- 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. 205 and 208).”
- Second Opinion. The FECA Procedure Manual states that if the second opinion specialist submits an opinion which is equivocal, lacks rationale, or fails to address the specified medical issues, the CE should seek clarification or further rationale from that physician. When the OWCP undertakes to develop the evidence by referring the case to an Office-selected physician, it has an obligation to seek clarification from its physician upon receiving a report that did not adequately address the issues that the OWCP sought to develop. As such, the CE should seek clarification from the referral physician and request a supplemental report to clarify specifically noted discrepancies or inadequacies in the initial second opinion report.
- Administrative Review (AR) — An uncontroverted traumatic injury (TI) claim in which medical bills are not expected to exceed $1500 and a wage loss claim has not been filed. These cases are automatically closed upon case creation, without 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 TI case.
AR cases will be automatically reopened if the medical bills exceed $1500, a wage loss or recurrence claim is received, or if the case record is changed due to receipt of a late agency controverted [challenge], or the COP nurse has closed the case without a return to full time employment by the claimant. AR cases may also be reopened manually. The case should be reopened when, for example, a request for surgery is received.
- Orthopedic Shoes. If an accepted injury to the foot modifies its structure so that the employee cannot be fitted with ordinary shoes, specially constructed ready-to-wear or custom-built shoes may be furnished upon the recommendation of the attending physician. If such shoes will be required permanently, the purchase of two pairs may be authorized. Alterations to stock shoes usually worn by the claimant will also be authorized if needed.Obtaining Appliances and Arranging for Repairs. Devices which are specifically fitted to and worn by the claimant, such as back braces, eyeglasses, and artificial eyes are considered personal rather than government property. Upon the recommendation of the attending physician, such appliances may be repaired or replaced without advance approval when the estimated cost is less than $500. Repairs or replacements costing more than this amount should be approved in advance by the OWCP District Medical Advisor if possible.
- Referee medical examinations. A referral for a referee examination will be undertaken when a conflict of medical opinion between the attending physician and an OWCP-appointed physician, such as, a second opinion physician or the District Medical Advisor, has been identified and the medical opinions are of equal weight. Once a Referee medical determination is rendered, the OWCP will assign the weight of medical evidence to said opinion. Or in other words, the Referee’s opinion will override the attending physician and the second opinion physician or the District Medical Advisor’s opinion. However, in some instances, the OWCP will assign the weight to the second opinion if the attending physician has not been currently active in the claimant’s case. This can also occur if the attending physician fails to provide an acceptable challenge to the second opinion’s findings.
- A traumatic injury is defined as a wound or other condition of the body caused by external force, including stress or strain. The injury must be identifiable as to time and place of occurrence and member or function of the body affected, and it must be caused by a specific work event, or incident, or series of work events, or incidents during a single day or work shift.
- An occupational disease is defined as a condition which is produced by continued or repeated exposure to elements of the work environment over a period longer than one workday or shift.
- 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.
- Dual Benefits. Receipt of benefits from other Federal agencies, such as, the Office of Personnel Management (OPM), Social Security Administration (SSA), or the Department of Veterans’ Affairs (VA) may require an election of benefits or an offset. Other benefits, such as, separation incentives or buyouts may also require an offset of compensation benefits.