Category Archives: Claims

Short Form Closure FECA-PT2 Procedure Manual

Administrative Review (AR) — an uncontroverted traumatic injury claim in which medical bills are not expected to exceed $1,500 and a wage loss claim has not been filed. These cases are automatically closed upon case creation, without a Claims Examiner (CE) review.

AR cases can be reopened automatically or manually. Such reopened cases will usually contain some medical evidence and may be adjudicated immediately.

Extent and duration of injury-related disability do not have to be fully developed before adjudication. However, if one or more of the five basic requirements (timeliness, civil employee, fact of injury, performance of duty, causal relationship) is not met, the CE will proceed with development as with any other T1 case. See 2-0800-4.

  • Automatic Reopening. AR cases will be automatically reopened if the medical bills exceed $1,500, a wage loss or recurrence claim is received, or if the case record is changed due to receipt of a late agency controversion [challenge], or the COP nurse has closed the case without a return to full-time employment by the claimant.
  • Manual Reopening. AR cases may also be reopened manually. The case should be reopened when, for example, a request for surgery is received.

Information Above per FECA Procedure Manual

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 writeContinue ReadingContinue 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

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