Printing - FECA-PT2 - National Association of Letter Carriers

a. Initial Disallowances. Such disallowances are usually based on the claimant's failure to
meet his or her burden of proof to establish one of the five basic elements of the claim, i.e., time,
civil employee, fact of injury, performance of duty, or causal relationship.
(1) Burden of Proof. FECA PM 2-0800 discusses the claimant's responsibilities in primary
cases.
(2) Evidence Required. FECA PM 2-0801 through 2-0805 discuss the information needed
to establish the basic elements of a claim.
(3) Affirmative Defense. FECA PM 2-0804 discusses injuries caused by the claimant's
intoxication, willful misconduct, or intent to injure oneself or another [see 5 U.S.C.
8102(a)]. The Employees' Compensation Appeals Board (ECAB) has ruled that the OWCP
may not raise an affirmative defense for the first time on appeal (see Hope Kahler, 39 ECAB
588). Therefore, in any case where one of these factors is present, the CE must consider it
in the original disallowance of benefits.
The decision should include a finding that even if the element in question were met, the
claim would be denied based on the reason supporting the affirmative defense. For
example: "Even if it were found that your injury occurred in the performance of duty,
coverage under the FECA would be denied for the reason that your intoxication was the
proximate cause of your injury."
b. Terminations of Continuing Compensation Payments. Such terminations may or may not
include medical benefits.
(1) No Continuing Injury-Related Disability. Such a determination requires careful
weighing of medical evidence.
(2) Failure to Seek or Accept Suitable Employment. The legal authority is found at
section 5 U.S.C. 8106(c). See FECA PM 2-0814.
(3) Conviction for Defrauding the FECA Program. The legal authority is found at section
5 U.S.C. 8148(a). See paragraph 12 below.
c. Disallowances of Particular Benefits.
(1) Continuation of Pay (COP). Form CA-1050 may be used to deny COP. See FECA PM
2-0807.10.
(2) Particular Periods of Disability. In an accepted claim, the medical evidence may not
establish entitlement to benefits for all periods of time claimed. See FECA PM 2-0807.
(3) Recurrences of Disability. Claims for recurrence may arise from changes in the
claimant's medical condition or work status. See FECA PM 2-1500.
(4) Permanent Partial Impairment. A claim for permanent impairment may be denied,
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