Printing - FECA-PT2 - National Association of Letter Carriers

practicality are essential criteria to be used when considering proposed modifications. If an
existing sink can be reinstalled at another height [see this chapter paragraph 6.a(5)] to
achieve the required modification, this is preferable to discarding it and replacing it with a
new sink.
(5) Similarly, when a claimant lives in a rented walk-up apartment prior to the injury
and can no longer climb stairs, the difference in rent may be paid for the most nearly
comparable elevator apartment available. The CE must ensure that the proposed
apartment is equivalent to the pre-injury living quarters in terms of living area, amenities
and community desirability.
(6) If a renter living in a remote area needs a modification not allowed by the property
owner, and there is no rental property available within a reasonable distance, the feasibility
of relocation, new construction, or any other viable option should be weighed.
(7) For true rental situations, the claimant is required to provide proof of adequate
insurance. Claimants must carry renter's insurance that reflects the present value of the
belongings within the residence, unless the modifications were furnished at a cost under
$1,000. If the claimant is living with a family member, the home owner should carry the
insurance.
b. Technical Development. The technical development of the housing
modification will take the same course for renters as for the home owners described in the prior
paragraph, with the exception that the landlord or home owner must agree to the modifications.
2-1800-8 Adjudication of Proposals
8. Adjudication of Proposals.
a. Medical evidence as described in paragraph 4 above is required. A claimant seeking a
housing or vehicle modification should be advised to submit the requested documentation needed
to establish medical necessity. If the claimant fails to submit the necessary documentation, a
formal decision with appeal rights should be issued. This decision should discuss the evidence of
record and provide an explanation of why it is insufficient to support the medical necessity.
Technical development of a proposal, or review of a submitted proposal, is not necessary if the
evidence of record does not establish that the proposed modifications are necessitated by
work-related restrictions.
b. If medical necessity is established, then technical development to establish the criteria
noted in paragraphs 5, 6 or 7 is warranted. As noted previously, it is often necessary to have an
OWCP RC or FN involved in this process. The CE will review the itemized proposal and determine
whether the specified modifications are warranted. This would be an appropriate time for a
telephone conference between the CE, the claimant, the RS, the RC, the FN and the party
performing the modification (as appropriate) to discuss the proposal, particularly if changes to, or
clarification of, the proposal are needed before authorization can be given.
c. The CE's recommendations for approving proposals are to be routed to the Senior Claims
Examiner (SrCE), regardless of the cost involved. If the proposal is approved, the SrCE should
FECA-PT2 Printed: 06/08/2010 726