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2-0810 Exhibit 6: Letter to Physician Requiring Additional Medical Justification Dear PHYSICIAN NAME: The Office of Workers' Compensation Programs (OWCP) has authorized and reimbursed physical therapy services for CLAIMANT NAME for a period of 120 days. Please be aware that the following additional medical information is required before reimbursement for further therapy can be authorized: (a) Diagnosis for which physical therapy will be administered. (b) Specific functional deficits which are to be treated including a description of how these affect the patient's physical activities. (c) Specific functional goals of the additional therapy. (d) Expected duration and frequency of treatment. (e) Modalities, procedures and/or tests and measures to be administered detailed by Physicians' Current Procedural Terminology (CPT-4) procedure codes. If additional therapy is planned for this patient, please submit a report containing the above mentioned items to OWCP for consideration. Sincerely, CLAIMS EXAMINER FECA-PT2 Printed: 06/08/2010 360
2-0810 Exhibit 7: Letter of Warning to Physician Failing to Supply Requested Information Dear PHYSICIAN NAME: This letter concerns your patient(s) who is/are claimants under the Federal Employees' Compensation Act (FECA). The regulations of the Office of Workers' Compensation Programs state that medical providers who do not furnish information as requested by the Office, or who furnish inappropriate treatment to the claimants, may be excluded from payment and participation as a provider of medical services under the FECA. The pertinent section of the regulations is found at 20 C.F.R. 10.450, as follows: A physician, hospital, or provider of medical support services or supplies shall be excluded from payment under the Act if such physician, hospital or provider has....EITHER: (f) Failed, neglected or refused on three or more occasions during a twelve month period, to submit full and accurate medical reports, or to respond to requests by the Office for additional reports or information, as required by the Act at 10.410 of this part [OR: (g) Knowingly furnished treatment, services or supplies which are substantially in excess of the claimant's needs, or of a quality which fails to meet professionally recognized standards.] This Office has identified the following instances of non-compliance with this section of the regulations [concisely summarize the evidence and refer to supporting documentation, which should be attached to the letter]. The OWCP values its relationships with medical providers. However, it is vital that EITHER: we receive full and accurate medical reports OR: claimants receive appropriate medical treatment. Your future disregard of the regulatory provision cited above will lead to your exclusion from payment and participation as a provider of medical services under the FECA. Please telephone me at (area code and number) if you have any questions. Sincerely, DISTRICT DIRECTOR FECA-PT2 Printed: 06/08/2010 361
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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
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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
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 and 336: e. In cases involving a preexisting
Page 337 and 338: (1) The consultant should be asked
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: 2-0810 Exhibit 5: Sample Paragraph
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
Page 387 and 388: . Suspension of Compensation. OWCP
Page 389 and 390: certification clauses on the CA-103
Page 391 and 392: SI Payment/Entitlement Suspension i
Page 393 and 394: with the return to work effort. CFF
Page 395 and 396: should be placed in a PN status. OP
Page 397 and 398: force. 10. If the business has had
Page 399 and 400: I am writing in follow up to the Fo
Page 401 and 402: 2-0812 Exhibit 6 - Periodic Entitle
Page 403 and 404: Service. On 03/14/2003, the claiman
Page 405 and 406: Authorized Medical Care for Substan
Page 407 and 408: a. OPM's regulations on retention r
Page 409 and 410: 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
Page 525 and 526:
. Death Benefits. When compensation
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(3) Certification. The CE should ha
Page 529 and 530:
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
Page 537 and 538:
d. Obtaining Elections--Educational
Page 539 and 540:
(3) The CE must advise the claimant
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c. Injuries On and After September
Page 543 and 544:
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
Page 551 and 552:
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
Page 585 and 586:
. 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
Page 599 and 600:
3. REVIEW BY THE EMPLOYEES' COMPENS
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SIGNATURE _________________________
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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
Page 625 and 626:
. 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
Page 631 and 632:
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
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
Page 649 and 650:
emains the same regardless of wheth
Page 651 and 652:
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
Page 671 and 672:
2-1601 Exhibit 5: Request for Comme
Page 673 and 674:
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
Page 687 and 688:
2-1602 Exhibit 5: Sample Compensati
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2-1603 APPEALS TABLE OF CONTENTS Pa
Page 691 and 692:
d. Timeliness of Filing. A person r
Page 693 and 694:
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
Page 701 and 702:
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
Page 707 and 708:
(1)While at a Job Corps Center, an
Page 709 and 710:
(1)Enrollees are required to report
Page 711 and 712:
coverage under 5 U.S.C. 8101. b. Co
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Page 715 and 716:
2-1800-2 Authority 2. Authority. Ho
Page 717 and 718:
determined by the type of vehicle,
Page 719 and 720:
greatest current fair market value
Page 721 and 722:
Such certification from an architec
Page 723 and 724:
over $10,000, and that amount must
Page 725 and 726:
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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