Printing - FECA-PT2 - National Association of Letter Carriers

2-0812-1 Purpose and Scope
1. Purpose and Scope. This chapter discusses procedures for monitoring disability claims paid on the
periodic roll and for developing evidence to determine continuing entitlement to compensation as well as
the nature of that entitlement. Monitoring of death claims is addressed in FECA PM 2-0700.
Payment on the periodic roll is an efficient method of ensuring regular payment of compensation to those
with long-term compensable disabilities. In all periodic roll cases, it remains the responsibility of the
Claims Examiner (CE) to ensure that evidence remains current in the case, that all suitable medical care is
provided, and that appropriate use is made of nursing and rehabilitation services. Quality case
management, with active monitoring of the progress of the case, should be utilized to obtain the best
possible outcome and a return to employment where at all feasible.
2-0812-2 Statutory Provisions
2. Statutory Provisions. When a case has been accepted, the claimant is entitled to compensation
benefits and medical treatment for the medical condition(s) found to be related to the employment.
a. Sections 5 U.S.C. 8105-8106 provide that compensation is payable for wage loss caused by
a medical condition found to be related to the employment.
b. Section 5 U.S.C. 8107 provides that compensation is payable for the permanent loss or loss
of use of certain anatomical members, functions, or organs of the body. Except for disfigurement,
schedule award entitlement is payable consecutively, but not concurrently, with an award for wage
loss due to the same injury.
c. Section 5 U.S.C. 8111 provides for additional compensation for the service of an attendant
where required; after January 4, 1999, this is generally paid as a medical expense pursuant to 5
U.S.C. 8103.
2-0812-3 Burden of Proof in Continuing or Terminating Benefits
3. Burden of Proof for Terminating Benefits. Having accepted a claim and initiated payments, the
OWCP may not terminate compensation without a positive demonstration, by the weight of evidence, that
entitlement to benefits has ceased. Generally, this means that a claimant's failure to reply to a request for
a medical report is insufficient grounds to terminate benefits. However, failure to report for or cooperate
with an OWCP directed medical examination would constitute grounds for suspension of benefits under
section 8123 of the FECA. Furthermore, when a claimant is receiving benefits on the periodic roll, benefits
may not be terminated or reduced without giving the claimant prior notice and an opportunity to provide
evidence of continuing entitlement, except in a limited set of circumstances (see FECA PM 2-1400).
2-0812-4 Placement and Monitoring of Claims and Periodic Roll
4. Placement and Monitoring of Claims on the Periodic Roll. Where prolonged (over 90 days) or
permanent disability is expected, compensation for wage loss should be paid on the periodic roll. After
payment has begun, the CE is responsible for obtaining medical and non-medical evidence to determine
continued entitlement. The CE is responsible for periodic review of active cases to ensure that payments
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