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2-0402 Exhibit 1: Worksheet For Investigation Of FEC Claimant Name of Claimant or Beneficiary:_________________________________ OWCP Case File No._______________________ SSN___________________ Address:_________________________________________________________ _________________________________________________________________ Telephone Number:______________________________ Date of Injury:________________________________ Condition(s) for Which Benefits are Claimed/Paid:________________ _________________________________________________________________ Claimant's Occupation:___________________________________________ Employment Address:______________________________________________ _________________________________________________________________ Has case been accepted? Yes___ No___ If so, is compensation being paid? Yes___ No___ If so, at what rate? $________ each four weeks Purpose of Investigation: ____Determine facts surrounding injury or exposure ____Periodic roll employment check ____Periodic roll activity surveillance ____Overpayment financial questionnaire ____Other (explain below) Reasons investigation is requested:______________________________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Specific actions requested (interview, observation, etc.)________ _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ Claims Examiner:_____________________________ Date:______________ Telephone Number:________________________ 2-0402 Exhibit 2: Incident Report, Form DL-156 Page 1 (Link to Image) 2-0402 Exhibit 2: Incident Report, Form DL-156 Page 2 (Link to Image) 2-0402 Exhibit 3: Referral of FEC Case to the OIG Form CA-503 (Link to Image) FECA-PT2 Printed: 06/08/2010 44
2-0500 CONFERENCING TABLE OF CONTENTS Paragraph and Subject Date Trans. No. Table of Contents 06/98 98-05 1. Purpose 07/95 95-28 2. Responsibilities 07/95 95-28 3. Cases Suitable for Conferencing 07/95 95-28 4. Preparation for Conferencing 07/95 95-28 5. Elements of Conference 07/95 95-28 6. Senior CE Actions 07/95 95-28 7. Memorandum of Conference 07/97 97-19 06/98 98-05 8. Comments 07/95 95-28 07/97 97-19 9. Due Process 07/95 95-28 2-0500-1 Purpose 1. Purpose. The purpose of this chapter is to provide specific instructions for holding conferences with claimants, employing agency personnel, or other parties to resolve complex issues, and to facilitate the claimant's early return to work. The issues commonly addressed through conferencing include controversions, disputed facts or occurrences, and overpayments. In such situations, the conference is employed as a means of fact- finding, following which a decision is made. The return-to-work (RTW) conference is different from other kinds of conferencing in that its goal is to assist the claimant's return to the work force, and as such is a form of principled negotiation. If the objective of the RTW conference is reached, all parties to the negotiation will experience a positive result. Although conferences will sometimes be held in person with several parties in attendance, most conferences will be held by telephone and with only one party at a time. However, a typical RTW conference by telephone will involve several parties--the Senior Claims Examiner (SrCE), the Field Nurse, the Staff Nurse, the claimant and/or a representative of the employing agency (though not physicians). On occasion the Claims Examiner (CE) assigned to the case will also take part. 2-0500-2 Responsibilities 2. Responsibilities. The SrCE is responsible for conferencing cases where an issue is in dispute, where detailed technical evidence is required to decide an issue, or to facilitate return to employment. Except in overpayment cases and those involving return to work, the Supervisory Claims Examiner (SCE) is responsible for identifying cases for conferencing and will refer them to the SrCE. The District Director will keep a file containing all Memorandums of Conference. FECA-PT2 Printed: 06/08/2010 45
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 and 34: full appeal rights, and the adjudic
Page 35 and 36: B Both A Aggravation 2-0402 SECURIT
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: disposition, a report, enclosing th
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.
Page 85 and 86: a. QCM Screen. When the QCM screen
Page 87 and 88: (c) Confirmation of Data. After ent
Page 89 and 90: (1) NFN*--Referred to Field Nurse.
Page 91 and 92: 2-0601-6 Effect of RTW on QCM Statu
Page 93 and 94: 2-0601 Exhibit 1: Disability Tracki
Page 95 and 96:
SRE Referred to SrCE for Conference
Page 97 and 98:
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
Page 105 and 106:
(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
Page 225 and 226:
Page 227 and 228:
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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Page 245 and 246:
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
Page 323 and 324:
evaluating the merits of medical re
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situation where ten days earlier th
Page 327 and 328:
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
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
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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
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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
Page 373 and 374:
f. Physician's estimate of the date
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2-0812 PERIODIC REVIEW OF DISABILIT
Page 377 and 378:
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
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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
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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
Page 417 and 418:
(2) To reduce compensation in this
Page 419 and 420:
The specificity of the reasons offe
Page 421 and 422:
in conjunction with graded conditio
Page 423 and 424:
(1) Where the claimant cannot perfo
Page 425 and 426:
2-0813 Exhibit 2: Non-Cooperation W
Page 427 and 428:
Page 429 and 430:
2-0814 REEMPLOYMENT: DETERMINING WA
Page 431 and 432:
Exhibits 1. Sample Letter to Claima
Page 433 and 434:
. Preliminary Assessment of Positio
Page 435 and 436:
(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
Page 455 and 456:
If you receive an increase in pay o
Page 457 and 458:
2-0814 Exhibit 3: Sample Letter To
Page 459 and 460:
RATE DATE FOR SCHEDULE AWARDS 01/10
Page 461 and 462:
(1) Kinds of Appointments. The Post
Page 463 and 464:
year, in the teaching profession, w
Page 465 and 466:
(b) Census enumerators; (c) Casual
Page 467 and 468:
The CE should consider these factor
Page 469 and 470:
The greatest of these pay rates wil
Page 471 and 472:
the Department of Veterans Affairs
Page 473 and 474:
degree of expense, hardship, and in
Page 475 and 476:
(2) Basic bi-weekly pay x premium p
Page 477 and 478:
2-0900-9 Computing Daily Pay Rate 9
Page 479 and 480:
2-0900-11 Computing Monthly Pay Rat
Page 481 and 482:
The salary for these employees may
Page 483 and 484:
2-0901 COMPUTING COMPENSATION TABLE
Page 485 and 486:
2-0901-2 Related Topics 2. Related
Page 487 and 488:
(4) A GS-12 CE or designated CE may
Page 489 and 490:
2-0901-4 Factors in Computing Compe
Page 491 and 492:
(3) For schedule award payments, th
Page 493 and 494:
(4) Compensation payable for less t
Page 495 and 496:
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
Page 501 and 502:
(3) ( ) (a) is capable of earning (
Page 503 and 504:
automatic pay increases. For exampl
Page 505 and 506:
claimant to a higher pay rate under
Page 507 and 508:
(a) the beneficiary's maintenance,
Page 509 and 510:
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
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
Page 541 and 542:
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
Page 553 and 554:
When a third party is or may be leg
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(6) Ltr. CA-1109, Authorization to
Page 557 and 558:
7. Administration of Third Party Ca
Page 559 and 560:
(3) If not accurate or complete, th
Page 561 and 562:
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
Page 579 and 580:
not be referred to the FEEWC until
Page 581 and 582:
FECA-PT2 Printed: 06/08/2010 581
Page 583 and 584:
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
Page 593 and 594:
2-1300-3 Requests for Lump-Sum Paym
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2-1300-4 Calculating Lump-Sum Sched
Page 597 and 598:
2-1300 Exhibit 2: Sample Appealable
Page 599 and 600:
3. REVIEW BY THE EMPLOYEES' COMPENS
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SIGNATURE _________________________
Page 603 and 604:
We have received your request for a
Page 605 and 606:
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
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
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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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Page 657 and 658:
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
Page 671 and 672:
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
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
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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
Page 733 and 734:
Memorandum of Agreement - Modificat
Page 735 and 736:
Memorandum of Agreement - Housing M
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