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

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INVESTIGATIONS (CONT’D)LACK OF WITNESS STATEMENTS:An agency’s statement such as “injury notwitnessed” is not sufficient for <strong>OWCP</strong> to adviseyou to stop paying COP. Under the FECA, aninjury does not have to be witnessed. Unlessthe agency submits evidence demonstrating thatinjury could not have occurred where employeeclaimed injury occurred, or when it occurred, orhow it occurred, <strong>OWCP</strong> accepts what theemployee reported as true.
INVESTIGATIONS (CONT’D)Providing Written Explanations:• Be brief and concise. (Try to keep it to no more than onepage. If more than one page, ask yourself if you aretrying to adjudicate the claim.)• First sentence should be a statement that agency doesnot believe employee is entitled to COP. Then, go on to- explain reasons why (e.g., why injury could not have occurred attime employee stated it happened)- attach evidence to support controversion• Date and sign it.• Provide a telephone number where claims examiner cancall you if s/he has questions or needs clarification.
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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
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Federal WorkersCompensationoClaims
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Traumatic Injuries (CA-1• Back st
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Agency Processing of Traumatic Inju
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Tips for CA-1 Form Completion- Agen
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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 35 and 36: Tips for CA-2 Form Completion- Agen
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 45 and 46: Tips for CA-7 Form Completion- Agen
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 and 70: Controverting COP vs.Challenging th
Page 71 and 72: 9 Reasons an Agency May Controvert
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: INVESTIGATIONS (CONT’D)CREDIBLE W
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
Page 121 and 122: No Authorization• Certain procedu
Page 123 and 124: Authorization EOB Code• Your clai
Page 125 and 126: Authorization Approval• If a requ
Page 127 and 128: AUTHORIZATION LETTER
Page 129 and 130: 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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