Skip to page content
Office of Workers' Compensation Programs
Bookmark and Share

Division of Federal Employees' Compensation (DFEC)

Bulletins, Circulars, and Transmittals (BCT) FY13

BCT Table of Contents


FECA Bulletins

FECA Bulletin No. 13-01

Reimbursement of Unallocated Claims Expenses for Defense Base Act (DBA) settlements under the War Hazards Compensation Act (WHCA), and Allocating Payments in a DBA Settlement of Multiple Injuries for Purposes of Reimbursing only WHCA-Covered Injuries


FECA Circulars

FECA Circular No. 13-01

Dual Benefits - FERS Cost of Living Adjustments

FECA Circular No. 13-02

Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately-Owned Automobiles Necessary to Secure Medical Examination and Treatment

FECA Circular No. 13-03

Employees' Compensation and Management Portal (ECOMP)


FECA Transmittals

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


Back to BCT Table of ContentsBack to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

FECA BULLETIN NO. 13-01

Issue Date: January 29, 2013

 


Subject: Reimbursement of Unallocated Claims Expenses for Defense Base Act (DBA) settlements under the War Hazards Compensation Act (WHCA), and Allocating Payments in a DBA Settlement of Multiple Injuries for Purposes of Reimbursing only WHCA-Covered Injuries

Background: The DBA provides a workers' compensation system for workers injured or killed while performing work for government contractors outside the United States. 42 U.S.C. 1651(a). Employers and carriers (E/Cs) are liable to pay periodic compensation and medical benefits to an injured employee or death benefits to his/her survivors. The DBA, by incorporating most provisions of the Longshore and Harbor Workers' Compensation Act, 33 U.S.C. 901-950 (LHWCA), also permits the parties to enter into a settlement of DBA liability under LHWCA section 8(i), 33 U.S.C. 908(i). Section 8(i) settlements must be approved by either an LHWCA District Director or ALJ. Settlements may be consummated before or after a decision and order on the claim. The approval of a settlement constitutes a compensation order making an award as provided under the terms of the settlement. Section 8(i) settlements may discharge the E/C from future liability only, or from liability for both past due and future benefits.

Where the DBA-covered injury or death results from a war risk hazard, the E/C may seek reimbursement for its payments under the War Hazards Compensation Act (WHCA), 42 U.S.C. 1704(a). The WHCA, administered by the Division of Federal Employees' Compensation (DFEC), provides a mechanism through which the United States reimburses an E/C for its payments under the DBA resulting from an injury or death caused by a "war risk hazard."

The WHCA also provides that a carrier seeking reimbursement may recover "reasonable and necessary" claims expenses. See 42 U.S.C. 1704(a). Under the WHCA's implementing regulations at 20 CFR Part 61, reasonable and necessary claims expenses are of two types, allocated and unallocated, incurred in connection with a case for which reimbursement is claimed. The regulations define "unallocated claims expenses" as costs that are incurred in processing a claim but cannot be specifically itemized or documented. 20CFR § 61.104(c). The regulations generally provide that "[a] carrier may receive reimbursement of unallocated claims expenses in the amount of 15% of the sum of the reimbursable payments" made under the DBA. See 20 CFR § 61.104(c).

References: 42 U.S.C. 1704; 20 CFR § 61.104

Purpose: To address the current practice under the WHCA of reimbursing carriers for unallocated claims expenses incurred in connection with DBA claims that are resolved by section 8(i) settlement.

Actions: In addition to providing a general rule for reimbursing unallocated claims expenses as described above, the regulations also grant authority to vary that calculation: "if this method of computing unallocated claims expenses [15% of total payments] would not result in reimbursement of reasonable and necessary claims expenses, the Office may, in its discretion, determine an amount that fairly represents the expenses incurred." 20 CFR § 61.104(c). Thus, while the regulations provide a general rule of thumb, ultimately the payment of unallocated costs should be a reasonable measure of unallocated expenses incurred. Under its terms, this regulation may be applied to either increase or decrease the amount of unallocated expenses that would otherwise be reimbursable under the general rule.

Under current practices, if the E/C requests reimbursement for unallocated expenses, the DFEC generally applies the 15% figure to the E/C's entire reimbursable payments, with the exception of an E/C's payment on a commuted award (see FECA Bulletin 12-01). Such an allotment is reasonable in cases where the E/C is merely seeking reimbursement for past expenses. However, where the E/C settles its future DBA liability, the practice of routinely calculating unallocated claims expenses as 15% of all of the carrier's payments merits modification, as it is not "reasonable." An E/C's payments under the terms of a settlement represent, at least in part, payment for future liability. The E/C should not have incurred any reasonable or necessary unallocated costs merely by settling such future liability (aside from the cost of putting together settlement documents). Yet, the current practice provides that in calculating unallocated claims expenses, all the payments are to be considered, including the payment in settlement of future liability.

The inclusion of those amounts in the calculation constitutes an unjustified payment to the E/C, because they are not reasonably related to the expenses in handling the DBA claim. Since the regulations grant considerable discretion in reimbursing unallocated costs, the DFEC will exercise this authority and use an alternative approach to calculating a reasonable and appropriate measure of unallocated costs subject to WHCA reimbursement in the case of DBA settlements. Accordingly, in circumstances where the E/C settles its future DBA liability and seeks reimbursement, the DFEC will reimburse unallocated costs equaling 15% of the payments it has made up until the time of settlement, together with those amounts paid in settlement of past due liability. The DFEC will exclude from the calculation payments that represent payment in settlement of future liability, as no unallocated costs will been reasonably incurred in the payment of these benefits.

A. Allocating between Payments for Past Due and Future Liability - Where an E/C has settled its DBA liability for a WHCA-covered injury, the calculation of unallocated claims expenses will now require that the E/C's reimbursable payments be identified as payments for either past due or future liability. Toward that end, settlements should first be divided between those entered into following the entry of an award, and those entered into in lieu of an award.

B. Settlement Following Entry of a DBA Award - Where an E/C enters into a settlement following the entry of a DBA award, it will be presumed that the E/C has paid all compensation due and owing up until entry of the settlement, as it is generally required to do under law. Therefore, where an E/C enters into a settlement following entry of a DBA award, amounts paid under the terms of the settlement will be presumed to be amounts paid in settlement of future liability and excluded from the unallocated cost calculation. It is the E/C's burden to demonstrate that any portion of post-award settlement payments were made in satisfaction of past due liability.

C. Settlement in Lieu of a DBA Award - Where an E/C enters into a settlement in lieu of an award, the E/C has the burden of demonstrating what portion, if any, of its payments are payment of past due compensation and thus included in the unallocated costs calculation (together with any payments made prior to settlement).

As an aid in making this allocation, the DFEC will give presumptive weight to the allocation of payments set forth in Form LS 208, "Notice of Final Payment or Suspension of Compensation Payments," which each E/C must file with the Division of Longshore and Harbor Workers Compensation (DLHWC) upon final payment of its DBA liability. The LS 208 requires an E/C to list all DBA payments it has made on account of disability or death together with all other payments, including payments made pursuant to a section 8(i) settlement. Those payments which the E/C records on the LS 208 as payment pursuant to a section 8(i) settlement will be presumed to be payments in settlement of future liability which will be excluded from the unallocated expenses calculation, unless the E/C reasonably demonstrates that a portion of its settlement payments were paid on past due liability.

D. Submission of Form LS 208 - Each E/C who seeks reimbursement for its payments on a DBA 8(i) settlement is required to submit with its reimbursement request the Form LS 208 which it previously filed with the DLWHC.

E. Preparation of Settlement Documents - An E/C will be reimbursed the sum of $1,000 for unallocated expenses incurred in putting together settlement documents. This will be in addition to the amount calculated for unallocated expenses based upon the portion of the settlement that has been established to be for payments of past due compensation.

F. Effective Date - Because the authority for exercising this discretion in reimbursing unallocated claims expenses already exists in the regulations, this approach to reimbursing an E/C its unallocated claims expenses in DBA settlement cases applies to all pending and future claims for reimbursement under the WHCA.

DBA Settlements Encompassing both WHCA Covered and Non-Covered Injuries

An E/C may enter into a single settlement of its DBA liability for multiple injuries. However, only those payments made in settlement of liability for injuries resulting from a war risk hazard are subject to potential reimbursement under the WHCA. Therefore, where a single DBA settlement satisfies an E/C's liability for both WHCA covered and non-covered injuries, an allocation between an E/C's payments for each type injury is also necessary.

The E/C, in meeting its burden of proving entitlement to WHCA reimbursement, must provide adequate documentation of a reasonable allocation between settlement payments for injuries that arise from a war risk hazard and those injuries that do not. Only the former payments will be subject to potential WHCA reimbursement. Failure to provide an adequate allocation of such payments will result in a denial of a reimbursement request for the settlement payments in their entirety

Applicability: All National Office staff and District Office claims personnel.

Disposition: This bulletin is to be retained until the FECA PM has been updated.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1 – FolioViews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal)

Back to BCT Table of Contents Back to Top of FECA Bulletin No. 13-01


Back to BCT Table of ContentsBack to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

FECA CIRCULAR NO. 13-01

November 27, 2012


SUBJECT: Dual Benefits - FERS Cost of Living Adjustments


Effective December 31, 2012, benefits issued by the Social Security Administration (SSA) will be increased by 1.7%. This requires the amount of the Federal Employees' Retirement System (FERS) Dual Benefits deduction to be increased by the same amount, to ensure the dollar-for-dollar offset remains current.

This adjustment will be made from the National Office for all cases that were correctly entered into the iFECS Compensation program. The adjustment will be effective with the periodic roll cycle beginning December 16, 2012. There will be no adjustment or overpayment declared for the period of December 1, 2012 through December 15, 2012.

The historical SSA cost of living adjustments are as follows:

12/01/2012 - 11/30/2013
12/01/2011 - 11/30/2012
12/01/2010 - 11/30/2011
12/01/2009 - 11/30/2010
12/01/2008 - 11/30/2009
12/01/2007 - 11/30/2008
12/01/2006 - 11/30/2007
12/01/2005 - 11/30/2006
12/01/2004 - 11/30/2005
12/01/2003 - 11/30/2004
12/01/2002 - 11/30/2003
12/01/2001 - 11/30/2002
12/01/2000 - 11/30/2001
12/01/1999 - 11/30/2000
12/01/1998 - 11/30/1999
12/01/1997 - 11/30/1998
12/01/1996 - 11/30/1997
12/01/1995 - 11/30/1996
12/01/1994 - 11/30/1995

1.7%
3.6%
0.0%
0.0%
5.8%
2.3%
3.3%
4.1%
2.7%
2.1%
1.4%
2.6%
3.5%
2.4%
1.3%
2.1%
2.9%
2.6%
2.8%

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: All Claims Staff and Fiscal Personnel

Back to BCT Table of Contents Back to Top of FECA Circular No. 13-01


Back to BCT Table of ContentsBack to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

FECA CIRCULAR NO. 13-02

Issue Date: February 14, 2013

 


Expiration Date: Date of Next Rate Change


Subject: Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately-Owned Automobiles Necessary to Secure Medical Examination and Treatment.

Background: Effective January 1, 2013, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile was increased to 56.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, a determination has been made to apply the applicable rate to disabled FECA beneficiaries traveling to secure necessary medical examination and treatment.

Applicability: Appropriate National Office and District Office personnel.

Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 5, Benefit Payments, Federal (FECA) Procedure Manual and 5 U.S.C. § 8103.

Action: The Central Bill Pay (CBP) facility has updated its system to reflect the new rates. Since there is no action required at the District Office level, the rates are being provided for informational purposes only.

The following is a list of the historical mileage rates used to reimburse claimant travel expense:

01/01/1995 – 06/06/1996
06/07/1996 – 09/07/1998
09/08/1998 – 03/31/1999
04/01/1999 – 01/13/2000

30.0 cents per mile
31.0 cents per mile
32.5 cents per mile
31.0 cents per mile

01/14/2000 – 01/21/2001
01/22/2001 – 01/20/2002
01/21/2002 – 12/31/2002
01/01/2003 – 12/31/2003
01/01/2004 – 02/03/2005
02/04/2005 – 08/31/2005
09/01/2005 – 12/31/2005

32.5 cents per mile
34.5 cents per mile
36.5 cents per mile
36.0 cents per mile
37.5 cents per mile
40.5 cents per mile
48.5 cents per mile

01/01/2006 – 01/31/2007
02/01/2007 – 03/18/2008
03/19/2008 – 07/31/2008
08/01/2008 – 12/31/2008
01/01/2009 – 12/31/2009
01/01/2010 – 12/31/2010
01/01/2011 – 04/16/2012
04/17/2012 – 12/31/2012
01/01/2013 to Present

44.5 cents per mile
48.5 cents per mile
50.5 cents per mile
58.5 cents per mile
55.0 cents per mile
50.0 cents per mile
51.0 cents per mile
55.5 cents per mile
56.5 cents per mile

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.

 

Douglas Fitzgerald
Director for
Federal Employees' Compensation

 

Distribution: All Claims Staff and Fiscal Personnel

Back to BCT Table of Contents Back to Top of FECA Circular No. 13-02


Back to BCT Table of ContentsBack to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

FECA CIRCULAR NO. 13-03

February 14, 2013


SUBJECT: Employees' Compensation and Management Portal (ECOMP)

PURPOSE: To announce the Office of Workers' Compensation Programs' (OWCP) web-based portal for the electronic submission of Federal Employees' Compensation Act (FECA) claim forms and case related documents.

BACKGROUND: The OWCP completed a comprehensive update of the FECA regulations in 20 C.F.R. Part 10, effective August 29, 2011. 20 CFR §§ 10.100, 10.101, 10.102 and 10.103 (Claims for traumatic injury, occupational disease, wage loss compensation, and schedule awards respectively) direct that all such notices should be submitted electronically wherever feasible to facilitate processing of such claims. Each of these regulations also explicitly requires that, "All employers that currently do not have such capability should create such a method by December 31, 2012."

To facilitate electronic form filing, the OWCP has created its own web-based application (ECOMP), with a comprehensive electronic system for recording workplace injuries and illnesses, and processing claims under the FECA. ECOMP is available to all federal agencies who wish to use it for electronic form filing free of charge.

ECOMP, which was released to the public on November 2, 2011, can be accessed directly at the following url: https://www.ecomp.dol.gov. The site currently contains two different types of functionality – electronic submission of documents and electronic submission of FECA claim forms.

1. Web-Enabled Electronic Document Submission (WEEDS). At the time of initial release, the only available component was the electronic submission of documents. This component, WEEDS, enables all stakeholders to upload documents directly into a FECA case file. Utilizing WEEDS provides numerous important advantages: a) the document is viewable in the OWCP case file by the Claims Examiner usually within 4 hours of submission - thus the time it takes for documents to travel via mail or fax is eliminated; b) ECOMP provides a Document Control Number (DCN) when a document is uploaded so the user can track when it has been uploaded into the case file; and c) upon receipt of a claim number for a new injury, documents can be uploaded into the claim record right away rather than mailing or faxing them, which can facilitate and speed processing and adjudication of claims.

2. Electronic Form Filing. On February 27, 2012, the second component of ECOMP was made available. This component allows injured workers (employed by an enrolled federal agency) to electronically file specified FECA claim forms. Some employing agencies already provide an electronic means for form submission, and the OWCP will continue to accept forms submitted via those existing, currently approved employing agency electronic submission platforms.

ACTIONS:

A. Web-Enabled Electronic Document Submission (WEEDS)

1. This feature enables all stakeholders to upload documents directly into a FECA case file. Stakeholders include, but are not limited to, injured workers (and their representatives), employing agencies, contract field nurses and rehabilitation counselors, and medical providers. Many of the letters used by the Division of Federal Employees' Compensation (DFEC) contain language referencing this option for document submission.

2. A user does not have to register or enroll with ECOMP to use this feature. Rather, any stakeholder with an internet connection and specific information about a FECA claim can upload documents directly into the case file. Before attempting to upload documents via ECOMP, a user needs to have the following pieces of information: claim number, claimant's last name, claimant's date of birth, and the date of injury. If these pieces of information do not match the OWCP case data exactly, submission of a document is not allowed.

3. Once a document has been uploaded to the case file, ECOMP can only be used to verify that the OWCP received the document, not when or if a response has been provided. Any stakeholder having a question about a document that has been submitted must contact the servicing District Office.

4. Some specific documents should NOT be uploaded through the WEEDS component of ECOMP. The ECOMP interface and associated documentation clearly note these exceptions, which include the following:

a)

CA-1 (Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation)
CA-2 (Notice of Occupational Disease and Claim for Compensation)
CA-7 (Claim for Compensation)

These forms should all be sent to DFEC's Consolidated Case Create Facility (US Department of Labor, OWCP/DFEC, 400 West Bay Street, Room 827, Jacksonville, FL 32202), if not electronically filed through ECOMP (see next section) or other approved electronic forms submission platforms.

b)

CA-16 (Authorization for Examination and/or Treatment)
CA-2a (Notice of Recurrence)
CA-5 (Claim for Compensation by Widow, Widower, and/or Children)

These forms should be sent to the DFEC Consolidated Case Create Facility.

c)

OWCP-915 (Claim for Medical Reimbursement)
OWCP-957 (Medical Travel Refund Request)

These forms should be submitted to the DFEC's central mailroom (US Department of Labor, OWCP/DFEC, PO Box 8300, London, KY 40742-8300).

d)

Medical bills and requests for authorization of medical procedures from medical providers

These should be submitted through the OWCP's Central Billing and Authorization Facility (see the DFEC website for more information).

e)

Appellate requests for the Branch of Hearings and Review and the Employees' Compensation Appeals Board

Each should be sent to the specific address outlined in the appeal rights that accompany any formal decision.

B. Electronic Submission of Claims Forms

1. Employing Agency Enrollment

a)

Unlike the WEEDS feature for electronic document submission, registration and enrollment is required before claim forms can be electronically filed.

b)

An employing agency must enroll through the OWCP/DFEC. Once the agency is enrolled in ECOMP, an injured worker can register and create an account in order to file a claim. When creating an account, the injured worker selects his/her agency from a drop-down menu during the registration process. All federal agencies are listed in the drop-down menu but remain inactive until such time that an agency is enrolled.

c)

In order to enroll in ECOMP, each agency must sign a Memorandum of Understanding (MOU). The MOU is a template that sets forth the expectations and responsibilities of the agency with respect to the sharing and transmittal of data via ECOMP. The MOU is signed by the employing agency's Designated Approval Authority (DAA), and then countersigned by the OWCP's DAA.

d)

Once the MOU has been signed by both the employing agency and the OWCP, the agency designates its Agency Maintenance User (AMU) for ECOMP. This AMU then works directly with the OWCP to implement the agency's structure into the ECOMP platform. This structure includes a breakdown by Department, Agency-Group, Agency, Division and Duty Station. Specificity down to the Duty Station level is used so that the injured worker can more easily identify his/her workplace when filing a claim, and the appropriate charge back code can be associated with the claim.

e)

After verifying the agency's structure in ECOMP, the employing agency must then decide whether to allow submission of all forms or only certain forms. An agency may limit ECOMP form submission to new injury claims only (CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, and CA-2, Notice of Occupational Disease and Claim for Compensation), or to compensation claims only (CA-7, Claim for Compensation), or allow submission of all form types. This decision is entirely the employing agency's decision. If an agency chooses to limit submission by form type, the injured worker will be so notified if he/she attempts to file a claim form via ECOMP that is not currently permitted by the employing agency.

f)

For more information on enrolling in ECOMP, agencies may contact the DFEC's Branch of Technical Assistance.

2. Injured Worker (Claimant) Registration

a)

When the injured worker registers and creates an account with ECOMP, he/she must identify the employing agency as noted above.

b)

A new user must enter his/her Social Security Number (SSN) as part of the account creation process. When filing any claim form, the user must enter his/her SSN, which will be verified against the account information. If the information does not match, the user will be unable to file a claim. Also, when filing a CA-7, the SSN entered must match the SSN associated with the existing OWCP case file in order to proceed.

c)

The claimant must provide an email address that is to be used for communication from the ECOMP system. Note that ECOMP will not generate any email to an injured worker or agency user that contains sensitive Personally Identifiable Information (PII). Instead, ECOMP primarily uses the individual's initials, employing agency name, and the ECOMP Control Number (ECN) to identify the form in question. As explained below, this system may not be used by injured workers or agencies to communicate by email.

d)

The claimant must also provide answers to security questions to help safeguard the usage of the account.

3. Reporting an Injury or Illness

a)

The OSHA Form 301, Injury and Illness Incident Report, is completed by agencies when a recordable work-related injury or illness has occurred. This form helps the employer and OSHA develop a picture of the extent and severity of work-related incidents.

b)

For new injury claims, some agencies may require the injured worker to first file an OSHA Form 301 before filing a FECA form, while others may not. This is an employing agency decision, and ECOMP supports both options. The injured worker will be led through the process, step by step, regardless of the requirement selected by the agency. If an OSHA Form 301 is not required by a particular agency, the process begins with a CA-1 or CA-2 form – see Item 4 below.

c)

If required, the OSHA-301 is electronically routed to the Supervisor (based on the Supervisor's email address input by the user) and on to the agency's designated OSHA Record Keeper. It is then stored in the ECOMP database. The data can then be used to produce an OSHA-300, Log of Work-Related Injuries and Illnesses, and/or form OSHA-300A, Summary of Work-Related Injuries and Illnesses.

d)

Note that a contractor who is employed by an agency can also file an OSHA-301, but will not file a corresponding FECA claim form. (In the vast majority of situations, such contractors will not be considered employees for FECA purposes and may be covered under state workers' compensation law.)

4. Claims for Traumatic Injury and Occupational Disease

a)

Usually, the first step for a Federal employee who has sustained an injury or occupational disease is to file a CA-1 or CA-2 form. As noted above in Item 3, some agencies first require the completion of an OSHA Form 301. If an OSHA Form 301 is completed, some of the pertinent information will be pre-populated in the CA-1 or CA-2 form based upon the information input by the injured worker on the OSHA Form 301. However, the information can always be edited and/or updated by the injured worker when filing the FECA claim.

b)

The data required by ECOMP is the same as the data requested on the existing CA-1 and 2 forms; ECOMP only guides the user through the form's completion. The form is then electronically routed to the employee's supervisor (based on the Supervisor's email address input by the user), and then on to the agency's designated Agency Reviewer (usually an injury compensation or human resources specialist). Once completed, the form is then forwarded to the OWCP for case creation. See Item 6 below for signature requirements.

» If, however, the injury was designated as a First Aid or No Lost Time/No Medical Expense injury, it is stored in the ECOMP database unless or until it is reactivated by the Agency Reviewer.

c)

When initiating the claim, the injured worker can upload documents pertaining to that claim for submission to the OWCP, e.g. medical reports, witness statements, etc. Likewise, the supervisor and the Agency Reviewer can also upload pertinent documents. When the claim is submitted to the OWCP, the uploaded documents travel with the claim to the OWCP.

d)

As the form moves through the various review stages and is submitted to the OWCP, the injured worker and employing agency receive emails pertaining to that form each time it moves and/or the review status changes. When it is submitted to the OWCP and a case number is assigned, the injured worker receives one final email with the assigned case number. There is no further communication via ECOMP after the claim has been submitted and the case has been created.

e)

Once a case has been created by the OWCP, ECOMP no longer tracks the status of that case. ECOMP can only be used to submit the claim form to the OWCP. If the injured worker or employing agency has any questions about the claim after it has been assigned a case number, he/she must contact the servicing District Office in writing by either uploading a letter into ECOMP using the WEEDS application or mailing a printed letter using the U.S. Postal Service, or by phone. For certain "self-help" inquiries, certain stakeholders may use one of the following web-based options:

» The injured worker can view his/her case and compensation claim status, billing updates (including reimbursements), coverage limitations, and other information via the Claimant Query System (CQS) by clicking on the word "Claimant" next to the FECA photo online at: http://owcp.dol.acs-inc.com.

» Employing agencies can use the Agency Query System (AQS), a secure internet site that provides access to similar information for authorized personnel from federal agencies. There is a link to the AQS site on the ECOMP home page.

5. Claims for Wage Loss and Schedule Award

a)

CA-7 forms for wage loss or schedule award are submitted in a similar manner. Like the CA-1 and CA-2, the data required by ECOMP is the same as the data requested on the existing CA-7 form; ECOMP only guides the user through the form's completion. The form is then electronically routed to the employee's supervisor (based on the Supervisor's email address input by the user) and then on to the Agency Reviewer. Once completed, the form is then forwarded on to the OWCP.

b)

CA-7 forms can be filed for all injuries, including new injury claims filed through ECOMP and any existing claims previously filed with the OWCP using other approved forms filing methods. In order to file a CA-7 for an existing OWCP case, the user will need to have the following pieces of information: claim number, claimant's last name, claimant's date of birth, and the date of injury. If these pieces of information do not match the OWCP case data exactly, electronic submission of a CA-7 is not allowed. The user must also input his/her SSN, which must match the SSN of the case for which the form is being filed.

c)

When initiating the CA-7, the injured worker can upload documents pertaining to that claim for submission to the OWCP, e.g. supporting medical documentation. Likewise, the supervisor and the Agency Reviewer can also upload pertinent documents. When the claim is submitted to the OWCP, the uploaded documents travel with the claim to the OWCP. Form CA-7a (Time Analysis Form) can also be submitted through ECOMP when a CA-7 is filed by the injured worker.

d)

As the CA-7 moves through the various review stages within ECOMP, the injured worker and employing agency receive emails pertaining to that form each time it moves and/or the review status changes. When the form is submitted to the OWCP, the injured worker receives one final email indicating that the form has been received. There is no further communication via ECOMP after the claim has been received by the OWCP.

e)

Once the CA-7 has been received by the OWCP, ECOMP no longer tracks the status of that form. ECOMP can only be used to submit the claim form to the OWCP. If the injured worker or employing agency has any questions about the claim after it has been received by the OWCP, he/she must contact the servicing District Office or use one of the electronic methods outlined in 4e, above.

6. Signatures on Claim Forms

a)

Since these claim forms are submitted electronically, they will not bear an actual signature from the injured worker or the Supervisor. As required by the OWCP and explicitly set forth in the MOU, however, the employing agency must retain signed hard copies.

b)

The MOU provides that, "To the extent that any forms containing the signature of an employee are submitted electronically, including, but not limited to, Form CA-1, CA-2, CA-7, CA-7a, [AGENCY NAME] agrees that it will retain the original form(s) submitted by the employee, bearing original signatures, and make such forms available for inspection by the DFEC. Although the signed copies of such forms are physically maintained by the employing agency, they remain covered by the government-wide Privacy Act system of records entitled DOL/GOVT-1."

c)

DFEC claims staff will be able to ascertain whether a claim form was submitted via ECOMP by checking the marking on the top right corner of the form. If the claim has been submitted via ECOMP, a black box will appear showing the ECOMP Control Number and the email address/user name of the various individuals who initiated and reviewed the form (e.g. injured worker, supervisor and Agency Reviewer).

d)

If a designated Agency Reviewer submits a claim on behalf of an employee, his/her name will appear in the signature block on the claim form.

7. Training and Assistance

a)

Training modules and videos for the various filing functions are available on the ECOMP site. These include specific instructions for how to file the various forms as an injured worker, how to review the forms as a Supervisor, and how to review the forms as an OSHA Record Keeper or Agency Reviewer. These training modules are available on the ECOMP site to any user, whether registered with ECOMP or not.

b)

Once an employing agency signs the required MOU, the DFEC's Branch of Technical Assistance will provide training for designated agency officials, as needed, on the use of ECOMP.

8. Time Requirements for Claims Submission

Reminder: The OWCP's regulations prescribe employing agency time limitations for the submission of claims for traumatic injury and occupational disease, as well as claims for compensation. ECOMP has several features that allow an employing agency to actively manage the timely submission of claim forms, including automatic and manual reminders for the supervisor and Agency Reviewer.

a)

Claims for traumatic injury and occupational disease should be filed no more than 10 working days after receipt of the notice from the employee. See 20 CFR § 10.110.

b)

Claims for compensation due to disability or permanent impairment should be filed no more than 5 working days after receipt from the employee. See 20 CFR § 10.111.

 

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: All DFEC Staff; Employing Agencies

Back to BCT Table of Contents Back to Top of FECA Circular No. 13-03


Back to BCT Table of ContentsBack to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

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.

Remove

Insert

Part

Chapter

Paragraphs

Part

Chapter

Paragraphs

 

 

 

2

2-1401

1-7

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

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

Back to BCT Table of ContentsBack to Top of FECA Transmittal No. 13-01


Back to BCT Table of Contents Back to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

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


Remove

Insert

Part

Chapter

Paragraphs

Part

Chapter

Paragraphs

2

2-0601

4 and 12

2

2-0601

4 and 12

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

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)

Back to BCT Table of ContentsBack to Top of FECA Transmittal No. 13-02


Back to BCT Table of Contents Back to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

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


Remove

Insert

Part

Chapter

Paragraphs

Part

Chapter

Paragraphs

1

1-200

Exhibit 2

1

1-200

Exhibit 2

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

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

Back to BCT Table of ContentsBack to Top of FECA Transmittal No. 13-03


Back to BCT Table of Contents Back to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

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


Remove

Insert

Part

Chapter

Paragraph

Part

Chapter

Paragraph

3

3-0500

5

3

3-0500

5

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

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

Back to BCT Table of ContentsBack to Top of FECA Transmittal No. 13-04


Back to BCT Table of Contents Back to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

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.

Remove

Insert

Part

Chapter

Paragraph

Part

Chapter

Paragraph

2

2-0805

1-8

2

2-0805

1-7

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

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)

Back to BCT Table of ContentsBack to Top of FECA Transmittal No. 13-05


Back to BCT Table of Contents Back to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

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


Updates to Existing Procedure Manual Chapters:

Remove Old Pages

Insert New Pages

Part

Chapter

Paragraph

Part

Chapter

Paragraph

 

 

 

2

2-0700

29-31

     

2

2-0814

27-31

Completely New/Revised Procedure Manual Chapters:

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.

Remove

Insert

Part

Chapter

Paragraph

Part

Chapter

Paragraph

2

2-0901

1-19
Exhibit 1-6

2

2-0901

1-19
Exhibit 1-4

2

2-0808

1-8

2

2-0808

1-12
Exhibit 1

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

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)

Back to BCT Table of ContentsBack to Top of FECA Transmittal No. 13-06


Back to BCT Table of Contents Back to BCT Table of Contents


U.S. Department of Labor

Office of Workers' Compensation Programs
Division of Federal Employees' Compensation
Washington, D.C. 20210

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.

Remove

Insert

Part

Chapter

Paragraphs

Part

Chapter

Paragraphs

2

2-1400

1-12
Exhibits 1-11

2

2-1400

1-19
Exhibit 1

File this transmittal sheet behind the checklist in front of the Federal (FECA) Procedure Manual.

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

Back to BCT Table of ContentsBack to Top of FECA Transmittal No. 13-07


Back to List of Chapters Back to BCT Table of Contents