CA810 Revised 2009 CA 801 810

User Manual: CA-801

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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 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

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: New Jersey, New York, Puerto Rico

and the Virgin Islands.

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: Alaska, Idaho, Oregon and

Washington.

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 DOL-

GOVT 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 first-

time 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. Exposure to Infectious Agents

2-2. Traumatic Injury

2-3 Occupational Disease

2-4. Recurrences

2-5 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 CA-

1.)

(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 agency-

sponsored 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 agency-

directed 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 110-

181 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 Time

3-2 Civil Employee

3-3 Fact of Injury

3-4 Performance of Duty

3-5 Causal Relationship

3-6 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 non-

appropriated 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 pre-

existing allergy, compensation will be payable for the period of work-

related 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 Administrative Matters

4-2 Burden of Proof

4-3 Questionable Cases

4-4 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 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

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 work-

related 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 45-

day 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 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

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 X-

ray 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 CA-

16. 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 6-

5 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 OWCP-

1500 to the OWCP central mailing address.

Dentists should use the ADA Form J515.

Hospitals, nursing homes and hospice facilities must use the Form UB-

92.

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 Disability Benefits

7-2 Death Benefits

7-3 Dual Benefits

7-4 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;

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 312

Leg 288

Hand 244

Foot 205

Eye 160

Thumb 75

First finger 46

Great toe 38

Second finger 30

Third finger 25

Toe other than great toe 16

Fourth finger 15

Loss of hearing – monaural 52

- binaural 200

Breast 52

Kidney 156

Larynx 160

Lung 156

Penis 205

Testicle 52

Tongue 160

Ovary (including Fallopian tube) 52

Uterus/cervix 205

Vulva/vagina 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 reference-

repealed)

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 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

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 non-

work-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 wage-

earning 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 wage-

earning 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 work-

related 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. Obtaining information

9-2. Inspection and Protection of Records

9-3. Managing Compensation Programs

9-4. Record-Keeping

9-5. 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 (CA-

801) 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 Form Title Purpose Prepared By When

Submitted Completed

Forms Sent To

CA-1 Federal Employee's Notice

of Traumatic Injury and

Claim for Continuation of

Pay/Compensation

Notifies supervisor

of a traumatic

injury and serves

as the report to

OWCP when (1)

the employee has

sustained a

traumatic injury

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

Employee or

someone

acting on

employee's

behalf;

witness (if

any);

supervisor

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

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

Notifies supervisor

of an occupational

disease and

serves as the

report to OWCP

when (1) the

disease 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 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

Employee or

someone

acting on

employee's

behalf;

witness (if

any);

supervisor

By employee

within 30 days

(but will meet

statutory

requirements if

filed no later

than three years

after last

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

Supervisor by

employee or

someone acting

on employee's

behalf; then to

appropriate

OWCP office by

supervisor

CA-2a Notice of Recurrence Notifies OWCP

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

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 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

Injury

compensation

specialist with

access to the

Agency

Query

System

(AQS)

As soon as

possible after an

employee

returns to duty

following a

period of

disability

Electronically

submitted to

OWCP via the

Agency Query

System (AQS)

CA-5 Claim for Compensation by

Widow, Widower and/or

Children

Claims

compensation on

behalf of these

dependents when

injury results in

death

Person

claiming

compensation

(for self or on

behalf of

children) and

attending

physician

Within 30 days,

if possible, but

no later than

three years after

death. If the

death resulted

from an injury for

which a disability

claim was timely

filed, the time

requirements for

filing the death

claim have been

met.

Supervisor, by

claimant or

someone acting

on claimant's

behalf; then to

appropriate

OWCP district

office

CA-5b Claim for Compensation by

Parents, Brothers, Sisters,

Grandparents or

Grandchildren

Claims

compensation on

behalf of these

dependents when

injury results in

death

Person

claiming

compensation

(or guardian

on behalf of

children) and

attending

physician

Within 30 days,

if possible, but

no later than

three years after

death. If the

death resulted

from an injury for

which a disability

claim was timely

filed, the time

requirements for

filing the death

claim have been

met.

Supervisor, by

claimant or

someone acting

on claimant's

behalf; then to

appropriate

OWCP district

office

CA-6 Official Superior's Report

of Employee's Death Notifies OWCP of

the work-related

death of an

employee

Supervisor Within 10 work

days after

knowledge by

supervisor of an

employee's work

related death

Appropriate

OWCP district

office

CA-7 Claim for Compensation Claims

compensation for

(1) leave without

pay due to injury

related disability or

absence to obtain

medical treatment;

(2) repurchase of

sick or annual

leave used due to

injury related

disability or

absence to obtain

medical treatment;

(3) loss of wage

earning capacity

resulting from the

work injury; (4)

schedule award for

permanent

impairment

resulting from the

work injury

Employee

and

supervisor or

injury

compensation

specialist

By employee as

soon as possible

following wage

loss or

awareness of

impairment; by

supervisor or

injury

compensation

specialist within

5 work days of

receipt from

employee

Supervisor by

employee or

someone acting

on employee's

behalf; then to

appropriate

OWCP office by

supervisor

CA-7a Time Analysis Form Attached to form

CA-7 when

compensation is

claimed for

intermittent dates

of absence due to

work injury. Lists

dates for which

compensation or

leave buy back is

claimed

Employee

and

supervisor or

injury

compensation

specialist

By employee,

along with CA-7,

as soon as

possible after

absence; by

supervisor or

injury

compensation

specialist within

5 work days of

receipt from

employee

Appropriate

OWCP district

office

CA-7b Leave Buy Back

Worksheet/Certification

and Election

Attached to form

CA-7 when leave

buy back is

claimed.

Completed by

employing agency

to provide

employee with

estimate of

amount needed to

repurchase leave

and election as to

whether to

proceed

Employee

and

supervisor or

injury

compensation

specialist

By supervisor or

injury

compensation

specialist, along

with form CA-7,

upon receipt of

employee

signature

electing to

repurchase

leave

Appropriate

OWCP district

office

CA-16 Authorization for

Examination and/or

Treatment

Authorizes an

injured employee

to obtain

immediate

examination

and/or treatment

from a physician

chosen by the

employee for an

on-the-job injury

and provides

OWCP with initial

medical report.

Part A:

Supervisor

Part B:

Attending

physician

Part A: By

supervisor within

four hours of a

traumatic injury.

May be issued

up to one week

after injury.

Part B: By

attending

physician or

medical facility

as promptly as

possible after

Part A: Given to

employee to

provide to

physician

Completed form

sent to appropriate

OWCP district

office

Treatment may be

obtained from a

local hospital or

physician

initial

examination

CA-17 Duty Status Report Provides

supervisor and

OWCP with interim

medical report

containing

information on

employee's ability

to return to work

and physical

limitations

Side A:

Supervisor

Side B:

Attending

physician

Promptly upon

completion of

examination

Original to

employing agency;

copy to OWCP

central mail

address

CA-20 Attending Physician's

Report Provides medical

support for claim

and is attached to

Form CA-7 (can

also be obtained

or submitted

separately);

provides OWCP

with medical

information

Attending

physician Promptly upon

completion of

examination

Appropriate

OWCP district

office, if attached

to form CA-7;

OWCP central

mail address

otherwise

CA-40 Designation of a Recipient

of the Death Gratuity

Payment under Section

1105 of Public Law 110-

181

Designates the

manner in which a

death gratuity of

up to $100,000

payable under

Section 1105 of

Public Law 110-

181 will be

disbursed when a

Federal employee

dies of injuries

incurred in

connection with his

or her service with

an Armed Force in

a contingency

operation

Employee

and

supervisor or

injury

compensation

specialist

Any time a

Federal

employee is

deployed

overseas or

otherwise

assigned to

provide service

to an Armed

Force in a

contingency

operation, as

defined in

Section 1105 of

Public Law 110-

181. Completed

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

Supervisor by

employee or

someone acting

on employee's

behalf; then to

appropriate

OWCP office by

supervisor upon

death of employee

in connection with

service with an

Armed Force in a

contingency

operation

OWCP-5 Work Capacity Evaluation Provides OWCP

with medical

opinion on

employee's ability

to work, and any

work limitations

experienced by the

employee

Attending

physician Promptly upon

completion of

examination

OWCP Central

mail address

OWCP-

915 Claim for Medical

Reimbursement Used to seek

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.

Employee As soon as

possible after

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

OWCP Central

mail address

OWCP-

957 Medical Travel Refund

Request Used to seek

reimbursement for

expenses incurred

for travel to obtain

medical treatment

of a work related

condition

Employee As soon as

possible after

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

OWCP Central

mail address

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 Peace Corps Volunteer

??008300 Non-Federal Law Enforcement

Officer

??002100 VISTA Volunteer

??024300 Job Corps Enrollee

??030200 Mail Messenger

??350100 Contract Job Cleaner

??062100 Student Nurse

??046200 Forest Service Volunteer

??134100 Volunteer Weather Observer

??009900 State Maritime Academy Cadet

??009900 ROTC Cadet

??093000 Federal Juror

??218100 Civil Air Patrol Volunteer

??068500 Volunteer Hospital Worker

??024300 Youth Conservation Corps

Volunteer

??047500 County Agent, Dept. of Agriculture

??350600 Student Aide

Alpha/Numeric Code Title

??982500 Seaman

??020400 Coast Guard Reserve Member

??024000 Coast Guard Auxiliary Member

??002300 National Park Service Collaborator

??009900 College Work/Study Participant

??006000 Chaplain

??186300 State/Local Agriculture Inspector

??003000 Sports Clinic Performer

??018800 Entertainer/Armed Forces

??024300 Vocational Trainee

??046000 Forest Service Cooperator

??131600 Gage Reader, Corps of Engineers

??470100 Maintenance Worker, Dept. of

HUD

??002600 National Park Service Volunteer

??020400 National Defense Executive

Reserve

??174000 National Teacher Corps Member

Alpha/Numeric Code Title

??061000 Contract Nurse

??060200 Contract Physician

??063000 Nutritional Aide, USDA

??174000 Reader for the Blind

??101600 Trust Employee, Smithsonian

Institution

??045700 Soil/Water Conservation District

Employee

??024300 Youth/Adult Conservation Corps

Enrollee

??009900 Military Academy Cadet

??000600 Volunteer Trainee Probation

Officer

??000600 Urban Crime Prevention Program

Volunteer

??034500 Congressional Staff Member

APPENDIX C OCCUPATIONAL DISEASE CHECKLISTS