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

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“NO TIME LOST” (NTL) CASES ANDCONTROVERTING COPTraumatic Injury cases that t meet the following fourrequirements remain in a “unadjudicated status” at <strong>OWCP</strong>and medical bills will be paid until they exceed $1500.00 or aCA-7, Claim for Compensation, is filed by the employee.4 Requirements: 1) Traumatic Injury2) Claim not controverted by agency3) Medical expenses under $1500.004) No CA-7, Claim for Compensation, filedlf you think a claim should be controverted say so, or medicalbills will automatically be paid on the case.
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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
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Form CA-16 Instructions cont.
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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 and 80: INVESTIGATIONS (CONT’D)CREDIBLE W
Page 81 and 82: INVESTIGATIONS (CONT’D)Providing
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
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Treatment Suite Related EOB Codes
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Notification of Unreported Earnings
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Can you do a forfeiture based on aC
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Determine the Period of the Forfeit
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An interesting case…The claimant
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• The Board has held that there i
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Office Decision Affirmed• Appella
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Office Decision Reversed• Appella
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Cases that typically do NOT lead to
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Fraud Against the ActPublic Law 103
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§8148 Continued(3) If an individua
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Fraud ConvictionUnder §8148, the c
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FECA Program Highlightsg
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Benefits from Electronic Filing‣
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E-filing via AQSDivision i i of Fed
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Forms You Will be Able toe-file thr
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Ground Rules‣ Just like CA-1s and
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How Will the ICS E-file forms?•Th
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What the ICS will seePop-Up willapp
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Pre-Populated Populated Fields on C
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Major Differences Web form vs. Pape
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Fields on CA-7bPre-Populated Popula
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Claimant Query System(CQS)Universal
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Click on the CQS link on the left h
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IT Enhancements on theHorizon for N
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Key IVR Features‣ Ability to ‘s
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COP/RTW Redesign, Phase 2Descriptio
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OWCP Basic Training - 15th Annual Federal Workers ...

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