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

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CONTROVERTING COP• 20 C.F.R. 10.221 states that an employing agency maycontrovert a claim. Controvert means to challenge ordeny the validity of the claim.There are the nine (9) reasons for controverting (notpaying) COP. Do not pay COP if one of these reasonsapplies in the case.Agency should indicate “controversion” on the CA-1claim form and specify which reason(s) applies.
9 Reasons an Agency May Controvert COPThe agency may terminate or not begin COP only ifthe controversion is clearly based on one of the ninecategories listed below. It should be remembered that<strong>OWCP</strong> makes all final determinations and can overturnthe agency controversion and require that COP bepaid. The nine mandatory categories for controversionare listed below with an explanation following each:1. Disability results from an occupational disease orillness.2. The employee is excluded by 5 USC 8101 (1) B or E.This section of the law deals mostly with volunteers(unpaid) to the federal government.3. The employee is neither a citizen nor a resident of theUnited States or Canada.4. The injury occurred off the employing agency’spremises and the employee was not involved in official“off premises duties”.
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OWCP Basic Training
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OWCP Structure and JurisdictionThe
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Information and RecordsIndividual c
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PenaltiesThe regulations set forth
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Program BenefitsFECA provides for f
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Compensation BenefitsFederal employ
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Compensation for Loss of WagesThe A
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Schedule AwardThe Act provides for
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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 and 50: The Basic Elements of a Claim
Page 52 and 53: Statements/Comments• In cases inv
Page 54 and 55: A note about property vs.premises (
Page 56 and 57: Pre-existing existing Conditions•
Page 58 and 59: Three Statutory ExclusionsWillful M
Page 60 and 61: Three Statutory ExclusionsIntoxicat
Page 62 and 63: Withdrawal of a Claim
Page 64 and 65: Continuation of Pay
Page 66 and 67: Continuation of Pay (COP)The 1974 a
Page 69: Controverting COP vs.Challenging th
Page 73 and 74: CONTROVERTING COP (CONT’D)OTHER R
Page 75 and 76: INVESTIGATING ENTITLEMENT TO COP
Page 77 and 78: INVESTIGATIONS (CONT’D)SUBMIT OBJ
Page 79 and 80: INVESTIGATIONS (CONT’D)CREDIBLE W
Page 81 and 82: INVESTIGATIONS (CONT’D)Providing
Page 84: “NO TIME LOST” (NTL) CASES ANDC
Page 87 and 88: COUNTING COP DAYS
Page 89 and 90: Portion of DayIf the employee stops
Page 91 and 92: End of PeriodThe claimant's entitle
Page 93 and 94: Counting COP Entitlement - Example
Page 95 and 96: RETURNING INJURED EMPLOYEES TO MODI
Page 97 and 98: Requesting Medical ReportsA. The fi
Page 99 and 100: Weight of Medical EvidenceWhen OWCP
Page 101 and 102: Preparing the Job OfferHowever, if
Page 103 and 104: Suitable OffersTo find an offer of
Page 105 and 106: Disqualifying FactorsVerify that no
Page 107 and 108: What to do when a job offer is vali
Page 109 and 110: If the reasons for refusal are not
Page 111 and 112: Moving ExpensesMoving Expenses and
Page 113 and 114: AUTHORIZATION LEVELS• LEVEL 1: Pr
Page 115 and 116: What requires authorization?• Whe
Page 117 and 118: Info Required for Auth Requests:Rou
Page 119 and 120: Info Required for DME Auth• Claim
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No Authorization• Certain procedu
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Authorization EOB Code• Your clai
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Authorization Approval• If a requ
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AUTHORIZATION LETTER
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Medical Bill Processing
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Claimant Eligibilityibilit• Each
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Treatment t Suite• Services that
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Unreported Earnings or ActivitiesFo
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The Road to ForfeitureIf the employ
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Evidence Required to Establish Forf
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Administrative ActionsOnce the offi
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Other ECAB cases…..• The Office
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Office Decision Affirmed• The Boa
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Office Decision Affirmed• Appella
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Cases that do NOT lead to Forfeitur
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FECA Fraudand Criminal Prosecution
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§8148 Forfeiture of benefits by co
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18 U.S.C. 1920"§1920. False statem
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Pretrial DiversionDuring pretrial d
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FECA Program Highlightsht‣Electro
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CA-7 and CA-3 3e-Filing‣ Effectiv
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Overview• Forms to be filed via A
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Benefits of E-filing‣ Early recei
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How Will the ICS E-file forms?•Th
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What the ICS will seeICS willcomple
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How will the ICS know it worked?In
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Major Differences Web form vs. Pape
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Fields onCA-7aPre-Populated Populat
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RequiredFields on CA-3Pre-Populated
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CQS - Claimant Query SystemCQS will
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CQS case summary and status will di
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Description:DFEC Centralized IVRThe
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IVR Continued‣ Reduced staff work
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COP/RTW Redesign Features‣ COP As
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