Division of Federal Employees' Compensation (DFEC)
Basic Information on New Claims
The Federal Employees' Compensation program provides Federal employees who sustain work related injury or illness with benefits such as medical care, wage loss replacement, and help in returning to work. Our goal is to provide the proper benefits as quickly as possible.
If you have questions about your OWCP claim, your supervisor or the Injury Compensation Specialist at your agency may be able to answer them. If he or she cannot provide the advice you need, contact our office.
For case-specific information about an established claim, contact your district office. Have your 9-digit case file number and Social Security Number available when calling. Following the menu fully may provide the answer to your question, such as the current status of your case, the status of compensation claims, etc. If you leave a message, please speak clearly, and be prepared to leave the following information when asked: your name, your case file number, your telephone number (including area code), and a brief message with your specific questions. We need this information to locate your file and address your specific concerns. We will make every effort to return your call within 2 business days.
All medical providers should contact our medical authorization and bill processing contractor (ACS) for all authorizations and billing questions. Automated information is available 24 hours per day at 1-866-335-8319 or online at http://owcp.dol.acs-inc.com. The medical authorization fax line is 1-800-215-4901. If you, your doctor, or other medical providers require direct contact with a customer service representative, you may call 1-844-493-1966, Monday-Friday, 8am-8pm EST, toll free.
You can view your case and compensation claim status, billing updates (including reimbursements), coverage limitations, and other information via the Claimant Query System (CQS) online at http://owcp.dol.acs-inc.com.
If you choose to write to our office, send all correspondence to: OFFICE OF WORKERS' COMP PROGRAMS, PO BOX 8300, LONDON, KY 40742-8300. It is recommended that you keep a copy of all documents sent to OWCP. Please ask specific questions concerning your claim, instead of general questions about its status. Please write or type clearly on 8 1/2 by 11" paper, and write your case number at the top of each page of correspondence. You may expect a reply to a specific request in a timely manner.
Adjudicating Your Case
If you have filed a Form CA-1 for a traumatic injury, and have not lost time from work, limited medical expenses may be paid by OWCP without a formal review of your claim being conducted. In such case, you will not receive a written decision on your claim and may not receive any further correspondence. Your agency representative may be able to advise you in this situation.
If we make a formal review of your case, you are responsible for providing enough factual and medical information for OWCP to decide whether you are entitled to benefits. We will help you to meet this responsibility by asking you for the information we need that is not already included in your file. You should send any additional information in writing.
If you are claiming an occupational disease, make sure that you provide all information outlined in the instructions included with Form CA-2, as soon as possible. If we approve your case after formal review and you have lost time from work due to the injury, we will advise you in writing of the acceptance and send you further information about your benefits.
If we deny your case, we will provide you with an explanation of why your claim is denied and advise you fully of your appeal rights, including the time frames for exercising these rights and the offices you should contact.
If a work-related injury results in an employee's death, a claim for survivor's benefits may be filed on Form CA-5 or 5b. The survivor(s), the employing agency on behalf of the survivor(s), or the estate may file the claim for benefits. These sensitive cases are processed expeditiously by an experienced claims examiner.
Disability for Work
The FECA provides wage loss benefits for periods of disability that are due to a work related injury or illness. All periods of wage loss must be supported by medical reports demonstrating that you are disabled for work.
It is your responsibility to advise your agency once your physician finds you capable of returning to work in some capacity. You need to arrange for your physician to advise your agency of any physical limitations due to the injury. Form CA-17 is generally used for this purpose. If your agency can provide work within your restrictions, you are required to return to work.
Most employees who suffer disabling traumatic injuries (filed on Form CA-1) are entitled to receive Continuation of their regular Pay (COP) for disability from work. In order to be eligible for COP, you must provide medical evidence showing that you are disabled for work because of effects of the injury. Your employing agency pays COP, and the usual deductions from your salary are made. COP cannot be paid for more than 45 calendar days. Where disability continues after entitlement to COP ends, compensation from OWCP is paid.
In order to claim disability compensation, complete Form CA-7, which may be obtained from your employing agency, and submit it to your supervisor or injury compensation specialist. Be sure to include medical evidence supporting disability for all periods claimed.
If compensation is approved and you begin receiving compensation payments from this Office, you should continue to submit Form CA-7 every two weeks, unless you are notified by this Office that this is no longer necessary.
COP is not payable in claims for occupational disease. Form CA-7 should be filed to claim compensation beginning with the date that disability for work begins.
The FECA provides medical benefits and services needed to treat the accepted injury.
Authorization in Traumatic Injury Claims:
If you are claiming a traumatic injury, your employing agency may have issued you a Form CA-16 so that you could obtain medical treatment right away. This authorization covers non-surgical treatment and continues for up to 60 calendar days from the date of injury.
If your case is approved, you will remain entitled to medical treatment for your accepted condition. However, if your case is denied, the authorization provided by Form CA-16 will not be valid after the date of denial.
Form CA-16 is not issued for occupational disease cases.
Initial Choice of Physician:
You have the right to select the first doctor who treats you for your injury. If that physician refers you to a specialist, we will honor that referral as long as it is for the work-related condition. If you are first seen by a physician designated by your employer, you still have the right to choose your treating physician. If you wish to change physicians from this initial choice, you must request approval from OWCP. Send a letter stating your reasons for wanting this change, along with the name, address and specialty of the physician to whom you wish to change. We will advise you of our decision in this matter. We will only pay bills from the physician you chose first, until a change in physician is approved.
The FECA recognizes chiropractors as physicians only to the extent that their treatment consists of manual manipulation of the spine and only where the accepted condition is a subluxation of the spine. This subluxation must be shown by x-ray to exist. The x-ray must be taken shortly after the claimed injury. The chiropractor's report must provide an exact diagnosis of your condition based upon this x-ray and explain how the subluxation is related to the claimed injury. Referrals by a chiropractor for other treatment must be approved by OWCP in advance.
If your injury requires physical therapy, it is usually authorized for the first 120 days from the date of injury. We will need further medical support for physical therapy beyond 120 days. OWCP must approve in advance any surgery or procedure other than emergency surgery (that is, a procedure which must be performed right away to preserve life or the function of an organ or body part). You (or your medical provider) should contact OWCP for authorization at least 30 days before the intended date of the procedure. We will advise you of the information needed to determine whether OWCP can pay for the requested procedure.
Telephone medical authorization requests should be directed to our central bill processing agent. Further information regarding medical authorizations can be found in the Medical Authorization/Bill Pay for Injured Workers section of our website.
All paper bills should be submitted to the designated U.S. Department of Labor, DFEC mailing address. Bills from medical providers other than hospitals should be submitted on a Form HCFA-1500 (also known as OWCP-1500). This is a standard medical billing form that is readily available to all medical providers. Please be sure your case number is entered on the billing form.
Reimbursements : Reimbursements to you for bills you have paid must still be submitted on the same required forms listed above with proof of your payment. Include Form CA-915 with all requests for reimbursement.
Hospital Bills: These should be submitted on Form UB -92. The hospital admission/discharge summary should be included with the bill.
Pharmacy Bills: The preferred method of payment is for the pharmacy to directly bill electronically via Point of Sale. Pharmacy reimbursement claims must include the NDC Code for the prescription drug and the vendor's NCPDP number.
Travel Reimbursements: These requests should be submitted on OWCP-957, available at your personnel or injury compensation office.
Change of Address:
If your contact information changes (mailing address or telephone number), notify us promptly in writing over your signature. We cannot accept these changes over the telephone. Be sure to include your case number.
Attorneys and Authorized Representatives:
You do not need the services of an attorney or representative to claim benefits under the FECA. However, you may obtain such services if you wish to do so, at your own expense. Before we can release information to, or discuss your case with, any representative, including a family member, we will need a statement signed by you, stating that you designated someone to represent you in your OWCP claim. The contact information for that party is also required.