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2-0200 GENERAL PROVISIONS OF THE FECA TABLE OF CONTENTS Paragraph and Subject Date Trans. No. Table of Contents 07/04 04-05 1. Purpose and Scope 08/91 91-36 2. General Provisions of the FECA 07/04 04-05 3. Responsibilities of the Claims Examiner 07/04 04-05 4. Reference Materials for Claims Examiners 07/04 04-05 2-0200-1 Purpose and Scope 1. Purpose and Scope. This chapter is intended to serve as an introduction to the coverage and requirements of the Federal Employees' Compensation Act (FECA) as amended. It summarizes the general provisions of the Act and describes the responsibilities of the Claims Examiner (CE) in administering the FECA. The reference materials listed at the end of the chapter should be available to CEs in each district office. 2-0200-2 General Provisions of the FECA 2. General Provisions of the FECA. a. Definition of Injury. The term "injury" includes all diseases proximately caused by the employment as well as damage to or destruction of medical braces, artificial limbs and other prosthetic appliances. Aggravation of a pre-existing condition by the employment is also compensable. b. Requirements for Eligibility. Each claim for compensation must be filed within three years of the date of injury, except where the official superior had actual knowledge of the injury within 30 days of its occurrence. The claimant must be a civil employee, and an injury must have resulted from the incident claimed. Finally, the injury or disease must have occurred in performance of the claimant's duties, and it must be causally related to factors of employment. See FECA PM 2-800 through 2-806. c. Medical Care. An injured employee who meets the statutory conditions of coverage is entitled to all medical care which is required to cure, give relief, or reduce the degree or period of disability. No dollar maximum or time limitation is placed on medical care, which will be provided as long as the evidence indicates it is needed for the effects of the job-related injury. See FECA PM 2-810 and FECA PM Part 3.
d. Continuation of Pay. An employee who sustains a disabling job-related traumatic injury is entitled to continuation of regular pay (COP) for a period not to exceed 45 calendar days. To qualify for COP, the injured employee must file written notice of injury and claim for COP within 30 days of the injury. COP is not considered compensation and is subject to taxes and other payroll deductions. The employee must make separate claim for monetary compensation if the disability exceeds 45 days or results in any permanent disability. See FECA PM 2-807. e. Compensation. Generally, for total disability an employee with no dependents is entitled to compensation equivalent to two-thirds of the weekly salary, while an employee with one or more dependents is entitled to three-fourths of the salary. Certain additional amounts, such as premium pay, night and Sunday differential, dirty work pay, and hazardous duty pay, may be included in salary. Overtime pay, however, cannot be included. A special formula is applied in cases where the employee is a part-time worker, an unpaid volunteer, a temporary employee, or a person working in a similar category. See FECA PM 2-900. Compensation payments are subject to garnishment for past due alimony and child support payments if the district office receives the proper documentation from a state agency or a court order that supports such action. f. Vocational Rehabilitation. If the injured worker suffers a vocational handicap due to the injury and cannot resume usual employment, vocational rehabilitation services may be arranged to assist in training for work that the claimant can perform in the disabled condition. Rehabilitation services are usually provided by private rehabilitation counselors, who are supervised by the OWCP. Where rehabilitation is under way, the OWCP may provide a monthly maintenance allowance not to exceed $200, in addition to compensation for wage loss. See FECA PM 2-813 and OWCP PM Part 3. g. Attendant Allowances. 20 C.F.R. 10.312 allows payment for services of an attendant where it is medically documented that the claimant requires assistance to care for personal needs such as bathing, dressing, eating, etc. Such services are paid as a medical expense under 5 U.S.C. 8103; are limited to $1500 per month under 5 U.S.C. 8111; and are paid directly to the provider of the services. See FECA PM 2-812. h. Duration of Compensation. Compensation payments for total disability may continue as long as the medical evidence supports such payment. As with medical care, no cap is placed on the amount or the length of time for which compensation for total disability may be paid. See FECA PM 2-812. i. Reemployment and Loss of Wage-Earning Capacity. When an injury results in partial disability, and the employee suffers a wage loss because of the disability, compensation may be paid for such loss of wage-earning capacity. See FECA PM 2-814.
Page 1 and 2: LIST OF CHAPTERS PART 2 - CLAIMS (I
Page 3: eference materials, decisions, and
Page 7 and 8: o. Review of OWCP Decisions. Under
Page 10 and 11: 2-0300 COMMUNICATIONS TABLE OF CONT
Page 12 and 13: 2-0300-4 Regular Correspondence 4.R
Page 14 and 15: (1) Format. All letters should be p
Page 16 and 17: If the information requested cannot
Page 18 and 19: few types of cases are developed in
Page 20 and 21: c Filing Down. After reviewing or c
Page 22 and 23: the automated system (see FECA PM 2
Page 24 and 25: i. Advising the Parties. When case
Page 26 and 27: (3) Mail and File staff will notify
Page 28 and 29: 2. Responsibilities. The CE has pri
Page 30 and 31: DO: Disallowed pending. D1: Denied
Page 32 and 33: through the system will be given at
Page 34 and 35: (1) Daily Roll. The codes for daily
Page 36 and 37: een issued. The pay status is UD. D
Page 38 and 39: 1. Worksheet for Investigation of F
Page 40 and 41: medical services received should be
Page 42 and 43: c. After Assignment for Investigati
Page 44 and 45: outside of ESA, whether a private c
Page 46 and 47: materials.
Page 48 and 49: 2-0500 CONFERENCES TABLE OF CONTENT
Page 50 and 51: (4) A formal follow-up or comment p
Page 52 and 53: e. Describe each party’s position
Page 54 and 55:
12. Conferences 13. Intervention St
Page 56 and 57:
2-600-2 Introduction 2. Introductio
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Authorizing medical treatment. Auth
Page 60 and 61:
2-600-4 Case Adjudication 4. Case A
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2-600-6 Customer Service and Commun
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medical issues. In addition, the cl
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If the surgery is authorized, the C
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address for submission of reports a
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If the CN closes the case and the c
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��Assist in work
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permissible. The process for extend
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2-600-9 Vocational Rehabilitation S
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expected after completion of the pr
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2-600-10 Employing Agency Intervent
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2-600-11 Claimant Intervention 11.
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2-600-12 Conferences 12. Conference
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2-600-13 Intervention Strategies an
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the various options, the CE needs t
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c. Return to modified work, with or
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2-0601 Disability Management Tracki
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a. Return to Work. Returning the cl
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(2) COP Nurse Closure. In traumatic
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further entitlement to compensation
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esumes, the DM record should be reo
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DM Tracking, the status code TCQ is
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(2) RHI (Rehabilitation Plan in Pla
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specifics of the RTW, the RS enters
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codes should only be used if a FN o
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actually close out the DM record on
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(not CNC) so that the case continue
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new work stoppage should be reflect
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2-0700 DEATH CLAIMS TABLE OF CONTEN
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2-0700-1 Purpose and Scope 1. Purpo
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c. Notice to Survivors of Right to
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(a) Four-weekly and monthly compens
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(3) If the parties lived apart for
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(3) If the child does not begin pos
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Compensation was terminated effecti
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. Dependency Criteria. The test of
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(3) Proof of physical or mental inc
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parents would not be harmful). d. D
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payment regardless of whether the d
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2-0700-17 Periodic Roll Review 17.
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(2) If extenuating circumstances ex
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2-0800-21 FECA Death Gratuity 21. F
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2-0800 INITIAL DEVELOPMENT OF CLAIM
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not clearly identified, or the rela
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claim to the correct type and notif
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official duties (or an activity inc
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. Developing the Case. Development
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since expeditious treatment for the
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(a) The employing agency should be
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(4) The agency challenges the claim
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evidence. In general, medical repor
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Example: “You have opined that th
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(2) Cardiac and psychiatric conditi
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Exhibit 1: Nature of Injury Codes (
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V9 Virological/Infective/Parasitic,
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notice of injury or death any writt
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immediate superior had actual knowl
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(4) If a claim is not received by O
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(1) Disappearance During a Period o
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2-0802 CIVIL EMPLOYEE TABLE OF CONT
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2-0802-4 Proof that the Injured/Dec
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. Proof of Status. Any material dis
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2-0802-10 Volunteer Workers with th
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2-0802-15 Employees of the U.S. Pro
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2-0802-18 Cadets at State Maritime
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2-0802-22 Participants in Community
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2-0802-27 Student Volunteers, Inter
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2-0802-32 Federal Emergency Managem
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Establishing whether an injury, tra
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2-0803-5 Development of Medical Evi
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1. Purpose and Scope. This chapter
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(2) In disability cases an explanat
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(3) Workers having a fixed place of
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employment, who are injured while o
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is receiving transportation service
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and should show how they acquired t
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(2) Whether other employees were re
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Whether a fall at work is idiopathi
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performance of duty." Thus, under t
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(3) States how, when, and how often
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2-0804-14 Statutory Exclusions 14.
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2-0804-14 Statutory Exclusions (con
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(2) The official superior should al
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c. Development. (1) It is the CE's
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d. OWCP Policy. Employees performin
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However, the case of Brenda Getz, 3
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discussion with his supervisor conc
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ecause the employee's cardiac arres
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appellant attributes his emotional
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something the employee did while on
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j. Developing Factors of Employment
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When it has been determined that on
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2-0804-19 Deleterious Effects of Me
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Paragraph and Subject 2-0805 CAUSAL
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(1) Temporary aggravation involves
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(2) If examination or treatment was
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(6) Certain other kinds of cases re
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(2) A nurse becomes disabled by pul
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which includes an opinion concernin
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Chapter 2-0806, Initial Acceptances
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sent to the employing agency, and t
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The following sample language may b
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condition. When the claimant's inab
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period immediately following a job-
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2-0807-5 Employee Status 5. Employe
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c. End of Period. The claimant's en
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OWCP requires. g. Claim Forms. The
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2-0807-11 Regular Pay 11. Regular P
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2-0807-12 Delayed Disability 12. De
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(c) Census Enumerators--the date on
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2-0807-15 Relationships Between Lea
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(b) If the refusal is not found to
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d. Period of Payment. To determine
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2-0808 SCHEDULE AWARDS & PERMANENT
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and the opinion of the District Med
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those indicated in the FECA. See 5
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2-0808-7 Payment of Schedule Awards
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later date which is due to work-rel
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2-0809 STATEMENTS OF ACCEPTED FACTS
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elationship is not an issue would n
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For some types of claims, such as h
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modifications.) d. SOAF Footer. The
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a. Evidence. Raw evidence, such as
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September 10, 2008), in which the a
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The claim has been accepted for rig
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2. Several letter carriers were out
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14. Authorizing Medical Treatment a
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2-0810-2 Introduction 2. Introducti
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2-0810-4 Sources of Medical Evidenc
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under the FECA. See Dona M. Mahurin
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To be acceptable as medical evidenc
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not rationalized. The physician sho
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only once can weigh as heavily as,
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2-0810-7 Requesting Information fro
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or sufficient rationale, and the CE
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Also, where a referee examination i
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(5) The AP cannot or will not send
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other physician is supported by obj
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described. (d) As appropriate, an a
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attending the second opinion examin
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issue(s). While the referee’s rep
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of an excluded medical report were
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examination under 5 U.S.C. 8123(d).
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would require a more detailed expla
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2-0810-16 Functional Capacity Evalu
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the requested item, the CE should a
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the facility is fully suitable for
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above. e. Denial of Approval. If th
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2-0810-21 Attendant Allowance 21. A
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2-0811 Nurse Case Management Chapte
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A Staff Nurse assigned to each dist
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5. The Field Nurse (FN). A FN is as
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examples of these instances are: (1
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notification. (6) Release to return
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intervention, the CE and the FN wil
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collaboration between the CE and SN
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assigned, the FN should be notified
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clear goals or direction, as well a
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a. Conference Calls. During the nur
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FEDERAL (FECA) PROCEDURE MANUAL Cha
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Page 401 and 402:
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2-0813 Vocational Rehabilitation Se
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When it appears that the claimant
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This chapter explains the procedure
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Lastly, this chapter explains the p
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2. Stautory, Regulatory and Program
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Section 8111 of the Act allows the
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Section 8151 of the Act provides re
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The Code of Federal Regulations dis
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The Vocational Rehabilitation (VR)
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(1) The RS’s responsibilities inc
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(3) The CE’s responsibilities inc
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a. Compensation for Wage Loss. Sect
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c. Schedule Awards. If a claimant r
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4. Restoration Rights with the Fede
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a. OPM’s regulations on retention
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c. When an injured worker resumes e
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5. Referrals for Vocational Rehabil
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If the attending physician cannot f
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. The CE should ensure that the fil
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Note - Prior to referral, the CE sh
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(2) The claimant should be capable
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(4) There should not be any outstan
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d. The FN may recommend a vocationa
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The FN will focus on the medical as
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g. To identify cases for early inte
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i. Making the Referral. The CE refe
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(2) The name of the attending physi
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(4) The date on which disability (o
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(6) Whether or not the CE authorize
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(8) When the case is being referred
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(10) An indication as to whether or
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j. Limited Referrals. If the claima
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(2) An Occupational Rehabilitation
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The CE should identify the non-empl
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a. Roles and responsibilities. In o
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(a) Refer the claimant to an RC to
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(c) Advise the CE that the case has
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(2) Role of the RC. Working under t
Page 554:
with the claimant so that all perti
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(4) Role of the claimant. Claimants
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(1) If the employer has shown no in
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c. Interruptions. PPE may be interr
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(1) If the claimant returns to work
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(3) If the EA does not provide an o
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7. Plan Development. If efforts to
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sufficient numbers to make successf
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to the claimant, and the RS will di
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(3) On-the-job training is another
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a. Services offered during this pha
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c. Time Frames. The PNE phase usual
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(c) It must support an LWEC rating,
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a. Various medical services can be
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(7) Reports. The ORP facility must
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Interrupt status is used when rehab
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esolve misunderstandings, or provid
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a. CE Responsibilities. The CE has
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(3) The CE should appropriately dev
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wage-earning capacity had he or she
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days is calculated from the date pl
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ating of the claimant’s WEC has b
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a. A conference may be helpful any
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a. Return to Work with the Previous
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DFEC has adopted the following defi
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7. REPETITIVE MOVEMENTS OF WRISTS (
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2-0814 REEMPLOYMENT: DETERMINING WA
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Exhibits 1. Sample Letter to Claima
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. Preliminary Assessment of Positio
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(b) If the attending physician cont
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employing agency, however, has an a
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e. Payment/Reimbursement of Relocat
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income to the claimant. The CE will
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on June 5, 1997, returned to work o
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not equate to a finding that the po
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imprisonment. The implementing regu
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coworkers had treated him poorly wh
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(2) If OWCP is seeking modification
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. LWEC Determination Not Made. When
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2-0814 Exhibit 1: Sample Letter To
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SAMPLE LETTER TO CLAIMANT ADVISING
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2. Establishing a Pay Rate 3/11 11-
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letter, secure e-mail with the empl
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The salary for full-time rural carr
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(a) Full-time firefighters, such as
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(1) Career seasonal employment. Thi
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(which is discussed in further deta
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of the injury having regard to the
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so supportive rationale should be i
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2-0900-5. Effective Date of Pay Rat
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date, would be used because it was
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. Administrative Inclusions. It has
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hourly rate (computed using the 208
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an employee’s pay rate: (1) Overt
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shifts (which is the most common si
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6 days per week, for example. This
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2-0900-11 Computing Monthly Pay Rat
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similar employment” under §8114
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When there is no disability, claima
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18. Other Payees 12/95 07/00 04/02
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(d) Death benefits, FECA PM 5-307.
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(2) The CE is responsible for notin
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(2) The amounts payable for funeral
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2-0901-8 Basic Computations 8. Basi
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c. Conversion from Daily to Weekly
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Hourly wage X no. of hours per day
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2-0901-11 Maximum Compensation 11.
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2-0901-13 (RESERVED) 13. (Reserved)
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...wages received 2, 5 or 10 years
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decision is issued do not alter tha
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injury. The pay rate for the job he
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e. Representative Payee. When OWCP
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For example, let us assume that the
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(3) If the child does not begin pos
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2 In disability cases, minimum is v
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01/04/87 31.20-46.80 156.00-234.00
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6 The amendments of 07/04/66 establ
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01/01/68 3.7 457 15 09/01/80 4.0 15
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2-0901 Exhibit 5: Percentage Table
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PERCENTAGE TABLE OF SCHEDULE AWARDS
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11 12 cost-of-living increases) 13
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compensation payable; (2) In disabi
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(1) Contact the appropriate person
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the retirement acts. (2) When an em
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(b) If there is accrued compensatio
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Offices (DVARO). In some places the
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(a) No reduction in a schedule awar
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d. Obtaining Elections--Educational
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(3) The CE must advise the claimant
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c. Injuries On and After September
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Based on information contained in t
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2-1000-16 Benefits for Judicial Off
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the CE should suspend compensation
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(See PM 2-0814.11.) (6) An employee
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2-1000 Exhibit 2: OPM Contact List
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When a third party is or may be leg
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attorney) (5) Form EN-1108, Long Fo
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7. Administration of Third Party Ca
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confirms receipt of the refund and
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On the written recommendation of th
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(3) Provide the claimant or attorne
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any SOR for which a refund check ha
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In any other case, where a judgment
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asserted for pain and suffering of
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h. Costs of Suit. The costs of suit
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(6) Section 8133(a) of the FECA pro
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(2) The initial demand letter in an
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efficiently and effectively accompl
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procedures for regular third party
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10.700(b).
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a. Under 5 U.S.C. § 8127(b) and in
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. Should an application be submitte
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(2) The Nature and Complexity of th
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notice of payment of compensation o
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(4) The claimant did contest the am
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2-1300-2 Authority 2. Authority. Se
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annuity adequate to meet living exp
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2-1300 Exhibit 1: Sample of Initial
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FEDERAL EMPLOYEES' COMPENSATION ACT
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Case Number: Employee: APPEAL REQUE
Page 811 and 812:
Dear CLAIMANT NAME: I am writing in
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2-1300 Exhibit 5: Information Neede
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Notice of Reduction 8. Sample Lette
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(1) Notification to Claimant. The C
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See FECA PM 2-0807.10. (2) Particul
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2-1400-4 Notices of Decision Notice
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f. Conclusion. Where the decision i
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approach will assist readers at eve
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(3) A specific service which the cl
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2-1400-7 How to Issue Pre-Terminati
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the claimant for the CE's signature
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(a) Compensation is being terminate
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. Source of Advice. District office
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prior to imprisonment, payment for
Page 839 and 840:
Basis for Decision: While Dr. Smith
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2-1400 Exhibit 3: Sample Notice of
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2-1400 Exhibit 4: Sample Letter Con
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2-1400 Exhibit 6: Sample Notice of
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2-1400 Exhibit 8: Sample Letter Con
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2-1400 Exhibit 10: Sample Letter De
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2-1500 RECURRENCES TABLE OF CONTENT
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(e.g., "pipeline" grants); (c) True
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(3) The case was originally accepte
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c. Case Management. The CE should c
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determined in its November 24, 1999
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2-1600 REVIEW PROCESS TABLE OF CONT
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(2) Any file in which a complaint a
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1. Purpose and Scope. This chapter
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5. Review of the Written Record. Th
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Where it has been determined that a
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submit any comments and/or document
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2-1602 RECONSIDERATIONS TABLE OF CO
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inform the claimant that OWCP will
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discretion is not subject to review
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only evidence submitted is cumulati
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now at issue, the SrCE should prepa
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2-1603 APPEALS TABLE OF CONTENTS Pa
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d. Timeliness of Filing. A person r
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2-1603-6 Cases Returned to District
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2-1700 SPECIAL ACT CASES TABLE OF C
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2-1700-4 Peace Corps 4. Peace Corps
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(2) Staff Spouses. (a) The spouses
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the children born of such pregnanci
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(3) Return from Service Abroad. d.
Page 907 and 908:
(3) Compensation for death will be
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(1)While at a Job Corps Center, an
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(1)Enrollees are required to report
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that observers on vessels that are
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2-1800 HOUSING & VEHICLE MODIFICATI
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the appropriate medical specialty.
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educed by the trade-in value of the
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available comes with extras (like a
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of living, due to personal preferen
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enrichment.” ECAB stated that wit
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such as increased durability or deg
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proposal, or review of a submitted
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collision insurance on vehicles pai
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By signing this agreement, all part
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Memorandum of Agreement - Modificat
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Date: Memorandum of Agreement - Hou
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