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medical services received should be explored when reported by the claimant. Discrepancies in dates may be due to the claimant's lapse of memory, and unidentified providers may be Office consultants who reviewed the file. If a significant discrepancy is reported, the case file and billing history should be reviewed, and remaining problems referred to the OIG for investigation as explained in paragraph 5. b. CEs should obtain ACPS and BPS reports periodically to determine if improper payments are being made on cases under their jurisdiction. In addition, payment histories on missing cases should also be reviewed. Any evidence of medical or compensation payments made on a case which are not clearly supported by the evidence of record or otherwise explained should be brought to the attention of the Assistant District Director (ADD). 2-0402-4 Information from Outside Sources 4. Information from Outside Sources. Witnesses, whistleblowers, and other complainants occasionally call or send statements reporting that a claimant has undeclared earnings, engages in vigorous yard work while collecting total disability compensation, etc. The CE should document the file with a complete description of any incoming call and compare the information against other evidence in file to determine whether the allegation requires investigation. The lay person, unfamiliar with compensation, may place undue significance on observations of work and activity. If legitimate questions arise from the complaint, the CE should resolve them in one of the ways described above, by development of the record or by referral for investigation. The CE should not continue to correspond or discuss the case with a spouse, neighbor or other external party. If an affidavit or statement is required from such a party, it should be obtained by an investigator. 2-0402-5 Unreported Earnings 5. Unreported Earnings. A doctor's report or a letter may contain indications that a claimant has earnings which are not being reported. If an interim medical report mentions the claimant's job, Form CA-1032 may be sent to obtain confirmation of the employment, or a narrative letter may be drafted asking for specific information. If the claimant's response is inconsistent with the record, an investigation may be requested. Further evidence of unreported employment should be referred to the OIG. Claimants are required to report all employment, whether salaried or not, and self-employment. They are not required to report investment income or ownership of a business in which they take no active part. If the claimant's role in a business or employment activity is ambiguous, the claimant should be asked for precise information about the activities performed, the hours of activity each day or week, and any other information which would enable the CE to determine whether the claimant has demonstrated an earning capacity. If the claimant's responses continue to be unclear, the CE may request an investigation to determine the extent of the claimant's activities, and whether these activities generate any income. 2-0402-6 Action Where Fraud is Not Involved 6. Action Where Fraud is Not Involved. Investigation by a Compliance Officer of the Wage and Hour Division, an OWCP investigator, or by claims personnel may be requested as
a routine matter in situations which present no clear indication of fraud. For example, such an investigator may check on the activities of a person receiving periodic roll benefits to obtain specific evidence of the kinds of physical movement (lifting, climbing) the claimant is able to engage in, or visit a workplace to determine the factors of employment to which the claimant is exposed. a. Recommending Cases for Investigation. (1) If a thorough investigation is needed, the CE should prepare an information worksheet (Exhibit 1) and a typewritten memorandum to the ADD, which includes: (a) The particular issues about which additional evidence is required; it is the CE's responsibility to give a clear and concise description of the specific problem so that the need for the investigation will be apparent. (b) A resume of the relevant evidence appearing in the record. (c) A brief explanation of the reason this evidence is not sufficient to permit a proper determination. (d) A brief outline for the kind of evidence which the investigator should seek, including the names of any persons the CE believes should be contacted. Other material pertinent to the investigation, such as a blank OWCP-20 to collect financial information in an overpayment case, may be attached to the worksheet. (2) When only a few items are needed to adjudicate a case (i.e., a witness statement or an existing specific medical report which correspondence has filed to produce), the CE may request a limited investigation to secure the evidence. The request should contain the full names and addresses of the custodians of the needed evidence. Under no circumstances should the CE attempt to instruct the investigator concerning the conduct of the inquiry. b. Decision to Investigate and Assignment of Claim. After compiling the material listed above, the CE will send it to the ADD through the Supervisory Claims Examiner. If the ADD agrees with the CE's recommendation, he/she will forward it to the District Director (DD), who will decide whether the case should be investigated. If so, the DD will forward it to the appropriate office for assignment. In accordance with 5 U.S.C. 554(d), an individual who will be involved in the final adjudication of a case may not participate in such an investigation.
Page 1 and 2: LIST OF CHAPTERS PART 2 - CLAIMS (I
Page 3 and 4: eference materials, decisions, and
Page 5 and 6: d. Continuation of Pay. An employee
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 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
Page 58 and 59: Authorizing medical treatment. Auth
Page 60 and 61: 2-600-4 Case Adjudication 4. Case A
Page 62 and 63: 2-600-6 Customer Service and Commun
Page 64 and 65: medical issues. In addition, the cl
Page 66 and 67: If the surgery is authorized, the C
Page 68 and 69: address for submission of reports a
Page 70 and 71: If the CN closes the case and the c
Page 72 and 73: ��Assist in work
Page 74 and 75: permissible. The process for extend
Page 76 and 77: 2-600-9 Vocational Rehabilitation S
Page 78 and 79: expected after completion of the pr
Page 80 and 81: 2-600-10 Employing Agency Intervent
Page 82 and 83: 2-600-11 Claimant Intervention 11.
Page 84 and 85: 2-600-12 Conferences 12. Conference
Page 86 and 87: 2-600-13 Intervention Strategies an
Page 88 and 89: the various options, the CE needs t
Page 90 and 91:
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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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
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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
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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
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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
Page 887 and 888:
only evidence submitted is cumulati
Page 889 and 890:
now at issue, the SrCE should prepa
Page 891 and 892:
2-1603 APPEALS TABLE OF CONTENTS Pa
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d. Timeliness of Filing. A person r
Page 895 and 896:
2-1603-6 Cases Returned to District
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2-1700 SPECIAL ACT CASES TABLE OF C
Page 899 and 900:
2-1700-4 Peace Corps 4. Peace Corps
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(2) Staff Spouses. (a) The spouses
Page 903 and 904:
the children born of such pregnanci
Page 905 and 906:
(3) Return from Service Abroad. d.
Page 907 and 908:
(3) Compensation for death will be
Page 909 and 910:
(1)While at a Job Corps Center, an
Page 911 and 912:
(1)Enrollees are required to report
Page 913 and 914:
that observers on vessels that are
Page 916 and 917:
2-1800 HOUSING & VEHICLE MODIFICATI
Page 918 and 919:
the appropriate medical specialty.
Page 920 and 921:
educed by the trade-in value of the
Page 922 and 923:
available comes with extras (like a
Page 924 and 925:
of living, due to personal preferen
Page 926 and 927:
enrichment.” ECAB stated that wit
Page 928 and 929:
such as increased durability or deg
Page 930 and 931:
proposal, or review of a submitted
Page 932 and 933:
collision insurance on vehicles pai
Page 934 and 935:
By signing this agreement, all part
Page 936 and 937:
Memorandum of Agreement - Modificat
Page 938 and 939:
Date: Memorandum of Agreement - Hou
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