Federal Employee's Compensation Act (Worker's Compensation Benefits)

Chapter 5: Section 5

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. 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. 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. The Employees’ Compensation Operations and Management Portal at www.ecomp.dol.gov allows employees to download claim forms, file claims, track the status of existing claims, and upload new documents in existing claims, among other services.

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. Federal employees generally are eligible for FECA coverage regardless of the length of their service or the type of position held. 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 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 submit forms 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.

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.

Overseas Assignments and Deployments—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.

You bear the 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.

If you are injured in a war zone, you 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, you 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.

You may designate the entire FECA death gratuity or a portion to a beneficiary other than a spouse; the employing agency must notify a spouse in that event.

Furloughs—When you are on total or partial wage loss benefits and your employing agency orders a furlough, FECA compensation continues at the usual rate and you remain on leave without pay status. If you are required to work a modified light duty schedule, compensation benefits are not payable for work time lost as a result of a furlough.

If you sustain a traumatic injury and are receiving continuation of pay before a furlough day has been scheduled, continuation of pay will apply. However, if you sustain a traumatic injury and already have been scheduled for one or more furlough days, there would be no COP entitlement for any day that you were not scheduled to work due to furlough.

Schedule award and medical benefits are unaffected by a furlough.

Injuries incurred when you are off work due to a furlough are not compensable. Also see Furloughs in Chapter 9, Section 1

POWER Initiative—A July 19, 2010, presidential memo created a 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.

Continuation of Pay

If you sustain a disabling traumatic injury, you are entitled to continuation of pay (COP) for a period not to exceed 45 calendar days. This is considered salary for all 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.

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 your monthly pay 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 you resume regular full-time employment with the federal government), whichever is greater.

FECA compensation generally is calculated at two-thirds of your monthly pay rate if you have 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 (including same-sex spouses married in a jurisdiction recognizing such marriages, regardless of place of residence) residing with you or receiving regular support payments from you; an unmarried child who lives with you or who receives regular support payments from you 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 you. 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, you return 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 your loss of earning capacity. If you are partially disabled, the wage earning capacity is determined by actual earnings, or if you have no actual earnings, an amount determined by OWCP taking into consideration the nature of the injury and other factors that affect your 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.)

Claimants generally are required to either provide electronic funds transfer information for direct deposit of their payments to an account at a financial institution or enroll in the Treasury’s Direct Express program (the main exception is payments to beneficiaries residing in foreign countries). Those not doing so will be enrolled in the Direct Express Debit MasterCard card program, a prepaid debit card program.

Insurance Coverage—When a federal employee enters a leave without pay status, the employing agency no longer deducts health and life insurance premiums. If compensation for wage loss is payable under the FECA, the responsibility for making those deductions transfers to the OWCP. OWCP deductions for health and life insurance become effective on the first day of unpaid leave status. Insurance deductions are not made for intermittent hours or days within a pay period.

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.

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. You may retain optional FEGLI life insurance while receiving compensation if you are eligible to continue Basic insurance and 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 you, 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—If you 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.

Schedule Awards

Schedule awards are payments 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. The covered injuries, standards of determination and amounts payable are at 20 CFR 10.404.

Schedule award amounts vary from 15 weeks to 312 weeks of compensation. There is an additional award for serious disfigurement of the head, face or neck.

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.

Schedule awards can be paid while you are receiving federal salary or retirement benefits, are working for private industry, or are self-employed. You may not receive wage loss compensation and schedule awards benefits concurrently for the same injury.

If you sustain 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 you die during the course of a schedule award from causes unrelated to the compensable injury, your dependents are entitled to two-thirds of the balance of the award.

Also see Compensation Schedule at www.dol.gov/owcp/dfec/regs/statutes/feca.htm.

Medical Care Benefits

FECA covers all medical care you need 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. You have 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 you to the extent allowed by federal and state law. If your injury requires physical therapy, the therapy usually is authorized for the first 120 days from the date of injury. OWCP requires 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 a non-emergency procedure. OWCP will advise you of the information needed to determine whether it will pay for the requested procedure.

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 begins to receive 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. Medical bills can be submitted online through http://owcp.dol.acs-inc.com/portal/main.do.

Pharmacy Fee Schedule—Effective May 1, 2014, the Office of Workers’ Compensation calculates the maximum allowable fee for pharmacy billings of prescription drugs using a formula which differentiates between brand name and generic drugs. For federal employees, the maximum allowable fee is 90 percent of the average wholesale price for brand name drugs and 70 percent for generic drugs, plus a $4 dispensing fee for both each.

Vocational Rehabilitation—If you are permanently disabled, you 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 you are undergoing an approved course of training. Also, you will be paid compensation at the rate for total disability while pursuing an OWCP-approved training course.

Survivor and Death Benefits

If you die as a result of a job-related injury, your surviving spouse and dependents may qualify for monthly compensation benefits. Your surviving spouse must be living with or dependent for support on you at the time of death (or living apart for reasonable cause or because of your desertion). These policies include a same-sex marriage valid in the jurisdiction where the marriage took place regardless of the place of residence.

If no children are eligible, your surviving spouse would receive 50 percent of your salary. If there are children, your surviving spouse would receive 45 percent of your 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 salary and each additional child is entitled to 15 percent, up to a maximum of 75 percent, payable on a share and share alike basis.

Compensation to your surviving spouse ends on his or her death or on remarriage unless 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.

If there is no surviving spouse or eligible child, parents, minor brothers and sisters, and grandparents and grandchildren who were totally dependent on you at the time of death may be entitled to smaller survivor benefits.

If survivors are eligible for both death compensation and a survivor annuity from OPM, they must elect only one of the benefits.

Survivor benefits will be reduced if you were covered under FERS and the survivors are eligible for Social Security benefits based on your federal employment.

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

FECA compensation will be terminated if medical evidence is submitted that indicates that you no longer have residual limitations from the accepted condition and can return to the former job without limitations; or your employer makes a suitable job offer which is unreasonably refused by you. OWCP will determine both the suitability of the job offer and the reasonableness of your refusal.

It is your responsibility to advise your agency if 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 generally is used for this purpose. If your agency can provide work within your restrictions, you are required to return to work.

Also, OWCP requires most individuals receiving FECA disability benefits to undergo medical examinations at its discretion by a medical officer of the United States or by a physician designated or approved by the Labor Department. You may have a physician designated and paid by you present to participate in the examination. If there is disagreement between the two physicians, the department appoints a third.

Receipt of a schedule award (see above) does not necessarily mean the recipient has recovered for purposes of job restoration rights. It only means that part of the body is considered to have reached maximum medical improvement.

FECA benefit payments can be suspended if you do not cooperate with a specific directive from OWCP (such as to undergo a medical examination as described above) or fail 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.

Job Restoration Rights—The restoration rights of employees who sustain compensable injuries fall into four categories depending on the duration of the injury and the extent of recovery:

• Fully recovered within one year. If you fully recover within one year from the date compensation began, you have mandatory restoration rights to your 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. You must apply for restoration immediately and must be restored immediately and unconditionally by your former agency.
• Fully recovered after one year. If full recovery takes longer than one year from the date compensation begins, you are entitled to priority consideration for your former position or an equivalent one, provided you apply for restoration within 30 days of the date compensation ends. Priority consideration means the agency enters you on its re-employment priority list. If the agency cannot place you in your former commuting area, you are entitled to priority consideration for an equivalent position elsewhere in the agency.
• Physically disqualified. If you are a FECA compensationers who is medically unable to return to your former occupation but you are able to do other work, you are considered to be physically disqualified. You 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 you otherwise would be entitled, depending on the circumstances. These restoration rights are agency-wide. After one year, you 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, if you are a partially recovered employee, you are expected to fully recover eventually. If you have not yet fully recovered but are able to work in some capacity, you are entitled to be considered for employment in the former commuting area. Your agency must make every effort to place you, but there is no absolute right to restoration. If you are restored at a lower grade or pay level, OWCP will make up the difference in pay, or your agency may elect to pay you at the former rate. If you later fully recover, you are entitled to the restoration rights of a fully recovered employee, based on the timing of the recovery. If you are a partially recovered employee, you have an obligation to seek employment within your capabilities. If you refuse to accept a suitable job offer, OWCP may terminate compensation. OWCP determines whether an agency job offer is suitable according to your medical restrictions, education, and vocational background.

Other factors affecting restoration rights are the timeliness of the application for restoration, your performance and conduct prior to the injury, and the availability of positions. (Note: As an injured employee, you enjoy no special protection in a reduction in force. Separation by reduction in force or for misconduct while on compensation means you have no restoration rights.) Full recovery is determined by a decision to end FECA benefits on the basis that you are 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. Your standing in the organization, such as supervisory level, is not a factor. You may appeal to the Merit Systems Protection Board asserting an agency’s failure to restore, improper restoration, or failure to return you following a leave of absence. See 5 CFR 353 subpart C.

Claims-Filing Time Limits

The Federal Employees’ Compensation Act provides that a claim for compensation must be filed within three years of the injury. For a traumatic injury, the time limit begins to run from the date of injury. For a latent condition, it begins to run when an injured employee with a compensable disability becomes aware, or reasonably should have been aware, of a possible relationship between the medical condition and the employment. Where the exposure to the identified factors of employment continues after this knowledge, the time for filing begins to run on the date of the employee’s last exposure to those factors.

If a claim is not filed within three years, compensation still may be paid if written notice of injury was given within 30 days or if the employer had actual knowledge of the injury within 30 days after it occurred. Timeliness is determined by the OWCP district office as part of the adjudication process.

Administration

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.

Appeals

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 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, fax (202) 693-6367, 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 501. Decisions of the ECAB are final and may not be appealed to federal or state courts.

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