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Division of Federal Employees' Compensation (DFEC)

FECA Transmittals

Table of Contents

 


Fiscal Year 2014

FECA Transmittal No. 14-01

CHAPTER 2-1701, PEACE CORPS

FECA Transmittal No. 14-02

CHAPTER 2-0601, DISABILITY MANAGEMENT TRACKING

FECA Transmittal No. 14-03

CHAPTER 8-0200, REFERRALS FOR REHABILITATION

FECA Transmittal No. 14-04

CHAPTERS 1-0200, JURISDICTION

FECA Transmittal No. 14-05

CHAPTER 2-0901, COMPENSATION CLAIMS
CHAPTER 5-0400, HEALTH BENEFITS INSURANCE

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Fiscal Year 2013

FECA Transmittal No. 13-01

CHAPTER 2-1401, INITIAL DENIALS

FECA Transmittal No. 13-02

CHAPTER 2-0601, DISABILITY MANAGEMENT TRACKING

FECA Transmittal No. 13-03

CHAPTER 1-200, JURISDICTION

FECA Transmittal No. 13-04

CHAPTER 3-0500, OWCP Directed Medical Examinations

FECA Transmittal No. 13-05

CHAPTER 2-0805, CAUSAL RELATIONSHIP

FECA Transmittal No. 13-06

CHAPTER 2-0901, COMPENSATION CLAIMS
CHAPTER 2-0700, DEATH CLAIMS
CHAPTER 2-0808, SCHEDULE AWARDS AND PERMANENT DISABILITY CLAIMS
CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY

FECA Transmittal No. 13-07

CHAPTER 2-1400, DISALLOWANCES

FECA Transmittal No. 13-08

CHAPTER 3-0500, OWCP Directed Medical Examinations

FECA Transmittal No. 13-09

CHAPTER 2-0814, JOB OFFERS AND RETURN TO WORK
CHAPTER 2-0815, DETERMINING WAGE-EARNING CAPACITY BASED ON ACTUAL EARNINGS
CHAPTER 2-0816, DETERMINING WAGE-EARNING CAPACITY BASED ON A CONSTRUCTED POSITION
CHAPTER 2-1500, RECURRENCES
CHAPTER 2-1501, MODIFICATION OF LWECs

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Fiscal Year 2012

FECA Transmittal No. 12-01

CHAPTER 2-0601, DISABILITY MANAGEMENT TRACKING

FECA Transmittal No. 12-02

CHAPTER 2-1601, HEARINGS AND REVIEWS OF THE WRITTEN RECORD

FECA Transmittal No. 12-03

CHAPTER 2-1602, RECONSIDERATIONS

FECA Transmittal No. 12-04

CHAPTER 1-0200, JURISDICTION

FECA Transmittal No. 12-05

CHAPTER 3-300, AUTHORIZING EXAMINATION AND TREATMENT

FECA Transmittal No. 12-06

CHAPTER 2-0812, PERIODIC REVIEW OF DISABILITY CLAIMS
CHAPTER 2-1402, FORFEITURE

FECA Transmittal No. 12-07

CHAPTER 2-0807, CONTINUATION OF PAY AND INITIAL CLAIMS FOR COMPENSATION

FECA Transmittal No. 12-08

CHAPTER 2-1200, REPRESENTATIVES' SERVICES

FECA Transmittal No. 12-09

CHAPTER 7-0100, INTRODUCTION TO NURSE INTERVENTION

FECA Transmittal No. 12-10

CHAPTER 2-0803, FACT OF INJURY

FECA Transmittal No. 12-11

CHAPTER 7-0300, CONTINUATION OF PAY (COP) NURSES

FECA Transmittal No. 12-12

CHAPTER 8-0100, INTRODUCTION TO REHABILITATION

FECA Transmittal No. 12-13

CHAPTER 2-0900, DETERMINING PAY RATES

FECA Transmittal No. 12-14

CHAPTER 8-0800, ASSISTED REEMPLOYMENT

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Fiscal Year 2011

FECA Transmittal No. 11-01

RELEASE – REVISION TO FECA PROCEDURE MANUAL
CHAPTER 0-100, INTRODUCTION TO FECA AND DFEC
CHAPTER 0-200, PROGRAM DIRECTIVES

FECA Transmittal No. 11-02

RELEASE - REVISION TO FECA PROCEDURE MANUAL
CHAPTER 2-0813, VOCATIONAL REHABILITATION SERVICES

FECA Transmittal No. 11-03

RELEASE - REVISION TO FECA PROCEDURE MANUAL
CHAPTER 2-0900, DETERMINING PAY RATES

FECA Transmittal No. 11-04

RELEASE - REVISION TO FECA PROCEDURE MANUAL
CHAPTER 2-0800, INITIAL DEVELOPMENT OF CLAIMS
CHAPTER 2-0806, INITIAL ACCEPTANCES

FECA Transmittal No. 11-05

RELEASE - REVISION TO FECA PROCEDURE MANUAL
CHAPTER 2-0811, NURSE CASE MANAGEMENT
CHAPTER 2-0600, DISABILITY MANAGEMENT

FECA Transmittal No. 11-06

RELEASE - REVISION TO FECA PROCEDURE MANUAL
CHAPTER 3-0500, OWCP DIRECTED MEDICAL EXAMINATIONS

FECA Transmittal No. 11-07

RELEASE - REVISION TO FECA PROCEDURE MANUAL
CHAPTER 2-0900, DETERMINING PAY RATES

FECA Transmittal No. 11-08

RELEASE - REVISION TO FECA PROCEDURE MANUAL
CHAPTER 2-0500, CONFERENCES

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Fiscal Year 2010

FECA Transmittal No. 10-01

Modifies Part 2, Chapter 0100; CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY; CHAPTER 2-0900, DETERMINING PAY RATES; CHAPTER 2-0901, COMPUTING COMPENSATION; CHAPTER 2-1500, RECURRENCES

FECA Transmittal No. 10-02

Modifies CHAPTER 2-0900, DETERMINING PAY RATES, AND 2-0901, COMPUTING COMPENSATION, PART 2- CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA Transmittal No. 10-03

Modifies CHAPTER 2-1800, HOUSING AND VEHICLE MODIFICATIONS, PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA Transmittal No. 10-04

Modifies Part 2 and Part 3 of the FECA Procedure Manual

FECA Transmittal No. 10-05

Chapter 2-0812 has been revised in its entirety

FECA Transmittal No. 10-06

Chapter 2-700 has been updated to add paragraph 21 which addresses a new death gratuity

FECA Transmittal No. 10-07

The entire chapter has been updated and revised to reflect the changes that have taken place with regard to reorganization of responsibility between FEC district offices.

FECA Transmittal No. 10-08

Revision to chapter 2-1601, Hearings and Reviews of the Written Record

FECA Transmittal No. 10-09

REVISION TO FECA PROCEDURE MANUAL CHAPTER 1-200, JURISDICTION

FECA Transmittal No. 10-10

REVISION TO FECA PROCEDURE MANUAL CHAPTER 2-0810, Developing and Evaluating Medical Evidence

FECA Transmittal No. 10-11

REVISION TO FECA PROCEDURE MANUAL CHAPTER 2-0600, DISABILITY MANAGEMENT, CHAPTER 2-0811, EARLY MANAGEMENT OF DISABILITY CLAIMS, CHAPTER 2-0901, COMPUTING COMPENSATION

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Fiscal Year 2009

FECA Transmittal No. 09-01

FT 09-01 modifies Part 0, Chapter 0100

FECA Transmittal No. 09-02

FT 09-02 modifies Part 1, Chapter 0200

FECA Transmittal No. 09-03

FT 09-03 modifies Part 6, Chapter 0300

FECA Transmittal No. 09-04

FT 09-04 modifies Part 6, Chapter 0200

FECA Transmittal No. 09-05

FT 09-05 modifies Part 2, Chapter 1000

FECA Transmittal No. 09-06

FT 09-06 modifies Part 2, Chapter 0401

FECA Transmittal No. 09-07

FT 09-07 modifies Part 2, Chapter 0809

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Fiscal Year 2007

FECA Transmittal No. 07-01

Revision to Chapter 4-100, Special Case Procedures, Introduction, PART 4

FECA Transmittal No. 07-02

Revision to Chapter 2- 1700, Special Act Cases, PART 2

FECA Transmittal No. 07-03

Revision to Chapter 1-200, Jurisdiction, PART 1

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Fiscal Year 2006

FECA Transmittal No. 06-01

Revision to Chapter 1-0200, Jurisdiction, Part 1 - Mail and Files

FECA Transmittal No. 06-02

REVISION TO CHAPTER 1100, FECA THIRD PARTY SUBROGATION GUIDELINES, PART 2

FECA Transmittal No. 06-03

Revision to Chapter 5-0202, Fee Schedule Appeals, Bill Adjustments, District Director
Exceptions and Cases/Providers on Review, Part 5 - Benefit Payments

FECA Transmittal No. 06-04

REVISION TO CHAPTER 2-1200, FEES FOR REPRESENTATIVES' SERVICES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA Transmittal No. 06-05

FECA TRANSMITTAL NO. 06-05 September 4, 2006

FECA Transmittal No. 06-07

REVISION TO CHAPTER 4-0100, SPECIAL CASE PROCEDURES, INTRODUCTION, PART 4 - SPECIAL CASE PROCEDURES,FEDERAL (FECA) PROCEDURE MANUAL

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Fiscal Year 2005

FECA Transmittal No. 05-01

Revision to Chapter 6-0200, Initial Overpayment Actions, PART 6 – Debt Management, Federal (FECA) PROCEDURE MANUAL

FECA Transmittal No. 05-02

Revision to Chapter 2-1200, Fees for Represtatives' Services Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 05-03

Revision to Chapter 5-0200, Overview of the Bill Processing System (BPS), Part 5 - Benefit Payments, Federal (FECA) Procedure Manual

FECA Transmittal No. 05-04

Release Revision to Chapter 2-0901-6, Computing Compensation Part 2 Claims, Federal (FECA) Procedure Manual

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Fiscal Year 2004

FECA Transmittal No. 04-01

Revision to Chapter 2-0800, Development of Claims, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 04-02

Revision to Chapter 2-1602, Reconsiderations

FECA Transmittal No. 04-03

Revision to Chapter 6-0100, Overpayment Overview, 6-0200, Initial Overpayment Actions, and 6-0300, Debt Liquidation, PART 6 – Debt Management, Federal (FECA) Procedure Manual

FECA Transmittal No. 04-04

Revision to Chapter 2-807, Continuation of Pay and Initial Payments

FECA Transmittal No. 04-05

Revision to Chapters 2-0100, Introduction, and 2-0200, General Provisions of the FECA, PART 2 – Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 04-06

Revision to Chapter 5-0400, Health Benefits Insurance, and Creation of Chapter 5-0401, Life Insurance Part 5 - Benefit Payments, Federal (FECA) Procedure Manual

FECA Transmittal No. 04-07

Revision to Chapter 1-0200, Jurisdiction, Part 1 - Mail and Files, Federal (FECA) Procedure Manual

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Fiscal Year 2003

FECA Transmittal No. 03-01

Revision to Chapter 3-0700, Schedule Awards, PART 3 MEDICAL, Federal (FECA) Procedure Manul Explanation of material Transmitted

FECA Transmittal No. 03-02

REVISION TO CHAPTER 2-1500, RECURRENCES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA Transmittal No. 03-03

Revision to Chapter 2-800 Development of Claims, PART 2 – CLAIMS, FEDERAL (FECA) Procedure Manual

FECA Transmittal No. 03-04

Revision to Chapter 2-1700, Special Act Cases, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA Transmittal No. 03-05

Revision to Chapter 3-0500, Medical Examinations, Part 3 - Medical, Federal (FECA) Procedure Manual

FECA Transmittal No. 03-06

Revision to Chapter 2-0812, Periodic Review of Disability Cases, PART 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 03-07

Revision to Chapter 2-1300, Lump-Sum Payments, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 03-09

Revision to Chapter 2-11, Feca Third Party Subrogation Guidelines, Part 2 - Claims, Federal (FECA) Procedure Manual (Formerly Chapter 2-1100, Subrogation and Other Remedies)

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Fiscal Year 2002

FECA Transmittal No. 02-01

Revision to Chapter 2-900, Determining Pay Rates, Federal (FECA) PROCEDURE MANUAL

FECA Transmittal No. 02-02

Revision to Chapter 1-0200-2, General Jurisdiction, PART 1 – Mail and File, Federal (FECA) PROCEDURE MANUAL

FECA Transmittal No. 02-03

Revision to Chapter 2-1602, Reconsiderations, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA Transmittal No. 02-04

Revision to Chapter 2-1200, Fees for Reprsentatives' Services, FEDERAL (FECA) PROCEDURE MANUAL

FECA Transmittal No. 02-05

Revision to Chapter 2-0811 - Early Management of Disability Claims, FEDERAL (FECA) PROCEDURE MANUAL

FECA Transmittal No. 02-07

Revision to Chapter 2-900, Determining Pay Rates, Federal(FECA) PROCEDURE MANUAL

FECA Transmittal No. 02-08

Revision to Chapter 2-200-2 (e), General Provisions - PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL. Revision to Chapter 2-700-2, Death Claims, PART 2 – Claims, FEDERAL (FECA) PROCEDURE MANUAL. Revision to Chapter 2-901-18, Other Payees PART 2 – Claims (FECA) PROCEDURE MANUEL.

FECA Transmittal No. 02-11

Revision to Chapter 2-1700, Special Act Cases, Part 2-Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 02-12

Revision to Chapter 2-0808, Schedule Awards and Permanent Disability Claims, PART 2 - Claims, Federal (FECA) Prodedure Manual

FECA Transmittal No. 02-13

Revision to Chapter 3-0700, Schedule Awards, Part 3 – Medical, Federal (FECA) Procedure Manual

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Fiscal Year 2001

FECA Transmittal No. 01-01

Revision to Chapter 4-0300, War Hazards (12/00A)

FECA Transmittal No. 01-02

Checklist, Federal (FECA) Procedure Manual (01/01A)

FECA Transmittal No. 01-03

Revision to Chapters 2-901, Computing Compensation, and 2-401, Automated System Support for Case Actions (02/01B)

FECA Transmittal No. 01-04

Revision to Chapter 2-900, Determining Pay Rates

FECA Transmittal No. 01-06

Revision to Chapter 2-810, Developing and Evaluating Medical Evidence

FECA Transmittal No. 01-08

Revision to Chapter 0-0100, Introduction to FECA and DFEC, Federal(FECA) Procedure Manual

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Fiscal Year 2000

FECA Transmittal No. 00-01

New Chapter 5-0207, BPS Reports (01/00A)

FECA Transmittal No. 00-02

New Part 1 - Mail and Files (02/00A)

FECA Transmittal No. 00-03

New Chapter 2-0300, Communications, and revised Chapter 2-0400, File Maintenance and Management (02/00A)

FECA Transmittal No. 00-05

Revision to Chapter 0-0100, Introduction to FECA and DFEC (02/00A)

FECA Transmittal No. 00-06

Revision to Chapter 2-1000, Dual Benefits (02/00A)

FECA Transmittal No. 00-07

Revision to Chapters 3-300, Authorizing Examination and Treatment, and 3-400, Medical Services and Supplies (08/00A)

FECA Transmittal No. 00-08

Revision to Chapters 2-805, Causal Relationship, and 2-810, Developing and Evaluating Medical Evidence (08/00A)

FECA Transmittal No. 00-09

Revision to Chapters 2-700, Death Claims, and 2-901, Computing Compensation (09/00B)

FECA Transmittal No. 00-10

Revision to Chapters 2-200, General Provisions of the FECA, and 2-812, Periodic Review of Disability Cases (08/00B)

FECA Transmittal No. 00-11

Revision to Chapters 2-807, Continuation of Pay, and 2-1500, Recurrences (09/00A)

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Fiscal Year 1999

FECA Transmittal No. 99-01

Revision to Chapter 4-0300, War Hazards (10/98A)

FECA Transmittal No. 99-02

Revision of FECA Program Memorandum 280, and of Chapter 2-0400, File Maintenance and Management, and Chapter 2-0402, Security and the Prevention of Fraud and Abuse (10/98A)

FECA Transmittal No. 99-03

Checklist, Federal (FECA) Procedure Manual (10/98A)

FECA Transmittal No. 99-04

Revision to Chapter 6-0300, Debt Liquidation, Part 6 - Debt Management, Federal (FECA) Procedure Manual (11/98A)

FECA Transmittal No. 99-05

Revision of Chapter 2-0808, Schedule Awards and Permanent Disability Claims, Chapter 2-0810, Developing and Evaluating Medical Evidence and 2-1700, Special Act Cases, Part 2 - Claims, Federal (FECA) Procedure Manual (11/98A)

FECA Transmittal No. 99-06

Revisions to Chapter 3-201, Staff Nurse Services, Chapter 3-700, Schedule Awards, and Chapter 3-900, Administrative Matters, Part 3 - Medical, Federal (FECA) Procedure Manual (11/98A)

FECA Transmittal No. 99-07

Revision to Chapter 2-1601, Hearings and Reviews of the Written Record, Part 2 - Claims, Federal (FECA) Procedure Manual (01/99A)

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Fiscal Year 1998

FECA Transmittal No. 98-01

Checklist, Federal (FECA) Procedure Manual (11/97A)

FECA Transmittal No. 98-02

Revisions to Chapter 2-0400, File Maintenance and Management, and Chapter 2-1000, Dual Benefits (11/97B)

FECA Transmittal No. 98-03

Revisions to Chapter 2-0401, Automated System Support for Case Actions (11/97B)

FECA Transmittal No. 98-04

Release of New Chapter 2-0601, Disability Tracking and QCM Tracking Systems; Revision to Chapter 2-0401, Automated System Support for Case Actions; Revision to Chapter 2-1500, Recurrences; and Revision to the List of Chapters (01/98B)

FECA Transmittal No. 98-05

Revision of Chapter 2-0500, Conferencing, Chapter 2-700, Death Claims, Chapter 2-800, Development of Claims, and Chapter 2-0802, Civil Employee, Part 2 - Claims, Federal (FECA) Procedure Manual(05/98)

FECA Transmittal No. 98-06

Revision to Chapter 0-0100, Introduction to FECA and DFEC (10/98A)

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Fiscal Year 1997

FECA Transmittal No. 97-01

Revision to Chapter 2-0900, Determining Pay Rates, and Chapter 2-1000, Dual Benefits (11/96A)

FECA Transmittal No. 97-02

Revision To Chapter 2-0700, Death Claims, Chapter 2-0806, Occupational Illness, and Chapter 2-0811, Early Management of Disability Claims Part 2 - Claims, Federal (FECA) Procedure Manual (11/96B)

FECA Transmittal No. 97-03

Revision To Chapter 2-0810 - Developing and Evaluating Medical Evidence, and Chapter 2-0813, Reemployment: Vocational Rehabilitation Services , Part 2 - Claims, Federal (FECA) Procedure Manual (11/96A)

FECA Transmittal No. 97-04

Revision To Chapter 2-0600, Case Management, Part 2 - Claims, Federal (FECA) Procedure Manual (01/97A)

FECA Transmittal No. 97-05

Checklist, Federal (FECA) Procedure Manual (01/97A)

FECA Transmittal No. 97-06

Not Published

FECA Transmittal No. 97-07

Revision To Chapter 2-0804, Performance of Duty, and Chapter 2-0813, Reemployment: Vocational Rehabilitation Services, and Chapter 2-0814, Reemployment: Determining Wage-Earning Capacity, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 97-08

Revisions to Chapter 2-1000, Dual Benefits, and Chapter 2-1602, Reconsiderations (07/97A)

FECA Transmittal No. 97-09

Revision to Chapter 2-1400, Disallowances (03/97A)

FECA Transmittal No. 97-10

Revisions to Chapter 2-0814, Reemployment: Determining Wage-Earning Capacity, and Chapter 2-1500, Recurrences, Part 2 - Claims, Federal (FECA) Procedure Manual (05/97A)

FECA Transmittal No. 97-12

Revisions to Chapter 2-1600, Review Process; Chapter 2-1601, Hearings and Reviews of the Written Record; Chapter 2-1602, Reconsiderations; and 2-1603, Appeals; Part 2 - Claims, Federal (FECA) Procedure Manual (05/97A)

FECA Transmittal No. 97-13

Revision to Chapter 2-0900, Determining Pay Rates, and Chapter 2-0901, Computing Compensation, Part 2 - Claims, Federal (FECA) Procedure Manual (06/97A)

FECA Transmittal No. 97-14

Revision to Chapter 6-0200, Initial Overpayment Actions, Part 6 - Debt Management, Federal (FECA) Procedure Manual (07/97A)

FECA Transmittal No. 97-16

Revisions to Chapter 2-600, Case Management, Chapter 2-807, Continutation of Pay and Initial Payments, Part 2 - Claims, Federal (FECA) Procedure Manual (09/97A)

FECA Transmittal No. 97-17

Revisions to Chapter 2-811, Early Management of Disability Claims, Chapter 2-812, Periodic review of Disability Cases, and Chapter 2-0814, Reemployment: Determining Wage-Earning capacity, part 2 - Claims, Federal (FECA) Procedure Manual (07/97A)

FECA Transmittal No. 97-19

Revisions to Chapter 2-0500, Conferencing; Chapter 2-0700, Death Claims, and Chapter 2-0804, Performance of Duty, Part 2 - Claims, Federal (FECA) Procedure Manual (07/97B)

FECA Transmittal No. 97-20

Revisions to Chapter 2-0810, Developing and Evaluating Medical Evidence; Chapter 2-1100, Subrogation; and Chapter 2-1200, Fees for Representatives' Services, Part 2 - Claims, Federal (FECA) Procedure Manual (07/97B)

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Fiscal Year 1996

FECA Transmittal No. 96-01

Revision to Chapter 2-0806, Occupational Illness,Chapter 2-0800, Development of Claims, and Chapter 2-0400, File Maintenance and Management, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-02

Revision to Chapter 2-0900, Determining Pay Rates, and Release of New Chapter 2-0901, Computing Compensation, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-03

Revision to Chapter 0-0100, Introduction to FECA and DFEC, Part 0 - Overview, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-04

Revision to Chapter 3-0201, Staff Nurse Services: Chapter 3-0400, Medical Services and Supplies; Chapter 3-0500, Medical Examinations; and Chapter 3-0700, Schedule Awards, Part 3 - Medical, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-05

Revision to Chapter 2-0805, Causal Relationship, and Chapter 2-0806, Occupational Illness, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-06

Revision to Chapter 2-0900, Determining Pay Rates, And Chapter 2-0901, Computing Compensation, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-07

Revision to Chapter 2-814, Reemployment: determining Wage-Earning Capacity, Part 2 - Claims,Federal (FECA) Procedure Manual

FECA Transmittal No. 96-08

Revision to Chapter 4-0300, War Hazards, Part 4 - Special Case Procedures, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-09

Revision to Chapter 2-1100, Subrogation and Other Remedies; Chapter 2-1200, Fees for Representatives'Services; and Chapter 2-1500, Recurrences, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-10

Revisions to Chapters 5-0100. Introduction, and 5-0101, Security of the Fiscal Operation; Revisions to and Replacement of Chapters 5-0201, Authorizing Medical Payments, 5-0202, Processing Bills for Payment, 5-0203, Bill Coding under Medical Fee Schedule, 5-0204, Appeals of Fee schedule Determinations, and 5-1002, BPS Jobs and Keying Instructions, Part 5 - Benefit Payments, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-11

Revision to Chapters 2-1000, Dual Benefits, and 2-0813, Reemployment: Vocational Rehabilitation Services, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-12

Revision to Chapter 2-0814, Reemployment: Determining Wage-Earning Capacity, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-13

Revision to Part 5, Benefit Payments, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-14

Revision to Chapter 2-1000, Dual Benefits, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-15

Revision to Chapter 3-0201, Staff Nurse Services, Chapter 3-0300, Authorizing Examination and Treatment, and Chapter 3-0600, Requirements for Medical Reports (09/96B)

FECA Transmittal No. 96-16

Revision to Chapter 2-0814, Reemployment: Determining Wage-Earning Capacity, and 2-1700, Special Act Cases, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-17

Revision to Chapter 2-0900, Determining Pay Rates, and Chapter 2-0901, Computing Compensation, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-18

Revision to Chapter 2-1602, Reconsiderations, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-19

Revision to Chapter 4-0600, Reserve Officers' Training Corps, Part 4 - Special Case Procedures, Federal (FECA)

FECA Transmittal No. 96-20

Revision to Chapter 2-0806, Occupational Illness, and Chapter 2-0814, Reemployment: Determining Wage-Earning Capacity, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-21

Revisions to Chapter 5-0204, Principles of Bill Adjudication, Part 5 - Benefit Payments, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-22

Revision to Chapter 2-0401, Automated System Support For Case Actions, and Chapter 2-1400, Disallowances,Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-23

Revision to Chapter 2-0814, Reemployment: Determining Wage-Earning Capacity, Part 2 - Claims, Federal (FECA) Procedure Manual

FECA Transmittal No. 96-25

Revision to Chapter 0-0100, Introduction to FECA and DFEC (07/96B)

FECA Transmittal No. 96-26

Revision to Chapter 2-0700, Death Claims, and Chapter 2-1400, Disallowances (07/96B)

FECA Transmittal No. 96-27

Revision to Chapter 2-1602, Reconsiderations (09/96A)

FECA Transmittal No. 96-28

Revision to Chapter 2-0802, Civil Employee, and to FECA Program Memorandum 249 (09/96B)

FECA Transmittal No. 96-29

Issuance of New Chapter 5-0700, Chargeback, Part 5 - Fiscal (09/96B)

FECA Transmittal No. 96-30

Revision to Chapter 2-0810, Developing and Evaluating Medical Evidence, and Chapter 2-0813, Reemployment: Vocational Rehabilitation Services (09/96B)

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-1701, PEACE CORPS

FECA TRANSMITTAL NO. 14-01

 

 

November 7, 2013


EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Compensation (DFEC) and the Peace Corps have historically worked together to improve the workers' compensation experience for returning volunteers who have sustained an injury or occupational illness as a result of service with the Peace Corps. In an effort to provide better outreach to Peace Corps volunteers, DFEC has a link on its home page with information specific to Peace Corps volunteers.

To further improve the quality of the information provided in relation to Peace Corps cases and to update its own internal guidance for even more consistent claims handling, DFEC with issuance of this transmittal is releasing an entirely new Procedure Manual (PM) chapter pertaining solely to claims devoted to Peace Corps volunteers, PM 2-1701.

Information relative to Peace Corps volunteers used to be found in three separate places within the Federal Employees' Compensation Act (FECA) PM: Chapter 1-200-3, Chapter 2-1700-4 (and Exhibit 1 in that chapter) and Chapter 3-300-7. Chapter 3-300-7 had been updated in February, 2012 via FECA Transmittal 12-05 and some specific changes pertaining to Peace Corps cases were made at that time, to include the addition of new conditions for which the Peace Corps could provide treatment if the cost was less than $1000. PM 2-1700-4 had not been updated since early 2007 and PM 1-200-3 had not been updated since May, 2010.

Chapter 1-200-3 is amended to reflect that all Peace Corps cases (including National office claims) will initially be handled in the Cleveland District Office, as the Cleveland office has ongoing close contacts with that office.

New PM chapter 2-1701 incorporates the information pertaining to Peace Corps cases that had been in 2-1700 and 3-300 and includes additional and newly updated information as outlined below; it also removes outdated citations and references that were contained the Peace Corps section of 2-1700. PM chapter 1-200-3 was amended to correspond with the jurisdictional rules provided in Paragraph 5, below.

Paragraph 1, Introduction, provides the genesis for the establishment of the Peace Corps and outlines that the chapter will focus on the unique aspects of coverage under that pertain specifically to volunteers in the Peace Corps. It also notes that claims for Peace Corps employees who work for the Peace Corps, other than as volunteers or volunteer leaders, are handled in the same manner as other claims and that there are no special rules for handling claims from such employees.

Paragraph 2, Statutory Provisions of the FECA, provides the text of §8142 of the FECA, which pertains specifically to Peace Corps.

Paragraph 3, Regulatory Provisions under the FECA, provides the text of 20 C.F.R §§8 10.730 and 10.731, which pertain specifically to Peace Corps.

Paragraph 4, Statutory Authority for Peace Corps, provides relevant references to specific sections of Peace Corps Act.

Paragraph 5, Jurisdiction, outlines that Peace Corps claims are initially adjudicated in the Cleveland District Office, after which they are transferred to other district offices if approved.

Paragraph 6, FECA Coverage of Employees/Volunteers, discusses the differences in coverage for Peace Corps volunteers, staff employees, and staff spouses (while performing service or engaged in official travel).

Paragraph 7, Conditions of Coverage During Training, explains that Peace Corps applicants have the protection of the FECA while performing their training assignments or while engaged in any activity which is a reasonable incident of the training assignment.

Paragraph 8, Conditions of Coverage while Serving Abroad, provides information relative to section 5(d)(2) of the Peace Corps Act. This paragraph explains that injuries of trainees and volunteers while abroad are deemed to have occurred while in the performance of duty, and any disease contracted abroad is deemed to have been proximately caused by the employment. The exclusions for willful misconduct, intent to bring about injury or death of self or another, or intoxication, which appear in §8102 of the FECA and section 5(d)(2) of the Peace Corps Act, are noted as exceptions.

A discussion of various types of medical conditions, such as dental disease, mental illness and pregnancy, is included in this paragraph as well. Also, as first noted in FECA Transmittal 12-05, this paragraph specifically notes that injury due to assault or sexual assault (including treatment for sexually transmitted disease and mental health treatment) are covered under the FECA.

Paragraph 9, Conditions of Coverage Returning from Service Abroad, outlines that a volunteer who returns to the United States immediately after completing service abroad has the protection of the FECA while traveling to the United States unless a material deviation occurs. If the volunteer is terminated at a foreign post of duty, the volunteer has the protection of the FECA only during that part of the trip when on the direct or most usually traveled route between the foreign post of duty and the United States.

Paragraph 10, Payment of Medical Costs by Peace Corps, provides that where treatment of certain specified service-related medical conditions or injuries costs less than $1500, the Peace Corps will, at its discretion, pay medical costs directly. If the cost for necessary treatment is $1500 or more, a claim must be filed under the FECA using normal procedures.

  • The $1500 dollar limit is an update effective with this transmittal. The prior dollar limit of $1000 was re-evaluated at the request of the Peace Corps. In keeping with FECA procedures regarding cases which are simple or do not involve large expenses, and in recognition that medical costs have risen since the $1000 amount was implemented, the dollar amount was increased.
  • Likewise, DFEC also considered expansion of additional medical conditions that can be considered under this authority. In February, 2012 new conditions were added to the previously approved list of medical conditions (see FECA Transmittal 12-05). Additions at that time included: vaginal yeast infections (candidiasis); acute otitis media; acute sinusitis; constipation; and hemorrhoids.
  • With the issuance of this transmittal, DFEC is adding giardia to this list (as long as the condition requires only a one-time treatment).
  • DFEC is also adding initial tuberculosis treatment to this list, with a caveat. Tuberculosis can be classified as either latent tuberculosis or tuberculosis disease. Treatment for latent tuberculosis is optional for the infected individuals and there is no time sensitivity for treatment since they are asymptomatic; however, volunteers who develop tuberculosis disease do need immediate treatment. As a result, the discretionary conditions for which the Peace Corps can provide up to $1500 in treatment includes tuberculosis with the caveat that a claim form must be submitted in all tuberculosis claims.

Paragraph 11, Initial Authorization for Medical Care, outlines that requests for initial authorization of medical care in emergency situations (prior to creation of a case) should be directed to the Cleveland District Office and requests for treatment, after a case has been created, should be referred to OWCP's authorized billing agent (like all other cases).

Paragraph 12, Reporting Injuries and Deaths, outlines that Peace Corps volunteers are required to report injuries in the manner required by 20 C.F.R §§ 10.100 and 10.101; however, for ease of handling while the volunteer is overseas, some special handling processes are used.

  • With respect to timely filing of the claim, if the volunteer sustains an injury or occupational disease while abroad, the volunteer should notify his/her supervisor/team leader. The Peace Corps will then typically provide for any medical care needed while abroad and should document the volunteer's medical file accordingly. By documenting the medical file with any treatment provided, a claim (if filed later) will meet the eligibility for timely filing, which is one of the five necessary elements for acceptance of a claim. See FECA PM 2-0801. Upon separation, the volunteer should then submit Form CA-1 (for traumatic injury) or Form CA-2 (for occupational disease) to the Peace Corps. Upon receipt of a form, the Peace Corps should then assist with questions; complete its part of the form; and forward the claim to OWCP.
  • The Peace Corps should provide the dates of enrollment and separation, and the dates of service abroad with any claim submitted.
  • With the claim form, the Peace Corps should also submit the volunteer's medical record, which usually includes the results of the pre-employment and termination examinations and a record of medical care received during service. This medical information is needed when adjudicating claims, as noted above. While in some instances OWCP may only need limited information from the medical record, OWCP reserves discretion to request and receive the entire medical record from Peace Corps.

Paragraph 13, Claims for Disability Compensation, provides specific information relative to the filing and payment of compensation claims for Peace Corps volunteers. It is noted that the date of the volunteer's separation will be the date pay stops and that entitlement to compensation for temporary or permanent disability begins on the date following the date of separation. Specific information on other elements related to payment of compensation, such as pay rates, effective payrate dates, and waiting days, is also provided. Continuation of Pay is not paid to Peace Corps volunteers. See 20 C.F.R. 10.200 (d).

Paragraph 14, Disability Management, outlines that Peace Corps volunteers (and all employees of the Peace Corps) are entitled to all services provided for under the FECA. This includes the full complement of nurse intervention and vocational rehabilitation services provided as part of the Disability Management process.

Exhibit 1, Annual Pay Rates for Computing Compensation for Peace Corps Volunteers, provides the payrate amounts, effective the date of injury (separation) through the present year.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


Chapter 1-200-3 has been amended. Chapter 2-1701 is entirely new. Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0601, DISABILITY MANAGEMENT TRACKING

FECA TRANSMITTAL NO. 14-02

 

 

November 18, 2013


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0601 was revised and updated in its entirety in October, 2011. The chapter was then updated in November, 2012, and additional updates are being made at this time as outlined below. These updates include new coding logic that was added to iFECS effective November 18, 2013.

Paragraph 1, Purpose and Scope, was updated to include references to other relevant parts of the Procedure Manual, Part 7 Nurse Intervention and Part 8 Rehabilitation.

Paragraph 6, DM Codes, was updated to indicate that there are six, not five, types of mandatory codes since Dual Tracking codes are really specific unto themselves. The portion of this paragraph pertaining to mandatory CE Intervention Codes also now includes a reference to codes for the following circumstances: a second opinion examination has been determined to be unnecessary; valid work tolerance limitations are in file, but the claimant has not returned to work; and valid work tolerance limitations are not in file. The codes are then described in more detail in other paragraphs. Additional information was also added relative to the RMV code to clarify that it should be entered after concurrence by a Supervisor that the DM record should be deleted and that valid DM cases should not be removed from DM via the RMV code.

Paragraph 7, CE Intervention Codes, which outlines mandatory CE codes, was updated in a few places, and some reorganization took place so that the codes are listed in alpha order within the chapter.

  • The explanation of the MSN code was moved into this paragraph and out of the Optional Code paragraph, since this code is mandatory if it is determined that a second opinion in a total disability case is not necessary. The description remained essentially the same; however, more detail was added to remind staff that the fact that a claimant is released to limited duty and/or is participating in Vocational Rehabilitation is not in itself a valid reason to use the MSN code. To use the code in such cases, the file should reflect that there are no pending issues related to (1) continuing causal relationship of the condition(s) to the work injury/illness, or (2) whether the claimant could return to full duty.
  • WTL (Valid WTLs in File-No RTW) is a new code. This code is required when valid work restrictions for all conditions have been obtained but the claimant has not yet returned to work. "All conditions" include those which have been accepted in the current claim as well as any other accepted conditions in other case files, conditions which pre-existed the injury, and conditions which arose after the injury. There are two options for entry of the WTL code in the DM record:

(1) Manual Entry by the CE. The effective date of the status is the date of the most recent medical work release outlining the necessary work restrictions.

(2) Auto-Population from the response provided in the Periodic Entitlement Review (PER) record. If the CE answers "Yes" to the PER question "Valid work restrictions in file for all conditions?", the PER will then require entry of the date of the most recent medical work release outlining the necessary work restrictions. After entry of this information in the PER record, the DM record will auto-populate the WTL code in the DM record. The effective date of the status will auto-populate with the date entered in the PER record (i.e. the date of the most recent medical work release outlining the necessary work restrictions). The pertinent question in the PER will only activate for cases in a PR or PN status since cases in a PW status already have a determined wage earning capacity.

  • WTX (Valid WTLs not in File) is a new code and complements the WTL code. If the claimant has not been released to work and remains totally disabled from reemployment, code WTX is required. This code is also required when a claimant who previously had been given a work release, but had not returned to work, is no longer released to work due to an increased disability or when the work tolerance limitations have changed such that they are no longer considered valid (in these situations, the WTX code can be entered in the DM record subsequent to the previously entered WTL code - the previously entered WTL code should not be deleted from the DM record). Like the WTL code, there are two options for entry of the WTX code in the DM record:

(1) Manual Entry by the CE. The effective date of the status is the date the CE determines that valid work restrictions are not file for all conditions.

(2) Auto-Population from the response provided in the PER record. If the CE answers "No" to the PER question "Valid work restrictions in file for all conditions?", the PER will auto-populate the WTX code in the DM record. The effective date of the status will auto-populate with the date of the PER record closure.

NOTE: Entry of either the WTL or WTX code can be made and updated at any time during the life of a DM case/record, but it is mandatory upon Field Nurse closure when a claimant has not returned to work (via CE manually entry) and when completing a PER record for any case with a status of PR or PN (via auto-population). However, for optimal case management, the CE should also update the DM record with a WTL or WTX code whenever the claimant's ability to work changes, not just at the time of nurse closure and during the annual PER review.

Paragraph 12, Optional Codes, was updated as outlined below.

Additional DM codes were added to assist with the management and monitoring of disability cases:

PRX (Pre-reduction cannot be finalized). PRX can be entered after a proposed notice of reduction has been sent to the claimant and subsequent evidence or argument is received which hinders the CE from proceeding with a final notice of reduction. The effective date of code PRX should be the date of the notification sent to the claimant advising him/her of the determination to discontinue with the proposed reduction.

PTX (Pre-termination cannot be finalized). PTX can be entered after a proposed notice of termination has been sent to the claimant and subsequent evidence or argument is received which hinders the CE from proceeding with a final notice of termination. The effective date of code PTX should be the date of the notification sent to the claimant advising him/her of the determination to discontinue with the proposed termination.

An explanation was added for the already existing TRL code:

TRL (Transfer of case). TRL can be entered to denote a transfer of a case file from one District Office to another. The TRL code can be entered by the receiving District Office effective the date it received the transferred case.

The explanation of the SUR code was updated to indicate that the effective date for the code can be a future date, which was a change made in the noted iFECS release.

SUR (Surgery Authorized). SUR can be entered when the claimant has approved surgery. This code is useful for alerting the CE to re-evaluate the disability management options for this case. The effective date of code SUR should be the date the surgery is performed. If the surgery is scheduled for a date in the future, entry of this future date is allowed.

Paragraph 13, Closure Codes and Resolutions, was updated in a few places primarily to account for coding associated with return-to-work in temporary positions and failure to accept appropriate temporary light duty assignments commensurate with 20 C.F.R. 10.500. See FECA Transmittal 13-09 and PM chapter 2-814 for more detail.

  • In sub-paragraph "c" in this section, the explanation of CNC was updated slightly but the meaning remains essentially unchanged. This code is used if the claimant's work restrictions have reached a stable and well-defined state, the claimant has returned to a full-time light duty work assignment with no wage loss, and a formal LWEC decision cannot be issued due to the work assignment being a non-classified and/or temporary position.
  • Also in sub-paragraph "c", an explanation for a new code, TNW (RTW temp LD w/wage loss-10.500), was added. This code is similar to the CNC code but is to be used in cases where a formal LWEC decision cannot be issued, but the claimant is receiving wage loss compensation on the periodic roll based upon his/her actual earnings. It is similar to a CNC in that the claimant's work restrictions have reached a stable and well-defined state and the EA is providing a consistent light duty work assignment in a non-classified position and/or a position that is temporary in nature. However, unlike a CNC case, the claimant's employment is either less than full-time or full-time with lower wages than what the claimant earned in his/her date of injury job.
  • In sub-paragraph "d", which addresses cases where there was NO actual RTW, but the claimant is medically able to RTW, an explanation of the new code TNX (Comp reduced/declined temp LD-10.500) was added. TNX should be used when a claimant is provided a temporary light duty assignment that is either less than full-time or full-time with lower wages than what the claimant earned in his/her date of injury job; the temporary assignment appropriately accommodates the claimant's medically-imposed work restrictions; and the claimant declines the assignment. A formal decision should be issued in this instance and the effective date of the TNX code is the date of the final decision.
  • Sub-paragraph "e", which addresses situations where there is no disability from work, has been updated with an explanation of the new CCT code (Comp terminated/declined temp LD-10.500). CCT should be used when a claimant is provided a temporary light duty assignment that would result in no wage loss; the temporary assignment appropriately accommodates the claimant's medically-imposed work restrictions; and the claimant declines the assignment. A formal decision should be issued in this instance and the effective date of the CCT code is the date of the final decision.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 8-0200, REFERRALS FOR REHABILITATION

FECA TRANSMITTAL NO. 14-03

 

 

November 8, 2013


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 8-0200, Referrals for Rehabilitation, is a new chapter in FECA Procedure Manual (PM), Part 8 - Vocational Rehabilitation Intervention.

Currently, Referral Screening (Development) is discussed in Part 3 of the OWCP PM, Chapter 3-0300. As outlined in FECA Transmittal No. 12-12, however, it has been decided that moving information pertaining to DFEC's Rehabilitation Program into the FECA PM is warranted. The OWCP PM chapter will remain, and that chapter may be referenced for a historical perspective, but since it has not been recently updated, this new chapter (FECA PM 8-0200) should be consulted for any rehabilitation referral issues, since it contains the most current policies and procedures for DFEC.

Paragraph 1, Authority, provides a reference for relevant statutory and regulatory provisions and provides Employees' Compensation Appeals Board (ECAB) precedent pertaining to the provision of rehabilitation services.

Paragraph 2, Purpose and Scope, defines referral screening and identifies the two related steps.

Paragraph 3, Referral Sources and Mechanics, explains the importance of early case referral and identifies the various sources of referrals for rehabilitation.

Paragraph 4, Referral Requirements, outlines the information which each referral for rehabilitation should include and provides the process by which such referral should be transmitted to the RS.

Paragraph 5, Active Field Nurse Cases and Dual Tracking, identifies those instances in which a case may be referred for rehabilitation concurrently with active Field Nurse (FN) services.

Paragraph 6, Screening, defines the goal of screening and provides the time frame within which such screening should be completed. This paragraph also explains the three components required for review (medical, non-medical, and injured worker information) and provides guidance on how to clarify any vague or missing information.

Paragraph 7, Referral Outcome, explains how to open an active rehabilitation case and assign a Rehabilitation Counselor (RC) when necessary or close a case from referral when the case is not in posture for rehabilitation services.

Paragraph 8, Limited Referrals, defines those instances in which a referral to an RC on a limited basis may be appropriate even though one or more of the referral requirements has not technically been met.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


Chapter 1-200-3 has been amended. Chapter 2-1701 is entirely new. Because transmittal of the FECA Procedure Manual is electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTERS 1-0200, JURISDICTION

FECA TRANSMITTAL NO. 14-04

 

 

January 29, 2014


EXPLANATION OF MATERIAL TRANSMITTED:

The exhibit outlining the special case designations is being updated. Two new case designations are being added, as outlined below.

NYS (Navy Yard Shootings) – This case designation will be used to identify cases containing reports of injuries related to the Navy Yard shootings at the headquarters of the Naval Sea Systems Command inside the Washington Navy Yard in Southeast Washington, D.C. on September 16, 2013.

LAX (LAX Shootings) – This case designation will be used to identify cases containing reports of injuries related to the shootings inside Terminal 3 of the Los Angeles International Airport on November 1, 2013.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0901, COMPENSATION CLAIMS
CHAPTER 5-0400, HEALTH BENEFITS INSURANCE

FECA TRANSMITTAL NO. 14-05

 

 

March 24, 2014


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0901 paragraph 12 has been updated to reflect that a claimant who is legally married to a same sex spouse is entitled to the augmented compensation rate per the June 26, 2013 Supreme Court decision of United States vs. Windsor, which struck down the provision of the Defense of Marriage Act (DOMA) that prohibited the federal government from recognizing legally married same sex couples. See also FECA Bulletin 14-01 (issued December 12, 2013).

Chapter 5-0400 paragraph 3 Health Benefits Insurance has been updated to reflect that OWCP will administer health benefits to same sex spouses and children of same sex marriage in accordance with OPM’s guidance following the ruling in United States vs. Windsor.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


These chapters are being updated. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is issued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-1401, INITIAL DENIALS

FECA TRANSMITTAL NO. 13-01

 

 

November 27, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1401, Initial Denials, is a new chapter in Part 2 of the Federal Employees' Compensation Act (FECA) Procedure Manual (PM).

This chapter describes the steps involved in processing an initial case denial if any one of the five basic requirements has not been established. Along with FECA PM 2-0801 through 2-0805, it covers the factors that should be addressed when denying an initial claim and preparing the formal Notice of Decision.

Currently, formal decisions are discussed in Chapter 2-1400 (Formal Decisions). The issuance of an initial denial is a distinct process, though, and as such, it has been decided that moving information pertaining to the initial denial of a claim to an entirely new chapter is warranted. In doing so, the process for denying all initial claims (including claims for emotional conditions) will be updated and expanded to provide clear guidelines for the denial of an initial claim when one of the five basic elements has not been met.

Paragraph 1, Purpose and Scope, outlines that the chapter will focus solely on the process of issuing a denial on an initial claim when one of the five basic elements has not been met.

Paragraph 2, Statutory and Regulatory Requirements, provides references to Section 5 U.S.C. 8124(a) of the FECA, as well as 20 C.F.R. §§10.115 and 10.121, as the authority for the information contained in the chapter.

Paragraph 3, Burden of Proof, discusses the claimant's burden of proof for establishing a claim, and the necessary steps the Claims Examiner (CE) must take before an initial claim can be formally denied.

Paragraph 4, Element for Denial, outlines the procedure for reviewing the claim to determine whether the five basic elements have been met after the claimant has been provided the opportunity to submit necessary evidence. It outlines that the five basic elements should be considered in a hierarchical manner.

Paragraph 5, Writing the Initial Denial, discusses how to prepare the initial denial once it has been determined which of the five basic elements has not been established. It notes that the initial denial is a legal document which serves as a basis for further action in the claim, including appeals, and that it should provide a clear explanation of the disallowance of the claim.

Paragraph 6, Emotional Condition Denials, discusses the denial of an initial claim for an emotional condition, and the importance of identifying and discussing all evidence that pertains to the specific issue, including any unsuccessful attempts to obtain significant evidence. It also discusses the need to distinguish between those workplace activities and circumstances which are factors of employment and those which are outside the realm of employment for purposes of compensation, as well as determining whether the event or situations alleged actually existed or occurred.

Paragraph 7, iFECS Coding, outlines proper case coding for iFECS when an initial claim is denied.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


This is a new chapter. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is issued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0601, DISABILITY MANAGEMENT TRACKING

FECA TRANSMITTAL NO. 13-02

 

 

November 27, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0601 was updated in its entirety in October, 2011. Additional updates are being made at this time to provide more clarity with regard to DM Track Dates for Traumatic Injury cases which did not meet the eligibility requirements to become Triage COP Cases. In addition, clarification is also being provided on the use of an existing Optional DM Code (MNR), as well as the introduction and explanation of several new Optional DM Codes.

Paragraph 4, DM Records, now provides instructions on how to set the DM Track Dates for manually created DM Records for Traumatic Injury cases which did not meet the eligibility requirements to become Triage COP Cases. Instructions are provided for those cases where the DM record is created prior to the expiration of the COP period, as well as those cases where the disability extends beyond the COP period.

Paragraph 12, Optional Codes, now includes additional new DM codes to assist with the management and monitoring of disability cases:

ADO
DMA
JON
MDN
MRR
MSN
MSR
NIC
RIC

Agency Declined to Offer Modified Job
DMA referral complete
Job Offer not Suitable
Medical Development Needed
Referred to Scheduler for Referee
Second Opinion not Necessary per SCE
Referred to Scheduler for Second Opinion
Nurse Intervention via CE
Rehabilitation Intervention via CE

This paragraph has also been revised to provide further clarification regarding the use of code MNR (Narrative Report Received). Specifically, the use of the MNR code was further defined as being used only when a narrative medical report is submitted in response to a specific request from the CE (after the entry of the QAP code). In order to input the MNR code, the narrative report should address the questions posed by the CE in the QAP letter.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 1-200, JURISDICTION

FECA TRANSMITTAL NO. 13-03

 

 

November 27, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

The exhibit outlining the special case designations is being updated. Two new case designations are being added, as outlined below.

CLJ (Camp Lejeune Water Contamination) – This case designation will be used to identify cases containing reports of injuries related to contaminated water in Camp Lejeune, North Carolina. On August 6, 2012, the President signed the "Honoring America's Veterans and Caring for Camp Lejeune Families Act of 2012" (Camp Lejeune Act), which provides for medical care for certain conditions for veterans and their families who were exposed to contaminated water while stationed in Camp Lejeune, North Carolina. The passage of the Camp Lejeune Act highlighted the need for special tracking of these claims.

A federal employee would be entitled to FECA benefits for a timely claimed medical condition (including a latent condition) caused by water contamination at Camp Lejeune if he or she was exposed to such water contamination in the performance of duty (including through employer-provided housing) and could provide medical evidence that such exposure caused, contributed to or aggravated that medical condition.

HSA (Hurricane Sandy 2012) – This case designation will be used to identify cases containing reports of injuries related to Hurricane Sandy (which made landfall in late October, 2012) and its aftermath.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 3-0500, OWCP Directed Medical Examinations

FECA TRANSMITTAL NO. 13-04

 

 

December 20, 2012


Background: Section 8123(a) of the Federal Employees' Compensation Act (FECA) and 20 CFR §10.321 provide for the appointment of a referee physician to examine the claimant and resolve a conflict of medical opinion in a case. This medical appointment is also referred to as an Impartial Medical Examination (IME). The selection of a physician to perform an IME is done by the district offices using the Medical Management application within the Integrated Federal Employees' Compensation System (iFECS).

FECA Procedure Manual (PM) 3-500-5 outlines how the Division of Federal Employees' Compensation (DFEC) uses the Medical Management application. When a physician is selected, the scheduler inputs the appointment date and time into the Medical Management application. The application then saves the appointment information and prompts the scheduler to generate the ME023, Appointment Notification Report, for imaging into the case file. Since the ME023 report can only be generated through the Medical Management application, it serves as documentary evidence that the referee appointment was scheduled through the use of the rotational system in the Medical Management application.

However, over the past year the Employees' Compensation Appeals Board (ECAB) has questioned the DFEC's documentation of this process and indicated that there was other documentation available that was not being presented as evidence of the rotational selection, and that the ME023 report alone was insufficient to substantiate proper selection of the impartial specialist. The ME023 report can only be generated through the Medical Management application, and the information contained therein cannot be altered; therefore, the ME023 report serves as documentary "best" evidence that the referee appointment was in fact scheduled through the use of the rotational system in the Medical Management application.

To satisfy the concerns and questions raised by the ECAB, and to further document the referee selection process, the DFEC has enhanced the current ME023 report effective December 17, 2012 to provide more information relative to the scheduling of an IME appointment. The enhancements include a listing of all physicians contacted and bypassed prior to the selection of the IME physician, as well as a certification statement. This information was previously included in certain case files via screen shots, but in many cases that information was not readable due to the quality of the screen shots.

This updated version of the ME023 report can only be generated for new appointments created on and after the date of this update in iFECS. It cannot be accurately generated for appointments made prior to December 17, 2012, and the prior version of the ME023 report (without bypass information) can no longer be duplicated.

As system updates were required to modify this report, updates were also made to the Medical Management application so that the physicians were automatically grouped into zip clusters based upon specified mileage ranges outside of the initial zip cluster (50 miles, 75 miles, and continuing in 25 mile increments up to 200 miles), as seen on the report.

Explanation of Changes: The process for IME selection and scheduling has not changed. The DFEC will continue to use a rotational method for selection of IME physicians. However, to further explain the rotational process and to document the new MEO23 report, paragraph 5, Medical Management Application, has been outlined as described below.

The initial paragraph was updated to note that on rare occasions the Medical Management Application (MMA) will be used to locate a qualified second opinion examiner if a second opinion examiner within the second opinion contract for the District Office cannot be utilized. In these instances, the rotational requirement does not apply.

In sub-paragraph 5a, a typographical error was corrected. The DFEC's data system was known as FECS, not iFECS, in 2000, so this reference was corrected.

Sub-paragraph 5b was updated to clarify that the specified 200-mile radius is calculated from the claimant's home zip code.

Sub-paragraph 5c was re-worded slightly for clarity.

Sub-paragraph 5d was shortened significantly, since a complete explanation of the rotational process was moved to a new paragraph, 5e.

Sub-paragraph 5e (Presentation of Physicians) is completely new. This section provides detail regarding how physicians are presented to the scheduler in both the initial zip cluster and then outside of the initial zip cluster. This paragraph also describes the order the physicians are presented within each of these ranges – first those who have not had a previous appointment scheduled within the Medical Management application (presented alphabetically), and then those that have had a previous appointment scheduled within the Medical Management application (by the date that the last appointment was scheduled, with the most recent being at the bottom of the presentation order).

Sub-paragraph 5f, formerly sub-paragraph 5e, was not changed.

Sub-paragraph 5g, formerly sub-paragraph 5f, was updated slightly to reference the rotation previously described in sub-paragraph 5e. Former sub-paragraph 5g was separated into two distinct paragraphs – 5h and 5i. And former sub-paragraph 5h, which described the order in which physicians were presented for selection, has been deleted since the information has been absorbed into sub-paragraph 5e.

New sub-paragraph 5h outlines that when the scheduler inputs the appointment date and time into the Medical Management application, the ME023, Appointment Notification Report, is generated for imaging into the case file.

New sub-paragraph 5i describes in detail the data contained in the ME023 report based upon the system updates made as of December 17, 2012.

Sub-paragraph 5j, formerly sub-paragraph 5i, was not changed.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0805, CAUSAL RELATIONSHIP

FECA TRANSMITTAL NO. 13-05

 

 

January 29, 2013


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0805 has been revised in its entirety. The chapter has been streamlined and updated to include new language, and the structure of the chapter has been changed. Many of the paragraphs have been reordered, renamed, consolidated, and updated. The number of paragraphs in the chapter has been reduced from 8 to 7.

No substantive changes were made to paragraph 1, but the title was updated to Purpose and Scope.

Paragraph 2, Types of Causal Relationship, added some language to clarify the types of causal relationship, and outdated language was deleted.

Paragraph 3, Evidence Needed, has been amended to include a reference that a report of a physician assistant or a certified nurse practitioner will be considered medical evidence if countersigned by a qualified physician. Some outdated language has been removed, more detail was added, and the information within the paragraph was reorganized.

Paragraph 4, Evaluating Medical Opinions, has been reconstructed, with new sections addressing when an attending physician negates causal relationship and actions to take when insufficient evidence has been submitted.

Paragraph 5, Obtaining Additional Medical Opinion, has been completely rearranged. It addresses when additional medical development may be warranted and how to proceed with such development.

Paragraph 6, High-Risk Employment (formerly paragraph 8), contains essentially the same information as the prior paragraph 8. Former paragraph 6, Consequential and Intervening Injuries, is now paragraph 7.

Paragraph 7, Consequential and Intervening Injuries, provides greater detail as to what factual and medical evidence is needed to properly develop these claims. Prior paragraph 7, Psychological Factors Affecting Medical Condition, has been removed.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, the DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0901, COMPENSATION CLAIMS
CHAPTER 2-0700, DEATH CLAIMS
CHAPTER 2-0808, SCHEDULE AWARDS AND PERMANENT DISABILITY CLAIMS
CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY

FECA TRANSMITTAL NO. 13-06

 

 

February 15, 2013


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0901 has been updated in its entirety, and pertinent information pertaining to death claims, schedule awards, and loss of wage-earning capacity (LWEC) payments has moved into other Procedure Manual chapters for ease of referencing related guidance within one subject chapter. The chapter has also been renamed Compensation Claims (rather than Calculating Compensation), since the chapter discusses receipt and development of claims, as well as the actual payment process.

CHAPTER 2-0901, COMPENSATION CLAIMS

Paragraph 1, Purpose and Scope, provides a summary of the information provided in the chapter, as well as pertinent references to other chapters that reference payments.

Paragraph 2, Responsibilities, outlines the Claims Examiner's (CE's) responsibility for adjudicating each claim for compensation, determining the pay elements necessary for calculation of the payment, and for entering all necessary data into the case management system.

Paragraph 3, Certification, discusses the various certification levels and outlines that by certifying a payment, a certifier is verifying that the adjudication and calculation of the payment (including all pay elements) are correct, that all payment data is entered correctly in the case management system, and that all pay elements entered correspond with the documentation in the file.

Paragraph 4, Receipt of Claims, discusses the actions to take upon receipt of a claim initially following the Continuation of Pay (COP) period (and references PM 2-807 for further guidance). This paragraph also discusses receipt of subsequent claims for compensation and reminds examiners that for these claims the Employing Agency must verify work/leave status when submitting claims forms, and this can only be done once the period has passed.

Paragraph 5, Development of Compensation Claims, provides a discussion of the development actions that may be needed when adjudicating and paying compensation claims. This paragraph also reminds CEs to initiate Disability Management actions in wage claims where the claimant has not returned to full duty at the time payment is being made.

Paragraph 6, Factors in Calculating Compensation, provides a brief outline of the items to consider when paying a compensation claim, and cites the sections within the chapter that discuss those factors.

Paragraph 7, Period of Entitlement, discusses the period of entitlement as a factor in determining whether to pay the claimant on the Daily Roll (DR) or on the Periodic Roll (PR). This paragraph also reminds CEs that payment should be made on the daily roll for intermittent hours lost when a claim is made for intermittent hours only, i.e. partial days or partial hours lost during a period. Payment for straight total disability should not be made based on hours lost.

Paragraph 8, Work Days/Calendar Days, discusses the difference between "calendar day" and "work day" calculations and when each is appropriate. The paragraph also stresses the importance of using the correct schedule (days and hours) when paying "work days."

Paragraph 9, Basic Calculations, outlines basic calculations and has examples of such calculations.

Paragraph 10, Special Determinations, provides detailed information for Census workers and Firefighters.

Paragraph 11, Waiting Days, provides information pertaining to waiting days and the application differences for Postal and non-Postal cases.

Paragraph 12, Compensation Rate, explains the basis for payment of augmented compensation and provides a discussion of dependents. This includes not only references to a spouse, but also details relating to children over the age of 18 and those incapable of self-support.

Paragraph 13, Minimum Compensation, provides information pertaining to the minimum (MIN) compensation rate and how it is applied.

Paragraph 14, Maximum Compensation, provides information pertaining to the maximum (MAX) compensation rate and how it is applied.

Paragraph 15, Insurance Deductions, discusses insurance deductions and the effective date for necessary deductions. The importance of timely deductions and transferring the health benefits insurance enrollment is stressed. This paragraph also provides an overview of the various types of life insurance coverage, as well as dental and vision insurance coverage.

Paragraph 16, Consumer Price Index Adjustments, outlines the basis for cost of living adjustments (CPIs) and how these are applied.

Paragraph 17, Other Payees, discusses the various payees that may exist in a case other than the claimant. Further information was added in particular to the discussion of Representative Payees.

Paragraph 18, Leave Buy Back, provides detailed information on the leave buy back process.

Paragraph 19, Wages Lost for Medical Examination or Treatment, discusses payment for time lost due to medical appointments for treatment of the work-related condition, as well as payment of compensation for time lost due to an OWCP-directed examination.

Exhibit 1, Minimum Compensation Rates, outlines the historical MIN rates through the current year.

Exhibit 2, Maximum Compensation Rates, outlines the historical MAX rates through the current year.

Exhibit 3, Cost-Of-Living Adjustments, outlines the historical CPIs through the current year.

Exhibit 4, Activity Codes, provides a list of all Activity Codes, which are used for payments in certain types of cases.


CHAPTER 2-0700, DEATH CLAIMS

PM 2-0700 already contains a discussion of several elements of pay pertaining strictly to death cases, including an extensive discussion of the various types of possible beneficiaries (2-0700-7 through 2-0700-10). Payment in death cases is also discussed in 2-0700-11, and burial and termination payments are discussed in 2-0700-14 and 2-0700-15, respectively.

A new paragraph has been added to 2-0700 for elements of pay previously mentioned in PM 2-0901 but not already specifically covered in this chapter. The information has been added to this chapter so that the CE can find all relevant information pertaining to payments in death cases in one chapter, to the extent possible.

Paragraph 22, Additional Payment Considerations, was added to the end of the chapter. This paragraph discusses the period of entitlement, MIN and MAX rates, CPI adjustments, and health benefits deductions. Clarification was also added outlining that if a widow/widower receiving death benefits dies, compensation is payable through the date of death, just as it is if a claimant dies while receiving compensation.

Paragraph 21, FECA Death Gratuity, was also updated to include that on December 31, 2011, Congress amended 5 U.S.C. 8102a, the law authorizing death gratuities under FECA, by Section 1121 of Public Law 112-81. Pursuant to that amendment, federal employees may now designate the entire FECA death gratuity to an alternate beneficiary (previously, this designation was limited to 50% of the FECA death gratuity). Effective December 31, 2011, the employing agency is required to notify the federal employee's spouse, if one exists, if that employee designates a person other than the spouse to receive all or a portion of the FECA death gratuity. These changes took effect on enactment.


CHAPTER 2-0808, SCHEDULE AWARDS AND PERMANENT DISABILITY CLAIMS

While incorporating the information pertaining to schedule awards from the previous 2-901, this chapter was updated and revised throughout.

Paragraph 1, Purpose and Scope, states that the primary focus of the chapter is to focus on the development, adjudication and payment of schedule awards.

Paragraph 2, Impairment and Disability, remains essentially unchanged, except that statutory and regulatory references and ECAB citations were added.

Paragraph 3, Permanent Total Disability, also remains essentially unchanged from the prior paragraph of the same name, except the paragraph was re-numbered from paragraph 4 to paragraph 3. A note was added to clarify that there is no specific case status to differentiate or classify a claimant as permanently, totally disabled as defined by 5 U.S.C. 8105(b).

Paragraph 4, Entitlement to Schedule Awards, includes much of the information in the prior paragraph 5 of the same name. A reference to possible entitlement to a lump sum was added with a citation for PM Chapter 2-1300. This paragraph was also updated to include a new section referencing that effective August 29, 2011 the Secretary added by regulation the skin as a new schedule member, for up to 205 weeks of compensation, for injuries sustained on or after September 11, 2001. An update was also made to explain that if a claimant loses wages to obtain medical treatment during the period of a schedule award (e.g. claims hours due to a medical appointment with the treating physician), compensation for the hours lost may be paid concurrently with a schedule award, as time lost for medical appointments is not considered disability.

Paragraph 5, Evaluation of Schedule Awards, includes much of the information in the prior paragraph 6 of the same name. A new section on skin impairment was added. A point of clarification was added noting that impairment ratings for schedule awards include those conditions accepted by the OWCP as job-related, and any pre-existing permanent impairment of the same member or function. Also, a section was added addressing how to calculate impairment for adjoining members. The prior portions pertaining to obtaining medical evidence and review by the District Medical Advisor (DMA) were moved into new paragraph 6.

Paragraph 6, Obtaining Medical Evidence, discuses the development to be taken when a schedule award is requested, as well as the necessary review by the DMA.

Paragraph 7, Schedule Award Payments, is new and discusses all elements of pay for schedule awards. PM 2-0808 previously had a discussion of several elements of pay pertaining strictly to schedule awards (prior paragraph 7, titled Payment of Schedule Awards). The information contained within that paragraph was combined with the information pertaining to schedule awards in the prior 2-0901, and a new paragraph 7 was created. This compilation was done so that the CE can find all relevant information pertaining to schedule award payments in one chapter, to the extent possible. This paragraph includes general considerations such as previous impairment to the same schedule member and the interruption of awards. There is also a discussion of the various payment elements, including the beginning date of the award, the percentage of loss, the period of the award, the pay rate (with a reference to PM 2-900), compensation rate, MIN/MAX applications, and the effective date for CPI adjustments.

Paragraph 8, Schedule Award Decisions, is new and discusses the necessary elements of a formal schedule award decision, including a reference that the medical report used for the final determination should be included with the decision.

Paragraph 9, Claims for Increased Schedule Awards, includes information from the prior paragraph 7, but is now its own section for ease of reference. New information in this paragraph addresses claims for increased awards calculated under the same edition of the AMA Guides and the resulting overpayments that may occur, along with a few other updates for clarification.

Paragraph 10, Disfigurement, is not new and remains essentially unchanged from the previous paragraph of the same name. The only real difference is the paragraph number based on the insertion of new material described above, a new section (f) that outlines that a schedule award for the skin may be payable in addition to an award paid for disfigurement, and a reference to the $3500 possible award amount in section (d).

Paragraph 11, Schedule Awards after Termination of Compensation and Medical Benefits, is new and outlines the actions to take if a claim for a schedule award is received after a formal decision denying compensation and/or medical benefits has been issued.

Paragraph 12, Schedule Awards and Refusal of Suitable Work, is new and discuses that once an §8106(c) sanction decision has been issued, the claimant has no ongoing entitlement to compensation for continuing TTD or schedule award payments, but then clarifies that the commencement of the schedule award begins on the date of MMI. Therefore, if MMI was obtained prior to invoking the §8106(c) sanction, the claimant is entitled to schedule award payments from the date of MMI through the date of the §8106(c) sanction decision.

Exhibit 1, Percentage Table for Schedule Awards, was added. The percentage table for schedule awards was moved from 2-0901 into the schedule award chapter for ease of reference.


CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY

A discussion of Loss of Wage-Earning Capacity (LWEC) payments had been previously included in 2-0901-15. That entire paragraph has been moved into the chapter that discusses LWECs and LWEC decisions. This move was made so that the CE can find all relevant information pertaining to LWECs and LWEC payments in one chapter, to the extent possible.

Paragraph 14, Loss of Wage-Earning Capacity (LWEC) Payments, was added. The information previously contained in 2-0901-15 was essentially moved without any changes, except that references to other chapters or paragraphs were updated as needed based on the movement of this information.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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The following chapters have been updated in their entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-1400, DISALLOWANCES

FECA TRANSMITTAL NO. 13-07

 

 

February 19, 2013


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1400, Disallowances, has been updated and revised in its entirety.

This chapter describes various types of disallowances and details the steps involved in preparing and issuing the formal decision. Initial denials of claims are discussed in detail in PM 2-1401.

Paragraph 1, Purpose and Scope, outlines that the chapter will focus on the process of issuing post-adjudicatory disallowances, although the general requirements outlined pertain to all types of formal decisions issued by the OWCP.

Paragraph 2, Regulatory Provisions, provides references to 20 C.F.R. § 10.540 and 20 C.F.R. § 10.541 as the authority for the information contained in the chapter.

Paragraph 3, Responsibilities, discusses the OWCP's burden of proof in issuing a post-adjudicatory disallowance. It outlines the necessary steps the Claims Examiner (CE) must take before a formal decision can be issued and during the adjudication process. It also details the CE's responsibilities with timeframes, signature authority, appeal rights, decision copies, and iFECS coding.

Paragraph 4, Whether Pre-Termination Notices are Required, discusses the instances in which terminations do not require notice prior to cessation of benefits, and the instances in which terminations do require notice prior to cessation of benefits.

Paragraph 5, Decision Format and Content, discusses that all decisions should contain findings of fact sufficient to identify the benefit being denied, the reason for the disallowance, and be tailored to the specifics of the individual case so that the claimant understands the specific defect in his/her claim for benefits. It outlines the use of the Letter Decision when denying less complex issues, and the Notice of Decision when denying more complex issues or when a more detailed discussion of the evidence is required.

Paragraph 6, Writing the Decision, discusses that the disallowance is a legal document which should be clearly written and easily understood by all audiences. It outlines that when writing the decision, the CE should use basic language, cite specific references, draw clear findings of fact from the evidence, and consider all of the evidence which bears on the issue at hand.

Paragraph 7, Pre-Termination Notices, discusses the process for issuing decisions when the weight of medical evidence establishes that the claimant is no longer entitled to benefits previously authorized. It outlines the necessary steps the CE must take before a final termination can be issued, such as evaluating evidence to ensure it supports the conclusion and affording the claimant 30 days to submit additional evidence to maintain the current level of benefits he/she has been receiving. It also outlines follow-up actions and potential outcomes to the pre-termination notice.

Paragraph 8, Termination Decisions, discusses the key points of the pre-termination that need to be included in the final decision, and outlines that the case management system must be properly coded to reflect the termination.

Paragraph 9, Claims for Compensation, discusses the formal disallowance process for claims filed for leave without pay, leave buy back, or other wage loss.

Paragraph 10, Medical Authorization Requests, discusses the process of formally denying medical authorization requests, when needed, after any necessary development.

Paragraph 11, Additional Diagnoses and Consequential Injuries, discusses the formal disallowance process for additional diagnoses and consequential injuries when the medical evidence establishes that they are not a result of the original injury/illness.

Paragraph 12, Recurrences, discusses the formal disallowance process for both a recurrence of a medical condition and a recurrence of disability.

Paragraph 13, Reductions/Loss of Wage-Earning Capacity, discusses issuing formal decisions when it has been determined that the claimant has the capacity to earn wages, even if not employed.

Paragraph 14, Sanctions for Failure to Accept Suitable Work, discusses the process for issuing sanction decisions due to the claimant's refusal or abandonment of suitable work per Section 8106 of the FECA.

Paragraph 15, Forfeiture, discusses issuing formal decisions when a claimant fails to make an affidavit or report when required, or knowingly omits or understates any part of his earnings per Section 8106 of the FECA.

Paragraph 16, Suspensions, discusses issuing suspension decisions when a claimant fails to cooperate with the OWCP's direction.

Paragraph 17, Convictions for FECA fraud, discusses issuing a termination of benefits when the claimant is convicted of defrauding the FECA, or pleads guilty to defrauding the FECA per Section 8148 of the FECA.

Paragraph 18, Imprisonment for Felonies Other Than Fraud, discusses issuing suspension decisions and terminating entitlement to all medical and compensation benefits when the claimant has been convicted and imprisoned due to a felony per Section 8148 of the FECA.

Paragraph 19, Rescissions, discusses the process of issuing formal disallowances per Section 8128 of the FECA when it has been determined that the original decision was issued in error.

Exhibits 1-10 have been deleted from the chapter. Exhibit 11, Signature Authority, is now Exhibit 1, Signature Authority, and it has been updated. Signature authority for attorney fee limits is now outlined in Chapter 2-1200, Representative's Services, and certification authority for payments is discussed in Chapter 2-901, Compensation Claims.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


This chapter has been updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is issued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 3-0500, OWCP Directed Medical Examinations

FECA TRANSMITTAL NO. 13-08

 

 

May 13, 2013


EXPLANATION OF MATERIAL TRANSMITTED:

To satisfy the concerns and questions raised by the Employees Compensation Appeals Board (ECAB), and to further document the referee selection process, the DFEC enhanced the ME023 report effective December 17, 2012 to provide more information relative to the scheduling of the appointment. See FECA Transmittal 13-04 for an explanation of these updates.

The DFEC continues to use the Medical Management application in iFECS to schedule referee examinations. This has not changed. Paragraph 5 of PM Chapter 3-500 discusses this application in detail. Effective May 13, 2013, the Medical Management application in iFECS has again been updated; therefore, paragraph 3-500-5e(3) is being updated accordingly to discuss the new functionality.

The Medical Management application sets 200 miles as the maximum limit for a zip code range; this has not changed. Previously, though, if that 200-mile range was exhausted without making an appointment, the scheduler had to document the case file by imaging a copy of the bypass report to show that a search within the Medical Management application had been exhausted. A copy of the bypass report was necessary because an ME023 report could not be generated since an appointment was unable to be scheduled. Once the scheduler had documented the case file with the complete bypass report, s/he could then proceed with an alternative scheduling method as outlined in paragraph 5b of the chapter.

With this May 13, 2013 update to the Medical Management application, the scheduler no longer has to independently run the complete bypass report in order to document the file. iFECS will now automatically generate a "Zip Code Exhausted" report if the 200-mile range is exhausted. The scheduler can then proceed with scheduling via an alternative method, including entry of a different zip code in the Medical Management application. This may be necessary, for instance, if the claimant lives in a very remote area and will need to travel to a larger city in order to attend a scheduled examination. In this instance, the scheduler will enter the zip code of the city to which the claimant will be traveling.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0814, JOB OFFERS AND RETURN TO WORK
CHAPTER 2-0815, DETERMINING WAGE-EARNING CAPACITY BASED ON ACTUAL EARNINGS
CHAPTER 2-0816, DETERMINING WAGE-EARNING CAPACITY BASED ON A CONSTRUCTED POSITION
CHAPTER 2-1500, RECURRENCES
CHAPTER 2-1501, MODIFICATION OF LWECs

FECA TRANSMITTAL NO. 13-09

 

 

June 4, 2013


EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Compensation (DFEC) with this issuance outlines a comprehensive strategy for return to work in all situations where a certain defined level of return to work is possible. This Procedure Manual release complements the DFEC's overall proactive approach to more efficient claims management, which includes claims intake via electronic filing and ECOMP to improve benefit delivery; earlier field nurse intervention to facilitate more effective medical management; active disability management; and a more dynamic and interactive approach to claims management of return to work wherever medically and vocationally feasible.

The DFEC has taken the unusual step of releasing five entirely new chapters that discuss each topic relating to return to work in greater depth for ease of use for claims staff. Our program focus on return to work, coupled with the changing dynamics in the federal workforces including telework and more flexible scheduling, has caused us to revisit program policies that in some instances posed artificial barriers to return to work for workers and their agencies. Since the passage of the Federal Employees Compensation Act (FECA) in 1916, administrators of the program have been charged with administering the program in a cost effective manner comporting with the intent of Congress as set forth in the legislative history of the 1916 Act that "an employee is bound to do what work he can." Statement of Congressman McCoy, Federal Employees' Compensation Hearings, April 3, 1914 at 53.

To that end, FECA Procedure Manual Chapter 2-0814 has been updated in its entirety, and pertinent information pertaining to loss of wage-earning capacity (LWEC) determinations has been moved into new Procedure Manual chapters for ease of referencing related guidance within one subject chapter. 2-0814 now only addresses job offers, temporary light duty assignments, and abandonment of employment, including what instances the sanction provisions of 5 U.S.C. §8106(c) will newly apply. The new chapter 2-0815 address wage-earning capacity decisions based on actual earnings, including new use of part-time positions, and the new chapter 2-0816 addresses wage-earning capacity decisions based on a constructed position.

Chapter 2-1500, Recurrences, has also been updated and revised. This chapter describes policies and procedures for developing claims for recurrent medical conditions and recurrent disability. It also addresses return to work issues related to recurrences. Updates were made throughout the chapter to remove discussion of recurrences as the result of a withdrawal of limited duty with a formal Loss of Wage-Earning Capacity (LWEC) decision in place. This information was moved to new Chapter 2-1501, Modification of LWECs, and references were provided in 2-1500 accordingly. Chapter 2-1501, Modification of LWECs, is an entirely new chapter. Prior to this release, modification of a formal LWEC was discussed in Chapters 2-0814 and 2-1500. The information in both of these chapters has been absorbed into this new chapter and it has been updated throughout. This chapter describes the process for modifying a formal LWEC and discusses the three criteria for modification. This chapter also describes the criteria for developing and making a determination on claims for compensation for disability following the issuance of a formal LWEC decision.

Note - FECA Bulletin 09-05 (United States Postal Service National Reassessment Program Guidance), issued August 18, 2009, describes the procedures for possible modification of an LWEC if circumstances in the case indicate that the position in question may have been withdrawn (in whole or in part) as a result of the United States Postal Service's National Reassessment Process. This bulletin has not been modified, replaced or incorporated herein, as the National Reassessment Process concluded on January 31, 2011, per documentation received from the United States Postal Service dated July 1, 2011.

CHAPTER 2-0814, JOB OFFERS AND RETURN TO WORK

Beyond removal of the paragraphs concerning wage-earning capacity, multiple updates were made to this chapter to provide more detail throughout and to update previous guidance based on the dynamics of the changing federal workforce. Given the more targeted focus of the chapter, the chapter name was also changed from "Reemployment: Determining Wage-Earning Capacity" to "Job Offers and Return to Work."

Former Paragraph 1, Purpose and Scope, and Paragraph 2, Introduction, have been combined into a new Paragraph 1 entitled Purpose and Scope. It has been updated to reflect the more focused nature of this chapter.

Paragraph 2 is now titled Statutory and Regulatory Provisions and provides the statutory and regulatory authority pertaining to job offers and return to work. This section contains the regulatory provisions that outline an employee's responsibilities to work where medically feasible, both where temporary light duty within restrictions is offered and available, and where sanctionable suitable employment is offered.

Paragraph 3, Policy, has been modified slightly, and the language dealing with wage-earning capacity determinations has been removed.

Paragraph 4, Offers of Employment, has been updated in its entirety.

  • This paragraph still outlines the necessary elements of a job offer, and while the existing requirements are still in effect, a new requirement to include the claimant's work schedule has been added. Also, if the job offer is for a site outside of the claimant's residential area, the EA must document that it first searched for suitable employment in the claimant's geographic area before it settled for a position outside of it and provide this statement to the OWCP.
  • The prior language that stated that a job which involved less than 4 hours of work per day where the claimant could work more than 4 hours per day could not be found suitable has been removed. Due to the current dynamics of the changing federal workforce, the OWCP acknowledges that Employing Agencies (EAs) may need flexibility to provide suitable work to their employees. Given that one of the OWCP's primary missions is facilitate return to work where possible, paragraphs 4c(1) and (2) now provide that while ideally a job offer should be made for the number of hours for which a claimant has been released to work, other alternatives are acceptable and will be found suitable. The EA may offer a job for fewer hours than the claimant was actually released to work, and as long as the job offer is for at least half of the total hours for which the claimant has been released to work, the job offer can be found suitable. However, a job offer of less than 2 hours per day and less than 20 hours per pay period will always be considered unsuitable for purposes of an §8106(c) sanction. If the EA cannot accommodate the full number of hours for which the claimant has been released to work, the EA must provide written verification that it is unable to provide work for the full number of hours for which the claimant has been released to work. If this written verification is on file, a position with less than that number of hours can be found suitable. Examples are provided in this paragraph to illustrate some hypothetical circumstances that are both acceptable and unacceptable.
  • The distinction between temporary and permanent job offers has been clarified, indicating that the CE should contact the EA if it is not clear whether a position is temporary or permanent and ask the EA to clarify in writing the nature of the offer.
  • New references to telework as a viable option for offering suitable employment have been added. Factors to consider are included, and a reference was added that a limited referral for vocational rehabilitation services may be considered if the claimant alleges that any of the necessary factors have not been met. Any refusal to cooperate with a Rehabilitation Counselor in this capacity should be pursued under §8113(b), not under §8106(c).
  • Language has been added outlining that the CE should explain to the claimant how the job was deemed to be suitable and identify the medical evidence which represents the weight of medical opinion with respect to the claimant's work capacity.

Paragraph 5, Job Offer Refusal, remains largely unchanged, but more detail has been added.

  • Additional guidance was provided with regard to actions to take if the claimant provides evidence that his or her refusal of a job offer was based upon the attending physician's advice.
  • A new section was added which addresses job offer refusals where a formal Loss of Wage-Earning Capacity (LWEC) rating is in place. It is noted that the existence of an established LWEC decision alone is not a valid reason for refusing suitable work in all instances; however, the CE must carefully evaluate the prior LWEC decision to determine if it can be modified. If the CE determines that the offered job is suitable and that the LWEC is in posture for modification on the basis of an improved medical condition, the CE should prepare the 30-day notice of suitability and simultaneously propose to modify the LWEC.

Paragraph 6, Issuing a Final 8106(c) Decision, is a new paragraph that expressly deals with issuing a final decision under the penalty provision of 5 U.S.C. §8106(c).

Paragraph 7, Relocation Expenses, is former Paragraph 6, and while updated for current practices, it remains largely unchanged.

Paragraph 8, Abandonment of a Suitable Job, is former Paragraph 10, and has been updated to provide greater instruction in cases where a claimant returns to work and then stops working and submits a claim for compensation. In such cases, the CE should evaluate any evidence submitted and the reasons for the work stoppage. If the evidence of file is insufficient to establish a recurrence and the CE has determined that the job is suitable, the CE must advise the claimant simultaneously of the penalty provision of 5 U.S.C. §8106(c) and of the evidence necessary to establish a recurrence of disability.

Paragraph 9, Temporary Assignments, is a new section that addresses the requirements of 20 C.F.R. §10.500, which provides that -

(a) Benefits are available only while the effects of a work-related condition continue. Compensation for wage loss due to disability is available only for any periods during which an employee's work-related medical condition prevents him or her from earning the wages earned before the work-related injury. For example, an employee is not entitled to compensation for any wage-loss claimed on a CA-7 to the extent that evidence contemporaneous with the period claimed on a CA-7 establishes that an employee had medical work restrictions in place; that light duty within those work restrictions was available; and that the employee was previously notified in writing that such duty was available. Similarly, an employee receiving continuing periodic payments for disability was not prevented from earning the wages earned before the work-related injury if the evidence establishes that the employing agency had offered, in accordance with OWCP procedures, a temporary light duty assignment within the employee's work restrictions. (The penalty provision of 5 U.S.C. §8106(c)(2) will not be imposed on such assignments under this paragraph.) [Emphasis added]

The meaning and intent of 20 CFR §10.5(f) is also emphasized. This section defines disability as "the incapacity, because of an employment injury, to earn the wages the employee was receiving at the time of injury. It may be partial or total." If the claimant was provided with a light duty assignment within his or her restrictions, total disability for the period of the assignment has not been substantiated. [Emphasis added]

This new paragraph addresses when a temporary light duty assignment is appropriate outside the confines of §8106, and establishes the principle that a claimant who is capable of earning wages equivalent to his date-of-injury wages is not entitled to compensation. It explains the different actions required when such a temporary light duty assignment is offered to a claimant who is on the periodic roll versus a claimant who is not, and describes the requirements for an offer of a temporary, light-duty assignment made to a claimant on the periodic roll. This paragraph also emphasizes that when a temporary light duty assignment ends or the work is no longer available, the claimant should submit Form CA-2a through the EA, and that the claimant is entitled to be placed back on the periodic roll (PR) immediately as long as medical evidence supports that any disabling residuals of the work-related condition still exist. No development is typically needed prior to placing the claimant back on the PR and resuming wage-loss compensation, and payment should not be unnecessarily delayed.

The prior exhibits have been removed.

CHAPTER 2-815, DETERMINING WAGE-EARNING CAPACITY BASED ON ACTUAL EARNINGS

Chapter 2-815, Determining Wage-Earning Capacity Based on Actual Earnings, is an entirely new chapter of the FECA Procedure Manual, Part 2 - Claims. The chapter replaces, revises, and expands upon procedure previously located in Chapter 2-814.7 and 2-814-14.

This chapter explains the procedures for determining entitlement to compensation after reemployment. It also provides guidance on making a determination as to whether the alternative employment fairly and reasonably represents the employee's wage-earning capacity (WEC), and presents procedures for issuance of the formal loss of wage-earning capacity (LWEC) decision.

Paragraph 1, Purpose and Scope, indicates that this chapter provides guidance on calculating LWEC compensation, determining whether earnings fairly and reasonably represent the WEC, and issuing the formal LWEC decision.

Paragraph 2, Statutory and Regulatory Provisions, provides the statutory and regulatory authority for determining a WEC based on actual earnings.

Paragraph 3, Initial Fiscal Actions, provides a summary of the immediate actions the CE should take following notification that a claimant has returned to work.

Paragraph 4, Computing Entitlement to Compensation, provides a detailed discussion of how to compute the compensation of a partially disabled claimant using the Shadrick formula. Significant clarification has been provided on the computation of the "Current Pay Rate for Job/Step When Injured." See (c)(2) and (d)(2) in this paragraph. Additional guidance has also been provided in computing compensation for claimants whose agencies use pay banding. See (e)(3) in this paragraph.

Paragraph 5, Determination of Whether Earnings are Representative of the Wage-Earning Capacity, outlines the criteria that a CE should use to determine whether the claimant's actual earnings fairly and reasonably represent his or her WEC. The paragraph is broken down into cases where the alternative employment was (1) within and (2) outside of the Federal Government.

  • For return to work within the Federal Government, further explanation has been added to make clear that a part-time position may fairly and reasonably represent the WEC of a claimant whose stable, established medical restrictions limit him or her to part-time work, even when the claimant was a full-time employee on the DOI. See (c)(1)(b) in this paragraph. However, even though a job offer for less than the number of hours that the claimant has been released to may be found suitable (see 2-0814-4), for a part-time position to fairly and reasonably represent the WEC of a claimant, the position should involve the number of hours the claimant is capable of working as indicated in the current, stable medical restrictions.
  • Clarification has also been added to assist CEs in determining when a position is temporary, and whether a position represents "classified" work. See (c)(3) in this paragraph.
  • The section addressing return to work outside the Federal Government is entirely new procedure. It provides guidance on the criteria needed to establish that such a position represents the WEC. It also addresses the evidence that should be provided by the Rehabilitation Specialist (RS) or Rehabilitation Counselor (RC) to support such a finding, depending on the circumstances of the case.

Paragraph 6, Issuance of Decision, discusses the appropriate time to issue a formal loss of wage-earning capacity decision, and addresses the elements such a decision should generally contain.

Paragraph 7, Retroactive Determinations, details the limited circumstances in which a retroactive formal loss of wage-earning capacity decision may be issued, and reiterates that the CE must address that the work stoppage or change in alternative positions did not occur because of any change in the claimant's injury-related condition affecting ability to work.

CHAPTER 2-0816, DETERMINING WAGE-EARNING CAPACITY BASED ON A CONSTRUCTED POSITION

Chapter 2-0816, Determining Wage-Earning Capacity Based on a Constructed Position, is a new chapter in the FECA Procedure Manual (PM), Part 2 – Claims. The chapter replaces, revises, and expands upon procedure previously located in Chapter 2-814.8.

Paragraph 1, Purpose and Scope, identifies those situations in which it may be appropriate to determine a WEC based on a constructed position.

Paragraph 2, Statutory and Regulatory Provisions, provides the statutory and regulatory authority for determining a WEC based on a constructed position.

Paragraph 3, Factors Considered, defines the factors established in §8115 which require consideration in determining a WEC based on a constructed position.

Paragraph 4, Medical Suitability, outlines the evidence necessary to establish that a selected position is medically suitable.

Paragraph 5, Vocational Suitability, discusses the criteria used to determine whether the claimant is vocationally capable of performing the selected position.

Paragraph 6, Reasonable Availability, describes how to establish that a selected position is reasonably available within the claimant's commuting area.

Paragraph 7, Special Determinations, discusses those circumstances when the additional factors may need to be considered.

Paragraph 8, Issuance of Decision, outlines the steps the CE should take to notify the claimant of the office's WEC determination based on a constructed position and the general requirements for such a decision.

Paragraph 9, Retroactive Determinations, discusses the very limited instances in which a determination of WEC based on a constructed position may be issued on a retroactive basis.

CHAPTER 2-1500, RECURRENCES

Paragraph 1, Purpose and Scope, was modified slightly to include a cross-reference to new chapter 2-1501, which addresses modifications of formal LWEC decisions.

Paragraph 2, Regulatory References, defines a recurrence of a medical condition and recurrence of disability as outlined in 20 C.F.R. §§10.5(y) and 10.5 (x). 20 C.F.R. §10.104, addressing how a recurrence claim is filed, and 20 C.F.R. §10.509, addressing reductions in force, were also cited.

Paragraph 3, Claims for Recurrence, which was prior paragraph 4, was revised to expand the discussion of the types of prior decisions that may impact the recurrence claim. It was also clarified that a Form CA-7 may constitute a valid claim for recurrent disability in certain circumstances.

Paragraph 4, Recurrence of Medical Condition, which was prior paragraph 5, was modified slightly to further explain the type of evidence the claimant should submit to support the claim for recurrence of a medical condition.

Paragraph 5, Recurrent Disability for Work within 90 Days of Return to Duty, which was prior paragraph 6, was modified to include a cross-reference to Chapter 2-1501, Modification of LWECs, for cases where a formal LWEC decision is in place at the time of the recurrence claim.

Paragraph 6, Recurrent Disability for Work after 90 Days of Return to Duty, which was prior paragraph 7, was revised to further explain, in detail, the type of evidence necessary to support a recurrence claim. The discussion of a withdrawal of limited duty with an existing LWEC determination has been moved to Chapter 2-1501, and a reference was provided in this section accordingly.

Paragraph 7, Termination Including for Cause, outlines that when a claimant stops work for reasons unrelated to the accepted employment injury, there is no disability within the meaning of the FECA. The procedures addressing this topic were revised to provide guidance that comports with the ECAB caselaw in this area, the seminal case being John W. Normand, 39 ECAB 1378 (1988). For Normand principles to apply, it should be established that the employing agency offered light duty; the claimant had been working the light duty position at the time of termination; that the employing agency noted that light duty would have still been available if the claimant had not been terminated for cause; and, most importantly, there is no evidence in the record that the claimant was unable to perform the light duty position.

Paragraph 8, Compensation for Recurrent Disability, was modified slightly to include information on recurrent pay rates and the responsibilities of the certifier.

Paragraph 9, Disability Management Actions, is a new paragraph that was added to stress the importance of ascertaining the claimant's work status upon acceptance of a recurrence and then taking prompt disability management actions as needed.

CHAPTER 2-1501, MODIFICATION OF LWECs

Paragraph 1, Purpose and Scope, outlines that the chapter provides information on modifying a formal LWEC decision. A reference to 2-1500 is provided, as well as a reference to FECA Bulletin 09-05.

Paragraph 2, Regulatory References, references 20 C.F.R. §§ 10.5(f), 10.509 and 10.511.

Paragraph 3, Criteria for Modification, discusses each of the three criteria for modification of an LWEC.

This paragraph now also provides guidance for when a claimant with a prior formal LWEC rating accepts a position with no wage loss and returns to work. In this instance, no employment-related disability or wage-loss entitlement continues, and the CE should terminate compensation on the basis that there is no disability within the meaning of the Act despite the fact that an LWEC is in place. Because the claimant was previously receiving compensation in accordance with a formal LWEC decision, the termination should be made prospectively so that no overpayment results. The prior LWEC should then be reviewed to determine if modification is necessary.

Paragraph 4, Initial Actions, discusses that the party seeking modification of the LWEC has the burden to prove that one of the three criteria outlined above has been met and evaluating the request for modification.

Paragraph 5, Development, discusses the procedures for development of the evidence to determine if modification of the formal LWEC decision is appropriate. This paragraph outlines the actions to take if the claimant has requested a modification, as well as the actions to take if the OWCP is seeking modification. New guidance is specifically provided with regard to actions to take if the claimant returns to work in a position with increased work hours or more strenuous duties, resulting in reduced or zero wage loss.

Paragraph 6, Termination of Employment, notes that when an employee is terminated while in the receipt of an LWEC, one of the three criteria must still be met for modification of the LWEC to occur.

Paragraph 7, Withdrawal of Light Duty, discusses the withdrawal of a light duty position when an LWEC is in place and how one of the three criteria must still be met.

Paragraph 8, Decision, outlines the decisions issued when the evidence does and does not support modification of the LWEC rating. This paragraph also includes guidance for terminations for no residuals (when the evidence substantiates that there are no residuals of the work injury).

Paragraph 9, Disability Management Actions, stresses the importance of taking prompt disability management actions if an LWEC decision is modified.

Paragraph 10, Intermittent Claims for Wage Loss, outlines when and how a claim for intermittent disability can be paid without modifying a formal LWEC determination.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, Fiscal Personnel, Systems Managers, and Technical Assistants)

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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0601, DISABILITY MANAGEMENT TRACKING

FECA TRANSMITTAL NO. 12-01

 

 

October 6, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0601 has been revised in its entirety. This chapter now provides an overview of the goals and coding associated with the entire Disability Management (DM) process. The coding applies to both the Quality Case Management (QCM) and Periodic Roll Management (PRM) portions of DM; therefore, the chapter has been renamed Disability Management Tracking.

Paragraph 1 outlines the purpose and scope of the chapter, and provides related references to Chapter 2-0600 (Disability Management), Chapter 2-0810 (Developing and Evaluating Medical Evidence), Chapter 2-0811 (Nurse Case Management) and Chapter 2-0813 (Vocational Rehabilitation Services).

Paragraph 2 provides an overview of the DM process and the differences between QCM and PRM. This paragraph also stresses the importance of consistent and accurate coding in the DM Tracking application for proper analysis and measurement of actions taken during the DM process.

Paragraph 3 outlines the two primary goals of Disability Management - return to work and resolution - and how these goals are measured.

Paragraph 4 discusses the actual DM records, including when to create a record, the meaning of a Track Date vs. a Start Date and how to maintain a DM record.

Paragraph 5 discusses the various DM categories and their meanings.

Paragraph 6 outlines the differences between mandatory and optional codes, and how and why the RMV code should be used to remove a record from DM Tracking.

Paragraph 7 outlines the mandatory Claims Examiner (CE) Intervention codes and when they should be used.

Paragraph 8 discusses the mandatory codes to be used during the Nurse Intervention Phase of DM.

Paragraph 9 discusses the codes that are used to designate that a case has a dual tracking effort with both a Field Nurse (FN) and a Rehabilitation Counselor (RC).

Paragraph 10 focuses on the various codes that are used during the Vocational Rehabilitation portion of DM.

Paragraph 11 details when and how the return-to-work (RTW) codes are to be used.

Paragraph 12 outlines the optional codes that are available for use and how they can assist the CE with management of the DM record.

Paragraph 13 provides guidance on the use of closure codes and the interplay between closure codes and resolutions. This paragraph outlines which closure codes count as resolutions and the differences depending on whether the case is in the QCM or PRM portion of DM.

Paragraph 14 acknowledges that some DM codes have become obsolete; therefore, when reviewing previous coding in a DM record some codes may appear that are no longer available for use.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation


The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-1601, HEARINGS AND REVIEWS OF THE WRITTEN RECORD

FECA TRANSMITTAL NO. 12-02

 

 

October 6, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1601 has been revised in its entirety to reflect changes that have taken place both throughout the Division of Federal Employees' Compensation (DFEC) and specifically within the Branch of Hearings and Review.

References to case files being transferred upon request of a hearing have been removed. Several changes have been made to the sections on arranging for and conducting hearings due to the fact that most hearings are no longer held in-person but are conducted electronically via telephone or videoconference. Other changes were made in response to the changes in the Code of Federal Regulations (20 CFR §§ 10.615 through 10.622) published on June 28, 2011, effective August 29, 2011.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation


The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

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Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-1602, RECONSIDERATIONS

FECA TRANSMITTAL NO. 12-03

 

 

October 6, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1602 has been revised in its entirety. The chapter has been streamlined and updated to include new language, and the structure of the chapter has been changed. Many of the paragraphs have been reordered, consolidated, and updated to reflect the reconsideration process in its entirety. Exhibits 1-6 have been deleted.

Paragraph 5 "Special Evidence or Argument" has been moved and incorporated into a new paragraph 3 titled "Preliminary Processing."

Paragraphs 4 "Evidence or Argument Required" and 7 "Evaluating Sufficiency of Evidence" have been moved and incorporated into a new paragraph 6 titled "Timely Applications."

Paragraphs 6 "Prima Facie Denials" and 9 "Protecting Claimant's Further Appeal Rights" are now incorporated into a new paragraph 7 titled "Non-Merit Decisions."

Other changes were made in response to the changes in the Code of Federal Regulations (20 CFR §§ 10.605 through 10.610) published on June 28, 2011 and effective August 29, 2011. These changes include a distinction in the requirement regarding when a reconsideration request must be sent to the employing agency. Where there is a legal argument or factual basis for a merit review, the application together with copies of pertinent supporting documentation should be sent to the employing agency, and the employing agency is provided with 20 days to submit comments or documentation. Medical evidence submitted with the request, however, shall not be furnished to the employing agency since it does not constitute documentation that is pertinent for review and comment by the employing agency. Therefore, where a reconsideration request pertains only to a medical issue, the employing agency should be notified that a request for reconsideration has been received, but OWCP is not required to wait 20 days for comment before reaching a determination, except when that claimant is deployed in an area of armed conflict.

The other significant change is to the timeliness standards for reconsideration requests. The regulations at §10.607 now provide that the request for reconsideration must be received within one year, which is a change from the prior standard for timeliness (that an application for reconsideration must be sent within one year).

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation


The chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 1-0200, JURISDICTION

FECA TRANSMITTAL NO. 12-04

 

 

November 07, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

The Division of Federal Employees' Compensation (DFEC) has at times used specific case numbering series to designate cases that are related to a particular event. DFEC will no longer use numbering series and will instead now use 3-character case designations within the Integrated Federal Employees Compensation System (iFECS). The exhibit outlining the prefixes and the previously-used numbering series has, therefore, been updated. Also, since case prefixes are part of the case number itself, whereas case designations are only viewable in iFECS, the one exhibit has been split into two.

Exhibit 1 now lists the prefixes used for FECA cases. The prefixes are reflected in the case number.

Exhibit 2 now lists the case designations used for FECA cases. The designations are viewable only in iFECS. Also, two additional case types were added. Although never given a special numbering series and never listed in a previous exhibit, cases associated with the bombing of the United States embassy in Nairobi on August 7, 1998 and the Alfred P. Murrah Federal Building in Oklahoma City on April 19, 1995 were identified. They were provided with a case designation in the new scheme, OKC and NAI respectively, so these case types are now specifically listed in the exhibit.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation


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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 3-300, AUTHORIZING EXAMINATION AND TREATMENT

FECA TRANSMITTAL NO. 12-05

 

 

February 24, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 3-0300 has been revised in its entirety. The chapter includes new language and updated references throughout. Other updates have been made based on changes in the regulations. On August 13, 2010, the Office of Workers' Compensation Programs (OWCP) published in the Federal Register a proposal to amend the regulations governing the administration of the Federal Employees' Compensation Act (FECA). On June 28, 2011, the new Regulations became final with an effective date of August 29, 2011. The regulations pertaining to medical and related benefits in Section 10.300 through 10.315 had minimal changes; some of those changes are reflected in this chapter. Also, exhibit 1 (a copy of the CA-16) has been deleted.

Paragraph 1 outlines the purpose of the chapter, which is to describe the circumstances under which OWCP or, in some instances, the employing agency, may authorize medical services for injured claimants.

Paragraph 2 provides an overview of the authorization process and specifies that the majority of such requests are received initially by the Office of Workers' Compensation Programs' (OWCP) designated bill processing agent. The paragraph also discusses the types of treatment requested. Changes made based on the updated regulation at 20 CFR §10.310 include the following: specifically noting OWCP's authority to utilize field nurses in facilitating and coordinating medical care; clearly stating that certain non-physician providers (physicians' assistants, nurse practitioners and physical therapists) may provide authorized services to injured employees, to the extent allowed under Federal and state law, including licensure by any appropriate regulating body for that profession; and clarifying that for a chiropractor's service to be considered under the direction of a qualified physician, a physician must actually prescribe those services.

Paragraph 3 discusses the CA-16, Authorization for Examination and/or Treatment, which is the vehicle by which the employing agency authorizes initial examination and/or medical treatment for an employee who sustains a traumatic injury at OWCP expense. Based on the updated regulation at 20 CFR §10.300, Form CA-16 authorizes treatment for 60 days from the date of injury, not the date the form is signed.

Paragraph 4 briefly outlines the various types of prohibited authorizations, including excluded providers, issuance to oneself, issuance to minors, etc.

Paragraph 5 outlines the various types of medical facilities where care may be authorized, such as physicians' offices, hospitals, and federal medical facilities. This paragraph also stipulates that ordinarily the physician selected for treatment should be located within a reasonable distance of the employee's home or place of employment, and travel should be undertaken by the shortest route, and, if practical, by public conveyance. Per 20 CFR §10.315, a "reasonable distance of travel" is further defined as a roundtrip distance of up to 100 miles.

Paragraph 6 discusses transfer of termination of medical care and outlines the procedures for making these decisions.

Paragraph 7 focuses on Peace Corps cases and entitlement to medical care for these specific injured workers based on their status with the Peace Corps, both prior to and after separation. Information regarding Peace Corps cases is also contained in PM 2-1700-4, and some of the information in Paragraph 7 of this chapter is duplicative. Specifically, 2-1400-4c(2)(d) discusses that the Peace Corps will, at its discretion, pay medical costs directly for treatment of certain specified service-related medical conditions or injuries costing less than $1,000. Conditions covered by this provision are listed in 2-1400-4c(2)(d), and they are also listed in this chapter. The list in this chapter, however, has been updated to include additional conditions in which Peace Corps and OWCP have agreed that Peace Corps can cover costs directly. These new conditions include the following: vaginal yeast infections (candidiasis); acute otitis media; acute sinusitis; constipation; and hemorrhoids. This paragraph also now specifically notes that injury due to assault or sexual assault (including treatment for sexually transmitted disease and mental health treatment) are covered under the FECA.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation


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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0812, PERIODIC REVIEW OF DISABILITY CLAIMS
CHAPTER 2-1402, FORFEITURE

FECA TRANSMITTAL NO. 12-06

 

 

May 11, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

FECA PM Chapter 2-0812 has been updated and revised.

Updates were made based on the changes in the Code of Federal Regulations (20 CFR §§ 10.417 and 10.537) effective August 29, 2011. These regulations outline the reporting requirements for students and dependents over the age of 18 who are incapable of self support.

Updates were also made as a result of an updated Social Security Administration Form SSA-581. The new version of this form, which was approved by the Office of Management and Budget, is now in such a format (with bar codes and fill in boxes) that the Division of Federal Employees' Compensation (DFEC) can no longer automatically generate this form with the annual Form CA-1032 that is sent to the claimant. Therefore, rather than automatically issuing the form with every Form CA-1032 issued, the Claims Examiner should selectively request submission of the form when there is any evidence of earnings or employment.

  • Form CA-0936 (the cover letter to the claimant asking for completion of Form SSA-581) can still be found in Correspondence Library. Form SSA-581 can be found on DFEC's intranet site. The CE should write the claimant's case number on the SSA-581 before it is mailed to the claimant.

The chapter was also reorganized to more closely tailor the evidence review required with the annual Form CA-1032 (with EN-1032 attachment). Further detail was also added with regard to the information provided to the claimant and requested by the claimant on Form EN-1032.

Lastly, the section on Forfeiture was deleted from Chapter 2-812 and a new chapter devoted entirely to Forfeiture, Chapter 2-1402, was created.

CHAPTER 2-0812, PERIODIC REVIEW OF DISABILITY CLAIMS

Paragraph 1, Purpose and Scope, was updated slightly to cross-reference the new chapter 2-1402, and also to make it clear that the purpose of this chapter was to discuss the periodic review of the medical evidence, as well as the key factual elements to review in conjunction with the annual CA-1032 form.

No changes were made to paragraph 2, Statutory Provisions.

Paragraph 3, Burden of Proof for Terminating Benefits, was modified only slightly to include a cross reference to FECA PM 2-810-13 when discussing grounds for suspension of benefits under section 8123 of the FECA.

The information contained in the prior paragraph 4 was split into two distinct paragraphs (4 and 5). Paragraph 4, Placement on the Periodic Roll, reminds CEs that when the medical evidence indicates that disability is expected to continue for more than 60-90 days, compensation should usually be paid on the periodic roll, and that the CE should advise the claimant when such payments are initiated.

Paragraph 5, Monitoring Claims on the Periodic Roll, outlines the necessary elements for review in general terms and establishes the timeframe guidelines (based on case status) that should be used when determining the adequacy of medical evidence in the file.

Paragraph 6, Medical Elements of Review, outlines the elements of the medical review for periodic roll cases, including the expected content of the medical report, necessary follow-up actions, and guidance regarding changes in medical status and review of existing attendant allowances. Chapter 2-0810, Developing and Evaluating Medical Evidence, should also be consulted for a more detailed discussion of reviewing medical evidence.

Paragraphs 7 through 12 correspond with topics covered on Form EN-1032.

Paragraph 7, Employment and Earnings, reminds CEs that if there is any evidence on Form EN-1032 that the claimant has any type of employment or earnings, further action is warranted. Further information can be obtained directly from the claimant, and issues to be developed are provided based on whether the work activity is characterized as a sole proprietorship, a partnership or a corporation. Information can also be obtained from the Social Security Administration (SSA) if the claimant completes Form SSA-581; benefits may not be suspended for failure to complete Form SSA-581, however, as authorization to obtain reports from the SSA is not a requirement for receipt of compensation.

Paragraph 8, Dependents, outlines the criteria to review when the claimant is receiving augmented compensation based on one or more dependents. This paragraph includes updated material based on the new criteria in 20 CFR §§ 10.417 and 10.537 for reporting requirements for dependents. References to the CA-1615 and CA-1618 letters were deleted, since these letters no longer exist; the Student Dependency letter is now the letter to use. For students, the reporting requirement has been changed from twice-yearly to annually. The claimant, however, is required to report any changes to student status in the interim. For dependents over the age of 18 but incapable of self support, a review is also required annually. However, if the status of such a dependent is unlikely to change, the claimant may establish the permanency of the condition by submitting a well rationalized medical report which describes that condition and the ongoing prognosis of that condition. Once the permanency of the condition is established, the CE does not need to seek further information regarding that condition; however, if there is a change in that condition, the claimant is required to immediately report that change to OWCP. If the permanency of such a condition is established, the CE should prepare a memorandum to the file for concurrence by the Supervisory Claims Examiner.

Paragraph 9, Dual Benefits, provides the basic criteria to review to determine if the claimant is in receipt of benefits from other Federal agencies such as the Office of Personnel Management, Social Security Administration, or the Department of Veterans' Affairs, as receipt of one of these benefits may require an election or offset. FECA PM Chapter 2-1000 has a detailed discussion of dual benefits, but this paragraph now clearly notes that the CE should review the case for a possible SSA/FERS dual benefit regardless of the claimant's response to the relevant question on the EN-1032.

Paragraph 10, Third Party Settlements, reminds CEs to refer any case in which a new settlement has been made or reported to the Office of the Solicitor.

Paragraph 11, Fraud and Felony Conviction, outlines that if a claimant is convicted of fraud in connection with the application for or receipt of benefits under the FECA, 5 U.S.C. 8148(a) requires termination of all future benefits, including medical benefits. And if a claimant is imprisoned based on a felony conviction unrelated to the FECA claim, 5 U.S.C. 8148(b) requires suspension of benefits to the claimant, but allows payment of benefits to eligible dependents during the time that the claimant is imprisoned.

Paragraph 12, Address Changes, simply reminds CEs to be sure that any address change is updated in the case management system.

Paragraph 13, Actions Based on Form EN-1032 Responses, emphasizes that follow-up action in response to an outstanding issue on Form EN-1032 should be taken promptly in order to avoid or minimize any improper payment.

Paragraph 14, Suspension of Compensation, outlines the process for suspending compensation for non-receipt of the Form EN-1032.

Paragraph 15, Periodic Entitlement Review (PER) Codes, outlines how these codes are used for documenting the periodic entitlement review that is to take place on an annual basis in conjunction with the release of Form CA-1032.

Paragraph 16, Disability Management (DM) Status Codes, outlines that DM codes are used to document actions that may coincide with the development undertaken as the result of a PER review or a final PER action, but that a PER action or closure code will not always coincide with a DM status code, since the PER application is distinct from DM Tracking, each serving a unique purpose. For a complete explanation of DM coding, see FECA PM Chapter 2-0601.

No changes were made to Exhibit 1, PN Memo Example, but the remaining exhibits were deleted.

CHAPTER 2-1402, FORFEITURE

Paragraph 1, Purpose and Scope, outlines the limited scope of this chapter and cross references FECA PM 2-0812 for a more detailed discussion of reviewing cases on the periodic roll.

Paragraph 2, Statutory Provisions, provides the reference to Section 8106(b) of the FECA and clarifies that the statutory authority for forfeiture applies to the omission or understatement of earnings and work activity; it does not apply to similar misrepresentations of dependent status, receipt of dual benefits, etc.

Paragraph 3, Periodic Roll Review, sets the foundation for reviewing periodic roll cases in conjunction with the release of the annual Form CA-1032.

Paragraph 4, CA-1032 Reporting Requirements, provides an overview of the specific directions provided to the claimant when responding to the questions regarding work and volunteer activity.

Paragraph 5, Key Elements of a Forfeiture Decision, clarifies that there are two key requirements for a finding of forfeiture under Section 8106(b)(2): 1) whether the claimant failed to report earnings; and 2) whether he/she did so knowingly. It is not enough to merely establish that there were unreported earnings. The evidence must demonstrate the claimant knowingly failed to report the earnings or activity.

Paragraph 6, Definition of Earnings, provides the regulatory references for the definition of earnings and the requirements for reporting volunteer activity.

Paragraph 7, Definition of Knowingly, provides the regulatory definition for the term, as well as discussion regarding what to look for when making this determination. Relevant decisions of the Employees' Compensation Appeals Board (ECAB) are also included.

Paragraph 8, Penalty Decision, discusses the formal decision and the necessary elements, as well as direction on issuing the simultaneous overpayment decision.

Paragraph 9, Form CA-7, Claim for Compensation, provides guidance on issuing a forfeiture decision based on a Form CA-7, as opposed to the Form EN-1032, with the essential difference being that a forfeiture in this instance is based only on the period claimed on the form, rather than the 15-month period prior to the signature date on the Form EN-1032.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation


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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0807, CONTINUATION OF PAY AND INITIAL CLAIMS FOR COMPENSATION

FECA TRANSMITTAL NO. 12-07

 

 

June 8, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0807 has been revised in its entirety. The chapter has been streamlined and updated to include new language, and the structure of the chapter has been changed. Many of the paragraphs have been reordered, renamed, consolidated, and updated to reflect the Continuation of Pay (COP) process in its entirety. The number of paragraphs in the chapter has been reduced from 17 to 15.

The amendment to the Federal Employees' Compensation Act (FECA), which moved the 3-day waiting period for US Postal Service workers to the beginning of the COP period, rather than the period after COP, has also been incorporated. This amendment was Title IX of the Postal Service Accountability and Enhancement Act, effective 12/20/06.

No substantive changes were made to paragraph 1, but the title was updated to Purpose and Scope.

Paragraph 2 was renamed Statutory Authority and has been updated to include a reference to Title IX of the Postal Service Accountability and Enhancement Act.

Paragraph 3, COP Defined, has been amended to include that COP is allowable for time lost for medical care.

Prior paragraph 5, Employee Status, was moved to paragraph 4 and retained the same name and information.

Paragraph 5, Employee Responsibilities, is a compilation of the information contained in previous paragraphs 4 and 7.

Paragraph 6, Employing Agency Responsibilities, contains essentially the same information as the prior paragraph 8.

Paragraph 7, Controversion of COP, contains essentially the same information as the prior paragraph 9, but the reasons for controverting COP have been reorganized based on the applicable regulatory references.

Paragraph 8, Counting COP Days, is a compilation and reorganization of the information previously found in paragraph 6 (Period of Entitlement), paragraph 12 (Delayed Disability), and paragraph 13 (Recurrence of Disability).

Paragraph 9, Interruption and Suspension of COP, and paragraph 10, Termination of COP, provide the information previously found in paragraph 14.

Paragraph 11, COP and Modified Duty Assignments, covers the information found previously in paragraph 16 and includes additional guidance.

Paragraph 12, Payment of COP, provides details regarding the three-day waiting period before COP may be granted to Postal employees. 20. C.F.R. §10.200(c) also reflects this statutory change to 5 U.S.C 8117 (per Title IX of the Postal Service Accountability and Enhancement Act, effective 12/20/06), which provides that Postal Service employees are not entitled to continuation of pay for the first 3 days of temporary disability unless that disability exceeds 14 days or is followed by permanent disability.

Paragraph 13, COP and Leave Election, contains essentially the same information contained in prior paragraph 15, but the information has been reorganized and supplemented.

Paragraph 14, Formal Adjudication of COP, discusses the information contained in the prior paragraph 10, and also provides more detailed information regarding the development, approval, and denial of COP.

Paragraph 15, Initial Claims for Compensation Following COP, updates the information previously found in paragraph 15 and emphasizes the commitment of the Division of Federal Employees' Compensation (DFEC) that claimants are not without income during the period immediately following the expiration of COP. This paragraph outlines how the initial payment should be made. The examiner is then directed to FECA Procedure Manual Chapter 2-901 for further guidance regarding ongoing payments.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation


The chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-1200, REPRESENTATIVES' SERVICES

FECA TRANSMITTAL NO. 12-08

 

 

June 8, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1200 has been updated and revised in its entirety. Some changes were made based on the updates in the Code of Federal Regulations, effective August 29, 2011. The chapter name has also been updated to REPRESENTATIVES' SERVICES, rather than Fees for Representatives' Services, since the chapter discusses more than just fee approval.

Paragraph 1, Purpose and Scope, outlines that the chapter covers both communication with representatives as well as instructions for fee approval.

Paragraph 2, Authority and Citations, includes both statutory and regulatory references pertaining to authorized representatives. This paragraph also provides information regarding who may act as an authorized representative, including when a federal employee may do so, and the regulatory reference that provides that OWCP may communicate with any member of an authorized attorney's law firm.

Paragraph 3, Corresponding with Representatives, outlines the actions that should be taken upon receipt of a claimant's signed authorization, and provides a detailed discussion of what correspondence should be sent to an authorized representative.

Prior paragraph 4, How Fees for Services are Paid, outlines that the claimant is solely responsible for paying the fee and other applicable charges, and that OWCP will not reimburse a claimant, nor is OWCP in any way liable for the cost of the representation.

Paragraph 5, Fees Which May Not Be Approved, explains that fees for service in matters which have no relation to the claim should not be approved. This paragraph also provides a discussion of contingency fees and reiterates that "contingency fees are not allowed in any form." 20 C.F.R. §10.702(a).

Paragraph 6, Fee Approval, discusses the entire fee application and approval process. This paragraph includes a discussion regarding the necessary elements of a fee application, what to do if information is missing from the fee application submission, how to develop and review disputed applications, and how to issue a formal decision regarding a fee reduction.

Paragraph 7, Authority to Approve Fees, lists the authority to approve disputed fee requests by position and dollar amount.

Paragraph 8, Timely Case Action, outlines that where the representative has submitted an application for fee approval prior to or at the time of submission of the evidence needed to reach a decision in the case, the CE should issue the notification of case acceptance, the notice of payment of compensation or notice of award, along with the ruling on the fee request, when possible. This paragraph also reminds CEs that compensation checks should usually not be forwarded to a representative, even with the claimant's approval.

Paragraph 9, Fee Requests in Disallowed Claims, explains that where a compensation claim is disallowed, a formal decision should still be made on the representative's fee application.

Paragraph 10, Inquiries From State Bar Associations Relating to FECA Representative, outlines that where an inquiry is received from a State Bar Association relating to a FECA representative's conduct, the CE should provide the applicable citations to regulations and procedures concerning representative fees, but exercise the utmost care regarding the disclosure of evidence from the FECA file.

The prior Exhibit 1, Sample Formal Decision, has been deleted.

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation


The chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 7-0100, INTRODUCTION TO NURSE INTERVENTION

FECA TRANSMITTAL NO. 12-09

 

 

DATE July 26, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 7-0100, Introduction to Nurse Intervention, is a new chapter in a completely new part of the FECA Procedure Manual, Part 7 – Nurse Intervention.

FECA PM 2-0600, Disability Management, and FECA PM 2-0811, Nurse Case Management, discuss the role of nurse case management during the early phases of a disability claim. These chapters focus on disability management and nurse intervention from a Claims Examiner's perspective. Currently, OWCP's Nurse Intervention Program is also discussed in Part 3 of the FECA PM, in FECA PM 3-0201, Staff Nurse Services, and in FECA PM 3-202, Contract Field Nurse Certification. The chapters in Part 3 provide information pertaining to the nurse intervention from the Staff Nurse and contract nurse perspective.

OWCP's Nurse Intervention Program is in integral piece of the overall disability management process and, as such, it has been decided that moving information pertaining to this program to an entirely new Part of the PM is warranted. In doing so, procedures will be updated and expanded to reflect DFEC's most recent revisions to the use of contract nurses in our disability management protocols, many of which are already outlined in the Part 2 chapters noted above. The relevant Part 3 chapters will remain until all information has been updated and absorbed into Part 7; however, since Part 7 will contain the most recent guidance and procedures, Part 7 should be consulted first (prior to the part 3 chapters) and, if questions arise, the Part 7 guidance should be followed.

Paragraph 1, OWCP Objectives, lays the foundation for the Nurse Intervention Program by clearly conveying OWCP's commitment to seeing that benefits for compensation and medical services are appropriately and timely provided, and reiterating our commitment to assisting injured workers in obtaining a successful medical recovery and minimizing the period of disability from work.

Paragraph 2, Scope, notes that this chapter focuses only on the objectives and purpose of nurse intervention and the types of nurses involved, and then references the Part 2 chapters noted above as additional resources. This paragraph also provides the regulatory authority (20 C.F.R. §10.310(a)) for using field nurses to facilitate and coordinate medical care.

Paragraph 3, Purpose, discusses how nurse intervention has been incorporated into the Quality Case Management (QCM) portion of the Disability Management process, and how involving nurses in the early stages of disability cases facilitates expedited medical care and recovery and can result in shortening the length of disability from work.

Paragraph 4, National Office Nurse Consultant, outlines the role and some of the duties of the National Coordinator for the nurse program, which include planning and developing methods for the assessment of the OWCP nurse program and serving as a resource for the District Office Staff Nurses.

Paragraph 5, District Office Staff Nurses, outlines the critical role of the Staff Nurse in the overall success of the nurse intervention program and provides an overview of the duties, which include the following: coordinating the assignment of contract nurses for specific cases; monitoring contract nurses' performance in correlation to both contract specifications and quality of services provided; reviewing nurse reports for completeness and timeliness prior to authorizing payment of bills; and communicating with the CE as needed with regard to issues that arise during the nurse intervention phase.

Paragraph 6, Continuation of Pay (COP) Nurses, outlines that COP Nurses are contracted nurses assigned in traumatic injury cases where the injured worker has immediate disability and has not returned to work within 7 days following the date of work stoppage. The expectations of the CN are outlined, and it is noted that CNs only have a role during the COP period in traumatic injury cases and are strictly triage nurses whose work is performed telephonically.

Paragraph 7, Field Nurses, explains that Field Nurses are contracted registered nurses whose contact is generally in person, and that assignment of Field Nurses should occur as soon as possible after the injury occurs and the claim has been approved for a work-related injury. An overview of the FN duties is also provided.

 

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation


The chapter is an entirely new chapter in a new part of the PM. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entirely new chapter is issued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0803, FACT OF INJURY

FECA TRANSMITTAL NO. 12-10

 

 

August 22, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0803 has been updated and revised in its entirety. The chapter has been updated to include new language, and the structure of the chapter has been changed.

Paragraph 1, Purpose and Scope, outlines that the chapter will discuss the guidelines for determining whether the third basic element of a claim, Fact of Injury (FOI), has been met. It also references FECA PM Chapter 2-0800 (Development of Claims) as a source for further information pertaining to how to properly develop claims.

Paragraph 2, Components of Fact of Injury, discusses the two components of this element: Fact of Injury-Factual and Fact of Injury-Medical. This paragraph also makes it clear that both of these criteria must be satisfied before proceeding to consider the fourth basic element of a claim, performance of duty.

Paragraph 3, Fact of Injury – Factual, provides a description of the evidence that should be reviewed to determine whether FOI-Factual has been satisfied. The paragraph also discusses sources of evidence and outlines some issues that the CE may need to develop.

Paragraph 4, FOI-Medical, discusses the criteria for determining whether FOI-Medical has been satisfied, and indicates that the CE should develop the case if a medical diagnosis in connection with the claimed injury is not present.

Paragraph 5, Denial Reason, discusses on what basis to deny the case if one or both of these essential elements of Fact of Injury have not been met.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 7-0300, CONTINUATION OF PAY (COP) NURSES

FECA TRANSMITTAL NO. 12-11

 

 

DATE August 22, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 7-0300, Continuation of Pay (COP) Nurses, is a new chapter in the FECA Procedure Manual (PM), Part 7 – Nurse Intervention.

FECA PM 2-0600, Disability Management, and FECA PM 2-0811, Nurse Case Management, discuss the role of nurse case management during the early phases of a disability claim. These chapters focus on disability management and nurse intervention from a Claims Examiner's perspective. Currently, OWCP's Nurse Intervention Program is also discussed in Part 3 of the FECA PM. The chapters in Part 3 provide information pertaining to the nurse intervention from the Staff Nurse and contract nurse perspective.

As outlined in FECA Transmittal No. 12-09, it has been decided that moving information pertaining to the Nurse Intervention Program to an entirely new Part of the PM is warranted. The relevant Part 3 chapters will remain until all information has been updated and absorbed into Part 7; however, since Part 7 will contain the most recent guidance and procedures, Part 7 should be consulted first (prior to the Part 3 chapters), and if questions arise, the Part 7 guidance should be followed.

This new chapter, 7-0300, discusses the COP Nurse phase of the Nurse Intervention Program. Involving COP Nurses in certain traumatic injury disability cases during the 45-day COP period allows for expedited adjudication efforts, thus resulting in earlier disability case management activities which assist in the medical recovery and return to work of injured employees.

Paragraph 1, Background, lays the foundation for the implementation of the COP Nurse intervention program and provides historically related references to FECA Bulletin 00-15, FECA Bulletin 01-09, and FECA Bulletin 10-04.

Paragraph 2, Purpose and Scope, outlines the purpose and scope of the chapter, providing related references to FECA PM 2-0600 (Disability Management) and 2-0811 (Nurse Case Management).

Paragraph 3, Introduction, defines the role of the COP Nurse and the benefits obtained from the COP Nurse intervention activities.

Paragraph 4, Identification of Cases for Assignment of COP Nurse, details how certain traumatic injury disability cases are identified for COP Nurse assignment eligibility.

Paragraph 5, COP Nurse Intervention Actions, provides an overview of the nurse intervention activities to be provided and the timeframes allowed for the completion of such activities.

Paragraph 6, COP Nurse Reimbursement, specifies that when the COP Nurse closes a case, the Staff Nurse reviews the closure for appropriateness and accuracy, and then, after approval, the closure report is generated and the bill is sent for processing.

Paragraph 7, Claims Examiner Action Upon COP Nurse Closure, outlines the case management expectations after the Claims Examiner receives the completed COP Nurse closure report.

Paragraph 8, COP Nurse Closure Codes, specifies the various types of closure codes used to triage the disability status of the traumatic injury cases assigned for COP Nurse intervention.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The chapter is an entirely new chapter in a new part of the PM. Because transmittal of the FECA Procedure Manual is primarily electronic, the DFEC is discontinuing the practice of inserting page numbers when an entirely new chapter is issued.

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7-0300

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 8-0100, INTRODUCTION TO REHABILITATION

FECA TRANSMITTAL NO. 12-12

 

 

DATE August 22, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 8-0100, Introduction to Rehabilitation, is a new chapter in a new part of the FECA Procedure Manual, Part 8 – Rehabilitation.

FECA PM 2-0600, Disability Management, and FECA PM 2-0813, Vocational Rehabilitation Services, discuss the role of rehabilitation in a disability claim. These chapters focus on disability management and vocational rehabilitation from a Claims Examiner's (CE's) perspective. Currently, DFEC's Rehabilitation Program is also discussed in Part 3 of the OWCP PM. The chapters in Part 3 provide information pertaining to rehabilitation from the Rehabilitation Specialist (RS) and contract Rehabilitation Counselor (RC) perspective.

Vocational Rehabilitation is in integral piece of the overall disability management process, and, as such, it has been decided that moving information pertaining to this program to an entirely new Part of the FECA PM is warranted. In doing so, procedures will be updated and expanded to reflect DFEC's most recent revisions to the use of contract RCs in our disability management protocols, many of which are already outlined in the Part 2 chapters noted above. The OWCP PM chapter will remain; however, since Part 8 of the FECA PM will contain the most current guidance and procedures, the FECA PM should be consulted first (prior to the OWCP PM), and if questions arise, the FECA PM guidance should be followed.

Paragraph 1, OWCP Objectives, lays the foundation for the vocational rehabilitation program by clearly conveying OWCP's commitment to seeing that benefits for compensation and medical services are appropriately and timely provided, and reiterating our commitment to assisting injured workers in obtaining a successful medical recovery and minimizing the period of disability from work.

Paragraph 2, Purpose, discusses how vocational rehabilitation is part of DFEC's disability management process, and outlines two underlying themes that are core components of the rehabilitation portion of disability management: (1) close coordination of CE and RS/RC actions; and (2) a clear, consistent message to the injured worker that return to some kind of work is expected as soon as the worker is medically ready.

Paragraph 3, Scope, notes that this chapter focuses only on the objectives and purpose of vocational rehabilitation, including the legislative and regulatory authority under which such services are provided, and then references the OWCP PM and the relevant FECA Part 2 chapters as additional resources.

Paragraph 4, Statutory, Regulatory and Program Requirements, provides the authority for DFEC's vocational rehabilitation program.

Paragraph 5, Roles and Responsibilities, describes the roles of the relevant participants, and then references FECA PM 2-0813 as an additional resource.

Paragraph 6, Compensation Entitlement During and After Vocational Rehabilitation, discusses how compensation is paid during the vocational rehabilitation effort, identifies the bars to receipt of such compensation, and explains how compensation is reduced following the completion of rehabilitation services.

Paragraph 7, Restoration Rights with the Federal Government, provides the authority by which an injured worker who has either fully or partially recovered may return to duty with the previous employer. This provision is administered by the Office of Personnel Management.

Paragraph 8, Available Services, outlines the various medical and vocational rehabilitation services available to an injured worker and identifies which of those services are considered substantial services for the purpose of successful rehabilitation closure.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The chapter is a new chapter in a completely new part of the FECA Procedure Manual, Part 8 – Rehabilitation. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is issued or reissued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0900, DETERMINING PAY RATES

FECA TRANSMITTAL NO. 12-13

 

 

August 23, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

A minor update is being made to Chapter 2-0900, paragraph 8 (Applying Increments of Pay).

Paragraph 8(a) previously indicated that Sunday premium pay should be requested for the year prior to the pay rate effective date; however, this is not necessary if the worker regularly worked on Sundays. If an additional amount or percentage was paid for Sunday work, and the file contains no evidence showing that this amount varied or was paid irregularly, the CE may add the indicated amount or percentage to the base pay reported without further inquiry. If the evidence shows, however, that the amount or percentage paid for Sundays varied or was paid irregularly, the CE should determine the amount of additional pay received during that year and add it to the reported base pay.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 8-0800, ASSISTED REEMPLOYMENT

FECA TRANSMITTAL NO. 12-14

 

 

September 25, 2012


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 8-0800, Assisted Reemployment, is a new chapter in FECA Procedure Manual (PM), Part 8 – Vocational Rehabilitation Intervention.

Currently, Assisted Reemployment is discussed in Part 3 of the OWCP PM, Chapter 3-0401. As outlined in FECA Transmittal No. 12-12, however, it has been decided that moving information pertaining to DFEC's Rehabilitation Program into the FECA PM is warranted. The OWCP PM chapter will remain, and that chapter may be referenced for a historical perspective, but since it has not been recently updated, this new chapter (FECA PM 8-0800) should be consulted for any Assisted Reemployment issue, since it contains the most current policies and procedures for DFEC.

Paragraph 1, Purpose and Scope, defines Assisted Reemployment as a temporary subsidy designed to encourage employers to choose qualified rehabilitated workers, thereby increasing the number of job offers made by private employers.

Paragraph 2, Background, describes the inception of Assisted Reemployment in FY 1992.

Paragraph 3, Funding Authority, provides a reference to the authority that allows DFEC to use the FECA fund to pay a portion of the salary of a newly reemployed Federal worker (who is eligible for disability benefits under the FECA) via Assisted Reemployment.

Paragraph 4, Eligible Employers, outlines that Assisted Reemployment salary reimbursement may be offered to employers in the private sector, but not to a business owned or managed by the injured worker, the injured worker's relatives, an employee of OWCP (or his/her family), or an OWCP vocational rehabilitation counselor (or his/her family).

Paragraph 5, Reimbursement Parameters, discusses that the rate and duration of Assisted Reemployment salary reimbursement offered should be negotiated separately with each employer, depending on the nature of the job market and the particular circumstances in the case. The paragraph then lists the restrictions and parameters for payment of the subsidy.

Paragraph 6, Eligible Cases, explains that a Claims Examiner (CE), a Rehabilitation Specialist (RS), or a Rehabilitation Counselor (RC) may propose Assisted Reemployment for an injured worker during Plan Development, or at any time during Placement, especially if it seems that it may be difficult to place the injured worker, but cautions that such subsidies should not be considered in instances where the claimant is not putting forth a good-faith effort in the return-to-work process or has demonstrated non-cooperative behavior.

Before proceeding with AR, the file should reflect that the Employing Agency (EA) has declined or failed to offer appropriate modified employment.

Paragraph 7, Assisted Reemployment Initiation, discusses the first steps the RS and RC should take when it has been decided to pursue Assisted Reemployment as part of the vocational rehabilitation plan.

Paragraph 8, Placement Phase, outlines the steps the RS and RC should take during the placement phase, including: contacts by the RC; reporting outcomes of such contacts in the monthly reports; and possibly informal conferences with potential employers who are interested in Assisted Reemployment.

Paragraph 9, Assisted Reemployment Approval, discusses the Assisted Reemployment Memorandum of Agreement that is used to record the terms of the wage subsidy once an arrangement has been finalized. This paragraph also references the shell AR Agreement, available in Correspondence Library, but cautions the RS to tailor the agreement for the particular circumstances of the case but not alter any of the essential elements.

Paragraph 10, Case Closure, explains that a worker may be considered successfully rehabilitated when employed for more than 60 days without interruption (due to the disability), and that the same basic principle applies to cases with Assisted Reemployment subsidies, except that wage reimbursement payments will be made on the injured worker's behalf for up to three years after the return to work, and post-employment services may be provided throughout this entire period.

Paragraph 11, Post-Employment Services, discusses how these services are authorized and the time frames involved.

Paragraph 12, Payment of Assisted Reemployment Subsidies, outlines how employers submit claims for reimbursement (via Form CA-2231), and the steps the RS takes when reviewing these submissions for payment authorization.

Exhibit 1, Assisted Reemployment Memorandum of Agreement, is the shell agreement that is to be used when approving an Assisted Reemployment subsidy.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The chapter is completely new. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is issued.

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FECA TRANSMITTAL NO. 11-01

October 8, 2010


EXPLANATION OF MATERIAL TRANSMITTED:

Part 0 of the Procedure Manual has been updated in its entirety to reflect the current organization of DFEC, updated references to various directives, and current practices pertaining to dissemination of said directives.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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0-0100

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0-0100

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0-0200

1-6

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FECA TRANSMITTAL NO. 11-02

February 24, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0813 has been revised in its entirety. This chapter now provides an overview of the entire Vocational Rehabilitation (VR) process and is therefore now titled Vocational Rehabilitation Services.

Four sections from 2-0811 have been incorporated into this chapter: Referrals for Vocational Rehabilitation Services, Return to Work with Previous Employer, Plan Development, and Return to Work with New Employer. Other than removing these sections, no other changes have been made to 2-0811. The remaining paragraph in 2-0811 is Nurse Services, and since this chapter will be revised to focus solely on nurse case management, it is being renamed Nurse Case Management at this time.

The first 3 paragraphs of 2-0813 outline the purpose of VR services; the statutory, regulatory and Program requirements pertaining to VR; and entitlement to compensation during the VR process.

Paragraph 4 discusses restoration rights with the Federal government under section 8151 of the FECA.

Paragraph 5 outlines the criteria for referrals for VR services. This discussion includes referrals for immediate placement, as well as those for work hardening programs and those for concurrent and task based rehabilitation services in conjunction with Field Nurse services.

Paragraph 6 discusses the Placement with Previous Employer (PPE) phase of VR.

Paragraph 7 outlines what happens during the Plan Development phase of VR and specifically identifies that jobs selected for a plan must be medically and vocationally suitable, as well as reasonably available.

Paragraph 8 discusses the Training phase of VR and the types of training that are available.

Paragraph 9 focuses on the Placement with New Employer (PNE) phase of VR.

Paragraph 10 provides details regarding Assisted Reemployment, which is a subsidy that can be used during PNE to encourage employers to choose qualified rehabilitated workers whom they might otherwise not hire.

Paragraph 11 details the VR services that are provided once an injured worker has returned to work.

Paragraph 12 outlines the various services that can be offered under the umbrella of Medical Rehabilitation, including Occupational Rehabilitation Plans.

Paragraph 13 provides information on the use of the Interrupt status during VR services.

Paragraph 14 focuses on effective communication among the Claims Examiner, Rehabilitation Specialist, Rehabilitation Counselor, and the injured worker, and the importance of such communication for a successful VR effort.

Paragraph 15 provides guidance to Claims Examiners for managing medical issues during VR.

Paragraph 16 specifically discusses the effects of substance abuse and methods for addressing this particular medical issue during VR.

Paragraph 17 outlines the effects of non-cooperation during the various stages of VR services and discusses the various sanction decisions that may be issued.

Paragraph 18 provides guidance for the appropriate actions to take if OPM benefits are elected during the various stages of VR.

Paragraph 19 concludes with a discussion of the possible outcomes of VR.

Finally, two new exhibits have been added. Exhibit 1 is titled Physical Demand Definitions and Exhibit 2 is titled Environmental Conditions Definitions. These exhibits outline the definitions DFEC has adopted from the Selected Characteristics of Occupations Defined in the Revised Dictionary of Occupational Titles. These definitions should be used when comparing the established work restrictions to the physical requirements of positions identified in the Dictionary of Occupational Titles.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The following chapters are being updated in their entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

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1-19
Exhibits 1-2

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FECA TRANSMITTAL NO. 11-03

March 17, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0900 has been updated in its entirety to include more detailed explanations in all paragraphs. Additions have been made, and obsolete information and/or references have been deleted. Additionally, previous paragraphs 6 and 7 of the chapter have been reversed so that the prior paragraph 7 (Elements Included in Pay Rate) is now paragraph 6, and prior paragraph 6 (Elements Excluded from Pay Rate) is now paragraph 7.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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2-0900

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Exhibit 1

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FECA TRANSMITTAL NO. 11-04

June 14, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapters 2-0800 and 2-0806 have been revised in their entirety. Chapter 2-0800 now provides an overview of the initial development of claims, and the chapter itself has been renamed Initial Development of Claims. Chapter 2-0806 now provides an overview of the acceptance of claims and has been renamed Initial Acceptances.

The procedures contained in the revised 2-0800 are a compilation of those outlined in the prior 2-0800, Development of Claims, and 2-0806, Occupational Illness. Much of the prior 2-0800 has been incorporated into this revised chapter, and most of the prior 2-0806 has been deleted and incorporated into the new 2-0800.

PM Chapter 2-0800, INITIAL DEVELOPMENT OF CLAIMS

Paragraph 1 outlines the purpose and scope of the chapter.

Paragraph 2 outlines the types of claims, traumatic and occupational, and discusses the difference between basic and extended occupational disease claims. This paragraph also includes a discussion of administratively reviewed claims.

Paragraph 3 outlines the forms used for all types of claims and the completion of those forms. The paragraph also discusses how to handle incomplete and incorrect forms.

Paragraph 4 outlines the responsibilities for the claimant, OWCP and the employing agency.

Paragraph 5 outlines the general development of a case and how to identify and request necessary information.

Paragraph 6 discusses the circumstances in which a case may be accepted without a medical report in the file.

Paragraphs 7 and 8 outline the development of factual and medical evidence, including the sources of both types of evidence, how to resolve factual discrepancies, and phrasing questions to obtain both factual and medical evidence.

Paragraph 9 discusses the extended medical development of certain cases when the nature of exposure is in question, the diagnosis is not clearly identified, or the relationship of the condition to the exposure is not obvious.

Paragraph 10 discusses obtaining evidence from employing agencies and the procedures for requesting the evidence.

Paragraph 11 outlines the procedures for withdrawing a claim prior to adjudication.

Paragraph 12 discusses group injuries where two or more employees are injured in the same incident.

Exhibit 1 (Nature of Injury Codes) has been moved from the prior PM Chapter 2-0806 into this chapter. Some updates have been made as well based on available codes. The prior exhibit in this chapter was deleted since a sample/shell letter for withdrawal of a claim is available in Correspondence Library.

PM CHAPTER 2-0806, INITIAL ACCEPTANCES

Paragraph 1 outlines the purpose and scope of the chapter and notes that disallowances are discussed in FECA PM 2-1400.

Paragraph 2 discusses the procedures for accepting the claim if the five basic requirements are met.

Paragraph 3 outlines the CE's responsibility to verify the claimant's work status and begin Disability Management actions, if appropriate, upon case acceptance.

Paragraph 4 outlines the procedures for when an injured worker is claiming multiple medical conditions.

Paragraph 5 discusses the resolution of a medical condition at the time of case acceptance and includes sample language that can be utilized in the acceptance letter to the claimant.

Paragraph 6 outlines the procedures for closing a case at the time of case acceptance and includes sample language.

Paragraph 7 discusses the CE's responsibility in addressing employing agency challenges and controversions and includes sample language.

Paragraph 8 outlines the procedures for determining whether a pre-existing medical condition has been aggravated by an injury or job duties.

Paragraph 9 discusses claims filed due to risk of future exposure or prevention of future injury and the CE's responsibility when this type of claim if filed.

All exhibits that were previously contained in 2-0806 have been deleted and there were no new exhibits added. The majority of the exhibits were sample development letters that were not moved into the new chapter since sample/shell letters are available in Correspondence Library. The prior Nature of Injury Codes exhibit was updated and moved into PM Chapter 2-0800.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The following chapters are being updated in their entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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2-0806

1-9

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FECA TRANSMITTAL NO. 11-05

June 14, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0811 has been revised in its entirety. This chapter now provides details of the case management process during the Nurse Intervention period.

Paragraph 1 outlines the purpose and scope of the chapter, and provides related references in Chapter 2-0600 (Disability Management) and Chapter 3-0201 (Staff Nurse Services) and 3-0202 (Contract Field Nurse Certification).

Paragraph 2 provides an overview of the Disability Management (DM) process and how nurse intervention is an integral part of the management of a claim during this period.

Paragraph 3 briefly outlines the role of each type of nurse: Staff Nurse (SN), Continuation of Pay Nurse (CN) and Field Nurse (FN).

Paragraph 4 discusses the CN intervention period, including how and when cases are assigned to CNs, the timeframes for CN activity, and the expectations for the CN. This paragraph also outlines the Claims Examiner's (CE's) role in adjudicating claims and initiating further DM actions if the CN case is closed and the claimant has not returned to work in a full-time capacity.

Paragraph 5 discusses the role and responsibilities of the FN.

Paragraph 6 outlines the FN's role in assisting claimants in returning to work and assisting CEs in moving a case towards resolution and stresses that early referral for nurse intervention services is critical to ensuring successful disability management. This paragraph also discusses different situations in which a FN is needed.

Paragraph 7 outlines the requirements for the FN referral and specifies that the referral should be specific to the circumstances of the case and include the goals of the intervention, the issues which the FN should address with the physician, and any pending adjudicatory actions.

Paragraph 8 discusses what should be expected from the FN during the assignment period and available options for the CE should the claimant choose not to cooperate with the FN.

Paragraph 9 focuses on how critical regular and timely communication between the CE, SN, and FN are to a successful outcome.

Paragraph 10 outlines the updated timelines for nurse assignments. A significant change is the removal of the "Interrupt" status. Instead of using more rigid timelines, DFEC is instead moving to purposeful decision making specific to each case with increased use of extensions. If there is something specific the FN can do to further the return-to-work effort and maximize medical recovery, extensions can be approved by the CE and then the Supervisor for a period not to exceed 10 months (with some exceptions). As long as there is a clear indication that FN services would be useful for a specific purpose and that purpose/direction has been provided to the FN as clearly evidenced in the file, extensions may be granted. 30-day extensions to monitor a full-time return to work and 60-day extensions to monitor a light duty return to work are automatic. And for optimal case management results, collaboration between the CE and SN is strongly encouraged and should occur when extensions are to be granted or if there is any question regarding the appropriateness of FN closure.

Paragraph 11 details the criteria for Dual Track Intervention and explains the circumstances where it may be beneficial to assign a Rehabilitation Counselor (RC) to a case in conjunction with a FN. The dual track approach is warranted if the Employing Agency (EA) is trying to accommodate the claimant's work restrictions but is having difficulty formulating a position, but vocational testing, an ergonomic evaluation, or assistive technology may assist the EA with the formulation of a job offer. Dual tracking may also be useful if the claimant has a medical condition which is likely to lead to permanent work restrictions, and there is no possibility that the EA would be able to accommodate those restrictions, in which case the claimant may benefit from a collaborative approach where the FN continues to assist with medical recovery while the RC begins early vocational assessment and planning.

Paragraph 12 outlines the CE's responsibility to medically manage each case, even during the Nurse Intervention period. While the FN will be actively involved in working with the claimant, the physician, and the EA, the ultimate responsibility of managing the direction of the case continues to rest with the CE. The CE can direct the FN to obtain specific information from the physician, but if this is not effective, the responsibility rests with the CE.

Paragraph 13 provides some ideas regarding best practices that can be used during the nurse intervention phase of Disability Management.

Chapter 2-0600 is also being updated based on revisions to the Nurse Case Management chapter so that both chapters contain consistent guidance.

Paragraph 3 has been updated to remove the reference to Telephonic Nurses, since DFEC is no longer making that distinction.

Paragraph 8 has been updated to remove the references to Telephonic Nurses and reflect the new timelines for FN services. Updates were also made to reflect the various dual tracking scenarios in which task-based rehabilitation assignments may be made in conjunction with FN services.

Paragraph 9 has been similarly updated to reference the various dual tracking scenarios.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

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Three paragraphs in the following chapter are being updated.

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2-0600

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2-0600

3, 8 and 9

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FECA TRANSMITTAL NO. 11-06

July 27, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 3-0500 has been revised in its entirety. Information previously contained within the chapter has been updated and duplicative portions of the chapter have been deleted.

Prior paragraph 2, Initial Examinations, has not been included in this chapter, since the information can be found in 3-0300. Likewise, prior paragraph 6, Exclusion of Medical Evidence, has not been included in this section, since the information is already contained in 2-0810. Also, the prior Exhibit 1, Form CA-19, has been removed since it is outdated and other referral methods are now used.

The focus of this chapter is now solely on OWCP directed second opinion (SECOP) and impartial medical evaluations (IME); therefore, the name of the chapter has been changed from Medical Examinations to OWCP Directed Medical Examinations. This chapter now provides detail of the steps involved in scheduling OWCP directed examinations and using the current Medical Management application in the Integrated Federal Employees' Compensation System (iFECS).

Paragraph 1 outlines the purpose and scope of the chapter and provides related references in Chapter 2-0810 (Developing and Evaluating Medical Evidence), Chapter 3-0300 (Authorizing Examination and Treatment), and Chapter 3-0600 (Requirements for Medical Reports).

Paragraph 2 provides the statutory authority for SECOP and IME examinations, pursuant to section 8123 of the FECA.

Paragraph 3 focuses on when and how to refer a case for a SECOP. It discusses how physicians are chosen, what information to include with the referral, how a claimant is notified once a SECOP is scheduled, requirements for any special accommodations (e.g. hearing impaired claimant), and the Claims Examiner's (CE) responsibility in obtaining the SECOP report timely and ensuring that it is complete and addresses the necessary issues.

Paragraph 4 discusses the referee examination process, including how and when cases are referred. This paragraph highlights the importance of using the rotational system, currently the Medical Management application in iFECS, in the selection of IME specialists. It discusses the CE's role in identifying the need for an IME, the selection process for the IME physician, what information should be provided to the IME physician and the claimant, and requirements for any special accommodations. It also discuses the CE's responsibility in obtaining the IME report timely and ensuring that it is complete and addresses the necessary issues.

Paragraph 5 focuses on the Medical Management application in iFECS, which replaced the previous Physician Directory System. It discusses the rotational scheduling feature and how a file should be documented with the appointment information. This paragraph also outlines the circumstances in which an appointment can be scheduled outside the usual rotational guidelines and the documentation that is required if that occurs.

Paragraph 6 provides a comprehensive guide to appropriate codes available to document the reasons for bypassing a physician in the rotational system.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

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3-0500

1-7
Exhibit 1

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3-0500

1-6

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FECA TRANSMITTAL NO. 11-07

September 2, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0900 was updated in its entirety earlier this year. A few additional updates are being made at this time to provide more clarity with regard to effective pay rate dates.

Paragraph 5, Effective Date of Pay Rate, has been modified in two places. Section (a) now includes a specific reference to the determination of an effective pay rate date in an occupational disease case. Section (c) now specifically discusses effective pay rate dates for schedule award cases. As a result, the prior section (c) that discussed death cases has now been moved to section (d) with no changes. Exhibit 1, Determining Effective Pay Rate Date for Schedule Awards, has also been updated.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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FECA TRANSMITTAL NO. 11-08

September 21, 2011


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0500 has been revised and updated to include new language, a change in the structure, and references to the two types of conferences – formal and informal. The chapter itself focuses on formal conferences though, as informal conferences during the Disability Management (DM) process are discussed in detail in PM Chapter 2-600-12.

Paragraph 1 provides an overview of the chapter.

Paragraph 2 outlines that both the Senior Claims Examiners (SrCE) and the GS-12 Claims Examiner (GS-12 CE) are responsible for conducting conferences, but also notes that non-journey level CEs may also participate in some types of conferences.

Paragraph 3 discusses the two specific types of conferences (formal and informal) and some of the distinctions between the two.

Paragraph 4 discusses the different types of cases suitable for formal conferences.

Paragraph 5 outlines the necessary steps the SrCE/GS-12 CE must take in preparing for a conference call.

Paragraph 6 discusses the necessary elements of a conference.

Paragraph 7 discusses actions required by the SrCE/GS-12 CE during the conference discussion.

Paragraph 8 outlines the essential elements of a Memorandum of Conference.

Paragraph 9 discusses when comments are required and when comments are not required after a conference is conducted.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC has discontinued the practice of inserting page numbers when an entire chapter is reissued.

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY
CHAPTER 2-0900, DETERMINING PAY RATES
CHAPTER 2-0901, COMPUTING COMPENSATION
CHAPTER 2-1500, RECURRENCES

FECA TRANSMITTAL NO. 10-01

October 5, 2009


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0814 has been revised. Paragraph 7 (Determining WEC Based on Actual Earnings) has been updated to include a reference for determining loss of wage-earning capacity under Performance-Based Alternative Pay Systems (pay banding). Paragraph 8 (Determining WEC Based on Constructed Position) has been updated to include more guidance for claimants in prison and how imprisonment for a felony conviction affects entitlement to compensation under 5 U.S.C. 8148 (b). More examples have been added to Paragraph 10 (Abandonment of Job). Paragraph 11 (Modifying Formal LWEC Decisions) has been updated to clarify the distinction between modifying an LWEC and making a determination on a recurrence. Paragraph 12 (Termination of Employment) has been updated to include more specific guidance. A new sub-paragraph (d) has been added to Paragraph 13 (Effect of Federal Reemployment on Retirement Status). Updated citations from the Employees' Compensation Appeals Board (ECAB) have been added throughout the chapter. Exhibit 4 has been deleted.

Paragraph 2-0900-12, Special Determinations, has been revised to address pay rates under Performance-Based Alternative Pay Systems (pay banding).

Chapter 2-0901 has been revised. Paragraph 14 (Schedule Awards) has been updated to remove outdated language pertaining to the former Sequent system and payment sheets. Paragraph 15(c) (Loss of Wage Earning Capacity, Computation) has been updated to include clarification pertaining to 2 numbers used in the Shadrick formula. A new item has been added to paragraph 15(f) (Loss of Wage Earning Capacity, Special Determinations) to establish procedures for determining loss of wage-earning capacity under Performance-Based Alternative Pay Systems (pay banding). Paragraph 15(g) (Loss of Wage Earning Capacity, Reinjury) was expanded to include a specific reference to part-time work schedules at the time of reinjury. Paragraph 18(d) (Other Payees, A State and Municipal Court or Agency) was updated to reference a Memorandum of Understanding with the Department of Health and Human Services Office of Child Support Enforcement. Updated citations from ECAB have also been added throughout the chapter.

Chapter 2-1500-7 has been updated to clarify the distinction between modifying an LWEC and making a determination on a claim for a recurrence; to make it clear that when an LWEC is in place, proper claims handling requires that a claim for ongoing total disability (as opposed to a brief intermittent period) must be treated as a modification of the LWEC and not as a recurrence of disability; and to clarify that when a proper LWEC is in place, payment for ongoing recurrent total disability may not be made.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 2-0900, DETERMINING PAY RATES, AND 2-0901, COMPUTING COMPENSATION, PART 2- CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 10-02

October 19, 2009


EXPLANATION OF MATERIAL TRANSMITTED:

The Department of Commerce is responsible for conducting the Decennial Census and employs enumerators and crew leaders to gather statistical data through interviews with property residents. The Bureau of the Census expects to hire approximately one million individuals with temporary appointments not to exceed 180 days. These employees will work an average of 84 hours during a four to five week period, one week of which will be training. After evaluating work patterns for the 2000 Census, the Department of Commerce has provided data regarding pay rates and standard workdays derived from the 2000 Census. The work patterns for the 2010 Census are expected to closely resemble the 2000 Census.

Chapter 2-0900-12 and Chapter 2-0901-9 have both been updated to reflect information pertaining to the 2010 Decennial Census.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO CHAPTER 2-1800, HOUSING AND VEHICLE MODIFICATIONS, PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 10-03

October 26, 2009


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1800 has been revised in its entirety and updated to include new language, a change in the structure of the chapter, and new exhibits.

Paragraphs 1, 2 and 3 have been updated.

Paragraphs 4 through 10 have been revised and renamed.

Medical development is now the sole focus of paragraph 4.

Paragraphs 5, 6 and 7 now focus individually on vehicle modifications, housing modifications for home owners and housing modifications for renters. Each of these paragraphs outlines the general criteria related to the kind of modification, as well as the technical development required.

Paragraph 8 discusses the adjudication of the proposals (formerly paragraph 7).

Paragraph 9 discusses the payment for the modifications (formerly paragraph 8).

Paragraph 10 discusses later requests for modification (formerly paragraph 9).

The former paragraph 10 (Record Keeping) has been deleted.

Four sample agreements to be used in the following situations have been added as exhibits:

  • OWCP Vehicle Purchase or Modification
  • OWCP Housing Modification for Home Owners
  • OWCP Housing Modification for Renters
  • OWCP Housing Modification for Family-Owned Homes

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


FILING INSTRUCTIONS:

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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0808, SCHEDULE AWARDS AND PERMANENT DISABILITY CLAIMS
CHAPTER 2-0900, DETERMINING PAY RATES
CHAPTER 2-1601, HEARINGS AND REVIEWS OF THE WRITTEN RECORD
CHAPTER 2-1602, RECONSIDERATIONS
CHAPTER 3-0700, SCHEDULE AWARDS

FECA TRANSMITTAL NO. 10-04

January 9, 2010


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0808 has been revised in its entirety to incorporate changes resulting from the adoption of the Sixth Edition of the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment, which was effective May 1, 2009. Paragraph 5 was updated to clarify further that a schedule award may not be paid in one case if the claimant is in receipt of compensation for temporary total disability in another case if the entitlement to each is based on the same part of the body. Paragraph 5 was also updated to include information about schedule awards unpaid at death.

Chapter 2-0900, paragraph 2, has been revised to provide procedures for establishing an effective pay rate in occupational disease claims. Paragraph 5 has been updated and Exhibit 1 has been added to provide specific guidance for determining the effective pay rate date for schedule awards. Paragraph 5 was also updated to include more specific guidance with regard to recurrent pay rates.

Chapter 2-1601, paragraph 8, has been revised to incorporate changes pertaining to the Sixth Edition of the AMA Guides to the Evaluation of Permanent Impairment, effective May 1, 2009.

Chapter 2-1602, paragraph 4, has been updated to provide more guidance pertaining to the type of evidence required for review. Paragraph 5 has been revised to incorporate changes pertaining to the Sixth Edition of the AMA Guides to the Evaluation of Permanent Impairment, effective May 1, 2009.

Chapter 3-0700 has been revised in its entirety to incorporate changes resulting from the adoption of the Sixth Edition of the AMA Guides to the Evaluation of Permanent Impairment, which was effective May 1, 2009. Exhibit 1 - Use of Sixth Edition of AMA Guides to the Evaluation of Permanent Impairment is new and outlines changes relevant to the Sixth Edition, as previously described in FECA Bulletin 09-03. Exhibit 2 (previously Exhibit 1) is the Percentage Table of Schedule Awards, Form CA-699 – with no changes. The previous Exhibit 2 (Sample DMA Evaluation) has been deleted. Exhibit 3 (Hearing Loss Medical Opinion, Form CA-51) remains unchanged. The prior Exhibit 4 (Use of Fifth Edition of AMA Guides to the Evaluation of Permanent Impairment) has been deleted and replaced with a new Exhibit 4 – the article "Rating Spinal Nerve Extremity Impairment Using the Sixth Edition" from the July/August 2009 edition of the The Guides Newsletter published by the AMA. This newsletter has been reproduced with permission of the AMA.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


Only certain pages within the following chapters are being updated.

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The following chapters are being updated in their entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0812, PERIODIC REVIEW OF DISABILITY CASES
CHAPTER 2-1400, DISALLOWANCES

FECA TRANSMITTAL NO. 10-05

March 5, 2010


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0812 has been revised in its entirety. The chapter has been streamlined and updated to include new language, a change in the structure of the chapter, and the inclusion of new exhibits.

With the exception of paragraphs 1 through 3, the remaining paragraphs have been reordered, consolidated, and updated to reflect current procedures for entitlement reviews of periodic roll cases using the Periodic Entitlement Review (PER) application in the Integrated Federal Employees' Compensation System (iFECS). 13 paragraphs now comprise this chapter.

Paragraph 4 "Placement and Monitoring of Claims on Periodic Roll" has been revised by deleting references to Form CA-674 and the section on Expiration Dates. Form CA-674 references have been replaced with references to the PER application within Disability Management in iFECS.

The former paragraph 5 "PRMS Action Codes" has been deleted. It has been replaced with paragraphs 12 and 13, Periodic Entitlement Review (PER) Codes and Disability Management (DM) Status Codes. All codes have been updated to reflect the codes currently found in iFECS. The new paragraph 5 "Definition and Frequency of Reviews" is an updated version of the prior paragraph 7 of the same name.

The former paragraph 6 "Elements of Review" and paragraph 8 "Medical Evidence" have been updated and the focus of the paragraphs has been more clearly defined in the new paragraph 6 "Medical Elements of Review" and the new paragraph 8 "Factual Elements of Review." The new paragraph 6 "Medical Elements of Review" contains more details on the procedures for obtaining medical information from the treating physician. The new paragraph 8 "Factual Elements of Review" has sub-sections arranged similarly to the order of information provided on the CA-1032. A reference to a dependent over the age of 18 who is incapable of self-support has been added. Language concerning FERS offset was also added to the Dual Benefits discussion.

Paragraph 9 "Attendant's Allowance," has been moved to paragraph 7. The procedures for determining entitlement and authorization of an attendant allowance have been deleted.

The former paragraph 10 "Reports of Earnings" has been updated and moved to paragraph 9. This section also contains information about reporting self-employment, including unremunerated or volunteer activities. Portions have also been revised to update the procedures for obtaining earnings information from the Social Security Administration (SSA).

The former paragraph 11 "Actions on Reports of Earnings and Dependents" has been moved to paragraph 10, and the entire section concerning forfeiture of benefits has been moved into a new paragraph, paragraph 11 "Forfeiture." This section has been updated and includes new ECAB citations pertaining to the concept of "knowingly."

The former paragraph 12 "Federal Employees' Group Life Insurance (FEGLI)" has been removed completely since the information can be found in PM Chapter 5-0401. As noted above, the new paragraph 12 is now "Periodic Entitlement Review (PER) Codes."

Paragraph 13 is new and contains the Disability Management (DM) Status Codes, as well as a breakdown of which codes count as Periodic Roll Management (PRM) resolutions.

Signature Authority (previously Exhibit 4) has been updated, but deleted from this chapter and moved to Chapter 2-01400 as Exhibit 11. Paragraph 2 of Chapter 2-01400 has also been updated accordingly. The signature authority references were updated to reflect the correct certification amount for GS12 Claims Examiners and also to include signature authority levels for disputed attorney fees. A specific reference was also added for denials of CA-7 claims.

Exhibit 1 is now a sample memorandum to the file to be used to document the change of the case status to PN.

Exhibit 2 is the same as the prior Exhibit 1, but it has been renamed "Sample Questions Regarding Self-Employment."

Exhibit 3 is a sample letter to be used when a Form CA-1032 is incomplete.

Exhibit 4 is a sample letter to be used when no report of earnings has been received.

Exhibit 5 is a sample letter to be used when no report of dependents has been received.

Exhibit 6 is a list of the Periodic Entitlement Review (PER) codes.

Exhibit 7 is a list of Disability Management (DM) status codes. This list also details which codes count as a PRM resolution.

Exhibit 8 is a sample memorandum to the file to be used when documenting a PCR (no change to entitlement) code in DM Tracking.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0700, DEATH CLAIMS

FECA TRANSMITTAL NO. 10-06

April 16, 2010


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-700 has been updated to add paragraph 21 which addresses a new death gratuity. The National Defense Authorization Act for Fiscal Year 2008, Public Law 110-181, amended the FECA, creating a new section 8102(a). The section establishes a new FECA benefit for eligible survivors of federal employees and Non-Appropriated Fund Instrumentality (NAFI) employees who die of injuries incurred in connection with service with an Armed Force in a contingency operation. The new paragraph, 2-0700-21, addresses the handling of these claims.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL

CHAPTER 1-200, JURISDICTION

FECA TRANSMITTAL NO. 10-07

May 14, 2010


EXPLANATION OF MATERIAL TRANSMITTED:

The entire chapter has been updated and revised to reflect the changes that have taken place with regard to reorganization of responsibility between FEC district offices. Specifically, the chapter has been updated to reference the shift in creation of Arkansas cases to the Kansas City office and the shift in the creation of New Mexico cases to the Denver office.

The chapter and exhibit have also been updated to reference the Death Gratuity claims created under section 8102a, with a DG case prefix, which will be handled in the Cleveland office. And the section referencing cases that were to be created and developed in the usual district offices but sent to Cleveland for adjudication has been deleted since it is no longer applicable.

The exhibit was also updated to delete the reference to the 5,000,000 numbering series used in War Hazard Compensation cases, since the WH prefix is used instead. The exhibit reference to the 1S prefix for smallpox cases was also deleted since this was never implemented.

The Seasonal Residence portion of paragraph 5 has also been updated to allow more flexibility in the transfer of these cases if a transfer is needed for necessary case management.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL
CHAPTER 2-1601, Hearings and Reviews of the Written Record

FECA TRANSMITTAL NO. 10-08

June 2, 2010


EXPLANATION OF MATERIAL TRANSMITTED:

Paragraph 9 has been updated.

Part (a) has been updated to indicate that upon receipt of a decision from the Branch of Hearings and Review, an action should be taken by the district office within 15 days, rather than 30 days.

Part (c) has been added to document the longstanding existing process used if a District Office disagrees with the decision issued by the Branch of Hearings and Review.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE – REVISION TO FECA PROCEDURE MANUAL
CHAPTER 1-200, JURISDICTION

FECA TRANSMITTAL NO. 10-09

August 30, 2010


EXPLANATION OF MATERIAL TRANSMITTED:

The exhibit outlining the prefixes and numbering series used for the creation of cases has been updated to include the following:

3,010,000 – Numbering series used to identify cases containing reports of injuries related to the H1N1 virus, which was effective in 2009.

3,020,000 – Numbering series used to identify cases containing reports of injuries related to the April 20, 2010 fire and explosion at the Deepwater Horizon Facility operated by BP Exploration & Production, Inc. and the resulting clean up efforts.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO FECA PROCEDURE MANUAL
CHAPTER 2-0810, Developing and Evaluating Medical Evidence

FECA TRANSMITTAL NO. 10-10

September 1, 2010


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0810 has been revised in its entirety. The chapter has been streamlined and updated to include new language and a change in the structure of the chapter.

Paragraphs 1 and 2 have been updated and provide an overview of the chapter.

Paragraph 3 discusses general principles to consider when reviewing medical evidence and includes a discussion of terms such as aggravation, acceleration and precipitation.

Paragraph 4 outlines various sources of medical evidence with a brief explanation of the potential usefulness of each. This paragraph also outlines documents not to be considered as medical evidence, such as internet articles and disability determinations of other agencies.

Paragraph 5 outlines the various components of medical reports.

Paragraph 6 discusses weighing medical evidence in detail and details how the weighing of medical evidence should be addressed in formal decisions.

Paragraph 7 outlines the process of requesting information from the Attending Physician.

Paragraph 8 discusses reviews by the District Medical Advisor.

Paragraph 9 discusses second opinion examinations. The use of video surveillance as part of these examinations was added.

Paragraph 10 goes into greater detail about second opinions for surgery.

Paragraph 11 discusses the use of referee physicians when a conflict of medical opinion exists.

Paragraph 12 discusses the exclusion of medical evidence and the updated procedures for excluding a medical report in an imaged case file.

Paragraph 13 outlines the procedures for suspension of benefits under Section 5 U.S.C. 8123(d) for refusing to submit to or obstructing an examination.

Paragraph 14 discusses general procedures for developing and authorizing medical treatment. Specific details pertaining to these processes with the Central Bill Payment and Medical Authorization Unit are not included.
Paragraphs 15 – 20 provide further guidance for specific kinds of requests.

Paragraph 15 provides more guidance for diagnostic tests.
Paragraph 16 discusses functional capacity evaluations.

Paragraph 17 references special equipment and furniture.

Paragraph 18 outlines information necessary for consideration of a health club or spa membership.

Paragraph 19 discusses physical therapy and how to evaluate the need for ongoing therapy.

Paragraph 20 refers to chiropractic and osteopathic manipulative treatment.

Paragraph 21 discusses the procedures for authorizing attendant care.

Paragraph 22 discusses claimants in prison.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


The following chapter is being updated in its entirety. Because transmittal of the FECA Procedure Manual is primarily electronic, DFEC is discontinuing the practice of inserting page numbers when an entire chapter is reissued.

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1-22

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RELEASE - REVISION TO FECA PROCEDURE MANUAL

CHAPTER 2-0600, DISABILITY MANAGEMENT
CHAPTER 2-0811, EARLY MANAGEMENT OF DISABILITY CLAIMS
CHAPTER 2-0901, COMPUTING COMPENSATION

FECA TRANSMITTAL NO. 10-11

September 2, 2010


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0600 has been revised in its entirety. This chapter now provides an overview of the entire Disability Management (DM) process, and the chapter itself has been renamed Disability Management.

The procedures contained in the revised 2-0600 are a compilation of those outlined in the prior 2-0600, Case Management, and 2-0811, Early Management of Disability Claims. Most of the prior 2-0600, with the exception of 5 paragraphs and 2 exhibits, has been incorporated into this revised chapter, and, with the exception of one paragraph, all of the prior 2-0811 has been incorporated.

The one paragraph of the prior 2-0811 that was not incorporated into this new chapter is the paragraph pertaining to dependents (prior paragraph 2-0811-10). This paragraph has been moved to the end of chapter 2-0901, Computing Compensation. It is now paragraph 20 in that chapter and has retained the same name, Dependents. Changes made to the paragraph as it was moved include an updated PM reference in 20a and deletion of some of the language pertaining to death claims, since death claims are specifically covered in PM 2-0700.

The portions of the prior 2-0600 that have not been completely incorporated into this chapter have been moved without updates to 2-0811, and they have the same corresponding names and paragraph numbers as they had in 2-0600. Chapter 2-811 should be revised later this year, but, for now, the following paragraphs have been moved to 2-0811 without updates, other than the switch of the chapter reference from 2-0600 to 2-0811:

5. Nurse Services
7. Referrals for Vocational Rehabilitation Services
8. Return to Work with Previous Employer
10. Plan Development
11. Return to Work with New Employer

The only portion of these paragraphs updated, when moved, was 5e(2), which was deleted since occupational disease claims can be referred for nurse services.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


Only certain pages in the following chapter are being updated.

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2

2-0811

5, 7, 8, 10 and 11
Exhibits 2-3


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FECA TRANSMITTAL NO. 09-01

December 1, 2008


RELEASE - REVISION TO CHAPTER 0-0100, INTRODUCTION TO FECA AND DFEC, PART 0 - OVERVIEW, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Exhibit 1, Jurisdiction of District Offices has been updated to reflect all changes in jurisdiction including moving most of the Special Jurisdiction claims to the Cleveland district office, moving a part of the Maryland claims to the Philadelphia district office and, most recently, moving Arkansas claims to the Kansas City district office.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 09-02

December 1, 2008

RELEASE - REVISION TO CHAPTER 1-0200, GENERAL JURISDICTION, PART 1 - MAIL AND FILES, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 1-0200 has been revised to reflect the change in jurisdiction for cases originating in Arkansas. The responsibility for these cases moved from the Dallas district office to the Kansas City district office effective October 1, 2008.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 6-0300, DEBT LIQUIDATION, PART 6- DEBT MANAGEMENT, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 09-03

June 1, 2009


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 6-0300.19 has been revised to establish procedures for collection of moneys paid for periods after the death of a claimant. Exhibit 1 has been updated to reflect the current debt interest charges.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 6-0200, INITIAL OVERPAYMENT ACTIONS, PART 6- DEBT MANAGEMENT, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 09-04

June 15, 2009


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 6-0200.4(e)(2) has been expanded to establish procedures for recovery of existing debts from the estate of a deceased claimant.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 2-1000, DUAL BENEFITS, PART 2- CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 09-05

June 1, 2009


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1000.17.d. regarding offset of compensation based on voluntary separation incentive payments (VSIP). Previous offset instructions differentiated between VSIPs paid based on a specific number of weeks of salary and those capped at a specified amount of money. However, in order to be equitable to all claimants, offsets for both types of payments should be computed in the same manner regardless of the way the employing agency has offered separation pay. This section has been expanded to include instructions on calculating the number of weeks of salary a specified capped separation pay represents.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 2-0401, AUTOMATED SYSTEM SUPPORT FOR CASE ACTIONS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 09-06

September 28, 2009


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0401 has been revised in its entirety with respect to the current automated case management system. Three paragraphs (Call-Ups, TPCUP Codes and Reports) were deleted since the information was no longer applicable.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 2-0809, STATEMENTS OF ACCEPTED FACTS, PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 09-07

September 28, 2009


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0809 has been revised in its entirety. The chapter has been streamlined and updated to include new language, a change in the structure of the Chapter, and the inclusion of exhibits containing sample Statements of Accepted Facts (SOAFs).

With the exception of paragraphs 1 and 2, the remaining paragraphs have been reordered and consolidated. There are now eight paragraphs instead of fourteen.

Paragraph 3 "Definitions" has been deleted.

Paragraphs 4 "Nature of SOAF," and 6 "Need for SOAF," have been incorporated into paragraph 2, "Introduction."

Paragraphs 7 "Length of SOAF," 8 "Form of SOAF," and 11 "Requirements for SOAFs" have been combined into paragraph 4 and renamed "Composition of the SOAF."

Relevant portions of paragraph 10 "Weighing Factual Evidence and Drawing Conclusions" have been incorporated into "Responsibilities of the CE" and "Composition of the SOAF," Paragraphs 3 and 4, respectively.

Paragraph 13 has been changed from "Additional Elements" to "Optional Elements," and is now paragraph 6.

Paragraph 8 "Modification of SOAFs" has been added to specifically address the necessity of modifying or correcting a prior SOAF when that SOAF no longer accurately reflects the relevant current facts of a case.

Four sample Statement of Accepted Facts have been added as exhibits.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 4-0100, SPECIAL CASE PROCEDURES, INTRODUCTION, PART 4 - SPECIAL CASE PROCEDURES, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 07-01

November 25, 2006


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 4-100 section paragraph 1 Purpose and Scope and paragraph 3 Jurisdiction have been revised to reflect the jurisdiction change from the National Operations Office to the Cleveland District Office (District 9).

 

DOUGLAS C. FITZGERALD
Director
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 2-1700, SPECIAL ACT CASES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 07-02

January 22, 2007


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1700 has been revised to allow the Peace Corps to cover medical expenses for additional minor injuries and conditions for returning volunteers. Changes also include increasing the authorized coverage amount to $1000.

Exhibit 1 - Annual Pay Rates for Computing Compensation for Peace Corps and VISTA Volunteers has also been updated to reflect current pay rates.

 

DOUGLAS C. FITZGERALD
Director
Federal Employees' Compensation


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Module 6

83-99

Pina Culotta

410-965-8052

410-966-1042
410-966-6029

Please change the SSA contact information in Bulletin 97-9 to reflect these assignments.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

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RELEASE - REVISION TO CHAPTER 1-0200, JURISDICTION, PART 1 - MAIL AND FILES

FECA TRANSMITTAL NO. 07-03

September 28, 2007


EXPLANATION OF MATERIAL TRANSMITTED:

Exhibit 1 has been updated to include an additional special claim numbering series for reports of injuries sustained by federal employees during the conflict in Afghanistan.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 06-01

December 30, 2005


EXPLANATION OF MATERIAL TRANSMITTED:
RELEASE - REVISION TO CHAPTER 1-0200, JURISDICTION, PART 1 - MAIL AND FILES

Exhibit 1 has been updated to include an additional special claim numbering series for reports of injuries associated with Hurricane Katrina and its aftermath.

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 06-02

May 1, 2006


RELEASE - REVISION TO CHAPTER 1100, FECA THIRD PARTY SUBROGATION GUIDELINES, PART 2 - CLAIMS

EXPLANATION OF MATERIAL TRANSMITTED:

The chapter has been modified to reflect the transfer of responsibility for third party subrogation aspects of new and existing claims delegated to the Office of the Solicitor from the Regional Solicitor's Office (RSOL) to the Division of Federal Employees' and Energy Workers' Compensation (FEEWC) of the Office of the Solicitor.

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 06-03

March 28, 2006


EXPLANATION OF MATERIAL TRANSMITTED:

RELEASE - REVISION TO CHAPTER 5-0202, FEE SCHEDULE APPEALS, BILL ADJUSTMENTS, DISTRICT DIRECTOR EXCEPTIONS and CASES/PROVIDERS ON REVIEW, PART 5 - BENEFIT PAYMENTS, FEDERAL (FECA) PROCEDURE MANUAL

The previous Chapter 5-0202 (BPS Jobs) has been revised in its entirety. The new chapter provides guidance and instructions for processing appeals of medical fee schedule determinations and adjustments to erroneous bill pays, provides information on Return to Provider Letters (RTPs) and Remittance Vouchers (RVs) and provides information on District Director exceptions and case/provider on review

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 06-04

August 20, 2006

RELEASE - REVISION TO CHAPTER 2-1200, FEES FOR REPRESENTATIVES' SERVICES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1200 has been revised to clarify procedures when a representative's fee application is received which is missing the claimant's signed statement of agreement or disagreement.

 

DOUGLAS C. FITZGERALD
Director
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 06-05

September 4, 2006


RELEASE - REVISION TO CHAPTER 2-0804, PERFORMANCE OF DUTY SERVICES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

The Safe, Accountable, Flexible, Efficient Transportation Equity Act of 2005 (Public Law 109-59) allows Federal agencies in the National Capitol Region to pay for the costs of shuttle buses or other means of transportation between the place of employment and mass transit facilities. However, the bill specifically states that the employee will not be considered "in the performance of duty" under chapter 81 of title 5 by virtue of the fact that the employee is receiving transportation services. A paragraph has been added in Chapter 0804.6(c) to incorporate this into the section discussing travel to and from work.

 

DOUGLAS C. FITZGERALD
Director
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 06-07

November 25, 2006

RELEASE - REVISION TO CHAPTER 4-0100, SPECIAL CASE PROCEDURES, INTRODUCTION, PART 4 - SPECIAL CASE PROCEDURES,FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 4-100 section paragraph 1 Purpose and Scope and paragraph 3 Jurisdiction have been revised to reflect the jurisdiction change from the National Operations Office to the Cleveland District Office (District 9).

 

DOUGLAS C. FITZGERALD
Director
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 05-01

November 1, 2004


EXPLANATION OF MATERIAL TRANSMITTED:

RELEASE - REVISION TO CHAPTER 6-0200, INITIAL OVERPAYMENT ACTIONS, PART 6 - DEBT MANAGEMENT, FEDERAL (FECA) PROCEDURE MANUAL

Chapter 6-200 is revised to update the current resource base used to evaluate an individual's assets for the purpose of considering whether recovery of an overpayment would defeat the purpose of the FECA.

Paragraph 6.a.(1)(b) is revised to reflect a current resource base of $4800 for an individual, $8000 for an individual with a spouse or one dependent, plus $960 for each additional dependent. The increased resource base amounts have been determined by OWCP based upon data furnished by the Bureau of Labor Statistics (20 C.F.R. 10.436(b)).

 

E. MARTIN WALKER
Acting Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 05-02

March 7, 2005


EXPLANATION OF MATERIAL TRANSMITTED:

RELEASE - REVISION TO CHAPTER 2-1200, FEES FOR REPRESENTATIVES' SERVICES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

For the purpose of clarity and to reflect the substantial regulatory changes that went into effect in 1999, Chapter 2-1200 has been entirely rewritten.

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 05-03

April 15, 2005


EXPLANATION OF MATERIAL TRANSMITTED:

RELEASE - REVISION TO CHAPTER 5-0200, OVERVIEW OF THE BILL PROCESSING SYSTEM (BPS), PART 5 - BENEFIT PAYMENTS, FEDERAL (FECA) PROCEDURE MANUAL

The previous Chapter 5-0200 (Overview of the BPS) has been revised in its entirety. The new chapter explains the flow of bills through the Office, describes the various types of billing statements that are processed, and provides an overview of actions that are required in conjunction with bill processing. It also includes new material concerning ACS and its Central Bill Pay processes and procedures.

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 05-04

August 12, 2005


EXPLANATION OF MATERIAL TRANSMITTED:

RELEASE – REVISION TO CHAPTER 2-0901-6, COMPUTING COMPENSATION PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

Chapter 2-0901, paragraph 6 has been updated to account for changes in compensation processing due to the implementation of the Integrated Federal Employees' Compensation System (iFECS).

Paragraph 6(b)(1) of this chapter is revised to reflect that payments should now be entered in fractions of hours instead of being rounded to the nearest whole hour.

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 04-01

January 16, 2004


RELEASE - REVISION TO CHAPTER 2-0800, DEVELOPMENT OF CLAIMS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0800 is revised to incorporate the information contained in FECA Bulletin 99-15 issued March 17, 1999. Specific changes appear in paragraph 5.d. and subparagraphs (1) thru (7). This update makes the claims examiner (CE) aware that the claimant or survivor has the ability to withdraw a claim for benefits prior to the adjudication of a claim. This update also provides instructions on how the CE should handle a written request for withdrawal of a claim.

Exhibit 1 has been added to provide a sample letter that should be used to notify the claimant or survivor when a request to withdraw a claim is approved.

Other specific changes made in Chapter 2-0800 are discussed below.

In paragraph 5.b.(4) the requirement for placing a call-up on a case file that requires further development is removed.

Paragraph 6.e. was updated to include the street address for the Department of Commerce, National Climatic Center.

In paragraph 8.a. the reference to Form CA-18 was removed.

Paragraphs 8.b.(1) and 8.c.(2) were updated to remove the reference to obsolete Form CA-1006. (See FECA Circular 03-08).

Paragraph 9.b. was updated to clarify the use of leading questions when requesting an impartial medical opinion.

Paragraph 11.a. has been revised to include additional guidance for cases where the factual evidence involving disputes may require conferencing. In paragraph 11.c. the reference to Form CA-110a was removed.

Minor changes were made in Paragraphs 14.a. and 14.b. regarding reopened short form closure cases.

Other than the changes stated above, pages were repaginated with no change in the contents.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 04-02

January 26, 2004


RELEASE - REVISION TO CHAPTER 2-1602, RECONSIDERATIONS

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1602 is revised to reflect the fact that revised letters and form decisions, designed to assist the claims examiner in issuing reconsideration decisions, are available in the National Letter Generator, and will be incorporated in the National Correspondence Library.

A note has been added to section c. of paragraph 3 discussing the "clear evidence of error" standard. In paragraph 4, a. and b. have been revised and c. has been added to further elaborate on the issue of Evidence or Argument Required. Also, a note has been added to paragraph 5.b. distinguishing a reconsideration request which disputes the percentage of the impairment awarded from one that is claiming increased impairment due to further work-related exposure.

There is also a revision to paragraph 8 of this chapter at c.(2) to clarify that an acceptance letter with the attachment "Now That Your Claim Has Been Accepted" should be issued whenever a reconsideration decision results in an initial acceptance of the claim. References to "Notice of Decision" or a "Memorandum to the Director and Compensation Order" are replaced with "Decision" to reflect that either of these types of decisions or a letter decision may be acceptable methods of issuing reconsideration decisions, depending upon the circumstances. The important feature of the decision is that it contains all of the elements required by the circumstances of the case. Finally, paragraph 10 has been added to further elaborate on the topic of Review on the Director's Own Motion in accordance with Section 8128(a) of the FECA.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 04-03

May 28, 2004


RELEASE - REVISION TO CHAPTERS 6-0100, OVERPAYMENT OVERVIEW, 6-0200, INITIAL OVERPAYMENT ACTIONS, AND 6-0300, DEBT LIQUIDATION, PART 6 – DEBT MANAGEMENT, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Part 6 of the FECA Procedure Manual has been updated to clarify the instructions provided for the processing of overpayments of compensation (including allowing due process under §' 8129 of the FECA), and the procedures for the liquidation of debts to OWCP. The revisions have been tailored to be reflective of the current regulations at 20CFR Part 10, sections 10.430 through 10.441. The material presented incorporates the current parameters for handling debts at various dollar levels, and includes actions to be taken when a fraud conviction has occurred.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 04-04

March 8, 2004


RELEASE -REVISION TO CHAPTER 2-807, CONTINUATION OF PAY AND INITIAL PAYMENTS

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-807 is revised to incorporate several revisions to procedures.

In paragraph 2 the reference to Form CA-1 is replaced with "an OWCP claim form" to make it clear that a claimant's right to COP should not be jeopardized because they completed the wrong form, such as a CA-2 or CA-2a, when a CA-1 would have been appropriate. Form CA-2a is added to paragraph 7.a to include a CA-2a in the forms that contain words of claim sufficient to satisfy timely filing requirements. The requirement that the form show whether the employee wishes to use leave or request COP is deleted from this paragraph as that is not a requirement for timely filing. Paragraph 7.a (1), regarding the submission of a sick leave slip is deleted as not relevant.

Paragraph 8.c is revised to make clear that the agency is to notify the employee of their right to elect COP. Reference to Form CA-3 is deleted from paragraph 8.i.

Paragraph 10 is revised in several places to reflect the fact that revised letters and form decisions, designed to assist the claims examiner in developing and issuing COP decisions, are available in the DFEC Letter Generation System, and will be incorporated into the Correspondence Library. References to Form CA-800 and CA-3 are deleted from this paragraph also.

Paragraph 11.f. is revised to include the fact that military field and training pay earned by members of the National Guard and Military Reserve is only included in COP in the limited circumstances where there is an actual loss of military pay.

The example provided in paragraph 13 illustrating COP for a recurrence is updated to provide dates that coincide with the requirement that any balance of COP commence within 45 days of the first return to duty.

Reference to medical matrices, short-term roll and Form CA-8 are removed from Paragraph 17.d. There are a few other minor edits for clarity.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 04-05

July 9, 2004


RELEASE - REVISION TO CHAPTERS 2-0100, INTRODUCTION, AND 2-0200, GENERAL PROVISIONS OF THE FECA, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapters 2-0100 and 2-0200 have been revised to remove references to out dated procedures and obsolete materials that are no longer in use. In Chapter 2-0100, the changes that were made involved rewording to provide emphasis or greater clarity of the language. The changes in Chapter 2-0200 largely involve rewording for clarity with some reorganization. Paragraph 4, which is entitled Reference Materials for Claims Examiners, has been divided into References Available in FolioViews and On-line and District Office Reference Library.

 

NANCY JENSON
Acting Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 04-06

August 6, 2004


RELEASE - REVISION TO CHAPTER 5-0400, HEALTH BENEFITS INSURANCE, AND CREATION OF CHAPTER 5-0401, LIFE INSURANCE PART 5 – BENEFIT PAYMENTS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Previous Chapter 5-0400 (Health Benefits and Life Insurance) has been revised and split into two distinct chapters. The revised Chapter 5-0400 now deals exclusively with health benefits insurance issues. The newly created Chapter 5-0401 is dedicated solely to life insurance issues. Both chapters have been updated to include all current regulations regarding health benefits and life insurance, as well as current rates and coding. References to out dated procedures and obsolete materials have been removed.

 

NANCY JENSON
Acting Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 04-07

August 11, 2004


RELEASE - REVISION TO CHAPTER 1-0200, JURISDICTION, PART 1 – MAIL AND FILES, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 1-0200 has been revised to reflect the changes that have taken place with regard to reorganization of responsibility between FEC district offices, and between OWCP regions. Specifically, the revisions in this chapter incorporate the changes in jurisdiction described in FECA Bulletin 04-01, which identifies which of the special jurisdiction cases are to remain in the National Operations Office and which ones are to be handled in District Office 9 in Cleveland, OH. Additionally, this chapter incorporates the change in jurisdiction that took effect on February1, 2003, causing all cases in Maryland in which the claimant's zip code is 21xxx to be transferred to the jurisdiction of District 3 in Philadelphia, PA.

 

SHARON M. TYLER
Acting Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 03-01

June 30, 2003


RELEASE - REVISION TO CHAPTER 3-0700, SCHEDULE AWARDS, PART 3 MEDICAL, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Paragraphs 2 and 4 are updated to incorporate FECA Bulletin No. 01-05, providing the effective date for use of the Fifth Edition of the AMA Guides to the Evaluation of Permanent Impairment. Exhibit 4 of this chapter is replaced, incorporating the attachment to FECA Bulletin 01-05 which provides a discussion regarding the use of the Fifth Edition of the AMA Guides.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 03-02

September 9, 2003


RELEASE - REVISION TO CHAPTER 2-1500, RECURRENCES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Paragraph 5 of Chapter 2-1500, Recurrence of Medical Condition, has been updated to include new language. Section c. of this paragraph notes that claims for recurrence following an approved destructive surgery do not require significant development. Paragraph 7.a.(4) on Recurrent Disability for Work After 90 Days from Return to Duty has been modified to clarify the current procedures if withdrawal of light duty occurs when no previous LWEC determination has been made. Paragraph 7.a.(5) has been added to describe CE actions upon withdrawal of light duty with an existing LWEC determination (including "0" LWEC) in place.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 03-03

January 2, 2003


RELEASE - REVISION TO CHAPTER 2-0800 DEVELOPMENT OF CLAIMS, PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-0800 is updated in paragraphs 4 on Forms and 5 on Processing Claims to incorporate FECA Bulletin 96-10. This update removes the procedural requirements for completing items 20-23 of Form CA-800. It also removes the reference to Form CA-1009 being separate from form letter CA-1008. The reference to sending the case file to the file room or other location pending adjudication has also been removed.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 03-04

May 9, 2003


RELEASE - REVISION TO CHAPTER 2-1700, SPECIAL ACT CASES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

In Chapter 2-1700, paragraph 8 has been revised to include additional guidance on handling the claims of contract observers on vessels. Subparagraph d. addresses other considerations specifically pertaining to determination of pay.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 03-05

May 23, 2003


RELEASE - REVISION TO CHAPTER 3-0500, MEDICAL EXAMINATIONS, PART 3 - MEDICAL, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 3-0500, at paragraph 4.b.(1), is modified to note that the services of all qualified Board-certified specialists, including those certified by the AOA (American Osteopathic Association) and the ABMS (American Board of Medical Specialties) of the American Medical Association, are to be used to obtain referee medical examinations.

Paragraph 7.a. has also been revised to clarify the point that OWCP may use osteopathic physicians certified by the AOA as well as medical doctors certified by the ABMS to perform referee medical examinations. It also points out that medical referral groups are now used throughout OWCP to arrange for second opinion examinations.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 03-06

June 30, 2003


RELEASE - REVISION TO CHAPTER 2-0812, PERIODIC REVIEW OF DISABILITY CASES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

A new paragraph 5, on PRMS codes has been inserted into Chapter 2-812. This has resulted in all the succeeding paragraphs being re-numbered, e.g., the previous paragraph 5 is now paragraph 6. The new paragraph 5 incorporates the PRMS coding referenced in FECA Bulletins No. 95-15 and 99-03 into the Procedure Manual. Three new codes are added, i.e. (R0), (R4), and (T7).

Paragraph 10 of Chapter 2-0812 has been updated to include revised procedures for issuing CA-1036s, CA-935s, and SSA-581s, incorporating FECA Bulletin No. 01-04.

Paragraph 12 of Chapter 2-0812 has been updated to include new instructions for completing form RI 20-8 from the Office of Personnel Management. The section has also been updated to clarify when the claims examiner should make deductions for optional life insurance.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 03-07

July 15, 2003


RELEASE - REVISION TO CHAPTER 2-1300, LUMP-SUM PAYMENTS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

A new paragraph 4 has been added to Chapter 2-1300 to explain how CEs will use the new Lump-Sum Schedule Award Calculator program to calulate future lump-sum award payments. The paragraph entitled "Requests for Reconsideration of Lump-Sum Decisions" has been renumbered as paragraph 5. In addition, revisions have been made throughout the Chapter to reflect the correct C.F.R. and FECA citations. Finally, exhibit 5 was removed, a revised exhibit 6 became a part of exhibit 3, and exhibits 1-4 were revised to reflect the correct C.F.R. citations and the new appeal rights.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 03-09

September 24, 2003


RELEASE - REVISION TO CHAPTER 2-1100, FECA THIRD PARTY SUBROGATION GUIDELINES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL (FORMERLY CHAPTER 2-1100, SUBROGATION AND OTHER REMEDIES)

EXPLANATION OF MATERIAL TRANSMITTED:

For the purposes of clarity and ensuring that subrogation procedures are uniform across OWCP and the Regional Solicitor's Offices of SOL (RSOL), Chapter 2-1100 has been rewritten in its entirety. In addition, the new chapter incorporates the substantial regulatory changes that went into effect in 1999. Finally, the chapter has been renamed FECA Third Party Subrogation Guidelines to more accurately reflect its contents.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 02-01

January 14, 2002


EXPLANATION OF MATERIAL TRANSMITTED: RELEASE - REVISION TO CHAPTER 2-900, DETERMINING PAY RATES, FEDERAL (FECA) PROCEDURE MANUAL

A paragraph has been added to clarify who qualifies as a career seasonal employee for pay rate purposes. "Substantially the whole year", is normally defined as at least 11 months. However, the normal work schedule for the teaching profession is less than 11 months. Therefore, "substantially the whole year" is not 11 months for teachers.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 02-02

January 14, 2002


EXPLANATION OF MATERIAL TRANSMITTED: RELEASE - REVISION TO CHAPTER 1-0200-2, GENERAL JURISDICTION, PART 1 – MAIL AND FILE, FEDERAL (FECA) PROCEDURE MANUAL

Chapter 1-0200-2 is revised to transfer the responsibility for claims adjudication and case management of claims for employees and their relatives of the Office of Workers' Compensation Programs in the Midwest (formerly Chicago) Region (Illinois, Indiana, Michigan, Minnesota, Wisconsin, Ohio, Iowa, Kansas, Missouri, and Nebraska).

The OWCP claims originated in the Midwest Region have in the past been sent to the Kansas City district office (District 11) for adjudication and management. Now that the Kansas City district office (District 11) has been assigned to the Midwest Region it is necessary to avoid any possible conflict of interest in the claims being adjudicated and maintained under the same region in which the injured employees (and their relatives) work and report.

All new claims for OWCP employees and their relatives, in the Midwest Region, will be created in and fall under the jurisdiction of the National Operations Office (District 25). All existing claims for OWCP employees and their relatives, in the Midwest Region, will be transferred to the National Operations Office (District 25) for case management.

This requirement will be specifically stated through revision of paragraphs 1-0200-2(g)(2) and 1-0200-2(l) of the FECA Procedure Manual.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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Chapter

Pages

1

1-0200-2

1-6

1

1-0200-2

1-6

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FECA TRANSMITTAL NO. 02-03

February 25, 2002


RELEASE - REVISION TO CHAPTER 2-1602, RECONSIDERATIONS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1602 is revised to modify the FECA procedures in accordance with the new Federal regulations, which were approved and made final on November 25, 1998, and made effective on January 4, 1999. Upon review of the new regulations you will note that the part specifically pertaining to the reconsideration process starts at Subsection 10.605 and concludes at Subsection 10.610. Several section numbers changed and require update to conform to the revision of the Federal regulations.

Both paragraphs of Chapter 2-1602 3.b were updated to reflect the correct section number of Title 20 of the Code of Federal Regulations (CFR). The new CFR references is 20 CFR 10.607(a) rather than 20 CFR 10.138. The reference to 28 CFR 10.131(a) (assessing the timeliness of a hearing request) was removed.

Paragraph 3.d. of Chapter 2-1602 was also updated. Reference to Title 20 CFR Part 10.138(b) was changed to Title 20 CFR Part 10.608(b).

Also, paragraph 5.b. of Chapter 2-1602 was updated to include the fifth edition of the Guides effective February 1, 2001.

Finally, Exhibits 2 and 4 of Chapter 2-1602 were revised to reflect the new CFR references. The revised changes are 20 CFR 10.607(b) and Section 10.607(a) respectively. Other than the changes stated above, pages were repaginated with no change in the contents.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 02-04

February 25, 2002


RELEASE - REVISION TO CHAPTER 2-1200, FEES FOR REPRESENTATIVES' SERVICES, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Changes have been made to Chapter 2- 1200-7(a) page 8, to reflect revised limits for fee approval by district office personnel.

Claims Examiners (Grade 9-12) are authorized to evaluate fee requests up to $10,000. Senior claims examiners are authorized to evaluate fee requests up to $15,000, and Supervisory Claims Examiners are authorized to evaluate fee requests up to $50,000. Fee requests over $50,000 should be evaluated by the Assistant District Director or District Director.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 02-05

February 26, 2002


RELEASE - REVISION TO CHAPTER 2-0811, EARLY MANAGEMENT OF DISBILITY CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL EXPLANATION OF MATERIAL TRANSMITTED:

Changes were previously made to Chapter 2-0811 in accordance with FECA Bulletin 97-04 and FECA Transmittal 97-17. One of the changes was to delete the obsolete reference to the 'Short Term Roll' (previously section 10). All changes referenced in the bulletin and transmittal were made in the FECA procedure manual. Unfortunately, the Table of Contents was not updated in folioviews.

This transmittal is being issued for the purpose of updating the Table of Contents for Chapter 2-0811.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 02-07

April 18, 2002


RELEASE - REVISION TO CHAPTER 2-900, DETERMINING PAY RATES, FEDERAL (FECA) PROCEDURE MANUAL EXPLANATION OF MATERIAL TRANSMITTED:

A paragraph has been added at PM 2-900.4.a.(2) to clarify that teachers are not subject to the provisions for career seasonal employees since working "substantially the whole year", in the teaching profession, would be less than 11 months.

A paragraph has been added at PM 2-900.7.b.(22) to incorporate the provisions of the Federal Firefighters Overtime Pay Reform Act of 1998 into the increments of pay which may be included in the employee's pay rate.

PM 2-900.8.d. has been added to incorporate the methods of computing the pay rate for federal firefighters covered under the Federal Firefighters Overtime Pay Reform Act of 1998.

Minor changes have been made to the entire chapter to correct references to forms that have been revised, letters that have been revised, other PM chapters that have undergone revision in the past, etc.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 02-08

April 22, 2002


RELEASE - REVISION TO CHAPTER 2-200-2 (e), GENERAL PROVISIONS - PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL. REVISION TO CHAPTER 2-700-2, DEATH CLAIMS, PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL. REVISION TO CHAPTER 2-901-18, OTHER PAYEES, PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUEL.

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-200-2 (e) is revised to show that any compensation payment, not just death benefits, is subject to the new federal law regarding garnishment of FECA benefits in order to pay for past due alimony and child support payments.

Chapter 2-700-2 is revised to show the change in federal law that allows compensation payments from FECA, including survivor benefits, to be garnished in order to collect overdue alimony and child support payments. All requests for garnishment must be submitted with proper documentation from a state agency or a court order.

Chapter 2-901-18 is revised to show that the state/municipal agency or court that issues the garnishment order should be classified under "other payee" for compensation purposes.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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0901

i, ii, 29,30

2

0200

i,2,3,4,5,6

2

0200

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FECA TRANSMITTAL NO. 02-11

August 26, 2002


RELEASE - REVISION TO CHAPTER 2-1700, SPECIAL ACT CASES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-1700, paragraph 8 has been added to this chapter to include guidance on handling the claims of contract observers on vessels. The addition of this paragraph incorporates the information contained in FECA Bulletin 97-13 issued June 4, 1997.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 02-12

August 30, 2002


RELEASE - REVISION TO CHAPTER 2-0808, SCHEDULE AWARDS AND PERMANENT DISABILITY CLAIMS,PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Changes have been made to Chapter 2-0808, paragraphs 6.a., 6.d.(1) and 7.b.(4), to reflect that we currently use the AMA Guide to the Evaluation of Permanent Impairment, Fifth Edition, effective February1, 2001. All permanent partial impairment awards determined on or after the effective date of the Guides, regardless of the date of the medical examination, should be based on the fifth edition.

Also, paragraph 8 on Disfigurement has been revised to remove the requirement that the claimant personally appear before the Assistant District Director in a disfigurement claim. Paragraph 8.d., OWCP Medical Evaluation, fully describes the new process. The District Medical Advisor will make his or her assessment based on the medical evidence and photographs in file. Paragraph 8.e., with the previous heading of "Interview in District Office," is replaced with the final section, Payment of Award.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 02-13

August 29, 2002


RELEASE - REVISION TO CHAPTER 3-0700, SCHEDULE AWARDS, PART 3 – MEDICAL, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Paragraph 5 on Disfigurement has been revised to remove the requirement that the claimant personally appear before the Assistant District Director in a disfigurement claim. The paragraph fully describes the actions of the District Medical Advisor (DMA) in the new process. The DMA will make his or her assessment based on the medical evidence and photographs in file. Also, in the event that maximum medical improvement has not been reached, the DMA will continue to offer an opinion as to whether the option of plastic surgery will improve the appearance or decrease the degree of disfigurement.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 01-01

November 6, 2000

RELEASE – REVISION TO CHAPTER 4-0300, WAR HAZARDS, PART 4 – SPECIAL CASE PROCEDURES, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:


Exhibit 3 is updated to show the 1999 and 2000 yearly increases under the Longshore and Harbor Workers' Compensation Act.

 

DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 01-02

October 25, 2000


EXPLANATION OF MATERIAL TRANSMITTED:

This release transmits the current checklist for the Federal (FECA) Procedure Manual. The checklist is a comprehensive accounting of all Procedure Manual pages issued as of September 30, 2000. The previous checklist, issued October 5, 1998, and all transmittal sheets through No. 00-11 may be discarded. This current checklist should be retained at the front of the Procedure Manual, with transmittal sheets after No. 00-11.

 

DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation


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PROMPT PAYMENT INTEREST RATES

1/1/01 - 6/30/01

6 3/8%

7/1/00 - 12/31/00

7 1/4%

1/1/00 - 6/30/00

6 3/4%

 

 

7/1/99 - 12/31/99

6 1/2%

1/1/99 - 6/30/99

5.0%

7/1/98 - 12/31/98

6.0%

1/1/98 - 6/30/98

6 1/4%

7/1/97 - 12/31/97

6 3/4%

1/1/97 - 6/30/97

6 3/8%

7/1/96 - 12/31/96

7.0%

1/1/96 - 6/30/96

5 7/8%

7/1/95 - 12/31/95

6 3/8%

1/1/95 - 6/30/95

8 1/8%

 

 

7/1/94 - 12/31/94

7.0%

1/1/94 - 6/30/94

5 1/2%

7/1/93 - 12/31/93

5 5/8%

1/1/93 - 6/30/93

6 1/2%

7/1/92 - 12/31/92

7.0%

1/1/92 - 6/30/92

6 7/8%

7/1/91 - 12/31/91

8 1/2%

1/1/91 - 6/30/91

8 3/8%

7/1/90 - 12/31/90

9.0%

1/1/90 - 6/30/90

8 1/2%

 

 

7/1/89 - 12/31/89

9 1/8%

1/1/89 - 6/30/89

9 3/4%

7/1/88 - 12/31/88

9 1/4%

1/1/88 - 6/30/88

9 3/8%

7/1/87 - 12/31/87

8 7/8%

1/1/87 - 6/30/87

7 5/8%

7/1/86 - 12/31/86

8 1/2%

1/1/86 - 6/30/86

9 3/4%

7/1/85 - 12/31/85

10 3/8%

1/1/85 - 6/30/85

12 1/8%

 

DMS INTEREST RATES

1/1/01 - 12/31/01

6%

1/1/00 - 12/31/00

5%

 

 

1/1/99 - 12/31/99

5%

1/1/98 - 12/31/98

5%

1/1/97 - 12/31/97

5%

1/1/96 - 12/31/96

5%

7/1/95 - 12/31/95

5%

1/1/95 - 06/30/95

3%

 

 

1/1/94 - 12/31/94

3%

1/1/93 - 12/31/93

4%

1/1/92 - 12/31/92

6%

1/1/91 - 12/31/91

8%

1/1/90 - 12/31/90

9%

 

 

1/1/89 - 12/31/89

7%

1/1/88 - 12/31/88

6%

1/1/87 - 12/31/87

7%

1/1/86 - 12/31/86

8%

1/1/85 - 12/31/85

9%

 

 

Prior to 1/1/84

not applicable

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FECA TRANSMITTAL NO. 01-03

January 30, 2001


RELEASE -REVISION TO CHAPTERS 2-901, COMPUTING COMPENSATION, AND 2-401, AUTOMATED SYSTEM SUPPORT FOR CASE ACTIONS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapters 2-401 and 2-901 are revised to clarify the requirements for certification and verification of compensation payments. Chapter 2-901, Exhibits 1, 2, and 3 are updated to include the recent minimum, maximum and CPI amounts.

Chapter 2-901.3 is revised to clarify the requirement that all payment set-ups, except routine daily roll payments, must be initialed and dated by the certifier before the payment is issued. Further revision to this paragraph makes it clear that certification and verification are separate tasks. The verifier's initials and date must appear on the CP040 print-out prior to the cut-off date. This paragraph is also updated to reflect the fact that all GS-12 Claims Examiners now have the certification authority previously reserved for Senior Claims Examiners.

Where a payment has to be revised or re-entered after the initial keying, the certifier is responsible for updating the TPCUP program. This requirement is specifically stated in paragraphs 2-401.10a and 2-401.10c. The reference to Form CA-8 is deleted from this paragraph, also. Paragraph 2-401.3 is revised to indicate that the CE refers any change of address to the designated individual rather than making the change themselves.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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Ex 1, p. 3-4
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Ex 3

2

2-401

i,1, 17-20

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2-401

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FECA TRANSMITTAL NO. 01-04

April 26, 2001


RELEASE— REVISION TO CHAPTER 2-900, DETERMINING PAY RATES

EXPLANATION OF MATERIAL TRANSMITTED:

The calculation of weekly payrate using the 2087 formula was erroneously outlined in the last paragraph of 2-900-10(c)(2). This paragraph has been modified to correct this error.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 01-06

 


RELEASE— REVISION TO CHAPTER 2-810, DEVELOPING AND EVALUATING MEDICAL EVIDENCE

EXPLANATION OF MATERIAL TRANSMITTED:

The requirement that a note be entered for initial physical therapy authorization has been removed, as has the erroneous reference to the need for a proposed termination prior to denial of physical therapy for any period beyond that authorized.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 01-08

 


RELEASE - REVISION TO CHAPTER 0-0100, INTRODUCTION TO FECA AND DFEC, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Exhibit 2, which contains addresses and telephone numbers for all district offices, requires frequent revision. In recent years, this information has been available to OWCP staff via the Intranet and to external users via the program's web site. Because electronic changes are easier and faster to make, and because the paper version of this information is now redundant, Exhibit 2 is being removed from this chapter. A reference to finding the addresses and telephone numbers on the program's web site has been added to paragraph 3c.

 

DEBORAH B. SANFORD
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 00-01

January 6, 2000

RELEASE - NEW CHAPTER 5-0207, BPS REPORTS, PART 5 - BENEFIT PAYMENTS, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

New Chapter 5-0207, BPS Reports, replaces and updates Chapter 5-1001. The Outline for Part 5 is updated to reflect this change, and the removal of Chapter 5-1002, which was previously replaced by Chapters 5-0201, BPS FECS001 Programs, and 5-0202, BPS Jobs.

 

DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation


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Outline

 

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5-207

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FECA TRANSMITTAL NO. 00-02

February 10, 2000


RELEASE - NEW PART 1 - MAIL AND FILES, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

These chapters replace Part 1 - Communications and Records. The topics are much the same as those covered in the previous Part 1. However, material more relevant to claims staff (e.g., how to prepare correspondence), now appears in new PM 2-0300, Communications, and revised PM 2-0400, File Maintenance and Management.

This revision does not address imaging of case files. We will be issuing an Operations Manual with instructions about the imaging process for use by each office as it "goes live" with imaging. That document will be structured much like Part 1, and after the processes it describes have been refined in light of experience, its contents will be incorporated into Part 1.

The new Part 1 chapters include the following:

Chapter 1-0100, Introduction--the responsibilities of various parties for the district office's mail and file operation, and the structure of Part 1.

Chapter 1-0200, Jurisdiction--the jurisdictions of the various district offices.

Chapter 1-0300, Processing Mail--the kinds of mail received and how to handle them. This chapter also addresses sorting and recording mail, as well as how to process cash received and how to process outgoing mail.

Chapter 1-0400, Creation of Cases--the contents of new cases and how to create them.

Chapter 1-0500, Maintenance of Cases--how to maintain case files, including dividing files and doubling cases. The chapter also addresses how to send cases out of the office and process them on return.

Chapter 1-0600, Transfer, Loan, and Retirement of Cases--describes how to send files from one office to another. The chapter also addresses retirement of closed files to the Federal Records Center (FRC), and handling of cases recalled from the FRC. The OWCP Records Disposal Schedules are currently under revision. When they are issued in final form, the portion which addresses retention of FECA claim files will be added to this chapter as an exhibit.

While the automated system is referenced in various places, the basic resources for keying instructions and data management are the Users Manuals for the various subsystems.

 

DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation


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Exs. 1-2

 

1-0100

i, 1-2
Ex. 1

 

1-200

i, 1-9
Exs. 1-4

 

1-0200

i, 1-6
Ex. 1

 

1-201

i, 1-14
Exs. 1-2

 

1-0300

i, 1-11
Ex. 1

 

1-300

i, 1-6
Exs. 1-3

 

1-0400

i, 1-7
Ex. 1

 

1-400

i, 1-8

 

1-0500

i, 1-6

 

1-500

i, 1-9

 

1-0600

i, 1-5
Ex. 1

 

1-501

i, 1-7

     
 

1-502

i, 1
Ex. 1

     
 

1-600

i, 1-13
Exs. 1-5

     

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Distribution: List No. 5--Folioviews Groups C and D
(All Supervisors, Index and Files Personnel, Systems Managers, and Technical Assistants)

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FECA TRANSMITTAL NO. 00-03

February 10, 2000


RELEASE - NEW CHAPTER 2-0300, COMMUNICATIONS, AND REVISED CHAPTER 2-0400, FILE MAINTENANCE AND MANAGEMENT, PART 2- CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

A new PM Chapter 2-0300, Communications, is issued with this transmittal. It includes material on priority correspondence which previously appeared in the previous PM Part 1 - Communications and Records, and two paragraphs on providing copies of correspondence to employing agencies and employees' representatives which formerly appeared in PM 2-0400. It also contains material originally published in FECA Bulletin 92-20 about providing responses to controlled correspondence received in the National Office.

PM 2-0400 has been revised and updated so that the material it contains corresponds to the newly revised FECA PM Part 1 - Mail and Files. As with Part 1, this chapter does not address imaging, which will be discussed in a separate Operations Manual. This chapter will be revised to include procedures for imaging after the program gains experience with this process. Finally, the paragraph addressing standards for timeliness of case actions has been moved to PM 0-0100, as the standards apply to the program as a whole and not just to claims personnel.

 

DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation


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2-0300

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i, 1-11

 

2-0400

i, 1-10

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FECA TRANSMITTAL NO. 00-05

March 3, 2000


RELEASE - REVISION TO CHAPTER 0-0100, INTRODUCTION TO FECA AND DFEC, PART 0 - OVERVIEW, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

New paragraph 5 has been added to PM 0-0100 to address standards for timeliness of case actions. A shorter version of this paragraph formerly appeared in PM 2-0400. The material about training now appears in paragraph 6.

Minor changes have been made to paragraphs 3, 4a(1) and (2), and 6a, b, and c, and the entire chapter has been repaginated. Finally, Exhibit 2 has been updated to show the current telephone and fax numbers for the Branch of Hearings and Review.

 

DENNIS M. MANKIN
Acting Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 00-06

January 14, 2000


RELEASE – REVISION TO CHAPTER 2-1000, DUAL BENEFITS, PART 2 – CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

The list of staff members at OPM who may be contacted about dual benefits issues has been revised.

 

Dennis M. Mankin
Acting Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 00-07

June 30, 2000


RELEASE - REVISION TO CHAPTERS 3-300, AUTHORIZING EXAMINATION AND TREATMENT, AND 3-400, MEDICAL SERVICES AND SUPPLIES, PART 3 - MEDICAL, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 3-300, paragraph 6c is revised to reflect the fact that an employee need not consult OWCP for approval when the physician initially selected refers the employee to an appropriate specialist.

A phrase referring to attendant services is removed from Chapter 3-400, paragraph 6a to reduce confusion.

These changes are related to the 1999 revisions to the Regulations.

 

DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation


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3-400

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FECA TRANSMITTAL NO. 00-08

July 12, 2000


RELEASE - REVISION TO CHAPTERS 2-805, CAUSAL RELATIONSHIP, AND 2-810, DEVELOPING AND EVALUATING MEDICAL EVIDENCE, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapters 2-805 and 2-810 are revised to reflect provisions of the revised Regulations as discussed in Bulletin 99-13.

20 CFR 10.311 allows the acceptance of a diagnosis of subluxation from a chiropractor without review of the actual x-rays or x-ray report. Chapter 2-805, paragraph 3a is revised accordingly.

20 CFR 10.323 provides that the actions of an employee's representative will be considered the actions of the employee for the purpose of determining whether a claimant refused to submit to or obstructed a required medical examination. This revision is reflected in Chapter 2-810, paragraph 14.

Chapter 2-810, paragraph 15 is revised to include the fact that OWCP will not approve an elaborate service or appliance where a more basic one is suitable.

 

DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation


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2-810

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FECA TRANSMITTAL NO. 00-09

July 28, 2000


RELEASE - REVISION TO CHAPTERS 2-700, DEATH CLAIMS, AND 2-901, COMPUTING COMPENSATION, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapter 2-901 has been substantially revised. Former Paragraph 13 has been renumbered paragraph 19, and revised to incorporate the procedures for processing claims for leave buy back discussed in FECA Bulletin 96-11. Paragraph 13 is now reserved. Exhibit 4 has been removed. Paragraph 18 has been expanded to include the criteria for approving a representative payee. This information was previously found in the Regulations prior to the recent revision. Paragraph 11 is revised to include the fact that the maximum pay rate does not apply to compensation paid due to an assault which occurred during an attempted or actual assassination of a Federal official.

Chapter 2-700, paragraph 8 is revised to include the fact that student status should be verified twice each year.

These revisions incorporate the information provided in FECA Bulletin 99-11.

 

DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation


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27
Ex 4

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2-901

i
15-20
27-32

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FECA TRANSMITTAL NO. 00-10

August 9, 2000


EXPLANATION OF MATERIAL TRANSMITTED:

Chapters 2-200, paragraph 2, and 2-812, paragraph 8, are revised to reflect provisions of the revised Regulations regarding payment of an attendant allowance discussed in FECA Bulletin 99-09. (The first part of paragraph 9 has been reformatted, but the contents have not changed.)

 

DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 00-11

July 31, 2000


RELEASE - REVISION TO CHAPTERS 2-807, CONTINUATION OF PAY, AND 2-1500, RECURRENCES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapters 2-807 and 2-1500 are revised to reflect provisions of the revised Regulations regarding COP entitlement found in FECA Bulletin 99-06. Specific changes appear in 2-807 paragraphs 4a, 6a, 6c, 7a, 7b, 8d, 9g, 11, 12b, 13, 14a, 14b, 14d, former 15e (deleted) and former 15f (renumbered 15e) and 16a. (Paragraph 2-807.11, as it refers to FLSA for firefighters, has not been revised at this time. FECA Bulletin 00-05 provides current guidance on this.) Chapter 2-1500, page 9 was reformatted to remove some duplicate text.

 

DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation


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i, 9-10

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2-1500

i, 9-10

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FECA TRANSMITTAL NO. 99-01

October 5, 1998

RELEASE - REVISION TO CHAPTER 4-0300, WAR HAZARDS, PART 4 - SPECIAL CASE PROCEDURES, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

Exhibit 3 is updated to show the 1996, 1997, and 1998 yearly increases under the Longshore and Harbor Workers' Compensation Act.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 99-02

October 5, 1998

RELEASE - REVISION OF FECA PROGRAM MEMORANDUM 280, AND OF CHAPTER 2-0400, FILE MAINTENANCE AND MANAGEMENT, AND CHAPTER 2-0402, SECURITY AND THE PREVENTION OF FRAUD AND ABUSE, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

Program Memo 280 states that AUO (administratively uncontrollable overtime) pay is to be added as a percentage of basic pay in cases where the injury occurred after October 1, 1990. It has been determined that AUO pay applies not only to pay rates based on date of injury, but also to those based on the date disability began and the date of recurrence. An addendum to this effect is being added to the Program Memo.

In PM 2-0400.12, the heading is corrected to refer to representatives.

In PM 2-0402.7, the reference to the ESA Manual of Administration is replaced by a reference to DLMS (Department of Labor Manual Series) 8. The ESA Manual no longer exists.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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Program Memo 280

Program Memo 280

Part

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2

2-0400

i, 11

2

2-0400

i, 11

 

2-0402

i, 5-6

 

2-0402

i, 5-6

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Distribution: List No. 1--Folioviews Groups A and D
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FECA TRANSMITTAL NO. 99-03

October 5, 1998

RELEASE - CHECKLIST, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

This release transmits the current checklist for the Federal (FECA) Procedure Manual. The checklist is a comprehensive accounting of all Procedure Manual pages issued as of August 31, 1998. The previous checklist, issued September 30, 1997, and all transmittal sheets through No. 98-05 may be discarded. The current checklist should be retained at the front of the Procedure Manual, with transmittal sheets after No. 98-05.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 99-04

October 30, 1998

RELEASE - REVISION TO CHAPTER 6-0300, DEBT LIQUIDATION, PART 6 - DEBT MANAGEMENT, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

Exhibit 1 is revised to show the debt collection interest rates for 1995-1998.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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6-0300

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Ex. 2, p. 1

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FECA TRANSMITTAL NO. 99-05

November 17, 1998

RELEASE - REVISION OF CHAPTER 2-0808, SCHEDULE AWARDS AND PERMANENT DISABILITY CLAIMS, CHAPTER 2-0810, DEVELOPING AND EVALUATING MEDICAL EVIDENCE, AND 2-1700, SPECIAL ACT CASES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

In PM 2-0808.7, the reference to PM 2-900.12 has been updated to PM 2-901.14.

In PM 2-0810.14(d), the second sentence currently states that if a claimant fails to attend a medical examination as directed by OWCP, compensation is suspended until the claimant appears for the examination. In fact, compensation is suspended until the refusal or obstruction stops, which is defined as the date on which the claimant agrees, either in writing or by telephone, to attend the examination. Compensation is restored retroactive to that date, but payment should not be certified until it has been verified that the claimant in fact did attend the examination.

For example, an examination is scheduled for May 1. The claimant states on March 15 that she will not attend. Compensation should be suspended effective March 15. The claimant telephones the office on April 5 and states that she will attend the examination after all. On May 1, after verifying that the claimant appeared for examination, compensation for the period April 5-May 1 may be certified.

The paragraph has been revised accordingly.

In PM 2-1700, Exhibit 1 has been updated to reflect the 1997 and 1998 increases in pay rates for Peace Corps and VISTA volunteers.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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i, 29-30

 

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i, 29-30

 

2-1700

i, Ex. 1

 

2-1700

i, Ex. 1

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FECA TRANSMITTAL NO. 99-06

November 5, 1998

RELEASE - REVISIONS TO CHAPTER 3-201, STAFF NURSE SERVICES, CHAPTER 3-700, SCHEDULE AWARDS, AND CHAPTER 3-900, ADMINISTRATIVE MATTERS, PART 3 - MEDICAL, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

A new paragraph 15 addressing functional capacity evaluations has been added to PM 3-201. The material duplicates the content of PM 2-810.20.

Page 6 of PM 3-700 was inadvertently omitted from a previous printing and is added back into the chapter at this time. (The page is dated November 1998 since the actual date of issuance is unknown.) Current pages 6 and 7 have been renumbered 7 and 8.

A new paragraph 8 has been added to PM 3-900, stating the long-standing though informal policy within DFEC that no more than four hours of compensation or continuation of pay should be authorized for a routine medical appointment.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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i, 5-8

 

3-0700

i, 5-8

 

3-0900

i, 7-8

 

3-0900

i, 7-8

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FECA TRANSMITTAL NO. 99-07

January 4, 1999

RELEASE - REVISION TO CHAPTER 2-1601, HEARINGS AND REVIEWS OF THE WRITTEN RECORD, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

This chapter has been revised to modify the FECA procedures in accordance with the new Federal regulations which were approved and made final on November 25, 1998, and made effective on January 4, 1999. Upon review of the new regulations you will note that the part specifically pertaining to the Branch of Hearings and Review starts at § 10.615 and concludes at § 10.622. There are several changes which refer to extended deadlines for submitting requests, evidence or comments.

In paragraph 5 on Reviews of the Written Record, the number of days given to the employing agency to submit comments has been changed from 15 to 20 days, and the claimant's period for review and comment is increased from 15 to 20 days. Paragraph 6.a. is modified to allow 30 days instead of 15 between the date of mailing the hearing notice to the scheduled date of the hearing. Paragraph 6.b. refers to attachment CA-1127a (Exhibit 4) in which the period for comment on the hearing after release of the transcript is increased from 15 to 20 days. Similarly, paragraph 8.a. refers to the comment period for the employing agency after release of the transcript, and the fact the claimant has 20 days from the release of the comments to the claimant to review and comment as well. In paragraph 9 which discusses Cases Returned from H&R to the district offices, all references to Form CA-8 have been changed to Form CA-7.

However, the most important changes refer to the guidelines for requesting subpoenas, and the elimination of postponements except under the extraordinary circumstances specified in Section 10.622(c) of the new regulations. Paragraph 6.d. on Withdrawal and Postponement of Hearing Requests in Chapter 2-1601 has been rewritten to reflect the changes within the regulations at 20 CFR 10.622. Paragraph 6.e. of this chapter on Abandonment of Hearing Requests has also been rewritten to conform with this section of the regulations. Paragraph 6.e. of this chapter has been modified mainly to conform with the new deadline for requesting the subpoena of witnesses or documents for testimony or evidence at the oral hearing. Exhibits 2 through 6 are letters used by H&R which have been modified to reflect the changes in the various deadlines, and the more substantive changes regarding subpoenas, postponements, and withdrawal of and abandonment of hearing requests pursuant to the new regulations.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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i - 9
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FECA TRANSMITTAL NO. 98-01

September 30, 1997


RELEASE - CHECKLIST, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

This release transmits the current checklist for the Federal (FECA) Procedure Manual. The checklist is a comprehensive accounting of all Procedure Manual pages issued as of July 25, 1997. The previous checklist, issued November 20, 1996, and all transmittal sheets through No. 97-20 may be discarded. The current checklist should be retained at the front of the Procedure Manual, with transmittal sheets after No. 97-20.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 98-02

December 1, 1997

RELEASE - REVISIONS TO CHAPTER 2-0400, FILE MAINTENANCE AND MANAGEMENT, AND CHAPTER 2-1000, DUAL BENEFITS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

Paragraph 7c of PM 2-0400 is revised to allow for use of an overnight delivery service when sending cases from one office to another.

In paragraph 8 of PM 2-1000, several references to obsolete Form CA-687 have been removed. Elections from the Department of Veterans Affairs should be obtained by narrative letter.

Finally, the list of staff members at OPM who may be contacted about dual benefits issues has been revised.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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2-0400

i, 5-6

 

2-1000

i, 19-22
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2-1000

i, 19-22
Ex. 2

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FECA TRANSMITTAL NO. 98-03

December 1, 1997

RELEASE - REVISIONS TO CHAPTER 2-0401, AUTOMATED SYSTEM SUPPORT FOR CASE ACTIONS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

A variety of changes are made to this chapter, as follows:

References to the short-term roll and code PV have been removed in accordance with FECA Bulletin 97-04. Specifically, paragraph 7 has been modified, paragraph 9b(2) and the second half of paragraph 9b(4) have been removed, and the subparagraphs have been renumbered.

In light of the recent revisions to PM 2-1400, the term "notice of decision" has been added to "compensation order" in paragraphs 9a(4) and 9c(1), and in 9c(2) the term "formal decision" has replaced "compensation order".

In paragraph 9a(4), the amount payable for medical bills without formal adjudication has been changed to $1500 in accordance with current procedures.

Material about automated tracking of reopened cases which were originally closed short form has been added to paragraph 9e. This material was originally published in FECA Bulletin 93-10.

Finally, paragraph 10 has been modified to reflect the contents of FECA Bulletin 93-11.

The balance of the chapter has been repaginated.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

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FECA TRANSMITTAL NO. 98-04

January 28, 1998

RELEASE - RELEASE OF NEW CHAPTER 2-0601, DISABILITY TRACKING AND QCM TRACKING SYSTEMS REVISION TO CHAPTER 2-0401, AUTOMATED SYSTEM SUPPORT FOR CASE ACTIONS; REVISION TO CHAPTER 2-1500, RECURRENCES; AND REVISION TO THE LIST OF CHAPTERS PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

This chapter incorporates into the PM the contents of FECA Bulletins 97-02, 95-13, 94-24, 94-11, and 93-10 insofar as those contents are still current. While the material concerning recurrences could logically have been added to PM 2-1500, the close relationship between the Disability and QCM Tracking Systems represented a stronger argument for keeping the discussion of both systems in one place.

References to the new chapter have been added to the first paragraphs of PM 2-0401 and PM 2-1500.

The List of Chapters is revised to include the new chapter.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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2-0601

i, 1-14
Ex. 1-2

 

2-1500

i, 1-2

 

2-1500

i, 1-2

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FECA TRANSMITTAL NO. 98-05

June 2, 1998


RELEASE - REVISION OF CHAPTER 2-0500, CONFERENCING, CHAPTER 2-700, DEATH CLAIMS, CHAPTER 2-800, DEVELOPMENT OF CLAIMS, AND CHAPTER 2-0802, CIVIL EMPLOYEE, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

In PM 2-0500, a reference to Exhibit 1 which should have been deleted with the actual exhibit (see FECA Transmittal 97-19) is removed from paragraph 7.

Paragraph 10 of PM 2-0700 is revised to reflect the ECAB's holding in Clyde Stevenson (Donna R. Stevenson), Docket No. 95-3016, Issued February 4, 1998. The Board held that compensation was payable to a grandchild even though the widower was receiving benefits as well. A sentence has been added to paragraph 10b stating that siblings, grandparents, and/or grandchildren may receive compensation even if a widow, widower and/or children are receiving compensation as long as the total percentage does not exceed 75%. Also, the phrase "(if one or more of this class of people are the only survivors)" has been removed from paragraph 10a(2)(a). Finally, the definition of "grandchildren" in paragraph 10 has been rephrased.

In PM 2-0800, a new paragraph 14, Reopening Short-Form Closure Cases, has been added to reflect some of the material first published in FECA Bulletin 94-5.

In PM 2-0802, a new paragraph is added to address the status of contract observers on vessels, as discussed in FECA Bulletin 97-13.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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2-0800

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2-0800

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2-0802

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FECA TRANSMITTAL NO. 98-06

September 30, 1998

RELEASE - REVISION TO CHAPTER 0-0100, INTRODUCTION TO FECA AND DFEC, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

Exhibit 2 is modified to reflect the current telephone and fax numbers for the Jacksonville and Denver District Offices. Also, the new telephone number for the Branch of Hearings and Review is shown (the fax number remains unchanged).

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-01

October 30, 1996


RELEASE - REVISION TO CHAPTER 2-0900, DETERMINING PAY RATES, AND CHAPTER 2-1000, DUAL BENEFITS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

In PM 2-0900, paragraph 4a(2) has been modified to state that concurrent employment may be used to demonstrate the ability to perform full-time work. This statement appeared in the previous version of this chapter, but it was dropped in error when the chapter was revised.

Beginning in 1982, the number of hours which make up the work year for most Federal employees (that is, those whose status and rules of work are governed by the Office of Personnel Management and its regulations) was changed by statute from 2080 to 2087. However, the number of hours which make up the work year has remained 2080 for employees of the U.S. Postal Service. Paragraph 10b is modified to reflect this difference.

The last line of paragraph 12f is modified to state that the pay rate should be determined in accordance with section 8114(d) (that is, the reference to subparagraph (3) has been removed).

In PM 2-1000, paragraph 13b has been revised to state that cases from the Mine Safety and Health Administration (MSHA) are handled in the Kansas City District Office. The lettering of the first subparagraph on the following page has also been corrected.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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2-1000

i, 25-26

 

2-1000

i, 25-26

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FECA TRANSMITTAL NO. 97-02

November 20, 1996

RELEASE - REVISION TO CHAPTER 2-0700, DEATH CLAIMS, CHAPTER 2-0806, OCCUPATIONAL ILLNESS, AND CHAPTER 2-0811, EARLY MANAGEMENT OF DISABILITY CLAIMS PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL


EXPLANATION OF MATERIAL TRANSMITTED:

FECA Transmittal No. 96-26 removed the requirement that copies of certificates submitted to support payment of death benefits bear the raised seal of the custodian of records. The three chapters titled above are being revised to remove this requirement for birth, marriage, divorce, and adoption certificates as well.
The specific references changed are paragraphs 5f, 7 and 9 of PM 2-0700; Exhibit 2 of PM 2-0806; and paragraph 10d of PM 2-0811.

However, the Claims Examiner may still request a certificate bearing a raised seal if he or she has any doubt as to whether a document presented to support a claim for benefits is authentic. If this is done, the certificate should be photocopied for the file and the certified copy should be returned to the sender.

PM 2-0700 is also revised to add a new paragraph 20 addressing the gratuity recently authorized by Public Law 104-208 for survivors of employees who died in the line of duty on or after August 2, 1990. This gratuity, in an amount not to exceed $10,000, is paid by the employing agency, not the OWCP. However, burial and administrative expenses paid by OWCP are subtracted from the entitlement, so employing agencies will need to contact claims staff for this information in individual claims.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

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p. 2

 

2-0806

i, Ex. 2,
p. 2

 

2-0811

i, 13-14

 

2-0811

i, 13-14

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FECA TRANSMITTAL NO. 97-03

November 11, 1996


RELEASE - REVISION TO CHAPTER 2-0810 - DEVELOPING AND EVALUATING MEDICAL EVIDENCE, AND CHAPTER 2-0813, REEMPLOYMENT: VOCATIONAL REHABILITATION SERVICES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

In Chapter 2-0810, a new paragraph 20 is added to address the material about Functional Capacity Evaluations (FCEs) which was first published in FECA Bulletin No. 96-12.

In Chapter 2-0813, paragraph 5c modifies the criteria for referring claimants for vocational rehabilitation services. Ordinarily, claimants are to have stable, well-defined work limitations which allow them to work eight hours per day before such referral is made. Where this is not the case, the Claims Examiner (CE) is expected to work toward establishing the claimant's ability to work full-time through a variety of case management methods. The CE will be required to document any inability to establish work limitations of eight hours a day by a Memorandum to the File.

However, where an occupational rehabilitation program (ORP) may be of benefit, the requirement that the claimant be able to work eight hours per day need not be met. Also, where it appears that the employing agency can offer work to an employee who can work at least four hours per day, the case may be referred for rehabilitation services on this basis. However, if the offer does not materialize, and the Rehabilitation Specialist cannot proceed further with the employing agency, the CE must attempt to establish the claimant's ability to work eight hours per day, as described above.

Paragraph 5d is modified to remove the specific reference to the RH-4 report, which is seldom used, and to remove the requirement for a "full" description of work limitations before referral.

Paragraph 5e is modified to state that, when referring cases for vocational rehabilitation services, Claims Examiners should not authorize Rehabilitation Counselors to contact attending physicians when work tolerance limitations have been established by a second opinion or referee examination. Form OWCP-14 has been revised to make the options clearer. (Paragraph 6 has been edited slightly to conserve space on the page.)

Paragraph 11a is expanded to include failure to begin or continue pre-vocational training and failure to appear for a functional capacity evaluation (FCE) in the definition of non-cooperation with early vocational rehabilitation efforts.

Paragraph 11c is modified to state that the 90 days of placement assistance is computed from the date of the Form OWCP-3.

Paragraph 12b is changed to state that where compensation is suspended or reduced due to non-cooperation with vocational rehabilitation efforts, the case status should remain PR, since an LWEC decision has not been issued. The example of multiple sanctions in paragraph 12c is modified to show that compensation is reduced (rather than suspended) for the second and third instances of non-cooperation, though when cooperation resumes, compensation is restored at the rate for total disability.

Finally, a new paragraph 13, Occupational Rehabilitation Programs, has been added. It addresses material first published in FECA Bulletin No. 96-09.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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19

 

2-0813

i, 3-4
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FECA TRANSMITTAL NO. 97-04

November 11, 1996


RELEASE - REVISION TO CHAPTER 2-0600, CASE MANAGEMENT, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Paragraphs 5, 6e and 6g have been revised to incorporate the material concerning the role of registered nurses in QCM cases which was first published in FECA Bulletin No. 96-06. (A similar revision is being made to PM 3-0201). The attachments to that bulletin have also been added as Exhibits 4 and 5.

Former paragraph 7, "Return to Work with Previous Employer", has been divided into two paragraphs. New paragraph 7 addresses referrals for vocational rehabilitation services, while new paragraph 8 addresses returns to work with the previous employer.

Paragraph 7a modifies the criteria for referring claimants for vocational rehabilitation services. Ordinarily, claimants are to have stable, well-defined work limitations which allow them to work eight hours per day before such referral is made. Where this is not the case, the Claims Examiner (CE) is expected to work toward establishing the claimant's ability to work full-time through a variety of case management methods. The CE will be required to document any inability to establish work limitations of eight hours a day by a Memorandum to the File.

However, where an occupational rehabilitation program (ORP) may be of benefit, the requirement that the claimant be able to work eight hours per day need not be met. Also, where it appears that the employing agency can offer work to an employee who can work at least four hours per day, the case may be referred for rehabilitation services on this basis. However, if the offer does not materialize, and the Rehabilitation Specialist cannot proceed further with the employing agency, the CE must attempt to establish the claimant's ability to work eight hours per day, as described above.

Paragraph 7b is modified to state explicitly that, when referring cases for vocational rehabilitation services, Claims Examiners should not authorize Rehabilitation Counselors to contact attending physicians when work tolerance limitations have been established by a second opinion or referee examination. Form OWCP-14 has been revised to make these options clearer. Also, Form OWCP-14 should contain the gross amount of compensation.

Various other changes have been made to paragraphs 7 and 8 to clarify and update the material found there.

Former paragraph 8, "Return to Work with New Employer", has been divided into three paragraphs. New paragraph 9 addresses the 10-month letter, new paragraph 10 addresses development of vocational rehabilitation plans, and new paragraph 11 addresses returns to work with new employers.

Paragraph 10c(1) is expanded to clarify the Claims Examiner's role in reviewing vocational rehabilitation plans, and paragraph 10c(2) is expanded to address the claimant's motivation in the context of vocational training programs.

Paragraph 11a is modified to state that the Rehabilitation Specialist has the authority to approve an extension of 90 days in Placement New Employer/Short-Term Assisted Reemployment status when the claimant is cooperating with vocational rehabilitation efforts.

Here again, a number of other changes have been made to paragraphs 9-11 to clarify and update the material found there.

Former paragraph 9 has been renumbered paragraph 12. Also, paragraph 2a is modified to reflect the increase in the number of paragraphs in this chapter from 9 to 12.

The chapter as a whole has been reviewed and edited in light of the program's experience with nurse intervention. References to telephone interventions have been added, and a reference to Staff Nurses serving in the capacity of Field Nurses has been removed. Other changes have been made for clarity and consistency.

Finally, the balance of the chapter has been repaginated.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-05

November 20, 1996


RELEASE - CHECKLIST, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

This release transmits the current checklist for the Federal (FECA) Procedure Manual. The checklist is a comprehensive accounting of all Procedure Manual pages issued as of August 2, 1996. The previous checklist, issued September 28, 1995, and all transmittal sheets through No. 96-26 may be discarded. The current checklist should be retained at the front of the Pro- cedure Manual, with transmittal sheets subsequent to No. 96-26.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-07

January 1, 1997


RELEASE - REVISION TO CHAPTER 2-0804, PERFORMANCE OF DUTY, AND CHAPTER 2-0813, REEMPLOYMENT: VOCATIONAL REHABILITATION SERVICES, AND CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

In Chapter 2-0804, references to several ECAB decisions in paragraphs 12 and 17 have been updated to show citations to the published volumes.

In Chapter 2-0813, one reference to an ECAB decision in paragraph 11 has also been updated. Also, Exhibit 2 has been revised to make it clear that in the training stage, compensation is reduced to the LWEC rate (a suspension of the rate for total disability). References to "penalty decision" have been removed, since this phrase is usually used only with respect to terminations under 5 U.S.C. 8106(c) and some confusion has resulted from using the phrase in the context of non-cooperation with vocational rehabilitation efforts.

In Chapter 2-0814, the discussion in paragraph 7a of the kinds of appointments and tours of duty which may be considered suitable has been expanded.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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Ex. 1-2

 

2-0813

i, 13-14
Ex. 1-2

 

2-0814

i, 11-12

 

2-0814

i, 11-12

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FECA TRANSMITTAL NO. 97-08

July 9, 1997


RELEASE - REVISIONS TO CHAPTER 2-1000, DUAL BENEFITS, A ND CHAPTER 2-1602, RECONSIDERATIONS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Paragraph 4a of PM 2-1000 is modified to state that the rules for electing between OPM benefits and FECA benefits also apply to reemployed annuitants.

Exhibit 4 of PM 2-1602 is modified to correct the ZIP code shown in the address for the ECAB.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-09

March 1, 1997


RELEASE - REVISION TO CHAPTER 2-1400, DISALLOWANCES

EXPLANATION OF MATERIAL TRANSMITTED:

For the past two years, an OWCP/FECA reinvention team has been examining various aspects of formal decisions. After authoring FECA Bulletin No. 95-16, "Compensation Orders--Delegation of Signature Authority", the team turned to streamlining the process of issuing formal decisions.

The product of this effort is a series of decision formats for initial disallowances of cases which do not meet one of the five basic requirements, with the exception that the format for performance of duty denials is not designed to address emotional stress cases. Using these formats, the Claims Examiner can deny a case on the basis that the requested information has not been received, or that the requested information is not sufficient to accept the claim. The formats are being added to the Letter Generator system and will be listed under "Formal Decisions" on the Letter Generator index page, as follows:

Time:

Evidence Received Not Sufficient
Additional Evidence Not Received

Civil Employee:
Evidence Received Not Sufficient
Additional Evidence Not Received

Fact of Injury:

Factual Evidence Received Not Sufficient
Additional Factual Evidence Not Received
Medical Evidence Received Not Sufficient
Additional Medical Evidence Not Received

Performance of Duty:

Evidence Received Not Sufficient
Additional Evidence Not Received

Causal Relationship:

Evidence Received Not Sufficient
Additional Evidence Not Received

In some of these letters, the Claims Examiner must choose among two or more options so that the decision will fit the circumstances of the case. For instance, the decision addressing timeliness requires choices between "The CLAIMED INJURY or LAST EXPOSURE..." and between "You WERE AWARE or REASONABLY SHOULD HAVE BEEN AWARE...."

When decisions are issued using these formats, or a similar approach, neither the compensation order (the "Findings of Fact" page) nor the cover letter (usually Form CA-1042) will be required. However, the Claims Examiner must still make findings of fact specific to the case in question in the body of the decision. The standards set by the ECAB for the contents and quality of formal decisions must be met, whether the decision is issued using these formats or another approach.

The reinvention team most recently focused on Memorandums to the Director and compensation orders. While many offices have streamlined the decision-making process somewhat by incorporating Memoranda to the Director in decisions, there continued to be concern that the use of two documents where one would suffice is rather cumbersome. The following specific problems with the format of the Memorandum to the Director and the compensation order were identified:

Memorandum to Director. While the apparent audience of the Memorandum to the Director is the Director of the OWCP, the real audience is the reviewer of the memorandum, the claimant, and employing agency personnel. Similarly, while the decision-making process apparently includes the Director of the OWCP, this process in fact almost always occurs entirely within the district office. The current format of the Memorandum to the Director thus unintentionally obscures the true nature of the decision-making process.

Compensation Order. The layout of this document, which is legal in origin, is not user-friendly. When the Memorandum to the Director is included by reference, the findings basically repeat information and conclusions which are stated in the narrative. The phrase "By Order of the Director, OWCP" in the signature block suggests that the Director has a role in the decision-making process, which is misleading, as noted above.

To address these concerns, a new Notice of Decision has been designed for all disallowances which cannot be addressed using pre-formatted text. The Notice of Decision will consolidate the functions of the compensation order and the Memorandum to the Director. Each decision will include the following elements: Statement of Issue, Requirements for Entitlement, Background, 260 Discussion of Evidence, Basis for Decision, and Conclusion.

Use of a standardized format should result in decisions which are more uniform in the kinds of information conveyed and easier to write and to understand.

The Notice of Decision will be directed to the claimant and signed by the Claims Examiner or Senior Claims Examiner who makes the decision. It will not refer to the Director of the OWCP.

This revision contains several other changes. It removes the requirement to list the elements of the claim which are established before addressing the issue at hand, and it removes the requirement to prepare a memorandum which recommends continuation of compensation when evidence submitted in response to a pre-reduction or pre-termination notice overcomes the evidence of record on which the proposed action was based.

Other material removed from this chapter includes the following:

Paragraph 3, Fatal Cases. This material appears in PM 2-0700.

Paragraph 4, Continuation of Pay. This material appears in PM 2-0807.

Paragraph 5d, Failure to Report for an Office-Directed Medical Exam. This topic is covered in PM 2-0810.14.

All offices should provide training on this transmittal within 30 days of receipt.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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Exs. 1-10

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FECA TRANSMITTAL NO. 97-10

May 29, 1997


RELEASE - REVISIONS TO CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY, AND CHAPTER 2-1500, RECURRENCES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Paragraph 3b of PM 2-1500 defines recurrences of disability.
A statement at the end of current subparagraph (2) refers readers to paragraph 2-1500.9 with respect to terminations of employment. This statement has been read as applying to subparagraph (1) as well, though such a reading is not intended. As a result, in several cases which have come to our attention, denials have been issued in error.

The scenario which has occurred in these cases is as follows: the claimant was rated for loss of wage-earning capacity (LWEC) based on actual earnings with the employing agency for 60 days. The employing agency eliminated the light duty job, and the claimant applied for compensation based on temporary total disability. OWCP then denied modification of the LWEC, instead of treating the claim as a recurrence of disability. In accordance with Hedman, the withdrawal of light duty does in fact meet the definition of a recurrence, and the claim should be developed for recurrence.

To stem confusion over this matter, the statement referring readers to the paragraph concerning terminations of employment has been moved to the beginning of subparagraph 3b(2). Paragrpah 7 has also been modified to reflect this change by removing the distinction between cases rated for LWEC and those not rated.

It also appears that the paragraph 2-1500.9 itself is more properly included in PM 2-0814, as it addresses recurrences only in passing. Therefore, this paragraph has been removed from PM 2-1500 and added (with slight modifications) to PM 2-0814 as new paragraph 12. A reference to this paragraph in paragraph 7e has been modified, and current paragraph 12 has been renumbered paragraph 13.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-12

June 27, 1997


RELEASE - REVISIONS TO CHAPTER 2-1600, REVIEW PROCESS; CHAPTER 2-1601, HEARINGS AND REVIEWS OF THE WRITTEN RECORD; CHAPTER 2-1602, RECONSIDERATIONS; AND 2-1603, APPEALS; PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Chapters 2-1601, 2-1602, 2-1603 are modified to state that Form CA-1009, Now That Your Claim Has been Accepted..., should be released when benefits are payable following a reconsideration, hearing, or appeal. Paragraph 8e of PM 2-1601, paragraph 8c of PM 2-1602, and paragraph 5d of PM 2-1603 have been changed.

Also, PM 2-1602, paragraphs 7b(1), 8c(1), and 8c(3) are modified to allow for use of a Notice of Decision instead of a memorandum to the Director and compensation order when issuing a reconsideration decision.

Finally, the term "compensation order" has been replaced with "formal decision" in PM 2-1601.4b(2), and "notice of decision" has been included with "compensation order" in PM 2-1600.3c. Also in PM 2-1600, the term "formal decision" has replaced "final decision" throughout, and references to "the Office" have been changed to "OWCP".

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-13

June 18, 1997


RELEASE - REVISION TO CHAPTER 2-0900, DETERMINING PAY RATES, AND CHAPTER 2-0901, COMPUTING COMPENSATION, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

PM 2-0900 is modified as follow:

1. A new subparagraph 7b(22) adds dive pay to the increments which may be included in the pay rate. This form of pay is granted to wage system workers for the specific hours they actually perform diving duties.

2. Paragraph 10 is reorganized and expanded to provide a fuller discussion of computing pay rates for regular Federal employees who are paid by the hour.

3. A new paragraph 12f addresses the compensation entitlement of Special Census workers. Current paragraph 12f is relettered paragraph 12g.

PM 2-0901 is modified as follows:

1. References to the short-term roll have been removed from paragraphs 3b(3), 6b(2), and 7b. All of paragraph 2a(2) has been removed, and the following subparagraphs have been renumbered.

2. Exhibits 1, 2, and 3 are updated to show the recent increases in the CPI and the minimum and maximum rates of compensation.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-14

July 1, 1997


RELEASE - REVISION TO CHAPTER 6-0200, INITIAL OVERPAYMENT ACTIONS, PART 6 - DEBT MANAGEMENT, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

Some uncertainty has arisen on accountability reviews as to what action, if any, should be taken if the claimant submits payment after receiving the preliminary decision. Paragraph 4a is modified to state that a brief acknowledgment letter should be sent to the claimant in this situation.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-16

September 1, 1997


RELEASE - REVISIONS TO CHAPTER 2-0500, CONFERENCING; CHAPTER 2-0700, DEATH CLAIMS, AND CHAPTER 2-0804, PERFORMANCE OF DUTY, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

References to the short-term roll have been removed from these chapters in accordance with FECA Bulletin 97-04. Specifically, PM 2-600.4b, PM 2-806.8a, and PM 2-807.17d have been modified.

Also, in light of the recent revisions to PM 2-1400, the term "formal decision" has replaced "compensation order" in PM 2-600, paragraphs 7c(4) and 12a, and in PM 2-807, paragraphs 16b(2)(b) and 16b(4).

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-17

July 1, 1997


RELEASE - REVISIONS TO CHAPTER 2-811, EARLY MANAGEMENT OF DISABILITY CLAIMS, CHAPTER 2-812, PERIODIC REVIEW OF DISABILITY CASES, AND CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

References to the short-term roll and code PV have been removed from these chapters in accordance with FECA Bulletin 97-04:

In PM 2-811, paragraph 3 has been modified; paragraph 7a has been modified and paragraph 7a(2) has been removed, with paragraph 7a(3) renumbered (2); and paragraph 9 has been rewritten to reflect use of the periodic roll in early disability cases.

In PM 2-812, paragraph 6b has been removed and subsequent paragraphs have been relettered. Paragraph 8c(2) has been modified.

In PM 2-814, paragraphs 7b(1) and 12b(3) have been modified.

Also, references to "compensation orders" have been changed to "formal decisions" in PM 2-812.10c(2) [first paragraph and subparagraph (b)] and in PM 2-814.4d(2), 5d(1) and 10b(2)) in light of the recent revisions to PM 2-1400.

Finally, in response to a question which has arisen from several district offices and at least one employing agency, a sentence is being added to PM 2-814.6a stating that it is not proper to authorize relocation expenses for an employee who has been offered a temporary job which is not expected to lead to a permanent assignment. This is so even if the original job was temporary and the offered job would otherwise be suitable.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-19

July 25, 1997


RELEASE - REVISIONS TO CHAPTER 2-0500, CONFERENCING; CHAPTER 2-0700, DEATH CLAIMS, AND CHAPTER 2-0804, PERFORMANCE OF DUTY, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

In PM 2-0500, a sentence has been added to the end of paragraph 7 to describe the elements of a Memorandum of Conference. Exhibit 1 is being removed as unnecessary.

Paragraph 8 has been rearranged to clarify two points. Specifically, paragraph 8a is modified to state that when the outcome of the conference will be favorable to the claimant, it is not necessary to obtain comments from any party to the conference before issuing the decision. Also, paragraph 8b is modified to state that the issue for resolution need not be addressed in a separate memorandum.

Also, in light of the recent revisions to PM 2-1400, references to "compensation orders" have been changed to "formal decisions" in paragraph 6a of PM 2-0700 and in paragraphs 16e and 17k (at end) of PM 2-0804.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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FECA TRANSMITTAL NO. 97-20

July 25, 1997


RELEASE - REVISIONS TO CHAPTER 2-0810, DEVELOPING AND EVALUATING MEDICAL EVIDENCE; CHAPTER 2-1100, SUBROGATION; AND CHAPTER 2-1200, FEES FOR REPRESENTATIVES' SERVICES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

EXPLANATION OF MATERIAL TRANSMITTED:

In light of the recent revisions to PM 2-1400, references to compensation orders have been expanded to include formal decisions in general in paragraphs 10f and 13b of PM 2-0810; in paragraph 27 of PM 2-1100; and in paragraph 10 of PM 2-1200.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-0806, OCCUPATIONAL ILLNESS, CHAPTER 2-0800, DEVELOPMENT OF CLAIMS, AND CHAPTER 2-0400, FILE MAINTENANCE AND MANAGEMENT, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-01

October 10, 1995


EXPLANATION OF MATERIAL TRANSMITTED:

In July, National Office personnel surveyed a statistically valid sample of occupational illness claims in two district offices to determine what proportion of cases were simple OD and what proportion required extensive development of the evidence. The reviewers also assessed how long it took to adjudicate these cases.

This survey showed that occupational illness claims fall into two strikingly different groups, depending on nature of injury:

The large majority of all occupational illness cases usually required far less than the 180 days allotted for adjudication. This group included most of the claims for orthopedic injury, skin diseases, and infectious diseases.

The rest of the occupational illness cases usually required extensive development of the evidence for adjudication. This group included claims for stress (whether manifested as an emotional, gastrointestinal, or cardiac condition); multiple chemical sensitivity and sick building syndrome; strokes and other vascular diseases; pulmonary conditions; and hearing loss.

The reviewers also noted that if a second inquiry was made to obtain requested evidence in either group of cases, this letter almost never resulted in receipt of the requested information.

These findings have led us to believe that adjudication time frames for occupational illness cases can be adjusted to reflect the nature of injury without imperiling the quality of adjudication or requiring more work from claims personnel.

The new time frames for adjudication will be as follows:

For claims requiring the basic period for development:

75% within 90 days
95% within 180 days

For claims requiring an extended period for development:

70% within 180 days
98% within 365 days

To allow for clear distinctions between these groups, the number of codes for nature of injury has been increased, and their use has been refined. Cases involving skin, musculoskeletal, and infectious disorders, as well as certain other conditions (nature of injury code beginning with S, M, V or O) are to be adjudicated within 90 days.

The revised codes are shown as Exhibit 21 (note that general code "D9" has been dropped). The codes have also been programmed into the adjudication screen on the Sequent system, so that claims staff will know what time frame applies to each individual case. If multiple conditions are claimed, and more than one time frame applies, the longer period will be allowed for adjudication. If the nature of injury is miscoded, the CE is authorized to change it effective the date of this transmittal.

The CE is encouraged to adjudicate rapidly any case where the five basic requirements are clearly met, either when the claim is first submitted or when basic missing evidence has been received, and the underlying factors of employment have obviously led to the condition claimed. The procedures for such claims remain basically unchanged.

The requirement that general requests for information be made twice in occupational illness claims is being eliminated.

Any time a claim for occupational illness is adjudicated within 90 days of submission and the claimant has not returned to work, the CE should refer it for nurse services. When the claim is adjudicated after 90 days of submission and the claimant has not returned to work, the CE should consider whether such referral would be useful. Such referrals assist the program's objectives of managing the medical aspects of the claim and returning claimants to work as early as possible.

PM 2-0806.5, Evaluating Evidence in Cases Not Classified as Simple OD, has been removed as duplicative of material appearing in PM 2-0804 and 2-0805. The rest of the chapter has been reorganized and streamlined.

PM 2-0800.11 is being changed to include material previously found in PM 2-0806 about obtaining information by telephone, as it applies to claims in general, not just those for occupational illness. (Former paragraphs 11 and 12 have been renumbered 12 and 13, respectively.)

PM 2-0400 has been revised to reflect adjudication time frames for both basic-development and extended-development occupational illness claims, and the third tier standards for traumatic injury cases have been removed. Also, standards in other categories have been updated.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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Revision to Chapter 2-900, Determining Pay Rates, and Release of New Chapter 2-0901, Computing Compensation, Part 2 - Claims, Federral (FECA) Procedure Manual

FECA TRANSMITTAL NO. 96-02

December 12, 1995


EXPLANATION OF MATERIAL TRANSMITTED:

The material which formerly appeared in Chapter 2-0900 has been revised and expanded into two chapters. Revised Chapter 2-0900 now focuses exclusively on determining pay rates, while Chapter 2-0901 addresses computation of compensation payments.

Changes to Chapter 2-0900 include the following:

Paragraph 2, Establishing a Pay Rate, describes in general how to determine a pay rate.

Paragraph 3, Kinds of Appointments and Tours of Duty, has been added to help claims personnel clarify employment status.

Paragraph 4, Average Annual Earnings, contains much of the information previously found in the discussion of setting weekly pay rates. The steps needed to identify situations requiring further investigation and to establish the pay rate have been clarified.

Paragraph 5, Effective Date of Pay Rate, discusses recurrent pay rates which are lower than date of injury pay rates.

Paragraph 6, Elements Excluded in Pay Rate, states explicitly that amounts received for unemployment compensation may not be included in the pay rate.

Paragraph 7, Elements Included in Pay Rate, addresses holiday pay for non-Postal employees and availability pay for criminal investigators.

Paragraph 8, Applying Increments of Pay, has been added to clarify when the reported increments may be used as given, and when further information must be obtained. A section concerning calculations of pay rates involving FLSA overtime has also been added.

Paragraph 9, Computing Daily Pay Rate, has been modified to reflect that a daily pay rate should not include any increment of pay (that is, the restriction is not limited to receipt of night differential).

Paragraph 10, Weekly Pay Rate, contains a step-by-step description of how to apply the provisions of section 5 U.S.C. 8114. The definition of career seasonal status which appears in this paragraph has also been clarified. (The "career seasonal" status of employees whose employment does not meet this test may be redetermined, though district offices need not undertake any special searches for such cases. Any claimant whose career seasonal status is redetermined should be found not with fault if an overpayment results.)

Paragraph 12, Special Determinations, contains a section on pay rate determination for rural carriers (paragraph 3 also discusses these employees).

The exhibit addressing night differential and the Table of Julian days have been removed as obsolete.

New Chapter 2-0901 includes the following changes and additions:

Paragraph 2, Related Topics, provides cross-references to other parts of the FECA Procedure Manual and other resources concerning various aspects of making compensation payments.

Paragraph 3, Responsibilities, recognizes that CEs are increasingly performing functions once reserved for fiscal personnel and describes the changes to the certification process which were published in FECA Bulletin No. 95-14. Also, the amount which may be certified by a Senior CE or designated CE has been raised to $50,000.

Paragraph 7, Work Days/Calendar Days, discusses the distinction between these two methods of calculation, and provides formulas for their use.

Paragraph 8, Basic Computations, includes a discussion of compressed work schedules ("flextime") and how pay rates should be computed for employees working such schedules.

Paragraphs 10 and 11 address minimum and maximum compensation respectively.

Paragraph 15, Loss of Wage-Earning Capacity (LWEC), includes a discussion of locality pay. It also addresses how reevaluation of routes affect the compensation entitlement of rural carriers.

Paragraph 17, Death Benefits, addresses entitlements payable in death cases in addition to compensation for survivors.

Paragraph 18, Other Payees, discusses additional parties who may receive compensation, including representative payees.

A new exhibit showing ACPS activity codes has been added.

Many cross-references to other parts of the Procedure Manual have been added to both chapters.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

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RELEASE -REVISION TO CHAPTER 0-0100, INTRODUCTION TO FECA AND DFEC, PART 0 - OVERVIEW, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-03

October 2, 1995


EXPLANATION OF MATERIAL TRANSMITTED:

Exhibit 2 has been revised to reflect new telephone and fax numbers for District 13.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 3-0201, STAFF NURSE SERVICES: CHAPTER 3-0400, MEDICAL SERVICES AND SUPPLIES; CHAPTER 3-0500, MEDICAL EXAMINATIONS; AND CHAPTER 3-0700, SCHEDULE AWARDS, PART 3 - MEDICAL, FEDERAL (FECA) PROCEDURE MANUAL


FECA TRANSMITTAL NO. 96-04

October 10, 1995


EXPLANATION OF MATERIAL TRANSMITTED:

Several chapters of PM Part 3, Medical, have been revised as follows:

3-0201:

Paragraph 7c has been revised to state that, if the nurse arranges a second opinion examination and the physician selected is not listed in the Physicians' Directory System, the nurse should advise the Medical Management Assistant of the physician's name and address so that this information can be added to the system.

3-0400:

Paragraph 3c has been changed to remove the statement that a motorized wheelchair may not be provided if the claimant has the services of a full-time attendant. Also, paragraph 7c has been revised to more closely define situations where experimental treatments may be considered. Such requests must continue to be referred to the OWCP Medical Director.

3-0500:

Paragraph 4 has been modified to reflect that medical brokerage firms may arrange the mechanics of referrals for impartial examination without compromising the impartiality of the examination itself. This policy was first published in FECA Bulletin 95-01.

3-0700:

Exhibit 4, which describes calculations of schedule awards according to the fourth edition of the AMA Guides to the Evaluation of Permanent Impairment, has been added to this chapter. This material was first published in FECA Bulletin Nos. 95-07 and 95-17. References to the new exhibit have been added to paragraphs 2 and 4.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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3-0700

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RELEASE - REVISION TO CHAPTER 2-0805, CAUSAL RELATIONSHIP, AND CHAPTER 2-0806, OCCUPATIONAL ILLNESS, PART 2 - CLAIMS FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-05

NOVEMBER 1, 1995


EXPLANATION OF MATERIAL TRANSMITTED:

A new paragraph 8, High-Risk Employment, has been added to PM 2-0805 to address determinations of causal relationship in cases arising from employment situations where exposure to specific diseases is common. This paragraph contains the material first published in FECA Bulletin 95-21. Also, the title of paragraph 7 has been changed to "Psychological Factors Affecting Medical Condition" to reflect the terminology of DSM-4, and the contents of the paragraph have been modified slightly in light of this change.

Exhibit 20 of PM 2-0806 has been changed to include the material first published in FECA Bulletin 95-20. Related material previously found in MEDGUIDE Chapter 4.6 has also been added. The material concerning carbon tetrachloride poisoning has been removed, as this substance is no longer used.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-0900, DETERMINING PAY RATES, AND CHAPTER 2-0901, COMPUTING COMPENSATION, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-06

March 21, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

In PM 2-0900, the following changes have been made:

1. Paragraph 4a is ambiguous with respect to career seasonal pay rates. The true policy is contained in paragraph 2-900.4a(1)(a), which states that a career seasonal employee "is entitled to receive compensation on the same basis as an employee with the same grade and step who has worked the whole year". That is, a full-time career seasonal employee's pay rate would be based on a full-time year-round employee's earnings, while a part-time career seasonal employee's pay rate would be based on a part-time year-round employee's earnings, and so on. Subparagraph (d) directly below implies that a career seasonal employee would be paid at the full-time rate even if the employee worked a part-time or intermittent schedule. This language is being clarified to conform with the wording of the preceding paragraph.

2. Paragraph 4c(3)(b) concerns comparisons between the employee's earnings and the earnings of a similarly-situated employee. The paragraph is modified to state that if the "same or most similar class" contains more than one employee, the earnings of the employee who worked the "greatest number of hours" should be used.

3. Paragraph 5a(3) states that if the pay rate on date of injury is the same as on the date of disability, the date of injury pay rate should be chosen. This is incorrect, and the paragraph is being modified accordingly. Section 5 U.S.C. 8146a provides that CPIs will be applied beginning one year after disability begins, and ACPS determines entitlement for a CPI from the effective date of pay rate. Unless the pay rate on date disability began is used, CPI increases will be awarded in error to some claimants whose disability has not exceeded one year.

In PM 2-0901, Exhibit 5 was partly obscured in the printing process. It is reissued with this transmittal.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-07

November 29, 1995


EXPLANATION OF MATERIAL TRANSMITTED:

In two recent cases, the Employees' Compensation Appeals Board set aside decisions terminating compensation based on abandonment of suitable work because the claimants had not been provided with their due process rights. The following quotation from one of the cases summarizes the issue:

It is well established that the termination of benefits under section 8106(c) raises due process and fairness considerations. These considerations arise because compensation benefits constitute a property interest that is protected by the due proces clause. The Supreme Court has held that the essential requirements of due process are "notice and an opportunity to respond." These essential due process principles require that an employee have "at least notice and an opportunity to respond in some manner" prior to the termination of compensation benefits. Accordingly, the Board finds that appellant's compensation may not be terminated under section 8106(c)(2) for neglecting suitable work without prior notification and an opportunity to respond. [Mary A. Howard, Docket No. 92-886, Issued May 19, 1994; footnotes omitted]

Therefore, new paragraph 10 has been added to this chapter to address the procedures which should be followed when a claimant abandons his or her job. The 8106(c)(2) provision should be invoked only if a retroactive LWEC determination cannot be done and only after a recurrence of total disability has been explored. These procedures parallel those already in place for refusing a job offer. Former paragraphs 10 and 11 have been renumbered 11 and 12 respectively, and paragraphs 9a and 9b have been revised slightly in light of this change.

Also, page 2 of Exhibit 2 has been revised to include deductions for basic life insurance and post-retirement basic life insurance, and Exhibit 4 has been updated to show revised Form CA-817. Exhibit 5 has been removed as superfluous.

Finally, citations in paragraphs 6d(2), 7e and 8e have been updated, and the sequence of paragraph 6, which contained two subparagraphs lettered "c", has been corrected.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 4-0300, WAR HAZARDS, PART 4 - SPECIAL CASE PROCEDURES, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-08

November 29, 1995


EXPLANATION OF MATERIAL TRANSMITTED:

Exhibit 3 is updated to show the 1994 and 1995 yearly increases under the Longshore and Harbor Workers' Compensation Act.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-1100, SUBROGATION AND OTHER REMEDIES; CHAPTER 2-1200, FEES FOR REPRESENTATIVES' SERVICES; AND CHAPTER 2-1500, RECURRENCES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-09

December 12, 1995


EXPLANATION OF MATERIAL TRANSMITTED:

The second page of the Table of Contents to PM 2-1100 was omitted in error from FECA Transmittal No. 95-36; it is included in this transmittal. The Table of Contents to PM 2-1200 has been updated to include the exhibit.

Paragraph 8a of PM 2-1500 has been modified to remove the references to regular duty with respect to use of COP after a recurrence. This change is in accordance with section 10.208(b)(3) of OWCP's regulations.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISIONS TO CHAPTERS 5-0100, INTRODUCTION, AND 5-0101, SECURITY OF THE FISCAL OPERATION; REVISIONS TO AND REPLACEMENT OF CHAPTERS 5-0201, AUTHORIZING MEDICAL PAYMENTS, 5-0202, PROCESSING BILLS FOR PAYMENT, 5-0203, BILL CODING UNDER MEDICAL FEE SCHEDULE, 5-0204, APPEALS OF FEE SCHEDULE DETERMINATIONS, AND 5-1002, BPS JOBS AND KEYING INSTRUCTIONS, PART 5 - BENEFIT PAYMENTS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-10

January 31, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

Procedure Manual chapters which deal with the DFEC Medical Bill Processing System (BPS) have been completely revised and reorganized. These changes are necessary because of the conversion of the BPS in 1992 from a bill payment system to a bill processing system.

The revised procedures retain the portions of the existing procedures which are still relevant to the enhanced BPS. However, these retained procedures will be found in different places. Procedures described in FECA Bulletins 93-3, New Procedure Code Modifiers, 93-9, System Enhancements, 94-8, Explanation of Benefits Letters, 94-9, Duplicate Checking and Bypass Codes, 94-23, Implementation of the New Fee Revised OWCP Medical Fee Schedule Effective June 14, 1994, 95-18, Discounts on Hospital Bills, and 96-3, Excluded Provider Changes, have been incorporated. Information has been reorganized to reflect major functional areas.

Chapters 5-0100 and 5-0101 have been updated. The new/revised chapters being issued which deal specifically with the BPS are:

Chapter 5-0200 - Overview of the BPS;

Chapter 5-0201 - BPS FECS001 Programs;

Chapter 5-0202 - BPS Jobs;

Chapter 5-0203 - BPS Codes;

Chapter 5-0204 - Principles of Bill Adjudication;

Chapter 5-0205 - Bill Resolution; and

Chapter 5-0206 - Appeals of EOB Denials and Fee Schedule Determinations.

The following additional chapters will be issued at a future date:

Chapter 5-0207 - BPS Reports, which describes the various BPS reports available, their uses, and how to run them; and

Chapter 5-0208 - Other BPS Activities, which provides information on other activities related to the BPS which are not addressed elsewhere, such as tracers, audits, controls, and supervisory/management review. FECA Bulletin 94-10, Supervisory Sampling of Bills, will be incorporated in this chapter.

All exhibits and tables of contents have been modified for inclusion in folioviews.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTERS 2-1000, DUAL BENEFITS, AND 2-0813, REEMPLOYMENT: VOCATIONAL REHABILITATION SERVICES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-11

February 9, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

In PM 2-1000, a new subsection is added to paragraph 8b to address how to determine the percentage of election where the Department of Veterans Affairs has awarded percentages of disability for more than one impairment. The material following the new paragraph has been repaginated.

In PM 2-0813, a new subsection is added to paragraph 9a to state that subsidies to employers for assisted reemployment should cease if compensation payments to the claimant are terminated.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-12

March 21, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

This transmittal conveys several changes involving refusal to accept suitable work, abandonment of a suitable job, and application of the penalty provisions of 5 U.S.C. 8106(c).

1. In Michael E. Moravec, Docket No. 93-1137, issued February 1, 1995, the ECAB addressed a case where the employing agency made a job offer after the claimant had returned to work elsewhere. The district office terminated compensation on the grounds that the claimant improperly refused an offer of suitable work.

In reversing this decision, the Board stated that: "It is well established that once the Office has accepted a claim, it has the burden of justifying termination or modification of compensation benefits". The Board also stated that, in relying on section 5 U.S.C. 8106(c)(2) to terminate benefits,

the Office has impermissibly focused its attention on this portion of the Act without also giving appropriate consideration to section 8115 of the Act. The Board has previously discussed the need for the Act to be interpreted in its entirety in order to best arrive at its intended meaning. It is well established that the Act is a remedial statute and should be broadly and liberally construed in favor of the employee to effectuate its purpose and not in derogation of the employee's rights.

Noting the relationship between sections 8106 and 8115, the Board concludes that "a proper evaluation of appellant's continued entitlement to compensation cannot be made without also undertaking an evaluation of appellant's wage-earning capacity under section 8115 of the Act."

Because the claimant earned actual wages for several years before the Office terminated benefits, the Board found that the Office has an affirmative duty to decide whether the position actually worked fairly and reasonably represented the claimant's wage-earning capacity before determining that the position offered by the employing agency was suitable and terminating compensation. This position is consistent with PM 2-0814.5a(2).

Such job offers will usually come from the original employing agency. The issue of whether the claimant's actual earnings fairly and reasonably represent the loss of wage-earning capacity (LWEC) may already have been determined, or it may have to be addressed when the new position is offered. Either way, the Claims Examiner must make such a determination before considering termination based on refusal of a suitable job. We are modifying paragraph 5b(2) to state that refusal of a job offer by a claimant with actual earnings which fairly and reasonably represent his or her wage-earning capacity is acceptable.

Unlike a claimant with actual earnings, a claimant who has been rated for LWEC based on a constructed position and who is not working must accept a suitable job offer. If the claimant does not accept the position offered, compensation will be terminated under 5 U.S.C. 8106(c)(2). Paragraph 5c is modified accordingly.

This position may appear inconsistent with OWCP's long-standing policy that an LWEC decision may be disturbed only if the claimant's medical condition has changed, the claimant has been vocationally rehabilitated, or the original decision was in error. However, the Office's decision to terminate a claimant's compensation for a constructed LWEC under 5 U.S.C. 8106(c)(2) when he or she refuses an offer of suitable work has no effect on any underlying rating under 5 U.S.C. 8115. Rather, the previous determination of the claimant's WEC remains in place and is superseded by the Office's termination decision when the claimant later refuses the employing agency's offer of suitable work.

2. A prior version of this chapter stated that retirement was an acceptable reason for refusing suitable employment. This reason will henceforth again be considered acceptable, in spite of the ECAB's holding in Bankston. New subparagraphs 5a(6) and 10c(3) are added to effect this change, and the reference to Bankston is removed from paragraph 10a. A sample notification letter to the claimant with respect to his or her entitlement to benefits in this situation is shown as new Exhibit 5 (a reference to the old exhibit 5 is removed from paragraph 12c.)

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO PART 5, BENEFIT PAYMENTS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-13

March 28, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

A new List of Chapters is issued for Part 5.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-1000, DUAL BENEFITS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-14

April 3, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

A new paragraph 17 has been added to incorporate the material about severance and separation pay which was originally published in FECA Bulletin 96-02.

Paragraphs 3 and 4 of the bulletin stated that when separation pay was based on a period of time, an award for loss of wage-earning capacity (LWEC) would not be considered a dual benefit, but that when the separation pay was based on an amount of money, the LWEC would be considered a dual benefit. The latter conclusion is incorrect, and the addition to this chapter states that LWEC payments and separation payments are not dual benefits, regardless of the basis for the separation payment. Because of this change, the entitlement of employees receiving severance pay is identical to that of employees receiving separation pay.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 3-0201, STAFF NURSE SERVICES, CHAPTER 3-0300, AUTHORIZING EXAMINATION AND TREATMENT, AND CHAPTER 3-0600, REQUIREMENTS FOR MEDICAL REPORTS, PART 3 - MEDICAL, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-15

September 20, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

Paragraphs 7c(4) and 8 of Chapter 3-0201 have been revised to incorporate the material concerning the role of registered nurses in QCM cases which was first published in FECA Bulletin No. 96-06. (A similar revision is being made to PM 2-0600). Paragraph 8 has been retitled "Extensions and Interruptions of Nurse Services". The balance of the chapter has been repaginated.

In paragraph 2 of Chapter 3-0300, subparagraphs "c" and "d" have been relettered "b" and "c" respectively.

Finally, Exhibit 4 of Chapter 3-0600 has been revised to include 3,000 Hz in item 1. This change conforms to the recent revision of Form CA-1087.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY, AND 2-1700, SPECIAL ACT CASES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-16

May 1, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

In paragraphs 5a and 10a of PM 2-0814, a sentence has been added to state that pre-termination notice is not required when terminating benefits to a claimant who has retired.

In PM 2-1700, the exhibit has been updated to show new payrates effective January 1996.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-0900, DETERMINING PAY RATES, AND CHAPTER 2-0901, COMPUTING COMPENSATION, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-17

July 9, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

Paragraphs 12f of Chapter 2-0900 and paragraph 15f(2) of Chapter 2-0901 are revised to make clear that changes in a rural carrier's route evaluation do not result in a change in the pay rate for compensation purposes unless the pay rate otherwise qualifies as a date of injury, date disability begins or date of recurrence pay rate.

Also, paragraph 3b of Chapter 2-0901 is revised to add a definition of certification, which is to include initialing the payment setup both before and after the payment is keyed. In addition, delegation of authority to designated GS-11 Claims Examiners to certify initial death and schedule award payments has been eliminated. Such payments must be certified by Senior Claims Examiners or managers at the GS-12 level or above, as stated in new subparagraph (1). Subsequent subparagraphs have been renumbered.

Finally, Exhibits 1, 2, and 3 to Chapter 2-0901 are updated to include the new minimum, maximum, and CPI rates as first published in FECA Bulletins 96-07 and 96-08. Exhibit 5, the Percentage Table of Schedule Awards, has been updated to include the female reproductive organs, and Exhibit 6, Activity Codes, has been slightly edited.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-1602, RECONSIDERATIONS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-18

May 20, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

The ECAB has recently remanded a number of cases in which requests for reconsideration were denied because they were not timely filed. The remands occurred because the OWCP did not address whether the evidence or argument submitted by the claimant constituted clear evidence of error. Paragraph 3 and Exhibit 2 have been revised to indicate that such a statement must be included in any denial of a reconsideration request based on untimely filing.

A new paragraph 6 addresses prima facie denials. Former paragraphs 8 and 9, which addressed reconsiderations following suspension of compensation and reconsiderations of schedule awards, have been combined into a new paragraph 5.

The chapter as a whole has been streamlined and updated.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 4-0600, RESERVE OFFICERS' TRAINING CORPS, PART 4 - SPECIAL CASE PROCEDURES, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-19

May 20, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

Paragraphs 5 and 6 are expanded to clarify the difference between ROTC "line of duty" determinations and "performance of duty" as usually interpreted under the FECA. The balance of the chapter is repaginated.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-0806, OCCUPATIONAL ILLNESS,AND CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-20

June 12, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

In Chapter 2-0806, paragraph 3a(3)(b) is modified to state that preparation of a statement of accepted facts and certain medical development actions are not needed where surgery is contemplated in cases accepted for carpal tunnel syndrome, since surgery is often the recommended treatment for this condition.

In Chapter 2-0814, the following three changes have been made:

Paragraph 4a is changed to include Claims Examiners in the list of those who can solicit job offers from employing agencies.

Paragraph 7d(2) is modified to state that when a career seasonal employee is rated in a career seasonal job, the salary of the current job should be annualized before the Shadrick formula is applied.

Paragraph 11 is expanded to address modifications of LWEC ratings where claimants rated at part-time work increase their hours to full-time duty.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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2-0814

i, 1-2
15-16
25-27

 

2-0814

i, 1-2
15-16
25-27

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RELEASE -REVISIONS TO CHAPTER 5-0204, PRINCIPLES OF BILL ADJUDICATION, PART 5 - BENEFIT PAYMENTS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-21

June 1, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

Paragraph 6g concerning reimbursements has been revised to state that insurance companies applying for reimbursement of work-related medical payments may attach a signed certification of the payments made by the insurance company as proof of payment (rather than copies of cancelled checks). The National Association of Letter Carriers Health Benefit Plan's revised Form NALC-200 (April 1996) contains certification of the payments made, and no further verification of payment is needed. Charges and providers should be itemized on the HCFA-1500, NALC-200, or facsimile, and photocopies of the original bills are no longer required.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE -REVISION TO CHAPTER 2-0401, AUTOMATED SYSTEM SUPPORT FOR CASE ACTIONS, AND CHAPTER 2-1400, DISALLOWANCES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-22

June 10, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

A new paragraph 13 is added to PM 2-0401 to address ICD-9 codes. This material was first published in FECA Bulletin No. 93-12.

In PM 2-1400, the second paragraph of Exhibit 11 is revised to reflect that the authority to declare forfeiture in cases involving fraud against the FECA program is 5 U.S.C. 8148. The rest of the paragraph is reworded accordingly.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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2-1400

i-ii
Ex. 10-11

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RELEASE -REVISION TO CHAPTER 2-0814, REEMPLOYMENT: DETERMINING WAGE-EARNING CAPACITY, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-23

July 9, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

Action item 2 of FECA Transmittal No. 96-12 stated that retirement would once again be considered an acceptable reason for refusing or abandoning suitable employment. However, since the release of this transmittal, various arguments against this position have been raised, and we have been persuaded that it is unwise to counter the precedent which the Employees' Compensation Appeals Board set in the case of Roy Bankston, 38 ECAB 380.

Therefore, we are returning to the position affirmed by the Board, and paragraphs 5a, 5c, 10a, and 10d are modified to state that retirement is not a valid reason for refusing or abandoning suitable employment. Exhibit 5 is removed.

Finally, the citation to Maggie Moore in paragraph 5d has been updated.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 0-0100, INTRODUCTION TO FECA AND DFEC, PART 0 - OVERVIEW, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-25

August 1, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

Exhibit 2 is modified to reflect the new address for the Boston District Office.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 2-0700, DEATH CLAIMS, AND CHAPTER 2-1400, DISALLOWANCES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-26

August 2, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

Paragraph 5f of PM 2-0700 is modified to remove the requirement that copies of certificates submitted to support payment of death benefits bear the raised seal of the custodian of records.

Paragraph 11(f)(1) of PM 2-1400 has been clarified with respect to the amount of compensation payable to the dependents of convicted felons.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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i-ii
21-22

 

2-1400

i-ii
21-22

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RELEASE - REVISION TO CHAPTER 2-1602, RECONSIDERATIONS, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-27

August 1, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

Exhibits 2, 3, and 4 are modified to reflect the new address for the Employees' Compensation Appeals Board.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 2-0802, CIVIL EMPLOYEE, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL, AND TO FECA PROGRAM MEMORANDUM 249

FECA TRANSMITTAL NO. 96-28

September 10, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

New Paragraph 32 is added to describe coverage for emergency workers performing services at the direction of the Federal Emergency Management Agency (FEMA).

A question recently arose concerning coverage of workers in the Green Thumb program. This program was authorized as part of the Older American Community Service Employment Act, which is addressed in FECA Program Memorandums 249 and 267. However, these issuances do not mention the Green Thumb program explicitly. Therefore, the following pen-and-ink change should be made to Program Memorandum 249: "Coverage includes workers in the Green Thumb program."

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE - ISSUANCE OF NEW CHAPTER 5-0700, CHARGEBACK, PART 5 - FISCAL, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-29

September 30, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

This chapter formerly appeared as Chapter 5-0900. It has been completely revised and updated.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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RELEASE - REVISION TO CHAPTER 2-0810 - DEVELOPING AND EVALUATING MEDICAL EVIDENCE, AND CHAPTER 2-0813, REEMPLOYMENT: VOCATIONAL REHABILITATION SERVICES, PART 2 - CLAIMS, FEDERAL (FECA) PROCEDURE MANUAL

FECA TRANSMITTAL NO. 96-30

September 30, 1996


EXPLANATION OF MATERIAL TRANSMITTED:

In Chapter 2-0810, a new paragraph 20 is added to address the material about Functional Capacity Evaluations (FCEs) which was first published in FECA Bulletin No. 96-12.

In Chapter 2-0813, paragraph 5c is changed to state that cases referred for vocational rehabilitation services should have stable, well-defined work limitations which allow the claimant to work at least four hours per day. However, where an occupational rehabilitation program (ORP) may be of benefit, these requirements need not be met. The criteria for referral are expanded to include those applicable where an ORP has been recommended or appears to be warranted.

Paragraph 5d is modified to remove the specific reference to the RH-4 report, which is seldom used, and to remove the requirement for a "full" description of work limitations before referral.

Paragraph 5e is modified to state that, when referring cases for vocational rehabilitation services, Claims Examiners should not authorize Rehabilitation Counselors to contact attending physicians when work tolerance limitations have been established by a second opinion or referee examination. Form OWCP-14 has been revised to make the options clearer.

Paragraph 11a is expanded to include failure to begin or continue pre-vocational training and failure to appear for a functional capacity evaluation (FCE) in the definition of non-cooperation with early vocational rehabilitation efforts.

Paragraph 11c is modified to state that the 90 days of placement assistance is computed from the date of the Form OWCP-3.

Paragraph 12b is changed to state that where compensation is suspended or reduced due to non-cooperation with vocational rehabilitation efforts, the case status should remain PR, since an LWEC decision has not been issued. The example of multiple sanctions in paragraph 12c is modified to show that compensation is reduced (rather than suspended) for the second and third instances of non-cooperation, though when cooperation resumes, compensation is restored at the rate for total disability.

Finally, a new paragraph 13, Occupational Rehabilitation Programs, has been added. It addresses material first published in FECA Bulletin No. 96-09.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation


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i, 3-4
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19

 

2-0813

i, 3-4
11-12
15-16
19-22

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