Printing - FECA-PT2 - National Association of Letter Carriers

2-0800-2 Definitions
2. Definitions.
a. A Primary Case is a new file on which no developmental, adjudicative, or payment action
has been taken except for payment of bills associated with medical care authorized by the
employing agency.
b. A Secondary Case is a claim which is under development or which has already been
adjudicated.
c. 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 identifiable as to time and place of occurrence
and member or function of the body affected. It must be caused by a specific event or incident or
series of events or incidents during a single day or work shift.
d. An Occupational Disease is defined as a condition which is produced by continued or
repeated exposure to elements of the work environment such as noxious substances or damaging
noise levels over a period longer than one work day or shift.
e. The Five Basic Requirements which an FECA claim must meet in order to be compensable
are time, civil employee, fact of injury, performance of duty, and causal relationship.
f. A Prima Facie Claim is one which on "first appearance" (the literal meaning of the term)
demonstrates entitlement to compensation. Such a claim always requires development if it cannot
be accepted immediately.
g. Burden of Proof refers to the claimant's responsibility to establish the five basic
requirements of the claim. Once the claimant has made a prima facie case for the five basic
requirements, the Office has the responsibility to take the next step, either of notifying the
claimant what additional evidence is needed to fully establish the claim, or of developing evidence
in order to reach a decision. Once the claim is accepted and benefits are paid, the burden of
showing that payments should not continue shifts to the Office.
h. Case Development is the process of defining the issues which must be resolved and
soliciting medical and factual evidence in order to adjudicate the case.
i. Controversion of a claim refers to an employing agency's action to dispute, challenge, or
deny the validity of a claim. Controversion may be based on the information submitted by the
employee or secured on investigation and it is accomplished by completing the indicated portion of
Form CA-1 and submitting supporting evidence to OWCP.
2-0800-3 Responsibilities
3. Responsibilities.
a. Claimant. A person claiming compensation must show sufficient cause for OWCP to proceed
with processing and adjudicating a claim. OWCP has the obligation to aid in this process by giving
detailed instructions for developing the required evidence. OWCP also has a responsibility to
develop evidence, particularly when it is the type of information normally obtained from an
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