Chapter 5, Section 5: Federal Employees' Compensation Act (Workers' Compensation Benefits)
The Federal Employees' Compensation Act (FECA) (5 U.S.C. 8101) is the law governing the payment of workers' compensation benefits to federal employees who suffer a disability due to personal injury (including occupational disease) sustained while in the performance of duty and recurrences of such disabilities after release from treatment for them.
- By Almanac Staff
- Feb 19, 2012
General Rules and Procedures
The Federal Employees' Compensation Act (FECA) (5 U.S.C. 8101) is the law governing the payment of workers' compensation benefits to federal employees who suffer a disability due to personal injury (including occupational disease) sustained while in the performance of duty and recurrences of such disabilities after release from treatment for them. The act also provides for the payment of benefits to dependents if a job-related injury or disease causes the employee's death.
FECA is administered by the Labor Department's Office of Workers' Compensation Programs (OWCP) through district offices (see the table in this section), www.dol.gov/owcp/dfec. FECA forms are at www.dol.gov/owcp/dfec/regs/compliance/forms.htm; most are fillable electronically and some are submittable electronically. FECA rules are at 20 CFR Parts 1, 10, and 25.
All injuries, including disease proximately caused by employment, sustained while in the performance of duty by civilian employees of the United States (with the exception of non-appropriated fund employees), are covered, as are diseases and illnesses aggravated, accelerated or precipitated by the employment. Damage to or destruction of medical braces, artificial limbs, and other prosthetic devices incidental to a job-related personal injury is also compensable.
Probationary, temporary, part-time, seasonal, intermittent and term employees are covered on the same basis as permanent employees. Also, coverage is provided by special legislation to Peace Corps and VISTA volunteers, federal petit or grand jurors, volunteer members of the Civil Air Patrol, Reserve Officer Training Corps cadets, Job Corps, Neighborhood Youth Corps and Youth Conservation Corps enrollees, and nonfederal law enforcement officers under certain circumstances (e.g., situations involving crimes against the United States).
To claim benefits under FECA, an employee who sustains a work-related traumatic injury must give notice of the injury in writing on Form CA-1, which may be obtained from the employer or from the online address above. The employee must submit this notice to the employer. Another person, including the employer, may give notice of injury on the employee's behalf. FECA encourages applicants to electronically submitforms that can be submitted in that way.
The employee must provide medical and factual evidence to establish the essential elements of a claim. These elements generally include proof that the claim was filed within FECA's statutory time requirements, the injured or deceased person was an employee within the scope defined by FECA, the employee sustained an injury or disease, the employee was in the performance of duty when the injury occurred, and the employee's compensable condition resulted from the injury.
Benefits cannot be paid if a worker's injury or death is caused by the injured employee's intoxication or willful misconduct or by an intent to bring about the injury or death of oneself or another.
All injuries should be reported, since a seemingly minor injury may develop into a more serious condition. For protection, the employee should file a report of the injury with the immediate supervisor when it occurs. Benefits will not be paid unless an injury is reported.
A traumatic injury is defined as a wound or other condition of the body caused by external force, including stress or strain. The injury must be caused by a specific event or incident or series of events or incidents within a single day or work shift. Traumatic injuries include damage solely to or destruction of prostheses, such as dentures or artificial limbs. Traumatic injuries also include damage to or destruction of personal appliances, such as eyeglasses or hearing aids, when a personal injury requiring medical services occurred.
|Labor Department District Offices Workers’ Compensation Programs |
|U.S. Dept. of Labor, OWCP District Office Address
|District No. 1 — Boston
JFK Federal Building
Boston, MA 02203
(617) 624-6604 Fax
|Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont |
|District No. 2 — New York
201 Varick St.
New York, NY 10014
(646) 264-3006 Fax
|New Jersey, New York, Puerto Rico, and the Virgin Islands |
|District No. 3 — Philadelphia
Curtis Center, Suite 715 East
170 S. Independence Mall West
Philadelphia, PA 19106-3308
(215) 861-5453 Fax
|Delaware, Pennsylvania, and West Virginia; Maryland for claimants’ zip codes beginning with 21*** |
|District No. 6 — Jacksonville
400 West Bay St., Room 826
Jacksonville, FL 32202
(904) 357-4773 Fax
|Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee |
|District No. 9 — Cleveland
1240 E. Ninth St.
Cleveland, OH 44199
(216) 357-5378 Fax
|Indiana, Michigan, and Ohio; All special claims and all areas outside the U.S., its possessions, territories and trust territories |
|District No. 10 — Chicago
8th Floor, 230 S. Dearborn St.
Chicago, IL 60604
(312) 596-7145 Fax
|Illinois, Minnesota, and Wisconsin |
|District No. 11 — Kansas City
Two Pershing Square Bldg.
2300 Main St. Suite 1090
Kansas City, MO 64108-2416
(816) 502-0314 Fax
|Arkansas, Iowa, Kansas, Missouri, and Nebraska, all employees of the Department of Labor except Job Corps enrollees and their relatives |
|District No. 12 — Denver
P.O. Box 25602
One Denver Federal Center
Denver, CO 80225-0602
(720) 264-3124 Fax
|Colorado, Montana, New Mexico North Dakota, South Dakota, Utah, and Wyoming |
|District No. 13 — San Francisco
90 Seventh St., Suite 15300
San Francisco, CA 94103
(415) 625-7450 Fax
|Arizona, California, Hawaii and Nevada|
|District No. 14 — Seattle
1111 Third Ave., Suite 650
Seattle, WA 98101-3212
(206) 398-8151 Fax
|Alaska, Idaho, Oregon, and Washington|
|District No. 16 — Dallas
525 S. Griffin St., Room 100
Dallas, TX 75202
(972) 850-2301 Fax
|Louisiana, Oklahoma and Texas|
|District No. 25 — Washington, DC
800 N. Capitol St. N.W., Room 800
Washington, DC 20211
|District of Columbia and Virginia; Maryland when the claimant's zip code other than 21***|
An occupational disease is defined as a condition produced in the work environment over a period longer than one workday or shift. It may result from systemic infection, repeated stress or strain, exposure to toxins, poisons, fumes, or other continuing conditions of the work environment.
The length of exposure, not the cause of the injury or the medical condition which results, determines whether an injury is traumatic or occupational. For instance, if an employee is exposed to toxic fumes for one day, the incident is considered a traumatic injury. If the employee is exposed to toxic fumes for two or more days, the incident is considered an occupational disease.
A recurrence of disability is defined as a spontaneous return or increase of disability due to a previous injury or occupational disease without intervening cause, or a return or increase of disability due to a consequential injury. A recurrence of disability differs from a new injury in that with a recurrence, no event other than the previous injury accounts for the disability. A recurrence of medical condition is defined as a documented need for further medical treatment after release from treatment for the accepted condition or injury when there is no accompanying work stoppage. Continuous treatment for the original condition or injury does not qualify, nor does an examination without treatment.
Where an employee's injury or death in the performance of duty occurs under circumstances placing a legal liability on a party other than the United States, a portion of the cost of compensation and other benefits paid by OWCP must be refunded from any settlement obtained. OWCP will assist in obtaining the settlement and the Act guarantees that the employee may retain a certain proportion of the settlement (after any attorney fees and costs are deducted) even when the cost of compensation and other benefits exceeds the amount of the settlement.
Deployment -- While federal employees located abroad are not covered at all times and under all situations, deployed employees in travel status or on a special mission are covered under FECA for activities reasonably incidental to their employment, such as eating, sleeping and travel. Other principles adopted by federal workers' compensation law serve to extend FECA coverage to employees beyond performing the ordinary tasks of employment.
Further, FECA specifically covers any injury or death outside of the continental United States, other than an employee whose residence was at or near his or her place of employment, as a result of a "war risk hazard," which encompasses a wide variety of hostile actions, including terrorist acts targeting the United States or its allies.
An employee bears responsibility to submit supporting medical evidence. For example, a claim for extended disability may require detailed evidence explaining how the claimed injury relates to the deployment and the nature and length of the disability. OWCP can grant additional time when obtaining medical evidence is difficult.
While every injured employee has a right under FECA to their initial choice of physician, employees injured in a war zone may under certain circumstances request treatment at a military facility with expertise in injuries that more commonly occur in deployment.
Also see www.dol.gov/owcp/dfec/deployedemployees.htm.
See Employment Rights of Those on Military Duty in Chapter 8, Section 8 for coverage while on military duty.
A FECA death gratuity of up to $100,000 may be payable for a covered death due to service with an Armed Force in a contingency operation. Before deploying, employees may wish to complete the CA-40 Designation of Recipient of Death Gratuity Payment, available at www.dol.gov/owcp/dfec/regs/compliance/CA-40.pdf. Otherwise, that benefit would be paid according to a standard order of precedence.
POWER Initiative -- A July 19, 2010, presidential memo created a four-year program called the POWER initiative, for Protecting Our Workers and Ensuring Re-Employment, which added to prior workplace safety and health initiatives. It ordered agencies to improve their performance in: reducing total injury and illness case rates; reducing and analyzing lost time injuries; improving the timely filing of workers' compensation and wage loss claims; reducing lost production day rates; and speeding employees' return to work after serious injury or illness. Agencies were ordered to establish performance targets in each category, with general oversight by the Labor Department. See www.dol.gov/owcp/dfec/power.
Return to Work Initiative -- Executive Order 13548 of 2010 instructed agencies to raise rates of return to work for employees who sustain work-related injuries and illnesses, through increasing the availability of job accommodations and light or limited duty assignments, removing disincentives for claimants to return to work, and similar steps. The Office of Personnel Management and the Labor Department were made responsible for setting policies to assess agency performance in improving return to work and FECA claims processing.
FECA Coverage Rules
Federal employees generally are eligible for FECA coverage regardless of the length of time they've been on the job or the type of position held. Compensation payments can be made after wage loss begins and medical evidence shows that the employee is unable to perform the duties of his or her regular job.
An employee who sustains a disabling traumatic injury is entitled to continuation of pay (COP) for a period not to exceed 45 calendar days. This is considered salary for all intents and purposes, including tax deductions, and not injury compensation. In order to be eligible for COP, written notice of injury must be filed within 30 days of the injury.
Note: Under 5 U.S.C. 8117, U.S. Postal Service employees are not eligible for continuation of pay for the first three days of temporary disability. They may use annual leave, sick leave or leave without pay during that period. If the disability lasts more than 14 days or proves to be permanent, any annual or sick leave used will be restored and the employee will receive pay for any unpaid leave used.
See 20 CFR 10.200 for detailed policies on COP, including the exclusions of certain categories of employees.
Schedule awards are FECA payments that are provided for specified periods of time for the permanent loss, or loss of use, of certain parts and functions of the body. Partial loss or loss of use of these parts and functions is compensated on a proportional basis. Before payment of a schedule award can be considered, the condition of the affected part of the body must reach maximum improvement. This determination involves a medical judgment that the condition has permanently stabilized.
FECA Compensation Payments
Total disability benefits may be paid to injured workers to compensate them for lost wages after the end of a continuation-of-pay period or from the beginning of pay loss. An employee who receives disability payments will be notified by letter of the amount of compensation to be paid, including the pay rate used as a basis and the resulting compensation rate. Compensation payments for total disability may continue as long as the medical evidence substantiates total disability.
No compensation is payable for the first three days of wage loss unless the disability exceeds 14 days after the expiration of COP, where COP is payable, or the injury results in permanent impairment. Injured employees may use sick or annual leave credited to their account if so desired, in which event FECA compensation does not begin until the expiration of leave.
Monetary compensation is based on the monthly pay of the injured employee at the time of the injury, at the time the disability begins, or at the time a compensable disability recurs (if such recurrence begins more than six months after the injured employee resumes regular full-time employment with the United States), whichever is greater.
FECA compensation generally is calculated at two-thirds of the employee's monthly pay rate if he or she has no dependents, or three-fourths of the pay rate if married or with one or more dependents. For FECA benefit purposes, a dependent is: a wife or husband residing with the employee or receiving regular support payments from him or her; an unmarried child who lives with the employee or who receives regular support payments from him or her who is under age 18, or if over age 18 is incapable of self-support due to physical or mental disability; a student between 18 and 23 years of age who has not completed four years of post-high school education and who is regularly pursuing a full-time course of study; and a parent who is wholly dependent on the employee.
Locality, night differential, hazard, premium, holiday, and Sunday pay are included in determining the pay rate on which compensation is based, although overtime pay is not. The maximum payment per month cannot exceed three-fourths of the highest rate of basic pay provided for grade GS-15.
Minimum monthly compensation for total disability cannot be less than three-fourths of the lowest basic monthly pay level for GS-2, or the employee's monthly pay, whichever is less, except for increases resulting from cost-of-living adjustments.
If, as the result of an on-the-job injury, an employee returns to work at a lower rate of pay, compensation for loss of earning capacity is paid at the rate of two-thirds (without dependents) or three-fourths (with dependents) of the loss of earning capacity. The wage earning capacity of a partially disabled employee is determined by actual earnings, or if the employee has no actual earnings, an amount determined by OWCP taking into consideration the nature of the injury and other factors that affect the capacity to earn wages.
Compensation for disability cannot be paid concurrently with an annuity (including a lump-sum payment) under the Civil Service Retirement System (CSRS), or the Federal Employees Retirement System (FERS), or any other law providing retirement benefits in lieu of those provided under CSRS or FERS. An employee entitled to both types of benefits (i.e., retirement and FECA) must make an election; however, a new election may be made whenever it is to the employee's advantage to do so. (See Section 6 in this chapter.)
Insurance Coverage -- Under the Federal Employees Health Benefits program, employees, former employees, and survivors of deceased employees who meet certain requirements may continue their health benefits coverage while in receipt of disability or death compensation. The employee's or survivor's share of the cost of the FEHB insurance is withheld from the compensation.
Premiums for Federal Employees' Group Life (FEGLI) Insurance program Basic life insurance are withheld from compensation payments. The election of post-retirement Basic life insurance at the time of retirement determines whether Basic life insurance will decline after age 65 and if so, at what rate. OWCP will deduct premiums for post-retirement Basic life insurance when told to do so by OPM. An employee may retain optional FEGLI life insurance while receiving compensation if he or she is eligible to continue Basic insurance and has had the optional coverage for no less than the five years of service immediately preceding the disability, or the full period of service during which the optional coverage was available to that person, if less than five years.
Individuals receiving compensation who are separated from federal service, along with certain family members, are eligible to elect or continue coverage under the Federal Long-Term Care Insurance Program. See Eligibility in Chapter 2, Section 3.
Those on injury compensation, along with annuitants and survivor annuitants, are eligible to elect or continue coverage under the Federal Employees Dental and Vision Insurance Program. See Eligibility in Chapter 2, Section 4.
Cost-of-Living Adjustments -- For individuals who have been in receipt of compensation benefits for more than one year, those benefits are increased effective March 1 of each year by any percentage change in a Consumer Price Index for the 12 month period ending with December of the preceding year.
FECA may pay a schedule award for a permanent impairment to certain members or functions of the body (such as loss of use of an eye or arm or loss of function or removal of a kidney due to injury). The covered injuries, standards of determination, and amounts payable are at 20 CFR 10.404.
Schedule awards can be paid during a period where the employee is receiving federal salary or retirement benefits, is working for private industry, or is self-employed. Employees may not receive wage loss compensation and schedule awards benefits concurrently for the same injury.
If an employee sustains a period of temporary total disability during the course of the award, it may be interrupted to pay the period of disability; the schedule award will resume afterwards. If an employee dies during the course of a schedule award from causes unrelated to the compensable injury, his or her dependents are entitled to two-thirds of the balance of the award.
Schedule award amounts vary from 15 weeks to 312 weeks of compensation for total loss or loss of use of designated body parts. There is an additional award for serious disfigurement of the head, face or neck.
Medical Care Benefits
FECA covers all medical care that an employee needs to recover from the effects of a work-related injury, including hospitalization, nursing service, prosthetic appliances, and services of an attendant when required in severe injuries. The injured employee has the initial choice of physician and may select any qualified local physician or hospital to provide necessary treatment or may use agency medical facilities if available.
Except for referral by the attending physician, any change in the treating physician after the initial choice must be authorized by OWCP. Otherwise, OWCP will not be liable for the expenses of treatment. If there is any doubt as to whether a specific service, appliance, or supply is necessary to treat the work-related injury, the employee should consult OWCP prior to obtaining it.
The term "physician" includes surgeons, osteopathic practitioners, podiatrists, dentists, clinical psychologists, optometrists, and chiropractors within the scope of their practice as defined by state law. Payment for chiropractic services is limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist. If the physician selected has been excluded from participating in the compensation program the pertinent OWCP district office will advise the employee of the exclusion and the need to select another physician.
Non-physician providers such as physician assistants, nurse practitioners, and physical therapists may also provide authorized services for injured employees to the extent allowed by federal and state law.
Medical care coverage also extends to the necessary cost of transportation and expenses incident to securing medical services, appliances and supplies. Medical care for a compensable injury may be continued after a beneficiary accepts a retirement annuity. Bills for injury-related medical expenses should be submitted promptly. No bill will be paid for expenses incurred if the bill is submitted more than one year beyond the end of the calendar year in which the expense was incurred, or more than one year beyond the end of the calendar year in which the claim was first accepted as compensable, whichever is later.
Vocational Rehabilitation -- A permanently disabled employee may be provided with vocational rehabilitation services and an additional allowance may be paid for necessary maintenance in an amount not to exceed $200 per month while the employee is undergoing an approved course of training. Also, an employee will be paid compensation at the rate for total disability while pursuing an OWCP-approved training course.
Survivor and Death Benefits
When an employee dies as a result of a job-related injury, the individual's surviving spouse and dependents may qualify for monthly compensation benefits. The surviving spouse must be living with or dependent for support on the injured worker at the time of death (or living apart for reasonable cause or because of the employee's desertion).
If no children are eligible, a deceased worker's surviving spouse would receive 50 percent of the employee's salary. If there are children, a surviving spouse would receive 45 percent of the worker's salary, plus an additional 15 percent for each child up to a total of 75 percent of salary. If there is no widow or widower, FECA compensation for the first child is 40 percent of the employee's salary and each additional child is entitled to 15 percent of the employee's salary, up to a maximum of 75 percent, payable on a share and share alike basis.
Compensation to an employee's surviving spouse terminates upon his or her death or remarriage. A widow or widower's benefits continue, however, if the remarriage takes place after the age of 55. Awards to children, brothers, sisters and grandchildren end at the age of 18, unless the dependent is incapable of self-support, or continues to be a full-time student at an accredited institution, until he or she reaches the age of 23, or has completed four years of education beyond the high school level.
Compensation for a child ends when the child marries or reaches age 18. It can continue, however, after age 18 if the child is a full-time student, unmarried, under age 23, and has not completed four years of education beyond high school. It can also continue if the child is incapable of self-support because of physical or mental disability.
In rare instances, parents, minor brothers and sisters, and grandparents and grandchildren who were totally dependent on the deceased employee at the time of death may be entitled to a small portion of survivor benefits. Payments are not made after a beneficiary marries or completes four years of study beyond high school. When survivors are eligible from OPM, they may be eligible for both death compensation benefits and a survivor annuity from OPM. They must elect which of the two benefits they wish to receive.
Survivor benefits will be reduced if the employee was covered under FERS and the survivors are eligible for Social Security benefits based on the employee's federal
FECA provides for payment of reasonable burial expenses, up to a maximum of $800. Apart from any funeral or burial expenses, a separate sum of $200 is paid to the personal representative of a deceased employee for reimbursement of the costs incurred in terminating the deceased worker's status as an employee of the United States.
Recovery and Job Restoration
OWCP requires most individuals receiving FECA disability benefits to undergo medical examinations once a year. The evaluation usually is done by the employee's own physician. OWCP may, however, require the employee to be examined by another physician. FECA compensation will be terminated if medical evidence is submitted that indicates that the employee no longer has residual limitations from the accepted condition and can return to the former job without limitations; or the individual's employer makes a suitable job offer which is unreasonably refused by the employee. OWCP will determine both the suitability of the job offer and the reasonableness of a worker's refusal.
Receipt of a schedule award -- i.e., an OWCP payment for a permanent impairment of a specified body member, function, or organ -- does not necessarily mean the individual has recovered for purposes of job restoration rights. It only means that part of the employee's body is considered to have reached maximum medical improvement.
FECA benefit payments can be suspended if the employee does not cooperate with a specific directive from OWCP (such as a request to report for medical examination) or fails to respond within 30 days to a request for information on employment/earnings, dependents, or the receipt of dual benefits. Similarly, FECA compensation can be suspended if a beneficiary in a death case fails to respond to a request for information on continuing entitlement, such as verification of student status. Where an individual's response to such requests is subsequently received, OWCP may reinstate benefits retroactive to the date of suspension, if appropriate.
Job Restoration Rights -- If employees recover from their disability within one year from the date they became entitled to FECA payments, they have the right to return to their former jobs or an equivalent position. Even if their period of disability extends beyond one year, employees have priority placement rights to their former or equivalent positions.
The restoration rights of employees who sustain compensable injuries fall into four categories depending on the length and extent of recovery. Other factors affecting restoration rights are the timeliness of the application for restoration, the employee's performance and conduct prior to the injury, and the availability of positions. See 5 CFR 353, subpart C.
Full recovery is determined by a decision to terminate FECA benefits on the basis that the employee is medically able to resume regular employment. For purposes of restoration rights, a position with the same seniority, status, and pay means a position that is equivalent to the former one in terms of pay, grade, type of appointment, tenure, work schedule, and, where applicable, seniority. An employee's standing in the organization, such as first or second supervisory level, is not a factor.
The four categories are:
- Fully recovered within one year. Employees who fully recover within one year from the date compensation began have mandatory restoration rights to their former job or an equivalent position. This basic entitlement is to a position in the former commuting area. If a suitable vacancy does not exist, the restoration right is agency-wide. Employees must apply for restoration immediately and must be restored immediately and unconditionally by their former agency.
- Fully recovered after one year. If full recovery takes longer than one year from the date compensation begins, injured employees are entitled to priority consideration for their former position or an equivalent one, provided they apply for restoration within 30 days of the date compensation ends. Priority consideration means the agency enters the individual on its re-employment priority list. If the agency cannot place such individuals in their former commuting area, they are entitled to priority consideration for an equivalent position elsewhere in the agency.
- Physically disqualified. FECA compensationers who are medically unable to return to their former occupation, but who are able to do other work, are considered to be physically disqualified. Such individuals are entitled, within one year of the date compensation begins, to be placed in a position that most closely approximates the seniority, status, and pay to which they otherwise would be entitled, depending on the circumstances of the case. These restoration rights are agency-wide. After one year, such individuals are entitled to the same restoration rights as individuals who fall into the "partially recovered" category described below. Physically disqualified employees typically have a permanent medical condition that disqualifies them for their old or an equivalent position and makes it unlikely that they will ever be able to return to the former position.
- Partially recovered. In contrast to a physically disqualified worker, a partially recovered employee is expected to fully recover eventually. These individuals, who have not yet fully recovered but are able to work in some capacity, are entitled to be considered for employment in the former commuting area. The agency must make every effort to place the employee, but there is no absolute right to restoration. If the individual is restored at a lower grade or pay level, OWCP will make up the difference in pay, or the agency may elect to pay the employee at the former rate. If such employees later fully recover, they are entitled to the restoration rights of a fully recovered employee, based on the timing of the recovery. Partially recovered employees have an obligation to seek employment within their capabilities. If a partially recovered employee refuses to accept a suitable job offer, OWCP may terminate compensation. OWCP determines whether an agency job offer is suitable according to the individual's medical restrictions, education, and vocational background.
Claims-Filing Time Limits
Written report of a work-related injury must be given within 30 days to the employee's immediate superior and a claim for disability or death compensation must be filed within three years. The time limitations do not apply to: (1) minors until they reach the age of 21 or have had a legal representative appointed and (2) incompetent individuals while they are incompetent and have no duly appointed legal representative. In cases of latent disability, the time limitations do not begin to run until the employee has a compensable disability and is aware, or reasonably should be aware, that the disability is causally related to employment. A claim for disability or death compensation filed after the three-year period may not be allowed, unless the immediate superior had actual knowledge of the injury or death within 30 days, or written notice of the injury or death was properly given within 30 days.
The Act is administered by the Office of Workers' Compensation Programs (OWCP) of the Department of Labor. Further information regarding the law is at www.dol.gov/owcp/contacts/fecacont.htm or write to the Office of Workers Compensation Programs, U.S. Department of Labor, 200 Constitution Ave. N.W., Washington, DC 20210. The adjudication and payment of claims is handled by OWCP district offices (see the table in this section).
OWCP has a toll-free automated system that provides information regarding specific claims. By calling (866) 692-7487, injured workers and their representatives may access information regarding case status and compensation payments. Callers need to have their nine-digit case file or claim number and Social Security number.
All medical authorizations and bill processing are handled by a private contractor. Injured workers, medical providers, and employing agencies may go to http://owcp.dol.acs-inc.com to check eligibility and learn if authorization is required for a particular procedure, to check authorization and learn if authorization has been approved, to check bill payment status and to learn the status of submitted bills and reimbursement requests. Automated claimant eligibility, bill status, and medical authorization status is also available at (866) 335-8319.
OWCP asks that claimants first contact a district office (see table in this section) to resolve issues related to case status and compensation payment, and the contact points above to resolve issues related to medical authorizations and bill payments. Problems may also be addressed to the district directors for the Federal Employees' Compensation Program, and the regional directors for the Office of Workers' Compensation Programs.
All mail and bills for federal workers' compensation cases should be sent to: U.S. Department of Labor, DFEC Central Mailroom, P.O. Box 8300, London, KY 40742-8300.
There are three methods for reviewing a formal decision of the Office of Workers' Compensation Programs: reconsideration by the district office, a hearing before an OWCP hearing representative, and appeal to the Employees' Compensation Appeals Board (ECAB). For each method, time limitations and other restrictions apply (waivers are granted under certain circumstances), and not all options are available for all decisions. Specific rules and procedures are in 20 CFR Part 10, subpart G.
A request for reconsideration must be submitted to the district office within one year of the date of the OWCP decision for which review is sought and must contain either new evidence or new argument meeting certain thresholds. If reconsideration is granted, the case is reopened and reviewed on its merits.
A decision denying an application for reconsideration cannot be the subject of another application for reconsideration. The only review for this type of decision is an appeal to the ECAB.
A hearing is a review of an adverse decision by a hearing representative. The claimant can choose between an oral hearing or a review of the written record. At the discretion of the hearing representative, an oral hearing may be conducted by telephone, teleconference, videoconference, or other electronic means. In addition to the evidence of record, the employee may submit new evidence to the hearing representative.
A hearing request must be sent within 30 days (as determined by postmark or other carrier's date marking) of the date of the decision for which a hearing is sought by writing to the address specified in the decision. The claimant must not have previously submitted a reconsideration request (whether or not it was granted) on the same decision.
Final decisions of OWCP may also be appealed to the ECAB. However, certain types of final decisions cannot be appealed to the ECAB, including: decisions concerning the amounts payable for medical services, decisions concerning exclusion and reinstatement of medical providers, and denials of subpoenas independent of the appeal of the underlying decision.
Review by the ECAB is limited to the evidence of record; no new evidence may be submitted. Request for review by the ECAB must be made within 90 days from the date of the decision (180 days for those living in foreign countries other than Canada) to the Employees' Compensation Appeals Board, U.S. Department of Labor, Room S-5220, 200 Constitution Ave. N.W., Washington, DC 20210, phone (866) 487-2365 ,TTY (877) 889-5627, online www.dol.gov/appeals. If you request a hearing or reconsideration by OWCP as indicated above, the period within which you may request review by the ECAB will run from the date of any later decision by OWCP. Detailed rules are at 20 CFR Part 501.
Decisions of the ECAB are final and may not be appealed to federal or state courts.