Injury Compensation

If you have filed a Form CA-1 for a traumatic injury, and have not lost time from work, limited medical expenses may be paid by OWCP without a formal review of your claim being conducted. In such case, you will not receive a written decision on your claim and may not receive any further correspondence. Your agency representative may be able to advise you in this situation.

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. It must be caused by a specific event or incident or series of events or incidents during a single day or work shift. 20 CFR 10.5 (ee).

The following are examples of a traumatic injury: dog bite, knee strain after a trip and fall, neck strain after an auto accident, or a broken ankle after a slip on ice.

If OWCP makes a formal review of your case, you are responsible for providing enough factual and medical information for OWCP to decide whether you are entitled to benefits. OWCP will help you to meet this responsibility by asking you for the information they need that is not already included in your file. You should send any additional information in writing.

If you are claiming an occupational disease, make sure that you provide all information outlined in the instructions included with Form CA-2, as soon as possible. If OWCP approves your case after formal review and you have lost time from work due to the injury, they will advise you in writing of the acceptance and send you further information about your benefits.

An Occupational Disease is defined as a condition which is produced by continued or repeated exposure to elements of the work environment such as noxious substances or damaging noise levels over a period longer than one work day or shift.

If OWCP denies your case, they will provide you with an explanation of why your claim is denied and advise you fully of your appeal rights, including the time frames for exercising these rights and the offices you should contact.

If a work-related injury results in an employee's death, a claim for survivor's benefits may be filed on Form CA-5 or 5b. The survivor(s), the employing agency on behalf of the survivor(s), or the estate may file the claim for benefits. These sensitive cases are processed expeditiously by an experienced claims examiner.

If you are claiming a traumatic injury, your employing agency may have issued you a Form CA-16 so that you could obtain medical treatment right away. This authorization covers non-surgical treatment and continues for up to 60 calendar days from the date of injury.

If your case is approved, you will remain entitled to medical treatment for your accepted condition. However, if your case is denied, the authorization provided by Form CA-16 will not be valid after the date of denial.

Form CA-16 is not issued for occupational disease cases.

You have the right to select the first doctor who treats you for your injury. If that physician refers you to a specialist, OWCP will honor that referral as long as it is for the work-related condition. If you are first seen by a physician designated by your employer, you still have the right to choose your treating physician. If you wish to change physicians from this initial choice, you must request approval from OWCP. Send a letter stating your reasons for wanting this change, along with the name, address and specialty of the physician to whom you wish to change. OWCP will advise you of their decision in this matter. OWCP will only pay bills from the physician you chose first, until a change in physician is approved.

The FECA recognizes chiropractors as physicians only to the extent that their treatment consists of manual manipulation of the spine and only where the accepted condition is a subluxation of the spine. This subluxation must be shown by x-ray to exist. The x-ray must be taken shortly after the claimed injury. The chiropractor's report must provide an exact diagnosis of your condition based upon this x-ray and explain how the subluxation is related to the claimed injury. Referrals by a chiropractor for other treatment must be approved by OWCP in advance.

If your injury requires physical therapy, it is usually authorized for the first 120 days from the date of injury. OWCP will need further medical support for physical therapy beyond 120 days. OWCP must approve in advance any surgery or procedure other than emergency surgery (that is, a procedure which must be performed right away to preserve life or the function of an organ or body part). You (or your medical provider) should contact OWCP for authorization at least 30 days before the intended date of the procedure. OWCP will advise you of the information needed to determine whether they can pay for the requested procedure.

Automated bill and authorization status is available via OWCP's toll-free Interactive Voice Response (IVR) system at 866-335-8319.

To speak to a customer service representative regarding medical authorizations or bills, call toll free at 1-844-493-1966.

Send all bills for Federal workers' compensation cases to:

U.S. Department of Labor
DFEC Central Mailroom
PO Box 8300
London, KY 40742-8300

Please be sure to include the claim number on every page sent.

• Medical Authorization/Bill Pay for Injured Workers
• Medical Authorization/Bill Pay for Medical Providers
• Medical Authorization/Bill Pay for Employing Agencies

Information on Bills from Foreign Medical Providers

OWCP handles bills from foreign medical providers differently from U.S. territory and stateside medical providers.

Medical bills from foreign providers are sent directly to the special claims unit in OWCP's Cleveland District Office.

Foreign medical bills should be sent to:

• ATTN:David T. Woods
• United States Department of Labor
• 1240 East Ninth Street Room 851
• Cleveland, OH 44199

(Annotate the outside of the envelope with: DO NOT OPEN IN MAILROOM)

Foreign medical bills may also be faxed to OWCP at (216) 902-5601 or (216) 357-5464

Please be sure to include the claim number on every page sent as well as the claimant's current mailing address.

Medical Care Furnished by a Military Treatment Facility (MTF)

Department of Defense (DoD) appropriated fund employees are not billed for treatment at Military Treatment Facilities for initial or follow-up care for a work-related injury.

Please see HA Policy: 08-002 regarding care furnished by Military Treatment Facilities to Federal employees for on-the-job injuries and for occupational health.

Forms

OWCP's Division of Federal Employees' Compensation (DFEC) has made a variety of forms available online. DFEC's online forms

• How and when is a claim for wage loss compensation filed? §10.102
• How and when is a claim for permanent impairment filed? §10.103
• How and when is a claim for recurrence filed? §10.104
• What evidence is needed to establish a claim? §10.115
• What happens if, in any claim, the employer contests any of the facts as stated by the claimant? §10.117
• How does OWCP determine entitlement to benefits? §10.125
• After selecting a treating physician, may an employee choose to be treated by another physician instead? §10.316
• What is total disability? §10.400
• When and how is compensation for total disability paid? §10.401
• What are the basic rules governing continuing receipt of compensation benefits and return to work? §10.500
• What actions must the employer take? §10.505
• May the employer monitor the employee's medical care? §10.506
• How should the employer make an offer of suitable work? §10.507
• What actions must the employee take with respect to returning to work? §10.515

While compensation is usually claimed in two-week increments to conform to standard Federal pay periods, compensation checks are issued on a weekly or four-weekly basis. Payments of compensation for brief periods of temporary total disability or schedule impairments are issued on a weekly basis, while longer-term payments for disability, schedule award and death are made every four weeks. Payments may be sent to the beneficiary or to a financial institution which he or she designates but they may not be sent in care of the employee's representative unless guardianship or conservatorship is established.

Compensation payments are based on a percentage of the employee's salary (or a statutory pay rate). Payments are computed by multiplying the applicable percentage by the wage rate and increasing the result by any cost-of-living increases to which the beneficiary is entitled.

For both disability and death claims, the pay rate used to compute payments is the one in effect on the date of injury, date of recurrence or date disability began, whichever is higher. Thus, the pay rate for compensation purposes may change over the life of a claim.The salary used to compute compensation is not affected, however, by general increases in the rate paid for the employee's grade and step.Moreover, the pay rate is not affected by any promotion or raise the employee might have received in the future.

Additional Elements of Pay included in the salary are: night shift; Sunday differential; holiday pay; hazard pay; dirty work pay; quarters allowance and post differential for overseas employees and extra pay authorized by the Fair Labor Standards Act (FLSA) for employees who receive annual premium pay for standby duty and who also earn and use leave on the basis of their entire tour of duty, including periods of standby duty. Overtime pay is not included, except for administratively uncontrollable work covered under 5 U.S.C. 5545(c)(2).