Workers - Council of Prison Locals - C-33

: _ ^f'GE 1 orH DISTRICT TRATNITT -i
\Arorkers, Compensation Manual
TABLI OF CONTENTS
STIBPART -A- P-AGE NO
GENERAL PRO\/NIONS
I
INTRODUCTION.
DEFINITIONS AND FORMS.
INFORMATION I\ PROGRAM RECORDS
RIGHTS AND PENALTIES. .1.*""I\-1,'J.
SiTBPART B - FILTNG NOTICES AND cLAh4S; SLIBI\4rrrING E\IIDENCE
...10
........]2
""""""16
.....1
8
NOTICES AND CLAIMS FOR INJI,R\'. DISEASE, AND DEATH -
EMPLO\TE OR STIR\TTVORS ACTIONS. .. NOT]CES
....19
A.iD CLAIMS FOR INI,R\'. DISEASE AND DEATH -
EMPLO\,ER'S ACTIONS.. .
......,
EVIDENCE
.22
AND BL,RDEN OR PROOF..... ...........23
DECISIONSONENTITLEMENTTOBENTFITS.
.. .. ... . . .........25
SLtsPART C - CONTTI\JUATION OF PAY
ELIGIBILITY FOR COP.
CALCULATION
.....26
OF COP.
CONTROVERSION
....28
Ar.,\rD TERMINATION OF COp. .. ....... ..... ... ..:O
SL,tsP,ART D - MEDICAL AND RELATED BENEFITS a 1
_tt
EMERGENCY MEDICAT CARE. ...... MEDICAL
.....31
TREATMENT AND RELATED ISSIJE,S. .
DIRECT
.......33
MEDICAL EXAMNATIONS.
MEDICALREPORTS
,. ..35
... .......37
MED]CAL BILLS..
....38
SLIBPART E _ COMPENSATION A\D RELATED BENEFITS
)>
COX{PENSATION FOR DISABILITY A\D L\,{PAIR*\4ENT. . .
CO]\{PENSATIONFORDEATH...
" ,..39
..-.....12
ADTUSTI\4ENTS To CON4PENSATjON..... ... . ...
OVERPA\-MENTS.
*s
....4i
SLtsPART F - CONTI\UI\G BE\TFITS
RULES A\iD EYIDENCE
RETLRN
.....-5]
TO \\TORK- EMPLO\'ER'S RESPONSIBILITIES
RETLRN
.,)
TO \\/ORK - EN4PLO\.EE,S RESPONSIBILITIES . , . ,54
tg
25
5t

TABLE OF CONTENTS. SLTBPART F (CoNTINUEDi
REPORTS OF EARNINGS FROM EMPLOYMENT AND
SELF-EMPLOYMENT .. ... .51
REPORTS OF DEPE]VDENTS ...,,...58
REDUCTION AND TERI4INATION OF COMPENSATION
59
SLtsPART G APPEALS PROCESS
60
RECONSIDERATIONS AND RE\rrE'\l's By rHE DIRECTOR..... .........60
HEARINGS......
........(tZ
RE\/IE\A'S BY THE EMPLOYEES CO]VIPENSATION
APPEALS BOARD (ECAB). ..........66
SUBPART H - SPECLAL PRO\/N]ONS
REPRESENTATION. ...........66
THIRD PART}'LI.ABILITY ,.........68
FEDERAL GRANT AND PETIT .TLRORS ..........73
PEACE CORPS VOLLNTEERS.. ..........74
NON-FEDER{ LA\\I ENFORCEN4ENT OFFICERS ...........74
SLBPART i - NTORMATION FOR MED]CAL PRO\IIDERS
MEDICALRECORDSA\DBILLS...... .........71
MEDiCAL FEE SCHEDLTLE.
, ......7g
EXCLUSION OF PROVIDERS
83
APPENDIX A FORN4S
CA-10
CA-1 With Instruction Sheet
CA-2 \\'ith Insrruction Sheet
CA-2A \\'ith Instruction Sheer
CA- 3
CA-7 \\'tth lnstrucrion Sheel
CA-16 \\'ith lnstruction Sheet
CA-17
CA-20
il

PART 10--CLAIIIS FoR coNIpENSATIoN L,TDER THE FEDER{L
E}IPLOYEES' CO\IPENSATION ACT, AS A}IENDED
Sec.
Introduction
Subpart A--General pror.isions
10.0 \\hat are rhe pror.isions of rhe FECA. in generall
l0- 1 what rules qo'ern the administration ol the FECi and this
10.2 \\'hat do these regulations contain
10.3 Have the collection of infornration requirements of this part
Office of l\4anagemenr and Budget (ON,{B)
Definitions and Forms
10.5 \L'hat definirions appl)' to these regulations
10.6 \lhat special staturorv definitions appl), to dependents and sun'ivors
10.7 \Lhat forms are needed to process craims under the FECA
Information in Program Records
chapter
been approved bv the
l0-10 r\re all documents relatins to claims fiied underthe FECA considered
confidential 10.11 \\'ho maintains custodv and control of FECA records
10.i2 IIorv mav a FECA claimanl or benefician'obtain copies of protected records
10- 13 Sftat process is used bv a person u,ho wants to correct FECA- related documents
Rights and Penalties
I0.1 5 N4av compensation riehts be u.aived
10.16 What criminai penalties mav be imposed in connection with a claim under the
FECA
10.17 Is a benefician u'ho defrauds the Government in connection with a claim for
benefirs still entitled to those benefits
10.18 Can a beneficiarv' n'ho is incarcerated based on a felon.r, conviction still receive
benefirs
Subpart B-Filing Notices and Claims; Sutrmitting Evidence
Notices and Claims for Injury', Disease and Death--Emplol.ee or Sun,ivor's Actions
10.100 How and u'hen is a notice of traumatic injury, filed
10.101 How' arrd u'hen is a notice of occuparional disease fiied
l0- l 02 How and w'hen is a claim fbr u,age loss compensation {lied
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10.103 Horv and *'hen is a claim for permanent impairment filed
10.104 How and rvhen is a claim for recurrence filed
10.105 How and n,hen is a notice of death and claim for benefits filed
Notices and Claims for Injurl', Disease and Death--Emplol'er's Actions
10.110 What shouid the emplo,ver do r.vhen an emplol'ee files a notice of traumatic
injury or occupational disease
i 0.11 I \!}at should the emplo-ver do when an emplovee files an initial ciaim for
compensation due to disabilitv or perrnanent impairment
10. I i 2 What should the emplo."-er do rvhen an employee files a claim for continuing
compensation due to disability
10.113 What shouid rhe employer do rvhen an emplol'ee dies from a rvork-related injury
or disease
Evidence and Burden of Proof
10.11 5 What evidence is needed to establish a clain-r
10.116 What additionai evidence is needed in cases based on occupational disease
10. i 17 What happens if. in any claim, the emplo-ver contests an-v of the facts as stated
b-v the claimant
10. I 18 Does the employer paflicipate in the clainls process in any other wa.v
10.119 S,hat action will OWCP take with respect to information submitted by the
emplol'er
10.110 May a claimant submit additional evidence
10.121 What happens if OWCP needs more evidence from the claimant
Decisions on Entitlement to Benefits
10.125 llor.v does OWCP detennin entitlement to benefits
10.126 \\:hat does the decision contain
10.127 To u'hom is the decision sent
Subpart C--Continuation of PaY
10.200 What is continuation of pa-v
Eligibilit"v for COP
10.105 What conditions must be met to receive COP
10.206 \4ay an emplo.v-ee rlv,ho uses leave after an injury later decide to use COP
instead 10.207 N4ay an emplol'ee who returns to q'ork. then stops work again due to
the effects of the injury, receive COP
Responsibilities
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10.210 \Lhat are the emplo'ee's responsibilities in cop cases
10.21 I what are the emplol,'er's responsibiliries in cop cases,",
Calculation of COP
10.215 How does o\\'cp cornpute the number of dar-s of cop used
10.116 Horv is the pav rate for COp calculate dl'
10'217 Is COP charged if the emplol'ee continucs to q'ork. trut in a dilferent job rhat
pa1's less
Controversion and Termination of COp
i 0.220 \\,'hen is an employ-er not required to pav COp
10.221 How is a claim for COp controverted
10.222 when nrav an emplol'er terminate cop uhicir has alreadv begun
10'223 Are there other circumstances under nhich OWCP u'ill not authorize pavment o{'
COP
10.:24 What happens if OWCP finds that the emplovee is no1 entirled to COp after it
has been paid
Subpart D--Iledical and Related Benefits
Emergencv l\{edical Care
10.300 what are rhe basic rules for authorizinq emergencl,medical care
10.301 Ma-v- the phvsician desienated on Form CA-16 refer the emplovee to anorher
medical specialist or medical laciiiqv
10.302 Should the emplol'er authorize medicai care if he or she doubts tlrat the iniurv
occurred. or that it is work-related
10.303 Should ti.ie emplover use a Form CA-16 to aurhorize medical testing rvhen an
emplol'ee is exposed to a workplace hazud just once
10.304 Are there any exceptions to these procedures for obtaining emersencr,medical
care
N{edical Treatment and Related Issues
10-310 w'hat are the basic rules for obtaining medical care
I 0.31 I w'hat are the special mles for the sen,ices of chirooractors,.)
10'31I \\}at are the special ruies for the sen iccs of clinical nsr chojosisls.'
10.313 Wiil OWCP pur- for preventive trearment
I 0.i 14 Wiil OWCP pu), for the sen.ices of an artendant l
10.315 will owcP pay for transporrarion to obtain medical treatment
i0'316 After seiectine a treating phvsician. may an emplovee choose to be treated bv
another phvsician instead
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Directed l\{edical Examinations
10.320 Can O\\'CP re:quire an emplor,'ee to be examined b1,'anorher physician'
10.321 \!hat happen:; if the opinion of the ph-vsician selected by OWCP differs from the
opinion of the physician selected by the emplo,vee
10.322 W1lo pa.vs for second opinion and referee eraminations
10.323 What are the penalties for failing to repon for or obstructing a second opinion or
rcferee examinalion
10.324 \{ay an emplol'erequire an emplovee to underso a ph1'sical examination
connection *'ith a work-related iniun'
I\{edical Reports
10.330 \!hat are the requirements for medical reports
10.331 Horv and when should the rnedical repon be submitted
10.332 W-hat additional medical information u'ill OWCP require to support continuing
pa)'ment of benefits
10.333 Wiiat additional medical information u'ill OV!'CP rcquire to support r claim for a
schedule au'ard
Medical Bills
10.335 Hor.v are medical bills submitted
10.3-36 Wrat are the time frames for subrnitting biils
10.337 If OWCP reimburses an employ'ee only partiall,v for a n-redical expense. must the
provider refund the balance of the amount paid to the employee
Subpart E--Compensation and Related Benefits
Compensation for Disabili{v and lmpairment
10.400 What is total disability
10..101 When and how is compensation for total disabiliqv paid
10.102 What is partiai disabiliry
10..103 When and how is compensation for partial disabiliry paid
10.104 When and how is compensation for a schedule impainnent paid
i 0..105 \\,ho is considered a dependent in a claim based on disability or irnpairment
10.406 \\,hat are the maximum and minimum rates of compensation in disabiliry cases
Compensation for Death
10.-+
I 0 \\ho is entitled to compensation in case of death. and u'hat are the rates of
compensation payable in death cases
10.,11 I Whar are the maximum and minimum rates of compensation in death cases
10.'112 Will OWCP puy the costs of burial and transportation ofthe remains
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10'113 If aperson dies u'hile receivins a schedule a,,r.ard. to nhom is the balance of rhe
schedule au'ard pa1,'able
10.'+11 what reports of dependents are neederl in death cases'.,
10'41-5 \\ltat must a beneficialv do if the number of beneficiaries decreases,,)
10.416 Horv does a chanse in the number of beneficiaries affect the amount of
compensation paid to the other beneficiaries
10'117 \\'hat reports are needed uhen compensation pavmcnt-s continue for chilcjren
over age 18
Adjustments to Compensation
10.420 How are cost-of-living adjustments applied
10.421 lvlal'. a beneficiary receive other kindi of p".'*.nts from the Federal
Government concurrently u,ith compensation
10-12 lv'Ia-v compensation payments be issued in a rump sum
10.423 lvlav compensation pa)'ments be assisned ,o. or.rtu.hed by. creditors
10'124 Ma1'someone other than the beneficiarv be designated to ieceive compensation
pa1'ments
10.'125 \4al'cornpensation be claimed for periods of restorable lea'e
Overpat'ments
I 0.430 How does owcp notif.n* an indii,idual of a pa\,ment nlade
10.43 I what does owcp do u'hen an overpay-"nt i, identified
10'132 How can an individual present evidence to OWCP in response to a preliminarv
notice of an overpay'ment
l0'433 Under what circumstances can OWCP waive recovery of an overpal'ment
10'4i4 If OWCP finds that the recipient of an overpavment was not at l'auit- w1-rat
criteria are used to decide whether to u,air.e reco\:erv of it
10''+3-i Isanindi'idual responsibleforano\erpa\,nl.ntthot resultedfromanerrormade
by OWCP or another Government asencr,
10.436 Under r'l'hat circumstances tioUa recoverv of an overpavment defeat the purpose
of the FECA
10.437 Under what circumstances u'o.uld recoven- of an overpa),'ment be against equiqv
and good conscience
l0'4-18 Can OWCP require the individual who received the or.erpaymenro submit
additional fi nancial information
10.439 What is addressed at a pre-recoupment hearing
10'440 How' does OWCP communicate its final decision concernins reccven' of an
overpavment- and rvhar appeal righr accompanies ir
10.441 How are o\.erpalments collected
Subpart F--Continuing Benefi ts
Rules and Evidence
Page -5-

10.500 S"hat are the basic rules for continuing receipt of compensation benefits and
retura to rvork
10.5(11 What medical evidence is necessary to support continuing receipt of
compensation benefits
10.502 How'does OWCP er,aluatevidence in support of continuing receipt of
compensation benefits
10.501 Under rvhat circunrstances mav OWCP reduce or terminate compensation
benefits
Retu rn to \\io rk--Em plol'er' s Res ponsibilities
I0.505 \\l'rat actions must ihe emplo.ver take
10.506 May the emplol'er monitor the emplol'ee's medical care
i 0.507 How should the ernplo,ver make an of-fer of suitable u,ork
10.508 May relocation expenses be paid for an emplol,'ee n,ho u'ouid need to move to
accept an offer of reemplo)'ment
10.509 If an emplovee's iicht-duty job is elin-rinated due to downsizing, rvhat is the
effect on compensation
Retu rn to Work--E m plo.vee' s Resp onsib ilities
10.515 What actions must the employee take with respecto returning to work
10.516 How wiil an emplovee know if OWCP considers a job to be suitable
10.517 What are the penalties for refusing to accept a suitable job offer
10.518 Does OWCP provide serv'ices to help emplol'ees return to work
10.519 What action will OWCP take if an en-rployee refuses to undergo vocational
rehabilitation
10.520 How' does OWCP detennine compensation after an ernplo-vee completes a
vocational rehabilitation program
Reports of Earnings From Employment and Self-Emplol'ment
10.525 What information must the employ'ee report
10.,

10.701 Who may sen/e as a representative
10.702 Horv are fees for sen,ices paid
10.703 Horv are fee applications appror,'ed
Third P arfy L iabilir"v-
10.705 \\nnen must an emplo1'ee or other FECA beneficiary take action against a third
pan-.v-'
10.706 How n'ill a beneficiary know if OWCP or SOL has determined that action
against a third parfv is required
10J07 \\hat must a FECA beneficiary u'ho is required to tzLke action against a third
party do to satisfl'tl-re requirernent that the claim be "prosecuted"
10.708 Can a FECA beneficiary u'ho refuses to complv u'ith a request to assign a clairn
to the United States or to prosecute the claim in his or her o\ n name be penalized
10.709 What happens if a beneficiary directed by OWCP or SOL to take action against
a third partv does not believe that a claim can be successfull,v prosecuted at a reasonabie
cost
10.71 Under nhat circumstances must a reco\/ery of money or other propert-v in
connection with an injury or death for which benefits are pa1''able under the FECA be
reported to OWCP or SOL
10.711 How much of anv settlement or judgment must be paid to the l-lnited States
10.712 What amounts are included in the gross recovery
10.713 How is a structured settlement (that is, a settlement providing for receipt of
funds over a specified period of time) treated for purposes of reporling the gross
recovery 10.7i.+ \&'hat amounts are included in tire refundable disbursements
10.715 Isabeneficiaryrequiredtopaf interestontheamountof therefundduelothe
United States
10.716 Iftherequiredrefundisnotpaidwithin30daysofthe requestforrepal'ment.
can it be collected from pa1'ments due under the FECA
10.711 Is a settlement or judgment received as a result of allegations of medical
malpractice in treating an injury covered by the FECA a gross recovery that must be
reported to OWCP or SOL
10.7i8 Are pa1'ments to a beneficiaq'as a resuit of an insurance policy rvhich the
benet-rciarv has purchased a gross recoverv that must be reported to OWCP or SOL
10.719 If a settlement or judgment is received for more than one wound or medical
condition. can the refundabie disbursements paid on a single FECA claim be attributed
to different conditions for purposes of calculating the refund or credit orved to the Llnited
States
Federal Grand and Petit Jurors
10.725 \\hen is a Federal grand or petit juror covered under the FECA
10.126 S/hen does a juror's entitlement to disabilin'compensation begin
10.7:7 S'hat is the pay rate ofjurors for compensation purposes
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Peace Corps Volunteers
10.73 \\hat are the conditions of ccrverage for peace Corps volunteers and volunteer
leaders injured rvhile se^.inq outside the United States
10'731 What is the pa1 rate of Peace Corps r.oiunteers and volunteer leaders for
compensati on purposes
Non-Federal Lan Enforcement Officers
10.735 \\-hen is a non-Federal larv enforcement otficer (LEO) covered under the
FECA 10.736 w-irat are rhe time limits fbr filing a LEo claim
10'737 Hou'is a LEo claim filed. and u,ho can file a LEo claim
10.738 Under u'hat circumstances are benefits pa1'able in LEo claims
10.739 What kind of objective evidence of a potential Federal crime must erist for
coverase to be extended
10-7'10 In uhat situations rvill O\\'CP automaticallv presume that a lar.r'enforcemenr
officer is co','ered bv the FECA
10.711 How'are benefits calculated in LEO claims
Subpart I--Information for Medical pror.iders
l\{edical Records and Bills
10.800 \[,hat kind o1-medical records must providers keep
10.801 Horv are niedical bills to be submitted
10.802 Horu siiould an employ'ee prepare and submit requests for reimbursemenl l'or
medical expenses- transportation costs, loss of \^,ases, and incidental expenses
10.803 \lhat are rhe time limitations on owcp's pavment of bills
N{edical Fee Schedule
10.805 S,hat sen'ices are covered bv the OWCp feeschedule
10.806 How are rhe maximum fees iefined 10.g07How are pavments for particular
sen'ices calculated
10.808 Does the fee schedule appl-v- to er,ery kind of procedure
10.809 How are pa)'ments for medicinal drugs determined
I 0-810 How are pa'r'ments for inpatient medical sen ices determinerl
10.811 WJren and how are fees reduced
10-812 If OWCP reduces a fee. ma)' a provider request reconsideration of the reduction
10.813 If OWCP reduces a fee. mav a provider bill rhe claimanl fbr the balance
Exclusion of Proyiders
Page -9-

10.8 i i What are tire grounds for excluding a provider from payment under the FECA :
10.8I 6 What rvili cause OWCP to automatically exclude a phy'sician or other provider
of medical sen'ices and supplies
10.817 When are O\\'CP's exclusion procedures initiated
10.818 How is a provider notified of OWCP's intent to exclude him or her
10.8 I 9 What requirements must the provider's reply and OWCP's decision me et
10.820 How can an excluded providerequest a hearing
10.821 Horv are hearings assigned and scheduled
10.822 Horv are subpoenas or advisory opinions obtained
10.823 How will the administrative law judge conduct the hearing and issue the
recommendedecision
10.821 How can a partv request review by the Director of the administralil's 1311' judge's
recommendedecision'
10.825 What are the effects of exclusion
10.826 How can an excluded provider be reinstated
Authority: 5 U.S.C.301,8103.81'15 and 81:19: 31 U.S.C.3716 and 3717;
Reorganization Plan No. 6 of 1950. 15 FR 3114,64 Stat. 1263; Secretary's Order 5-96.
62 FR 107.
Introduction
Subpart A--General Provisions
Sec. 10.0 What are the provisions of the FECA, in general
The Federal Employees'Compensation Act (FECA) as amended (5 U.S.C. 8101 et
seq.) provides fbr the pa.v-ment of workers'compensation benefits to civilian otficers and
emplol.ees of all branches of the Government of the United States. The regulations in
this part describe the rules for filing. processing. and payins claims for benefits under
the FECA. Proceedines under the FECA are non-adversarial in nature.
(a) The FECA has been amended and extended a number of times to provide workers'
compensation benefits to volunteers in the Civil Air Patrol (5 U.S.C. 8141). members of
rhe Reserve Officers'Training Corps (5 U.S.C. 8140), Peace Corps Volunteers (5 U.S.C.
81-+2), Job Corps enroilees and Volunteers in Service to America (5 U.S.C. 8113).
members of the National Teachers Corps (5 U.S.C. 8143a). certain student emplol"ees (5
U.S.C. 535 i and 8144). certain law enforcement officers not employed by the Lrnited
States (5 U.S.C. 8191-8193). and various other classes of persons rvho provide or have
provided sen'ices to the Government of the United States.
(b) The FECA provides for payment of several q'pes of beneflts. including
compensation for u'age loss. schedule awards. medical and related benefits. and
vocational rehabiiitation services for conditions resulting frorn injuries sustained in
oerformance of duw while in service to the United States.
Page -1O-

(c) The FECA also provides for pa'ment of monetary compensarion to specified
sun'i'ors of an emprol'ee rvhose deith resurred from a..,ork- ierated injuru,*o
pa1'ment
ro,
of certain buriar expensesubject ro tire pror,isions of 5 u.S.c. gr34.
(d) All n'pes of benefits and condititns of etigitiiitl listed in this section are sub-jecr
to the provisions of the FECA and of this part. ihis section shall not be construed
modi$
to
or eniarge upon the pror,.isions of the FECA"
Sec' 10' l shat rules govern the administration of the FECA zurd this chapter
Irt accordance with 5 U.S.C. 8145 and Secretarv's order 5-96. tire responsibilitv for
administering the FECA- except for 5 U.S.C. 8l4b as it perrains to rhe Employees,
Compensation Appeals Board. has been delesated ro rne.Assistant Secretarv. for
Emplol'ment Standards. The Assistant SecreLry. in turn. rr"r a.l.got.aii. uurrro.ity and
responsibilitv for administering the FECA ro the Director of rhe office of Workers,
Compensation Programs (owCP). Except as otheru'ise provided by larv. the Director.
o['cP and his or her designees have the exclusive aurhority to administer. interpret and
enlorce the provisions of the Act.
Sec. 10.2 S,hat do these regulations contain
This part 10 sets forth the regulations governing administration of all claims filed
under the FECA. except to the extent rp."ifi.C in cenain particular provisions. Its
provisions are intended to assist persons seeking compensation benefits under the FECA.
as well as personnel in the r''arious Federal ug.n-.i., ,h. Department of Labor u,ho
process claims filed under the FECA or u'ho perform "nd
administrative firnctions w-ith
respecto the FECA- This part l0 applies to furt 1,5 of rhis chapter except as modified
part
b',
25. The various subparrs of this part contain the follou.ine:
(a) Subpart A: The eeneral statuton, and administrative frameu,ork for processing
claims under the FECA' It contains u ,,ut.-.nt of purpose ancl scope. toeether rvith
definitions of terms. descriptions of basic forms. information about the disclosure of
OWCP records- and a description of rights and penalties under the FECA. inciudine
convictions for fraud.
(b) Subpart B: The rules for filing notices of injury and claims for benefits under the
FECA' It also addresses evidence *i b*d.n or proor as u,ell as the process ot'making
decisions concerning eligibilit-v for benefits.
(c) Subpan C: The rules governing clairns for and pa).ment of continuation of pa1,.
(d) Subpart D: The rules soverning emergencv and rourine medical care. second
opinion and referee medical examinations direcred by OwCp. and medical reports and
records in general. It also addresses the kir,ls of treatment rvhich mav be authorized and
how medical biiis are paid.
(e) Subpart E: The rules relating to the pay'ment of monerar\j compensation benefits
for disabiliw. impairment and deaih. It includes the provisions 1br identif,ing and
processin_e o\ierpa)'ments of compensation.
Page -11-

1fl Subpart F: The rules governing the payment of continuing compensation benefits'
It inciudes provisions concerning the emplo-vee's and the employer's responsibilities in
retur:ting the emplo1,ee to w.ork. It also contains provisions goYerning reports of eamings
and dependents, recurrences, and reduction and termination of compensation benefits.
(g) Subpart G: The rules goveming the appeals of decisions under the FECA. It
includes piovisions reiating to hearings, reconsiderations. and appeals before the
Ernplol,.ees' Compensation Appeals Bcard.
iir) SuUputt n: fte lules conceming lcgal represcntation and for adjustment and
,..on:.ry fiom a third party. It also contains provisions relevant to three groups of
emplo,vees whose status requires special application of the provisions ofthe FECA:
Feieral grand and petit jurors, Peace Corps volunteers. and non-Federal larv enforcement
officers.
(i) Subpart I: Information for medical providers. It includes rules for medical rcports.
medical bills, and the OWCP medical fee schedule. as weli as the provisions for
exciusion of medical providers.
Sec. 10.3 Flaye the collection of information requirements of this part been approved bv
the Office of Management and Budgel (OMB)
The collection of information requirements in this part have been approved by OMB
and assigned Ot\48 control numbers 1215-0055. 12i5-0067. 1215-0078, 1215-0103-
1215-01b5, 1215-01 15. 1215-01 16.1215-0i44.
1215- 0151, 1215-0154, 1215-0155,
1215-01 61,1215-0167, 1215-0176,12i5-0178. 121,5-0i81. 1215-0193 and 1215-0194-
Definitions and Forms
Sec. 10.5 What definitions appl)'to these regulations
Certain q,ords and phrases found in this part are defined in this section or in the
FECA. Some orher words and phrases that are used only in limited situations are defined
in the later subparts of these regulations.
(a) Benefits or Compensation means the money OU/CP pa1's to or on behalf of a
beneficiary from the Employees' Compensation Fund tbr lost wages, a loss of wageearnins
capacitv or a pennanent physical impairment. as well as the money paid to
benefiiiaries for an emplo-n-ee's death. These hvo terms also include an-v" other amounts
paid out of the Employees' Compensation Fund for such things as medical treatmentmedical
examinations conducted at the request of OWCP as part of the claims
adjudication process. vocational rehabilitation sen'ices. sen'ices of an attendant and
funeral expenses. but does not include continuation ofpay'
(b) Beneficiary, .neaos an individual rvho is entitled to a benefit under the FECA and
this pan.
(c) Claim means a r,lritten assertion of an individuai's entitlement to benefits under
the FECA" submitted in a manner authorized by this part.
(d) claimant means an individual r.r'hose claim has been firled.
Page -12-

(e) Director means the Director of o\\-cP or a person designateci
her
to canr.out
functions.
his or
(f) Disabilif'" me:ans the incapacin'..because of an emplor.ment i'jun,.
\\'ages
to earn
the emplol'e3
the
\\'as receir,ing ai the time of in;un,.'tt rnav be parlial
(g)
or totar.
Eanrings from empio'ment or serf-empror.nent mcans:
( 1) Gross eamings or waqes before anv deductions ancl includes the value
subsistenceof
quarters. reimbursed expenses and an1. other qoods or sen ices
kind
receir.ed
as remuneration:
in
or
(2) A reasonablestinlate of the cost to ha'e someone else perfonn the
individual
duties of
who
an
accepts no remuneration. Neither lack of profits. nor the characterization
of the duties as a hobby'. removes an unremuneraled individual's responsibilitl.to
the estimated
report
cost ro rra'e someone erse perfonn his or her duties.
(h) Emplolree means. but is not limired to. an individual r,r'ho fits w.itliin one
following
of the
listed groups:
( 1) A ci'il olficer or emplovee in anv branch of the Government of the united
including
States.
an officer or etnploy'ce of an insrrumentalitv lvholly ou,ned by. ihe united
Statcs:
(2) An indii'idual rendering personal sen'ice to the L. nited States similar to the
service of a civil officer or emplol'ee of the united states, without pa-v or
pal"
for nominal
when a statute authorizes the acceptance or use of the serr.ice, or authorizes
pa)'ment of travei or other expenses ofihe individual:
(3)'qn individual- orher than an independent conrractor or an indiviclual empioved
an independent
bv
contractor, emplol'ed on the Nlenominee Indian Reserl,ation in
wisconsin in operations conducted under a statute relating to tribal timber and logeing
operations on that reserv,ation:
(a) An individual appointed to a position on the office staff of a former presidenr:
(5) or
An individual selected and sening as a Federal petit or grand juror.
(i) Emplol'er or Asencv means on}' .i. il agency or instrumentaiiry of the United
States Government- or anv other orqanization. group or institution emplor,ing an
individual defined as an "emplol'ee-" bv this section. These terms also refer to
and
officers
employees of an emplol'er having responsibilitv for the supervision. direction
control
or
of emploveeso-f that emplo-"*ei as an "immediate superior,,, and to other
emplovees designated.by the empiol'er to carrv out the functions vested in the emplo'er
under the FECA and this part, including officers or empiol,ees delegated responsibiiirr,:
by an emplol'er for authorizing medicai treatment for injured employees
fi) Entitlement means entitlement to benefits as determined by owcp under
FECA
the
and the procedures described in this oart.
(k) FECA means the Federai Empro'ees;con,,p.nrotion .Act. as amended.
(l) Hospital services means sen'ices and supplies provided b1' hospitals within
scope
the
of rheir practice as defined bv State lau..
(m) impairment means anv anatomic or functional abnormalitl,, or loss. A permanent
impairment is an-v such abnormaliqv or loss after maximum medicai improyement
been
has
achieved.
(n) Krouing'lv means u'ith knou'iedge. consciousll,- rviilfull;- or intentionallv.
Page -13-

(o) Nledical sen'ices means sen,ices and supplies provided b,v or under the
supen'ision of a phl,sician. Reimbursable chiropractic services are iimited to ph1'sir:al
examinations (and related laboratory tests), x-ra)'s performed to diagnose a subluxrtion
of the spine and treatment consisting of manual manipulation of the spine to correct a
subiuxation.
(p) lvfedical support sen'ices means senices. drugs. supplies and appliar-rces provided
bv a person other than a ph-u-sician or hospital.
(q) Occupational disease or Illness means a conciition produced b.v-- the rvork
environment over a period longer than a single r.r'orkday
shift.
(r) OWCP means the Office of Workers' Compensation Programs.
(s) Pay rate for compensation purposes means the employ'ee's pa1', as determined
under 5 U.S.C. 8114. at the time of injury, the time disabiiity begins or the tirne
compensabie disability recurs if the recurence begins more than six months after the
injured emplol'ee resumes regular full-time employ'ment with the United States"
n,ir.ichever is greater. except as otherrvise determined under 5 U.S.C. 8113 witlt respect
to any period.
(t) Ph.v-sician means an individual defined as such in 5 U.S.C. 8101(2), except during
the period for wirich his or her license to practice medicine has been suspended or
revoked b-v a State licensing or regulatoq/ authority.
(u) Quaiified hospital means any hospital licensed as such under State law n'hich has
not been excluded under the provisions of subpart I of this part. Except as otherwise
provided b-v- regulation, a qualified hospital shall be deemed to be designated or
approved by OWCP.
(v) Qualified physician means any ph-vsician u'ho has not been exciuded under the
provisions of subpart I of this part. Except as otherwise provided by regulation, a
quaiified ph.vsician shall be deemed to be designated or approved by OWCP.
(w) Qualified provider of medical support services or suppiies means any person,
other than a ph1-sician or a hospital. u'ho pror,'ide services, cirugs. supplies and
appliances for u'hich OWCP makes pa)-ment. who possesses anv applicable licenses
required under State law, and who has not been excluded under the provisions of subpart
I of this part.
(x) Recunence of disabiiity means an inability to u,ork after an emplol'ee has
returned to work, caused by a spontaneous cirange in a medical condition i'vhich had
resulted from a previous injury or illness u'ithout an inten'ening injury or new exposure
to the rvork environment that caused the illness. This term also means an inabiiity to
u,ork that takes place when a light-dur.v assignment made specificall-u- to accommodate
an emplol,ee's phy'sical limitations due to his or her work- related injury or iilness is
u,ithdrarn,n (except rvhen such rvithdrau'al occurs for reasons of misconduct, nonperformance
ofjob duties or a reduction-in-force), or when the phl"sical requirements of
iuch an assignment are aitered so that they exceed his or her establisired phvsical
limitations.
(1') Recunence of medical condition means a documented need for further medical
treatment after release from treatment for the accepted condition or injury when there is
no accompanf ing u,ork stoppage. Continuous treatment fbr the original condition or
Page -14-

injuT is not considered a "need for further medical treatment after release fioni
treatment." nor is an examination rvithout treatment.
(z) Representatir e meills an individual properll' aurhorized bv a claimant in qritinE
to ;tct for the ciainlant in comection u,ith a ciairn or proceedinq uncler the FECA or tiris
pafi' (aa) Student means an individual defined at 5 U.S.C. s rb r 117). Tu o rerms usc-d
in that particular dellnition are furrrrer defined as follorr,s:
(1) Additional n'pe of educational or training insritution means a technicai. trade.
I'ocational" business or professional school acciedited or licensed b1, the United States
Government or a State Govemment or an1,' political subdir.'ision thereof pror,iding
courses of not less than three months duration. that prepares the individual for a
livelihood in a trade, industry. r'ocation or profession.
(2) Year bevond the high schoolevel means:
(i) The 12-month period begiming the month after the individual graduares fiom high
school, provided he or she had indicated an intention to continue schooling r,,.ithin four
months of high school eraduation. and each successive 12-month period in u,hich there
is school attendance or the pa1'ment of compensation based on ruCh anendarce: or
(ii) If the individual has indicated that he or she u'ill not continue schoolins rvithin
four months of high school graduation. the l2-monrh period beginning roitirtlle monrh
that the individual enters school to continue his or heieducation. and each successive
1l-month period in w'hich there is school attendance or the pavment of compensation
based on such attendance.
(bb) Subluxation.means
- an incompiete dislocation. off-cenlering. misali,,nment.
fixation or abnormal spacing of the vertebrae u,hich must be demonstratrle on anv x-rav
film to an individual trained in the reading of x_ravs.
(cc) Sun iving spouse means the husband or u,iie lii''ing with or dependent for support
upon a deceased empiovee at the tirne of his or her death. or living apart for reasonable
cause or because of the deceased employee's desenion.
(dd) Temporary aggravation of a pre-existing condition means that factors of
emplovment have directlv caused that conditiorito b. more severe for a limited period of
time and have left no sreater impairment than exisled prior to the emplovment injun,.
(ee) Traumatic injurl'means a condition of the body caused b1- a ,p..ln. event or
incident" or series of events or incidents. withjna single rvorkdav or shift. Such
condition must be caused bv external force. including stress or strain. u,hich is
identifiable as to time and place of occurrence and member or function of the bodr,
affected.
Sec- 10.6 \\''hat special staturory definitions appiy ro dependents and sun,iyors
(a) 5 U'S-C- 8133 provides that cenain benefits are payable to cefiain enumeraterj
s-un'ivors of emploYees u'ho have died from an injury sustained in rhe performarlce of
dur.
(b) 5 U'S'C' 8148 also provides that certain other benefits ma-v be pa1,ab1e ro cerrain
famiil'' members of emplovees q'ho have been incarceraledue to a fejonv conviction.
(c) 5 U'S'C 8110(b) further provides that anv emplor,ee who is found to be eiicibie
for a basic benefit shail be entitlerl to have such basic beneflt augmented at a speciiied
Page -1$,

ate for cerlain persons rlho live in the beneficiary"s houseirold or u'ho are depcndent
upon the beneficiary f,:r suPPort.
(d) 5 U.S.C. gl0i, lli 10;8133 and 8l48, rvhich define the nature of such sun'ivorship
or dependency necessilry to quaiifl' a beneficiary for a survivor's benefit or an
augmented benefit. apply to the provisions of this part'
Sec. 10.7 \\,trat for^-rs are needed to process claims under the FECA
(a) Notice of injury. claims and certaiu specified reports shall be made on forms
presiribed by OWCP. Emplo,vershall 'ot modifu these forms or use substitute forms'
Employers are expectetl to maintain an adequate supply of the basic forms needed for
the proper recording and reporting of injuries.
Form No.
Title
(1) CA-l Federal Emplo,vee's Notice of Traumatic lnjury and Claim for
Continuation of Pay/Conlpensation.
12) CA-2 Notice of Occupational Disease and Claim for Compensation'
(3) CA-2a Notice of Emplol,ee's Recurrence of Disabiiit,v and Claim for Pa1'./
Compensation.
(4) CA-5 Claim for Compensation by Widou,. Widou'er and/or Children.
(5i CA-5b Claim for Compensation b1.' Parents. Brothers, Sisters. Grandparents, or
Grandchildren.
(6) CA-6 Official Superior's Reporl of Employee's Death'
il) Ct-l Claim for Compensation Due to Traumatic Injury or Occupational
Disease.
(8) CA-7a Time Anall'sis Form.
(9) CA-7b Leave Buy Back (LBB) WorksheeUCertification and Eiection.
( l0) CA-8 Claim for Continuing Compensation on Account of Disability.
(l 1) CA-16 Authorization of Examination and/or Treatment"
(12) CA-l7 Dur.v- Status RePort.
(13) CA-20 Attending Physician's Report.
(14) CA-20a Attending Ph1'sician's Supplemental Report.
(b) Copies of the forms listed in this paragraph are available for public inspection at
the Office of \\i orkers' Compensation Programs. Emplol ment Standards Administration.
U.S. Department of Labor. Washington. DC 20210. The,v mar also be obtained from
district offi".t, emplol'ers (i.e.. safery and health offices. supen'isors), and the internet^
at wrwv'. dol. eov./do I/esa/ou'cp.htm.
Information in Program Records
Sec. 10.10 .A.re all documents relatinsto claims filed underthe FECA considered
conJldential
Page -{6-

All records relatins to claims for benefits. including copies of such records maintained
b1' an empiover. are considered confidential and mainot be released. inspected. copied
or other$'ise disclosed except as provided in the Freldom of Information Acr and rhe
Privacv Act of 1974.
Sec. 1 0. 1 1 who maintains cuslod' and control of FECA records
All records relating to clairns for benefits filed under the FECA. including anr. copies
of sucir records maintainedtl, an emplol,ing aqenc\," are covered b),1h.;;,.,;mment_
u'ide Privacy'Act s)'slem of records entitled Dol,,bovr_l (office of \\,-orkers,
Compensation Programs. Federal Emplo-"-ees' Compensation Act File). This svstem olrecords
is maintained b,v- and underthe control of owCp, and. as such. all records
covered b;- DOL/GOVT- i are official records of O$;CP. The protecrion. reiease,
inspection and copving of records cor''ered b1'DOLiGoVT-l shall be accomplished in
accordance u'ith the rules. guidelines and provisions of this part. as rvell as those
contained in 29 CFR parts 70 and 71 . and u,ith the notice of th. s).srem of records and
routine uses published in the Federal Reeister. All questions relating to
access/disclosure. and,/ or amendment of FECA .".oid, maintained by OwCp or the
emploving aqenc\'. are to be resolved in accordance u.ith this section.
Sec' 10' 12 Horv nla\r a FEC,{ claimaxt or benefician' obtain copies of protected
records
(a) A claimant seeking copies of his or her officiai FECA file should address a requesr
to the District Director of the OWCP office having custody of the file. A claimant
seeking copies of FECA-related documents in the custodv of the emploler should folloiv
the procedures established by that agency.
(b) ( 1) \\hile an employing agenc,v may estabrish procedures that an injured
enlplol'ee or beneficiary should foliorv in requesting u.."r, to documents it maintains.
any decision issued in response to such a request must compll' w.ith the rules and
regulations of the Department of Labor u'hiCh qovern all other aspects of safeguardinq
these records.
(2) No emplol inu aeency has the authoritl' to issue determinalions rvith respect ro
requests for the correction or amendment of records contained in or covered bv
DOL"GOVT-1 . That authoritv is within the exclusive control of OWCp. rfr6, uni,
request for correction or alnendment received b,u* an emplof ing aeenc)' must be referred
to OWCP fbr review and decision.
(3) Any administrative appeal taken from a denial issued bv the emplol ing aeencv or
OWCP shall be fiied vi'ith the Solicitor of Labor in accordance u-ith :9 CFR 11 .7 and,
71 .9.
Sec' l0' 13 Wrat process is used bu a person who wants to co11ect FECA- related
documents
Page -17-

Any requesto amend a record covered by DOL/GOVT- 1 shouid be directed to the
district office having custody of the official file. No employer has the authorit-v to issue
detetminations rvith regard to requests for the conection of records contained in or
covered by DOL/ GOVT- I . Any request for con-ection received by an emplo,ver must be
referred to OWCP for review and decision.
Rights and Penalties
Sec. i 0.15 NIay compensation rights be waived
No employer or other person ma-v require an emplo\,ee or other claimant to enter into
any agreement, either before or after an injury or death. to wair,e his or her right to claim
compensation under the FECA. No waiver of compensalion rights shali be valid.
Sec. 10.16 What crinrinal penalties may be imposed in connection with a claim under
the FECA
(a) A number of statutory provisions make it a crime to fiie a false or fraudulent clain'r
or statement with the Gor,'ernment in connection with a claim under the FECA. or to
wrongfully impede a FECA claim. Included among these provisions are sections 287,
1001. 1920, and 1922 of title 18. United States Code. Enlbrcement of these and other
criminal provisions that may appiy to ciaims under the FECA are within the jurisdiction
of the Department of Justice.
(b) In addition. administrative proceedings may be initiated under the Program Fraud
Civil Remedies Act of i 986 (PFCRA), 3 i U.S.C. 3801- 12. to impose civil penalties and
assessments against persons who make, submit. or present, or cause to be made.
submitted or presented, false, fictitious or fraudulent claims or r,lritten statements to
OWCP in connection with a claim under the FECA. The Department of Labor's
regulations implementing the PFRCA are found at 29 CFR parr22.
Sec. I0.17 Is a beneficiar-v who defrauds the Government in connection with a claim
for beneflts still entitled to those benefits
\\hen a beneficiary either pleads guiltv to or is found guilry on either Federal or State
criminal charges of defrauding the Federal Government in connection rvith a claim for
benefits, the beneficiary's entitlemento any further compensation benefits will
terminate effective the date either the guiity plea is accepted or a verdict of guilt"v is
returned after trial, for any injury occurring on or before the date of such guiltv plea or
verdict. Termination of entitlement under this section is not affected by any subsequent
change in or recurrence of the beneficiary's medical condition.
Sec. i0.18 Can a beneficiary rvho is incarcerated based on a feionl' conviction stiil
receive benefits
Page -18-

(a) \\:henever a beneficiau is incarcerated in a State or Federal jail. prisol, penal
institution or other corectional facilin due to a State or Federal felonv conr.iction. he or
she forfeits all righls .o compensarion benefits during tr.,. p.lJ;;il;;;ution. e
benefician''s right to ;ontpensation benefits for the p.noa of his or her incarceration is
not restored after sucl incarceration ends- even though pavment of compensatron
benefits mav resume.
(b) If the beneficiarv has eligible dependents. O\\:CP u'ill pa1' compensationto such
dependents at a reduced rate durins the period of his or her incarceraritn. b,r-- appll.ing
the percentases or5. Lr.s.c. 8r33(;xr) through (5) to rh.;;;il;;il';r;;; current
entitlement rather than to the beneficiarv's monthly.pa1,.
(c) If OWCP's decision on entitlement is pending-u'iren the period of incarceration
begins. and compensation is due for a period of time prior to such incarceration.
pal.ment for that period will only' be macle to the beneficiarl, follor.ving iris or iter release.
Subpart B--Filing Notices and Claims; Submitting Er.idence
Notices and Claims for Injury, Disease, and Death--Employee or Sun'ir.or,s Actions
Sec. 10. 100 Horv and u'hen is a notice of traumatic injury- filed
(a) To claim benefits under the FECA. an emplovee who sustains a work-related
traumatic injury must give notice of tiie injury in uriting on Form CA-1, which may be
obtained from the etnplover or from the Internet at u,a\;'.dol.eor,./dol/esa/owcp.htm. The
empiovee must foru'ard this notice to the emplover. Another person. including the
employer- ma,u- give nolice of injury on the emplol,ee's behalf. The person sutmitting a
notice shall include the Social Security Number (SSN) of rhe injured emplor,ee.
(b) For injuries sustained on or aft.r september 7, lg74.a notice of injury must be
filed q'ithin three r''ears of the injury. (1-he form contains the necessa.y *o.Or of claim.)
The requirements for fiiing notice are further described in 5 U.S.C.8119. Aiso see Sec.
10.105 concernins time requirements for fiiing claims for continuation of pay.
(i) If the claim is not filed within three vears" compensation ma1,' still be allowed if
notice of injury was given n'ithin 30 dal's or the .-piu1'., had actual knowledge of the
injury or death within 30 days afler occurrence. Thii knou'ledge may consist of q,ritten
records or verbai notification. .An entrv into an emplovee's medical record may also
satisf'' this requirement if it is suffici.n, ro piace the .-pro1 ., o;;;;;;;i ulossrut.
work-related injury or disease.
(2) OWCP may excuse failure to comply rvith the rhree-year time requirement
because of trulv exceptional circumstances (for example. being heid priioner of u,ar).
(3) The claimant mav rvithdraw his or her claim (but not the notice of injury) by so
requesting in uriting to OWCP at anv time before OWCP determines e5g;Uiiin for
benefits. Any continuarion of pav (cop; sranted ro an emplol.ee after a ciaim is
u'ithdrau'n must be char{:ed to sick or annual leave- or considlred an overpar.ment of pai,
consistent u-irh 5 {l.S.C. 5584. at the emplovee's oprion.
(c) I{orvever. in cases of latent disabilitl'. the time for filing claim does not begin ro
run untii the emploYee has a compensable disabilirr,and is ar,,are. orreasonablv shouid
Page -19-

have been a\^,are. of the causai relationship betrveen the disability and the emplol'ment
(see 5 U.S.C. 8122(b))'
Sec. i0.101 Horv and when is a notice of occupational disease filed
(a) To claim benefits under the FECA. an emplol'ee wh9 has a disease which he or she
believes to be u,ork-related must give notice of ihe'condition in r'lriting on Form CA-z'
rvhich mav be obtained from the ernplo-ver or from the-lnternet at
umrv.dol.gov./doliesa/or,r,cp.htm. The emplo,vee must forrvard this r-rotice to the
emplo.ver. Another person. including ttt. .*pto1'.r, may' do so on the empiol'ee's behalf'
The person submitting a notice shall includsthe Social Security Number (ssN) of the
injured employee. The claimant ma,v withdraw his or her claim (but not the notice of
occupational disease) by so requesting in rwiting to OWCP at any time before O\ /CP
determines eligibiiity for benefits
.-^J ^- ^ .o.,,r+ ^ror.
rvork
(b) For occupational diseasesustained as a resuit of exposure to tnlunous
factors that occurs on or after September 7,1974, a notice of occupational disease must
be fiied within three -vears of the onset of the condition. (The form contains the
necessarv words of ciaim.) The requirements for timely filing are described in Sec'
10.100(bX1) through (3).
(c) I-lonever, iniases of latent disabiliry. tlie time for filing claim does not begin to
mn until the employee has a compensable disabiiit-v and is aware' or reasonably should
have been aware. oith. causal relationship betu,een the disabiiity arldthe employment
(see 5 U.S.C. 8122(b)).
Sec. 10.102 How and when is a claim for wage loss compensation filed
(a) Form CA-7 is used to claim compensation for periods of disabilitv not covcred bv
COP-
(1) An employee who is disabled with loss of pay for more than three calendar days
due to an injury, or someone acting on his or her behall must file Form CA-7 before
compensation can be Paid.
(i) fne emplo,vee ,hull .o.plete the front of Form CA-7 and submit the form to the
emplol,er for completion and transmission to owcP. 'rhe form should be completed as
,oon u, possible, but no more than 14 calendar days after the date pa1'stops due to the
injury or disease.
" (:j rne requirements fbr fiiing claims are funher described in 5 u.S'c. 8121'
(b) Form CA-8 is used to claim compensation for additional periods of disabilit-v after
Form CA-7 is submitted to OWCP.
(1) It is the empioyee's responsibiliw to submit Form CA-8. Without receipt of sucir
claim. OWCP has no knorvieige of continuing wage loss. Therefore, while disabiiity
continues. the emplol'ee should submit a ciaim on Form CA-8 each trvo t'eeks until
other*'ise instructed bY OWCP.
(2) The emplol,ee ,hull .o.npiete the front of Form CA-8 and submit 1he form to the
emplol''er for completion and transmission to OWCP'
Page -20-

(3) The emplovee is responsible for submitting. or arransing for rhe submittal of.
medicai evidence to O\\:CP u'hich establishes both rhat OlsaUlliq' conrinues and that the
disabilitf is due to the r.r'ork-related injury. Form CA-20a is atlached ro Fonn CA-g for
this purpose.
Sec. 10.103 Holl' and u'hen is a claim for pennanent impairmenr flled
Form CA-7 is used to claim compensation for impairment to a bod1.- pad cor-ered
underthe schedulestablished b1,.5 u.s.c.8107. If Form cA-7 has alreadv been filed to
ciaim disabilit-v .oTi:.n:lrion. an emplol'ee ma1,-file u.t"i- ro, *1l lnlp;rJrn.nt u1,.
sendins a letter to OWCP u'hich specifies tlie narure of the beneflt claimed.
Sec. 10. l0'1 Horv and rvhen is a claim for recurrence filed1)
(a) A recurrence should be reported on Form CA-la if it causes the emplol'ee to lose
time frorn work and incur a u'age loss. or if the emplovee experiences a renewed need
for treatment after previousil,' being released fto* .ur.. However. a notice of recurrence
should not be filed when a new injtrry. new occupational disease, or new event
contributins to an alreadl'-existing occupational disease has occurred. In these instances.
the employee should file Form CA-l or CA-2.
(b) The emplovee has the burden of establishing b-v* the rveight of reliable, probatir.e
and substantial evidence that the recurrence of OisiUititi, is causallv related to the
original injury.
( 1) The emplol'ee must include a detailed factual statement as described on Form
CA-2a. The emplo)'er may submit comments concerning the emploi,'ee's statement.
(2) The emplol'ee should arrange for the submittal of a detailed medical report from
the attending physician as described on Form CA-2a. The employ'ee should aiso submit.
or arranse for the subminal o1. similar medical repons for any examination and,/or
treatment received after retuming to rvork follou,inq the original inj,r.y.
Sec. i0.105 IJowand when is anotice of death and claim forbenefits flled
(a) If an employee dies from a u'ork-reJaled traumatic injurf, or an occupational
disease. anv sun/ivor ma!' file a claim for death benefits uiing Fonn CA-5 or C,A-5b.
u'hich may be obtained from the emplover or from the lnternet at
uuv'.dol.gor'./doliesa/ou'cp.htm. The sun'ivor must provide this notice in u,ritine and
forq'ard it to the emplol'er. Another person- including the emplol,er. mav do so on the
sun"ivor's behalf. The sun'ivor may also submit the compieted Form CA-5 or CA-5b
directl-"- to OWCP. The sun'ivor shall disclose rhe SSNs iiuf f sun,ivors on u,hose
behaif claim for beneflts is made in addition to the SSN of the deceased empiovee.'fhe
sun'ivor ma1' r'l'ithdrarv his or her claim (but not the notice of death) by so requesting in
uriting to OWCP at any time before OWCP derermines eligibilib- for benefiti.
(b) For deaths that occur on or after September 7 . 1974- a notice of death musr be
filed u'ithin three 1'ears of the death. The form contains the necessarv words of ciaim.
The requirements forrimely filing are described in Sec. 10.100(b.r(tl through 1:;.
Page -21-

(c) Hou,ever, in cases of death due to latent disabilitv, tlie time for filing the claim
does not begin to run until the surv'ivor is aware, or reasonably sirould have been avare.
of the .",rr"l reiationstrip between the death and the emplo,vment (see 5 U'S-C. 8122(b))'
(d) The fiiing of a notice of injury or occupational disease w-ili satisfo the time
requirements for a death ciaim based on the same injury or occupationai disease. if an
injured emplo,vee or someone acting on the employee's behalf does not file a claim
before the emplol'ee's death. the right to claim compensation for disabilitv" other than
medical exDenses ceases and does not sun'ive.
(e) A surlivor must be alive to receive any payment; tirere is no vested right to such
pa1,ment. A report as described in Sec. 10.414 of this part must be fiied once each 1'err
to support continuing pa1'ments of compensation.
Notices and Cleims for Injury, Disease,, and Death--Employer's Actions
Sec. 10. I I 0 What should the emplo1,er tlo rvhen an empiol,ee files a notice o{'traumatic
injury or occupational disease
(a) The emplo1,er shall complete the agencv portion of Form CA-1 (for trautratic
injurl,') or Ce-2 (fo, o..uputional disease) no more than 10 working days after receipt of
notice from the employee. The emplo,ver shall also complete the Receipt of Notice and
qive it to the employee. along with copies of both sides of Form CA-1 or Form CA-1.
iU) fir. employer must complete and transmit the form to OWCP within 10 working
days after receipt of notice fiom the en-rpioy-ee if the injury or disease u'ill likely result
in:
(1) A medical charge against OWCP:
(2) Disabiiity for work beyond the day or shift of injury';
(3) The need for more than tu,o appointments for medical examination and/or
treatment on separate da,vs. leading to time ioss from work;
(4) Future disabiliryt
(5) Permzurent impairment: or
(6) Continuation of pay pursuanto 5 U.S.C. 8118.
(c) The employer should not u,ait for submittal of supporting evidence before sending
the form to OWCP.
(d) If none of the conditions in paragraph (b) of this section applies, the Form CA-1
or CA-] shall be retained as a perrnanent record in the Employee Medical Folder in
accordance with the guidelines established by the Office of Personnel Management.
Sec. i 0.11 I W.hat should the emplol'er do u'hen an emplol,ee fiies an initial ciaim for
compensation due to disabiliq' or perrnanent impairment
(a) When an empio-n.ee is disabled by a work-related injuq/ and loses pay for more
than three calendar davs. or has a permanent impairment or serious disfigurement as
described in 5 U.S.C. 8107. the emplo-ver shall furnish the employee w.ith Form CA-7
for the purpose of ciaiming compensation.
Page -22-

(b) If the emplovee is receivins continuation of pa1, ^Cbi' (COp). the empioi-er should gir.e
Foim CA-7 to the emplovss by the 3Orh da1' of the period and submit the foan ro
o\\'CP b'the "10th da1'of tire COP perioa. ttthe emplo.'ee has not returned the form to
the emplor-er b1- the'10th da-v- of the CoP period. the'emplol,er should ask him or her to
submit it as soon as possibie.
(c) Upon receipt of Form CA-7 from the emplovee. or someone acting on his or her
behaif' the emplol'er shall complete the appropriate portions of rhe form. As soon as
possible, but no more than fir'e rvorking days-after receipt from the emplol.ee. the
emplol'er shail fomard the completed Fonn CA-7 and an1 accompan\,ing nredical reporl
to OWCP
Sec' 10.112 WJrat should the emplol'er do rvhen an emplor.ee files a claim for
continuing compensation due to disabilitl
(a) If the emplol'ee conlinues in a lcar'e-rl,ithout-pay stafus due to a u,ork-reiated
iljw after the period of compensation initiallv claimed on Form CA-7 ^the emplol.er
shall furnish the emplol'ee u'ith Form CA-8 for the purpose of claiming continuing
compensation.
(b) Upon receipt of Form CA-8 lrom the emplovee. or someone acting on his or her
behalf, the emplover shall complete the appropriate portions of the form. As soon as
possible. but no more than flve r.r'orkins dal,s after receipt lrom the employ,ee" the
emplol'er shali fom'ard the completed Form CA-8 and any accompanving medicai reporl
to OWCP.
Sec' 10' I 13 S'hat should the emplover do when an emplol,ee dies fiom a work-related
injury or disease
(a) The emplol'er sirall immediately report a death due to a u,ork- related traumatic
injury or occupational disease to OWCP t1'telephone. telesram. or facsimile (fa.x). No
more than 10 working davs after notification of the death. the emplo.v-er shall compiete
and send Form CA-6 to OWCp.
(b) When possible. the emplol'er shall fumish a Form CA-5 or CA--ib to all persons
likely to be entitled to compensation for rJeath of an emplovee. The emplol,er sirould
also supply information about compreting and fiiing the form.
(c) The employer shall promptry transmit Fonn cA-5 or cA-5b to owCp. The
emplol'er shall also promptlv transmit to OWCP any other claim or paper submitted
rvhich appears to claim compensation on account of death.
Evidence and Burden of proof
Sec' 10. 1 I 5 w-hat e'idence is needed to estabrish a craim
Forms CA-1- CA-2- CA-5 and CA-5b describe the basic evidence required. OWCp
may send anv request for additional evidence to the claimant and 1o iris or her
representatiYe- if anv. Evidence should be submitted in writinri. The er,idence submitted
Page -23-

must be reiiable, probative and substantial. Each claim for compensation must meet fir'e
requirements before OWCP can accept it. These requirements, u'hich the empiol.ee must
establ:.sh to meet his or her burden of proof, are as follorvs:
(a) The claim u,as filed ivithin the time limits specified by the FECA;
(b) The injured person was, at the time of injury. an emplo1'ee of the United States as
defined in 5 U.S.C. 8101(1) and Sec. 10.5(h) of this part;
(c) The fact that an injury, disease or death occurred;
(d) The injury, disease or death occurred while the employee \vas in the perfbrmance
ofduty; and
(e) The medical condition for which conrpensation or rnedical benefits is claimed is
causally related to the claimed injury, disease or death. Neither the fact that the condition
manifests itself during a period of Federai emplo,vment. nor the belief of the claimant
that factors of employ'ment caused or aggravated the condition. is sufficient in itseif to
establish causal relationship.
(f In all claims. the claimant is responsible for submitting. or arranging for submittal
of, a medical report from the attending physician. For rvage loss benefits, the claimant
must also submit medical evidence shorving that the condition claimed is disabling. The
rules for submitting medical reports are found in Secs. 10.330 through 10.333.
Sec. i0.116 \fuhat additional er,idence is needed in cases based on occupational
disease
(a) The emplol'ee must submit the specific detailed information described on Form
CA-2 and on any checklist (Form CA-35, A-H) provided by the employer. OWCP has
developed these checklists to address particular occupational diseases. The medical
report should also include the information specified on the checklist for the particular
disease ciaimed.
(b) The emplo.v-er should submit the specific detailed information described on Form
CA-2 and on an.v- checklist perlaining to the claimed disease.
Sec. 10. 1 i 7 \lhat happens if. in any claim. the emplol'er contests any of the facts as
stated by the claimant
(a) ^An employer u'ho has re ason to disagree rvith an,v aspect of the claimant's report
shall submit a statement to OWCP that specifically describes the factual allegation or
argument with which it disagrees and provide evidence or argument to support its
position. The emplover mav include supporting document such as witness statements.
medical reports or records. or any other relevant information.
(b) ,Any such statement shail be submitted to OWCP r,vith the notice of traumatic
injury or death. or u'ithin 30 calendar days from the date notice of occupational disease
or death is received from the claimant. If the emplol'er does not submit a n'ritten
explanation to suppon the disagreement, OWCP may accepthe ciaimant's report of
injury as estabiished. The emplover may not use a disagreement w'ith an aspect of the
claimant's report to delal- for*.arding the claim to OWCP or to compel or induce the
ciaimant to chanse or withdrau'the claim.
Page -24-

Sec' l0' I 18 Doe s the enlplol'er participate in the claims process in an1, other q.av.l
(a) The emplo\er is responsible for submitting to OWCP all reler.ant and probatir.e
factLral and medical evidence in its possession. orr,lhich it ma1'acquire throusjr
in'estigation or olhcr means. Such evidence nla), be submined at any.tirne.
(b) TJle enrploverrav ascertain the e\,ent surroundine an injury and the extent of
disabilitl' u'here it appears that an empior,ee u-ho alleges lotal disabiliw ma' be
performing other u'ork. or may be engaging in activities ulich *o"iJ i";icare less than
total disabiliti'- This authoril.v' is in addition to that given in Sec. i 0. 1 I g(a). Hos,eyer. t5e
provisions of the Privacl'Act apply to an)'endeavoJbv rhe emplor.er to ascertain the
facts ofrhe case (see Secs. 10.10 and 10.1 l).
(c) The emplol'er does not have the.right. except as provided in subpart C ol-this parr.
to acti'el)' parricipate in the craims acljudication iro."ir.
Sec' 10' 1 l9 \\hat action u-iil OWCP take with respecto informarion submined b,v the
emplover
o\ r'r'ill consider all evidence
"CP
submitted appropriatelv. and OWCp wiil inlbrm the
ernplol'ee' the emplovee's reptesentative. if an)-.-and the emplover of anv action taken.
w'here an emplover contests a claim u,ithin 30 day,s of the initial submittal and the claim
is later approved- o\\rCP u'ili noti11' the employ..-i of the rationale for approving the
clairn.
Sec. 10.i10 \,lai,' a claimant submit additionai e'idence
A claimant or a person acting on his or her behalf may submit to oWCp at any time
an1' other evidence relevant to the claim.
Sec. I 0.I I1 \\'hat happens if owcp needs more evidence from the claimant
If the claimant submits factual evidence. medical evidence. or both. but OWCp
determines that this evidence is not sufllcient to meet the burden of prooi OWCp u,ill
inform the claimant of the additional er,idence needed. The claimant u,ill be allou,ed at
ieast 30 davs to submit the evidence required. OWCP is not required to notifi, the
claimant a second time if the evidence sub-itt.d in response to its firstr.qu.rt is not
sufficient to meet the burden of proof.
Decisions on Entitlement to Benefits
Sec. 10.1:5 ljorv does owcp determinentirlement ro benefits
(a) In reachins anv decision with respect ro FECA coveraqe or entitlemenl. OwCp
considers the ciaim presented b1'the claimant. the report b1, the emplol'er. and the results
of such investigation as O\\/Cp mav deem necessan,.
Page -25-

(b) OWCP claims staff appiy the larv, the regulations, and its procedures to the facts
as reported or obtained upon i*.ttigation. They also apply decisions of the Emplol'ees'
Compensation Appeals Board and administrative decisions of OWCP as set forth iri
FECA Program \'femoranda.
Sec. 10.126 What does the decision contain
The decision shail contain frndings of iact anci a statement of reasoiis. It is
accompanied b-v infonnation about the claimant's appeal ri-ehts, q'hich may inciude the
right to a hearing, a reconsideration, and/or a review by the Employees' Compensatiotr
Appeals Board. (See subpart G of this part.)
Sec. I 0.127 To whom is the decision sent
A copy of the decision shall be mailed to the emplovee's last knor'm address. If the
emplope has a designated representative before OWCP, a cop.v of the decision rvill also
be mailed to the repre se ntatil e. Notification to either the emplol;ee or tlie representative
rvill be considered notification to both. A copy of the decision rvill also be sent to the
emplo.ver.
Subpart C--Continuation of Pa-v
Sec. 10.100 What is continuation of pay
(a) For most emplol,ees rvho sustain a traunratic injury. the FECA provides that the
emplol'er must continue the employee's reguiar pay during any periods of resulting
disabilitv. up to a maximum of -15 calendar days. This is cailed continuation of pay, or
COP. The emplover, nor OWCP. pa1's COP. Unlike wase loss benefits. COP is subject
to taxes and all other pa)'roll deductions that are made from regular income.
(b) The emplover must continue the pay of an emplo-vee rvho is eligible for COP. and
may not require the employee to use iris or her ou'n sick or annual leave, unless the
proyisions of Secs. 10.200(c). 10.220, or Sec. I0.222 apply. However. while continuing
the emplol,ee's pay. the emplol'er may controverthe employee's COP entitlement
pending a final determination by OWCP. OWCP has the exclusive authorify to
determine questions of entitlement and all other issues relating to COP.
(c) The FECA excludes certain persons from eligibiliqv for COP. COP cannot be
authorized for members of these excluded groups. which inciude but are not limited to:
persons rendering personal sen'ice to the United States similarto the serv'ice of a civil
tffi..r or emplofel of rhe United States, rvithout pay or for nominal pa-"-: volunteers (fbr
instance. in the Civil Air Patrol and Peace Corps); Job Corps and Youth Consen'ation
Corps enrollees: individuals in work-study programs- and grand or petit jurors (unless
othemise Federal emplol'ees).
Eligibilitl,for COP
Page -2&

Sec. 10.105 \\,hat conditions must be met 10 receive COp
(a) To be eligible for COP. a person must:
{ l) Har.e a "traumatic injun'" as defined at Sec. 10.5(ee) uhich is job-related and the
cause of the disabiliS'. and'or the cause of lost time tJue to the need for medical
examination and treatment:
(2) File Form CA-1 riithin 30 da1's of the date of the injury ftut if that form is nor
available. usin-q anorher form rvould not alone preclude receipt): anci
(3) Begin losing time from rvork due to the traumatic injun'u'irhin 45 davs of the
injurf'.
(b) O\\:CP ma1' find that the emplol'ee is not entitled to COP for other reasons
consistent rvith the statute (see Sec. 10.220).
Sec. 10.106 l\'f av an employ'ee who uses leave after an injury later decide to use COp
instead
On Form CA- l. an empiovee ma]- elect to use accumulated sick or annual leal.e. or
leave advanced b-v the a,qencv, instead of electine COP. The emplol'ee can change the
election benveen leave and COP for prospective periods at an)- point while eligibility for
COP remains.
'fhe empiovee may also change the election for past periods and request
COP in lieu of leave alreadv taken for the same period. In either situation. the follou,inc
provisions appli :
(a) The request must be made to the emplover q'ithin one vear of the date the leave
rvas used or the date of the rvritten approval of the claim bl,OWCP (if written approval
is issued)- whichever is later.
(b) W.here the empioyee is otherwise eligibie, the aeency shall restore leave taken in
lieu of anv of the 45 COP davs. Where any of the 4-i COP days remain unused. the
agency shall continue paJ- prospecli\.el]- .
(c) The use of leave may' not be used to delal' or extend the .15-da-v.. COP period or to
otlienvise affect the time limitation as provided bv 5 U.S.C. 8l 17. Therefore. anv leave
used during the period of eligibilifl' counts towards the -15-dav maximum entirlemento
COP.
Sec' 10.107 Mav an employee who returns to work. then stops rvork asain due to the
elfects of the injury- recei.r'e COP
If the emplovee recovers from disabilir.n- and returns to rvork- then becomes disabled
again and stops u'ork- the emplover shali pav anv of rhe ;15 dai's of entitlemento COp
not used during the initial period of disabilitl' n,here:
1a) The emplovee completes Form CA-2a and elects to receive reeular pav.
(b) OWCP did not denv the original claim for disabilirr,:
(c) The disabiliq'recurs and the emplovee stops work rvithin -15 da1's of rhe time rhe
empiovee first rerurned to work follorving the initial period of disabilin': and
(d) Pai' has not been continued for the entire -15,Javs.
Page -27-

Responsibilities
Sec. 10.210 \\'hat arr: the emplol'ee's responsibiiities in COP cases
An emplol'ee rvho sustains a lraumatic injury i"'hich he or she considers disabling. or
someone authorized to act on his or her behaif. must take the follon'ing actions to ensure
continuing eligibility for COP, The emplovee must:
(a) Complete and submit Form CA- l to the en-rplof ing agency as soon as possible.
but no later than 30 days from the date the traumatic inj.,ry, occurred.
(b) Ensure that medical evidence supporting disabiliqv' resulting from the claimed
traumatic injury, inciuding a statement as to rvhen the ernplo.v-ee can return to his or her
date of injury job, is provided to the emplol'er within 10 calendar days after filing the
claim for COP.
(c) Ensure that reler,'ant medical evidence is submitted to OWCP. and cooperate u'ith
OWCP in developing the clain-r.
(d) Ensure that the treating physician specifies work limitations and provides them to
the employer and/or representatives of OWCP.
(e) Provide to the treating phl.sician a description of anv specific alternative positions
offered the employee, and ensure that the treating ph1''sician responds promptly to the
ernployer and/or OWCP, with an opinion as to w'hether and how soon the empiol'ee
could perform that or any other specific position.
Sec. 10.211 What are the emplover's responsibilities in COP cases
Once the empioyer learns of a traumatic injury sustained by an emplovee. it shall:
(a) Provide a Form CA-l and Form CA-16 to authorize medical care in accordance
n'ith Sec. 10.300. Failure to do so may mean that OWCP will not uphold any termination
of COP by the employer.
(b) Advise the employee of the right to receive COP. and the need to elect among
COP, amual or sick leave or lear,e without pav, for any period of disabiliry.
(c) Inform the ernplol'ee of any decision to controvert COP and/or terminate pay, and
the basis for doing so.
(d) Complete Form CA- I and transmit it, along with all other available per-tinent
information- (including the basis for any controversion). to OWCP rvithin 10 working
da1's afler receiving the completed form from the employee.
Calculation of COP
Sec. 10.215 How does OWCP compute the number of da1's of COP used
COP is payabie for a maximum of 45 calendar da1's. and every day used is counted
toward this maximum. The foilor"'ing rules appl1,:
(a) Time lost on the day or shift of the injury does not count toward COP. (lnstead.
the agenc-v- must keep the emplol'ee in a pav stafus for that period);
Page -28-

(b) The first CoP daf is the first da1'disabili6- begins folloning rlie date of injury,
(providing it is withinthe 30 dals follorving rhe date"of injury), except r.r,irere the injury
occurs before the beginning of the u'ork dq. or shift. in uhich case tlre date of injury
cirarged
is
to COp;
(c) Anl part of a da1'or shift (except for the clar,of the injury ) counrs as a full cja'
torvard rhe -15
- J
calendar dar torel:
(d)-Regular
.
da1's off are included if CoP has been used on the regular rvork da's
inrmediateli' preceding or follou'ing the
"
reqular da1'(s) off. aurd medical id;;;''.
supports disabilitl,-; and
",
(e) Leave used during a period uhen CoP is othenvise payable is counted tolvard
45-day
the
CoP maximum as if the empro','ee had been in a cop status.
For emplol'ees
!0 u'ith part-ti.. o, intermitent schedules. alj calendar davs on utich
medical evidence indicates disabilitl'' are counled as Cop da1-s. reear.dless of rvhether
emplol'ee
the
\\'as or would have been scheduled to u,ork on those davs. The rate at n,hich
coP is paid for these emplo'ees is calculated accordingto Sec. 10.216(b).
Sec. 10.216 Horv is rhe pay rate fbr COp calculated
The emplover shall calculate CoP using the period of time and the u.eeklv pa' rare.
(a) The pay rate for CoP purposes is equal to the emplor.ee's ..grl"r::*,".k1).', pur-
(the ar,erage of the u,eekly pay over the preceding 52 ueeks).
( I ) The pav rate excludes overtime pa-v-. but includes other applicable extra pay
excepr to the extent prohibited by law.
(2) Changes
.
in pav or salary' (fbr example. promotion. demotion, within-erade
increases' termination of a temporary detail. eic.) u'hich would have otherw,ise occurred
during the 45-dav period are to be reflected in the neekly pay determination.
u'eekiv pav for CoP purposes is determined
.^lo.l,Ilt
according to the following
Iorrnulas:
( I ) For full or part-time rvorkers Qrermanent or temporan') u,ho work the same
number of hours each rveek of the vear (or of the appointment). the u,eekj)..pay.rate is
the houril'pa)' rate (A) in effect onthe date of injury, multipiied by ( x ) rhe number ol'
hours n'orked each week (B): A x B : Weekl-v pa-o--Rate.
(2) For part-time w'orkers (permanent or tempora6,) who do not u,ork the same
number of hours each u'eek. but r.l,ho do work eich wleek of the y,ear (or period of
appointment)' the weekly pav rate is an average of the u,eekly,earnings. esrablished by
dividing (

average dail-v-- rvage earned in the employment during the da,vs emplol'ed q'ithin the full
1,'ear immediately preceding the date of injury divided by 52 rveeks. u'hichever is greater.
Sec. 10.217 Is COP cirarged if the emplo)'ee continues to t\-ork, but in a different job
that pa1's less
If the employee cannot perform the duties of his or her regular position, but instead
u,orks in another job with different duties rvith no loss in pay, then COP is not
chargeable. COP must be paid and the da1,s counted againsthe 45 days authorized by
larv r.vhene\,er an actual reduction of pa1,' results from the injury, including a reduction of
pa-v for the employ'ee's normal administrative workrveek that results from a chanqe or
himinution in his or her duties follorving an injury. I{ou'ever. this does not include a
reduction of pay that is due solely to an emplol,'er being prohibited by larv from paf ing
extra paY to an emplol'ee for rvork he or sire does not actuaily perform'
Controversion and Termination of COP
Sec. 10.110 \Lhen is an emplo)'er not required to pa1'COP
An employ-er shali continue tiie regular pay of trn eligible emplol'ee r,i'ithout a break in
time for up to 45 calendar da1's, except when. and only u'hen:
(a) The disability was not caused by a traumatic injury;
(b) The emplo.vee is not a citizen of the United States or Canada:
(c) No uritten ciaim was filed u'ithin 30 days from the date of injury;
ial fn" injuty rvas not reported until after employment has been terminated:
ie) The inj"fu occun'ed offth. employing agenc,v's premises and was othenvise not
rvithin the performance of official duties:
(t) The injur.v was caused by the employee's willfui misconduct. intent to injure or
kill himseif or herself or another p.rton. or was proximately caused by intoxication b-v
alcohol or illegal drugs; or
(g) work did not stop unril more than 30 days following the injurv.
Sec. i0"211 How is a claim for COP controverted
When the emplol,'er Stops an empiovee'S pav for one of the reasons cited in Sec'
10.220, the emplo-'-er must controverthe claim for COP on Form CA-1' explaining in
detail the basis for the refusal. The final determination on entitlement to COP airval's
rests rvith OWCP.
Sec. I 0.222 When ma)' an employ'er terminate COP q'hich has already begun
(a) Wliere the emplol'er has continued the pav of the employ'ee' it mav be stopped
only when at least one of the foilou'ing circumstances is plesent:
it) fr4.al""l evidence u'hich on its io.. rrrpports disabilitv due 1o a rvork-related
iniun, is not received rvirhin l0 calendar davs after the ciaim is submitted (unless the
Page -3O-

emplo)'er's o\\r investigation shou's disabilitv to exist). \\:here rhe medical et,idence is
later provided- hou'ever. CoP shail be reinstated retroactive to the date of termination;
*,t9ita evidence
,,-11]jn": from the treating ph'sician shou's rhar rhe emplovee is nor
drsaDled trom fus or her reqular position:
(3) Medical eviclence from the treating ph1'sician shorl,s that the emplovee is not
totally disabled- and the emplovee refuses a uiritten olfer of a sr-ritable alternati'e
position u'hich is approved by the artendins phvsician. If O\\,Cp later determines that
the position was not suitable- owcP u'ill diieci the emplol'er to grant the ernplol.ee
COP retroactive to the termination dare.
!1) Jhe emplol'ee returns ro rvork with no loss of pa1,:
(5) The employee's period of employment expires or emplo.,'inent is otSem,ise
tenninated (as established prior to the date of iniun,):
(6) OWCP directs rhe emplover to srop COp: anaror
(7) COP has been paid for 45 calendai du1,.r.
(b) An employe.r ma)' not interrupt or stop COP to u,hich the emplol,'ee is otheru,ise
entitled because of a disciplinary aciion. unllss a preliminary notice rvm issued to the
emplol'ee before the date of injury and the action t..o.n., final or otherq.ise takes effect
during the COP period.
(c) An employ'er camot othenvise stop CoP unless it does so for one of the reasons
found in this section or Sec. r0.220. w1rere an emproy'er stops cop- it must f.ire a
controversion q'ith owCP- setting forth the basis on u,hich it terminated Cop. no later
than the effective ciate of rhe terJination.
Sec' 10'223 Are there other circumstances under wirich OwCp ivill not authorize
pa)'ment of COP
When owCP finds that an empioyee or iris or her representati'e refuses or obstructs a
medical examination required b-v.' owcP. the rieht to iop is suspended until the refusal
or obstruction ceases. CoP alreadv paid or puy'ubl. for the period of suspension is
forfeited. If alreadl'paid" the CoP mav be iharged to annual or sick leave or considered
an overpa)'ment of pay. consistent ll,ith 5 U.S.C. 55g4.
Sec' l0'221 What happens if O\ ICP finds that the emplol,ee is nor entitled to Cop
after it has been paid
s'here owCP flnds that the emplovee is not entitled to Cop after it has been paid. the
emplol''ee may chose to have fte time charged to annual or sick leave- or considered an
o\/erpa)'ment of pay under 5 Ll.S.C. 5584. The emplover must correct anv deficiencies in
COP as direcred by OWCp.
Subpart D--Medical and Related Benefits
Emergency Medical Care
Sec' I0'300 W'hat are the basic rules for authorizing emergenc-v medical care
Page -31-

(a) When an emplo,vee sustains a-work-related traumatic injury that requires medical
examination, medical treatment, o, uott. ,tt. emplo.ver shall authorize such examination
and/or treatment by issuing a Form CA- 16' Thi; form may be used for occupational
disease or iilness only if the emplo,ver has obtained prior permission from owcP'
(b) The employer shall issue po* CA-16 withiniour ho*'of the ciaimed injur'v' If
the employer gives verbal authorization for such care' he or she should issue a ForrrL cA-
16 u-ithin 48 hours. The employer is not r"qui'"d to issue"a Form CA-16 more than one
Reek after the occurrence of the ctalmed injury. The emplo.ver may not.authorize
eramination or medical or other treatment i" uny case tiiit owcP has disallorved'
(c)FormCA-i6mustcontainthefullnanreandadr]ressofthequaiifiedphysicianor
qualified medical facilir.v,* authorized to frot'ide service' The authorizing official must
sign and date the fbnn and must state hi, o' her title' Form CA-16 authorizes treatment
for 60 da.vs fiom the date of issuance, unless OWCP terminates the authorizatron
toffi*.
employer should advise the emplo-vee of the right to his or her initial choice
of ph.vsician. The .rnpioy., shall allow the emplo.vee to select a qualified physician'
after advising him or her of those ph1'sicians excluded under subpart try:J,1 *'
| "f
pirysician .qu U" in private practice. inciuding a health maintenance organlzatlon
(HMO), or empiol,ed by a Federal agency suJ as the Department of the Arm-v, Nar'1"
Air Force, or veterans Affairs. Any qualihed ph,vsician rnay provide initial treatment of
arvork-relatedinjuryinanemergency.SeealsoSec.l0.S25(b).
Sec. 10.301 NIay the phl,sician designated on Form CA-16 refer the emplovee to
another medical specialist or medical faciiity
The phi'sician designated on Form cA-16 maY refer the employee for further
examination. testing, or medical care. owCP will pay this physician or facility's bill on
rhe authority of Form cA-16. Tl-re employer should not issue a second Form cA-16'
Sec. I 0.302 Shouid the emplo-ver authorize medical care if he or she doubts that the
injury occurred, or that it is work-related
If the empioyer doubts that the injury occurred. or that it is work-related' he or she
should authorize medical care by.o*pl.,ing Form CA-16 and checking biock 6B of the
form. If rhe medical and factual evidence ,*t to owcP shou's that the condition treated
is not work-related" owcp will notifi the employee. the emplo.u-er. and the physician or
hospital that owcP r.r,ill not authorize pavment for any further treatment'
Sec. 10.303 Should the emplol'er use a Form cA-16 to authorize medical testing u'hen
an emplovee is exposed to a u'orkplace hazxdjust once
(a) Simple exposure to a workplace hazard. such as an infectious agent' does not
constifute a rvork-related injury entitling an emplol'ee to rnedical treatment under the
FECA. The empioyer thereiorl should iot use a Form CA-16 to authorize medical
testing for an empiol,ee rvho has merely been exposed to a rvorkpiace hazard' unless the
Page -32-

10'537 \\'ltat reports are needed q'hen compensation pavments conrinue for children
oler age l8'7
Reduction and Tcr;mination of Compensation
10.540 \\:hen and ho* is compensarion reduced or te',inated
10'541 \\'hat action vi'ili OWCP take after issuins uritten nolice of its intention ro
reduce or terminate compensation
Subpart G--Appeats Process
10.600 How'can final decisions of OUiCp be revicu,ed
Reconsiderations and Revien's by the Director
10.605 \\rhat is reconsideration
10.606 Hou'does a clainrant request reconsideration
10'607 what is the time limit for requesting reconsideration
I0.608 Horv does owcP decide u,hether to grant or deny the request for
reconsideration
10'609 Horv does OWCP decjde whether nen, evidence requires rnodification of the
prior decision'.)
10.610 What is a rer,ierv bv the Director
Hearings
10.61-5 What is a hearing
10.616 I{ou' does a claimant obtain a hearine
10.617 How is an orai hearing conducted
10'618 How is a re'iew of the written record conducterj
10.619 Mav subpoenas be issued for u,itnesses and documents
10.62 \\:ho pa)'s the costs associated u,ith subpoenas
10.621 what is the emplo),er's rore rvhen anoralhearing has been requested
10-622 Mav a claimant u'ithdraw a request for or postpone a hearing
Reviews by the Emplo'ees' Compensation Appears Board (fcAB)
10.625 \\,hat kinds of decisions mav be appealed
10.626 \\'iro has jurisdiction oi'cases on appeai ro the ECAB
Subpart H--Special Provisions
Representafion
10.70 \{a1,a claimant desienate a representative
Page -7-

elnplovee has sustained an identifiable injury or rnedical conilition as a result of that
eXpr65s1g' owCP uill authorize preventive treatment onl1'under certain q,ell-defrned
cilcumstances (see Sec. I0.3I3).
(b) Emplol'ers mav be required under other statutes or requlations to pror,ide their
enrplo\ees u'ith medical testine and,''or other services in situations described in
paraeraph (a) o1 this section. For example. regulations issued by- the Occupational Safetv
and Health Adrninistration at 29 CFR chapter XVII require enrplor.ers ,";r"r;;;;;;'t
emplovees u'ith medical consultations and,/or examinatlons lvhen they either exhibit
s1-lnptoms consistent u'ith exposure to a rvorkpiace hazard. or u'hen in icjentifiable
event such as a spill.leak or explosion occurs and results in the likelihood of exposure to
a u'orkpiace hazard. In addition.5 U.S.C. 7901 authorizes employers to establishealth
programs rvhose staff can perform tests for workplace hazardi, counsel emplol,-ees fbr
exposure or feared exposure to such hazards- and provide healh care screenins and
other associated sen'ices.
Sec' l0'304 Are there anv exceptions to these procedures lor obtaining medical care
In cases involving emergencies or unusual circumstances. O\\'Cp ma' authorize
treatment in a manner other than as stated in this subpart.
Medical Treatment and Related [ssues
Sec. 10-i10 \\'hat are the basic rules for obtainine rnedical care
(a) 'The emplol'ee is entitled to receive all medical sen'ices. appliances or supplies
u'hich a qualified phy'sician prescribes or recommends and u,hich OWCp considers
necessaT to treat the w-ork-related injury. The emplovee need not be disabled to receive
such treatment. If there is any doubt as to rvhetheia specific sen'ice. appliance or
suppiy is necessan'to treat the work-related injury, thi emplo;-ee should consult OwCp
prior to obtaining it- (b) Any qualified ptri sician or qualified hospital may pro'ide
such sen'ices. appiiances and supplies. A qualified prwider of medical ,upport sen,ices
may also furnish appropriate sen,ices. appliances. and supplies. owcp miv appiy a test
of cost-effectiveness to appliances and supplies. Wirh respecto prescribed medications.
owcP mav require the use of generic equir-alents whereir,.1,*. avaiiable.
Sec. 10.311 wrat are the speciarules forthe sen.ices of chiropractors
(a) The sen'ices of chiropractors that may be reimbursed are limited bv the FECA to
treatmento correct a spinal subluxation. l-he costs of phvsicel and related laboratory
tests,p,erformed bi' or required by a chiropractor to diagnose such a subiuxation are ajso
DavaDle.
(b) In accordance rT'ith 5 U.S.C. 8l0i(i)" a diaenosis of spinal "subluxation as
demonstrated by X-rav to exist" must appear in the chiropractor's report before OwCp
can consider pavment of a chiropractor's bill.
Page -33-

(c) A chiropractor may interpret his or her x-ra);s to the same extent aS any other
phrsician. to te given any weight. the medical report must state that x-rays support the
hnding of spinal subluxaiion. OWCP rvill not necessarily require submittal of the x-ra)',
or a report of the x-ray. but the report must be available for submittal on request'
(d) A chiropractor may also provide serv'ices in the nature of physical therapy under
the direction of a qualified physician.
Sec. 10.312 \\&at are the special rules forthe services of clinical ps1'choiogists
A clinical ps.vchologist may sen'e as a phl'sician only within the scope of his or her
practice as defined by State larv. Therefore. a clinical psychologist may not sen'e as a
ph1'sician for conditions that include a ph-vsical component unless the appiicable State
ia1v allo*,s clinicel ps1'chologists to treat ph,u-sical conditions. A clinical ps1'chologist
ma-v also perform teiting, evaluation and other sen'ices under the direction of a qualified
ph1'sician.
Sec. 10.313 Will OWCP pay for preventive treatment
The FECA does not authorize pa,vment for preventive measuresuch as vaccines and
inoculations. and in general. prevcntir,e treatment may be a responsibility of the
emplol,'ing asencv under the provisions of 5 U.S.C. 790i (see Sec. i0.303). Horvever.
OWCP can authorize trearn.ient for the following conditions. even though such treatment
is designed. in part, to prevent further injury:
(a) Complications of preventive measures rvhich are provided or sponsored by the
agency. such as an adverse reaction to proph,vlactic immunization.
(b) Actual or probable exposure to a known contaminant due to an injury'. thereby
requiring disease:specific measures against infection. Examples include the provision of
tetanus antitoxin or booster toxoid injections for puncfure u'ounds: administration of
rabies vaccine for a bite from a rabid or potentially rabid animal: or appropriate
measures rvhere exposure to human immunodeficiency virus (HIV) has occurred.
(c) Conversion of tuberculin reaction from negative to positive following exposure to
tuberculosis in the performance of duty. In this situation, the appropriate therapy may be
authorized.
(d) Where injury to one e1'e has resulted in loss of vision. periodic examination of the
uninjured e-ye to detect possible s)'mpathetic involvement of the uninjured eve at an
earil'' stage.
Sec. 10.314 Will O\\ICP pav for the services of an attendant
Yes. OWCP u,ill pa,v for the sen'ices of an attendant up to a maximum of $ 1 .500 per
month. u,here the need for such serr,ices iras been medicaliy documented. ln the exercise
of the discretion afforded by 5 U.S.C. 8111(a). the Director has determined that. excepl
-,vhere pa),menrs rvere being made prior to January 1.1999, direct pa)'ments to the
claimant to cover such sel,ices rvill no ionger be made. Rather. the cost of providing
attendant sen'ices will be paid under section 8103 of the Act. and medical bills forthese
Page -34-

sen'icesu'ill be considered under Sec. 10.801. This decision is based on tire follorvine
lactors:
(a) The additional pavments authorized under section 81 I 1(a) should not be
necessal)' since OSICP u-ill aulhorize pa1,'ment for personal care sen ices under i U.S.C.
8i03. u'hether or not such care includes medical senices. scl long as the personal care
sen'ices have been determined to be medically necessan' and are provided bv a irome
heaith aide. licensed practical nurse. or similariy trained individual.
(b) A home health aide. licensed practical nurse, or similarly trained indir-idual is
better able to provide qualiry' personal care sen'iccs- including assistance in feeding,
bathing, and using the toiiet. In the past- provision of supplementai compensation
directl-v to inj ured emplovees may har e encou"raged family' members to take on these
responsibilities el'en though thev mav not have been trained to provide such services. B,'.'
paf ing for the sen'ices under section 8103. OWCP can better determine vnhether the
sen'ices provided are necessarl and/or adequate to meet the needs of the injured
emplovee. In addition. a svstem requiring the personal care pror.ider to submit a bill to
OWCP, where the amount billed r.r,iil be subiecto OWCP's fee schedule. rvill result in
greater fi scal accountabilit_v.
Sec. i 0.315 Will OWCP pay for transportation to obtain medical treatment
The emplo-u-ee is entitled to reimbursement of reasonable and necessary expenses.
including transportationeeded to obtain authorized medical sen'ices. appliances or
supplies. To determine u'hat is a reasonable distance to travel, OWCP w'ill consider the
availability of sen'ices. the emplol'ee's condition. and the means of transportation.
Generaily, 25 miles from the place of injur"v. the work site. or the emplovee's home. is
considered a reasonable distance to travel. The standard form designated for Federal
emplovees to claim travel expenseshould be used to seek reimbursement under this
section.
Sec. I 0.316 After selecting a treating physician- mav an emplol'ee choose to be treated
b,v another phr,sician instead
(a)\Lhen the ph1'sician orieinailv selected to pror.'ide treatment for a u,ork-related
injury refers the emplovee to a specialist for further medical care. the employee need not
consuit O\['CP for approval. In all other instances. however. the emplol,ee must submit a
written requesto OWCP rvith his or her reasons for desiring a change of physician.
(b) OWCP wiil approve the request if it determines that the reasons submitted are
sufficient. Requests that are often approved include those for transfer of care from a
senerai practitioner to a physician who specializes in treating conditions iike the u,orkrelated
one. or the need for a new ph1'sician u'hen an employee has moved. The
emplover mav not authorize a chanse of physicians.
Directed Medical Examinations
Sec. I0.320 Can O\I'CP require an emplol'ee to be examined b1' another ph1'sician
Page -35-

OWCP sometines needs a second opinion from a medical specialist. The employee
must submit to examination by a qualified ph.vsician as oftetl and at such times and
plac,:s as OWCP considers t.utonibly necessary. The employee may have a qualified
ph1':;ician, paid by him or her. present at such examination. However' the employee is
not ,:ntitled to have anyone else present at the examination unless OWCP decides that
erceptional circumstances erist. For example, rvhere a hearing-impaired employee needs
an inierpreter. the presence of an interpreter u'ould be allorved. Also, OWCP may send a
case file for second opinion revierv *,h.rt actual examination is not needed, or *-itere thc
emplol'ee is deceased.
Sec. 10.321 \\hat happens if the opinion of the physician selected b"v OWCP differs
from the opinion of the physician selected by the emplol''ee
(a) If one medical opinion holds more probative value, OWCP will base its
determination of entitiement on that medical conclusion (see Sec. 10.502). A difference
in rnedical opinion sufficient to be considered a conflict occurs when two reports of
yirtually equal weight and rationale reach opposing conclusions (see James P. Roberts-
31 ECAB 1010 (1980)).
(b) If a conflict exists betr.reen the medical opinion of the employee's ph1'sician and
the medical opinion of either a second opinion ph."-sician or an OWCP n-redical adviser
or consultant, OWCP shall appoint a third physician to make an examination (see Sec.
10.502). This is called a referee examination. OWCP tuill select a ph,vsician who is
qualified in the appropriate specialtv and who has had no prior connection with the case.
ihe empio,vee is not entitled to have anyone present at the examination unless OWCP
decides that exceptional circumstances exist. For example. where a hearing-impaired
employee needs an interpreter, the presence of an interpreter \ /ould be allowed. Also, a
case fiie may be sent for referee medical review u'here there is no need for an actual
examination, or where the emplo.vee is deceased.
Sec. 10.322 \Lho pays for second opinion and referee examinations'
OWCP wiil pa1, second opinion and referee medical specialists directly. OWCP u'ill
reimburse the employee all necessary and reasonable expenses incident to such an
examination. including transportation costs and actual \ raqes lost for the time needed to
submit to an examination required by OWCP.
Sec. 10.323 'fr,hat are the penalties for failing to report for or obstructing a second
opinion or referee examination
If an emplol'ee refuses to submit to or in an.v way obstructs an examination required
b-v* OWCP. his or her right to compensation under the FECA is suspended until such
refusal or obstruction stops. The action of the employee's representative is considered to
be rhe action of the empioy'ee for purposes of this section. The emplovee will forfeit
compensation otheni-ise paid or pa1'able under the FECA for the period of the refusal or
Page -36-

obstruction. and anv contpensation alreadl'paid lor that period ri,ill be declared an
o\erpalment and u,i1l be subjecto recoverl' pursuant to 5 u.S.C. 9119.
Sec. l0-324 Jtlav an emploverequire an emplor ee to un

emplo)'er should use Form CA-i 7 to obtain interim reports concerning the duty status of
an emplo,vee with a disabling injury.
Sec. 10.332 What additional medicai information will OWCP require to support
continuing pa)'nent of benefits
In all cases of serious injury or disease, especially those requiring hospital treatment
or prolonged care, OWCP rvill request detailed narrative reports from the attending
physician at periodic inten,als. The ph1'sician w-ill be asked to describe continuing
medical treatment for the condition accepted by OWCP, a prognosis, a description of
rvork limitations. if any, and the physician's opinion as to the continuing causal
relationship betu'een the employee's condition and factors of his or her Federal
emplovment.
Sec. 10.33i What additional nredical information will O\\/CP require to support a
clair-n for a schedule award
To sr.rpport a claim for a schedule au'ard. a medical report must contain accurate
rreasurements of the function of the organ or member. in accordance with the American
N{edical Association's Guides to the Evaluation of Permanent Impairment. These
measurements mav include: The actual degree of loss of actil'e or passive motion or
defonnir.v; the amount of atrophy; the decrease. if any. in strength: the disturbance of
se nsation; and pain due to nerve impaim-rent.
\{edical Bills
Sec. 10.335 How are medical bills submitted
Usually, medical providers submit biils directly to OWCP. 'fhe rules for submitting
and paf ing biils are stared in subpart I of this pzrt. An emplol''ee claiming
reimbursement of medical expenseshouid submit an itemized biil as described in Sec.
10.802.
Sec. 10.336 What are the time frames for submitting bills
To be colsidered for pa1,ment. bills must be submitted by the end of the caiendar year
after the r,ear when the expense was incurred. or by the end of the calendar yea-r after the
1,ear when OWCP first accepted the claim as compensable. n'hichever is later.
Sec. 10.337 IfOWCPreimbursesanemplo-u-eeonll'partiall,vfora medical expense.
must the provider refund the balance of the amount paid to the employee
(a) The OWCP fee schedule sers maximum limits on the amounts payable for many
sen'ices (see Sec. 10.80-5).The emplo)'ee ma)'be only partially reimbursed formedical
Page -38-

expenses because the amount he or she paicl to rhe medical provider for a sen,ice
exceeds the maximum allou'able charge set by.the owcp fee schedule.
(b) if this happens. o\\-CP shail advise the emplol'ee of the maximum allorvable
cltarge for the service in question and of his or her responsibilitl.to ask rhe provider to
re'fund to the emplovee. or credit to the emplovee's account. the amount he or she paid
rvhich exceeds the maximum allou'able charge. The pro'ider may request
reconsideration of the fee determination as set forth in Sec. 10.g12.
(c) If the provider does not refund to the emplor,ee or credit to his or her accounthe
amount of monev paid in excess of the charge ivhich owcp allou,s. the emplol,ee
should submit documentation of the attempt to obtain such refund or credit to o\VCp.
OWCP ma,n- make reasonable reimbursement to the emplol.ee afler rer.ieu,ing the facts
and circumstances of the case.
Subpart E--Compensation and Related Benefits
Compensation for Disabilif.v'' and Impairment
Sec. 10..100 Whar is total disabiliry*
(a) Permanent total disabilit-v-
presumed to resuit from the loss of use of both hands.
both arms. both feet. or both legs. or the loss of sight of both er.es. Horver.er" the
presumption of permanent total disabiiity ur u r.rr.,lt of such loss may be rebutted bv
evidence to the contrarv. such as evidence of continued abiliqv to r,l,ork and to earn
wases despite the loss.
(b) remporarv total disabiliry is defined as the inabiiitr to return to the position held
at the time of injury or ea.rn equivalent \^'ages. or to perform other gainfui emploi,ment.
due to the u'ork-rellted injury'. Except as presumed under paragraph (a) of thii section.
an employee's disabiliqv status is alll,ar s considered temporary pending return to r.r,ork.
Sec. 10.401 when and how is compensation for total disabiiity paid
(a) Compensation is pavable u'hen the emplovee starts to lose pa-v- if the injury causes
permanent disabiliry or if pav loss continues for more than i-l calendar davs. Otherq-isecompensation
is pa1'able on the fourth dav after pav stops. Compensation may not be
paid whiie an injured emplol'ee is in a continuation of pav smtus or receives pa1,. fbr
leave.
(b) Compensation for total disabilin is pavable at the rare of 66\2/i\ percent of rhe
pav rate if the emplol'ee has no depenjents. or 75 percent of the pav rate if the emplol ee
has at least one dependent. ("Dependents" are defined at 5 u.s.c. g110(a).)
Sec. 10.402 What is parlial disabilir_,*
An injured emploYee u'ho cannot return to the position held at the time of injury, (or
earn equivalent wages) due to the work-relared injuqf'. but ufio is not totalll' disabled for
all gainful emplovment. is considered to be parrialr'disabled.
Page -39-

Sec. 10.403 When and how'is compensation for partial disabilit"v paid
(a) 5 U.S.C. 8115 outlines how compensation for partial disabiliqv is determined. If
the emplol'ee has actual earnings which fairly and reasonably represent his or her wageearning
capacity, those earnings ma,v form the basis for pa,vment of compensation for
partial disabilit"v. (See Secs. 10.500 tluough 10.520 concerning return to rvork.) If the
emplo1,'ee's actual earninss do not fairly and reasonably represent his or her wageearning
capacitl', or if the emplol,ee has no actual earnings. OWCP uses the factors
stated in 5 U.S.C. 8115 to select a position rvhich represents his or her rvage-eaming
capaciqv. Hou,ever. OWCP lvill not secure emplol'ment for the ernpioyee in the position
selected for establishing a rvage-earning capaciW.
('b) Compensation for partial disability is pa1'able as a percentage of the difference
betiveen the cmploy'ee's pav rate for compensation purposes and the emplo.'.-ee's rvageearning
capacit-v. The percentage is 66\2i3\ percent of this difference if the employee has
no dependents. or 75 percent of this difference if tiie empiol'ee has at least one
dependent.
(c) The formula which O\\'CP uses to compute the compensation pavabie for partiai
disability emplol's the fbllou'inq tenns: Pay rate for compensation purposes. uhich is
defined in Sec. 10.5(s) of this part: current pav rate. u'hich means the saiary or rvages for
the job held at the time of injury at the time of the determinatior-r; and earnings. which
means the emplol'ee's actual earnings. or the salary or pay rate of the position selected
by OWCP as representing the emplovee's wase- earning capacity.
(d) The emplovee's wage-eaming capacity in terms of percentage is computed by
dividing the employ'ee's earnings by the current pay rate. The comparison of earnings
and ''current" pay rate for the job held at the time of injury need not be rnade as of the
beginning of partial disability. OWCP may use anv convenient date for making the
comparison as long as both wage rates are in elfect on the date used for comparison.
(e) The ernplol'ee's \^,ase-earning capaciry in terms of dollars is computed by first
muitipl_v-ing the pay rate for compensation purposes b-u- the percentage of wage-eaming
capacir,v. The resulting dollar amount is then subtracted from the pay rate for
compensation purposes to obtain the emplol,ee's loss of rvage-earning capacitv"
Sec. 10.;+04 W-hen and how is compensation for a schedule impairment paid
Compensation is provided for specified periods of time for the perrnanent loss or loss
of use of certain members. orsans and functions of the body. Such loss or loss of use is
known as permanent impairment. Compensation for proportionate periods of time is
pal,able for partial loss or loss of use of each member. organ or function. OWCP
evaluates the degree of impairment to scheduie members, organs and functions as
defined in 5 LI.S.C. 8107 according to the standardset forth in the specified (by O\;CP)
edition of the ,{merican Medical Association's Guides to the Evaluation of Permanent
Impairment.
(a) 5 U.S.C. 8107(c) provides a iist of schedule members. Pursuant to the authoritv
provided by 5 U.S.C. 8107(cX22). the Secretary has added the following organs to the
compensation scheduie for injuries that were sustained on or afler September 7.1914:
Page -4O-

\Iember
Breast (one)
Kidnel'(one)
I-an'nx
Lung (one)
Penis
Testicie (one)
Tongue
Ovary,(one)
Uterus/cen'ix and r.uiva,rvaqina
\\'ecks
52
156
i60
156
205
52
160
52
205
(b) Compensation for schedule arvards is pa;-able at 66\2i3\ percent of rhe emplor,ee,s
pa\', or 75 percent of the pa-v u'hen the emplol.ee has at least one dependent.
(c) The period of compensation pavable under 5 u.s.c. g107(c) shall be reduced bY
the period of compensation paid or pa),able under the schedule for an earlier injury if:
(i) Compensation in both cases is for impairment of the same member or function or
different parts of the same member or function. or for disfigurement; and
(2) OWCP finds that compensation pavable for the later impairment in rvhoje or in
part u'ould duplicate the compensation pa1'able for the pre-existing impairment.
(d) Compensationot to exceed 53.500 ma1,'be paidibr serious disfigurement of rhe
face. head or neck uhich is likeli' to handicap u p.rron in securing or maintaining
emplo.v-ment.
Sec. i0.405 Who is considered a dependent in
impairment
a claim based on disabilitv or
(a) Dependents include a wife or husband; an unmarried child un6er 1g vears of age:
an unmarried chiid over 18 w-ho is incapable of self- support" a student. untit 6" or she
reaches 23 1-ears of- age or completes four vears of r.hoot be-,-ond the high schooi level:
or a wholly dependent parent.
(b) Augmented compensation pavable for an unmarried child. which rvould otheru,ise
terminate rvhen the child reached the age of 18. mav be continued u,hile the child is a
studenr as defined in _s Lr.S.C. gl0t(17).
Sec' 10'406 What are the maximum and minimum rates of compensation in disabilirv
cases
(a) Compensation for total or partial disabiliq'may not exceed 75 percent of rhe basic
monthlv pav of the highest step of urade 15 of t-he General Schedule. (Basic montirl)'pa1
does not include localitl' adjustments.) Hou,ever. rhis limit does nor apph, ro disability
sustained in the performance of dury u'hich rvas due to an assault ivhich occurred during
anatlemptedassassinationofaFederaiofficial
describedunderl0U.S.C.35l1a.1 or
1751(a).
Page -4{-

(b) Compensarion for total disability ma-v not be less than 75 percent of the basic
montiil),pa!,of the first step of grade 2 of the General Schedule or actual pay. uhichever
is less. (Basic monthly pay does not include localitl' adjustments.)
Compensation for Death
Sec. 10.410 Who is entitled to compensation in case of death. urd n'hat are ilre rates of
conrpensation pal able in death cases
(a) If there is no child entitled to compensation. the emplo,vee'surv'iving spouse rvill
1....ir,. compensation equal to 50 percent of the emplovee's monthiy pa-v* until death or
remarriage before reaching age 55. Upon remariage. the sun'iving spouse w'ill be paid a
lump sum equal to 24 times the monthly compensation pa1'ment (excluding
compensation payable on account of another individual) to which the surv'i\ring spouse
rvas entitled immediately before the remarriage. If remarriage occurs at aqe 55 or older.
the lur-np-sum pa.yment will not be paid and compensation will continue until death-
(b) Iithere is a child entitled to compensation. the compensation forthe sunivins
spouse u.ill equal 45 percent of the employee's monthly pay pius 15 percent for each
child. but the total percentage may not exceed 75 percent.
(c) If there is a child entitled to compensation and no surviving spouse. compensation
for one child nill equal 40 percent of the empiovee's monthly pay. Fifteen percent u'ill
be au,arded for each additional child. not to exceed 75 percent- the total amount to be
shared equally among all children.
(d) If ihere is no child or surviving spouse entitled to compensation. the parents will
receive compensation equal to 25 percent of the employee's monthly puy if one parent
n'as u{roily dependent on the empiol'ee at the time of death and the other u'as not
dependent to an-v extent, or 20 percent each if both were wholly dependent on the
employee, or a proportionate amount in the discretion of the Director if one or both were
partially dependent on the employee. If there is a child or sun'iving spouse entitled to
torp.ntotion, the parents w.ill receive so much of the compensation described in the
preceding sentence as, when added to the total percentages pa-v-able to the surviving
spouse and children. q'ill not exceed a total of 75 percent of the emplovee's monthiy
pa)'.
(e) lf there is no child. sun'iving spouse or dependent parent entitled to
compensation. the brothers. sisters. grandparents and grandchildren will receive
compensation equai to 20 percent of the employ'ee's monthly pa1' to such dependent if
one \\'as rvholll'dependent on the employee at the time of death: or 30 percenl if more
than one u'as rvholly dependent, divided among such dependents equally: or l0 percent
if no one rvas rvholl;- dependent but one or more \'!'as partlv dependent, divided among
such dependents equally. If there is a chiid. sun'iving spouse or dependent parent
entitled ro compensation, the brothers. sisters, grandparents and grandchiidren w'ill
receive so much of the compensation described in the precedine sentence as. when
added to rhe toral percentages pa)'able to the children. sun'iving spouse and dependent
parents. u'ill not excced e total of 75 percent of the emplovee'S monthl-v pa)'.
Page 42-

(l) A child- brother- sister or grandchild may' be entitled to receiye deat6 be'efits unril
death' marriaqe. or reaching age 18. Regarding entitienrenr after reaching age I g. refer to
Sec. 10.117 of these regulations.
Sec' 10'411 \\'hat are the maximum and minimum rares of compensation in death
cases
(a) Compensation for death mav not exceed the emplovee's pav or 75 percent of the
basic monthi."- pav of tire highest step of grade 15 of rhe General Schedule. except rhat
compensation mav exceed the emplol"ee's basic monthl-v pav if such ercess is created br,
authorized cost-ol-living increases. (Basic montirlv pof io.t not include localiry
adjustments.) Horvever. the marimum limit does noi ,pplr- when the death occurred
during an assassination of a Federal official described *i.r lg U.S.C.35l(a) or 1g
U.S.C. I 751(a).
(b) Compensation for death is computed on a minimum pay rate equal to the basic
monthly pav of an emplovee at the first step of grade 2 of the Generai Sclreduie. (Basic
monthlv pay does not include locality adjustments.)
Sec' 10'411 Will OWCP p"y the costs of burial and transportation of the rernains
In a case accepted for death benefits. OWCP w"ill pa-,- up to $800 for funeral and burial
expenses' Wlen an emplol'ee's home is u,'ithin the United States and the emplol,ee dies
outside the United States- or awav from home or the official dutv station. anadditional
amount ma1' be paid for transporting the remains to tire empiol'ee's home. An additional
amount o1-$200 is paid to the personal representative of rhe decedent for reimbursemenl
of the costs of terminatine the decedent'status as an emplovee of rhe United States.
Sec' 10.413 If a person dies u'hile receir"inq a schedule arvard. to w.hom is the balance
o1'the schedule aw.ard pa1,'able
The circumstances under which the balance of a schedule au,'ariJ ma1, be paid to an
emplovee'sun.ivors are described in 5 U.S.C. 8109. Therefore. if theie is no surr,,ivinc
spouse or cirild. O\ ;Cp rvill pa1,' benefits as lbllows:
(a) To the parent- or parents. u'holl1' dependent for support on the decedent in equal
shares u'ith an-'-. w'holly dependent brother, sister. grandiarent or,srandchild:
(b) To the parent- or parents. partially dependent for iupport on the decedent in equal
shares rvhen there are no u'hollr'dependent brothers. sisteis. erandparents or
grandchildren (or other u'hollv dependent parent): and
(c) To the parent. or parents. paniailJ'dependent upon the decedent.25 percenr of rhe
amount paYable. shared equallr'. and the remaining 75 percent to anv nholl--v dependent
brother- sister- grandparent or srandchild (or wholiy dependent parent). shared equalh,.
Sec. 10.4i'1 \\hat reporls of dependents are needed in dearh cases
Page -41

If a beneficiary is receiving compensation benefits on account of an emplol'ee's death-
OWCP will ask him or her to complete a report once each )rear on Form CA-12. The
report requires the beneficiary to note changes in marital status and dependents. If the
beneficiary fails to submit the form (or an equivaient u'ritten statement) rvithin 30 da,vs
of the date of request, OWCP shall suspend compensation until the requested fom or
equivalent u.ritten statement is received. The suspension rviil include compensation
pay'abie for or on behalf of another person (for example. compensation pa,vable to a
widow on behalf of a child). When the form or statement is received. compensation u.ill
be reinstated at the appropriate rate retroactive to the date of suspension, provided the
beneficiary is entitled to such compensation.
Sec. 10.415 What must a beneficiarv do if the number of beneficiaries decreases
The circumstances under u'hich compensation on account of death shall be terminated
are described in 5 U.S.C. 8133(b). A beneficiary in a claim for death benef-rts should
promptly notifu OWCP of any event which would affect his or her entitlemento
continued compensation. The temls "marriage" and "remarriage" include common-law
mariage as recognized and defined by State law in the State tvhere the beneficiary
resides. If a beneficiary'. or someone acting on his or her behalf. receives a check "vhich
includes pavment of compensation for any period after tire date u4ren entitlement ended.
he or she must promptly return the check to OWCP.
Sec. 10.416 How does a change in the number of beneficiaries affect the amount of
compensation paid to the other beneficiaries
If compensation to a beneficiary is tenninated. the amount of compensation payable to
one ormore of tire remaining benellciaries may be reapportioned. Similarll'. the birth of
a posrhumous child may resuit in a reapportionment of the amount of compensation
pa1'able to other beneficiaries. fhe parent. or someone acting on the child's behalf. shall
promptly notif,'OWCP of the birth and submit a copy of the birth certificate.
Sec. 10.1I7 What reports are needed u'hen compensation pavments continue for
children over age 18
(a) Compensation pa1-able on behalf of a child. brother. sister. or grandchild- rvhich
rvould otherw'isend when the person reaches 181'ears of age, shall be continued if and
for so long as he or she is not married and is either a student as defined in 5 U.S.C.
8101(17). or pirl'sically or mentally incapabie of seif-support.
(b) At least tu,ice each vear, OWCP wiil ask a beneficiary receiving compensation
based on the student status of a dependent to provide proof of continuing entitlemento
such compensation, including certification of school enroilment.
1c) Likeu,ise. at least frvice eacir 1,ear, OWCP u'ill ask a beneficiary or legai guardian
receiving compensation based on a dependent's ph1'sical or mental inabiiir,v- to support
himself or herself to submit a medical report veri['ing that the dependent's medica]
condition persists and that it conrinues to preclude self-support.
Page 4*

Adjustments to Compensation
Sr:c. I 0.420 llo*- are cost-of-li'ins adjustments applied
(a) In cases of disabiiiry'. a beneficiarv is eligible for cost-of- livins adjr.rstments
5 u's'c'
under
81'16a q'here injury-related disabilit' began more rhan on.l .ur. prior to
the
the
cost-of-livinq
date
adjustment took effect. The emplo'ee's use of .oniinuuiion of'pav
providedby'5U'S.C'BlI8,orofsickoramual
as
leir,e.duringan),parr oftheperiodof
disabilitv does not affecthe computation of the one-.r.ear period.
(b) stere an injury does not result in disabilin' but co,r.rp.nsation is pavable
pemranent
for
impairment of a covered member. o.gon or function of the boclr.. a
beneficiary is eligible for cost-of-lii'ing adj ustments under s u. s c. s r +, ,ri... ,rr.
began moie rtun
::,::i:::y:l,lTL"t.*enr
one )'ear prior ro rire dare rhe cost-of-riving
ad1 ustment took effecr.
(c) In cases of reculrence of disability. rvhere the pa1.'rate for compensation purposes
is the pay rate at the time disabilit,v recurs. a beneficiary is eiigible for cost-of-living
adjustments under 5 U.S.C- 8146a rvhere the effectir'. iur. of that pay rare besan more
than one 'ear prior to the date the cost-of li'ing adjustmentook el.fect_
(d) In cases of death. entitiement to cost-of-firing ad.iusrnrents under5 U.S.C. gl46a
begins rvith the first such adjustment occurring more than one vear after the date of
death' Hou'el'er. if the death \ ias preceded by:a period of injur,*-relatedisabilitv.
compensation pal"able to the survir,ors w'ill be increased by the same percentaqes as the
cost- of-living adjustments paid or pa1''able to the deceased emplol.ee ior the period of
disabilit,v, as w'ell as b-v- subsequent cost-of-living adjustments to u,hich the sunivors
n'ould othc-nvise be entitled.
10''121
1"t'
May a beneficiarv receive other kinds of pavments from the Federal
Govemrnent concurrently u,ith compensation
(a) 5 U.S.C. 8116(a) provides thar a beneficiarv mavnot receiye n'as.e-loss
compensation concurrentlv with a Federai retirement or sun'ivor annuitl,'. The
beneficiarv must elect the benefit that he or she wishesto receive. and the election. once
made. is revocable.
(b) An emplol'.ee mav receive compensation concurentl]- u.ith militan, retired par,.
retirement pay. retainer pav or equii'aient pa1' for se6,ice in the Armed Forces or other
uniformed services. subjecto the reduction of such paf in accordance u"ith 5 U.S.C.
,s532(b).
(c) An emplol'ee may not receive compensation for total disabilir,v- concurrently w,ith
severarlce pav or separation pay. Hou'ever. an emplovee mav concurrentlv receive
compensation for partial disabiliq' or perrnanent impairment to a schedule member.
organ or function with severance pav or separation pul,.
(d) Pursuanto 5 LI'S.C. 8116(d). a beneficiary maj receir e compensarion under rhe
FECA for either the death or disabiiitl'of an concurrenrll.u.ith benefits "rnptoi,..
under
titie II of the Social.securitv Act on account oi'the ase or death of such emplor.ee.
Ijou'e'er" this provision of the FECA also requir.r o=utcp lo reduce rhe amount of an.,
Page 45-

such compensatiolr b1, the amount of any Social Securiqv Act benefits that are
attributabie to the Federal service of the emplo,vee' . ^rr:^n
(e) To determine fhr: employee's entitlemento compensation' OWCP may lequlle an
employee to subn-rit an affidavit or statement as to the receipt of an.v Federally funded or
Federally assisted bent:fits. tf an employee fails to submit such affidavit or statement
w.ithin 30 days of the date of the ,.q,r.ri, his or her right to compensation shall be
suspended until such time as the requested affldavit or statement is received' At that time
compensation u,ill be reinstated retroactive to the date of suspension provided the
is entitled to such compensation'
"rnpio,u..
Sec. 10.122 Ma-v compensation pa-vments be issued in a lunp sum
(a) In erercise of the discretion afforded under 5 u.s'c. 8135(a), owcP has
determined that lump-sum pavments will not be made to persons entitied to rvage-loss
benefits (that is. rhose pal,able under 5 u.s.c. 8105 and 8106). Th^.i:.!:-.'T,ltn owcP
receives iequests for lump-sum payments for wage-loss benefits' OWCP u'ill not
exercise further discretion in the matter. This detennination is based on several factors'
including:
(1) The purpose of the FECA, which is to replace lost wages;
(2) The prudence of providing wage-loss benefits on aregular. recurring basis; and
i:) fir. high cost otitre long-ierm borrorving that is needed to pay out large lump
SUINS.
(b) Horvever. a lump-sum pa),ment may be made to an employee entitied to a
scheduie arvard under 5 U.S.C. 8107 where OWCP determines that such a payment is in
the employee's best interest. Lump-sum pa1'ments of schedule awards generally w'ill be
considered in the emplo1'ee's besi interest only rvhere the emplol'ee does not.reiy upon
compensation pai,'ments as a substitute for lost wages (that is. the employee is w'orking
or is receiving annuit-u-- payments). An emplo.vee possesses no absolute right to a lumpsum
pa)'ment of benefits payable under 5 U.S'C' 8107'
(c) Lump-srl* poy*.nts to surviving spouses are addressed in 5 lj.S.C.8135(b)'
Sec. l0'423 \4ay compensation pa1'ments be assigned to' or attached bv' creditors
(a) As a generai ruie. compensation and claims for compensation are excmpt from tire
claims of piivate creditors. This rule does not apply to claims submitted by Federal
agencies. hurther, an,v attempt by a FECA beneficiary to assign his or her claim is null
and void. How-ever. pursuanto provisions of the Social Security AcI.42 U.S'C' 659'
and regulations issued by the office of Personnel Management (oPNI) at 5 CFR part
5g1, FECA benefits. including survivor's benefits. may be garnished to collect overdue
aiimon;- and child support pa)-ments.
(b) Garnishment foi chiid support and alimony may be requested b1' providins a copv
of the State agency or court ordlr to the district oifice hanJling the FECA claim'
Sec. 10.121 Ma1' someone other than the benefician be designated to receive
compensation pa1'ments
Page -46-

A benefician'ma'be incapable of manaeins or directing the management of his
herbenefitsbecau.seofamentai
or
orphlsical disabilit,v.orbecauseofiegal incomperence.
or because he or she is under 18 r'eari of age. In this situation. absenthe appointment
a guardian of
or other part-r to t"nug. the financial affairs of rhc claimant bv a c,cun
administrati'e
or
bodl' authorized to do so. o\\'Cp in its sole dir;;;ri";ur: ujoro.
person
u
to sen'e as the representati'e pavee for funds due the beneficiary. '' "
Sec' l0'125 it4av compensation be claimed for periods of restorable lea'e
I'he emplovee may claim compensation for periods of annual and sick lea'e u,hich
restorable
are
in accordance u'ith the rules of rhe emplol,ing agency'. Forms Ct\-7aand
7b are
cAused
for this purpose.
Overpal'ments
Sec. 10-'130 How does owcp notifu an indi'idual of a par,.ment made
(a) In addition to providing narrati'e descriptions to recipients of benefits paid
pa1'able'
or
owcP includes on each periodic check a clear indication of the period for
tuhich payment is being made. A fonn is sent to the recipient rvith each supplemental
check u'hich states the date and amount of'the pa)'ment and the period for which
pavment is being made. For pavments sent by electronic funds tiansfer (EFT), a
notification of the date zrnd amount of pavmenr appears on the statement from the
recipient's financial institution.
(b) By these means- oWCP puts the recipient on notice that a payment u.as made and
the amount of the pa)'ment. If the amount received differs from the amount indicated on
the wrinen notice or bank statement. the recipient is responsible for notifying OWCp of
the difference. Absent affirmative eridence to the contrary.. the benefician,rvijl be
presumed to have receir,ed the notice of par.ment. u.hether mailed n.i.anr_ln"a
electronical l,v.
Sec- 10.431 s'hat does o\\rcp do u,hen an overpa),ment is identified
Before
-
seekins to recover an o\/erpavment or adjust benefits. owcp
beneficiarv' in uriting that:
(a) The overpa'ment exists. and the amount of overpaymenr:
wiil ad'ise the
., (b) A.preiiminary finding shorvs either that the indirlidual was or q,as not at fault
rne
in
creatlon of rhe overpa\-ment:
(c) He or she has the right to inspect and cop1, Government records relatine 10 the
overpavment: and
(d) He or she has the right to present evidence which chailenges the fact or amount
the
of
oYerpayment- and./or challenges the prelimina:1, finding that he or she was
the
at {ault in
creation of the overpavmen,lH. nr rh. may also ,.qu.'r, that recovery of the
overpayment be u,aived.
Page 47-

Sec. 10,432 IJow can an individual present evidence to OWCP in response to a
preliminary notice of an overpay'ment
The individual ma-v presenthis evidence to OWCP in writing or at a pre-recoupment
hearing. The evidence must be presented orthe hearing requestedwithin 30 days of the
date of the written notice of overpal'ment. Failure to requesthe hearing within this 30-
day time period shall constitute a \\'ait,er of that right"
Sec. 10.133 Under what circumstances can OWCP rvaive recoven'of an overpal'ment
(a) OWCP may consider rvaiving an overpavment oniy if the individual to rvhom it
uas ntade rvas not at fault in accepting or creating the overpa-v-ment. Each recipient of
compensation benefits is responsible for taking all reasonable measures to ensure that
pa;-ments he or she receives from OWCP are proper. The recipient must show good faith
and exercise a high degree of care in reporting events which ma-v affect entitlemento or
the amount of benefits. A recipient rvho has done anv of the following will be found to
be at fault with respecto creating an o\erpa)'ment:
(1) IVTade an incorrect statement as to a material fact r.r'hiche or she knerv or should
have knou,n to be incorrect: or
(2) Failed to provide information which he or sire knerv or should have known to be
material: or
(3) Accepted a payrnent n'hich he or she knerv or should have known to be incorrect.
(This provision applies only to the overpaid individual.)
(b) Whether or nor OWCP determines that an individual was at fault with respecto
tire creation of an overpayment depends on the circumstancesurrounding the
overpayment. The degree of care expected may varv rvith the complexity of those
circumstances and the individual's capacity to realize that he or she is being overpaid.
Sec. I 0.434 If OWCP finds that the recipient of an overpa-vment was not at fault, what
cnteria are used to decide u'hether to rvaive recovery of it
If O\\'CP finds that the recipient of an overpa)'ment was not at fault. repayment will
stiil be required unless:
(a) Adjustment or recoverv of the overpa)'mcnt u'ould defeat the purpose of the
FECA (see Sec. 10.436). or
(b) Adjustment or recoverv of the overpavment rvould be against equitv and good
conscience (see Sec. 10.137).
Sec. 10.435 Is an individual responsible for an overpa]-ment that resuited from an error
made by OWCP or another Government agencv
(a) The fact that OWCP may har,e erred in maliing the overpal'ment. or that the
overpa\.ment mav have resulted from an error by another Government agencl - does not
b_v itseif relieve the individual r.r'ho received the overpalment lrorn liabililv for
reDavmenl if the individual also was at fault in acceptinq the overpa)'ment'
Page -48-

(b) Hou.eYer. O\\'CP mar' find that the individual n'as not at fault if failure to reporl
an event affecting compensation benefits. or acceptance of an incorrect par.ment.
occurred because:
(1) The indiYidual reiied on misinformation given in r,rriting by OWCp (or b.v- anorher
Government agencv u.hich he or she had reason to belier."e was connected u,ith the
administration of benefits) as to the interpretation of a peninent provisiop of the FECA
or its regulations: or
(2) OWCP erred in calculating cost-of-living increases. schedule au'ard leneth and./or
percentase of impairment. or loss of u,aqe-earning capacit_v.
Sec' 10.436 Under u'hat circumstances vu'ould recovery of an orerpa).ment defeat rlie
purpose of the FECA
Recoven'of an overpavment u'ill defeat the purpose of the FECA if such recovervqould
cause hardship to a cunentiv or lbrmerl.v enlitled beneficiary because:
(a) The beneficiaT from u'hom O\\/CP seeks recor,ery needs substantiallv all of his
or her culrent income (including compensation benefitsj to mcet current ordlnan, and
necessan' living expenses: and
(b) The benefician"s assets do not exceed a specified amount as detennined b1'
OWCP from data furnished by the Bureau of Labor Statistics. A hicher amounr is
specified for a beneficiarv rvith one or more dependents.
Sec' i 0.137 Llnder w'hat circumstances rvould recoverv of an overpayment be against
equit5' and eood conscience
(a) Recoverv of an o\ erpa'ment is considered to be against equiry,- and good
conscience when anv individual q'ho received an overpa.r'ment u'ould experience se\-ere
financial hardship in attempting to repay the debt.
(b) Recoven'of an overpa\ment is aiso considered to be asainst equitv and good
conscience t{hen ant' individual. in reliance on such payments or on notice that such
paYments would be made- gives up a vaiuable right or changes his or her position for the
worse. In making such a decision. O\\;CP does not consider the indil'iduai's currenr
abiliqv to repay the overpal,ment.
( 1) To estabiish that a valuable right has been reiinquished. it must be shown that the
right was in fact valuable. that it canirot be regained- and that the action u,as based
chiefly or solel,v in reliance on the payments or on the notice of pa1,ment. Donations to
charitable causes or sratuitous transfers of funds to other individuals are not considered
reiinquishments of r,'aluable ri shts.
(2) To establish thar an indi'idual's position has changed fbr rhe worse. it must be
shown that the decision made would not othenvise have 1."n made but for the rer.oi^t ^{:
lrrL l lll,Pr t,l
benefits. and that this decision resulted in a loss.
Sec' I0-138 Can O\\;CP require the individuai u,ho received the overpar.ment to submit
additi onal financial information
Page -49-

(a) The individual r.vho received the o\-erpayment is responsible for providing
information about income, expenses *d uri.i, as specified by owcP
Lht: information
is needed to determine whether or not recovery of an overpal'ment r']'oyl! defeat the
purpose of the FECA, or be againu .q*iay*a Sooglon'iitntt'
This information'x'ill
U" used to determine the repavment schedule' if necessary'
"tro(b) Failure to submit the requesied information within 30 da1's of the request shaii
result in denial of r,vaiver, and no further request for n'aiver shall be considered until the
requested information is frrrnished'
Sec. 10.439 W-hat is adclressed at a pre-Iecoupment hearing
At a pre-recoupment hearing, the o\\rCP representative n'ill consider all issues in the
claim on u,hich a formal decision has been issued' Such a hearing u'ill thus fuifill
owcP,s obligation to provide pre- recoupment rights.ld a hearing under 5 u's'c'
812r1(b). Pre-recoupment hearings shall be conducted in exactly the same manner as
pror,,ided in Sec. 10.615 through Sec' 10'622'
Sec. 10.4,10 F{orvdoes o\ /cP communicate its final decision concerning recover;- of
an overpavment. antl what appeal right accompanies it
(a) owcP will send a copy of the finai decision to the individual lrom rvhom
recovery is sought; his or her representative. if an1': and t|e employing agenc,v'
(b) The only revierv of a final decision concerning an overpavment is t_o the
Employees' Compensation Appeals Board. The provisions of 5 U'S'C' 8121(b)
(concerning hearings) and: U.S.C.8ll8(a) (concerning reconsiderations) do not apply
to such a decision.
Sec. 10.4'11 How are overpa)'ments collected
(a) when an overpavment has been made to an individual who is entitled to further
payments. the individual shall refund to OWCP the amount of the overpa.Yment as soon
as the error is discovered or his or her attention is called to same. If no refund is made'
owcP shall decrease later payments of compensation, taking into accounthe probabie
extent of future pa\;ments, t^he rate of compensation. the financial circumstances of the
indi'idual, and anyother relevant factors, io as to minimize any hardship' Should the
individual die before collection has been completed. collection shail be made by
decreasing later payments. if any. pa1'able under the FEC,A' with respecto the
individual's death.
(b) When an overpa)'ment has been made to an individual who is not entitled to
further pa.vments. ttre inaividual shall refund to owcP the amount of the overpa)'ment
aS soon as the error is discovereci or his or her attention is called to same' Ti-re
overpa),ment is subjecto rhe provisions of the Federai Claims Collection Act of 1966
(as amended) and ma1, be reported to the Internal Rel'enue Service as inCome' [f the
individual fails to make suc|-refund. OWCP ma)' recover the same through an1''
aYailable means. including offset of salary. annuiry beneflts. or other Federal pa)'ments'
Page -5O-

including tax refunds as authorized bv the Tax Refund Olfset Program. or referral of rhe
debt to a collectic-rn asenc]. or to the bepartment of Justice.
Subpart F--Continuing Benefi ts
Rules and Er.idence
Sec. 10.500 \\hat are the basic rules go'u'ernine continuing receipt of compensrtion
benefits and return to u'ork
(a) Benefits are available only u'hile the effects of a u'ork-related condition continue.
Compensation for u'age loss due to disabiliry is ar.'ailable onll,for an.u* periods during
i'rhich an emploYee's rvork-related medical condition pre\,ents him or her from eaming
the rvaqes earned before the rvork-related injury'. Par,ment of medical benefits is
available for all treatment necessary due to a rvork-related medical condition.
(b) Each disabled emplol'ee is oiligated to perform such ll,ork as he or she can. and
oWCP's goal is to return each disabled emplovee to suitable nork as soon as he or she is
medically able. In determinine what
.'suitable
constitutes rvork" for a particular disabled
emplovee. OWCP considers the emplol,ee's current ph1'sical limitations. qhether the
$'ork is available r,r'ithin the emplol'ee's demonstrated commuting area. the emplo'ee,s
qualifications to perform such w-ork. and other relevant factors. (See Sec. 10.50g n.ith
respecto the pa)'ment of relocation expenses.)
Sec. 10.501 S'hat medical evidence is necessary to supporl continuing receipt of
compensation benefits
(a) The emplovee is responsible for providing sufficient medical evidence to iustifv'
payment of anv compensarion sought.
(1) To support pavment of continuing compensation. narrative medical evidence must
be submitted r.l'henever OWCP requests it but ordinarilv not less than once a 1,ear. It
must contain a phvsician's rationalized opinion as to \i,,hether rhe specific period of
alleged disability is causail-v- related to the employee's accepted injury o. illn.rr.
(2) The ph1'sician's opinion must be based on the facts of rhe case and the complete
medical backsround of the employee. must be one of reasonable medical certainty and
must include objective findings in support of its conclusions. Subjectir,e complaints of
pain are not sufficient. in and of themselves. to support pavment of continuing
compensation. Likeu'ise. medical limitations based solel.v on the fear of u posibl. future
injuru are also not sufflcient to support pavment of continuing compensatitn. See Sec.
10.330 for a fuller discussion of medical evidence.
(b) O\ /CP rnal' require an1'kind of non-invasive testing to determine rhe employee's
functional capacit,v. Failure to undergo such testins wiil result in a suspensjon of
benefits- In addition. OWCP may direct the emplqvee to unde.go u ,..ond opinion or
referee examination in any case it deems appropriate (see Secs. i0.320 and 10.321).
Page -51-

Sec. 10.502 How does OWCP evaluate evidence in support of continuing receipt of
compensation benefits
In considering the rr-iedical and factual evidence, OWCP rvill weigh the probative
yalue of the attending ph1'sician's report, any second opinion ph1'sician's report, an-Y
other medical reports. or any other evidence in the file. If OWCP determines that the
medical evidence supporting one conclusion is more consistent. logical. and u'eilreasoned
than evidenie supporting a contrary conclusion. OWCP will use the conclusion
that is supported b.v the rveight of the medical evidence as the basis for au'arding or
denf ing further benefits. If rnedical reports that are equally u'eil-reasoned support
inconsistent determinations of an issue under consideration- OWCP will direct the
emplol,'ee to undergo a referee examination to resoh'e the issue. The results of the
re firee examination rvill be given special rveight in determining the issue'
Sec. 10.503 Under rvhat circumstances may OWCP reduce or terminate colnpensation
benefits
Once OWCP has advised the ernplovee that it has accepted a clairl and iras either
approl-ed continuation of pay or paid medical benefits or compensation. benefits will not
be-terminated or reduced unless the weight of the evidence establishes that:
(a) The disability for u'hich compensation was paid has ceased:
(b) The disabling condition is no longer causalll' related to the emplol'ment;
1cj 'fne employ e-e is only parrially disabled: (d) The emplo,vee has retumed to rvork;
1ej fne beneficiary was convicted of fraud in connection vn'ith a ciaim under the
FECA. or the beneficiary was incarcerated based on an\I felon,v conviction; or
(fl O\VCP's initial decision was in error.
Retu rn to Wo rk--Em plo.ver' s Respo nsib iliti es
Sec. 10.505 What actions must the employer take
Upon authorizing medical care, the emplo-ver should advise the employ'ee in writing as
,oon u, possible oflis or her obligation to return to work under Sec. 10.210 and as
defined in this subpart. fhe term:'returnto work" as used in this subpart is not iimited
to returning to woik at the employee's normal worksite or usual position- but may
inciude returning to work at other locations and in other positions. In general. the
emplo-n'-er should malie all reasonabiefforts to place the employee in his or her former
or an equivalent position" in accordance with 5 U.S.C. 8151(bX2)' if the emplovee has
tully- recovered ifter one ),ear. The Office of Personnel Management (not OWCP)
administers this Provision.
(a) Where the emplo.ver has specific altemative positions available for partialll'
disabled emplo'ees.i6..n'pto1'er should advise the emplo1'ee in qriting of the specific
duties and physical requirements of those positions'
(b) Where rhe empioy-er has no specific alternative positions available for an
emplovee u,ho can p"tfo* restricted or limited duties. the emplol'er should advise the
Page -52-

emplo)'ee of anv accommooations the agencv can make to accommodate the enrplor,ee's
limitations due to the injury'.
Sec. 10.506 \4a1- the emplo'er monitor the emplor.ee's medical care
The emplover may monitor the emplovee's mcdical progress and dutl' status b)'
obtaining periodic medical repons. Form CA-17 is usualli,' adequate for this purpose. To
aid in returning an injured emplor,ee to suitable emplol,ment" the emplol,er ma1, also
contact the emplol'ee's phvsician in u,riting concerning the q,ork lirnitatio's imposcd b1.
the effects of the injut:'and possible job assigrunents. lHorn'..'.r. the emplol,,er shall not
contact the phl'sician by telephone or through personal r,isit.) \\,}en such contact is
made. the emplol'er sliall send a cop.r- of an1' such correspondence to O\1'Cp and the
emplovee, as u'ell as a copy of the ph1'sician's response when received. The emplor er
may also contact the emplo.vee at reasonable inten,als to request periodic medical
reports addressing his or her ability to return to work.
Sec. 10.507 Horv should the emplol'er make an offer of suitable u,ork
\\'-lrere the aftending ph,vsician or OWCP notifies the emplover in vuriring that the
e'mplovee is partiall-v* disabled (that is. the emplovee can perform ,o.. ,"oik but no1
refurn to the position held at date of injury'), tlie emplover should act as follows:
(a) If the emplolree can perform in a specific alternative position available in the
agency! and the emplover has advised the emplovee in wriring of the specific duties and
physical requirements. the ernployer shall notifi' the employee in u,riting immediately of
the date of availabilirv.
(b) If the employee can perform restricted or limiteddutjes-
the emplover should
determine u'hether such duties are available or whetheran existins job can be modified
If so, the emplol,er shail advise the emplol,ee in uriting of the duties. their physical
requirements and availabiiin-.
(c) The employer must make any' job olfer in uriting. I-lou,ever. the emplover mav
make a job offer verball,v as long as it provides the job offer ro rhe emplol-Le in nriting
u'ithin tu'o business davs of the verbal job offer.
(d) The offer rnust include a description of the duties of the position- the phl,sical
requirements of those duties. and the date bv which the empiol,ee is eirher to rerurn to
rvork or noti! the emplover of his or lier decision to accept orrefuse the job offer. The
empioyer must send a compiete copy of any- job offer to Otl'Cp when it is sent to the
emplovee.
Sec. 10.508 lt{av relocation expenses be paid for an emplo'ee who rvould need to move
to accept an offer of reemplo),ment
If possible. the employ''er should offer suitable reemplo)'menr in the location u,here the
empio;-ee curentl)i resides. If this is not practical- the emplol,'er mav offer suitable
reemplol'ment at the emplovee's former duty station or other location. \lhere the
distance between the location of the offered job and the locarion rvhere the emplovee
Page -53-

currenti)' resides is at least 50 miies. OWCP may pay such relocation expenses as are
considered reasonable and necessary if the employee has been tenninated from the
agencv's employment rolls and rvouid incur relocation expenses by accepting the offered
reemplo-vment. OWCP may also pay such relocation expenses u,hen the new emplol''er is
other than a Federal emplol'er. OWCP rvill notifu the emplo.vee that relocation expenses
are pa1'abie if it makes a finding that the job is suitable. To determine ra'hether a
relocation expense is reasonable and necessary. OWCP shall use as a guide the Federal
trave! reguiations for pennanent cha:rges of durv sration.
Sec. 10.509 If an empiol'ee's light-duty job is eliminate due to dounsizing. n'hat is the
elfect on compensation
(a) In general, an employ'ee rvill not be considered to have experienced a compensable
recurrence of disabilir,v- as defined in Sec. 10.5(x) merely because his orher emplover
has eliminated the emplo,vee's light-dui-v- position in a reduction-in-force or some other
form of downsizing. When this occurs. OWCP u'ill detennine the emplo-n.-ee's wageearning
capacity based on his or her actual earnings in such light-dury position if this
determination is appropriate on the basis that such eamings fairly and reasonably
represent the emplo.vee's rvage-eaming capacity and such a determination has not
already been made.
(b) For the purposes of this section only, a light-dutv position means a classified
position to which the injured employee has been formally reassigned that conforms to
the established physical limitations of the injured employee and for u'hich the emplol'er
has already prepared a written position description such that the position constitutes
''regular" Federal emplo,vment. In the absence of a " light-duty position" as described irl
this paragraph, OWCP w,ill assume that the employee was instead engaged in noncompetitive
employment which does not represent the emplol'ee's wage-earning
."puiit-n. i.e.. work of the type provided to injured emplo,vees who cannot otheru'ise be
employed by the Federai Govemment or in any well- knoran branch of the generalabor
market.
Retu rn to Wo rk--E m p lo.vee' s Responsibilities
Sec. 10.515 What actions must the employee take with respecto returning to u'ork'l
(a) If an employee can resume regular Federal emplol'ment. he or she must do so. No
further .o-p.n.ution for wage loss is pa1'able once the emplol'ee has recol'ered from the
ivork-relatea inj"ry'to the extent that he or she can perform the duties of the position
held at the time of injurv. or eam equivalent wases.
(b) If an employee cannot rerurn to the job heid at the time of injr,t)' due to partial
disabiliry from the eifects of the work-related injury. but has recovered enough to
perform some gpe of work, he or she must seek n'ork. In the alternative. the emplol'ee
musr accept suitable work offered to him or her. (See Sec. 10.500 for a definition of
''suitable rvork".) This rvork may be with the original emplol'er or through job
placement etTorts made by or on behalf of O\\ICP.
Page -54-

(c) if the emploverhas advised an ernplo.v-ee in uriting lhat specific alternatiye
positions exist q'ithin the aseno,. the emplov'ee shall pro-r.ide the description and
ph1'sical requirements of such altemate positions to the attendins phl,sician and ask
q'hether and rvhen he or she rviil be able to perform such duties.
(d) lf the emplover has advised an emplovee that it is rviliing to accommodate 5is or
her u'ork limitations. the emplovee shall so advise the attending ph1-sician and ask hint
or her to specifl'the limitations imposed by the injury. The en:plolnee is responsible for
adr.ising the employer immediately' of rhese limitatio's.
(e) From time to time. oWCP mav require the emplol,ee to report his or her efforts to
obtain suitable empiol'ment. u'hetheiu'ith the Federal Government. State and local
Governments. or in the private scctor.
Sec. 10-51 6 Horv r.r'ill an emplovee knor.r, if OWCP considers a job to be suitable
OWCP shall advise the emplovee that it has found the olfered work to be suitable and
afford the emplovee 30 da1"s to accept rhe job or present any reasons to counter O$iCp's
finding of suitabilirv. lf the emplol'ee presentsuch reasons, and OWCp determines that
the reasons are unacceptable, it u'ill notify the employ'ee of that determination and that
he or she has 15 da1's in rvhich to accepthe offered work u,ithout penaltv. At that point
ln
time' OWCP's notification need not state the reasons for finding that the emplovee,s
reasons are not acceptable.
Sec. 10.,i17 \\,hat are the penalties forrefusing to accept a suitable job offer
(a) 5 U.S.C. 8106(c) provides that a partiall,v disabled emplo,vee rvho refuses to seek
suitable work. or refuses to or neelects to \r,ork after suitable u,ork is offered to or
arranged for him or her. is not entitled to compensation. An employee who refuses or
neglects to work afi.er suitable work has been offered or secured for him or her has the
burden to show'thathis refusal or failure to work \4ras reasonable or justified.
(b) After providing the tlr-o notices cJescribed in Sec. 10.516. OWCP will rerminate
the emplovee's entitlement to llrrther compensation under 5 U.S.C. g105, g106. and
8107. as provided by 5 U.S.C. S106(cX2). However. the emplo-vee remains enritled ro
medical benefits as provided by 5 U.S.C. g103.
Sec. i 0.518 Does owcP prol'ide sen'ices to help emplo.v-ees return to rvork
(a) OWCP mar'. in its discretion. provide vocational rehabilitation serr.ices as
authorized by 5 U.S.C. 810'1. These sen'ices include assistance from registered nurses
u'orking under the direction of O\VCP. Among other things- these nurses ','isit the
u'orksite. ensure rhat the duties of the position do not.""..d the medical limitarions as
represented b1'' the weight of medical evidence established b1'OWCP. and address an1'
problerns the emplo.u-ee mav have in adjusting to the rvork setting. The nurses do not
evaluate medical evidence: owcp claims staff perform this function.
Page -5$

(b) Vocational rehabilitation services may also include vocational evaluation, testing.
training. and placement services with either the original employer or a new employer,
u'hen the injured ernplol'ee cannot return to the job held at the time of injury. These
sen'ices also include functional capacity evaluations, which help to tailor individual
rehabilitation programs to emplol,'ees'ph,vsical reconditioning and behavioral
modification needs, and help employees to meet the demands of current or potential
jobs.
Sec. 10.519 \&hat action rviil O\\'CP talie if an employee refuses to undergo vocational
rehabilitation
Under 5 U.S.C. 8104(a). O\ rCP nial direct a permanentll'disabled ernplol'ee to
undergo vocational rehabilitation. To ensure that vocationai rehabilitation services are
available to all u'ho might be entitled to benefit from them, an injured emplo,vee who has
a loss of rvage-earning capacitv shail be presumed to be "permanently disabied," for
purposes of this section only. unless and until the employee proves that the disabiiity is
not permanent. if an emplo,vee r.rithout good cause fails or refuses to appiy for. underQo,
participate in. or continue to participate in a vocational rehabilitation effort when so
directed. O\\'CP n'ill act as follows:
(a) Where a suitabie job has been identified. OWCP rvill reduce the employee's future
monerary compensation based on the amount which would likely have been his or her
u,aqe-earning capacirv had he or she undergone vocational rehabilitation. OWCP will
determine this amount in accordance u,ith the job identified through the vocational
rehabilitation planning process. u'hich includes meetings with the OWCP nurse and the
employer. The reduction will remajn in effect until such time as the employ.ee acts in
good faith to comply with the direction of OWCP.
(b) Where a suitable j ob has not been identified. because the failure or refusal
occurred in the early but necessarv stages of a vocational rehabilitation effort (that is.
meetings n'ith the OWCP nurse, inten,iervs, testing, counseling. functional capacity
evaluations, and rvork evaluations). OWCP cannot determine rvhat would have been tire
emplo,vee' s rn'age-earnin g capac iry.
(c) Under the circumstances identifled in paragraph (b) of this section, in the absence
of evicience to the contrary. OWCP u,ill assume that the vocational rehabilitation effort
rvould have resulted in a return to work with no loss of wage-earning capacity, and
OWCP will reduce the emplovee's monettn'conlpensation accordingly (that is. to zero).
This reduction will remain in effect until such time as the employee acts in good faith to
comply n'ith the direction of OWCP.
Sec. 10.-i20 Horv does OWCP determine compensation after an emplol'ee completes a
vocational rehabiiitation pro gram
After completion of a vocational rehabilitation plogram, OWCP may adjust
compensation to reflect the injured worker's wage-earning capaciry. Actual earnings u'ill
be used if rhey fairll' and reasonabll,' reflect the earnins capacitv. The position
determined to be the soal of a training plan is assumed to represent the emplo,vee's
Page -56-

earninq crpacitv if it is suitable and performed in sulficient number so as to be
reasonablv available, n'hether or not the empior ee is placed in such a position.
Rr:ports of Earnings From Employ'ment and Self-Emplor-ment
Sec. 10.525 \\:l-rat infonnation musl the emplor.ee report
(a) An empiol'ee u'ho is receivins compensation for partial or total disabilitv must
advise OWCP immediateil' of anv itr.* io nork. eirhei part-time or fuil-time. In
addition. an emplol ee u'ho is receiving compensation foi parlial or total disability rvill
periodicallv be required to submit a report of earnings lrom ernplo).ment or selfemplol'ment.
either parr-time or full-time. (See Sec. 10.5(g)
"eamings".)
for a definition of
(b) The emplovee must report even those earnings rvhich do not seem likelv to af1-ect
his or her level of bencfits. i\'{an1'kinds of income.lnougn not all. u,ill result i1reducrion
of compensation benefits. \\'hil; earning income u'ill not necessarill,'result in a
reduc-tion of compensation. failure to reporl income mav result in forfeiture of all
benefits paid during the reporring period.
Sec. 10.516 l\.{ust the emplol,ee report 'olunteer acti'ities
An empioYee rvho is receivins compensation ibr partial or total disabilit,v is
periodicall-v- required to repon volunteer activitl' or any other kind of actiyitr, u,hich
shou's that the employ'ee is no longer totall-v- disabled for work.
Sec. 10.527 Does OWCp verifi,-.reporrs of earnings
To rnake proper determinations of an employ'ee's entitlemento benefits. O\\,Cp mav
veril.v the earnings reported bv the empio,"-.ee tluough a variety of means. inciuding but
not limited to computer matches rvith the ofllce oi P..ro*el N4anagement and inquiries
to the Social Securilv Administration. Also. owCP mav perform co*mputer matches u,ith
records of State acencies. including but not lirnited to woikers'compensation
administrations. to determine rvhether private emplol,ers are paving workers,
compensation insurance premiums for recipients of benefits under the FEC..\.
Sec' I 0'528 What action u'ill OWCP take if the emplovee fails to file a reporr of
activitv indicating an abililv 1o rvork
o\ ,'CP periodicalh' requires each empior,ee who is receivine compensation benefits
to complete an affidavit as to anv w-ork, or activitv indicating an abiiir_n.. to u,ork. q.hich
the emplol'ee has performed for the prior I 5 monihs. If am emplol'ee who is required to
fiie such a report lbils to do so u'ithin 30 davs of the date of the request. his or her risht
10 compensation fbr wase loss under 5 U.S.C. 810-i or 8I 06 is suspended unrii OWCp
receives the requesled report. Ar ilrat time. owcp u,ill reinstare compensarion
retroactive to the date of suspension if the empiovee remains entitled to compensation.
Page -57-

Sec. i 0.529 What action will O$rCP take if the empiol'ee files an incomplete report
(a) If an emplol,ee kr,ow'ingly omits or understates any earnings or r'r'ork activitl'' in
making a report. he or she strili forfeit the riglit to compensation with respect tc any
;;;i;-f.r
which the report was required. A false or evasive statement' omrssron'
concealment. or mlsrepresentation with respecto employment activiry or eamings in a
report may also subject an emplo,vee. to criminal prosecutton'
'-'(!)
wlr... the right to compensation is forfeited. owcP shall recover anv
compensation alread.v paid for the period of forfeiture pursuanto 5 U'S'C' 8129 and
other relevant statutes.
Ileports of DePendents
Sec. 10.535 Horv are dependents defined, and uhat information must the emplovce
report
(a) Dependents in disabilitl, cases are defined in Sec. l0'405' shile the emplo'vee iras
one or more dependents. the emplol'ee's basic compensation for u'age loss or for
pemranent impairment shall be augmented as p.ovid"d in 5 U'S'C' 8110' (The rules for
death claims are found in Sec. 10'411')
(b)Anemployeell'hoisreceivingaugmentedcompensationonaccountof
dependents must advise OWCP immediately of any .f]*gt in the number or status of
dependents. The employ'ee should also promptl-v t.funa to OWCP an-Y* amounts received
on account of augmented compensation aftei the right to receil'e augmented
compensation has ceased. Anv difference betrveen actual entitlement and the amount
already paid be,vond the date entitlement ended is an overpayment of compensation and
may bL reco'ered pursuanto 5 U.S.C. 8129 a'd other relevant statutes'
i") An .mployee u,ho is receiying augmented compensation shall be periodically
,"quir.a to submit a statement as to any dependents- or to submit supporting documents
such as birth or marriage certificates oi .outt orders, to determine if he or she is still
entitled to augmented compensation.
Sec. 10.536 M-rat is the penalq'for failing to submit a report of dependents
If an emplo;-ee fails to submit a requested statement or supporting document rvithin
30 da1''s of the date of the request. OWCP u'ill suspend his or her right to augmented
compensation until OWCP receiues the requesred statement or supporting document' At
that time. owcP rvili reinstate augmented compensation retroactiYe to the date of
suspension, proyided that the .1npio-u.. is entitled to receive augmented compensation'
Sec. 10.537 \\,hat reports are needed *'hen compensation pavments continue for
children over age 18
(a) Compensation pal,abie on behalf of a child that rvould otherwise end u''hen the
child reaches 181'ears
of age u,ill continue if and for so long as he or she is not married
Page -58-

and is eirhera student as defined in j u.S.c. gl0i(17). orphl,sicalii,.ormentallv
incapable of self-support.
(b) At least tu'ice each vear, O\\;CP ri'ill ask an emplol-ee u'ho receir es compensarion
based on the student status of a child to pror ide proof of continuine entitlernent to such
compensation. inciuding certification of school enroiiment.
(c) Likeu'ise. at least tu'ice each vear, O\\'CP u,ill ask an emplol.ee u'ho receiyes
compensation based on a child's phi:sical or mental inability to iupport himself or herself
to submit a medical_reporl verif ing that rhe child's medicai condiiion persists and rhat i1
continues to preclude self-support.
(d) lf an emplolee_fails to submitproof u'ithin 30 da1's of the date of rhe requesr.
OWCP u'ill suspend the emplo)'ee's right to compensatitn until the requested
information is received. At that time O\\rCP rvili reinstate compensation retroactive to
the date of suspension. provided the emplol'ee is entirled to sucir compensation.
Reduction and Termination of Compensation
Sec. 10.510 \\'lien and lior.l is compensation reduced or terminated
(a) Except as provided in paragraphs (b) and (c) of this section. where the er.idence
establishes that compensation shouid be either reduced or terminated. O\\'Cp nill
provide the beneficiary *'ith u,ritten notice of the proposed action and sive him or her 30
dar-s to submit relevant evidence or argumenr to support entitlemento continued
payment of compensation. This notice u'ill include a description of the reasons for the
proposed action and a cop-n-- of the specific evidence upon rvhich OWCp is basing its
determination. Pavment of compensation will continue until anv evidence or argument
submitted has been reviewed and an appropriate decision has been issued. or until 30
da1's have elapsed if no additional evidence or argument is submitted.
(b) OWCP u'ill not prot,ide such written notice w'hen the beneficiarv has no
reasonable basis to expect that pavment of compensation wiii continue. For example.
rvhen a claim has been made for a specific period of time and that specific period
expires. no $ritten notice u'ill be eiven. Written notice vuiil aiso noi b. gi.','en u,hen a
beneficiary dies. u.hen OWCP either reduces or terminates compensation upon an
emplovee's return to rvork- when OWCP terminates only medical benefits after a
ph1'sician indicates that further medical treatment is not necessary or has ended. or u,hen
OWCP denies pa1'ment for a particular rnedicai expense.
(c)OU'CP w'ill also not provide such urinen noii.. u'hen cr',mpensation is
terminated- suspended or forfeited due to one of the following: A teneficiarv',s
conviction for fraud in connection rvith a claim under the FECA; a benefician''s
incarceration based on anv felony conr.'iction: an emplo.vee's failure to report lamings
from emplovment or self-emplor-ment: an emplol'eeis failure or refi:sal to eirher continue
performing suitable u'ork or to accept an offer of suitable u,ork: or an emplol.ee's refusal
to undergo or obstruction of a directed medical examination or treatment fbr substance
abuse.
Page -59-

Sec. 10.5211 What action u'iil OWCP take after issuing uritten notice of its intention to
reduce or terminate compensation
(a) If the beneficiary submits evidence or argument prior to the issuance of the
decision, OWCP will evaiuate it in light of the proposed action and undertake such
further development as it may deem appropriate. if an,v. Evidence or argument which is
repetitious, cumulative, or irrelevant will not require any further development. if the
beneficiary does not respond within 30 da.vs of the written notice, OWCP rvill issue a
decision consistent with its prior notice. OWCP rvill not grant any request fbr an
extension of this 30-day period.
(b) Evidence or argument which refutes the evidence upon u'hich the proposed action
rvas based u,ill result in the continued pa,vment of compensation. If the beneficiary
submits evidence or argument which fails to refute the evidence upon rvhich the
proposed action was based but rvhich requires further development. OWCP will not
ptoi'ia. the beneficiary u'ith another notice of its proposed action upon completion of
such tlevelopment. Once any further development of the evidence is completed- OWCP
r,vill either continue payment or issue a decision consistent witir its prior notice.
S ubpart G--Appeals Process
Sec. 10.600 Horv can final decisions of OWCP be reviewed
There are three rnethods for reviewing a formal decision of the OWCP (Secs- 10'i25-
10.127 discuss how decisions are made). These methods are: reconsideration by the
district office: a hearing before an OWCP hearing replesentative; and appeal to the
Ernplol,ees' Compensation Appeais Board (ECAB). For each rnethod there are time
iimitations and other restrictions which may apply. and not all options are available for
all decisions. so the emplovee should cclnsulthe requirementset forth below. Further
rules soreming appealsto the ECAB are found at part 501 of this title'
Reconsiderations and Reviervs by the Director
Sec, 10.605 \\'hat is reconsideration-
The FEC.\ provides that the Director may review an award for or against
compensation upon application by an emplol'ee (or his or her representatiYe) uho
,"..iu.. an adverse ALiislon. The employee shail exercise this right through a requesto
the district office. The request. along r.vith the supporting statements zurd evidence' is
calied the "application for reconsideration."
Sec. 10.606 Hou'does a claimant request reconsideration
Page -6O-

(a) An employ.ee (or representati'e) seekine reconsjderation shouldsend the
application for reconsideration to the adcjress as instructed br, o\\'cp in the llnal
oectslon.
(b) The applicarion for reconsideration. includine ail supporling documents. ntu-st:
(1) Be subrnitted in $ritins:
(2) Set forth arcuments an-d conrain e'idence rhat either:
(i) Shou.s that OWCP erroneouslv applied or interpreted a specific poinr of law;
(ii) Advances a relevant legal argument not prer,iouslv considered by OWCp: or
(iii) Constitutes relevant and pertinent new evidence not previouslv considered b'
O\\'CP.
Sec. 10.607 \vhat is the time limit for requesring reconsideration
(a) An appiication for reconsideration must be sent witirin one vear of the date of the
O\['CP decision for rvhjch rer,'iew is sought. If subrnitted by maii. the application rvill be
deemed timeh' if postmarked bi' the U.S. Postal Serr.,ice vu'ithin the time period allor,l,ed.
If there is no such postmark. or it is not legible. other evidence such as lbut not lin-rited
to) certifiedmail receipts. certificate of serl'ice. and affidavits. mav be used to establish
the mailing date.
(b) OU'CP u'ill consider an unrimell,application for reconsideration onl-v if the
application denlonstratcs clear evidence of ..lo, on the part of OWCp in its most recent
merit decision- The application must establish. on its face. that such decision \\'as
erToneous.
(c) The 1''ear in which a claimant has to timely request reconsideration shall not
include any period subsequent to an OWCP decision for which the claimant can
establish through probative medical el'idence that he or she is unable to communicate in
an)' \vay and that his or her testimonv is necessary in order ro obtain modification of the
decision.
Sec. 10.608 IJow does OWCP decide lr'irether to srant or deny rhe request for.
reconsideration
(a) A timely request for reconsideration ma1' be granred if OWCP determines that the
emploree has presented evidence and/or arsrxnent that meets at least one of the
standards described in Sec. 10.606(bX2). If reconsideration is granted, the case is
reopened and the case is revieu'ed on its merits (see Sec. 10.609).
(b) \Vhere the request is timel.v- but fails to meet at least one of rhe standards
described in Sec. 10.606(bX2). or rvhere the request is untimell'and fails to presenr anv
ciear er.idence of error. OWCP will den-v- the application for reconsideration u,ithout
reopening the case for a review on the merits. A decision denf ing an application for
reconsideration cannot be the sub-iect of another application for reconsideration. The
onlv revierv for this t1'pe of non-merit decision is an appeal ro rhe ECAB (see Sec.
10.625). and OWCP wiil not entertain a request for reconsideration or a hearine on this
decision denl.ing reconsideration.
Page -61-

Sec. 10.609 Horv does OWCP decide whether nerv evidence requires modification of
the prior decision
When application for reconsideration is granted. OWCP r.vill review the decision for
u,liich reconsideration is sought on the merits and determine rvhether the new evidence
or argument requires modification of the prior decision.
(a) After OWCP decides to grant reconsideration, but before undertaking the revies',
OWCP q,ill send a cop]' of the reconsideration application to the employer, which will
have 20 days from the date sent to comment or submit reievant documents' OWCP will
provide any such comments to the employee, u,ho rvill have 20 da,u.-s liom the date the
comments are senr ro him or her rvitirin rvhich to comment. If no comments are received
from the emplover. OWCP will proceed rvith the merit review of the case.
(b) A claims examinervho did not parlicipate in maliing the contestedecision will
conduct the merit revierv of the claim. When ali evidence has been revierved. OWCP
will issue a new merit decision, based on all the evidence in the record. A copy of the
decision wiil be provided to the agency.
(c) An emplol-ee dissatisfied rvith this new merit decision may again request
reconsideration under this subpart or appeal to the ECAB. An employee may tlot request
a hearing on this decision.
Sec. i0.6i0 What is a review by the Director
The FE,CA specifies that an award for or against pal'ment of compensation may be
revieu,ed at any time on the Director's o\m motion. Such review may be made without
resard to whether there is new evidence or information. If the Director determines that a
review of the arvard is warranted (including. but not limited to circumstances indicating
a mistake of fact or larv or changed conditions), the Director (at any time and on the
basis of existing evidence) may modiiy, rescind. decrease or increase compensation
previously u*-"id.d, or award compensation previousiv denied. A review on the
Director's orm motion is not subject to a request or petition and none shali be
entertained.
(a) The decision whether or not to review an award under this section is solely within
the discretion of rhe Director. The Director's exercise of this discretion is not subject to
revierv bi, the ECAB, nor can it be the subject of a reconsideration or hearing request.
(bJ Where the Director revien's an award on his or her o\\r1 motion, any resulting
decision is subject as appropriate to reconsideration- a hearing and/or appeal to the
ECAB. Jurisdiction on review or on appeal to ECAB is limited to a review of the merits
of the resulting decision. The Director's determination to revierv the award is not
revieu'abie.
[Iearings
Sec. 10.6i5 \\hat is a hearins
Page -62-

-\ Ilearirle is a rl icn of an acircrsc dccisiou br lrearing'icprcseutatire. Initrallr,. tite
clailtrattt catl cltoose betlrecrl tlo fonitats: ^\n oral hearinq or a rericu of the nritlcrt recorcl.
At thc discretion o1'the hcarittg I'epfcsentatire. an or-al ircarins nrav be conducrecl b1
te lcphotte ot.tclecoltlcrettce itt adciition to rhc cr iiclencc of record" tire clrpJoyee sr;ly sLrit'rit
ne \\ e\ idr-ltce to tlte hcaritr_g represe ntiri lVe.
Sec 10.6l(r Fiou cloes a clainrant obtain a itcar.iltq
(a) .{ clattttartt. in-jLrred orr or after.}irlr'-1. 1966. rr ho has reccrvecl a final aclrerse
decisioll bl thc'Cislrict o1'fice tttav obtain a hearin-g bv uriting to the acldresspeciliecl in the
decision. Thc ]tcaring rcqLlest ntust be scnt riithirr 30 clal's (as cicte;prined bl,postrrarli or
ctlter carrier's diLte rltarkirtg) of the date of the decisiop ior riSich a heat-it-tg isso'eitt. -fhe
claittratrt lllLlst llot hare prl ioLtslr subnrittccl a reconsiclcration rcqLlcst luicther or ltot it
\\ as srauted) on the same decision.
(b) The clairtlallt lttav specify'the tvpe o1'hearrng clesired - uhep nrakrng tle original
Itearing reqLlest. If the reclucst does not specifr. a fonrat. O\\'Cp ri ill schedule an oral
hearing. The claimant can request a change in the fomrat of hearing bi, nral

(f) The hearing remains open tbrthe submittal of additional evidence until 30 dars
after the hearing is held. unless the hearing representative. in his or her sole discretion'
srants ai1 extension. Onll' one such .*,.niion .av be granted. A cop;-- of the decision
r.vill be mailed to the ciaimant's last knou,n address. to an)'' representative. and to the
ernploy er.
ig.r Tne hearins represenrati'e detemrines the conciuct of the oral hearing and ma1'
terminate the hearlng at an\ time he or she determines that ail relevant eridence has
been obtained. or beiause of n-risbehavior on the part of the claimant aiid'cr
rspresentatir.e
or neer the place of the oral pre seni3tion.
Sec. i0.618 Ho\\,is a revierv of the $,ritien record conducteci
1a) Ttre hearing representative ri'ill revier'v the offrciai record and an1'' aCditionai
er,idence submitteC bi'the claimant and b-v.' the agenc-v-' The hearing representatile ml1
aiso conduct r.,hater.er inr.estigation is deemed necessary-. Nerv er,'idence and arguments
are to be submined at any time Lrp to the time specit-red bv O\\'CP, but the,v should be
submined as soon as possible to al'oid delay'ing the hearins plocess'
(b) The claimant sliould sr-rbmit. rvith his or her application for rer''ier'v. all evidence or
argument that he or she $'ants to presento the heering representative' Acop;- of all
n,.rrineni nrnrerial qiJl be sent to the emplol'er, which will have 20 dal's from the date it
rlrr!rr!
f-'rr
is sent to conment. (\ledical el.idence ii not considered "pertinent" for revier'v and
commenlb-v- the agenc-u.-. and it will therefore not be fumished to the agencv' OWCP has
sole responsibilit-"--for er aluating medical evidence.) The emplo-u-er shali send anycomments
to the claimant- w.ho r.r.ill har.'e l0 more davs from the date of the asencr''s
ccrtificate of sen ice to comment.
Sec. 10.619 NIa,v subpoenas be issued for rvitnesses and docr-rments
-{ claimant nla."- request a subpoena. bur tire decision to grant or den-u- such a reqttest is
rr..ithin the discretion of rhe hearing representative. The hearins representatlve mav lsslle
subpoenas for the aftendance and testimory- of rvitnesses. and for the production of
b,ooks. records, correspondence. papers or other relevant documents. Subpoenas are
issued for documents on11,' if the;* are relevant and cannot be obtained bv other means'
and for r,r,itnesses onll' where orai testimonl,' is the best wa.v to ascefiain ihe facis'
(a) A claimant ma!'request a subpoena onl-u.- as part of the hearings process- and no
subpoena rviil be issr.red under anv other part of the claims process. To recluest a
subpoena. the requestor must:
f t; SuUrnithe request in vr'riring and send it to tire heering representative as earll'as
possibie but no iaterthan 60 da1's (as e."idenced bv postmark- electronic marker or other
objeitive date mark') afier the date of the original hearing request.
f l) Expiain w,hv rhe testimonl'orevidence is directll'relevant to the issues at handand
a subpoena is the best merhod or opponunity to obtain such evidence because there
are no other means b1, *'hich the documents or testimonv could have been obtained'
(b)NosubpoenawiilbeissuedforanendanceoferrployeesofO\\/CP actingintheir
otficial cepacities as de cision-maicers or policy adminjstrators. For hearings taking the
Page -64-

fonn of a revieu'of the uritten record. no subpoena for the appearance of lvitnesses u-ill
be considered.
(c) The hearinq
.
representative issues the subpoena under his or her oun name. It ma-v
be sen'ed in person or b1' certified mail. retum receipt requested. addressed to the person
to be served at his or her last knou'n principal ptace or business or residence. A decision
to denl' a subpoena can only be appeiled ai pad ofan appeal ofanv adl,erse decision
u,hich results ftom the hearing.
Sec. 10.620 \lho pa1,'s the costs associated u,ith subpoenas
(a) Witnesses uho are not emplo'ee s or fbnner emplol'ees of the Federal Goyernment
shall be paid the same fees and mileage as paid for like sen'ices in the District Court of
the United States where the subpoena is returnable. except that expert r,"-irnesses shall be
paid a fee not to exceed the locar customan, fee for such sen ices.
(b) Wlere O\ ''CP asked that the rvitnes submit evidence into the case record or
asked lhat the witness attend. OWCP shall pay the fees and mileage. \l.l-rere the claimant
requested the subpoena, and where the witness submitted evidence into the record at the
request of the claimant. the claimant shall pay the fees and mileage.
Sec' l0'621 Whatistheemplover'sroleu,henanoralhearinghasbeen
requested
(a) 'fhe emplo}'er mav send one (or more. where appropriate) representative(s) to
obsen'e the proceeding- but the agency representative cannot eive iestimonv or argumcnt
or otherwise participate in the hearing. except w'here the claimant or the hearine
representative specifically asks the agency representatir-e to testi$.
(b) The hearing representative may deny i requesr by the claimant that the agencv
representative testifv u'here the claimant cannot show that the testimony u'ould be
relevant or where the aeency representative does not have the appropriate level of
knowled-ce to provide such evidence at the hearing. The emplo1,., -uy also comment on
the hearing transcript, as described in Sec. 10.617(e).
Sec. i 0.622 May a claimant r.r'ithdraw a request for or postpone a hearing
(a) The claimant and/or represenlative ma,u- withdraw the hearinq request at any.- time
up to and including the da1'the hearins is heid. or the decision issued. ivithdrarving the
hearine request means the record is relurned to the jurisdiction of the district office and
no funher requests for a hearing on the underlvine iecision rvill be considered.
(b) OWCP wiil entertain any-reasonable ,.qu.r-t for scheduline the oral hearing. but
such requests should be made at the time of the original application for hearing.
Scheduling is at the soie discretion of the hearing ,.p..r.niutive. and is not reviervable.
once the oral hearing is scheduied and OWCP has mailed appropriate viritten notice to
the claimant- the oral hearing cannot be postponed ar the .luimuni's request for any,
reason except those stated in paragraph (c) ofthis section. unless the hearing
representative can reschedule the hearing on the same docket (that is. during the same
hearing trip). \\'hen the requesl to postpone a scheduled hearine does n.t meel the tesr o1-
Page -65-

paragraph (c) of this section and cannot be accommodated on the docket, no further
opportunity for an oral hearing u'ill be provided. Instead, the hearing q'ill take the form
of a r"riew of the unitten record and a decision issued accordingiy. In the alternative, a
teleconference may be substiruted for the oral hearing at the discretion of the hearing
representative.
(c) Where the claimant is hospitalized for a reason which is not elective, or u'here the
death of the claimant's parent. spouse. or child prevents attendance at the hearing, a
postponement mav be granted upon proper documentation'
Revierv by the Employees' compensation Appeals Board (ECAB)
Sec. 10.625 \\hat kinds of decisions may be appealed
Only final decisions of OWCP may be appealed to the ECAB' However, certain t)'pes
of final decisions, described in tfiis part as not subject to furtl-rereview'. carulot be
appealed to the ECAB. Decisions that are not appealable to the ECAB include:
D..isions concerning the amounts payable for rnedical serv'ices. decisions conceming
exclusion and reinstatement of medical providers. decisions by the Director to review an
ar.r.ard on his or her oun motion. and denials of subpoenas independent of the appeal of
the underl-ving decision. In appeals before the ECAB, attorneys from the Office of the
Solicitor of Labor shall represent OWCP'
Sec. 10.676 Who has juriscliction of cases on appeal to the ECAB
while a case is on appeal to the ECAB, OWCP has no jurisdiction over the claim with
respecto issues u,hich directly relate to the issue or issues on appeai' The OWCP
continues to administer the claim and retains jurisdiction over issues unrelated to the
issue or issues on appeal and issues which arise after the appeal as a result of ongoing
administration of thl case. Such issues would include. for example. the ability to
terminate benefits u'here an individual returns to rvork while an appeal is pending at the
ECAB.
Subpart H--SPecial Provisions
Representation
Sec. 10.700 Mav a claimant designate a representative
(a) The claims process uncler the FECA is informal. Unlike manv u'orkers'
compensation laris. the employer is not a parr.V to the claim- and OS/CP acts as an
impartial evaluator of the .i,id"n".. Nevertheless. a claimant may appoint one individual
to represent his or her interests. but the appointment must be in writing'
(b) There can be only one representati"i at any one time. so after one lepresentati\ e
has been properl.v appointed. OWCP u'ill not recognize another individuai as
Page -66-

epresentative until the claimant rvithclrarvs tire autirorization of the first indi'idual. ln
addition. O\\-CP u'il1 recognize only certain tvpes of indir-iduals (see Sec. 10.70i).
(c) A properl-v- appointed representative uho is recognized b1'Otr'Cp ma1 make a
request or give direction to OWCP regarding the claims process. including a hearing.
This authoritl'' includes presenting or eliciting evidence. making *g*r.ni on facts or
the lau'. and obtaining information from the case file. to the same extent as the claimant.
Any notice requirement contained in this part or the FECA is fully satisfied if sen,ed on
the representative. and has the same force and effect as if sent to the claimant.
Sec. 10.701 \\ho ma-v- ser\,e as a representative
,\ claimant mav authorize anv individual to represent him or her in regard to a claim
under the FECA- unless that individual's sen'ice as a representative *'ould violate anv
applicable pror.ision of larv (such as 18 U.S.C. 205 and 208). A Federal emnlovee mav
act aS a representative onl1,-:
(a) On behalf of immediate familv members. defined as a spouse. children. parents,
and siblings of the representatir e. provided no fee or gratuitv is c6arged: or
(b) \Vhile actine as a union representative. defined as an)' officially sanctioned union
official. and no fee or gratuiw is charsed.
Sec. 10.70 How are fees for services paid
A representative mal' charge the claimant a fee and other costs associated with the
representation before OWCP. The claimant is soleiv responsible for paf ing the fee and
other charges. The claimant will not be reimbursed by OWCP. nor is OWap in any u,ay
liable for the amount of the fee. Administrative costs (mailine, copving, messenger
sen'ices. travel and the like, but not including secretarial sen'ices. paialegal and other
activities) need not be approved before the representative collects them. Before any fee
for sen'ices can be collected. however, the fee must be approved by the Secretary.
lCollecting a fee without this approval ma1 constiture a -ird.-."nor under l8 U.S.C.
t92.)
Sec. I0.703 llow are fee applications approved
(a) Fee .Application.
(1) The representative must submit the fbe application to rhe district office and/or the
Branch of Hearings and Revieu,. according to where the work for u,irich the fee is
charged u'as performed. The application shall contain the foilou,ing:
(i) An itemized statement sho'*"ing the representative's hourly raie. the number of
hours u'orked and specificallv identifl ing the u'ork performed and a toral amount
charged for the representation (excluiins administrati'e costs).
(ii) A statement of agreement or disagreement u'ith the amount charged. signed by
the claimant. The statement must also acknowledse that the ciaimant is arvare that he or
she musl Pav the fees and that OWCP is not responsible for paf ing the fee or other costs.
(l),A.n incomplete appiication will be refurned u,irh no further comment.
Page -67-

(b) Approval where there is no dispute. ['here a fee application is accompanied b'v a
signed statement indicating the claimant's agteement r'r'ith the fee as described in
pJ*grup' (aXlXii) of this section, the application is deemed approved'
(c) Disputed requests.
(1) where the claimant disagrees rvith the amount of the fee, as indicated in the
statement u..o*punying the ,r]b-ittul. OWCP u'ill evaluate the objection and decide
rvhether or not to approve the request. OWCP will provide a copy of the request to the
claimant and ask him or her to submit uny fu'tht' information in support of thc objection
rvithin 15 days from the date the request is forw'arded' After that period has passed'
owcp r.viil evaluate the information received to determine u'hether the amount of the
fee is substantially in excess of the value of sen'ices received by looking at the
follon'ing factors:
(i) Usefulness of the representative's sen/lces;
(ii) The nature and complexity of the claim;
(iii) The actual time spent on development and presentation of the claim: and
(iv) Customary local charges for sinrilar sen'ices'
(2) Where the claimant diiputes the representatil'e's request and files an objection
rvith OWCP, an appealable decision will be issued'
Third PartY Liabilit"v
Sec. 10.705 When must an employee or other FECA beneficiary take action against a
third parfy
(a) If an injury or death for u'hich benefits are payable under the FECA is caused'
w,hoily or partially, by someone other than a Federal emplo,vee acting within the scope of
his or her employment. tlie claimant can be required to take action againsthat third
parry. '
ttl The Otfice of the Solicitor of Labor (SOL) is hereby delegated authorit-v to
administer the subrogation aspects of certain FECA claims for OWCP' Either OWCP or
SOL can require a pECa benlficiary to assign his or irer claim for damages to the
United States or to prosecute the claim in his or her own narle.
Sec. 10.706 How u'ill a beneficiary knorv if OWCP or SOL has determined that aclion
against a third part]' is required
When OWCP cletermines that an ernployee or other FECA beneficiary must take
action against a third parf.v. it u'ill notiry the emplol'ee or beneficiary in vrriting' If the
case is transferred to SOL, a second notification may be issued'
Sec. 10.707 \Lhat must a FECA beneficiary r.l'ho is required to take action against a
third partl'do to satisfu the requirementthat the claim be "prosecuted"
At a rninimum. a FECA beneficiary must do the follou'ine:
Page -68-

(a) Seek danraqes for the injury or dearh l'rom the third partr,. eirhcr rhroueh an
aitorney or on his or her oun behalf:
(b) Either initiate a lau'suit ri jthin the appropriate statute of limitations period or
obtain aqriften release of this obligation from-O\\-Cp or SOL unless recor.en,is
possible throueh a nes.otiated settle*ment prior to filing suit:
(c) Refuse to settle or dismiss tlie case for an1' amount less than t5e amouni necessan,
to repaY oWCP's refundable disbursements. as defined in Sec. 10.711.ujrhout r.."i.inn
permission from O\\;CP or SOL:
(d) Provide periodic status updates and other relevant information in response to
requests from OWCP or SOL:
(e) Submit detailed information about the amountrecovered and rhe costs o1-the suit
on a ''Statement of Recove4," form appro,u,ed bv OWCp: and
(0 Paf'an_v required refund.
Sec' 10'708 Can a FECA beneficiarv rvho refuses to complv wirir a requesto assign a
claim to the United States or to prosecute the claim in his or her own narne be penalized
When a FECA beneficiary reflises a requesto either assign a claim or prosecute a
claim in his or her o\\.n name. OWCP may determine that he or she has forfeited his or
her ri-qhto all past or future compensation for the injury u'ith respecto u,hich the
request is made. Alternatively. OWCP may also suspend the FECA beneficiarv's
compensation pal'ments until he or she complies ilith the requesr.
Sec. l0-709 \\'hat happens if a beneficiarv' directed b1' OWCP or SOL to take action
aqainst a third panv does not believe that a claim can be successfullv prosecuted at a
reasonable cost
If a beneficiaT consults an attorney and is inforrned that a suit for clamages against a
third partv for the injurl or death for uhich benefits are pavable is unlikely to prevail or
that the costs of such a suit are not justified by'the poteniial recovery. he or she should
request that OWCP or SOL release him or her from the obiigation to proceed. This
request should be in u'riting and provide evidence of the artome\,'s opinion. If OSiCp or
SOL asrees. the benef'ician will not be required to take further action asainst the third
parf"v-.
Sec. 10.710 Under u'hat circumstances must a recoverv of monev or other propeqv in
connection w'ith an injuT or death for u,hich benefits are pai,able under tne FpCa be
reported to OWCP or SOL
Ar1" person q'ho has filed a FECA claim thar has been accepted by OWCP (u,hether
or no1 compensation has been paid). or who iras received FECA benefits in connection
u'ith a claim filed b;- another. is required to notif'OWCP or SOI- of the receipr of
mone)' or other propertv as a result of a settlement or judgment in connection with the
circumstances of that claim. This includes an injured emp-lo1'ee. and in the case of a
claim invol'ing the death of an empro),ee. a spouse- children or other dependents
Page -69-

entitled to receive surv'ivor's benefits' OWCP or SOL sirouid be notified in u'riting
rvithin 30 days of the receipt of such money or other propertl'or the acceptance of the
FECA claitn, u'hichever occurs later'
Sec. 10.711 How much of any settiement or judgn-rent must be paid to the united
States
The statute permits a FECA beneficiary to retain, as a.lninimum' one-fi{th of the net
amount of mone,v orpropertV remaining oft., u reasonable attorney's fee andthe costs of
litigarion have been ieaucted from theihird-party reco:-:ry- The United States shares in
the litigation expense by ailowing the beneficiary to retain' at the time of distribution'
an amount equiyalento a reasonable attorney's iee proportionate to the refund due the
United States. Afier the refund ou'ed to the United St"tts is calculated' the FECA
beneficiary retains any surplus remaining, and tir.is am-ount is credited' dollar for dollar'
against future compensation for the samJinjury, as defi1e

(l)Grossrecovery
Attornev's fees
(2) Subtotal A
(3) Costs of suit
Subtotal B
One-fiflh of Subtotal B
(-1) Subtotal C
Refundable Disbursements
(5) Subtotal D (lou'er of Subtotar c or refundable disbursements)
(6) Government's alloq'ance for anorne-v*'s fees [25.000/ 100.000) r
22.000] (attome\"s fees divided b1, gross recovery rhen multiplied by
Subtotal D)
Refund to the United States
(7) credit asainst future benefits 157.600-2.0001 (Subtotal c minus
refundable disbursements)
s r00.000
-25.000
75.000
-3.000
72.000
- 14"100
57.600
22.000
21.000
-5.500
16.500
35.600
Sec' 10.712 \vhat amounts are included in the sross reco'en'
(a) When a settlement or judement is paid to- or for, one indiyidual. t6e entire amou'lr.
except for the portion representing damage to real or personal properh'. is reporred as rhe
qross recovery. If a settlement or judtment is paid to or for more than one individual or
in more than one capacitv. such as a joint par.'ment to a husband and wife for personal
injury and loss of consortium or a pa1'ment to a spouse representing both loss of
consortium and wrongful death, the gross recoverv to be ieported ii the amount allocatecl
to the injured empioree. If ajudge orjury specifies tlie percentage of a contested verdict
attributable to each of several plaintiffs. OWCP or SOL will accept that division.
(b) In anv other case. u'here a judgment or settlement is paid to or on behalf of more
than one indil'idual. O\,'CP or SOL rviil determine rhe appropriate amount of t6e FECA
beneficiarl''s qross recovery and advise the beneficiar:u #its determination. FECA
beneficiaries mav accept OWCP's or SOL's cletermination or demonstrate cood cause Ibr
a different allocation. Shether to accept a specific allocation is at the discietion of SOL
or O\\rCP.
Sec. 10.713 How is a structured settlement (thatis. a settlement providing lbr receipt of'
funds over a specified period of time) treated for purposes of reponing the gross
recoven'
In this situation. the gross reco\/erl,to be reported is the present value of the right to
receive ali of the pa)'ments included in the structured sertlimenr. allocated in fie case of
multiple recipients in the same manner as single pa\jment reco'eries.
Sec. 10-714 What amounts are includecl in the refundable disbursements
The refundabie disbursements of a specific claim consist of the torai money paid b1,
OWCP from the Emplovees' Compensation Fund n'ith respect 10 rhat clainr to or on
Page -71-

ehalf of a FECA beneficiar-v-, less charges for any medical file revierv (i'e', the
ph.vsician does not examine'the emplol'le) done at the request of OWCP' Charges for
medic,al exaninations also ma-v be subtracted if the FECA benefician establishes that
the examinatious \\:ere required to be made available to the emplol'ee under a statute
other than the FECA by tlie emplo;,'ing agenct- or at the emplof ing agency's cost'
Sec. 10.715 ls a beneficiary required to pay interest on the amount of the refund due to
tl-re United States
If the refund due to the united States is not submitted rvithin 30 days of receiving a
request for pal.rnent from SOL or OWCP, interest shall accrue on the refund due to the
United States frorn the date of the requesi. The rate of interest assessed shall be the rate
of the current value of funds to the United States Treasury as pubiished in. the Federal
Register (as of the date the request for payment is sent)' Waiver of the collection of
interest shall be in accordancarvith the provisions of tl-re Department of-Labor
regulations on Federal Claims Coilection eoverning u'aivet of interest' 29 CFR 20'6i'
Sec. 10.716 If the required refund is not paid w'ithin 30 days of the request for
repa}'ment. can it be coilected fiom pavinents due under the FECA
If the required refuncl is not paid rvithin 30 days of the request for payment' OWCP
can. in its d'iscretion, collectthl refund by u'itltholdingali orpart of any payments
currenrlv pa-vable to rhe beneficiary under the FECA n'ith respect to any injury' The
rvaiver provisions of Secs. 10.432 *yough 10.440 do not apply to such determinations'
Sec. 10.711 Is a settlement or judgment received as a result of allegations of medical
malpractice in treating an injur,v covered by tlie FECA a gross recoverv that must be
reported to O$'CP or SOL
Since an injury caused by medical malpractice in treating an injury cor''ered by the
FECA is aiso an injury coyered under tht FECA, any recovery in a suit alleging such an
injur: is ueated u, g.o$ reco\ery that must be reponed to O\\'CP or SOL'
"
Sec. i0.718 Arepaymentstoabeneficiaryasaresultof aninsurance policywhichthe
beneficiary has purchased a gross ,..ot.ry;that must be reported to OWCP or SOL
Since pa),ments received by a FECA beneficiary pursuanto an insurance policy
purchased b;- someone other than a liable third party are not pavments in satisfaction of
^iiuUiii*
for tausing an inju* co'ered by the FECA, the.v are not considered a gross
recovery cor,ered it' ,..iion 8132 that rlquires filing a Statement of Recovery and
pa1.'ing anv required refund.
Sec. 10.719 If a settlement or judgment is received for more lhan one rvound or medical
condition. can the refundable disbursements paid on a single FECA claim be attributed
Page -72-

to different conditions for purposes of calculatinq the refund or credit og,ed to the United
States
(a).\ll r.r'ounds. diseases or other medical conditions accepted bv o\\'cp in
connection with a single claim are treated as the same injury for the purpose of
computing any required refund and any credit asainst frrture benefits inionnection u.ith
the receipt of a tecovery fi'om a third paqv, except that an injrt]'caused b1'medical
malpractice in treating an injury covered under the FECA u,ill be treated as a seDarale
injury for purposes of section 8132.
(b) lf an injury covered underthe FECA is caused under circumstances creating a
leqal liabilit-v in more than one person, other than the United States, to pav damages-
O\ ;CP or SOL u'ill determine u'hetherecoveries received fronr one oi more third
parties should be attributed to separate conditions for rvhich compensation is pa;-able in
connection u'ith a single FECA claim. If such an attribution is both practicable and
equitable, as determined bi' OWCP or SOL. in its tJiscretion. the conditions will be
treated as separate injuries for purposes of caiculating the refund and credit ou,ed to the
United States under secrion 8132.
Federal Grand and Petit Jurors
Sec. 10.725 \l''hen is a Federal grand or petitjuror covered under the FECA
(a) Federal *crand and petitjurors are covered underthe FIICA u.hen thev are in
performance of dur-v as ajuror.,,r'hich includes that time u.hen a iuror is:
( 1) In attendance at court pursuanto a summons:
(2) In deliberation:
(3) Sequestered b1' order ofajudee: or
(4) At a site. b.u-- order of the court. for the taking of a view.
(b) A juror is not considered to be in tire performance of dug r'r'hile travelinq to or
liom home in connection ilith the activities enumerated in parauraphs (at(l) riuough t-l)
of this section.
Sec. 10.76 \\hen does a juror's entitlement to disabilit_l'compensation begin
Pursuant to 18 U.S.C . 1877. entitlement to disabilitv compensation does not
corrrmence until the dav after the dale of termination of service as a juror.
Sec. 10-77 \\hat is the pav rate ofjurors for compensation purposes
For the pupose of computins compensation pa1-abJe for disabilitl,or death- a juror is
deemed to receive pay at the minimum rate for Grade GS-2 of the General Schedule
unless his or her actual pai/ as an "emplovee" of the United States while sen.ing on coun
leave is irigher. in rvhich case the pa\/ rale for compensarion purposes is determineci
accordance with 5 U.S.C.8l l4.
Page -7$

Peace Corps Volunteers
Sec. 10.730 \\l-rataletheconditionsof coverageforPeaceCorps volunteersand
volunteer leaders injured while sen'ing outside the United States
(a) Any injury sustained by a volunteer or volunteer leader rvhile he or she is located
abroad shail be presumed to have been sustained in the performance of dui-' and any
illness contracted during such time shall be presumed to be proximatel,r- cause d b-v the
employment. Ho\4ever, this presumption lvill be rebutted bv evidence that:
it;-fn. injury or illness uas caused by the claimant's rviilful misconduct, intent to
bring about the injury or death of self or another, or \^ias proximately caused by the
intoiication by alcohol or iliegal drugs of the injured claimaut: or
(2) The illness is shoun to have pre-existed the period of service abroad: or
i;) rn" injury or illness claimed is a manifestation of s1'rnptorns of, oI consequent to'
a pre-existing congenital defect or abnormaliry'
(b) If the presumption that an injury or illness was sustained in the performance of
duty is rebutied as provided by paragraph (a) of this section, the claimant has the burderl
of proYing b-v the rrb-itt"l of substantiai and probative er"idence that such injury or
illness was sustained in the performance of duty u'ith the Peace Corps'
(c) If an injury or iilness. or episode thereof. comes within one of the exceptions
desffibed in paragraph (aXl) ot i:) of this section. the claimant may nonetheless be
entitled to compensulio,r. This will be so provided he or she meets the burden o1'proving
b-v- the submittal of substantial. probative and rationalized medical evidence that the
iliness or injury was proximately caused by factors or conditions of Peace Corps sen'ice.
or that it was materially aggravated. accelerated or precipitated by factors of Peace
Corps sen'ice.
Sec. 10.731 What is thepay rate of Peace Corps volunteers and volunteer leaders for
c ompensation purpo ses
The pay rate for these claimants is defined as the pav rate in effect on the date
following separation. provided that the rate equals or exceeds the pay rate on the date of
injury, It is defined in accordance with 5 U.S.C. 81-12(a), not 8101(4).
Non-Federal Larv Enforcement Offi cers
Sec. 10.735 \tr'hen is anon-Federal larv enforcemcnt officer (LEO) covered under the
FECA
(a) A lar.v enforcement officer (officer) includes an employee of a State or locai
Govemment. the Governments of U.S. possessions and temtories, or an emplo-n-ee of the
United States pensioned or pensionabli under sections 521-535 of Title 4- D.C. Code'
rvhose functions include the activities listed in 5 U.S.C' 8191 '
1b) Benefits are avaiiable to officers u'ho are not " emplovees" under 5 U.S.C. 8101 "
and u,ho are determined in the discretion of OWCP to have been engaged in the
Page -7*

activities listed in 5 u.S.C' 8191 ',r'ith respect to the enforcernent of crimes asainsthe
L'tnited States. Individuais u'ho oni1, perform administratir,. zun.,io; t;il;;;';;"'-
officers are not considered officers. '
(c)Exceptasprovidedbr,'5U.S.C.8191
and8lg2andelseu.herein thispart.rhe
provisions of the FEC-A, and of subparts A. B. and D through l of this parr appl-v- to
officers.
Sec. 10-7i6 slrar are the time rir'irs for firing a LEo craim
o\\'cP must receive a claim for benefirs under 5 U.S.C. 8191 uithin fir-e vears after
the injury ordeath- This fir'e-learlimitation is not subject ro *oir.l. ir.1. i..,riing
provisions of 5 U.S.C. 8122(d) do not appl).to rhese ciaims.
Sec. 10.737 Florv is a LEo claim filed. and *-ho can file a LEo clainr
A claim for injurv or occupational disease should be filed on Form cA-72r: a death
claim should be filed on Form cA-72.All claims should be submined to the offlcer,s
emplol'er for completion and fonvarding to OWCP. A clairn mav be filed by the officer.
the officer's sun'ivor- or an-v- person or association authorized to act on behalf of an
officer or an officer's sun,ivois.
Sec. 10.738 Llnder u'hat circumstances are benefits pal.able in LEo claims
(a) Benefits are pa1'able rvhen an officer is injured u,hile apprehendiflg, or attempting
to apprehend. an individuai for the commission of a Federairime. Ho,v-ever. either an
actual Federal crime must be in progress or have been committed. or objective evidence
(of which the officer is aware at thelime of injury,) must exisr thar a poientiai Federal
crime was in progress or had already been committed. The actual or potential Federal
crime must.be.an integral part of the criminal activity toward u,hich the officer,s actions
are dlrected' I he f act that an injurf' to an officer is related in some n.av to the
commission of a Federal crime does not necessarily bring the injury u,ithin the coyerase
:^f.lt FECA' The FECA is not intended to cover orn..r, who are merelv enforcing local
laws.
(b) For benefits to be pavable when an officer is injured preventing, or atrempting ro
prevent, a Federal crime. there must be objective evidence that a Federal crime is about
to be committed' An officer's belief. unsupported by objective evidence. that he or she is
aciins to prevent the commission of a Federal crime rvili not result in coverage.
N4oreo'u'er- the of{lcer's subjective intent. as measured by ail ayaiiable e.u.jdence
(including the officer's own statements and testimony. irutuiiabie). must haye been
directed torvard the prevention of aFederal crime. In rhrs lonrext. an oflicer's oq,n
statements and testimonv al'e relevanto. but do not control, the determination of
coYerage.
Sec' I 0 '7 -i9 What kind of objective evidence of a potential Federal crime must erist fbr
co\.erage to be extendeC
Page -7$.

Based on the facts available at the time of the event, the officer must have an
awareness of sufficient infonnation which wouid lead a reasonable offtcer' under the
circumstances. to conclude that a Federal crime rvas in progress' or was-about to occur'
This awareness need not extend to the fr..ir. particulars of the crime (the section of
Title 18. United States Code. for erample). bui there must be sufficient evidence that
the officer rvas in fact engaged in actuai oi attempted apprehension of a Federal criminal
or prevention of a Federal crime.
Sec. 10.710 In u'hat situations q'ill OWCP automaticaily presume that a lar"'
enforcement officer is covered b,v the FECA
(a) Where an officer is detailed b1'' a competent State or local authority to assist a
Federai law enforcement authoritv in the piotection of the President of the United States'
or any other person actually pro,,:id.d or entitled to U.S' Secret Sen'ice protectiou'
coveraqe wiii be extended.
(b) Coverage for officers of the U.S. Park Police and those officers of the Uniformed
Division of the U.S. Secret Service who participate in the District of Columbia
Retirement S1,'stem is adjudicated under ihe principles set forth in paragraph (a) of this
section. and does not extend to numerous tangential activities of lar'v enforcement (for
example. reportlng to work. changing clothes). I{orvever' officers of the Non-Uniformed
Division of the {-,.S. Secret Service u'ho participate in the District of Columbia
Retirement Sy'stem are cor,ered under th; FECA during the perfbnnance of all otficial
duties.
Sec. 10.7'11 How are benefits calculated in LEO claims
(a) Except for continuation of pay, eligible officers and survivors are entitled to the
same benefits as if the officer had been an employee under 5 u.s.c. 8101. Horvever.
such benefits may be reduced or adjusted as OWCP in its discretion may deem
appropriate to reilect comparable benefits which the officer or sun'i'or received or
would have been entitled to receive by virtue of the officer's emplo-vment'
(b) For the purpose of this section, a comparable benefit includes any benefit that the
officer or sun,ir.or is entitledto receive because of the offtcer's emplo;*ment. including
pension and disabiiiry funds, State workers' compensation pa)'ments' Public Safetl'
Officers' Benefits Act pa-vments. and State and local lump-sum pa)/ments' Health
benefits coverage una ptoce.ds of life insurance policies purchased by the employer are
not considered to be comparable benefits.
(c) The FECA provides that, u,here an officer receives comparable benefits'
compensation benlfits are to be reduced proportionally in a mannel that reflects the
relative percentage contribution of the officer and the offlcer'S employ'er to the fund
which is the source of the comparabie benefit. Where the source of the comparable
benefit is a retirement or other s)'stem which is not fuily funded' the calcuiation of the
amount of the reduction will be based on a per capita comparison betu'een the
contribution b1,' the empioyer and the contritution by ail covered officers during the .v-ear
prior to the officer's injur;" or death'
Page -76-

(d) The non-receipt of compensation during a period u'here a dual benefit (such as a
lunrp-surn pa1''ment on the death of an officetfir i.;ng offset against compensation
entitlement does not rcsult in an adjustment of the respective benefit percentaees of
remaining beneficiaries because of a cessation of compensation under 5 U.S.C. gl33(c)
Subpart I--Information for l\{edical provitlers
l\Iedical Records and Bills
Sec. 10-800 \\:hat kind of medical records must pro'u.iders keep
Agenc' medical officers. private ph1'sicians and hospirals are required to keep records
of all cases treated bv them under tne fpCn so they can supplv O\\ Cp w-ith a history of
the injury, a description of the nature and extent ofinjury, thl iesuits of any cliagnostic
studies performed. the nature of the treatment rendered and the desree of anv
impairment and./or disabilitv arising from the inju,],.
Sec. 10.E01 Horv are medical bills to be submirted
(a) All charges for medical and surgical treatment- appliances or supplies furnished to
injured emplovees- except for treatnent anci supplies irovided Uy nursing homes. shall
be supported by medical evidence as provideO in Sec.- 10.800. The physiJian or provider
shall itemize the charges on the standard Health Insurance Claim Form. HCFA 1500 or
OWCP 1500. (for professional charges). the UB-92 (for hospitals). the Universal Claim
Form (for pharmacies). or other fonr rvarranted. and subn-rit rhe form promptlv to
OWCP.
"s
(b) The provider shall identifr' each service performed using the phvsician's Current
Procedural Terminology (CPT) code. the Health Care Financing Administration
Common Procedure Coding Svstem (HCPCS) code, rhe National Drug Code (NDC), or
the Revenue Center Code (RCC). with a brief narrative description. '*.lere no code is
applicable. a detailed description of sen,ices performed should be pror,ided.
(c) The provider shall also state each diagnosed condition and fumish the
correspondine diaenostic code using the "lnternational Classification of Disease. 9th
Edition- Clinical Modification" (lCD-9- CM), or as revised. A separare bill shall be
submitted u'hen the emplovee is discharsed from treatment or monthlr,. if treatment for
the u'ork-related condition is necessan, for more than 30 da's.
(1)
(i) Hospitals shall submit charges for medical and sureical treatment or supplies
promptl)'to OWCP on the Uniform Bili (UB-92). The piovider shall identifu each
outpatient radiology sen'ice. outpatient pathology ,.rvi.. and phvsical rherapy sen,ice
performed- usins IICPCS/ CPT codes u,ith a brief narrative deicriprion. The.t -_q. fo1.
each individual sen'ice. or the loral charqe lor all identical serr, ices. should also appear
in the UB-92.
(ii) Other outpatient hospitai senices for ivhich HCPCS/CPT codes exist shall aiso be
coded individuallv usins ihe coding scheme noted in this parauraph. Services for w,hich
Page -77-

there are no HCPCS/CPT codes available can be presented using the RCCI described in
the "National Uniform Billing Data Elements Specifrcations", current edition' The
provid.er shall also furnish the-diagnostic code utlng the ICD-9-CM' If the outpatient
hospital sen,ices include surgical and/or invasive procedures, the provider shall code
.u.ir pro..dure using the pro-per CPT,TICPCS codes and furnishing the corresponding
diagnosticodes using the ICD-9-CM.
iZl enu.,rrucieshall itemize charges for prescription medications, appliances' or
,uppii.. on the Universal Claim Form and tub*it them protlptl-Y to OWCP' Bills for
preicription medications must include the NDC assigned to the product' ihe gcncric or
trade name of tire drug provided. the prescriptio number, the quantit,v provided' and the
date the prescriPtion \\ras filled.
(3) Nursing horn., shall iternize charges for appliances, supplies or services on the
provider's biilhead stationery and submit them promptly to O\liCP'
(d) By submitting a biil and/or accepting pa1'menl' the provider signities that the
serv'ice for r,i'hich reimbursement is sought was performed as described and was
necessary. In addition, the provider theieb,v agrees to comply r'vith all regulations set
forth in this subpart concerning the renderlng of treatment and/or the process for seeking
reimbursement for mecjicai ,.*'i..., including the limitation imposed on the amount to
be paid for such sen'ices.
(e) ln summary. bills submitted by providers must: be itemized on the Health
Insurance Claim Form (for physiciansj, the UB-92 (for hospitals), or the Universal
Claim Form (for pharmu.i.i):-.ontain the signature or signature stamp of the provider:
and identifu the procedures using HCPCS/CPT codes. RCCs. or NDCs. Otherwise'
OWCP may retum the bill to rhe provider for correction and resubmission-
Sec. 10.802 Hor.r'should an emplo,vee prepale and submit requests for reimbursement
for medicai expenses. transportaiion costs. loss of wages, and incidental expenses
(a) If an employee has paid bills for medical. surgical or dental sen'ices. supplies or
appliances due to an injury sustained in the perfonnance of dutr'. he or she may submit
an itemized bill on the Health Insurance Claim Form. HCFA 1500 or OWCP 1500'
together with a medical report as provided in Sec. 10.800, to OWCP for consideration-
(1) The provider of such sen,ice shall state each diagnosed condition and furnish the
applicable iCO-q-C\a code and identifi each service performed using the applicable
fiCpCSlCpT code. with a brief nanatir,e description of the service performed. or, whete
no code is applicable" a detailed description of that sen'ice'
(2) The bili must be accompanied by evidence that the provider received pa1'ment for
the serv'ice from the empio,vee and a statement of the amount paid. Acceptable evidence
that pal,ment was received includes, but is not limited to. a signed statement b-v the
pro.id.r. a mechanical stamp or other device shou'ing receipt of pa1''ment" a copy of the
lmplol'ee's canceled check (both front and back) or a copv of the emplo1'ee's credit card
receipt.
(b) If sen'ices u'ere provided by a hospital. pharmac,v or nursing home. the emplol'ee
should submit the bill in accordance u'ith the provisions of Sec. 10.801 (a t. Any request
for reimbursement must be accompanied b-v evidence" as described in paragraph (a) of
Page -78-

tiris section. that the proi.'idereceived payment for the scn'ice from rhe emDlo'ee and a
statement of the amount paid.
(c) O\\'CP mav n'aive the requirements of paragraphs (a) and ft) of this section if
extensive delal's in the filing or the adjudication of a it"i- make it unusuall' difficult
for the employ'ee to obtain the required information.
(d) O\\:CP u'ill no1 accept copies of bills forreimbursement unless thev bearthe
original signature of the provider. nith evidence of pavment. Pavment for medical and
sursical treatment. appliances or supplies shall in general be no greater than the
maximurn allou'ahle charge for such serv'ice tletennined by the Director. as set forth in
Sec' 10.805. (e),\nemplol'eervill beonivpartiallvreimbursedforarnedical expense
if the arnount he or she paid to a proi'ider for the sen'ice erceeds the marimum
allowable charge set by the Director's scheduie. If this happens. OWCP shall adyise the
emplovee of the maximum allowable charge for the service in question and of his or her
responsibilitv to ask the provider to refund to the emplovee. or credit to the employee's
account, the amount he or she paid u'hich exceeds the maximum allou'able charge. The
proYidermayrequestreconsiderationofthefee cleterminationassetforthinSec, l0.8ll.
(0 If the provider faiis to make appropriate refund to the emplol,'ee. or to credit the
emplovee's accotmt. r.r'ithin 60 day-s after the emplol,ee requests a refund of a:ry.excess
amount. or the date of a subsequent reconsideration decision which continues to disallow
all or a por-tion of the appealed amount. O\\,'CP shall initiate erclusion procedures as
pror.ided b1,' Sec. 10.815.
(g) If the provider does not refund to the emplor.ee or credit to his or her accounthe
amount of mone.v paid in excess of the charge which OWCP allows. the emplovee
should submit documentation of the attempt to obtain such refund or credit io OwCp.
O\\'CP mav make reasonable reimbursement to the emplovee after revieu,ing the facts
and circumstances of the case.
Sec. I0.803 wtat are the time iimitations on owcp's pai'ment of bills
OWCP wiil pav providers and reimburse emplovees promprly for all bills receiyed on
an approved form and in a timely manner. Hou,ever. no bill wiil be paid for expenses
incurred if the bill is submitted more than one vear be1'ond rhe end of the calendar vear
in r'r'hich the expense was incurred or the sen'ice or supply was provided. or more than
one )/ear bevond the end of the calendar 1'ear in which the ciaim rl,as first acceoted as
compensable by OWCP. u'hichever is larer.
Medical Fee Schedule
Sec. 10.805 \!hat services are covered by the owcp fee schedule
(a) Payment for medical and other health sen,ices furnisheC by phvsicians. hospitals
and other providers for work-related injuries shall not exceed a maximum ailowable
charge for such sen'ice as determined by the Director. except as provided in this
section.
Page -79-

(b) The schedule of maximum allowable charges does not apply to charges for
sen ices provided in nursing homes, but it does apply to charges for treatment furnished
in a nursing home by a physician or other medical professional.
(c) The scheduie of maximum allowable charges also does not appl,v to charges for
appliances, supplies, sen'ices or treatment furnished by medical facilities of the U.S.
Public Health Service or the Departments of the Arm-v, Nary, Air Force and Veterans
Aifairs.
Sec. 10.806 Horv are the marimum fees defined
For professional medical services, the Director shall maintain a schedule of maximum
allorvatle fees for procedures performed in a given localit-v. The schedule shall consist
of: ,A.n assignment of a value to procedures identified by Health Care Financing
Administration Common Procedure Coding S,v-stem/Current Procedural Terminology
(HCPCS/CPT) code u,hich represents the relative skill. effort, risk and time required to
perform the procedure. as compared to other procedures ofthe saffle general class; an
index based on a relative value scale that considers skill. labor, overhead, malpractice
jnsurance alcl other related costs; and a monetar,value assignnlent (conversion factor)
for one unit of value in each of the categories of service.
Sec. 10.807 Horv are pa1'ments for particular services calculated
Pa,vment for a procedure identified by a HCPCS/CPT code shall not exceed the
amount derived by multiplying the relative values for that procedure by the geographic
indices for sen'ices in that area and b-v-. the dollar amount assigned to one unit in that
category of sen'ice.
(i) fne " iocaiit;-" which sen,es as a basis for the determination of average cost is
defined by the Bureau of Census Metropolitan Statistical Areas. The Director shall base
the determination of the relative per capita cost of medical care in a locality using
information about enrollment and medical cost per counfy, provided by the Health Care
Financing Administration (HCFA).
(b) The Director shall assign the relative vaiue units (RVUs) published by HCFA to
all services for u'hich HCFA has made assignments, using the most recent revision-
\I,here there are po RV-IJs assigned to a procedure. the Director may der.'elop and assign
any RVUs rhat he or she .onrid.r, appropriate. The geographic adjustment factor shail
be that designated by Geographic Practice Cost Indices for Metropolitan Statistical
Areas as devised fbr HCFA and as updated or rer,ised bv HCFA from time to time. The
Director u'ill devise conversion factors for each category of sen'ice. :urd in doing so may
adapt HCFA conr,'ersion factors as appropriate using OWCP's processing experience and
internal data.
(c) For example, if the unit values for a particular surgical procedure are 2.'18 for
phljsician's u,ork (W), 3.63 for practice expense (PE), and 0.48 for malpractice insurance
iM), una the doliar value assigned to one unit in that categon' of service (surgery) is
56l.l0. then the maximum allorvable charge for one perfbrmance of that procedure is
the product of the tlr.ree RVUs times the correspondingeographical indices for the
Page -8O-

localin'tinres the conversion factor. If the geographic indices for the localitv are
0.988(W). 0.9'18 (PE). and 1 .171(\4). then the ma-rimum pavment calculation is:
[(2.48X0.988) + (3.63X0.918) + (0.48X1 .171)l r $61.20 [2"45-" 3.44 ..56] x $6i.t0
6..15 x $61.20: 539-1.74
Sec. 10.808 Does the fee schedure appr-v to even'kind of procedure
Where the time- effort and skill required to perform a particular procedure vary, rvidely.
lrom one occasion to the next. the Director ma."'' choose not to assign a relative value to
that procedure. In this case the allou'able charge for the procedure uill be set
individually based on consideration of a detailed rnedical report and other evidence. At
its discretion. OWCP may set fees u'ithout regard to schedule limits for specially
authorized consultant examinations. for examinations performed under 5 LT.S.C. g123-
and for otirer speciallv authorized sen,ices.
Sec' 10.809 How are pa'ments for medicinal drugs determined
Pa1'ment for medicinal drugs prescribed b1'ph1'sicians shall not exceed the amount
deri'ed bir multipl-',-ing the a'erase whoresale price of the rnedication b1, the quantity or
amount provided. pius a dispensing fee.
(a) All prescription medications identified by'National Drug Code (NDC) u,ill be
assigned an average- wholesale price representinq the product's natjonally recognized
wholesale price as determined by suneys of manufacturers and wholesalers. The
Director n,ill establish the dispensine fee.
&) rhe NDCs, the average rvholelale prices. and the dispensine fee shall be revierved
lrom time to time and updated as necessar.
Sec. 10.810 l{ou' are pavments for inpatient medical services determined
(a) OWCP u'iil pa1' for inpatient medical sen'ices accordinq to pre- determined.
condition-specific rates based on the Prospective Pavment Sy:stem (ppS) devised b1,
HCFA (42 cFR parts .112.113.421.4g5. and 1g9). using this s1,stem, pavment is
derived by multiplf ing the diagnosis-reiated group (DRG) u,eight assigned ro the
hospital discharge b1,. the provider-specific factors.
(1) All hospital discharges will be classified according to rhe DRGs prescribed b1,rhe
HCF.{ in the form of the DRG Grouper sofnvare program. on rhis list. Lach DRG
represents the average resources necessarv to provide care in a case in that DRG relative
to the national average of resources consumed per case.
(2) The provider-specific factors u'iil be provided by HCFA in rhe form of rheir ppS
Pricer software prograln. The softn'are takes into consideration rhe r-r'pe of faciiitl,,
census division. actual geographic location (MSA) of the hospital. case mix cost per
discharge. number of hospirai beds. internbeds ratio, operatins cosr to charse ratio. and
other factors used by' HCFA to determine the specific rate for a- hospiral disJharge under
Page -8{-

their PPS. The Director may devise price adjustment factors as appropriate uslng
OWCP's processing erperience and internal data'
(3) OWCp rvill Lase payments to facilities excluded from HCFA's PPS on
consideration of detailed medical reports and other evidence.
(4) The Director shall revierv the pre-determined hospital rates at least once a vear'
and may adjust any or all components rvhen he or she deerns it necessarv or appropriate'
(b) The Director shali review the schedule of fees at least once a year, and may adjust
the scheduie or anv of its components rvhen he or she deems it necessary or appropriate'
Sec. 10.81 I When and horv are fees reduced
(a) owCP shali accept a provider's designation of the code to identifl' a billed
pro..dur" or sen'ice if the code is consisteit with medical reports a'd other evidence'
Where no code is supplied, OWCP may determine the code based on the narrative
description of the pro..dur. on the bifling fonn and in associated medical reports'
OWCP will pay no more than the maximum allorvable fee for that procedure'
(b) If the charge submitted for a service supplied to an injured employ'ee-exceeds the
maximum amount determined to be reasonatle according to the schedule. OWCP shall
pay rhe amount allowed by the schedule for that sen'ice and shail notis the provider in
r.r,riting that pal,ment wasreduced for that sen'ice in accordarlce u'ith the schedule'
OWCp shall also notifu the provider of the method for requesting reconsideration of the
baiance ofthe charge.
Sec. 10.812 If OWCP reduces a fee, may a provider request reconsideration of the
reduction
(a) A phy sician or other provider whose charge for service is onlv partially paid
because it exceeds a maximum allowable amount set by the Director may' within 30
days. request reconsideration of the fee determination'
"(i)
The provider should make such a requesto the OWCP district office w'ith
jurisdictionover the emplol'ee's claim. The request must be accompanied by
iocumentary evidence that the procedure performed was incorrectly identified by the
original code, that the presence of a severe or concomitant medical condition made
treitment especially aifficult. or that the provider possessed unusual qualifications. In
itseif. board-certification in a specialt-v is not sufficient evidence of unusual
qualifications to justi! an exception. These are the only three circumstances which u'ill
justiff ' reevaiuation of the paid amount.
(2\ A list of OWCP district offices and their respective areas of jurisdiction is
available upon request lrom the U.S. Department of Labor' Office of Workers'
Compensation Programs. Washington- DC 20210. or from the Internet at
rvwr.v.dol.gov./doVesuowcp.htm. Within 30 days of receiving the request for
reconsideration. the OWCP district office shail respond in writing stating rvhether or not
an additional amount rvill be allorved as reasonabie. considering the evidence submitted.
(b) If the OWCP distrjct office issues a decision which continues to disallow a
contested amount. the provider mav appl,v to the Regional Director of the region u'ith
Page -82-

Jurlsdrctron over the owcP district office. Tire application must be filed u,itirin j0
of the date of such dai.s
decision- and it ma1'be a.companied b1'additional
60
evidence.
da-v*s of receipt
\\,irhin
o-f such application. the Regional Director shail
$r:iting
issue a
stating
decision
*'hether in
o. nof an additional amoiurt u,iil be allorved as reasonable,
evidence submitted. This decision shall be
,THff:lTlhe
final, and shall nor be subject
Sec' 10'813 Ifo\\;cPreducesafee,mavapro'iderbilltheclaimant
forthebalance..
A provider rvhose fee for service is partialrl, paid b,v o\\icp as a
application
result of the
of its fee schedule or other tests for reasonableness in accordance *,ith this
nart not request th3ll reimbursement from ,ir. ..fio1.. for additional
(a)
amounts.
where a pro'ider's fee for a particr-rlar se."ice or procedure
public
is low,er
than
to the general
as provided by the schedule of maximum allor.r,able charges.
shall bill
the provider
at the lou'er rate. A fee for a particular service or procedure
than
u,hicir
the provider's
is higher
fee to the general public for that same sen,ice or procedure
considered
*,ill
a charse'-'s
be
rbstantially in excess of vr such Juu'Pruv provider's customarv
the purposes
charqes,,for
ofSec. r0.gr5(d).
(b) A provider rvhose fee for sen'ice is parrially paid bl,owcp
application 'charges as rhe result
of the
of the
scheduie of maximum allou,able and ll'ho
to
collects
coilect
or
from
attempts
the emplol'ee. eirher directly or through i collection
excess
aeent, any
of
amount
the charge
in
allou'ed bi' owcP. and *'ho doJs not cease such
appropriate
acrion
refund
or make
to the emplol'ee r.vitirin 60 da,vs of the date of the
shall
decision
be
of
subjecto
oWCp.
the exciusionprocedures pr;ri;J l; i... r0.815(h).
Exclusion of providers
Sec' 10'815 w-l-rat are the srounds for excluding a pro'ider from pa1'ment
FECA
under the
A phy'sician' hospital, or provider of medical services or suppiies shail
from payment
be excluded
under the FEbA if such ph'sician. hospitar or pro'ider
(a)
has:
Been convicted under anv criminal starute of fraudulent activities
u'ith
in
any
connection
Federal or State p.ogru* for u'hich pay'ments are made to providers
medical"
fbr
surgical
similar
or hospital ien.ices. appliances or supplies:
(b) Been excluded or suspended. or has resigned in liiu of exclusion
from
or
participation
suspension.
in zul'Feierai or State program referred to in paragraph
section;
(a) of this
(c) Knowingly made. or caused to be made. an' f-alse statement or
of a
misrepresentation
material fact in co'nection u'ith a determination of the right to rcimbursement
the FECA- or
under
in connection u,ith a request for pavment;
(d) Submirted' or caused to be submined- three or more bills or requests
within
for par,menr
a rwelve-month period under rhis subparl containing charges which
finds to
the
be
Director
substantialii'in excess of such pro'ider's customary charges-
Director
unless
finds
the
there is good cause for the bilis or requests conraining such charqes:
Page -83-

(e) Knorvingly failed to timely reimburse employees for treatment, senices or
,uppfi., t"*ltt .a under this subpart and paid for by OWCP;
(f) Failed. neglected or refused on three or more occasions during a 12-month period
to submit full and accurate medical reports, or to respond to requests by OWCP for
additionai reports or information. as required b,v the FlgA and Sec' 10'800;
(g) Knou,ingly furnished treatmelt. serv.ices or supplies u'hich are substantially in
excess of the emplo,vee's needs. or of a quality which fails to rneet professionaily
recognized standards; or
(h) Coliectcd or attempted to collect from the emplovee, either directl;- or through a
collection asent. an amount in excess of the charge aliou'ed by oWCP for the procedure
performed. and has failed or refused to make appropriate refund to the employee' or to
cease such coilection attempts, u'ithin 60 da1's of the date of the decision of OWCP'
Sec. 10.816 W}1at wjll cause OWCP to automatically exclude a phl"sician or other
provider of medical serv'ices and supplie s
(a) OWCP sirall automaticaily' exclude a ph-vsician, hospital, or provider of medical
sen,ices or supplies who has been convicted of a crime described in Sec' 10'815(a)' or
has been excluded or suspended. or has resigned in lieu of exclusion or suspension' fiorn
participation in any program as described in Sec' 10'815(b)'
^
(b) The exclusiotr^apfties to participating in the program and to seeking pa,vment
under the FECA fo. ,..,ri".s p.ito'o.O after the date of the entry of the judgment of
conr,'iction or order of exclusion. suspension or resisnation. as the case ma-v be. bv the
court or agency concemed. Proof of the conviction. exclusion, suspension or resignation
nru-n-.onrirt oiacopl'thereof authenticated by the seal of the court or agency concerned'
Sec. 10.8i7 When are OWCP's exclusion procedures initiated
Upon receipt of inlbrmation indicating that a ph1'sician. irospital or provider of
medical sen,ices or suppiies (hereinafter the pro','ider) has engaged in activities
enumeratedinparagrapts(c)through(h)of Sec. 10.815.theRegionalDirector.after
completion of inquiries he or she deems appropriate, may initiate procedures to exclude
the provider from participation in the FECA program. For the purposes of this section'
"Regional Director" ma-1, include any officer designated to act on his or her behaif'
Sec. 10.818 Hou, is a provider notified of OWCP's intent to exclude hirn or her
The Regional Director shail initiate the exclusion process by sending the provider a
letter. bi, cerfified maii and rvith rerurn receipt requested. u'hich shall contain the
follorving:
(a) A concise statement of the grounds upon u'hich exclusion shall be based:
(b) A summary of the information. rvith supporling documentation' upon r'vhich the
Regional Director has relied in reaching an initial decision that exclusion proceedings
should begin:
(c) An invitation to the provider to:
Page -84-

( I ) Resign voluntarill' frorn participation in the FECA pros,ram u'ir.hout admining or
denving the allegations presented in the letter: or
(2) Requesthat the decision on excrusion be based upon the existinq record and a:ri,
additional documentary information the prol'ider ma1,wish to furnish:
(d) A notice of the prol'ider's right. in the event of an adr.erse rulins bi, tire Regiolal
Director. to request a formal hearing before an administrative lau, judge:
(e) A notice that should the provider fail to ans\ .er (as described in Sec. 10.819) the
Ietter of intent r.r'ithin 30 calendar davs of receipt- the Regional Director mav deem 1he
ailegations made therein to be true and mav order exclusion of the provider u"irhout
conducting any further proceedings; and
(f) The name and address of the OWCP representative u.ho shall be responsible for
receir.'ing the ansu,er from the provider.
Sec- 10.819 \\hat requirenrents must the pror,'ider's repl-v and O\VCP's decision neet
(a) The provider's ans\\'er shall be in writing and shall include i1n answer to OWCp's
invitation to resign voluntarily. If the provider does not offer to resiqn. he or she shall
requesthat a detc'rnrination be made upon the existing record and an1,. additional
information pror,ided.
(b) Should the provider laii to ansrver theletter of intent r.l'ithin 30 calendar days of
receipt. the Regional Director mav deem the allegations made therein to be true and mav
order erclusion of the provider.
(c) B)' arransenlent u,ith theofficial representative. the provider maf inspect or
request copies of information in the record at any time prior to the Reeional Director's
decision.
(d) The Regional Director shall issue his or her decision in writine. and shall send a
copy of the decision to the provider by certified maii- rerurn receipt requested. The
decision shall advise the pror.ider of his or her right to request. *'itlrin:0 Ou1'r of the date
of the adverse decision- a formal irearing before an administralive law judge under the
procedureset forth in Sec. 10.820. The fiiing of a request for a hearing u'iihin the time
specified shall stav the effectiveness of the cjecision to exclude.
Sec. 10.820 Horv can an excluded pro'ider request a hearing
A request for a hearing shall be sent to the official representative named under Sec.
10.818(f) and shall conrain:
(a) A concise notice of the issues on rvhich the provider desires to gir,e evidence at
the hearing:
(b) ,b)' request for a more definite statement b_"- OWCp:
(c) Anl'request for the presentation of oral arsument or evidence: and
(d) .\l1' request for a certification of questions concerning professional medical
standards. medical ethics or medical regularion for an adr,isory opinion from a
competent recognized prof'essional organization or Federal. State or locai recuialon,
bodr'.
Page -85-

Sec. 10.821 Horv are hearings assigned and scheduled
(a) If the designated OWCP representative receives a timely request for hearing' the
OWCP representative shail refer the mafter to the Chief Administrative Law Judge of
the Department of Labor, who shall assign it for an expedited hearing' The
administratir.,e law judge assigned to the rnatter shall consider the request for hearing' act
on all requests thereinl and isiue a Notice of Hearing and Hearing Schedule for the
conduct of the hearing. A copy of the hearing notice shall be sen'ed on the provider by'
certified mail. rerurn leceipt'iequested. The Notice of Ifearins anC Heari'g Schedule
shall include:
(1) A ruling on each item raised in the request for hearing;
i:i A r.fr.iule for the prompt disposition of all preliminary matters' including
requests for more definite statements a1d for the ceftification of questions to advisory
bodies: and
(3) A scheduled irearing date not less than 30 da,vs after the date the schedule is
issued. and not iess than 15 da1,s after the scheduled conclusion of preliminary matters'
provided that the specific time and place of the hearing may be set on 10 dary' notice'
(b) The purpose of the designation of issues is to provide for an effective hearing
pro".rr. The piovider is entitled to be heard on any matter placed in issue his or her
''all -by^
1..rponr. to tlte Notice of Intent to Exclude, and may designate issues"
.for purposes
of hearing. Hou,ever- a specific designation of issues is required if the provider wishes
to interpo-se affirn-rative ,lefenses. or request the issuance of subpoenas or the
certification of questions for an advisory opinion'
Sec. i0.822 Ilow are subpoenas or advisory opinions obtained
(a) The pror.ider may apply to the administrative law judge forthe issuance of
subpoenas upon a showing ofgood cause therefor'
iU) e certification of ai.qu.st for an advisory opinion concerning professional
medical standards. medical ethics or medical regulation to a competent recognized or
professional organization or Federal, State or local regulatory agency may be made:
(l) As to an issue properlv designated by the provider. in the sound discretion of the
administratiye law judge, provided that the request will not unduly delay the
proceedings:
(2) gv bWCp on its o\ n motion either before or after the institution of proceedings,
and the results thereof sirall be made available to the provider at the time that
proceedines are instituted or. if after the proceedings are instituted. rvithin a reasonable
iime atieireceipt. The opinion. if rendered b1'the organization or agenc)/, is advisory
onll' and not binding on the administrative law judge'
Sec. 10.82j Howwill the administrative larvjudge conducthe hearing and issue the
recommended decision
(a) To the extent appropriate. proceedinss before the administrative larv judge shall be
"overned
bv l9 CFRpafi 18.
Page -86-

(b) The administrative lari' judge shall receir,e such reler,ant evidence as ma1,'be
adduceC at the hearing. Evidence shall be presented under oath. oraliv or in the forrn of
It'ritten slatements. The adrninistrative lau' judge shall consicierhe Notice and
Response, including all pertinent documents accorrpanf ing them. and mav also
consider anv evidence *'hich refers to the provider or to an1, claim ri,ith respecto u.hich
the provider has provided medical sen'ices. hospital seryices- or rnedical ser'ices and
supplies- and such other evidence as the administratir'e lau' judee ma1'determine to be
necessan' or useful in evaluatine the matter.
(c) All hearings shall be recorded and the original of rhe complete transcript shail
become a perrnanent part of the olficial record of the proceedings.
(d) Pursuant to 5 u.S.c. 8126. the administrarir.e larv judge mar':
(1) Issue subpoenas for and compel the afiendance of r.r'itnesses n'ithin a radius of 100
miles:
(2) Administer oaths:
(3) Examine rvitnesses; and
(-1) Require the production of books. papcrs. documents. and olher evidence with
respecto the proceedings.
(e) At the conclusion of the hearine. the administrative lau. judge shall issue a w,riften
decision and cause it to be sen'ed on ali parties to the proceeding. their representatives
and the Director.
Sec. 10.824 FIou'can a party request review b1'the Director of the administrative law
judee's recommendedecision
(a).An-v
parly adverselv affected or aggrieved b)' the decision of the administratiye
law judge mav file a petition for discretionary rer,iew u,ith the Director rvithin 30 daJ-s
after issuance of such decision. The administrative larv judge's decision. horvever. shall
be effective on the date issued and sirali not be sravecl except upon order of the Director.
(b) Revierv b1'the Director shall not be a matter of riqht but of the sound discretion of
the Director.
(c) Petitions for discretionary review shall be filed onlv upon one or more of the
follora'ing grounds:
( 1 ) A findinq or conclusion of material fact is not supported by substantial evidence:
(2) A necessary legal conclusion is erroneous:
(3) The decision is contrarv to law' or to the duli' promulgated rules or decisions of
the Director:
(4) A substantial question of iarv. policy. or discretion is invoived: or
(5) A prejudicial enor of procedure was commined.
(d) Each issue shail be separateiy numbered and plainiy and conciselv stated. and
shail be supporled bi"detailed citations to the record rvhen assignments of error are
based on the record" and by statutes. regulations or principal authorities reiied upon.
Except for good cause shown- no assignment of error b)' ,ur)'partv shall relv en apy
question of fact or larv upon which the administrative law judse had not been afforded
an opporfunitv to pass.
Page -87-

(e) A statement in opposition to the petition for d.iscretionary review may be filed' but
,u.it filing shail in no \va)/ delay action on the petition'
(0 If a petition is granied, review shall be limited to the questions raised by the
petition.
(g) A petition not granted within 20 days after receipt of the petition is deemed
denied.
(h) The decision of the Director shall be final rvith respecto the provider's
participation in the ploglam, and shaii not be subjecto further revierv by any court or
*. tO ,r, \\'hat are the effects of exciusion
(a) OWCP shall give notice of the exclusion of a phi'sician. hospital or provider of
medical services or suPPlies to:
(1) All OWCP district offices:
(2) All Federal emPio.vers;
(3) The HCFA:
(4) The State or local authorit-v responsible for licensing or cerlifl''ing the excluded
party; ' and
tSl All emplo,vees who are knon'n to have had treatment. services or supplies from
the excluded irovider within the six-month period immediately preceding the order of
exclusion.
(b) Notrvithstanding an,v exclusion of a ph;-sician. hospital. or provider of medical
seru-ices or supplies under this subpart. OWCP shall not refuse an employee
reimbursement for any othernise reimbursable medical treatment. service or suppiy if:
( 1) Such treatment. service or supply was rendered in an emerqency by an excluded
ph-vsician; or
(2) The employee could not reasonably have been expected to have known of such
exclusion.
(c) ,An emplol'ee who is notified that his or her attending ph1'sician has been excluded
shall have a ne\4'righto select a qualified ph-vsician.
Sec. 10.826 How can an excluded provider be reinstated
(a) If a ph1'sician, hospital. or provider of medical serv'ices or suppiies has been
automaticalil,' exciuded pwsuant to Sec. 10.816. the provider excluded rviil
automaticailv be reinstaied upon notice to O\\iCP that the conviction or exclusion rvhich
formed the basis of the automatic exclusion has been reversed or withdrawn. Hol\'evet.
an automatic reinstatement shall not preclude OWCP from instituting exciusion
proceedings based upon the underl,ving facts of the matter'
(b) A ph-vsician. hospital. orprovider of medical services or suppiies excluded from
participaiion as a result of an order issued pursuanto this subpafi may- apply for
reinstatement one year after the entry of the order of exclusit'n. unless the order
expressly provides for a shorter period. An appiication for reinstatement shall be
addressed to the Director for Federal Emplol'ees' Compensation. and shall contain a
Page -88-

conclse statement of the basis for the application. The application shoujd be
accompanied b;- supporting documents and affidavits.
(c) A request for reinstatement may be accoinpanied b,v a requestfor oral argument.
oral argument u'ill be allou'ed onll,in unusual circumstances u-hereit uill materiallv aid
the decision process.
(d) The Director fcrr Federal Emplol'ees' Compensation shall order reinstatement onl\
in instances q'here such reinstatement is clearly ionsistent u-ith the goal of riris subpart
to protect the FECA program against fraud and abuse. To sarisfv thii requirement the
provider must provide reasonable assurances that the basis for the exclusion w'ill not be
repeated.
2. Part 25 is rer.ised to read as follorvs:
Part 25--Compensation for Disabilih and De:rth of \oncitizen Federal Emplovees
Outside thc United States
Subpart A--General Provisions
Sec. 25.1 Horv are claims of Federai emplol'ees who are neither citizens nor residcnts
adjudicated
2-5.2 in general. u'hat is the Director's poiicy'regardine such claims
25.3 What is the authoritv to settle and pay such claims
25.'1 'fiftat t1'pe of evidence is required to establish a claim under this part
25.5 What special rules does OWCP appl]- to claims of third and fourth countn,
nationals
25.6 Ilow does OWCP adjudicate claims of non-citizen residents of possessions'/
Subpart B-The Special Schedule of Compensation
25.100 Horv is compensation for disabilitl.paid
25.101 How is compensarion for death paid
25.102 what general provisions does o\l-cp apply- to fte Special Schedule,l
Subpart c--Extensions of the Speciar Schedule of compensation
15.:00 How is the Special Schedule applied for empior,ees in rhe Republic of the
Philippines
25.101 How is the Special Schedule applied for emplol,ees in Australia
25 -202 How is the Special Schedule appiied for Japanese seamen
25.203 Ilow is the Special Schedule applied to non-resident aiiens in the Territon, of
Guam
Authoriw: 5 U-S.C.301.8137.81,15 and 81.19: 1946 Reorqanizarion plan No.2. sec.
3' 3 CFR 1943-1948 Comp.. p. 1064: 60 Stat. 1095: Reorganization Plan No. 19 of 1950.
sec. l, i cFR 1943-1953 Comp., p. l0l0: 64 Stat. 1271; Secreran-'s order 5-96" 62 FR
107 .
Page -89-

Subpart A--General Provisions
Sec. 25.1 How are ciaims of Federal emplo-vees u'ho are neither citizens nor residents
adjtrdicated
This part describes how'OWCP pays compensation under the FECA to employees of
the United States rvho are neither citizens nor residents of the United States' an)'territory
or Canatla. as well as to any dependents of such emplo,vees' It has been determined that
the compensation providei uni., the FECA is substantiali,v disproportionate. to the
.o.np.n*,ion for disabilitv or death u'hich is payabie in similar cases under local lan"
regJation, custom or otherrvise. in areas outside the United States' an1' territory or
Cana,Ja. Tl'rereibre, with respecto the claims of such emplo.vees uhose injury (or injurl
resulting in death) has occurred subsequent to December 7- 19'11, or may occur' the
regulations in this part shall appl-v
Sec.25.2 In qeneral. what is tire Director's poiicy regarding such clairns
(a) pursuant to 5 U.S.C. 8137. the benefit features of local rvorkers' compensation
lar.vs. or pror,'isions in the nature of workers' compensation. in effect in areas outside the
United States. any territory or Canada shall- effective as of December 7, 1941 and as
recognized by the Director. be adopted and apply in the cases of emplol'ees of the
United States rvho are neither citizens nor residents of the tinited States, any telrito$ or
Canada. unless a special schedule of compensatiotl for injury or death has been
established un

(d) Persons emploved in a countn' or area having no u,ell-definecl r.orkers'
compensation benefits structure shall be accorded the benefits provided--either by local
larv or special schedule--in a nearbv country as determined b,v the Director. ln seiectilg
the benefit strucrure to be applied. equitv and adrninistrativease rvill be giyen
consideration. as lrell as local custon.
(e) Cornpensation for disabilitv and death of non-citizens outside tire Unired States
under this part. u'hether paid under local law or special schedule. shall in no er,ent
exceed that generallv pavabie under the FEC.,\.
Sec. 25.3 \\'hat is the authoritv to setrle and pal,such claims
in addition to the authority to receive. process and pay' claims. q,hen deleqated such
representative or asenc)' receiving delegation of authorit,v shall. in respecto cases
adjudicated under this part- and n'hen so authorized by the Director. har,e authoritl' to
make lump-sum arvards (in the manner prescribed b;- 5 U.S.C. 8135) u,hener.er such
authorized representative shall deem such settlement to be for the best inlerest of the
United States. and to compromise and pav claims for any benefits provided for under
this part- including claims in nhich there is a dispute as to questions of lact or larv. The
Director shall. in instructions to the particular representatir,,e concerned. establish such
procedures in respecto action under this scction as he or she mav cleem necessrur,. and
mav specifi'the scope of an,v administrative review of such action.
Sec.25.-1 \[ta1ry'pe of et'idence is required to establish ac]aim under rhis part
Claims of emplovees of the United States who are neither citizens nor resi

determined by the Director. With respecto a United States territory or possession'
..local larv,, means only the law of the particular tenitory or possessiol'. .
(b) Benefits pavabie. Third and fourth country nationals shall be paid the benefits
upp)i.utt. to loiai hires in the country of hire or the place of emplo-vment' whiche'"'er
benefits are greater, provided that alibenefits payabli on account of one injury must be
paid under the same benefit structure' ^^*.^._--^+i^- kone
r,ided in
(1) Where no u,ell-defined workers' compensation benefits structure ls plo'
either the counrry of hire or the place of rhe pro'isions of Sec. 25.2(d) shall
"*iloy-"nt.
appl"v.
(2) Where equitable considerations as determined by the Director so lvarrant' a fourth
countrv national may be awarded benefits appiicable to local lires in his or her home
country.
Sec. 25.6 Horv does owcP adjudicate ciaims of non-citizen residents of possessions
An emplo,vee rvho is a bona fide permanent resident of any United States possession'
territory, commonwealth or trust territorv rvill receive.the full benefits of the FECA' as
amended. except that the application of tne minimum benefit provisions provided therein
shall be govemedby the reslrictionset forth in 5 U'S'C' 8138'
Subpart B--The Special Schedule of Compensation
Sec. 15.100 I{orv is compensation for disabilitv paid
compensation for disability shall be paid to the empioyee as follorvs:
(a) permanentotal disabilit-v. In casLs of permanentotal disabilitl'. 66\2/3\ percent
of the monthly pay during the period of such disability'
1b)'lemporary total disabiliry. In cases of temporary total disability" 66\2/3\ percent
of the monthiy pal'during the period of such disabiliry'
(c) Permanent partial aisaUiilty. In cases of permanent partial disability, 66\l/3\
percent of the monrhly pav. for the following losses and periods:
(1),,\rm lost: 280 u'eeks' compensation.
(2) Leg lost: l'18 rveeks'compensation-
(3) Hand lost: 212 rveeks' compensation'
(.1) Foot lost: 173 u'eeks' compensation'
(5) Eye lost: 140 rveeks' compensation.
(6) Thumb lost: 51 weeks' compensation'
(7) First finger lost: l8 weeks' compensation'
(8) Great toe lost: 26 weeks'compensation'
(9) Second finger lost: l8 r'r'eeks' compensation'
(10) Third finger lost: 17 weeks' compensation'
(11) Toe. othei than great toe. lost: 8 q,eeks'compensaticln.
(li) Founh finger lost: 7 R'eeks'compensation'
Page -92-

(13) Loss of hearins: One ear.5l q'eeks'compensation; both ears, 200 n-eeks'
compensation.
(1'1) Phalanges: Compensation for loss of more than one phalanx of a di_eit shall be
the same as for the loss of the entire digit. Compensation for loss of the firsi phalanx
shall be one-half of the compensation for the loss of the entire digit.
( 15) Amputated arm or leg: Compensation for an arm or a ies, if amputated at or
above the elborv or the knee, shall be the same as for the loss of the u.,ri o.leg: but. if
amputated bet$'een the elborv and the urist. or betrveen the knee and rhe ankle. the
compensation shall be the same as for the loss of tlie hand or the foot.
( 16) Binocular vision or percent of r ision: Compensation for loss of binocular r.ision"
or for 80 percent or more of the r..ision of an ey"e shall be the same as for the loss of the
(17) Trvo or more digits: Compensation for loss of tu'o or more digits. one or more
phalanges of two or more digits of a hand or foot ma,v be proportioned to the |oss of use
of the hand or foot occasioned thereby'. but shall not exceed the compensation for the
loss of a hand or a foor.
( 18 ) Total loss of use: Compensation for a permanent total loss of use of a member
shall be the same as for loss of the member.
(19) Panial loss or partial loss ofuse: Compensation for permanent partial loss or loss
of use of a member may be for proportionate loss of use of the member.
(20) Consecutive aw-ards: In any case in which there shall be aloss or loss of use o1'
more than one member or parts of more than one member set forth in paragraphs (c)( 1 )
through (19) of this section. but not amounting to permanent total aisabitiq', the aq,ard
of compensation shall be for the loss or ioss of use of each such member or part thereof.
u'hich ara'ardshall run consecutiveli'- except that where the injury. affects onlv rwo or
more digits of the same hand or foot" paragraph (c)( I 7) of this section shall apply..
(21) Other cases: ln all other cases w'ithin this class of disabiiir,v the compensation
durinq the continuance of disabiliry shall be that proportion of compensation for
permanentotal disabilit-"*. as determined under paragraph (a) of this section. u,hich is
equal in percentage to the degree or percentage of physical impairment caused b.v- the
disabiiitl'.
(22) Compensation under paragraphs (c)( 1) through (21) of this section for permanent
partial disabilitl'' shall be in addition to an)- compensation for temporarv total or
temporary parrial disabilitl'' under thjs section. and au'ards for temporarv total. temporary
partial- and permanent partial disability shall run consecutivelv.
(d) Temporary partial disabiliqv. In cases of temporarv parrial disabiliw. during the
period of disability-- that proponion of compensation for temporary total disabiliry'. as
determined under paragraph (b) of this section. u'hich is equal in percentage to rhe
degree or percentage of phl sical irnpairment caused b1, rlie rlisabiiitl,-.
Sec. 25.101 Hou' is compensation for death paid
If the disabilitl'causes death. the compensation shall be pal.abie in rhe amounr and to
or lbr the benefit of rhe follot'ins Dersons:
Page -93-

(a) To the undertaker or person entitled to reimbursement, reasonabie funerai
expenses not exceeding $200.
(b) To the sun'iving spouse. if there is no child, 35 percent of the monthly pay until
his or her death or remarriage.
(c) To the surr.iving spouse, if there is a child, the compensation pa-v-able under
paragraph (b) of this section, and in addition thereto 10 percent of the monthl.v rvage for
each child, not to exceed a total of 66\2/3\ percent for such sun'iving spouse and
children. If a child has a guardian other than the surviving spouse. the compensation
pa-vable on account of such child shall be paid to such guardian. The corr-rpensation of
any child shall cease rvhen he or she dies. marries or reaches the age of 18 .vears. or if
over such age and incapable of self-support. becomes capable of self-support.
(d) To the children. if there is no sun'iving spouse,25 percent of the monthly pay for
one child and I 0 percenthereof for each additional child. not to exceed a total of 66\2i3\
percenr thereof. divided among such children share and share alike. The compensation of
each child shall be paid until he or she dies, marries or reaches tiie age of 18, or if over
such age and incapabie of seif-suppor1, becomes capable of self-support. The
compensation of a chiid under legal age shall be paid to its guardian. if there is one,
othenvise to the person having the custody or care of such child, for such child. as the
Director in his or her discretion shall determine.
(e) To the parents. if one is wholly dependent for support upon tlte deceased
emplol,ee at the time of his or her death and the other is not dependent to zmy extent. 25
p.r..,rt of the monthly pay: if both are rvhoil-v dependent. 20 percenthereof to each: if
one is orboth are partly dependent. aproportionate amount in the discretion of the
Director. The compensation to a parent or parents in the percentage specified shall be
paid if there is no surviving spouse or child. but if there is a surviving spouse or child"
ihere shall be paid so much of such percentages for a parent or parents as. when added to
the totai of the percentages of the survir,'ing spouse and children, u'i1l not exceed a total
of 66\2/3\ percent of the monthly pay.
(0 To the brothers, sisters, grandparents and grandchildren- if one is n'holly

to his or her guardian, if there is one, other',r'ise ro the person iraving tlie custodl; or care
of such person. for such person. as the Director in his or her cjiscretion shall determine.
(h) Upon the cessation of an.n* person's compensation lor death under this subpart. the
colnpensation of onv lsrnxininc person entitled to continuing compensation in the same
case shall be adjusted- so that rhe continuing compensation shall be at the same rate suclr
person u'ould have receil'ed had no au'ard been made to the person q,hose conrpelsation
ceased.
(i) In cases rvhere there are tu'o or more classes of persons entitled to compensation
for death undcr this subpart. and the apportionment oisuch compensation as provided in
this section u'ould result in injustice. the Director mav in his o. h., discretion modifr,.
the apportionments to meet the requirements o1.the case.
Sec.25.102 \\tat general provisions does o\\,cp apply to the Special Schedule
(a) The definitions of tetms in the FECA. as amended. sirall apply to terms used in this
subpart.
(b) The provisions of the FECA. unless modified b1,'this subpart or orhen^ise
inapplicable- shall be applied rvhenerer possible in the application of this subpart.
(c) The provisions of the regulations 1br rhe adrninistraiion of the FECA, as amended
or supplemented from time to time bv instructions applicable to this subpart. shali apply
in the administration of compensation uncler this subpart. rvhener,er the1,' can reasonably
be applied
Subpart C--Extensions of the Speciar Schedule of compensation
Sec. 25-200 How is the Speciai Schedule applied fbr emplovees in rhe Republic of the
Philippines
(a)\{odified special schedule of compensation. Except for injuq,or death of directhire
emplot'ees of the U.S. lvlilitary Forces covered bf ihe Philippine lr4edical Care
Program and the Enlplovees' Compensation Program pursuanto the agreement signed
by the United States and the Republic of rhe Pirilippines on March 10, 1982 u,ho are aiso
members of the Philippine Social Securitv Svstem. the special schedule of
compensation established in subpart B of this part shall appl),, u,ith the modifications or
additions specified in paraeraphs (b) through (k) of rhis section. in rire Republic of the
Philippines- to injury or death occurrinq on or after Jul1, 1 . 1968- u,ith the following
limitations:
( 1) Temporary disabilitl,. Benefits for par menrs accruing on and after Jull' I . 1969.
for injuries causing temporary disabiiiry and s'hich occurred on and after Jul1, 1, 196g.
shall be pa1'able at the rates in the special schedule as modified in this secrion.
(l) Permanent disabilitv and death. Benefits for in_juries occurring on and after Julv l.
which
]968'
cause permanent disabiiirr- or death- shall be payable at the rates specified
in the special scheduie as modifiea initr;s section for all awards not paid in full before
Julr'1- 1969,andanyaq'ardpaidinfullpriortoJuir, 1-1969.Provided-that application
for adjustment is made. and the adjustmenl u,ill resuit in addirionai benefits of at leasr
Page -95-

S10. In the case of injur-ies or death occurring on or after December 8' 1941 and prior to
July 1, i968. the special schedule as modified in this section may be applied to
;;;rp-.;i".
u**a, for permanent disability or death. provided that the monthl-v and
aggregate naxlmum privisions in effect uith. time of injury or death shall prevail'
t-h.t,, totima are $50 and $4,000, respectively'
(b) Death benefits. 400 u,eeks' .on1p.nrution at trvo-thirds of the weekl-u.- rvage rate'
shared equally by the eiigible surt'ivors in the same class'
(c) Death beneficiariei. Benefits are pa,vable to the sun'ivors in the following order of
prioriry (ail beneficiaries in the highest appiicable ciasses are entitlcd to share equail'v):
( l ) Sun,iving spouse and unmarried children under 18" or o'er I 8 and totaiiy
incapable of self-suPPort.
(2) DePendent Parents.
(3) DePendent grandParents.
(4) Dependent grandchildren. brothers and sisters u'ho ate umrarried and L[rder i8' or
over 18 and totally incapabie of self-support'
(d) Burial alloq,ance. 1,1 u,eeks'*,ui.t or $-100. u'hichever is less' payable to the
eligible sunivor(s), regardless of the u".tuul expense' If there is no eligible survivor'
actual bunal expenses may be paid or reimburied. in an amount not to exceed what
rvould be paid to an eligible sun'ivor'
n at trvo- thirds of the weekiy
(e) Pennanent total disability. '400 weeks' compensatlol
u'age rate'
, -:-r r:^^L:ri*. \r.-^-^ --^li^oh'le idgd in
{q p..n'unent partial disabiliry. Where applicable. the conlpensatton provt
parauraphs (cX I ) through (19) of Sec. 25.1Oti. subjecto an aggregate limitation of 400
u,eeks, compensation. In all other cases, provided fc,r permanentotal disability that
proporrion or tn. compensation (paragroptt i.; of this section) *'hich is equivalentto the
degree or percentage oiphysical impairment caused by the disabiiity.
(g)1'empor"qi furti"i dlsability. Tr,"o-thirds of the weekly loss of rvage-earning
capacitv.
(h) Compensation period for temporary disability' Cornpensation for temporary
disabiliry is payable for a maximum period of 80 weeks'
(i) Ir4aximum compensation. The total aggregate compensation payable in any case'
for injurv or death ortoth, shail not.*...J$8,000. exclusive of medical costs and burial
allorvance. The weekly rate of compensation for disabiliqv or death shall.no.t exceed $35'
o Method of pa1,'ment. only compensation for tempolary disability shall be payable
p.rioaicatty. Compensation for permanent disabiliry and death shall be payable in full at
ihe time the extent of entitlement is established'
(k) Exceptions. The Director in his or her discretion ma)' make exceptions to the
regulations in this section b;':
(1) Reapportioning death benefits. for the sake of equin''
i:) E*.iuOing from consideration porential death beneficiarjes u'ho are not available
to receive Palrment-
(3) par,ing compensation for perrnanent disabilitl' or death on a periodic basis. u'here
thismethod of pu1-.nt is considered to be in the best interest of the beneficiarl''
Sec. 25.101 Horv is the Speciai Schedule applied for emplol'ees in Australia
Page -96-

(a) The special sciredule of cornpensation establisired b1' subpart B of this part shall
appl)' in Australia n'ith the modifications or addirions specified in paraeraptr 1U; of this
section. as of December 8. 1941. in all cases of injurl,'(or death fiom injrul.) u'hich
occurred betu'een December 8. 19+1 and December 31. 1961. inclusive. and shall be
applied retrospectilelv in all such cases of injury'(or death from injury). Compensation
in all such casespending as of Julv 15. 19-16. shall bereadjusted accordinelv. q.ith credit
taken in tlre amount of compensation paid prior to such date. Refund of compensation
shall not be required if the amount of compensation paid in any such case. other\vise
than through fraud. misrepresentation or mistake. and prior to July 15, 19.+6. exceeds tle
amoult provided for under this paragraph. and such case shali be deemed compromised
and paid under 5 U.S.C. 8137.
(b) The total aggregate compensation pa1'able in anv case under paragraph (a) of this
section, for injury or death or both, shall not exceed the surn of $.1.000. exciusive of
medicai costs' The maximum monthly rate of compensation in anv such case shall nor
exceed the sum of$50.
(c) The benefit arnounts pa1'able under the provisions of the Commonu,ealth
Emplovees' Compensation Act of 19-10-
196:1.
Australia. shall appl)' as of January I .
I 962- in Australia. as the exclusive measure of compensation in cases of injury (or death
from injury) accordina on and after January 1 . i 962. and shall be applied retrospectivelv
in all sr"rch cases" occurring on and after such date: Provided. that the compensation
pa1'able under the provisions of this paragraph shali in no event exceed that pal,able
under the FECA"
Sec. 15.202 Horv is the Special Schedule applied for.Tapanese seamen
(a) fhe special schedule of compensation established by subpart B of this part shall
apply as of November I .1971. with the modificalions or additions specified in
paragraphs (b) through (i) of this section. to injuries sustained outside rhe continental
United States or Canada by direct-hire Japanese searnen u,ho are neither citizens nor
residents of the United States or Canada and rvho are emploled by the \,lilitar.v Sealift
Comnand in Japan.
(b) Temporary total disabilitl'. Weekl-'- compensation shall be paid ar 75 percent of
the weekl1,- u'ase rate.
(c) Temporary partiai disabiliry. \\'eeklr,compensation shall be paid at 75 percent of
the rveekly loss of wage-earning capacin'.
(d) Permanent total disabilir-v*. Compensation shall be paid in a lump sum equivalenr
to 360 rveeks' \\'ages.
(e) Permanent partial disabiliq'. ( 1) The provisions of Sec. 25.100 shail apply ro rhe
t1'pes of perrnanent par-tiai disabiiity listed in paragraphs (cX1) through (19) of that
section: Provided that rveeklv compensation shall be paid at 75 percent of the u,eekly
$'aQe iate and that the number of weeks allowed for specified losses shajl be chansed as
lbllor,r's:
(i) Ann lost: 312 weeks.
(ii) Leg lost: 288 weeks.
(iii) Hand iost: 244 weeks.
Page -97-

(iv) Foot iost: 205 rveeks.
(v) E1'e lost: 160 rveeks.
(vi) Thumb lost: 75 weeks'
(vii) First finger lost: 46 u'eeks'
(viii) Second finger lost: 30 weeks'
(ix) Third finger lost: 25 r'veeks.
(x) Fourth finger lost: 15 weeks.
(xi) Great toe lost: 38 u'eeks.
(xii) Toe. other than great toe lost: i6 weeks'
(2) In all otirer.ur"rlhut proportion of the compensation pro'ided for-permanent
tor;l disabiliqv in paragraph (a) of tnit section u'hich is equivalento the degree or
percentage of ph1'sical impairmer-rt caused by the injury'
(fl Death. if there are fwo or more eiigible survivors.. compensation equiYalent to 360
rveeks'wageshall be paid to the sur'ivirs. share and share alike' If there is only one
eligible sun,ivor, compensation equivalento 300 u'eeks' wages shall be paid' The
foliou'ing sun'ivors are eligible for death benefits:
(1) Spouse who lived u,ith or was dependL-nt upon the employee.
i:; U*our.ied children under 21 who lived with or were dependent upon the
employ'ee.
(3) Adult children u'ho were dependent upon the emplo,vee b,v reason of physical or
mental disabiiiry.
(4) Dependent parents. grandparents urd grandchildren'
19; nLrriat allowance. S|OOO pal,able to tfie eligible sun'ivor(s). regardless of acfual
.rp"nr.r. If there are no eligible sun'ivors, actual expenses may be paid or reimbursed'
up to $ 1.000.
(h) Method of payment. Only compensation for temporary disability shall be payable
periodically, as entitlement accrues. Compensation for permanent disability and death
shall be payable in a lumP sum.
(i) Maxima. In all cases, the maximum weekl,u.. benefit shall be S130. Also, except in
cases of perrnanent total disabiiity and death" the aggregaie maximurn comPensation
pal,able for anv injury shall be 5'10.000.
0) Prior inju4,- IrLcases where injur.n'or death occurred prior to November 1" 1971'
U.nints will be paid in accordance rvith regulations promulgated, contained in 20 CFR
parts 1-399. edition revised as of January 1.1971.
Sec. 25.20i Horv is the Special Schedule appiied to non-resident aliens in the Territory
of Guam
(a) The special schedule of compensation established by subpart B of this part shail
appl),, u,ithihe modifications or additions specified in paragraphs (b) through {k) of this
s.itiorr, to injury or death occurring on or after July I ,I97I in the Tenitory of Guarn to
non- resident alien emplovees ,..rrrit.d in foreign countries for employment b1'the
miiitary departments in the Territory of Guam. Howeyer. the Director may. in his or her
ciiscretion- uOop, the benefit features and provisions of local workers'compensation iaw
as proyided in iubpart A of rhis parr. or substitute the special schedule in subpart B of
Page -98-

this part crr othcr rlodifications of the special schedule in this subpart C. if suc6
adoption or substitution rvouid be to the advantage of the emplovee or his or her
benefician'. Ihis schedule shall not apply' to anl* emplor ee n'ho becomes a permanent
resident in the Territon' of Guam prior to the date of his or her injury. or death.
(b) Deatli benefits.'100 u'eeks'compensation
tu,o-thirds of the .nreeklr'\vase rate,
shared equallv b1' the eligible sun,ivors iu the sarne class.
(c) Death beneficiaries. Beneficiaries of death benefits shail be determined in
accordance Vujth the laus or customs of the countn' of recruitmcnt.
(d) Burial aliou'ance. l.1u'eeks'\\'ages or $-100. whichever is less. pal.able to the
eligible sun'ivor(s). regardless of the a-ctual expense. If there is no eligible survivor.
acrual burial expenses mav be paid or reimbursed. in an amount not to erceed u.hat
u'ould be paid to an eligible sun-ivor.
(e) Permanent total disabilitl'. -100 rveeks'compensation atnvo- thircls of the u'eeklv
\\'age rate.
(l) Permanent partial disabilitv. \\ihere applicable. rire compensation provided in
paraeraphs (cX1) through (19) of Sec.25.100. subjectto an asgregate lirnitation of .100
rveeks' compensation. ln all other cases, that proportion of the compensation pror.ided
for permanent rotal disabiliq'(paraeraph (e) of this section) u,liich is equivalenr to rhe
degree or percentage of ph1'sical impairment caused by the disabilit-u--.
(g) Temporary parlial disabilit.,'. Tq'o-thirds of the weekly loss of rvage-earnine
capacitr,.
(h) Compensation period fbr ternporarl'disabilit-"-. Compensation for remporary
disabiliqv is payable for a marimum period of 80 u,eeks.
(i) Maximum compensation. The total aggregate compensation pal,able in anr case.
for injuT or death or both. shall not exceed $24,000. exclusive o1-medical costs and
burial allou'ance. The weeklv rate of compensation for disabiliti,' or death shall not
exceed $70.
0) Method of pa1"ment. Compensation 1'or temporan' disabilirl' shail be payable
periodicallv. Compensation for permanent disabilitl,' and dearh shall be pal,able in full at
the time the extent of entitlement is estabiished.
(k) Exceptions. The Director mav in his or her discretion make exception to the
reculations in this section b]':
(1) Reapportioning death benefits for rhe sake of equit1,.
(2) Excluding from consideration potential beneflciaries of a deceaseci emplolee rvho
are not available to receir e pa-\ ment.
(3) Paying compensation for permanent disabilin or death on a periodic basis. u,here
this method of pavment is considered to be in the best inte rest of rire cmplor.ee or his or
her benefician (ies).
Signed at Washincton. D.C.. this iTth dav of November. 1998.\lexis M. Herman.
Secretar-r' of Labor.
Bernard E. Anderson. Assistant Secretan' for Emplol'ment Standards Administrarion
[FR Doc. 98-31190 Filed I ]-14-98: 8:45 aml BILLNG CODE 1510t1_p
Page -99-

Page -{OO-

What A Federal Employee
Should Do When Injured At Work
Ponnrf
I rvuvt
fn
I Lv
Supervisor
Obtain
Medical Care
Fite
Written Notice
Every job-related injury should be reported as soon as possible to your supervisor.
Injury also means any illness or disease that is caused or aggravated by the
employmenl as well as damage to medical braces, artificial limbs and other
prosthetic devices.
Before you obtain medical treatment, ask your supervisor to authorize medical
tr€atmenl by use of form CA-16. You may initially select the physician to provide
necessary treatment. This may be a private physician or, if available, a local
Federal medical officer/hospital. Emergency medical treatment may be obtained
without prior authorization. Take the form cA-16 and form owcp-1soo/HcFA-l500
to the provider you select. The form owcp-1500/HcFA 1500 is the billing form
physicians must use to submit bills to owcp. Hospitals and pharmacies miy use
their own billing forms. on occupational disease claims form cA-.16 mav not be
issued without prior approval lrom OWCp.
In traumatic injuries, complete the employee's portion o{ Form cA-1. obtain the
form from your employing agency, complete and turn it in to your supervisor as
soon as possible, but not later than 30 days following the injury. For occupational
disease, use form cA-2 instead of form cA-1. For more detaiteo information
carefully read th€ 'Bene{its ..." and "lnstructions ..." sheets which are attached to
the Forms CA-1 and CA-2.
Obtain
Receipt of Notice
Submit Claim For
COP/Leave and/or
Compensation
For Wage Loss
A "Receipt" of Notice of lnjury is attached to each Form cA-.1 and Form cA-2. your
supervisor should complete the receipt and return it to you for your personal
records. lf it is not returned to you, ask your supervisor for it.
lf disabled due to traumatic injury, you may claim continuation of pay (cop) not to
exceed 45 calendar days or use leave. A claim for COP must be submitted no later
than 30 days following the injury (the form CA-1 is designed to serve as a claim for
continuation of pay). lf disabled and claiming cop, submit to your employing
agency within 10 work days medical evidence lhat you sustainod a oisaotin!
traumatic injury. lf disabled beyond the cop period, or if you are not entitled to
COP' you may claim compensation on form CA-7 or use leave. lf disabled due to
occupational disease, you may claim compensation on form cA-7 or use leave. A
claim for compensation for disability should be submitted as soon as possible after
it is apparent that you are disabled and will enter a leave-without-pay sratus.
TheFedera|Emp|oyees'CornpensationAct(FECA)isadministeredbytheU.S.o"pu,tffi
Standards Administration, office of workers' Compensation Program! lOwcey. Benefits include continuation
pay ol
lor traumatic injuries, compensation for wage loss, medlcal care and olher assistance for job-related injury
death'
or
For additional information about tne FgcR, read pamphlet CA-11, "when Injured at work" or Federal
Personnel Manual, chapter 810, Injury Compensation, available from your employing agency. The agency will
give you
also
the address of the owcp of f ice which services your area.
Post on Employees, B-fietin Boerd