Frequently Asked Questions
What must an employee do when injured at work?
- Report the injury to the supervisor right away and obtain first aid as necessary;
- Complete a written report (Form CA-1 or CA-2) and give it to the supervisor;
- If a traumatic injury is involved, and further medical treatment is needed, obtain authorization (Form CA-16) from the supervisor for treatment by a physician of the employee’s choice. If that physician is not available, the employee still has the right to choose a treating physician and should therefore select another;
What forms are used to report injuries and diseases?
Form CA-1, “Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation” is used to report traumatic injury.
Form CA-2, “Notice of Occupational Disease and Claim for Compensation,” is used to report an occupational disease.
The employee should carefully follow the instructions attached to Forms CA-1 and CA-2. Form CA-1 should be filed within 30 days of the injury, and Form CA-2 should be filed within 30 days of the date the employee realized the disease or illness was caused or aggravated by the employment. The forms may be obtained from the employer or from OWCP.
The employer is expected to submit a completed form to OWCP within 10 workdays.
What is the difference between a “Traumatic Injury” and an “Occupational Disease or Illness”?
A traumatic injury is a wound or other condition of the body caused by external force, including stress or strain. The injury must occur at a specific time and place, and it must affect a specific member or function of the body. The injury must be caused by a specific event or incident, or a series of events or incidents, within a single day or work shift.
Traumatic injuries include damage solely to or destruction of prostheses, such as dentures or artificial limbs. Traumatic injuries also include damage to or destruction of personal appliances, such as eyeglasses or hearing aids, when a personal injury requiring medical services occurred.
An occupational disease or illness is a condition produced by the work environment over a period longer than one work day or shift. The condition may result from infection, repeated stress or strain, or repeated exposure to toxins, poisons, fumes or other continuing conditions of the work environment.
The length of exposure, not the cause of the injury or the medical condition which results, determines whether an injury is traumatic or occupational. For instance, if an employee is exposed to toxic fumes for one day, the incident is considered a traumatic injury. If the employee is exposed to toxic fumes for two or more days, the incident is considered an occupational disease.
If my case is accepted, does this mean that the OWCP will automatically pay me?
No. You will only be paid monetary benefits if your medical evidence conclusively establishes that you are unable to work.
Are all work-related injuries covered under the FECA?
All kinds of injuries, including diseases caused by employment, are covered if they occur in the performance of duty. However, benefits cannot be paid if injury or death is caused by willful misconduct of the injured employee, by intent to bring about the injury or death of oneself or another, or by intoxication of the injured employee.
Does the FECA cover a pre-existing medical condition that is aggravated by factors of employment?
Yes. Diseases and illnesses aggravated, accelerated or precipitated by the employment are covered. The employee must submit medical and factual evidence showing that the employment aggravated, accelerated, or precipitated the medical condition.
Is it necessary to report all injuries that occur at work, even minor ones such as a cut finger or bumped knee?
All injuries should be reported when they occur, since a minor injury sometimes develops into a more serious condition. Benefits cannot be paid unless an injury is reported.
What requirements must a claim meet?
The employee must provide medical and factual evidence to establish five basic elements:
- The claim was filed within the time limits set by the FECA;
- The injured or deceased person was an employee within the meaning of the FECA:
- The employee actually developed a medical condition (or damaged a prosthesis) in a particular way;
- The employee was in the performance of duty when the event(s) leading to the claim occurred; and
- The medical condition found resulted from the event(s) leading to the claim.
What is the time limit for filing notice of injury and claim for compensation?
A notice must be filed within three years of the date of injury. However, if a claim is not filed within three years, compensation may still be paid if written notice of injury was given within 30 days, or the employer had actual knowledge of the injury within 30 days after it occurred.
Does the employer have the authority to accept or deny a claim?
No. Only OWCP may make this decision. While the employer pays or withholds COP, this action is subject to review by OWCP in every case.
How does OWCP decide whether a case can be accepted?
Some very simple cases with medical expenses below a set threshold are accepted automatically. In most cases, however, OWCP claims staff consider the factual and medical evidence sent by the employee and the employer.OWCP claims staff apply the law, the regulations, and the procedures to this factual and medical evidence. They also apply decisions of the Employees’ Compensation Appeals Board and administrative decisions of OWCP as set forth in FECA Program Memoranda.
If a case is accepted, does this automatically mean that OWCP will pay disability benefits?
No. A condition for which medical benefits are payable may not prevent an employee from working. Whether disability benefits are payable depends on what the medical evidence says.
If an individual disagrees with a formal decision of OWCP, what appeal rights are available?
OWCP encloses a description of appeal rights with each formal decision. These rights include:
- An oral hearing before an OWCP representative. The individual claiming benefits can testify and present written evidence. The hearing is held at a location near the individual’s home. He or she may have a representative at the hearing, but is not required to do so.
- A review of the written record by an OWCP representative. The individual claiming benefits will not be asked to attend or testify, but he or she may submit written evidence.
- Reconsideration by district office staff who were not involved in making the contested decision. The request must clearly state the grounds for requesting reconsideration, and it must include evidence not submitted before or a legal argument not made before.
- Review by the Employees’ Compensation Appeals Board (ECAB). The ECAB is part of the U.S. Department of Labor but separate from OWCP. Review by the ECAB is limited to the evidence of record, and no new evidence may be submitted. The individual claiming benefits may be represented by an attorney or by any other person authorized by that individual. The ECAB must approve any fee for such representation.
If an individual disagrees with the decision reached on appeal, can he or she obtain review through a State or Federal court system?
No. The methods of appeal are limited to those described above.
How will the OWCP determine how much my compensation payments will be?
Your payments will be two-thirds of your pay rate if you have no dependents tax free. If you are married, have children under the age of 18 or in college you will be paid three-fourths tax free. You would also be entitled to night differential, hazard, premium, holiday and Sunday pay. Overtime is excluded by law.
Will there be any deductions made from my compensation payments?
Yes. The OWCP will deduct your share for your health insurance, optional life insurance and post-retirement basic life withholdings if you are enrolled in these plans. Contributions and/or payments to your TSP will not be deducted.
Can compensation payments be garnished or claimed by creditors?
No. The OWCP will only allow garnishment of your compensation payments for alimony and child support payments if allowed by your state, and the legal process is served according to the laws of your state.
Can I choose the physician who will treat my work injury?
Yes. You are entitled to a first choice of physician or facility for treatment of your injury. A doctor working for or under contract to your employer may examine you in accordance with OPM regulations. However, your choice of doctor must be honored, and treatment by your physician cannot be delayed.
Can I choose a chiropractor as my first choice of physician to get my injury accepted?
Yes and No. If a chiropractor determines by X-ray that you have a partial dislocation and if his report meets the requirements of a probative medical report, your case will be accepted and he will be allowed to treat you in the form of manipulation of your spine only. A chiropractor may provide physical therapy under the direction of a physician.
Can I change my doctor?
If you wish to change your doctor after your first choice you must make your request in writing to the OWCP for approval and include the reasons for your request. If you fail to get approval, you may have to pay for unauthorized medical care. Also, medical opinions from an unauthorized doctor might not be considered by the Examiner.
Can my employer contact my doctor?
Yes and No. The Federal Employee’s Compensation Act [FECA] 20 CFR Ch. 1 §10.506 states, “As the employer, you may monitor the employee’s medical progress and duty status by obtaining periodic medical reports. However, the employer shall not contact the physician by telephone or through personal visit.
Does the OWCP cover a pre-existing medical condition that is aggravated by factors of your job?
Yes. Diseases and illnesses aggravated, accelerated or precipitated by your job are covered. You must submit medical and factual evidence showing that your job aggravated, accelerated or precipitated your medical condition.
Will I continue to be paid by the OWCP until I can return to my job at full duty?
No. If your doctor sets limitations and restrictions the OWCP will request your employer to provide you with suitable light or limited duty work. If your employer declines to provide a suitable position, then the OWCP will continue paying you and send you to Vocational Rehabilitation. The end result of the Vocational Rehabilitation process is not to physically find you a job but to reduce your monetary benefits.
What if my employer provides a light or limited duty position that pays less than my previous job?
If the light or limited duty position offered pays less, the OWCP will pay the difference. You cannot lose money.