Claim Denied for Failure to Establish 5th FECA Element

As an injured workers’ OWCP Representative, I have assisted numerous physicians in establishing a causal relationship.

Unless a doctor is well-schooled in the nuances of the Federal Employees Compensation Act [FECA] requirements to establish a causal relationship, the Office of Workers’ Compensation Programs (OWCP) will deny the claim. Medical reports that a doctor can write that are perfectly acceptable in the private sector, by the State or even with Federal Employee’s Health Benefit Insurance Carriers just won’t be sufficient with the OWCP. For it is not what the physician says but how he says it that will get cases accepted and medical procedures authorized. Most times, after numerous rejections by the OWCP, the physician will just throw in the towel. I would estimate that the majority of cases denied by the OWCP are due to the failure of the attending physician to establish a causal relationship.Continue Reading

Did You Know

Representation. Title 20 Chapter 1 Subchapter B Part 10 Subpart F §10.701 “Who may serve as a representative? A claimant may authorize any individual to represent him or her in regard to a claim under the FECA, unless that individual’s service as a representative would violate any applicable provision of law (such as 18 U.S.C.Continue Reading

Long-Term Opioid Prescription Therapy

If you have been prescribed opioids for pain for a long period of time, the Office of Workers’ Compensation Programs (OWCP) Division of Federal Employees’ Compensation has recently instituted a program of greater control on the prescribing and utilization of opioids. The OWCP’s initiative entails careful review, regular periodic monitoring and to greatly increase theirContinue Reading

Offset or Reduction of FECA Due Benefits to SSA Benefits

Section 8116(d) of the FECA requires that compensation benefits be reduced by the portion of SSA benefits based on age, disability or death that are attributable to Federal service and that, if an employee received SSA benefits based on Federal service, his or her compensation benefits shall be reduced by the amount of SSA benefitsContinue Reading

Recurrence or Not?

A recurrence of the medical condition is a documented need for additional medical treatment after release from treatment for the work-related injury. Continuing treatment for the original condition is not considered a recurrence. A recurrence of disability is a work stoppage caused by a spontaneous return of the symptoms of a previous injury or occupationalContinue Reading

OWCP Ordered Second Opinion Examination

An on the job injured Federal Employee must keep in mind that the Federal Employees’ Compensation Act (FECA) that is administered by the Office of Workers’ Compensation Programs (OWCP) is not a disability retirement program. The number one task for a Claims Examiner is to take timely intervention actions to obtain work tolerance limitations thatContinue Reading

The Reconsideration Appeal Versus the ECAB Appeal

The Employees’ Compensation Appeals Board (ECAB) was created in 1946 by Congress to hear appeals taken from determinations and awards under the Federal Employees’ Compensation Act with respect to claims of Federal employees injured in the course of their employment. The board has final authority to determine the liability of the Federal government with respectContinue Reading