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Injury On Duty
Who Decides Your Claim
What to do if Your
Claim is Denied
What to do if You Have an Occupational
Illness or Injury
What to do if You Have
a Traumatic Injury
What to do if You Have
a Recurrence
What OWCP Benefits
are Available
Returning to Work
OWCP Terminology
How do You File
Your Claim
Guidelines for Proving Your Claim with
Medical Evidence
FECA Benefits as Explained by OWCP
Appeal Rights
back to home
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FECA BENEFITS AS EXPLAINED BY OWCP |
Now that your claim has been accepted, you should be
aware of certain information concerning payment of bills
and compensation, authorization for surgery, return to
duty, dual benefits, and rehabilitation services.
BILLS. You are entitled to medical treatment and
expenses related to treatment for your injury. All
medical bills, except those from hospitals and
pharmacies, must be signed or stamped by the physician
and submitted on Form OWCP-1500. Also know as Form
HCFA-1500, this form can be obtained from your agency if
your physician is unfamiliar with it. If any medical
bills related to this injury were previously returned
because your case had not been accepted, they may be
resubmitted to this Office for consideration of payment.
Travel expenses should be submitted on SF-1012.
Bills for medical treatment may not be paid if submitted
more than one year beyond the calendar year in which you
received the treatment or the calendar year in which the
claim was first accepted as compensable by the Office,
whichever is later. Therefore, all bills for payment or
reimbursement, including travel vouchers, should be
submitted as promptly as possible after you incur the
expenses. You may ask your physician to submit bills
directly to the district office, or you may pay the
doctor and submit the paid bill for reimbursement.
Your acceptance letter states the medical condition(s)
which OWCP has accepted as work-related. Treatment for
those conditions only should be billed to OWCP.
CONSIDERATION: If you lose (or expect to lose)
pay because of your injury, you should obtain Form CA-7,
Claim for Compensation on Account of Traumatic Injury or
Occupational Disease, from your employing agency.
Complete Part A of the form and submit to your employer
for completion of Part B. In box 6, you may claim the
period your doctor estimates that you will be disabled
for work, or until your next medical appointment, but
not more than 30 days of wage loss. In order to minimize
any possible income interruption, your employing agency
should submit the completed Form CA-7 to the Office on
the 40th day of COP, and should include any medical
evidence in its possession concerning the injury.
Any claim for compensation must be supported by medical
evidence of injury-related disability for the period you
are claiming. Form CA-20, Attending Physician’s Report,
is attached to Form CA-7 for this purpose. In any
report, your physician should specifically state the
periods during which you are unable to perform (1) full
duty and (2) restricted duty. It is your responsibility
to arrange for the submission of supporting medical
evidence.
If you continue to lose pay because of work-related
disability after the dates claimed on the initial Form
CA-7, you should submit an additional Foam CA-7s, Claim
for Compensation, through your employer for additional
compensation. Form CA-20, Attending Physician’s Report,
should accompany Form CA-7, unless medical evidence
supporting disability for the period claimed has already
been submitted. If disability continues you should
submit through your employer additional Forms CA-7 (and
CA-20 if needed) for each period claimed, unless
otherwise informed by this Office.
Your employer should submit additional Form CA-7 to OWCP
approximately five days before the end of the period
claimed in the previous Form CA-7.
SURGERY. You must obtain approval in advance from
this Office for any surgical other than emergency
surgery in order to insure payment by OWCP. A second
opinion medical examination may be required before
surgery is authorized. If other than emergency surgery
was performed on account of the claimed injury before
the claim was approved, you should arrange for
submission of a report from your doctor stating the
reason why the surgery was necessary. You should also
arrange for submission of a copy of the operative
report.
Concerning any surgery planned for the future, you
should contact this Office at least 30 days before the
doctor plans to schedule the procedure authorization.
You should arrange for the doctors to submit a medical
report stating the need for the surgery is authorized at
the expense of this office.
RETURN TO DUTY: If you obtain or return to any
employment, you should notify this Office immediately.
You are not permitted to receive payments for temporary
total disability while employed. If you receive any
compensation checks with include payment for any period
you have worked, you should return them to us
immediately to prevent any overpayment. The employing
agency should also notify Office as soon as you have
returned to duty by calling the telephone number shown
above and filing Form CA-3, Report of termination of
Disability and/or payment.
DUAL BENEFITS. Claimants are prohibited from
receiving compensation for wage loss and Federal
Retirement benefits at the same time. Compensation for
wage loss includes payments for temporary total
disability and for loss of wage-earning capacity.
Claimants may, however, receive compensation for
schedule awards and a retirement annuity at the same
time.
REHABILITATION. You are responsible for asking
your doctor whether you can perform same work, and for
notifying your agency when your doctor says you are able
to perform some work. If you are indefinitely disabled
for your usual job, and your agency has not provided
light duty, you are eligible for vocational
rehabilitation services. We will attempt to arrange work
with your employing agency or a private employer.
Continued pay or compensation may be terminated if you
refuse work which is within your medical restrictions
without good cause, and benefits may be reduced if you
fail to cooperate with rehabilitation and payment
efforts.
PENALTY. Any person who knowingly makes any false
statement, misrepresentation, concealment of fact, or
any other act of fraud to obtain compensation as
provided by the FECA or who knowingly accepts
compensation to which he or she is not entitled is
subject to felony criminal prosecution and may, under
appropriate U.S. Criminal Code provisions, be punished
by a fine or not more than $10,000 or imprisonment for
not more five years, or both.
If you have any question concerning your case, please
write or call this district office. |
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