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adjudication code D7, D8, or D9, as appropriate, and pay status UD. (5) Noncontroverted no-time-lost cases which later require adjudication by the CE which cannot be accepted immediately must be reopened. This may be done manually or by the system, and the case status will be UN. f. Death. Cases on which death benefits are to be paid must be placed in status AF/DE, which allows payment of burial, administrative costs and survivor benefits. AF/UD may be used for a case in which employment-related death is accepted but documents such as birth certificates, marriage certificates, or election forms have not been received. When there is no further entitled beneficiary because of remarriage, completion of college, etc., the case should be closed AF/C5. 2-0401-9 Inquiries 9. Inquiries. In addition to its essential use in enabling CEs to take timely and proper action on files, and to enable supervisors to monitor case actions, the case management system provides basic information to contact representatives and others for use in responding to inquiries. It is to the advantage of the CE to maintain correct coding information in the system so that a representative can answer telephone inquiries without having to contact the CE for information. 2-0401-10 ICD-9 Codes 10. ICD-9 Codes. When conditions are accepted as work-related, the CE should enter the corresponding ICD-9 codes into the case management system. The codes are found in the ICD-9 manuals or electronic ICD-9 reference material. As additional conditions are accepted, the ICD-9 codes should be added to the system. a. Severity of Condition. The ICD-9 code should accurately reflect the severity of the condition accepted. For instance, if the OWCP has accepted a herniated lumbar disc (code 722.10), the code for lumbar strain (847.2) should not be used instead. Coding should be as specific as possible, coded to the 4 th or 5 th digit. b. Surgery. When a surgical procedure has been accepted as work-related, the CE should ensure that the accepted condition has been upgraded, when necessary, to ensure that bills will be paid appropriately. c. Psychiatric Conditions. When a claimant who has a physical work-related condition requires treatment for a related psychiatric condition (e.g., depressive reaction), the CE must add the psychiatric diagnosis to the system. Failure to do so may result in denial of bills for psychiatric care. d. Specific Identifiers. One-character identifiers unique to the case management system are used to add more specificity to ICD-9 codes. These identifiers are: R Right L Left FECA-PT2 Printed: 06/08/2010 34
B Both A Aggravation 2-0402 SECURITY & PREVENTION OF FRAUD & ABUSE TABLE OF CONTENTS Paragraph and Subject Date Trans. No. Table of Contents 10/98 99-02 1. Purpose and Scope 03/91 91-22 2. Monitoring Files and Documents 03/91 91-22 3. Payments 03/91 91-22 4. Information from Outside Sources 03/91 91-22 5. Unreported Earnings 03/91 91-22 6. Action Where Fraud is Not Involved 03/91 91-22 04/95 95-19 7. Action Where Fraud is Involved 10/98 99-02 8. Action upon Identifying Possible Fraud 03/91 91-22 08/95 95-33 01/92 92-12 9. Physical Security 01/92 92-12 Exhibits 1. Worksheet for Investigation of FEC Claimant 2. Incident Report, Form DL-156 Page 1 (Link to Image) Page 2 (Link to Image) 3. Referral of FEC Case to the OIG, Form CA-503 (Link to Image) 04/95 95-19 04/95 95-19 04/95 95-19 04/95 95-19 2-0402-1 Purpose and Scope 1. Purpose and Scope. This chapter describes Claims Examiners' (CEs') responsibilities in maintaining the security of payments of compensation. It establishes guidelines and procedures for referring cases to the Office of the Inspector General (OIG) or to investigators of the Wage and Hour Division or the Office of Federal Contract Compliance Programs (OFCCP). 2-0402-2 Monitoring Files and Documents 2. Monitoring Files and Documents. It is the CE's responsibility to monitor cases for indications of FECA-PT2 Printed: 06/08/2010 35
Page 1 and 2: LIST OF CHAPTERS PART 2 - CLAIMS (I
Page 3 and 4: which may be useful to the CE. b. C
Page 5 and 6: d. Continuation of Pay. An employee
Page 7 and 8: o. Review of OWCP Decisions. Under
Page 9 and 10: 2-0300 COMMUNICATIONS TABLE OF CONT
Page 11 and 12: 2-0300-4 Regular Correspondence 4.R
Page 13 and 14: (b) Formal Decision. If a formal de
Page 15 and 16: If the information requested cannot
Page 17 and 18: eferred to the NOO for adjudication
Page 19 and 20: 2-0400-6 Requesting Files 6. Reques
Page 21 and 22: the file. This process should mainl
Page 23 and 24: 2-0400-10 Case Transfers and Loans
Page 25 and 26: 2-0401 AUTOMATED SYSTEM SUPPORT FOR
Page 27 and 28: names and addresses is optional. By
Page 29 and 30: PW: Entitled to payment on periodic
Page 31 and 32: AM/C1: Condition accepted. Up to $1
Page 33: full appeal rights, and the adjudic
Page 37 and 38: a. Signatures. The CE must review c
Page 39 and 40: (a) The particular issues about whi
Page 41 and 42: c. Review by DD. Upon receipt of th
Page 43 and 44: disposition, a report, enclosing th
Page 45 and 46: 2-0500 CONFERENCING TABLE OF CONTEN
Page 47 and 48: necessary to identify the official(
Page 49 and 50: 2-0500-6 Senior CE Actions 6. Senio
Page 51 and 52: 2-0500-9 Due Process 9. Due Process
Page 53 and 54: This chapter outlines the major ste
Page 55 and 56: (d) Been notified that OWCP will pr
Page 57 and 58: 2-0600-4 Initial Actions 4. Initial
Page 59 and 60: 2-0600-5 Nurse Services 5. Nurse Se
Page 61 and 62: assess the claimant's environment a
Page 63 and 64: (4) Timely responses to telephone c
Page 65 and 66: for guidance in composing such ques
Page 67 and 68: (4) Only if the CE has taken these
Page 69 and 70: (1) RS Actions. If the claimant agr
Page 71 and 72: (3) Absent such a recovery, the OWC
Page 73 and 74: (c) After any training or other pre
Page 75 and 76: under way and the CE determines tha
Page 77 and 78: 2-0600 Exhibit 1: Sample Letter to
Page 79 and 80: 2-0600 Exhibit 3: Example of Letter
Page 81 and 82: 2-0600 Exhibit 5: Planning Chart fo
Page 83 and 84: period, and each new recurrence. a.
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a. QCM Screen. When the QCM screen
Page 87 and 88:
(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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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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2-0806 Exhibit 3: Sample Letter to
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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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Page 253 and 254:
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If you do not understand any part o
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Page 259 and 260:
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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
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W = Total number weeks worked P/W =
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COP is paid for the entire period o
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(c) When the physician's report ind
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(a) Assign or detail the employee t
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. Monitoring the Claim. (1) If Form
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(4) If conflicting information appe
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a. Permanent Total Disability (PTD)
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(1) Prior to December 7, 1940. No p
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(2) Impairment due to amputation is
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. Claims for Increased Schedule Awa
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compensation for temporary total di
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Medical. 2-0809-2 Introduction 2. I
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CE is ready to evaluate the evidenc
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the physician with a complete pictu
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(3) Personal habits such as smoking
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games or operating a construction b
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Jane Doe, date of birth 04/06/1965,
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elated to the employee’s duties;
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16. Physical Therapy 04/01 01-06 03
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evaluating the merits of medical re
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situation where ten days earlier th
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each opinion. The value of the evid
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manipulation of the body. They incl
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. The DMA's performance of these fu
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evidence from physicians who have n
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e. In cases involving a preexisting
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(1) The consultant should be asked
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value). Based on the results of thi
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However, if the impartial specialis
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2-0810-13 Exclusion of Medical Evid
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Leanna Garlington, 37 ECAB 849). Re
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(d) A suggested supplier, if any. (
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need for further treatment as detai
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2-0810-18 Transfer of Medical Care
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2-0810 Exhibit 1: Information from
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Dear CLAIMANT NAME: We need the fol
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2-0810 Exhibit 3: General Guideline
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2-0810 Exhibit 5: Sample Paragraph
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2-0810 Exhibit 7: Letter of Warning
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In addition, a primary goal of case
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(3) Release Form CA-1008 and Pamphl
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a. Where disability is present, the
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f. If the evidence obtained as a re
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eligible for disability benefits. A
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f. Physician's estimate of the date
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2-0812 PERIODIC REVIEW OF DISABILIT
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Page 379 and 380:
determine the status of dependents
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whether disability is related to th
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earnings or activity is in question
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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
Page 411 and 412:
2-0813-7 Communication Among the CE
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d. Cooperative Agreement. The title
Page 415 and 416:
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
Page 427 and 428:
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2-0814 REEMPLOYMENT: DETERMINING WA
Page 431 and 432:
Exhibits 1. Sample Letter to Claima
Page 433 and 434:
. Preliminary Assessment of Positio
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(b) If the attending physician cont
Page 437 and 438:
(3) The employing agency will be as
Page 439 and 440:
e. Payment/Reimbursement of Relocat
Page 441 and 442:
have no appeal rights attached. c.
Page 443 and 444:
were not reported to OWCP or were o
Page 445 and 446:
(3) If the employee can work only p
Page 447 and 448:
this instance the CE will need to e
Page 449 and 450:
d. Unacceptable Reasons for Abandon
Page 451 and 452:
closure of an installation, cessati
Page 453 and 454:
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
Page 459 and 460:
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
Page 471 and 472:
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
Page 489 and 490:
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 (
Page 503 and 504:
automatic pay increases. For exampl
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claimant to a higher pay rate under
Page 507 and 508:
(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
Page 535 and 536:
(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
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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
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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
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objective findings to support your
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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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(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
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the request. H&R will acknowledge r
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spouse or child prevents his or her
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OWCP shall pay fees requested by wi
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2-1601-9 Cases Returned from H&R 9.
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2-1601 Exhibit 2: Sample Letters Ac
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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
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percentage of the award under the S
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(2) The cover letter to the agency
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2-1602 Exhibit 1: Sample Letter Ret
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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
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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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Compensation for loss of wages may
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(3) Return from Service Abroad. d.
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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
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send an approval letter along with
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By signing this agreement, all part
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By signing this agreement, all part
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Memorandum of Agreement - Modificat
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Memorandum of Agreement - Housing M
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