Printing - FECA-PT2 - United States Department of Labor

payable.
If COP was elected but must be denied, and the case as a whole is
accepted, the appropriate status is AM/MC. This can change to AD/_
if a claim for leave repurchase or wage loss is accepted. If leave is
elected, but no period of disability is supported by medical evidence,
the appropriate codes are AM/MC.
(4) Closure (in minor cases). With the exception of noncontroverted
no-time-lost cases, all cases must be adjudicated, with acceptance of a
condition or formal denial, as well as appropriate status codes entered into
the case management system.
The appropriate closure codes for adjudicated cases involving no-time-lost,
leave, or short term disability situations are:
AM/C1: Condition accepted. Up to $1500 in medical payments can be
made without adjudication by the CE. No time lost.
AL/C2: Condition accepted. Some disability supported and covered
by leave. No further claim or bills expected.
Non-controverted no-time-lost cases will be closed without adjudication by
the CE as soon as they are created, and will not subsequently require the CE’s
attention unless any of the following apply:
(a)
(b)
The total amount of medical bills exceeds $1500;
Evidence is received to show that the injured employee was
disabled for work after the date of injury;
(c) Evidence is received to show that a schedule award may be
payable for permanent impairment.
Prior to releasing cases to the claims units, the District Office will identify the
non-controverted, no-time-lost traumatic injury cases.
COP cases should not be closed until a date of return to work is in file, on
Form CA-1, Form CA-3, or other documentation in the file. The appropriate
closure code, if no further disability is claimed, is AC/C4.
If COP is elected but disputed in an accepted case, the code should be AM/MC
until closure. The issuance of Form CA-1050 should not lead the CE to assign
a “D” code. If the case as a whole is denied, Form CA-1050 is not used and a
formal notice of decision with appeal rights is issued, with explicit reference to
any COP claimed or paid.
b. Compensation Payment.