Printing - FECA-PT2 - National Association of Letter Carriers

2-1400-1 Purpose and Scope
Purpose and Scope. Section 5 U.S.C. 8124(a) of the FECA requires the OWCP to make findings of fact
with respect to each claim filed and to make an award for or against the payment of compensation. When
the outcome is negative, the OWCP must issue a formal decision. This chapter describes how to prepare
such decisions, including pre-termination and pre-reduction notices.
2-1400-2 Policy
Policy. This paragraph addresses when formal decisions are to be released and the steps which the
Claims Examiner (CE) must take before considering issuance of a disallowance. It also discusses the
contents, form, and signature authority for disallowances.
a. When Decisions are Required. Formal decisions must be issued when claim forms have
been submitted. They may also be issued in response to letters requesting benefits or on the
OWCP's initiative. Further information on various kinds of disallowances is referenced in paragraph
3 below.
(1) Initial Decisions. A formal decision is required in any case where the OWCP has
received a Form CA-1, CA-2, CA-5 or CA-5b and it is clear after appropriate development
that one or more of the five basic requirements of the claim is not met.
(2) Claims for Compensation. A formal decision is required in any case where the OWCP
has received a Form CA-7, claiming compensation, and determined that the claim cannot be
paid after appropriate development. Note however that if the case in its entirety (or the
same period of compensation) has already been denied by formal decision, a new decision is
not needed for a CA-7 received after the date of denial. A letter should be sent to the
claimant indicating that the case (or period) has already been formally denied and refer the
claimant to any appeal rights that accompanied that decision.
(3) Specific Benefits. If a particular benefit (e.g., a certain kind of medical treatment)
must be disallowed, a letter to the claimant explaining why the benefit cannot be granted
will often suffice. However, a formal decision should be issued upon any request by the
claimant for such a decision.
(4) Continuing Entitlement. Where a claimant who is receiving compensation benefits is
no longer entitled to them, benefits must be terminated or reduced. The OWCP initiates
such decisions.
b. Due Process. Before preparing a disallowance of benefits, the CE must adequately develop
the claim and, where necessary, advise the claimant of his or her burden of proof in establishing
entitlement to benefits. Where ongoing benefits are at issue, the CE is responsible for advising the
claimant of the proposed termination or reduction including the reasons for the proposed action
and an opportunity to respond in writing.
(1) Notification to Claimant. The CE must notify the claimant in writing of the specific
additional evidence which is needed before denying any claim. The contents of such notices
are described in FECA PM chapters addressing various kinds of entitlement (see paragraph 3
for a list of references).
FECA-PT2 Printed: 06/08/2010 607