Printing - FECA-PT2 - United States Department of Labor

A case should remain in AP/PR status while the CE is determining its ultimate
disposition. Cases in PR status for one year or more should be reviewed to
determine whether there is a basis for rehabilitation, re-employment, or wage
earning capacity determination.
(4) Closure Without Denial. When a claimant who has been receiving
compensation on the daily roll returns to work and is discharged from medical
care, the case is closed AD/C5. A periodic roll case, when entitlement to
medical and compensation ends, becomes AP/C5. However, if expenses for
medical treatment are expected to continue after wage loss compensation
ends (the claimant is working or elected an OPM annuity), the case may be
held in AM/MC status and eventually closed AM/C5.
A0/C5 should not be used routinely on closed cases.
c. Denials.
(1) Use of Denial Codes. A denial adjudication code should reflect a
formal decision with full appeal rights, and the adjudication status date should
be the date of release of the formal decision by the authorized person.
Denied cases are always closed, except on remand from H&R or the ECAB.
The codes are shown in paragraph 6 above.
(2) Denial of Monetary Benefits with Continuing Medical Care. If
monetary benefits are denied by formal decision, but entitlement to
medical benefits continues, the case may be assigned code AT/MC.
Examples of AT/MC are:
(a) Claimant has x-ray evidence of asbestos-related disease,
but no disability for work and is entitled to yearly medical
examinations.
(b) Claimant returned to work without loss of earnings, but will
continue to require periodic payment of medical expenses, as
for prosthesis repair.
The use of these codes will enable district offices to distinguish cases
which are inactive but must be kept open and in inventory (AT/MC)
from those which are temporarily active but may eventually be closed
and removed from inventory via retirement (AM/MC).
(3) Closures. The appropriate closure code when a case is denied
for one of the five basic requirements is C3. C5 may be used with D5
when entitlement ceases after initial acceptance.
d. Reconsideration, Hearings, Appeal. Code D7 or D8 is used when a
remanded case is not in a payment status and a de novo decision has not