Printing - FECA-PT2 - National Association of Letter Carriers

(2) Form of Notice. In unadjudicated cases, or where a specific benefit is claimed, the
CE may use a form or narrative letter to notify the claimant of the information needed.
Where ongoing benefits are being paid, the CE should prepare a pre-termination or
pre-reduction notice (see paragraphs 6 and 7).
(3) Time Frames. The notice should advise the claimant of his or her burden of proof
and state how much time the claimant has to submit the evidence requested before a
formal decision will be issued.
(4) Parties Advised. The CE should send the notice to the claimant, with a copy to the
employing agency. If an authorized representative is present in the case, the CE should
also send the letter to the representative.
(5) Subsequent Actions. After releasing the letter, the CE should set a reminder for the
number of days specified in the letter. The CE should consider fully any new evidence
submitted in response to the request. If disallowance is still indicated, the CE should
prepare a formal decision as outlined in paragraphs 4 and 5. The CE should also prepare a
formal decision if the indicated amount of time has elapsed with no response. If an
authorized representative is present in the case, the CE must also send the formal decision
letter to the representative.
c. Contents of Disallowance. Each disallowance must contain findings of fact sufficient to
identify the benefit being denied and the reason for the disallowance. The disallowance must also
contain a description of the claimant's appeal rights. The CE may use letters and decisions with
pre-formatted text but should modify them, and include additional information as needed, in order
to fully explain the findings and rationale for disallowance. See paragraph 5 below concerning
preparation of decisions which are not pre-formatted.
d. Signature Authority. Designated CEs at the GS-12 level may deny the following: initial
claims for traumatic injury and occupational disease; most complex disability and death cases;
claims for recurrence; claims for continuation of pay; requests for medical treatment, equipment,
or supplies; requests for surgery; claims for schedule awards in hearing loss cases with no ratable
loss; and periods of intermittent wage loss where the claimant has not met the burden of proof to
establish entitlement to compensation. Designated CEs at the GS-12 level also issue 0% Loss of
Wage-Earning Capacity (LWEC) decisions and render decisions on disputed attorney fee requests
up to $10,000.
All other disallowances will be prepared for the signature of the Senior Claims Examiner (SrCE).
Signature authority parameters are outlined fully in Exhibit 11.
2-1400-3 Additional References
Additional References. This paragraph describes where detailed information about various kinds of
disallowances may be found. Weighing factual evidence is discussed in FECA PM 2-0809, and weighing
medical evidence is discussed in FECA PM 2-0810.
FECA-PT2 Printed: 06/08/2010 608