Printing - FECA-PT2 - National Association of Letter Carriers

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
been issued. The pay status is UD. D9 is used while an application for
reconsideration on a denied case is being processed. Cases in pay status
(LWEC, SA) which are remanded or under reconsideration will retain the
adjudication and pay status appropriate to their benefit status (e.g. AP/PW).
e. Reopening Closed Cases.
(1) Closed cases should not be reopened merely to pay medical
bills.
(2) Denied cases on which a medical bill is payable must be given a
payable status temporarily in some instances. Code AM/MC may be used. Efforts should be
made to ensure that cases are promptly restored to closed status after the bill has been
paid.
(3) Where Form CA-2a or other claim for recurrence is received, case
should be reopened using the last adjudication (A_) code and UD.
(4) Remands and reconsideration on denied cases should be assigned the
FECA-PT2 Printed: 06/08/2010 33