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prescribed limit) Note: Lump sum schedule award calculations must also be approved by a SCE. SENIOR CLAIMS EXAMINERS * All items listed under General GS-12 CE * All Complex Disability and Death Claims (approval/denial) * Proposed Terminations & Final Terminations * Proposed Reductions & Final Reductions * LWEC Modifications * 8106c Decisions; Rehabilitation Sanction Decisions * Disallowance of Disfigurement Awards * Suspension or Forfeiture of Benefits * Rescission of Acceptance * Housing or Vehicle Modifications * Reconsiderations * Disputed Attorney Fees ($0-$15,000) * Certification of Placement on the PR for TTD, LWEC or survivor benefits. * Certification of OPM/VA Election Letters * Certification authority $0-$50,000 SUPERVISORY CLAIMS EXAMINER OR HIGHER LEVEL * Payments in amounts greater than $50,000 must be verified/signed by a Supervisory Claims Examiner (SCE), GS-13 or higher level. This authority may be delegated to a SrCE in writing for a specific period of time, for example while serving as acting SCE. The SrCE should reflect such authorization on the payment sheet with an annotation of 'Acting SCE.' * Payment in excess of $99,999 must be certified by the Assistant District Director (ADD) or District Director (DD). * SCE – Disputed Attorney Fees ($0-$50,000) * DD or ADD – Disputed Attorney Fees > $50,000 FECA-PT2 Printed: 06/08/2010 640
2-1500 RECURRENCES TABLE OF CONTENTS Paragraph and Subject Date Trans. No. Table of Contents 08/00 05/03 10/09 00-11 03-02 10-01 1. Purpose and Scope 01/98 98-04 2. Policy 01/95 95-07 3. Definitions 01/95 95-07 05/97 97-10 4. Claims for Recurrence 01/95 95-07 5. Recurrence of Medical Condition 01/95 95-07 6. Recurrent Disability for Work 05/03 03-02 Within 90 Days of Return to Duty 01/95 95-07 7. Recurrent Disability for Work After 90 Days of Return to Duty 01/95 95-07 05/97 97-10 05/03 10/09 03-02 10-01 8. Compensation for Recurrent Disability 08/00 00-11 2-1500-1 Purpose and Scope 1. Purpose and Scope. This chapter describes policies and procedures for developing claims for recurrent medical conditions and recurrent disability. It also addresses return to work issues related to recurrences. The Disability Tracking System is addressed in FECA PM 2-0601. 2-1500-2 Policy 2. Policy. The purpose of this paragraph is to describe the policies of the Office of Workers' Compensation Programs (OWCP) with respect to claims for recurrence of medical condition and recurrence of disability. OWCP's regulations at 10.121 address the evidence which must be submitted to support such a claim. For recurrences of medical conditions, the claimant has the burden of proof to establish the relationship of the claimed recurrence to the injury. For recurrences of disability, the claimant has the additional burden of establishing that the claimed disability for work has resulted from the accepted condition. The burden exists whether the claimant returns to regular or light duty; in Terry L. Hedman, 38 ECAB 222, the Board FECA-PT2 Printed: 06/08/2010 641
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LIST OF CHAPTERS PART 2 - CLAIMS (I
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which may be useful to the CE. b. C
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d. Continuation of Pay. An employee
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o. Review of OWCP Decisions. Under
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2-0300 COMMUNICATIONS TABLE OF CONT
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2-0300-4 Regular Correspondence 4.R
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(b) Formal Decision. If a formal de
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If the information requested cannot
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eferred to the NOO for adjudication
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2-0400-6 Requesting Files 6. Reques
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the file. This process should mainl
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2-0400-10 Case Transfers and Loans
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2-0401 AUTOMATED SYSTEM SUPPORT FOR
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names and addresses is optional. By
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PW: Entitled to payment on periodic
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AM/C1: Condition accepted. Up to $1
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full appeal rights, and the adjudic
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B Both A Aggravation 2-0402 SECURIT
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a. Signatures. The CE must review c
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(a) The particular issues about whi
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c. Review by DD. Upon receipt of th
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disposition, a report, enclosing th
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2-0500 CONFERENCING TABLE OF CONTEN
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necessary to identify the official(
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2-0500-6 Senior CE Actions 6. Senio
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2-0500-9 Due Process 9. Due Process
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This chapter outlines the major ste
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(d) Been notified that OWCP will pr
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2-0600-4 Initial Actions 4. Initial
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2-0600-5 Nurse Services 5. Nurse Se
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assess the claimant's environment a
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(4) Timely responses to telephone c
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for guidance in composing such ques
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(4) Only if the CE has taken these
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(1) RS Actions. If the claimant agr
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(3) Absent such a recovery, the OWC
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(c) After any training or other pre
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under way and the CE determines tha
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2-0600 Exhibit 1: Sample Letter to
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2-0600 Exhibit 3: Example of Letter
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2-0600 Exhibit 5: Planning Chart fo
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period, and each new recurrence. a.
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a. QCM Screen. When the QCM screen
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(c) Confirmation of Data. After ent
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(1) NFN*--Referred to Field Nurse.
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2-0601-6 Effect of RTW on QCM Statu
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2-0601 Exhibit 1: Disability Tracki
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SRE Referred to SrCE for Conference
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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
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(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
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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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TITLE _____________________________
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eason, you should call or write to
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9. [FREE FLOW IF DESIRED] We may wr
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If you do not understand any part o
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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
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evaluating the merits of medical re
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situation where ten days earlier th
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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
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(d) A suggested supplier, if any. (
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need for further treatment as detai
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2-0810-18 Transfer of Medical Care
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2-0810 Exhibit 1: Information from
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Dear CLAIMANT NAME: We need the fol
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2-0810 Exhibit 3: General Guideline
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2-0810 Exhibit 5: Sample Paragraph
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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
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f. Physician's estimate of the date
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2-0812 PERIODIC REVIEW OF DISABILIT
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determine the status of dependents
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whether disability is related to th
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earnings or activity is in question
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eferred to the Office of Inspector
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. Suspension of Compensation. OWCP
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certification clauses on the CA-103
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SI Payment/Entitlement Suspension i
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with the return to work effort. CFF
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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
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2-0813-7 Communication Among the CE
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d. Cooperative Agreement. The title
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ehabilitation process. 2-0813-11 Fa
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(2) To reduce compensation in this
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The specificity of the reasons offe
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in conjunction with graded conditio
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(1) Where the claimant cannot perfo
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2-0813 Exhibit 2: Non-Cooperation W
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2-0814 REEMPLOYMENT: DETERMINING WA
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Exhibits 1. Sample Letter to Claima
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. Preliminary Assessment of Positio
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(b) If the attending physician cont
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(3) The employing agency will be as
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e. Payment/Reimbursement of Relocat
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have no appeal rights attached. c.
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were not reported to OWCP or were o
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(3) If the employee can work only p
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this instance the CE will need to e
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d. Unacceptable Reasons for Abandon
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closure of an installation, cessati
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Code, and returns to duty under ret
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If you receive an increase in pay o
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2-0814 Exhibit 3: Sample Letter To
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RATE DATE FOR SCHEDULE AWARDS 01/10
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(1) Kinds of Appointments. The Post
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year, in the teaching profession, w
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(b) Census enumerators; (c) Casual
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The CE should consider these factor
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The greatest of these pay rates wil
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the Department of Veterans Affairs
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degree of expense, hardship, and in
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(2) Basic bi-weekly pay x premium p
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2-0900-9 Computing Daily Pay Rate 9
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2-0900-11 Computing Monthly Pay Rat
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The salary for these employees may
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2-0901 COMPUTING COMPENSATION TABLE
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2-0901-2 Related Topics 2. Related
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(4) A GS-12 CE or designated CE may
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2-0901-4 Factors in Computing Compe
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(3) For schedule award payments, th
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(4) Compensation payable for less t
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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
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(3) ( ) (a) is capable of earning (
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automatic pay increases. For exampl
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claimant to a higher pay rate under
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(a) the beneficiary's maintenance,
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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
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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
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(b) The claimant may be entitled to
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d. Obtaining Elections--Educational
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(3) The CE must advise the claimant
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c. Injuries On and After September
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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
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2-1000 Exhibit 2: OPM Contact List
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When a third party is or may be leg
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(6) Ltr. CA-1109, Authorization to
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7. Administration of Third Party Ca
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(3) If not accurate or complete, th
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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
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not be referred to the FEEWC until
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FECA-PT2 Printed: 06/08/2010 581
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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
Page 589 and 590: 2-1200 Exhibit 1: Sample Formal Dec
Page 591 and 592: 2-1300 LUMP SUM PAYMENTS TABLE OF C
Page 593 and 594: 2-1300-3 Requests for Lump-Sum Paym
Page 595 and 596: 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
Page 601 and 602: SIGNATURE _________________________
Page 603 and 604: We have received your request for a
Page 605 and 606: 2-1400 DISALLOWANCES TABLE OF CONTE
Page 607 and 608: 2-1400-1 Purpose and Scope Purpose
Page 609 and 610: a. Initial Disallowances. Such disa
Page 611 and 612: (1) Failure to Appear for Medical A
Page 613 and 614: (1) The name and location of the em
Page 615 and 616: injury caused no disability for wor
Page 617 and 618: (3) A specific service which the cl
Page 619 and 620: 2-1400-7 How to Issue Pre-Terminati
Page 621 and 622: (a) The case is being referred beca
Page 623 and 624: (a) Compensation is being terminate
Page 625 and 626: . Source of Advice. District office
Page 627 and 628: usual rate, i.e., 75 percent of the
Page 629 and 630: objective findings to support your
Page 631 and 632: 2-1400 Exhibit 3: Sample Notice of
Page 633 and 634: 2-1400 Exhibit 4: Sample Letter Con
Page 635 and 636: 2-1400 Exhibit 6: Sample Notice of
Page 637 and 638: 2-1400 Exhibit 8: Sample Letter Con
Page 639: 2-1400 Exhibit 10: Sample Letter De
Page 643 and 644: (d) Closure of a base or other faci
Page 645 and 646: (1) The medical evidence needed to
Page 647 and 648: c. Case Management. The CE should c
Page 649 and 650: emains the same regardless of wheth
Page 651 and 652: 2-1600 REVIEW PROCESS TABLE OF CONT
Page 653 and 654: c. Formal Decision. Chapter 2-1400
Page 655 and 656: FECA-PT2 Printed: 06/08/2010 655
Page 657 and 658: the request. H&R will acknowledge r
Page 659 and 660: spouse or child prevents his or her
Page 661 and 662: OWCP shall pay fees requested by wi
Page 663 and 664: 2-1601-9 Cases Returned from H&R 9.
Page 665 and 666: 2-1601 Exhibit 2: Sample Letters Ac
Page 667 and 668: Exhibit 3, page 1 of 3: Hearing Not
Page 669 and 670: Exhibit 3, page 3 of 3: Hearing Ins
Page 671 and 672: 2-1601 Exhibit 5: Request for Comme
Page 673 and 674: 2-1602 RECONSIDERATIONS TABLE OF CO
Page 675 and 676: 2-1602-2 Policy 2. Policy. The foll
Page 677 and 678: d. Decision. An untimely applicatio
Page 679 and 680: percentage of the award under the S
Page 681 and 682: (2) The cover letter to the agency
Page 683 and 684: 2-1602 Exhibit 1: Sample Letter Ret
Page 685 and 686: Dear CLAIMANT NAME: We have reviewe
Page 687 and 688: 2-1602 Exhibit 5: Sample Compensati
Page 689 and 690: 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
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(3) Return from Service Abroad. d.
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Section 5 U.S.C. 8101(4), which pro
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(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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FECA-PT2 Printed: 06/08/2010 713
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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
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Memorandum of Agreement - Modificat
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Memorandum of Agreement - Housing M
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