good reason will be suspended until the employee reports for
examination.
C.
Agency Requests. The FECA does not address the issue of
medical examination directed by the agency. Parts 339 and 353 of
OPM’s regulations grant authority to agencies to arrange for
examination of any employee who files a compensation claim by a

physician of the agency’s choice, at the agency’s expense. However,
the purpose of such an examination is solely to determine if the
employee can work in some capacity, thereby facilitating a return to
work. Medical examinations may not be used to intimidate employees.
While agencies must send the results of such examinations to OWCP
and notify OWCP if the employee refuses to be examined, the results of
such examinations per se do not affect entitlement to compensation.

6-5. Exclusion of Providers
Certain providers may be excluded from participation in the Federal
employees’ compensation program. OWCP may not pay for the
services of such providers during the period of exclusion.
A.
Fraud. Providers who have been convicted under a criminal
statute for fraudulent activities in connection with a Federal or state
program which makes payments to providers for medical services are
automatically excluded from participation in the FECA program. This
means that OWCP will not honor their bills for services. Providers who
are excluded or suspended from similar Federal or state programs,
including Medicare, are also automatically excluded from participation in
the FECA program.
B.
Other Grounds. OWCP will begin exclusion procedures
upon receipt of information that a provider has knowingly: made a false
statement or misrepresented a fact in connection with a claim for
reimbursement or request for payment; charged more than the
provider’s customary fee for similar services without good cause; failed
to reimburse an employee who has paid a bill for treatment which was
also paid by OWCP; repeatedly failed to submit full and accurate
medical reports or failed to respond to requests for medical information;
or furnished treatment substantially beyond the employee’s needs or
which fails to meet professionally recognized standards.
C.
Due Process. The regulations appearing at 20 CFR §§
10.815-10.826 include due process at every step to protect the rights of
providers. These rights include administrative review of decisions and
consideration of reinstatement after a period of exclusion if reasonable
assurances exist that the action which led to the exclusion will not be

repeated. OWCP automatically reinstates providers who have been
restored to participation in Medicare by the Health Care Financing
Administration.
D.
Notification. OWCP periodically distributes to agencies the
names and addresses of excluded medical providers and reinstated
medical providers. Before authorizing medical services on Form CA-16,
the supervisor should ensure that the medical provider chosen by the
employee is not excluded. An excluded physician may be reimbursed
only for services rendered in a medical emergency. Designated agency
officials should report to the OWCP district offices any instances of fraud
or abuse coming to their attention.
E.
Medical Charges. On receipt of a bill from an excluded
provider, OWCP will determine whether either the agency or OWCP
notified the employee that the provider was excluded from the program.
If not, OWCP will generally honor the bill and advise both the provider
and the employee that, in accordance with the regulations, OWCP will
not pay for further treatment. An employee whose attending physician is
excluded will be allowed to choose a new physician.

6-6. Payment of Bills
OWCP’s contracted authorization and billing administrator provides
medical bill payment services for OWCP. This includes enrolling
providers, maintaining the provider file and performing certain bill
resolutions and adjustments.
Only those services rendered for work-related injuries will be paid.
Documentation usually takes the form of a report or clinical notes from
the physician, or a copy of the discharge summary from the hospital.
A.
Forms. Most providers must submit their bills on the
American Medical Association (AMA) Standard Health Insurance Form
(HCFA-1500). A version of the form which includes instructions for
submitting bills to OWCP carries the same form number OWCP-1500.
Either may be submitted. In some states the local version of the form
may not be designated “HCFA-1500” or may differ from the standard

AMA form in other ways. Such local variations are acceptable if they are
otherwise complete.
The following providers are required to use form HCFA-1500 or form
OWCP-1500 to submit bills: physicians; psychologists; chiropractors;
therapists, audiologists; radiologists; laboratories; ambulatory surgery
centers; home nursing services, ambulance services and suppliers of
medical equipment and goods. These providers can bill electronically via
one of the following web portals:
• The OWCP Web Bill Processing Portal
• ACS EDI Gateway
• P2P Link
The provider will complete the required fields on a screen which
resembles the HCFA-1500.
Pharmacies may bill electronically utilizing the above portals if charges
are submitted on a HCFA-1500 or OWCP-1500 form, and the National
Drug Code (NDC) number is accompanied by a J code. Pharmacies
which utilize the Pharmacy Bill Management (PBM) system for real-time
point of sale transactions may submit charges via the PBM portal (link to
site). Pharmacies which do not utilize these forms of electronic
submission should complete and submit form HCFA-1500 or OWCP1500 to the OWCP central mailing address.
Dentists should use the ADA Form J515.
Hospitals, nursing homes and hospice facilities must use the Form UB92.
Veterans Administration facilities must submit bills using the UB-92 for
in-patient charges or the HCFA-1500 for outpatient charges.
Bills from foreign providers may be submitted on billhead.
B.
Requirements. To be accepted for payment, the bill must
include the following minimum information:
(1)

Employee’s name and OWCP file number;

(2) Provider’s name, address (including zip code where
services were rendered), and ACS provider ID number;

(3) Diagnosis with appropriate International Classification of
Disease, 9th Edition(ICD-9) code;
(4)

Itemized list of services, with charges, and

(5) Tax identification number (the provider’s Employer
Identification Number or Social Security Number).

C.
Itemization. All bills must be sufficiently itemized to allow for
evaluation of charges. The Current Procedural Terminology (CPT) code
for each medical, surgical, X-ray or laboratory service should be shown
on the HCFA-1500, and bills should state the dates on which the
services or supplies were furnished. Individual dates are not necessary
if the bill is for repetitive charges over a period of time. In such cases,
the billing should show the beginning and ending dates of service and
the number of units of service.
D.
Time Limitation on the Payment of Bills. No bill or
reimbursement claim will be paid unless it is submitted to OWCP on or
before December 31st of the year following the calendar year in which
the expense was incurred or the claim or specific condition, as
appropriate, was first accepted as compensable by OWCP, whichever is
later.
E.
Disallowance of Charges. The payee will be advised by
Remittance Voucher (RV) of any adjustments to the bill. The RV will
explain the amount of the deletion or reduction, the particular charge
affected, the reasons for the action and the amount for which the bill is
being approved. If a bill is reduced because the charges exceed the
amount allowed by the OWCP fee schedule, this is noted on the RV.
The medical provider must accept the amount paid by OWCP as
payment in full, and may not attempt to collect any unpaid balance from
the employee. Bill status information is also available on line at
http://owcp.dol.acs-inc.com. This information is also available 24

hours per day, seven days per week via our contractor’s Interactive
Voice Response system (IVR) at (866) 335-8319.
F.
Reimbursement. An employee may request reimbursement
by submitting a completed Form OWCP-915, Claim for Medical
Reimbursement. For office visits and most medical procedures or
services, the Form HCFA-1500, completed in its entirety and signed by
the provider, must accompany the OWCP-915. For hospitalizations, a
UB-92, completed in its entirety, must be submitted with the OWCP-915.
For pharmacy bills, a paper pharmacy billing form containing the name
of the drug, the National Drug Code (NDC) and the date the prescription
was filled must be submitted with the OWCP-915. Proof of payment
must be submitted with the OWCP-915. As with payments to providers,
the amount claimed may be reduced according to the OWCP fee
schedule.
G.
Insurance Companies. Sometimes bills for a work-related
injury are submitted to an employee’s health insurance carrier. The
carrier may request reimbursement for such charges by submitting a
completed NALC-200, Health Insurance Claim Form, Carrier
Reimbursement (FECA Program) to ACS. This form, when completed
and signed by the carrier’s representative, requires no further verification
of payment.
H.
Transportation Expenses. Unless transportation is
furnished by the government, the employee may be reimbursed for
travel expenses to obtain medical care. Travel should be undertaken by
the shortest route and by public conveyance, such as bus or subway,
unless the medical condition requires the use of a taxicab or specially
equipped vehicle. An employee who uses his or her automobile will be
reimbursed at the standard mileage rate for government travel.
The Form OWCP-957 should be used to claim reimbursement for
travel expenses. All items will be reimbursed on the basis of actual
expenses. A per diem allowance is not payable. Wages and travel
expenses of an attendant to accompany the employee may be approved
if his or her condition is such that travel cannot be accomplished
otherwise. Authorization for this expense should be obtained in advance
of the travel, if possible.

I.
Incorrect Payments. An employee who receives a
reimbursement which he or she knows to be incorrect, either partially or
totally, should return the payment to OWCP immediately. If an
overpayment occurs, OWCP will determine whether the beneficiary is
with fault in the creation of the overpayment. Only if a beneficiary is
determined to be without fault may waiver of the overpayment be
considered.

Chapter 7. Compensation Benefits
This chapter describes the various forms of compensation benefits
which are available to injured employees and, in death claims, to
survivors. It also includes a section on computing compensation
payments.
7-1
7-2
7-3
7-4

Disability Benefits
Death Benefits
Dual Benefits
Computing Compensation

7-1. Disability Benefits
An employee who suffers work-related disability may be entitled to
receive one or more types of wage-loss compensation, according to the
nature and extent of disability incurred.
A. Temporary Total Disability. Compensation based on loss of
wages is payable after continuation of pay ends (see Chapter 5) or from
the beginning of pay loss. Without dependents, an employee is
generally entitled to compensation at the rate of 66 2/3% of his or her
salary. With dependents, he or she is entitled to compensation at the
rate of 75% of the salary.
(1) Dependents. The following are considered dependents
for compensation purposes:
(a) A wife or husband residing with the employee or
receiving regular support payments from him or her, either court-ordered
or otherwise;
(b) An unmarried child who lives with the employee or
who receives regular contributions of support from him or her and who is
under the age of 18, or over the age of 18 and incapable of self-support
due to physical or mental disability;
(c) An unmarried child between 18 and 23 years of
age who has not completed four years of post-high school education
and who is regularly pursuing a full-time course of study;

(d) A parent who is wholly dependent upon and
supported by the employee.
(2) Waiting Days. Except where the disability last more
than 14 days or permanent disability results from the injury, a three-day
waiting period, for which no compensation is payable, applies. Where
COP is paid, the three-day waiting period begins after the 45th day of
COP. For employees of the United States Postal Service, the three-day
waiting period applies to payment of COP, and begins on the first day of
the 45 day COP entitlement period.
OWCP will notify an employee who receives long-term disability
payments of the amount of compensation to be paid, including the pay
rate and compensation rate. Agency personnel should verify pay
information via the Agency Query System (AQS). Compensation
payments for total disability may continue as long as the medical
evidence supports total disability. Only rarely is an employee declared
permanently and totally disabled. Benefits provided for permanent total
disability are the same as those provided for temporary total disability.
B.
Schedule Awards. Compensation is provided for specified
periods of time for the permanent loss or loss of use of certain members
and functions of the body. Partial loss or loss of use of these members
and functions is compensated on a proportional basis.
(1) Compensation Schedule. The following table shows the
number of weeks payable for each schedule member if the loss or loss
of use is total:

Member

Weeks

Arm
Leg
Hand
Foot
Eye
Thumb
First finger
Great toe
Second finger
Third finger
Toe other than great toe
Fourth finger
Loss of hearing – monaural
- binaural
Breast
Kidney
Larynx
Lung
Penis
Testicle
Tongue
Ovary (including Fallopian tube)
Uterus/cervix
Vulva/vagina

312
288
244
205
160
75
46
38
30
25
16
15
52
200
52
156
160
156
205
52
160
52
205
205

Compensation for loss of binocular vision, or for loss of 80
percent or more of the vision of an eye, is the same as for loss of the
eye. The degree of loss of vision or hearing is determined without
regard to correction. That is, improvements obtainable with use of
eyeglasses, contact lenses and hearing aids are not considered in
establishing the percentage of the impairment. The law does not allow
for payment of a schedule award for impairment to the back, heart or
brain.
(2) Medical Evidence Required. Before OWCP can
consider payment of a schedule award, the condition of the affected part
of the body must reach maximum medical improvement. This
determination involves a medical judgment that the condition has

permanently stabilized. In most cases, the percentage of impairment is
determined in accordance with the American Medical Association’s
Guides to the Evaluation of Permanent Impairment, Sixth Edition, and
the evaluation on which the award is based must conform to the rules
set forth there.
(3) Claim and Payment. Form CA-7 may be used to file a
claim for schedule award, or consideration may be requested by
narrative letter. Compensation for a schedule award is computed by
multiplying the indicated number of weeks times 66 2/3% (without
dependents) or 75% (with dependents) of the pay rate. (See paragraph
A. (1) above for more information concerning dependents.)
(4) Decision. In issuing a schedule award, OWCP will
notify the employee and agency of its length (in number of weeks or
days), its starting date (the date of maximum medical improvement), the
pay rate on which benefits are computed and the compensation rate.
The decision will include a description of the employee’s appeal rights.
Schedule awards can be paid even if the employee returns to
work. Employees may not, however, receive wage-loss compensation
and schedule award benefits concurrently for the same injury. If an
employee sustains a period of total disability during the course of the
award, it may be interrupted to pay the period of disability. The schedule
award will resume afterwards. If an employee dies during the course of
a schedule award from causes unrelated to the injury, his or her
dependents are entitled to the balance of the award at the rate of 66
2/3%.
C. Loss of Wage-Earning Capacity. When the medical evidence
shows that the employee is no longer totally disabled, OWCP will work
toward his or her reemployment, either with the original agency or with
another employer. (This process is described in Chapter 8.) If the
employee is reemployed at a lower-paying job, or if OWCP determines
that he or she can perform the duties of a lower-paying job deemed
medically and otherwise suitable, compensation will be paid on the basis
of the loss of wage-earning capacity.
(1) Payment. The FECA provides that employees who
are partially disabled by a work-related injury or illness shall be

compensated at a rate equal to 66 2/3% (without dependents) or 75%
(with dependents) of the wage loss incurred as a result of the disability.
(Paragraph A.(1) above discusses dependents.) Benefits are paid for
the duration of the wage loss due to work-related disability.
(2) Decision. When OWCP determines that the employee
can perform a particular job and that the job fairly and reasonably
represents the employee’s wage-earning capacity or is otherwise
suitable and available, OWCP issues a formal decision. This decision
describes the basis for this determination and the formula used to
compute the new level of benefits. It also contains a description of the
employee’s appeal rights.
D.
Disfigurement. Where the employee suffers injury to the
face, head, or neck and disfigurement results, the FECA provides for an
award of compensation not to exceed $3,500 if the disfigurement will
likely be a handicap in securing or maintaining employment. As with
schedule awards, payment of an award for disfigurement cannot be
considered until maximum medical improvement has occurred. Such
awards can be considered only for seriously disfiguring scars and
deformities.
E.
Attendant’s Allowance. If an injury is so severe that the
employee is unable to care for his or her physical needs such as
feeding, bathing or dressing, an attendant’s allowance of up to $1,500
per month may be paid. The assistance required must be personal in
nature. An attendant’s allowance cannot be paid for housekeeping
services. An employee who believes he or she is entitled to such an
allowance should contact the district office by letter, for instructions on
how to apply for this benefit.
Effective January 4, 1999, all attendants’ allowances are paid as
medical expenses. A home health aide, licensed practical nurse or
similarly trained individual is to provide the necessary services, including
assistance in feeding, bathing and using the toilet. Like other medical
providers, the attendant is to bill OWCP using Form OWCP-1500 or
HCFA-1500.
F.
House and Vehicle Modifications. An employee whose
injury severely restricts mobility and independence in the normal

functions of living, either permanently or for a prolonged period, may be
entitled to house and/or vehicle modifications. Examples of such
conditions include blindness, profound bilateral deafness or total loss of
use of limbs such that a prosthesis, wheelchair or leg brace is required.
An employee may apply for such modifications by narrative letter. They
must be recommended by the attending physician and the modified
house or vehicle must be consistent with the employee’s pre-injury
standard of living.

7-2. Death Benefits
The survivors of a Federal employee whose death is work-related are
entitled to benefits in the form of compensation payments, funeral
expenses, transportation expenses for the remains, if necessary, and
payment for termination of the deceased’s status as a Federal
employee.
A.
Entitlement. The following individuals are entitled to
compensation:
(1)

A widow or widower;

(2) An unmarried child under the age of 18, or over the
age of 18 who is incapable of self-support due to mental or physical
disability;
(3) An unmarried child between 18 and 23 years of age
who has not completed four years of post-high school education and is
regularly pursuing a full-time course of study;
(4) A parent, brother, sister, grandparent or grandchild
who was wholly or partially dependent on the deceased.
B.
Compensation Payments. Compensation is paid at the
following rates:
(1) A surviving spouse with no eligible children is entitled
to compensation at the rate of 50% of the deceased employee’s salary.
Benefits are paid to the spouse until death or remarriage, if he or she is

under age 55. If a spouse under age 55 remarries, OWCP makes a
lump-sum payment equal to 24 times the monthly compensation at the
time of remarriage. Remarriage after the age of 55 does not affect
benefits.
(2) A surviving spouse who has eligible children is entitled
to compensation at the rate of 45% of the deceased employee’s salary.
An additional 15% is payable for each child, to a maximum of 75% of the
salary. The children’s portion is paid on a share-and-share-alike basis.
(3) If the deceased employee leaves no spouse, the first
child is entitled to 40% and each additional child is entitled to 15% of the
deceased employee’s salary, to a maximum of 75%, payable on a
share-and-share-alike basis.
(4) Other surviving dependents may be entitled to
benefits at various percentages specified by the FECA according to the
degree of dependence. Contact the district office for information about
claims in this category.
C.
Funeral and Burial Expenses. Up to $800 will be paid for funeral
and burial expenses. If the employee dies away from his or her area of
residence the cost of transporting the body to the place of burial or
cremation will be paid in full. Itemized funeral bills should be sent to
OWCP. In addition, a $200 allowance will be paid in consideration of
the expense of terminating the deceased’s status as a Federal
employee.
D.
Employing Agency Death Gratuity. Survivors of employees who
died in the line of duty on or after August 2, 1990 are entitled to a death
gratuity not to exceed $10,000, less burial and administrative expenses
paid by OWCP. Death gratuity payments that are made by employing
agencies do not constitute dual benefits and no election between them
and OWCP benefits is required.
E.
FECA Death Gratuity. Under an amendment to the FECA, up to
$100,00 may be paid by OWCP to survivors of "an employee who dies
of injuries incurred in connection with the employee's service with an
Armed Force in a contingency operation." This one-time death gratuity is
disbursed to the survivors in a specific order of precedence set forth in

the statute. An employee may change the order of precedence of
survivors, as well as designate up to 50 percent of the benefit to any
person. Designation of beneficiaries must be made in writing, signed
and dated by the employee and an employing agency official. OWCP
has created a designation form which may be used to specify the
desired distribution of the death gratuity. It is recommended that this
form be completed and retained by the employing agency any time an
employee is assigned to provide service to an Armed Force in a
contingency operation. The form may be found on the DFEC website at:
http://www.dol.gov/owcp/dfec/DeathGratuity.htm

7-3. Dual Benefits
The FECA prohibits payment of compensation and certain other Federal
benefits at the same time. This prohibition does not, however, prevent
an individual from filing for benefits from more than one government
program at a time. For instance, a claimant for disability benefits may
file for a retirement annuity (regular or disability) while his or her claim
with OWCP is pending. Similarly, a claimant for death benefits may file
for a death annuity while his or her claim with OWCP is pending. Only if
both benefits are approved will the rules governing dual benefits be
invoked.
A.
Office of Personnel Management (OPM). Except for
schedule awards, a person may not receive disability benefits from
OWCP concurrently with a regular or disability annuity (CSRS or FERS).
Also, a person may not receive death benefits from OWCP concurrently
with a survivor’s annuity (CSRS or FERS).
Therefore, a beneficiary entitled to both benefits must elect
between them. An individual may, however, receive disability benefits
from OWCP or an annuity from OPM on his or her own behalf along with
death benefits from the other agency which are payable on account of a
spouse’s death.
Either OWCP or OPM may offer the election, depending on which
agency determined entitlement first. The beneficiary may change his or
her election based on the more advantageous benefit.

B.
Department of Veterans Affairs (VA). Individuals entitled to
receive both compensation from OWCP and veterans’ benefits may
need to elect between the two. Such an election is required when the
disability or death resulted from an injury sustained in civilian Federal
employment and the VA has held that it was caused by military service,
or when the VA increases a service-connected disability award due to
an injury sustained in Federal civilian employment. In the latter case the
election involves only the increase in VA benefits due to disability
incurred during civilian employment. No election is required between
OWCP benefits and VA benefits for strictly service-related disability. In
death claims, OWCP may not duplicate any payment made by the VA
for funeral or burial expenses and the total payable by both agencies
may not exceed $800.
C.
Social Security Administration. An employee may receive
Social Security payments and OWCP benefits at the same time, subject
to income limitations imposed by the Social Security Administration.
OWCP will offset any Social Security old age or death benefits which are
attributable to the employee’s Federal service and paid to an employee
or his or her survivors.
D.
Lump Sum Death Benefits. The lump sum death benefit
available to survivors of an employee covered under the Federal
Employees Retirement System (FERS) is considered a dual benefit.
The lump-sum death benefit must be repaid by the survivor or absorbed
by OWCP benefits before any OWCP benefits would be paid to the
survivor.
E.
Other Federal Income. An employee may receive
compensation concurrently with military retired pay, retirement pay,
retainer pay or equivalent pay for service in the armed forces or other
uniformed services subject to reduction of such pay. (Delete referencerepealed)
An employee may receive severance pay concurrently with
compensation for a schedule award or for loss of wage-loss capacity but
not with compensation for temporary total disability. Separation pay
may constitute a dual benefit and an agency offering such payments
should contact OWCP for further guidance.

Finally, an employee may receive unemployment compensation
benefits concurrently with OWCP benefits, although the state may offset
a portion of these benefits.

7-4. Computing Compensation
While compensation is usually claimed in two-week increments to
conform to standard Federal pay periods, compensation checks are
issued on a weekly or four-weekly basis. Payments of compensation for
brief periods of temporary total disability or schedule impairments are
issued on a weekly basis, while longer-term payments for disability,
schedule award and death are made every four weeks. Payments may
be sent to the beneficiary or to a financial institution which he or she
designates but they may not be sent in care of the employee’s
representative unless guardianship or conservatorship is established.
Compensation payments are based on a percentage of the employee’s
salary (or a statutory pay rate). Payments are computed by multiplying
the applicable percentage by the wage rate and increasing the result by
any cost-of-living increases to which the beneficiary is entitled.
A.
Pay Rate. For both disability and death claims, the pay rate
used to compute payments is the one in effect on the date of injury, date
of recurrence or date disability began, whichever is higher. Thus, the
pay rate for compensation purposes may change over the life of a claim.
The salary used to compute compensation is not affected, however, by
general increases in the rate paid for the employee’s grade and step.
Moreover, the pay rate is not affected by any promotion or raise the
employee might have received in the future.
B.
Additional Elements of Pay. Included in the salary are: night
shift; Sunday differential; holiday pay; hazard pay; dirty work pay;
quarters allowance and post differential for overseas employees and
extra pay authorized by the Fair Labor Standards Act (FLSA) for
employees who receive annual premium pay for standby duty and who
also earn and use leave on the basis of their entire tour or duty,
including periods of standby duty. Overtime pay is not included, except

for administratively uncontrollable work covered under 5 U.S.C.
5545(c)(2).
The supervisor should report these elements of pay by indicating
the weekly or biweekly amount, if the employee has a regular schedule.
Otherwise, the supervisor should compute and submit to OWCP the
dollar amount paid in each category for the calendar year preceding the
effective date of the pay rate.
C.
Compensation Rate. The compensation rate is the
percentage applied to the salary to determine the monetary amount of
the compensation payment. (These rates are described in Chapters 7-1
for disability case and 7-2 for death cases.)
D.
Cost-of-Living Increases. Each March 1, the increase in the
cost of living for the preceding calendar year is determined. If the
beneficiary has been entitled to compensation for at least one year
before March 1, a cost-of-living increase may be applied to the benefits.
E.
Minimum and Maximum Rates. The law provides for
minimum and maximum payments of compensation.
(1) Disability. Compensation for temporary total disability or
schedule awards may not exceed 75% of the basic monthly salary of an
employee at the highest step of the GS-15 level. For temporary total
disability it may not be less than 75% of the basic monthly salary of an
employee at the first step of the GS-2 level or actual pay, whichever is
less.
(2) Death. Compensation for death may not exceed 75% of
the highest step of the basic GS-15 level and it may not be less than the
minimum pay of the first step of the basic GS-2 salary. In no case may it
exceed the employee’s salary except when the excess is created by
cost-of-living increases.
F.
Buy-back of Leave. Compensation entitlement for leave
repurchase is computed in the same way as compensation for
temporary total disability. Because leave is paid at 100% of the usual
wage rate and compensation is paid as a percentage, the employee will
likely owe the agency money for repurchased leave.

Form CA-7a is used when dates of leave are intermittent or when
more than one continuous period of leave is claimed. Form CA-7b
explains how leave is repurchased and asks the agency to estimate the
amount of compensation payable. The agency should advise the
employee of the amount it requires to reinstate the leave and both
parties must agree to the transaction before submitting the form.
G.
Lump-Sum Payments. The FECA was designed to provide
periodic payments of compensation benefits so that beneficiaries would
have a continuing source of income. With few exceptions, such benefits
are free from speculation, fluctuation and attachment by creditors, and
they are also generally free from taxes. OWCP will consider making a
lump-sum payment of compensation only to pay a schedule award or as
a survivor’s benefit to a widow or widower who remarries before age 55.
H.
Incorrect Payments. An employee who receives a
compensation payment which is incorrect should return the payment to
OWCP immediately. If an overpayment occurs, OWCP will decide
whether the beneficiary is with fault in creating the overpayment. Only if
OWCP determines that the beneficiary is without fault may waiver of the
overpayment be considered.
I.
Health Benefits. OWCP makes deductions for health
benefits coverage in cases where beneficiaries are entitled to continue
their enrollment. Compensation must be paid for at least 28 days for
deductions to be made and deductions cannot be made for periods less
than 14 days.
(1) Criteria. The following requirements must be met to
continue enrollment:
(a) Disability. If an employee was enrolled in a health
plan under the Federal Employees’ Health Benefit Plan at the time of
injury, the enrollment will continue while compensation is being paid.
(b) Death. Enrollment may continue for the surviving
family members if the deceased employee was enrolled for Self and
Family at time of death and at least one covered family member
receives compensation as a surviving beneficiary under the FECA.

Beneficiaries may change health benefits plans during open
season in the same manner as current Federal employees.
(2) Transfer. If the employee will likely be on OWCP rolls
for 90 days or more, OWCP will ask the employer to transfer the
enrollment. If the employee returns to full duty (more than 32 hours per
week), OWCP will transfer the enrollment back to the agency. If
compensation benefits are terminated or if the employee elects an
annuity from OPM, OWCP will transfer enrollment to OPM. (Once
benefits from OWCP cease, there is no entitlement to health benefits
through OWCP.) OWCP will also transfer to OPM the enrollment of a
retired employee who is receiving a schedule award.
(a) Loss of Wage Earning Capacity (WEC).
Employees (except Postal Service Employees - see (b) below) receiving
compensation benefits for partial disability remain entitled to FEHB
coverage. Thus, the enrollment will be retained by the district office
and not transferred to the employing agency.
(b) Postal Service Employees. For all employees
who return to duty with the U.S. Postal Service with a WEC, OWCP will
transfer the enrollment back to the Postal Service to make the health
benefit deductions.
J.
Federal Long Term Care Insurance Program (FLTCIP).
FLTCIP, or “Long Term Care” is an insurance program sponsored by
OPM and administered by Long Term Care Partners, a private sector
partnership between the John Hancock Life Insurance Company and
the Metropolitan Life Insurance Company. Long Term Care is available
to all current Federal employees who are eligible for FEHB coverage,
whether or not they are currently enrolled in a plan. Individuals receiving
compensation who are separated from Federal service remain eligible to
elect long term care. In addition, surviving spouses of deceased Federal
or Postal employees are eligible. D.C. Government employees are not
eligible to apply for coverage in the Federal Program, even if they may
be eligible for FEHB coverage.
K.
Optional Life Insurance (OLI). For claimants injured before
January 1, 1990, basic life insurance continues at no cost to the

employee while he or she is receiving compensation, unless the
employee has elected Post-Retirement Basic Life Withholdings at 100%
or 50% of the original value. Claimants injured on or after January 1,
1990, must pay for basic life insurance.
The agency determines eligibility for OLI. Therefore, when
question “c” of section 10 on Form CA-7 is checked “yes”, OWCP
considers the claimant eligible for continued coverage as long as the
claimant is considered unable to return to duty.
Questions about basic life insurance should be referred to OPM.

Chapter 8. Managing Disability Claims
This chapter describes how OWCP manages disability claims. It also
addresses the process of reemploying partially disabled workers and the
sanctions applied to employees who do not cooperate with
reemployment efforts.
8-1
8-2
8-3
8-4
8-5
8-6
8-7
8-8
8-9

Initial Actions by OWCP
Retention Rights
Nurse Services
Reemployment with the Agency
Vocational Rehabilitation Services
Assisted Reemployment
Payment of Relocation Expenses
Employees in Light-or Limited-Duty Status
Separation from Employment

8-1. Initial Actions by OWCP
If it appears that disability will continue for at least 60 days, OWCP may
place the employee on the periodic roll and advise him or her that
payment is being made.
OWCP also informs the employee that benefits for total disability are
payable only while he or she is unable to perform his or her regular
duties at work. The employee is also advised that he or she is expected
to return to duty as soon as possible and is required to contact the
agency to see if light or limited duty is available.
At the same time, OWCP asks the agency to send a copy of the
employee’s job description, including physical requirements, and a copy
of his or her SF-171 or other employment application form. OWCP will
request information about the employee’s earnings and dependents
periodically during the course of disability.
When the medical evidence shows that total disability has ended,
OWCP will advise the employee that he or she is expected to seek

work. In accordance with 5 U.S.C. 8106, which provides for payment of
compensation to partially disabled employees, OWCP will make every
reasonable effort to arrange for employment of such employees. These
efforts will concentrate initially on the employing agency. Only if
reemployment with the agency is not possible will OWCP attempt to
place the employee with a new employer.
8-2. Retention Rights
Under 5 U.S.C 8151, an employee who recovers within one year of
starting compensation has mandatory rights to his or her old position or
its equivalent, regardless of whether he or she is still on the agency rolls.
If full recovery occurs after one year, or the employee is considered
partially recovered, he or she is entitled to priority consideration as long
as application is made within 30 days of the date compensation ceases.
Such employees incur no loss of benefits which they would have
received but for the injury or disease. The regulations on retention rights
are contained in 5 CFR Section 353, 301, 302, and 303. These sections
of the regulations, as well as 5 U.S.C. 8151 are administered by OPM,
not OWCP.
Any period of time during which an employee receives compensation
from OWCP is credited to the employee for the purposes of determining
rights and benefits based upon length of service, including eligibility for
retirement.
An employee who has applied for and been approved for Federal
retirement benefits is no longer considered an employee and any
reemployment is covered by OPM rules and regulations for reemployed
annuitants. This is true even if the employee never actually received a
Federal retirement annuity.
OWCP’s case management procedures emphasize return to work
before the expiration of the employee’s one-year entitlement to the same
or an equivalent job.

8-3. Nurse Services

COP Nurse Intervention. Beginning in FY 2000, OWCP implemented a
nurse intervention program during the COP period. Registered nurses
(RNs) under contract to OWCP call or meet with employees, physicians
and agency representatives to permit early identification of cases that
will require more extensive nurse intervention.

A.
This intervention is solely telephonic in nature and is
limited to 30 days of case management. All traumatic injury cases
with an initial work stoppage date less than 30 days prior to the date
the case is received by OWCP are considered for this program. If the
injured worker returns to work within 15 days of the date of the initial
work stoppage, the case will not be considered for this program.
B.
In cases where there is no return to work within 15 days
of work stoppage, a telephonic nurse will be assigned to the case to
contact the employer to ascertain the claimant's return to work status.
If contact with the employer cannot be made or is unproductive, a call
to the claimant will be placed to determine return to work status.
C.
While nurse intervention is not extensive during the COP
period, the nurses' medical knowledge and experience permits them
to identify cases that will require more extensive nurse intervention
due to the severity of the injuries, contemplated surgical intervention
or other issues impeding a return to work. Such early recognition
permits district offices to identify cases in need of prompt adjudication
and assists claims examiners in prioritizing adjudication efforts,
resulting in earlier active disability management in these cases.
D.
Since claims in which the injured worker has successfully
returned to work in a full time capacity may not require additional
nurse intervention, effective use of the electronic CA-3 by the
employing agency to notify OWCP of a return to work is critical to
maximize the benefits of this early nurse intervention.
Field Nurse (FN) Intervention. RNs under contract to OWCP call or
meet with employees, physicians and agency representatives to

ensure that proper medical care is being provided and to assist
employees in returning to work.
OWCP refers for services all employees with approved traumatic
injury claims who have continuing disability and, on a selective basis,
employees with approved occupational illness claims who have
continuing disability.
A.
Contacting the Interested Parties. FNs may contact
claimants, attending physicians and/or employing agencies to
address claimants' questions concerning medical care; to obtain
treatment plans, return to work plans, return to work dates and
descriptions of work limitations; and to arrange return to work.
B.
Return to Work. Conference calls may be held to arrange
for return to work. Such calls should always include agency officials.
When and employee returns to work the FN may accompany him or
her on a walk through of the job to ensure that the duties are within
the employee's medical limitations and that both the employee and
the supervisor understand the limitations.
C.
Agency Nurses. FNs may occasionally coordinate care
with agency nurses. As a rule, however, agencies should not assign
their own nurses to work with employees simultaneously with OWCP
RNs.
8-4. Reemployment with the Agency
When the medical evidence shows that total disability has ended the
agency is encouraged to consider reemployment. The following
procedures apply to all employees still on the agency’s rolls, regardless
of how long they have received compensation.
A.
Medical Evidence. To make a job offer the agency will need
medical evidence describing the employee’s medical limitations. (In
some cases OWCP can provide this information.) Medical reports which
address current limitations will usually suffice for this purpose. If the
employee refuses to provide sufficient medical information for the
agency to evaluate whether a job offer is appropriate , the agency
should advise OWCP.

B.
Degree of Recovery. If the employee is expected to return
eventually to the job held at the time of injury, the agency may offer light,
limited or modified duty pending full recovery. Any such offer should be
made in the manner outlined in paragraph D below. If the residuals of
the injury will prohibit the employee from returning to the position held at
the time of injury and the employee has received compensation for more
than one year, the agency should consider reemployment in the
following order of preference:
(1) Return to the position held at the time of injury with
modifications to accommodate the employee’s limitations;
(2) Employment in another position at the same salary as
the position held at the time of injury; or
(3) Employment in another position at a lower salary than
the position held at the time of injury.
C.
Guidelines for Reemployment. The position should be
compatible with the employee’s medical condition, including any nonwork-related medical condition which either pre-existed the injury at
work or developed since it occurred. A temporary position may be
offered only to a worker who held a temporary position when injured
and, if such a job is offered, it must be at least 90 days in duration.
Similarly, a seasonal position may be offered only to a worker who held
a seasonal position when injured.
Generally, an employee who is capable of working four or more hours a
day should be offered a position providing at least that much work, since
employment of less than four hours a day is considered sheltered work
and is reserved for the severely disabled. An offer of less than four
hours of work a day is suitable for an employee who cannot work longer
hours.
As far as possible, the tour of duty and the location of the identified job
should correspond to those of the job held on the date of injury. If a job
is offered in a location other than the one where the employee currently
resides, the agency must document that no positions are available in the

current location. The agency must ensure that any position offered will
be available for the entire period allowed for response to the offer.
D.
Elements of Job Offer. The agency may contact the
employee by telephone to advise that the job is available but the offer
must be confirmed in writing within two business days. A copy of the
offer must be sent to OWCP at the same time. The offer should include:
(1) A description of the duties to be performed;
(2) The specific physical requirements of the position and
any special demands of the workload or unusual working
conditions;
(3) The organizational and geographical location of the job;
(4) The date on which the job will be available;
(5) The date by which a response to the job offer is
required.
The agency should not, however, request election of OPM
benefits if the employee declines the job offer. OWCP is solely
responsible for obtaining such an election.

E.
Advising the Employee. If the employee does not accept
the job, OWCP will make a suitability determination. If the job is
deemed unsuitable, OWCP will advise the employing agency of the
reasons. If the job is found to be suitable, OWCP will notify the
employee in writing and advise that he or she is expected to accept the
job or to show reasonable cause for refusal. OWCP will advise the
employee that failure to accept the job or respond within 30 days will
result in termination of compensation payments.
F.
Employee Response. If the employee responds to the
agency, a copy should be forwarded to OWCP.

(1) Acceptance. If the employee accepts the job, the
agency should notify OWCP as soon as possible of the date of return to
duty so as to avoid overpayments of compensation. Effective the date
of return to duty, compensation will be terminated, if no loss of pay has
resulted, or reduced, if the new job pays less than the old.
(2) No Response. If no answer is received, OWCP will
terminate benefits and issue a formal decision on the basis that the
employee has refused suitable work.
(3) Refusal with No Explanation. If the employee refuses
the offer without explanation, OWCP will terminate benefits and issue a
formal decision.
(4) Refusal with Explanation. If the employee refuses the
offer and provides reasons in support of the refusal, OWCP will evaluate
them and determine whether reasonable cause has been shown. If so,
OWCP will advise the employing agency and compensation will
continue at a level reflecting the degree of disability while further
attempts at placement are made. If not, OWCP will advise the
employee and allow him or her an additional 15 days to return to work.
If the employee still does not return to work, OWCP will terminate
benefits and issue a formal decision.
Returning employees to gainful employment requires close cooperation
between agencies and OWCP. Early notification of job offers and
complete information about the offers aids OWCP in making its
decisions. For its part, OWCP recognizes its responsibility to evaluate
job offers promptly and advise employees of their rights and
responsibilities in a timely manner so as to avoid undue delays.

8-5. Vocational Rehabilitation Services
The FECA at 5 U.S.C. 8104 provides for vocational rehabilitation
services to assist disabled employees in returning to gainful employment
consistent with their physical, emotional and educational abilities. An
employee with extended disability may be considered for rehabilitation
services if requested by the attending physician, the employee or

agency personnel. In addition, OWCP will routinely consider a case for
rehabilitation services if the agency cannot reemploy the employee.
A.
Services Provided. An OWCP Rehabilitation Specialist will
contact the employee for an initial interview. The employee will then be
referred to a state or private Rehabilitation Counselor for development of
a rehabilitation plan. A plan may include one or more of the following:
selective placement with the previous employer, placement with a new
employer, counseling, guidance, testing, work evaluations, training and
job follow-up. Each employee is provided the services most suitable for
him or her and not every service will be included in a given rehabilitation
plan.
B.
Advice to Employee. When suitable jobs are identified,
OWCP will advise the employee that it appears that he or she has a
wage-earning capacity of a specific dollar amount which will likely
determine future compensation entitlement. The employee will be
advised that he or she is expected to return to work in a job similar to
the one identified, that partial compensation based on the wage-earning
capacity of the indicated job will probably be paid at the end of this effort
and that when he or she has completed any necessary training or other
preparation, OWCP will provide 90 days of placement services.
C.
Benefits Payable. An employee in an approved vocational
rehabilitation program may be paid an allowance in connection with this
program not to exceed $200 per month. The employee is also entitled
to compensation at the rate for total disability during the rehabilitation
program. Payment of a schedule award meets this requirement.
When the employee returns to work, OWCP will reduce
compensation to reflect the wage-earning capacity if the new job pays
less than the old. If reemployment is at the same or higher pay rate than
the job held at the time of injury, OWCP will fully reduce compensation
benefits. Even if the employee does not return to work, compensation
will, in all likelihood, be reduced.
D.
Penalties. Should an employee refuse to participate in an
OWCP rehabilitation program or refuse to make a good faith effort to
obtain reemployment, OWCP may reduce or terminate compensation
depending on the circumstances of the refusal.

E.
Constructed Positions. In some situations, reemployment
does not occur despite the best efforts of the employee and OWCP.
When this happens, OWCP may determine the employee’s wageearning capacity on the basis of a position that the medical evidence
indicates the employee can perform and that is available in his or her
commuting area. OWCP will determine the suitability of the position in
accordance with the following factors:
(1) The nature of the injury;
(2) The degree of physical impairment;
(3) The usual employment;
(4) The employee’s age;
(5) Qualifications for other employment, including
education, previous employment and training.
OWCP will issue a formal decision, including appeal rights, in any case
where the benefit level is affected.
F.
Continued Disability Payments. Only after careful medical
and vocational development will OWCP determine that an employee
has no current wage-earning capacity and should, therefore, be carried
on the long-term compensation rolls at the rate for total disability.

8-6. Assisted Reemployment
OWCP may reimburse an employer who was not the employer at the
time of injury for part of the salary of a reemployed worker. This wage
subsidy is intended to assist in reemploying workers who could not be
placed with their former employers. It is available to other Federal
employers as well as to State and local governments and the private
sector.
A.
Eligibility. To be eligible, the agency cannot have been the
worker’s employer at the time of the injury, as identified by OWCP

chargeback billings, appropriations account number and agency hiring
authority. Intra-departmental salary reimbursements are limited to
agencies with a separate appropriation number from that of the original
employing agency. It is not proper to use assisted reemployment where
an employee is transferred within the agency or where an agency uses
more than one appropriation number but hiring is controlled at a higher
organizational level.
B.
Conditions of Participation. The rate of reimbursement may
not exceed 75% of the employee’s gross wage. The actual rate of
reimbursement available is decided on a case-by-case basis by OWCP
and the agency.
Salary reimbursement may extend for up to 36 continuous
months, but it will not continue if the period of reimbursement is
interrupted by a recurrence of disability due to the accepted condition.
The subsidy may not be transferred from one employer to another.
An agency interested in participating in assisted reemployment
should contact the District Director or a rehabilitation specialist at the
OWCP district office. Where a potentially suitable job has been
identified, the rehabilitation counselor assigned to the worker will meet
with agency personnel to explain details of the program.
For OWCP to consider reimbursement of salary expenses, the job
offered must be found suitable, medically and otherwise. (See
paragraph 8-5 above) To make such a finding, OWCP needs a copy of
the position description which includes a statement of the physical
requirements of the job.
C.
Elements of Agreement. When a worker accepts a suitable
job offer, the new employing agency and OWCP will enter into an
Assisted Reemployment Cooperative Agreement. Each Agreement
includes the following elements:
(1) Employee’s name and OWCP claim number;
(2) Employer’s name and address;

(3) A description of the procedures for claiming
reimbursement and the payment schedule, including the method and
maximum amount of wage reimbursement payments from OWCP to the
employer for each employee hired;
(4) A job description and statement of starting wage rate.
D.
Transfer of Funds. Once OWCP and the agency agree to
financial and administrative arrangements, OWCP will contact the
agency to determine the best methods of payment and transfer of funds.
OWCP prefers to use the U.S. Treasury’s GOALS/OPAC (On-Line
Payment and Collection) system for reimbursement. For agencies
which do not process payments through the U.S. Treasury, OWCP will
make the reimbursement by check.
OWCP will then advise the agency, in writing, of the specific
accounting procedures for transferring funds. Payment is made after the
agency certifies, in writing, that the employee was actually employed
and received wages during the quarter for which reimbursement is
requested. Regardless of the method of reimbursement, OWCP will
require quarterly submittal of records of the wages paid to these
reemployed workers and the periods covered by those payments.

8-7. Payment of Relocation Expenses
OWCP’s regulations at 20 CFR Section 10.508 provide that an injured
employee who relocates to accept a suitable job offer after termination
from the agency rolls may receive payment or reimbursement of moving
expenses from the compensation fund. This regulation further states
that Federal travel regulations (Joint Travel Regulations for employees
of the Department of Defense) pertaining to permanent change of
station (PCS) moves are to be used as a guideline in determining
whether expenses claimed are reasonable and necessary.
A. Locations of Old and New Jobs. Relocation expenses may be
paid for a former employee who is partially recovered from a
compensable injury and who is offered a job in either the same or a
different commuting area from the former job. OPM regulations
governing the restoration rights of injured workers require consideration

of partially recovered employees only in the former commuting area.
Thus, the extent to which an agency considers partially recovered
employees for jobs outside the commuting area is a matter for agency
personnel to decide.
Former employees who move voluntarily to other locations and
are offered reemployment at their former installations are generally not
entitled to payment of relocation expenses. (See Federal Travel
Regulations or Joint Travel Regulations, as appropriate, and pertinent
Comptroller General decisions which address relocation in the
Government’s interest.) The extent to which relocation expenses are
payable when a fully or partially recovered employee is still on the
agency’s rolls is determined by government travel regulations pertaining
to PCS moves.
However, OWCP’s regulations state specifically that “the agency
may offer suitable employment at the employee’s former duty station or
other location” and that relocation expenses will be payable in either
case. Therefore, employing agencies should not discourage
applications for payment of relocation expenses to the previous duty
station. Given the savings in compensation costs which accrue to
employing agencies that return their injured workers to the employment
rolls, payment of relocation expenses to the original duty station is
considered to be in the interest of the government.
B.
Eligibility. Relocation expenses are payable only to
claimants who are no longer on the agency rolls. The distance between
the two locations must be at least 50 miles and the job must be
medically and vocationally suitable. OWCP will authorize payment of
expenses incurred to accept a temporary position as long as it is
expected to lead to a permanent assignment. The employee need not
show financial need for relocation expenses to be paid and
payment/reimbursement of relocation expenses may be considered
after the fact as long as the move took place after June 1, 1987, the
effective date of the provision governing such moves.
OWCP staff will determine whether relocation expenses can be
approved and will notify the employee and agency personnel. While
payment by the agency, with reimbursement by OWCP through the U.S.
Treasury’s GOALS/OPAC (On-Line Payment and Collection) system is

preferred, direct withdrawal from the compensation fund may be
authorized where necessary.
C.
Arranging the Move. Because employing agencies have
expertise in arranging PCS moves, OWCP asks agencies to calculate
the costs and coordinate the activities involved in such moves, as far as
possible. OWCP will be responsible for resolving any disputes between
the employee and the agency as to allowable costs in accordance with
government travel regulations.
D.
RITA Payments. The IRS considers at least a portion of
PCS payments to be reportable as income, even though such payments
are intended to reflect actual expenses, and employing agencies usually
include a Relocation Income Tax Allowance (RITA) to offset the
additional income tax liability incurred because of PCS reimbursements.
Because compensation benefits are not taxable, the RITA should not be
included in paying relocation expenses under the FECA.

8-8. Employees in Light- or Limited-Duty Status
Many agencies place both newly injured and long-term disabled
employees in light-or limited-duty jobs. Such placements usually benefit
both employers and employees. However, when employees continue to
hold such assignments after they are able to return to full duty, fewer
light- or limited-duty jobs are available for more recently injured
employees.
Therefore, it is the policy of OWCP to monitor injured employees who
hold light- or limited-duty jobs until they have returned to full duty or until
the medical evidence clearly establishes that they will never be able to
return to full duty. Employing agencies can aid in this effort by
identifying employees who have been in light- or limited-duty status for
over three months.

8-9. Separation from Employment
A.
Reductions in Force.
When a formal loss of wageearning capacity decision has been issued, the employee has the
burden to establish further entitlement to compensation. Therefore, the
status of an employee with an established wage-earning capacity who
is removed due to an across-the-board reduction in force (RIF) or the
closing of an installation (as opposed to the elimination of only light- or
limited-duty jobs), does not change with regard to receipt of FECA
benefits unless a formal claim for recurrence is filed When no formal
finding with regard to wage-earning capacity has been made and the
employee has worked in the position for at least 60 days, OWCP may
consider a retroactive loss of wage-earning capacity determination.
However, this does not preclude the employee from filing a formal claim
for recurrence.
B.
Removal for Cause. An employee who is separated for
misconduct and whose removal is wholly unconnected to the workrelated injury is not entitled to further compensation benefits.

Chapter 9. Agency Management of Compensation Claims
This chapter describes how agency personnel can learn more about the
claims of their current and former employees and how they can manage
their compensation programs.
9-1.
9-2.
9-3.
9-4.
9-5.

Obtaining information
Inspection and Protection of Records
Managing Compensation Programs
Record-Keeping
Chargeback

9-1. Obtaining Information
Agencies have several options for obtaining claim information and
contacting OWCP:
A.
Agency Query System (AQS). This system enables
employers to access data for their employees through an Internet server
that contains data on current case status, compensation payments and
medical bill payments for all active compensation cases. Individual
requests for access to AQS should be directed to the employing
agency’s Intra-Agency Coordinator.
B.
OWCP Interactive Voice Response (IVR). This system
enables callers to access information using their telephone keypads.
The IVR provides callers with information about submitting medical bills
for reimbursement and filing claims. It also allows callers to query the
Program’s database for the status compensation claims, the date of the
last compensation payment and other case-specific information.
C. ACS Website and IVR. Both the ACS website and the IVR
enable users to access information on medical eligibility, medical
authorization status and medical bill payment status.
D. Telephone: Most district offices have Customer Service
Representatives who can provide information on the status of a claim
and answer general questions. When more detailed information is
needed, the Claims Examiner responsible for the case file can often
satisfy the inquiry.

Agency managers with questions about common themes identified in a
number of claims may contact the district office for clarification. Only
inquiries that cannot be resolved in this way should be referred through
the agency’s headquarters. Policy questions may also be referred to
OWCP’s National Office.

9-2. Inspection and Protection of Records
Claims staff are instructed to provide agency personnel with copies of all
significant correspondence to employees, even when the employees are
no longer on the agency’s rolls. Under the routine use provisions of the
regulations governing release of information under the Privacy Act,
agencies are entitled to obtain copies of other materials in their
employees’ compensation files as well.
The use of these copies must, however, be consistent with the reason
the information was collected. In practice, this means that the use must
be connected in some way with the compensation claim. Agencies may
not use copies of information from claim files in connection with EEO
complaints, disciplinary actions or other administrative actions without
the employee’s consent. Any questions concerning use or release of
records should be directed to the district office.
To safeguard the privacy of information in compensation files, much of
which is inherently sensitive, agencies should observe the following
procedures:
A.
Making Specific Requests. Requests from the agency for
materials in a case file should include the specific reason for requesting
the information (e.g. to verify that the employee actually worked for the
agency or to attempt reemployment of the worker). OWCP will release
the requested information either by telephone or in writing once
satisfactory identification is presented. (This requirement needs to be
met only once if an agency designates a particular individual as a liaison
or principal contact with the district office.) Representatives of an
investigative body within an agency may also obtain information upon
presentation of proper credentials as long as the purpose for the request
is stated.

B.
Inspecting Files. An agency representative may ask to
inspect files at the district office. OWCP will accommodate all such
requests subject to logistical and physical limitations, including
reasonable advance notice of the visit and a list of cases to be reviewed.
Here again, the purpose should be stated specifically and the reviewer
should be identified before the visit. A picture ID must be presented at
the time of the visit unless the reviewer is known to the office.
C.
Penalties under the Privacy Act. It is not appropriate for
agency personnel to inspect records without a specific and valid purpose
for doing so. That is, curiosity is not an acceptable reason for review.
Agency personnel who review files should be conversant with the
restrictions of the Privacy Act and the penalties stipulated for violations.
These penalties include fines and imprisonment. OWCP will deny
further access to any individual who improperly uses information from
OWCP files.
D.
Contractors. If the agency wishes to designate a private
contractor to inspect the records, the agency should contact the OWCP
National Office, in writing, to obtain approval for the arrangements. The
agency should ensure that the contractor observes the regulations
governing the Privacy Act as they review the files and report their
findings to the agency.
Additional guidance regarding appropriate release of information from an
employee's case file may be found in FECA Circular No. 09-05 (link to
document).

9-3. Managing Compensation Programs
In the interests of providing good service to employees while containing
costs, OWCP encourages active management of workers’
compensation programs by agency personnel. It is important that
agencies devote the time and effort necessary to ensure that claims are
processed in a timely fashion. In particular, this means prompt
submission of notices of injury and claims for compensation to OWCP.

A.
Training. Ensure that sufficient training in technical and
managerial skills is given to staff who routinely handle compensation
claims and that resource materials are available to those who handle
them infrequently. (A list of courses and resources is shown in Chapter
1.)
B.
Administration. Establish a record-keeping system which
will enable the agency to maintain copies of claim forms, medical
reports, correspondence with OWCP and other materials related to each
compensation claim in an orderly fashion. Designate a representative
within each organization unit to act as a liaison with OWCP concerning
unusually difficult claims.

C.
Documentation. Ensure that the facts surrounding each
injury are adequately investigated at the time of injury. Such
investigation will help both the agency and OWCP to determine the
validity of the claim.
D.
Medical Information. Within OWCP and OPM regulations,
obtain medical information from OWCP or injured employees as often as
necessary to assess potential return to regular, light or limited duty.
Advise physicians of any light-duty assignments available and their
specific requirements. The agency can use the information gathered to
monitor the claimant’s medical care and notify OWCP if it appears that
the care is inadequate.
E.
Reemployment. Stay in touch with injured employees while
they are receiving compensation, identify jobs suitable for them and take
steps to reemploy recovered or recovering employees as soon as the
medical evidence shows this is possible.
F.
Financial Records. Monitor chargeback billings and arrange
to charge costs to the lowest organizational level practicable to make
managers more aware of costs. (Paragraph 9-5 below discusses the
chargeback system in detail.

9-4. Record Keeping
Employing agencies often retain documents in connection with workers’
compensation claims. Rules governing release, retention and disposal
of such records differ according to the nature and source of the
document involved.
A.
Documents in Employee Medical Folder (EMF). A notice of
injury not filed with OWCP is to be placed in the employee’s EMF and
retained in accordance with OPM regulations governing disposal of the
EMF.
B.
Documents in OWCP Case File. These documents include
medical reports, copies of letters and decisions and any other material
which is part of the case file, regardless of its source. These documents
should be maintained in folders apart from the EMF or Official Personnel
Folder, but such folders are not considered a “system of records”
separate from the case file. Rather, they are considered an alternate
location for the records, which remain under the jurisdiction of OWCP.
Their retention and disposal is covered by the OWCP Records
Retirement Schedule that requires case file material to be maintained for
two years after case closure.

9-5. Chargeback
The FECA program is financed by the Employees’ Compensation Fund
that consists of monies appropriated by Congress or contributed by
certain agencies from operating revenues. The chargeback system is
the mechanism by which the costs of compensation for work-related
injuries and deaths are assigned to employing agencies annually at the
end of the fiscal accounting period, that runs from July to June for this
purpose. Each year OWCP furnishes each agency with a statement of
payments made from the Fund on account of injuries to its employees.
The agencies include these amounts in their budget requests to
Congress. The sums appropriated or obtained from operating revenues
are deposited in the Fund.
A.
Identification. A compensation claim is identified as
belonging to a particular agency based on the agency code entered into

OWCP’s data processing system when the case is created. The agency
should code all initial notices of injury, disease and death to reduce
chargeback errors. The employing agency receives a postcard (CA801) containing only a case number. The agency should reference the
case number in the Agency Query System (ACS) to determine the
employee’s name. OWCP also provides each agency with quarterly
listings of the cases and charges that will appear on its yearly
chargeback bill.
B.
Errors. To prevent incorrect entries from appearing on the
quarterly chargeback report and yearly bill, agencies should review the
postcards and report errors to district offices as soon as possible. If no
objection is raised upon receipt of the postcard, OWCP assumes that
the chargeback code is correct and charges costs associated with the
case to that agency’s account.
If an agency receives a postcard that it believes to be incorrect, it
should notify OWCP, in writing, within 60 days. The district office will
then review the disputed case to determine whether a keying or coding
error occurred and correct the agency code if necessary.
C.
Quarterly Chargeback Report. Each agency receives a
quarterly report listing all case and costs for which charges will appear
on the yearly chargeback bill. This report can be used to identify and
correct errors before the agency is billed for them. When an agency
believes that a case appearing on its chargeback report does not belong
on its account, it should check current personnel and payroll records,
search the service record file and payroll records and/or send an inquiry
to the Federal Records Center. Agency personnel may also review
case files at the district office to resolve such discrepancies.
D.
Requesting Changes. Requests for changes based on
review of the quarterly chargeback report should be addressed to the
District Director. The request should be made within 90 days of receipt
of the report. It must be accompanied by appropriate documentation,
such as a copy of a SF-50, service record card (SF-7) or response from
the Federal Records Center. OWCP will review the case file and
supporting evidence to determine whether an incorrect agency code
was assigned. If the evidence does not support the agency’s request,

OWCP will send the agency a copy of the Form CA-1, CA2, or CA-6
from the case file and explain the basis for its finding.
If the evidence shows that the disputed case belongs on another
agency’s account, OWCP will notify the new agency and forward a copy
of Form CA-1, CA-2, or CA-6 from the case file. Before changing the
agency code, OWCP will provide the new agency 60 days to advance
any arguments for disputing ownership of the case. Due to the time
needed to verify information and correct errors, problems brought to
OWCP’s attention during the fourth quarter of a fiscal year may not be
corrected in time for that year’s bill. If incorrect charges appear on the
bill, adjustment will be handled as described below.
If the assigned chargeback code represents the wrong
organization or command within the agency, the request for change of
code must be made by an agency official with the authority to speak for
the entire department, rather than for a single command or
organizational unit.
E.
Adjustments to the Chargeback Bill. When an adjustment to
the yearly chargeback bill is desired, the agency must send the request
directly to the OWCP National Office. It must be accompanied either by
documentation that shows the disputed charge did not involve an
employee of that agency or by a complete explanation of the basis for
the agency’s objection. OWCP will make a decision and correct verified
errors by crediting the next year’s billing statement.
If another agency should have been charged, OWCP will so
advise that agency and a debit will appear on its next bill. Credits or
debits will be made only for charges appearing on the agency’s most
recent bill. An adjustment will be made only if it will affect the total for
the particular billing entity. OWCP will not transfer charges from one
organization to another on the same bill.

APPENDIX A

BASIC FORMS
BASIC OWCP FORMS

Form
Number
CA-1

Form Title
Federal Employee's Notice
of Traumatic Injury and
Claim for Continuation of
Pay/Compensation

Purpose

Prepared By

Notifies supervisor Employee or
of a traumatic
someone
injury and serves acting on
as the report to
employee's
OWCP when (1) behalf;
the employee has witness (if
sustained a
any);
traumatic injury
supervisor
which is likely to
result in a medical
charge against the
compensation
fund; (2) the
employee loses
time from work on
any day after the
injury date,
whether the time is
charged to leave
or to continuation
of pay; (3)
disability for work
may subsequently
occur; (4)
permanent
impairment
appears likely; or
(5) serious
disfigurement of
the face, head or
neck is likely to
result

When
Submitted
By employee
within 30 days
(but will meet
statutory
requirements if
filed no later
than three years
after the injury);
by supervisor
within 10 work
days following
receipt of the
form from the
employee

Completed
Forms Sent To
Supervisor by
employee or
someone acting
on employee's
behalf; then to
appropriate
OWCP office by
supervisor

CA-2

Notice of Occupational
Disease and Claim for
Compensation

CA-2a

Notice of Recurrence

Notifies supervisor Employee or
of an occupational someone
disease and
acting on
serves as the
employee's
report to OWCP
behalf;
when (1) the
witness (if
disease is likely to any);
result in a medical supervisor
charge against the
compensation
fund; (2) the
employee loses
time from work on
any day after the
injury date,
whether the time is
charged to leave
or leave without
pay; (3) disability
for work may
subsequently
occur; (4)
permanent
impairment
appears likely; or
(5) serious
disfigurement of
the face, head or
neck is likely to
result
Notifies OWCP
Employee
that an employee,
after returning to
work, is again
disabled due to a
prior injury or
occupational
disease, or has
suffered a
recurrence of the
accepted medical
condition. It also
serves as a claim
for continuation of
pay or
compensation
based on the
recurrence of a
previously
reported disability

By employee
Supervisor by
within 30 days employee or
(but will meet
someone acting
statutory
on employee's
requirements if behalf; then to
filed no later
appropriate
than three years OWCP office by
after last
supervisor
exposure to the
conditions
causing the
disease or
awareness of a
relationship
between the
disease and
Federal
employment); by
supervisor within
10 work days
following receipt
of the form from
the employee

Immediately
upon awareness
that the
employee has
suffered a
recurrence. An
employee who
stops work as a
result of
recurring
disability shall
advise the
supervisor
whether he or
she wishes to
continue
receiving regular
pay (if eligible)
or charge the
absence to sick
or annual leave
or leave without
pay

Supervisor by
employee or
someone acting
on employee's
behalf; then to
appropriate
OWCP office by
supervisor. An
employee no
longer employed
by the Federal
government
should complete
parts A and C and
submit all
materials directly
to the appropriate
OWCP district
office

CA-3

CA-5

CA-5b

CA-6

Report of Work Status

Notifies OWCP
that an employee
has returned to
work following a
period of disability;
provides
information on the
dates the
employee stopped
and returned to
work, the reason
for work stoppage
and whether the
employee has
returned to full or
modified duty
Claim for Compensation by Claims
Widow, Widower and/or
compensation on
Children
behalf of these
dependents when
injury results in
death

Injury
As soon as
compensation possible after an
specialist with employee
access to the returns to duty
Agency
following a
Query
period of
System
disability
(AQS)

Electronically
submitted to
OWCP via the
Agency Query
System (AQS)

Person
Within 30 days, Supervisor, by
claiming
if possible, but claimant or
compensation no later than
someone acting
(for self or on three years after on claimant's
behalf of
death. If the
behalf; then to
children) and death resulted appropriate
attending
from an injury for OWCP district
physician
which a disability office
claim was timely
filed, the time
requirements for
filing the death
claim have been
met.
Claim for Compensation by Claims
Person
Within 30 days, Supervisor, by
Parents, Brothers, Sisters, compensation on claiming
if possible, but claimant or
someone acting
Grandparents or
behalf of these
compensation no later than
Grandchildren
dependents when (or guardian three years after on claimant's
behalf; then to
injury results in
on behalf of death. If the
death
children) and death resulted appropriate
from an injury for OWCP district
attending
which a disability office
physician
claim was timely
filed, the time
requirements for
filing the death
claim have been
met.
Official Superior's Report Notifies OWCP of Supervisor
Within 10 work Appropriate
of Employee's Death
the work-related
days after
OWCP district
death of an
knowledge by
office
employee
supervisor of an
employee's work
related death

CA-7

Claim for Compensation

CA-7a

Time Analysis Form

CA-7b

Leave Buy Back
Worksheet/Certification
and Election

CA-16

Authorization for
Examination and/or
Treatment

Claims
Employee
By employee as Supervisor by
compensation for and
soon as possible employee or
(1) leave without supervisor or following wage someone acting
pay due to injury injury
loss or
on employee's
related disability or compensation awareness of
behalf; then to
absence to obtain specialist
impairment; by appropriate
medical treatment;
supervisor or
OWCP office by
(2) repurchase of
injury
supervisor
sick or annual
compensation
leave used due to
specialist within
injury related
5 work days of
disability or
receipt from
absence to obtain
employee
medical treatment;
(3) loss of wage
earning capacity
resulting from the
work injury; (4)
schedule award for
permanent
impairment
resulting from the
work injury
Attached to form Employee
By employee,
Appropriate
CA-7 when
and
along with CA-7, OWCP district
compensation is supervisor or as soon as
office
claimed for
injury
possible after
intermittent dates compensation absence; by
of absence due to specialist
supervisor or
work injury. Lists
injury
dates for which
compensation
compensation or
specialist within
leave buy back is
5 work days of
claimed
receipt from
employee
By supervisor or Appropriate
Attached to form Employee
injury
OWCP district
CA-7 when leave and
supervisor or compensation office
buy back is
injury
specialist, along
claimed.
compensation with form CA-7,
Completed by
upon receipt of
employing agency specialist
employee
to provide
signature
employee with
electing to
estimate of
repurchase
amount needed to
leave
repurchase leave
and election as to
whether to
proceed
Authorizes an
Part A:
Part A: By
Part A: Given to
injured employee Supervisor
supervisor within employee to
to obtain
Part B:
four hours of a provide to
immediate
Attending
traumatic injury. physician
examination
physician
May be issued Completed form
and/or treatment
up to one week sent to appropriate
from a physician
after injury.
OWCP district
chosen by the
Part B: By
office
employee for an
attending
on-the-job injury
physician or
and provides
medical facility
OWCP with initial
as promptly as
medical report.
possible after

Treatment may be
obtained from a
local hospital or
physician

CA-17

CA-20

CA-40

Duty Status Report

initial
examination

Provides
Side A:
Promptly upon Original to
supervisor and
Supervisor
completion of
employing agency;
OWCP with interim Side B:
examination
copy to OWCP
medical report
Attending
central mail
containing
physician
address
information on
employee's ability
to return to work
and physical
limitations
Attending Physician's
Provides medical Attending
Promptly upon Appropriate
Report
support for claim physician
completion of
OWCP district
and is attached to
examination
office, if attached
Form CA-7 (can
to form CA-7;
also be obtained
OWCP central
or submitted
mail address
separately);
otherwise
provides OWCP
with medical
information
Supervisor by
Designation of a Recipient Designates the
Employee
Any time a
employee or
of the Death Gratuity
manner in which a and
Federal
someone acting
Payment under Section
death gratuity of supervisor or employee is
on employee's
1105 of Public Law 110up to $100,000
injury
deployed
behalf; then to
181
payable under
compensation overseas or
appropriate
Section 1105 of
specialist
otherwise
OWCP office by
Public Law 110assigned to
181 will be
provide service supervisor upon
death of employee
disbursed when a
to an Armed
in connection with
Federal employee
Force in a
service with an
dies of injuries
contingency
Armed Force in a
incurred in
operation, as
contingency
connection with his
defined in
or her service with
Section 1105 of operation
an Armed Force in
Public Law 110a contingency
181. Completed
operation
form should be
maintained by
the employing
agency in the
employee's
official personnel
file, or a related
system of
records, until
such time as it is
needed

OWCP-5 Work Capacity Evaluation Provides OWCP Attending
with medical
physician
opinion on
employee's ability
to work, and any
work limitations
experienced by the
employee
OWCP- Claim for Medical
Used to seek
Employee
915
Reimbursement
reimbursement for
out of pocket
medical expenses
pertaining to the
treatment of an
accepted
condition. Form
OWCP-915 can be
used to seek
reimbursement for
expenses in
regard to medical
treatment,
prescription
medication and
medical supplies.
OWCP- Medical Travel Refund
Used to seek
Employee
957
Request
reimbursement for
expenses incurred
for travel to obtain
medical treatment
of a work related
condition

Promptly upon
completion of
examination

OWCP Central
mail address

As soon as
OWCP Central
possible after
mail address
the expense is
incurred. To be
timely, form
must be
submitted within
one year of the
end of calendar
year in which
expense was
incurred or claim
accepted by
OWCP

As soon as
OWCP Central
possible after
mail address
the expense is
incurred. To be
timely, form
must be
submitted within
one year of the
end of calendar
year in which
expense was
incurred or claim
accepted by
OWCP

APPENDIX B

INJURY/ILLNESS TYPE AND SOURCE CODES

Note: Select most specific type and source for event which initiated
injury/illness.
Use heading as "other" for that category.
Use TYPE as "verb" and SOURCE as "noun" to describe incident.
EXAMPLE: Employee slipped on ice, cut hand on rock.
TYPE: 210, fell on same level
SOURCE: 0220, weather
INJURY/ILLNESS TYPE CODES
100 STRUCK
110 Struck by
111 Struck by falling object
120 Struck against
200 FELL, SLIPPED, TRIPPED
210 Fell on same level
220 Fell on different level
230 Slipped, tripped (no fall)
300 CAUGHT
310 Caught on
320 Caught in
330 Caught between
400 PUNCTURED, LACERATED
410 Punctured by
420 Cut by
430 Stung by
440 Bitten by

500 CONTACT
510 Contact with (motion of person)
520 Contact by (motion of object)
600 EXERTION
610 Lifted, strained by (single action)
620 Stressed by (repeated action)
700 EXPOSURE
710 Inhalation
720 Ingestion
730 Absorption
800 TRAVELING IN
999 UNCLASSIFIED OR INSUFFICIENT DATA

INJURY/ILLNESS SOURCE CODES

0100 BUILDING OR WORKING AREA
0110 Walking/working surface (floor, street, curbs, porches)
0120 Stairs, steps
0130 Ladder
0140 Furniture, furnishings, office equipment
0150 Boiler, pressure vessel
0160 Equipment layout (ergonomic)
0170 Windows, doors
0180 Electric, electricity
0200 ENVIRONMENTAL CONDITION
0210 Temperature extreme (indoor)
0220 Weather (ice, rain, heat, etc.)
0230 Fire, flame, smoke (not tobacco)
0240 Noise
0250 Radiation
0260 Light
0270 Ventilation
0271 Tobacco smoke
0280 Stress (emotional)
0290 Confined space
0300 MACHINE OR TOOL
0310 Hand tool (powered: saw, grinder, etc.)
0320 Hand tool (non-powered)
0330 Mechanical power transmission apparatus
0340 Guard, shield (fixed, moveable, deadman)
0350 Video Display Terminal
0360 Pump, compressor, air pressure tool
0370 Heating equipment
0380 Welding equipment

0400 VEHICLE
0410 Privately-owned vehicle (includes rental)
0411 As driver
0412 As passenger
0420 Government-owned vehicle
0421 As driver
0422 As passenger
0430 Common carrier (airline, bus, etc.)
0440 Aircraft (not commercially scheduled)
0450 Boat, ship, barge
0500 MATERIAL HANDLING EQUIPMENT
0510 Earthmover (tractor, backhoe, etc.)
0520 Conveyor (for material and equipment)
0530 Elevator, escalator, personnel hoist
0540 Hoist, sling chain, jack (for material and equipment)
0550 Forklift, crane
0560 Handtrucks, dollies
0600 DUST, MIST, VAPOR, ETC.
0610 Dust (silica, coal, grain, cotton)
0620 Fibers
0621 Asbestos
0630 Gases
0631 Carbon monoxide
0640 Mist, steam, vapor, fume
0650 Particles (unidentified)
0700 CHEMICAL, PLASTIC, ETC.
0710 Chemical dry
0711 Corrosive
0712 Toxic
0713 Explosive
0714 Flammable
0720 Chemical liquid
0721 Corrosive

0722 Toxic
0723 Explosive
0724 Flammable
0730 Plastic
0740 Water
0750 Medicine
0800 INANIMATE OBJECT
0810 Box, barrel, container, etc.
0820 Paper
0830 Metal item, mineral
0831 Needle
0840 Glass
0850 Scrap, trash
0860 Wood
0870 Food
0880 Personal clothing, apparel, shoes
0900 ANIMATE OBJECT
0910 Animal
0911 Bite (dog)
0912 Bite (other)
0920 Plant
0930 Insect
0940 Human (violence)
0950 Human (communicable disease)
0960 Bacteria, virus (not human contact)
1000 PERSONAL PROTECTIVE EQUIPMENT
1010 Protective clothing, shoes, glasses/goggles
1020 Respirator, mask
1021 Diving equipment
1030 Safety belt, harness
1040 Parachute
9999 UNCLASSIFIED OR INSUFFICIENT DATA

OCCUPATION CODES

For Postal Service employees, the occupation code consists
of the characters "PS" plus the first four numbers of the
appropriate occupation code. For all other Federal
employees, the code begins with the two letters of the
employee's pay plan (i.e., "GS", "GM", "WG", etc.) followed
by the four numbers of the occupation series. For workers
who perform services for the Federal government but who
do not have job titles which fall under the usual job
classification systems, a list of "non-standard" occupation
codes and titles follows. Each code begins with the
characters "??" instead of the usual pay plan letters.
Alpha/Numeric Code

Title

??013600
??008300

Peace Corps Volunteer
Non-Federal Law Enforcement
Officer
VISTA Volunteer
Job Corps Enrollee
Mail Messenger
Contract Job Cleaner
Student Nurse
Forest Service Volunteer
Volunteer Weather Observer
State Maritime Academy Cadet
ROTC Cadet
Federal Juror
Civil Air Patrol Volunteer
Volunteer Hospital Worker
Youth Conservation Corps
Volunteer
County Agent, Dept. of Agriculture
Student Aide

??002100
??024300
??030200
??350100
??062100
??046200
??134100
??009900
??009900
??093000
??218100
??068500
??024300
??047500
??350600

Alpha/Numeric Code

Title

??982500
??020400
??024000
??002300
??009900
??006000
??186300
??003000
??018800
??024300
??046000
??131600
??470100

??174000

Seaman
Coast Guard Reserve Member
Coast Guard Auxiliary Member
National Park Service Collaborator
College Work/Study Participant
Chaplain
State/Local Agriculture Inspector
Sports Clinic Performer
Entertainer/Armed Forces
Vocational Trainee
Forest Service Cooperator
Gage Reader, Corps of Engineers
Maintenance Worker, Dept. of
HUD
National Park Service Volunteer
National Defense Executive
Reserve
National Teacher Corps Member

Alpha/Numeric Code

Title

??061000
??060200
??063000
??174000
??101600

Contract Nurse
Contract Physician
Nutritional Aide, USDA
Reader for the Blind
Trust Employee, Smithsonian
Institution
Soil/Water Conservation District
Employee
Youth/Adult Conservation Corps
Enrollee
Military Academy Cadet
Volunteer Trainee Probation
Officer
Urban Crime Prevention Program
Volunteer
Congressional Staff Member

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??020400

??045700
??024300
??009900
??000600
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??034500

APPENDIX C

OCCUPATIONAL DISEASE CHECKLISTS

APPENDIX D

ADDRESS LIST AND JURISDICTIONAL MAP

District Office 1 – Boston
U.S. Department of Labor, OWCP
JFK Federal Office Building, Room E-260
Boston, MA 02203
617-624-6600
District Office 2 – New York
U.S. Department of Labor, OWCP
201 Varick Street, Room 740
New York, NY 10014
646-264-3000

District Office 3 – Philadelphia
U.S. Department of Labor, OWCP
Curtis Center, Suite 715 East
170 S. Independence Mall West
Philadelphia, PA 19106-3308
215-861-5481
District Office 6 – Jacksonville
U.S. Department of Labor, OWCP
400 West Bay Street, Room 826
Jacksonville, FL 32202
904-357-4777
District Office 9 – Cleveland
U.S. Department of Labor, OWCP
1240 East Ninth Street, Room 851
Cleveland, OH 44199
216-357-5100
District Office 10 – Chicago
U.S. Department of Labor, OWCP
230 South Dearborn Street, Eighth Floor
Chicago, IL 60604
312-596-7157
District Office 11 – Kansas City
U.S. Department of Labor, OWCP
Two Pershing Square Building
2300 Main Street, Suite 1090
Kansas City, MO 64108
816-502-0301
District Office 12 – Denver
U.S. Department of Labor, OWCP
1999 Broadway, Suite 600
Denver, CO 80202
720-264-3000

District Office 13 – San Francisco
U.S. Department of Labor, OWCP
90 Seventh Street, Suite 15300
San Francisco, CA 94103
415-625-7500
District Office 14 – Seattle
U.S. Department of Labor, OWCP
1111 Third Avenue, Suite 650
Seattle, WA 98101-3212
206-398-8100
District Office 16 – Dallas
U.S. Department of Labor, OWCP
525 South Griffin Street, Room 100
Dallas, TX 75202
972-850-2300
District Office 25 – Washington, D.C.
U.S. Department of Labor, OWCP
800 N. Capitol St., N.W., Room 800
Washington, D.C. 20211
202-513-6800



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