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(3) The opinions of the attending physician and the "second opinion" physician (both Board-certified specialists) differ on an issue such as causal relationship or the nature and extent of work limitations. However, the opinion of one physician is speculative, equivocal and/or unrationalized while the opinion of the other physician is supported by objective findings and is fully rationalized. The opinion of the first physician would be of diminished probative value and would be of lesser weight than that of the second physician. 2-0810-10 Obtaining Second Opinions for Surgery 10. Obtaining Second Opinions for Surgery. This paragraph describes the steps required when surgery is requested. a. Emergency surgery may be defined as any procedure which needs to be performed promptly after the onset of a condition or injury in order to preserve life or function of an organ or body part. Elective (or non-emergency) surgery may be defined as any procedure which is necessary for the adequate or normal function of an organ or body part, but which does not need to be performed promptly after the onset of the condition in order to achieve its purpose. b. For emergency surgery, no prior authorization by the Office is required. However, prior authorization is required for all elective surgery. When requesting authorization, the following minimum documentation must be submitted from the attending physician: the name of the surgical procedure; diagnosis of the specific condition(s) which will be treated by the surgery; the type of surgery (emergency or elective); and the reason surgery is needed. Any ambiguity or omission in an attending physician's request for surgery should be resolved by telephone if possible, or by the RN if one is involved in the case. The individual making the call should prepare a detailed summary of any telephone conversation for the case record. c. When authorization is requested for certain types of elective surgery, the CE must obtain a second medical opinion concerning the need for the procedure. The elective surgical procedures involved are: spinal surgery, organ transplants, and destructive procedures (i.e., chordotomy, rhizotomy, or amputation of a body part). d. In cases involving spinal surgery the CE will obtain the minimum documentation described in paragraph 10b, and send the case file to the medical unit for referral to an Office consultant who will evaluate the request for surgery on the basis of the written record. The consultant will be advised that his or her report may be made available to the claimant and the attending doctor. FECA-PT2 Printed: 06/08/2010 336
(1) The consultant should be asked to provide a rationalized opinion concerning the need for the surgical procedure, using the following guidelines (also see Exhibit 3): (a) The surgical procedure must be related to the claimant's accepted condition. (b) The medical reports must adequately describe the clinical history and severity of the condition, the results of the physical examination of the claimant, and the results of pertinent diagnostic tests. The presence or absence of complications should also be described. (c) As appropriate, an adequate trial of conservative treatment should have been attempted prior to the decision to perform surgery. (d) The history, physical examination, and/or results of pertinent diagnostic tests should support a specific diagnosis. (e) The diagnosed condition warrants surgical intervention according to current medical concepts, and the proposed surgical procedure is within the realm of accepted medical practice. (2) The file will be returned to the CE with the consultant's report. If the consultant agrees that surgery is warranted, the CE will authorize it. If the consultant's opinion is equivocal or negative, or if it indicates the need for clinical data not present in the file, the CE should prepare the file for a second opinion examination by formulating appropriate questions (see Exhibit 4). (3) When the referral is arranged, the Medical Management Assistant (MMA) will provide the claimant and the attending doctor with a copy of the consultant's opinion which precipitated the need for the second opinion examination. The usual procedures for notifying the claimant of the second opinion examination will be followed, and the specialist should also be advised that a copy of the report will be furnished to the claimant and the attending doctor. The specialist should provide a report which contains a clinical history, results of a physical examination, results of any diagnostic tests performed, and a reasoned opinion regarding the appropriateness of the proposed surgery. (4) If the specialist agrees that surgery is warranted, the CE will authorize it. FECA-PT2 Printed: 06/08/2010 337
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LIST OF CHAPTERS PART 2 - CLAIMS (I
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which may be useful to the CE. b. C
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d. Continuation of Pay. An employee
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o. Review of OWCP Decisions. Under
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2-0300 COMMUNICATIONS TABLE OF CONT
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2-0300-4 Regular Correspondence 4.R
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(b) Formal Decision. If a formal de
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If the information requested cannot
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eferred to the NOO for adjudication
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2-0400-6 Requesting Files 6. Reques
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the file. This process should mainl
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2-0400-10 Case Transfers and Loans
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2-0401 AUTOMATED SYSTEM SUPPORT FOR
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names and addresses is optional. By
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PW: Entitled to payment on periodic
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AM/C1: Condition accepted. Up to $1
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full appeal rights, and the adjudic
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B Both A Aggravation 2-0402 SECURIT
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a. Signatures. The CE must review c
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(a) The particular issues about whi
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c. Review by DD. Upon receipt of th
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disposition, a report, enclosing th
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2-0500 CONFERENCING TABLE OF CONTEN
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necessary to identify the official(
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2-0500-6 Senior CE Actions 6. Senio
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2-0500-9 Due Process 9. Due Process
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This chapter outlines the major ste
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(d) Been notified that OWCP will pr
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2-0600-4 Initial Actions 4. Initial
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2-0600-5 Nurse Services 5. Nurse Se
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assess the claimant's environment a
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(4) Timely responses to telephone c
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for guidance in composing such ques
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(4) Only if the CE has taken these
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(1) RS Actions. If the claimant agr
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(3) Absent such a recovery, the OWC
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(c) After any training or other pre
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under way and the CE determines tha
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2-0600 Exhibit 1: Sample Letter to
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2-0600 Exhibit 3: Example of Letter
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2-0600 Exhibit 5: Planning Chart fo
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period, and each new recurrence. a.
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a. QCM Screen. When the QCM screen
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(c) Confirmation of Data. After ent
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(1) NFN*--Referred to Field Nurse.
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2-0601-6 Effect of RTW on QCM Statu
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2-0601 Exhibit 1: Disability Tracki
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SRE Referred to SrCE for Conference
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21. FECA Death Gratuity 4/10 10-06
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. Claimant. The claimant is respons
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2-0700-6 Adjudication 6. Adjudicati
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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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The CE should prepare a memorandum
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. Employee Status. The $200 payment
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(b) Form CA-1617 should be released
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2-0700-20 Gratuity 20. Gratuity fro
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2-0700 Exhibit 1: Percentages of En
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2-0800-2 Definitions 2. Definitions
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. Employing Agency. The FECA requir
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claimant, the CE should send a copy
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(3) The case must be coded as withd
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entire group of cases must be adjud
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2-0800-10 Investigation 10. Investi
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2-0800-13 Affirmative Defense 13. A
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2-0801 TIME TABLE OF CONTENTS Parag
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5 U.S.C. 8122 on the ground that no
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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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2-0802-1 Purpose and Scope 1. Purpo
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(1) The precise time when the worke
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2-0802-8 Contract Job Cleaners Used
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2-0802-13 Volunteer Workers with th
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(1) Whether, prior to the transfer
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. The pay rate for compensation pur
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2-0802-24 U.S. Park Police and Secr
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a participant or crew leader servin
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2-0803 FACT OF INJURY TABLE OF CONT
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2-0803-4 Development of Factual Evi
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2-0804 PERFORMANCE OF DUTY TABLE OF
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time before or after the end of the
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(a) A diagram showing the boundarie
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d. Workers in a Travel Status. (1)
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2-0804-6 To and From Work 6. To and
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(a) The reason the employee was req
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(1) At the time of the injury, the
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(1) Martha G. List, 26 ECAB 200. Em
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duty, the CE may approve the case.
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action taken; and (4) Statements fr
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2-0804-14 Statutory Exclusions 14.
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would justify such disobedience. (c
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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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such as soliciting new members or c
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c. Performance Ratings. The Board r
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Where an employee asserts that emot
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The Board noted that Cannon was unl
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Since both cases involve procedures
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Ashberry's disability was not compe
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no longer be considered so in light
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2-0804-18 Employing Agency Physical
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f. This matter was initially addres
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compensation would be payable for t
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limited to the period of work-relat
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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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the body originally injured is term
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2-0806 OCCUPATIONAL ILLNESS TABLE O
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2-0806-1 Purpose and Scope 1. Purpo
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the following steps, depending on w
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(4) Exposure to and Identification
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While records of past medical treat
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the medical connection between lift
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(b) The medical evidence presented
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2-080 Exhibit 2: Sample Letter to C
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TITLE _____________________________
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eason, you should call or write to
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9. [FREE FLOW IF DESIRED] We may wr
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If you do not understand any part o
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stressful situations in your person
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TITLE FECA-PT2 Printed: 06/08/2010
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I am writing in reference to your c
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We may write directly to a physicia
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2-0806 Exhibit 20: Sample Questions
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TA Amputation TB Back strain TC Con
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(D )Other Disability, Occupational
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a. Traumatic Injury. If an air traf
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2-0807-6 Period of Entitlement 6. P
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d. Return to Duty. The injured empl
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f. The injury was not reported on a
Page 285 and 286: W = Total number weeks worked P/W =
Page 287 and 288: COP is paid for the entire period o
Page 289 and 290: (c) When the physician's report ind
Page 291 and 292: (a) Assign or detail the employee t
Page 293 and 294: . Monitoring the Claim. (1) If Form
Page 295 and 296: (4) If conflicting information appe
Page 297 and 298: a. Permanent Total Disability (PTD)
Page 299 and 300: (1) Prior to December 7, 1940. No p
Page 301 and 302: (2) Impairment due to amputation is
Page 303 and 304: . Claims for Increased Schedule Awa
Page 305 and 306: compensation for temporary total di
Page 307 and 308: Medical. 2-0809-2 Introduction 2. I
Page 309 and 310: CE is ready to evaluate the evidenc
Page 311 and 312: the physician with a complete pictu
Page 313 and 314: (3) Personal habits such as smoking
Page 315 and 316: games or operating a construction b
Page 317 and 318: Jane Doe, date of birth 04/06/1965,
Page 319 and 320: elated to the employee’s duties;
Page 321 and 322: 16. Physical Therapy 04/01 01-06 03
Page 323 and 324: evaluating the merits of medical re
Page 325 and 326: situation where ten days earlier th
Page 327 and 328: each opinion. The value of the evid
Page 329 and 330: manipulation of the body. They incl
Page 331 and 332: . The DMA's performance of these fu
Page 333 and 334: evidence from physicians who have n
Page 335: e. In cases involving a preexisting
Page 339 and 340: value). Based on the results of thi
Page 341 and 342: However, if the impartial specialis
Page 343 and 344: 2-0810-13 Exclusion of Medical Evid
Page 345 and 346: Leanna Garlington, 37 ECAB 849). Re
Page 347 and 348: (d) A suggested supplier, if any. (
Page 349 and 350: need for further treatment as detai
Page 351 and 352: 2-0810-18 Transfer of Medical Care
Page 353 and 354: 2-0810 Exhibit 1: Information from
Page 355 and 356: Dear CLAIMANT NAME: We need the fol
Page 357 and 358: 2-0810 Exhibit 3: General Guideline
Page 359 and 360: 2-0810 Exhibit 5: Sample Paragraph
Page 361 and 362: 2-0810 Exhibit 7: Letter of Warning
Page 363 and 364: In addition, a primary goal of case
Page 365 and 366: (3) Release Form CA-1008 and Pamphl
Page 367 and 368: a. Where disability is present, the
Page 369 and 370: f. If the evidence obtained as a re
Page 371 and 372: eligible for disability benefits. A
Page 373 and 374: f. Physician's estimate of the date
Page 375 and 376: 2-0812 PERIODIC REVIEW OF DISABILIT
Page 377 and 378: 2-0812-1 Purpose and Scope 1. Purpo
Page 379 and 380: determine the status of dependents
Page 381 and 382: whether disability is related to th
Page 383 and 384: earnings or activity is in question
Page 385 and 386: eferred to the Office of Inspector
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. Suspension of Compensation. OWCP
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certification clauses on the CA-103
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SI Payment/Entitlement Suspension i
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with the return to work effort. CFF
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should be placed in a PN status. OP
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force. 10. If the business has had
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I am writing in follow up to the Fo
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2-0812 Exhibit 6 - Periodic Entitle
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Service. On 03/14/2003, the claiman
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Authorized Medical Care for Substan
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a. OPM's regulations on retention r
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d. To identify cases for early inte
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2-0813-7 Communication Among the CE
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d. Cooperative Agreement. The title
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ehabilitation process. 2-0813-11 Fa
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(2) To reduce compensation in this
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The specificity of the reasons offe
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in conjunction with graded conditio
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(1) Where the claimant cannot perfo
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2-0813 Exhibit 2: Non-Cooperation W
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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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(3) The employing agency will be as
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e. Payment/Reimbursement of Relocat
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have no appeal rights attached. c.
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were not reported to OWCP or were o
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(3) If the employee can work only p
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this instance the CE will need to e
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d. Unacceptable Reasons for Abandon
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closure of an installation, cessati
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Code, and returns to duty under ret
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If you receive an increase in pay o
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2-0814 Exhibit 3: Sample Letter To
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RATE DATE FOR SCHEDULE AWARDS 01/10
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(1) Kinds of Appointments. The Post
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year, in the teaching profession, w
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(b) Census enumerators; (c) Casual
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The CE should consider these factor
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The greatest of these pay rates wil
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the Department of Veterans Affairs
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degree of expense, hardship, and in
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(2) Basic bi-weekly pay x premium p
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2-0900-9 Computing Daily Pay Rate 9
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2-0900-11 Computing Monthly Pay Rat
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The salary for these employees may
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2-0901 COMPUTING COMPENSATION TABLE
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2-0901-2 Related Topics 2. Related
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(4) A GS-12 CE or designated CE may
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2-0901-4 Factors in Computing Compe
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(3) For schedule award payments, th
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(4) Compensation payable for less t
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2-0901-9 Special Determinations 9.
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2-0901-11 Maximum Compensation 11.
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payment. a. Beginning Date. Schedul
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(3) ( ) (a) is capable of earning (
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automatic pay increases. For exampl
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claimant to a higher pay rate under
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(a) the beneficiary's maintenance,
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Letter CA-1208 to the claimant, wit
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01/01/76 4.4 10/10/76 18.96-28.44 9
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01/02/2000 44.98-67.47 224.91-337.3
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10/07/79 144.56 722.78 - (2,891.12)
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*Calendar Days 01/01/2001 3.3 365 1
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PERCENTAGE TABLE OF SCHEDULE AWARDS
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2-0901 Exhibit 6: Activity Codes AC
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12. Tennessee Valley Authority 02/9
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. Death Benefits. When compensation
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(3) Certification. The CE should ha
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elected, refer the case to the inac
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(b) If there is accrued compensatio
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Centers, and DVA Hospitals. If the
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(b) The claimant may be entitled to
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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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(a) Calculate the number of weeks w
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I. Claimants must elect between Fed
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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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(6) Ltr. CA-1109, Authorization to
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7. Administration of Third Party Ca
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(3) If not accurate or complete, th
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the DCE, is urgent should be sent i
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(3) Provide the claimant or attorne
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for a course of action. All formal
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In any other case, where a judgment
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(b) 5 percent of the total to be al
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To determine the amount to be liste
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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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of the employee. The USPS cannot re
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not be referred to the FEEWC until
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FECA-PT2 Printed: 06/08/2010 581
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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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and the requested fee is reduced du
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2-1200 Exhibit 1: Sample Formal Dec
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2-1300 LUMP SUM PAYMENTS TABLE OF C
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2-1300-3 Requests for Lump-Sum Paym
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2-1300-4 Calculating Lump-Sum Sched
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2-1300 Exhibit 2: Sample Appealable
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3. REVIEW BY THE EMPLOYEES' COMPENS
Page 601 and 602:
SIGNATURE _________________________
Page 603 and 604:
We have received your request for a
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2-1400 DISALLOWANCES TABLE OF CONTE
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2-1400-1 Purpose and Scope Purpose
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a. Initial Disallowances. Such disa
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(1) Failure to Appear for Medical A
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(1) The name and location of the em
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injury caused no disability for wor
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(3) A specific service which the cl
Page 619 and 620:
2-1400-7 How to Issue Pre-Terminati
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(a) The case is being referred beca
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(a) Compensation is being terminate
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. Source of Advice. District office
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usual rate, i.e., 75 percent of the
Page 629 and 630:
objective findings to support your
Page 631 and 632:
2-1400 Exhibit 3: Sample Notice of
Page 633 and 634:
2-1400 Exhibit 4: Sample Letter Con
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2-1400 Exhibit 6: Sample Notice of
Page 637 and 638:
2-1400 Exhibit 8: Sample Letter Con
Page 639 and 640:
2-1400 Exhibit 10: Sample Letter De
Page 641 and 642:
2-1500 RECURRENCES TABLE OF CONTENT
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(d) Closure of a base or other faci
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(1) The medical evidence needed to
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c. Case Management. The CE should c
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emains the same regardless of wheth
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2-1600 REVIEW PROCESS TABLE OF CONT
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c. Formal Decision. Chapter 2-1400
Page 655 and 656:
Page 657 and 658:
the request. H&R will acknowledge r
Page 659 and 660:
spouse or child prevents his or her
Page 661 and 662:
OWCP shall pay fees requested by wi
Page 663 and 664:
2-1601-9 Cases Returned from H&R 9.
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2-1601 Exhibit 2: Sample Letters Ac
Page 667 and 668:
Exhibit 3, page 1 of 3: Hearing Not
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Exhibit 3, page 3 of 3: Hearing Ins
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2-1601 Exhibit 5: Request for Comme
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2-1602 RECONSIDERATIONS TABLE OF CO
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2-1602-2 Policy 2. Policy. The foll
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d. Decision. An untimely applicatio
Page 679 and 680:
percentage of the award under the S
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(2) The cover letter to the agency
Page 683 and 684:
2-1602 Exhibit 1: Sample Letter Ret
Page 685 and 686:
Dear CLAIMANT NAME: We have reviewe
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2-1602 Exhibit 5: Sample Compensati
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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
Page 695 and 696:
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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Compensation for loss of wages may
Page 703 and 704:
(3) Return from Service Abroad. d.
Page 705 and 706:
Section 5 U.S.C. 8101(4), which pro
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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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coverage under 5 U.S.C. 8101. b. Co
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2-1800-2 Authority 2. Authority. Ho
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determined by the type of vehicle,
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greatest current fair market value
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Such certification from an architec
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over $10,000, and that amount must
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2-1800-7 Housing Modifications for
Page 727 and 728:
send an approval letter along with
Page 729 and 730:
By signing this agreement, all part
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By signing this agreement, all part
Page 733 and 734:
Memorandum of Agreement - Modificat
Page 735 and 736:
Memorandum of Agreement - Housing M
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