OWCP Basic Training - 15th Annual Federal Workers ...

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The 5 <strong>Basic</strong> Elements• 1. Time To Submit Claim• Continuation of Pay……………30 Days• Compensation (inc. medical)…3 Years• 2. Civil Employee• 3. Fact Of Injury• 4. Performance Of Duty• 5. Causal Relationship
Page 1 and 2: OWCP Basic Training
Page 3 and 4: OWCP Structure and JurisdictionThe
Page 5 and 6: Information and RecordsIndividual c
Page 7 and 8: PenaltiesThe regulations set forth
Page 9 and 10: Program BenefitsFECA provides for f
Page 11 and 12: Compensation BenefitsFederal employ
Page 13 and 14: Compensation for Loss of WagesThe A
Page 15 and 16: Schedule AwardThe Act provides for
Page 17 and 18: Other BenefitsAttendant AllowanceUn
Page 19 and 20: Federal WorkersCompensationoClaims
Page 21 and 22: Traumatic Injuries (CA-1• Back st
Page 23 and 24: Agency Processing of Traumatic Inju
Page 25 and 26: Tips for CA-1 Form Completion- Agen
Page 27 and 28: Form CA-16• Only used in Traumati
Page 29 and 30: Form CA-16 Instructions cont.
Page 31 and 32: Occupational Diseases (Form CA-2)OW
Page 33 and 34: Agency Processing of an Occupationa
Page 37 and 38: Recurrence of Disability Cont.It do
Page 39 and 40: Form CA-2a Notice of Recurrence
Page 41 and 42: What if the wrong form issubmitted?
Page 43 and 44: Form CA-7 Claim for Compensation
Page 47 and 48: Form CA-7b Leave Buy Back
Page 49: The Basic Elements of a Claim
Page 53 and 54: Five Basics continued:• Performan
Page 55 and 56: Diversions from Duty and TDY• Gen
Page 57 and 58: Three Statutory ExclusionsWhere the
Page 59 and 60: Three Statutory ExclusionsEmployee
Page 61 and 62: Can an agency challenge a claim?•
Page 63 and 64: Withdrawal of a Claim• Added in t
Page 65 and 66: TOPICS TO BE COVERED• COP DEFINED
Page 67: COP Eligibility and EntitlementElig
Page 70 and 71: CONTROVERTING COP• 20 C.F.R. 10.2
Page 72 and 73: 9 Reasons an Agency May Controvert
Page 74 and 75: CONTROVERTING COP (CONT’D)Example
Page 76 and 77: INVESTIGATIONS• If you believe th
Page 78 and 79: FACTUAL EVIDENCE1. Witness statemen
Page 80 and 81: INVESTIGATIONS (CONT’D)LACK OF WI
Page 82: Importance of Submitting Statements
Page 86 and 87: Termination of COPWhere the employe
Page 88 and 89: Beginning of COP PeriodIf the emplo
Page 90 and 91: Leave Use During COP Period• If a
Page 92 and 93: Counting COP Entitlement - Example
Page 94 and 95: THE FINAL WORD…OWCP is the final
Page 96 and 97: Medical Evidence - Burden of Proof(
Page 98 and 99: Requesting Medical Reports Cont.2.
Page 100 and 101:
Job OffersOur office will take imme
Page 102 and 103:
Don’t Use Vague TermsThe physical
Page 104 and 105:
Suitable Offers Cont.(2) Determine
Page 106 and 107:
What to do when a job offer is neit
Page 108 and 109:
Acceptable Reasons For Refusal1. A
Page 110 and 111:
Recognizing and Handling Issues of
Page 112 and 113:
Request for Medical Authorizationan
Page 114 and 115:
Overview• Services that requireau
Page 116 and 117:
How to Submit an Auth Request• We
Page 118 and 119:
Info Required for Physical Therapy
Page 120 and 121:
Auth Requests will be returnedif:
Page 122 and 123:
Authorization EOB Codes• Claims l
Page 124 and 125:
Authorization EOB Code• EOB Code
Page 126 and 127:
FURTHER DEVELOPMENTLETTER
Page 128 and 129:
Timelines for Prior MedicalAuthoriz
Page 130 and 131:
Why will some bills deny?• Claima
Page 132 and 133:
Claimant Eligibilityibilit• Claim
Page 134 and 135:
Treatment Suite Related EOB Codes
Page 136 and 137:
Notification of Unreported Earnings
Page 138 and 139:
Can you do a forfeiture based on aC
Page 140 and 141:
Determine the Period of the Forfeit
Page 142 and 143:
An interesting case…The claimant
Page 144 and 145:
• The Board has held that there i
Page 146 and 147:
Office Decision Affirmed• Appella
Page 148 and 149:
Office Decision Reversed• Appella
Page 150 and 151:
Cases that typically do NOT lead to
Page 152 and 153:
Fraud Against the ActPublic Law 103
Page 154 and 155:
§8148 Continued(3) If an individua
Page 156 and 157:
Fraud ConvictionUnder §8148, the c
Page 158 and 159:
FECA Program Highlightsg
Page 160 and 161:
Benefits from Electronic Filing‣
Page 162 and 163:
E-filing via AQSDivision i i of Fed
Page 164 and 165:
Forms You Will be Able toe-file thr
Page 166 and 167:
Ground Rules‣ Just like CA-1s and
Page 168 and 169:
How Will the ICS E-file forms?•Th
Page 170 and 171:
What the ICS will seePop-Up willapp
Page 172 and 173:
Pre-Populated Populated Fields on C
Page 174 and 175:
Major Differences Web form vs. Pape
Page 176 and 177:
Fields on CA-7bPre-Populated Popula
Page 178 and 179:
Claimant Query System(CQS)Universal
Page 180 and 181:
Click on the CQS link on the left h
Page 182 and 183:
IT Enhancements on theHorizon for N
Page 184 and 185:
Key IVR Features‣ Ability to ‘s
Page 186 and 187:
COP/RTW Redesign, Phase 2Descriptio
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