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Office of Workers' Compensation Programs
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Office of Workers' Compensation Programs (OWCP)

Division of Federal Employees' Compensation (DFEC)

District Office 16 — OWCP and the Treating Physician

Medical providers should send all mail and bills for Federal workers' compensation cases to the following address:

U.S. Department of Labor
DFEC Central Mailroom
PO Box 8300
London, KY 40742-8300

Effective 09/02/03, the Federal Employees' Compensation (FEC) division of OWCP has consolidated its medical authorization and bill payment processes. If you need medical authorization or have a question concerning a bill, please contact us at the following:

Medical Authorzation
Telephone: (866) 335-8319
Fax: (800) 215-4901

Bill Payment Status
Telephone: (866) 335-8319
Website: http://owcp.dol.acs-inc.com


Your Patient - Information for Medical Practioners

Note: This pamphlet is for information only and does not detail the full effect of law or regulations.

OWCP Guide for Treating Physician

Attention all medical providers, please review OWCP's message regarding the HIPPA.

The Federal Employees' Compensation Act (5 USC 8101 et seq.), which is administered by the U.S. Department of Labor, Office of Worker's Compensation Programs (OWCP), provides workers' compensation coverage to civilian employees of the United States who suffer employment-related injury, disease, or illness. FECA serves only Federal workers and employers, and has different benefits and requirements than the state workers' compensation programs, which cover private employers.

As a workers' compensation program, the FECA differs from Federal or State disability retirement program in that benefits are awarded based on the causal relationship of the disability to the employment and the resulting loss of wage earning capacity. In addition, the program is not adversarial in nature and OWCP's decisions are based on documented evidence of record. For this reason, OWCP seeks accurate and concise medical documentation to determine the individual's entitlement to benefits and services. The following information on FECA benefits and how the program works has been prepared to assist you when seeing Federal employees for the accepted, work-related condition(s) (injuries, diseases, or illness).


Basic Benefits

Medical Care: The employee initially selects a physician or medical facility to provide the necessary treatment. The initial medical care may be authorized by the employing agency. OWCP will authorize medical services required to treat the accepted condition(s) which can include:

  • Examinations
  • Hospitalization
  • Surgery
  • Physical, Occupational, Respiratory Therapy
  • Medications
  • Appliances
  • Medical Supplies
  • Work Hardening
  • Psychiatric and Psychological

Reimbursable chiropractic services are limited to treatment consisting of manual manipulation of the spine to correct a subluxation demonstrated by x-ray.

OWCP enters into agreements with physicians to provide medical evaluation services and to assist the office by interpreting medical reports, clarifying medical issues, and reviewing request for surgery and other modalities of treatment.

OWCP also uses medical specialists for second opinion examinations to address medical issues which can not be resolved with the available medical information. These examinations are performed by physicians who specialize in the field of medicine pertinent to the issue. In cases where a conflict of opinion is determined to have occurred, OWCP secures the medical opinion of a referee specialist, chosen by rotation among the available specialists in a given geographic area who are Board certified in the appropriate area of medicine. Such services may be use to resolve conflicts of opinion on pertinent issues such as relationship of a condition to factors of employment, or the extent of disability.

Disability Benefits: FECA provides monetary compensation for loss of wages resulting from the accepted condition(s). Entitlement to monetary compensation for wage loss terminates when it is determined that the employee is medically able to perform the duties of the position held at the time of injury, or when no work-related disability remains.

Total Disability: Paid when the employee is medically restricted from any and all gainful employment as a result of the accepted condition(s).

Partial Disability: Paid when the employee is not totally disabled but is capable of performing duties which are compatible with the medically imposed work limitations resulting from the accepted condition(s). The amount of compensation paid is commensurate with the employee's loss of wage-earning capacity.

Schedule Award: A schedule award is payable when the condition has reached maximum improvement and is stable. Compensation is paid for permanent impairment of certain organs or functions of the body (but not whole body impairments). The most current version of the AMA Guides to the Evaluation of Permanent Impairment forms the basis for awards.

Nurse Intervention: OWCP certifies registered nurses (RN) with specialized skills in case management to facilitate medical recovery of the Federal employee. The RN encourages injured worker involvement in medical recovery and early return to work. The RN can authorize non-invasive diagnostic tests and treatment prescribed by the treating physician and serve as a liaison among OWCP, injured worker, employer and medical provider. In addition, the RN provides ongoing support during the first 60 days after an injured worker returns to work to assure a safe, successful re-entry into the work place.

Vocational Rehabilitation: OWCP certifies skilled and experienced Rehabilitation Counselors (RC) to assess the employee's vocational potential and provide a variety of services to enter and maintain suitable employment. Services can include:

  • Counseling and guidance,
  • Vocational testing,
  • Medical Rehabilitation services,
  • Vocational Training,
  • Work Site Modification,
  • Placement Assistance,
  • Employment Follow-up Support.

The RC works with the treating physician to seek clarification on the impact of the employee's limitation(s) in a work setting.


How The Program Works

The medical information provided by the treating physician(s) is very crucial in helping the office determine whether benefits should be provided, the type of benefits to which the employee is entitled, and how long the benefits should continue.

Authorization: The initial authorization of medical care at OWCP expense is made by the employing agency using Form CA-16, Authorization for Examination and/or Treatment. The authorization is subject to the conditions indicated on the form. Based on the necessity for or the appropriateness of continued medical care as indicated by the case record, OWCP may grant, continue, or terminate an authorization for examination/treatment at OWCP expense.

Billing: OWCP accepts charges for necessary professional medical services related to treatment of the work-related injury or disease using:

  • The Form HCFA 1500/OWCP 1500A, the AMA Health Insurance Claim form for professional services,
  • Form UB 82 for hospitals
  • Universal Drug Claim forms for pharmacies.
  • CPT/HCPS codes which are updated every year,
  • A fee schedule.

Reports: Either through Department of Labor forms or by narrative report, comprehensive medical information is vital in determining the employee's initial and continuing entitlement to benefits. The office specifically requires information on the following:

  • Diagnosis of the work-related condition(s)
  • Prognosis of the work-related condition(s)
  • Identify any existing impairment from the work-related condition(s)
  • Address the individual's capacity to work:
  • Describe specific physical and/or mental limitations.
  • When requested by the office, estimate percentage of permanent impairment of a member or function of the body that resulted from the accepted condition(s), using the AMA Guides where applicable.

This information should be supported by documentation from the history, physical examination, x-ray and other test results that support the stated conclusion. If an opinion is not based on conclusive evidence, the supportive evidence with any additional evidence used to rule out of the other likely causes must be cited.