Impact of OWCP Guidelines on FECA Claims
The Office of Workers Compensation Programs (OWCP) administers the Federal Employees’ Compensation Act (FECA). OWCP is part of the U.S. Department of Labor.
When a U.S. Government employee is injured on the job and makes a FECA claim, they make the claim through OWCP. OWCP guidelines can have a significant impact on how the claim proceeds.
Attorney Daren Sarphie explains the impact of OWCP guidelines on FECA claims.
Introduction to OWCP and FECA
The OWCP is part of the Division of Federal Employees’ Compensation (DFEC) within the Department of Labor. 5 U.S.C. § 8121 authorizes the U.S. Department of Labor to administer FECA. A person making a FECA claim must submit the claim to the Secretary of Labor, providing the information required by the Secretary of Labor on an approved form.
How OWCP Guidelines Shape FECA Claims
OWCP guidelines allow for uniform and orderly processing of FECA claims. When it comes to FECA benefits, the OWCP guidelines are the HOW—How does someone make a FECA claim? How does the Department of Labor adjudicate the claim?
The purpose of the guidelines is to make the process clear to those making and processing claims. The guidelines help administrators decide claims consistently.
OWCP Guidelines on FECA Claims
To administer FECA, the OWCP has developed several procedure guidelines for claim processing. These guidelines include the following:
DFEC Procedure Manual: The manual has eight parts covering various topics, including movement of files within the office, claims processing, benefit payments, medical services and supplies, and special case procedures.
Continuation of Pay Nurse Handbook (CNHB): Explaining the purpose of the CN Intervention Program, procedures, and time frames.
Field Nurse Handbook: Explaining assignments and disability management for field nurses, authorization of medical services, and case information privacy.
Vocational Rehabilitation Counselor Handbook: Detailing the Vocational Rehabilitation Program with FECA, including communication, documentation, and procedures for non-cooperation.
DFEC Bulletins, Circulars, Transmittals and Program Memoranda: These communications explain changes to guidelines. For example, FECA Bulletin No. 24-02, issued March 18, 2024, published compensation pay rate changes for 2024. Many topics, including case management, payment methods, and standard procedures for various benefits, are covered.
Navigating Complex OWCP Procedures
Navigating complex OWCP procedures begins with the initial injury. Tell your employer about the injury as soon as possible but within 30 days maximum. Use the Employees’ Compensation Operations & Management Portal to make the report.
There is a three-year time limit to file for FECA benefits. To file for benefits, use Form CA-1 for traumatic injury and CA-2 for occupational disease. If you already have a FECA case number, you can use Form CA-7, Claim for Compensation.
Once you file, OWCP assigns a claim number, and your supervisor and agency workers’ compensation division receive copies.
Administrative authorization or under development
Straightforward cases with minor injury are flagged by program software. They’re labeled Administrative Authorization of Limited Benefits. If your case is assigned this status, you may receive medical care for your work injury up to $1,500.
If your case is more serious or complex, it is called under development. You’ll receive a letter saying that you need to submit detailed medical information. You have 60 days, but you should always submit the information as soon as possible. Then, OWCP claims administrators accept or deny your case based on guidelines. Decisions may take up to 180 days.
If your case is accepted, you must follow the procedures to bill the OWCP for your medical care. To receive payment for lost income, you must file for Wage Loss Compensation using the case management portal.
Addressing Disputes and Denials Under OWCP Guidelines
Disputes may arise during the FECA claims process. If your claim is denied, you have 30 days to request a hearing. A hearing may be oral or based on a written record, and additional evidence is allowed.
You have one year to ask for reconsideration, and additional evidence is allowed. You have 180 days to request an ECAB (Employees’ Compensation Appeals Board) review, with evidence already submitted. You must determine which action to take. The path that is best for you depends on several factors.
As disputes arise in your FECA claim, OWCP guidelines can be important to resolving the issue. These guidelines can give you information on what administrators need to see for your case to be approved and provide insight on what standards may be used to decide various issues.
Some of the guidelines address topics of interest in significant detail. For example, Factual in Basic OD Claims from FECA Part 2 of the DFEC Procedural Manual, Chapter 2-0803, Fact of Injury, explains the evidence to establish exposure to work factors causing occupational disease. Occupational disease cases are categorized as basic or extended. The difference is the nature of exposure. Basic cases are related to skin, orthopedic, viral, infectious, and parasitic diseases. These requests can be adjudicated quite easily with basic medical information establishing the work-related nature of the injury. An extended case likely requires detailed development of medical evidence, as the relationship of work to the condition may not be obvious.
This example of occupational disease processing serves as an example, but there are many guideline topics. By knowing what to expect, you can prepare the necessary evidence and evaluate your claim for completeness.
Legal Assistance in OWCP-Guided Claims
You can have legal assistance in an OWCP-guided FECA claim. At Sarphie Law, we understand the importance of guidelines in how your case may be decided. We are familiar with the guidelines and how to access the various information that may be especially important in your case.
You can have an experienced lawyer identify the issues that matter to your case and create a customized case plan. We take the steps necessary to pursue your benefits.
Contact an Experienced OWCP Lawyer
Sarphie Law handles FECA claims nationwide. We don’t simply file your case. We understand the impact of OWCP guidelines and how they are important for each person to receive the benefits that they have earned. To talk to an experienced OWCP lawyer, contact us today.
