What To Do if Your FECA Claim Is Denied

A denial of your Federal Employees’ Compensation Act (FECA) claim may feel like a significant setback, but it’s not the end of the road. By understanding the steps involved, you can successfully navigate your FECA claim denial and receive the benefits you deserve. Here is an overview of what to do if your FECA claim is denied.

Steps To Take After a FECA Claim Denial

Receiving a denial can be frustrating. If your claim is denied, it is important to act promptly and strategically. Here’s what you should do:

Review the Denial Notice

Carefully read the denial notice you received from the Office of Workers' Compensation Programs. This document will outline the reasons for the denial. This information will help you determine which steps should be taken next.

Gather Additional Evidence

Claims are often denied due to insufficient evidence. Strengthen your case by collecting:

• Medical Records: Obtain detailed medical reports and opinions from your treating physician that directly link your injury or illness to your job.
• Employment Records: Gather any documentation that can demonstrate the nature of your job duties and how they contributed to your injury.
• Witness Statements: Secure statements from colleagues or supervisors who witnessed the incident or can attest to your working conditions.

Consult with a FECA Attorney

Handling a claim denial can be challenging without the support of a FECA attorney. Speak with an attorney to gain a better understanding of how you should move forward.

Understanding the Appeal Process

If your FECA claim is denied, there are 3 ways that you can appeal the decision. Here’s how the process works:

Submit a Request for Reconsideration

You must file a written request for reconsideration to the OWCP within one year of the date of the denial. Your request should include:

• New Evidence: Attach any new medical records, employment documents, or witness statements that were not part of your original claim or considered by OWCP in its denial.
• A Detailed Explanation: Explain why you believe the denial was incorrect and how the additional evidence supports your claim. You can also make a new argument that was not considered by the OWCP when it denied your claim.

Request a Hearing

Getting denied any compensation or medical benefit that you believe that you are entitled to can be challenged by requesting a hearing with the Branch of Hearings and Review.

Hearings are typically done by telephone where a Hearing Representative will review the claim based on the record and evidence reviewed by the OWCP. If this happens, be prepared to:

• Present Your Case: Articulate the reasons for your appeal and how the evidence supports your claim.
• Answer Questions: Be ready to testify and answer questions from the hearing officer regarding your injury and the circumstances of your claim.

Appeal to ECAB

The Employee's Compensation Appeals Board (ECAB) can review and issue what is considered a final decision on your claim. ECAB will not review new evidence, and oral arguments rarely take place.

A decision will be issued, depending on which type of appeal you take. In a truly successful appeal, your claim will be approved and you will begin receiving benefits. Oftentimes, the claim will get sent back to the Claims Examiner to develop other issues. If denied again, you may be able to pursue one of the other two appeal options depending on what stage in the appeal process you are.

Contact Sarphie Law for Assistance

As you can see, the FECA process is complicated and confusing. Without proper guidance you may be spending years going in the same circles with no improvement in your medical or financial situation. At Sarphie Law, we are prepared to handle every step of the process for you to secure the benefits you deserve. Contact us today to review your claim and learn how we can help you.