Loading images...

FECA-OWCP FAQs

Frequently Asked Questions About FECA and OWCP

Q: I have been receiving OWCP compensation benefits for 10 years because I cannot work any more. My physician is sick and tired of OWCP’s requests for periodic medical reports. Why does OWCP keep requesting periodic reports?

A: FECA benefits, like all workers’compensation benefits, are not considered to be retirement benefits. With some rare exceptions, the FECA provides benefits only for as long as there is continuing medical proof of employmentrelated disability for work—hence OWCP’s periodic (usually yearly) requests for medical updates.

The principal exceptions are described in the FECA itself, which, at 5 USC 8105, provides that “the loss of use of both hands, both arms, both feet, or both legs, or the loss of sight of both eyes, is prima facie permanent total disability.”

Other exceptions are based on individual OWCP determinations to the effect that the disability, combined with age and other factors, is so severe as to permanently disqualify the injured employee for all work—and not just the work being performed at the time of injury. Being disabled for all work means just that—the results of the injury are so severe that the employee cannot perform any type of remunerative employment.

 

Q: I am receiving compensation benefits from OWCP for a back condition caused by my employment. Will my spouse receive benefits from OWCP if I die?

A: Only if your death is causally related to the OWCP-accepted back condition. If you die from other causes (e.g., a heart attack having no relationship to your back injury), compensation based on your disability will cease as of the date of your death, and your spouse will receive no benefits from OWCP. Your spouse may, however, be entitled to Civil Service survivors benefits—provided your spouse is eligible.

 

Q: I slipped and fell on a patron’s steps—an elderly lady who has always been very pleasant to me. OWCP says I must sue her as the third party responsible for my injury. Must I?

A: The FECA provides OWCP with the authority to require you to prosecute the third party responsible for your injury—or to assign your right to prosecute to OWCP. As the result of an agreement between OWCP and the Postal Service, the Postal Service has been given the right to accept assignments of the right to prosecute. The penalty for refusing to prosecute is loss of compensation benefits (you are not, however, required to assign your right to prosecute to the Postal Service if you decide to prosecute in your own name).

 

Q: I would like to have a copy of the medical report sent to OWCP by Dr. ________, an OWCP-selected medical specialist. The doctor refused to give me a copy. Can I obtain a copy from OWCP?

A: Yes. Based on your written request, OWCP will send a copy to you or to your authorized representative (in certain cases, such as a psychiatric report, OWCP will only send the copy to your representative or your attending physician).

 

Q: My Postal Service employment was terminated sometime ago and OWCP has been paying compensation benefits to me for several years—on the basis of a loss in earning capacity. The Postal Service has now requested that I report for a medical examination to see if I can return to work. Must I do so?

A: Compensation based on a loss of earning capacity reflects a determination by OWCP that your disability is partial—not total—and the FECA specifies, at 5 USC 8106(c), that a partially disabled employee is not entitled to compensation if the employee refuses to seek work or refuses or neglects to work after suitable work is offered. Consequently, it is best to cooperate with the Postal Service because if you do not, your refusal may be used by the Postal Service to try to convince OWCP that you have refused suitable work.

 

Q: My physician has written to OWCP and said that my heart condition is probably related to my work as a letter carrier. Why is OWCP questioning his opinion?

A: “Probably” is speculative and not acceptable to OWCP. A claim must be supported by medical evidence that clearly shows that the employee’s medical condition is causally related to the employment factors identified as the basis of the claim.

Medical opinions which contain the words “might be,” “may be,” or “could be” are almost worthless because they lack probative value—i.e., they are speculative.

P.S. Heart condition cases are usually based on factors of employment beyond the day or shift (see the Compensation Department’s article “Filing occupational disease claims” in the April 1985 issue of the Postal Record).

 

Q: My compensation payments were delayed for several months through no fault of my own or that of my employing agency. Will OWCP pay me interest?

A: No. There is no provision in the FECA for interest payments on compensation that has been delayed. Congress would have to enact (and the President sign) legislation to permit interest payments.

 

Q: I slipped and fell on the workroom floor, injuring my right arm and back. No permanent disability resulted and I received continuation-of-pay (COP)—and compensation benefits for my time off. Can I obtain additional compensation for my pain and suffering?

A: No. Pain and suffering is not compensable as such under the FECA. Pain, may, however, be a factor in arriving at the amount of a schedule award payable to an employee who suffers the permanent total or partial loss or loss of use of certain statutorily scheduled (listed) members, organs, or functions of the body.

 

Q: I made the mistake of electing sick leave instead of continuation-of-pay (COP) following my injury. Can I change my election?

A: OWCP’s instructions to employing agencies provide that if an employee has elected sick or annual leave and then wishes to elect COP, the agency is required to make such a change on a prospective basis (i.e., from the date of the employee’s request).

OWCP will not require an agency to restore leave retroactively, stating that the decision to restore leave and substitute COP retroactively rests with the employing agency. Unlike some other employing agencies, the Postal Service will not permit a retroactive change of election (544.14 of the Postal Service’s Employee and Labor Relations Manual) except “at the discretion of the installation head (424.5 of the Postal Service’s Handbook EL-505, Injury Compensation procedures for Control Offices/Points. February 1984).”

 

Q: I did not file a Form CA-1 (Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay Compensation) within 30 days of my injury; and I have now been told that I cannot obtain continuation-of-pay (COP) or compensation benefits. Is this true?

A: Yes and no. The FECA and OWCP’s regulations provide that an employee is not entitled to COP if written notice on Form CA-1 is not filed within 30 days after the injury. The employee is, however, entitled to claim compensation benefits for any period of injury-related loss of wages.

 

Q: I was seriously injured in an automobile accident and my physician has stated that I will never be able to return to work. I receive compensation benefits from OWCP on a regular basis and have been told by others that I should withdraw the amount of money I have paid into my civil service (OPM) retirement account—on the theory that my OWCP benefits will never stop. Should I do so?

A: Absolutely not. First, if you have a spouse, your spouse would be deprived of civil service survivor’s benefits if you die from causes other than disabilities resulting from the auto accident. Second, you may need civil service benefits if your medical situation improves to the point that you are no longer entitled to OWCP benefits—or improves to the point that you are no longer considered totally disabled, thereby causing OWCP to reduce your compensation benefits (on the basis of an earning capacity determination) to a level below what you can obtain from OPM.

 

Q: Can I obtain a schedule award for permanent disability to my back?

A: No. The back is not listed in the schedule (list) of members, functions and organs of the body subject to this provision of the FECA; and the Congress specifically excluded the back (plus the heart and brain) when amending the schedule in 1974. A schedule award is, however, payable should an injury to the back result in loss of use of an anatomical member, function, or organ listed in the schedule (e.g., paralysis of an arm or leg).

 

Q: I was injured when I slipped and fell on a wet floor in the employees’ rest room. Can I successfully sue the Postal Service?

A: No one has as yet—the Federal courts have repeatedly held that the exclusive remedy provisions of the FECA make it (i.e., the Compensation Act) the sole remedy for disability resulting from an on-the-job injury or occupational disease.

 

Q: Are letter carriers who are discharged as a result of a compensable injury entitled to be restored to duty upon recovery from the injury?

A: Yes. 5 U.S.C. 8151, and its implementing regulations, 5 C.F.R. 353.301 et seq., provide three distinct sets of restoration rights for employees discharged as a result of compensable injury.

1) An employee who fully recovers within one year after the date on commencement of compensation is entitled to be restored to duty immediately upon cessation of compensation.

2) An employee who fully recovers more than one year from the date compensation began is entitled to “priority consideration” for restoration to duty, provided the employee applies for reappointment within 30 days of cessation of compensation.

3) An employee who partially recovers from a compensable injury is entitled to have USPS “make every effort, according to the circumstances in each case” to restore the employee to limited duty.

These restoration rights may be enforced through the appeals procedures of the Merit Systems Protection Board (MSPB) by veterans and non-veterans alike. Because MSPB’s procedures are quite formal and quite complex, consideration should be given to obtaining an attorney to handle an appeal (MSPB’s regulations provide, under certain circumstances, for payment of attorney’s fees).

The above cited law and regulations apply to probationary employees, as well as to other employees—and under the Postal Service’s own regulations, a probationary employee restored to duty after the probationary period would have elapsed is not required to complete the probationary period, or to serve a new probationary period. (Ruppert v. USPS, 81 FMSR 5527, illustrates the exercise of restoration rights by a probationary letter carrier.)

 

Q: I am receiving disability retirement benefits from the Office of Personnel Management but need treatment from time to time because of an on-the-job injury sustained in 1966 which is not by itself disabling for work. Can I obtain this treatment at OWCP’s expense?

A: Yes, if you have medical evidence that clearly shows that the treatment is necessary because of the injury. In such case you should send the medical evidence to OWCP and ask for authorization to obtain the treatment at their expense.

 

Q: I was injured on Monday, June 3 and completed a Form CA-1 (Employees’ Notice of Traumatic Injury and Claim for Continuation of Pay Compensation) on Friday, June 7. The Postal Service has granted me continuation of pay (COP) effective June 7—denying me COP for the period June 3–6, 1985. Is this correct?

A: No. Retroactivity of a proper claim for COP filed within 30 days of the date of injury is required of the employing agency.

In this respect, OWCP’s regulations at 20 CFR 10.204(b) state: “The 45 days during which pay may be continued pursuant to this sub-part are calendar days and if the employee has stopped work due to the disabling effects of the injury, the period starts at the beginning of the first full day or first full shift during which the disability begins provided such disability began within six months of the occurrence of the injury.”

OWCP’s regulations also provide, again at 20 CFR 10.204(b): “The agency will keep the employee in a pay status for any fraction of a day or shift on which the disability begins with no ‘charge’ to the 45 day period. If the employee stops work for only a portion of a day or shift (other than the day or shift when disability begins), such day or shift will be considered as one calendar day. If the employee is not immediately disabled due to the injury, the 45 days will begin on the first full day or the first full shift when disability begins.”

If the Postal Service in your area is not granting retroactive COP, you should contact OWCP directly or through your NALC branch—or national business agent.

 

Q: Can I receive FECA compensation benefits at the same time I am in receipt of Social Security Administration benefits?

A: Yes, because OWCP does not require an election between FECA compensation benefits and Social Security benefits. In certain situations, however, the Social Security Act provides for a reduction in Social Security benefits—and will require employees to report workers’ compensation benefits such as FECA compensation. If Social Security payments are reduced because of the receipt of FECA compensation, it will be undertaken by the Social Security Administration (SSA)—not OWCP—and the SSA will inform the employee of the reasons for its action.

 

Q: I have been off work as a result of an on-the-job injury for two months. The Postal Service has advised me that I must provide medical evidence that I am able to return to work before I am allowed to return. Must I do so?

A: Yes. Section 864.3 of the Postal Service’s Employee and Labor Relations Manual provides: “Employees returning to duty after 21 days or more of absence due to illness or serious injury must submit medical evidence of their ability to return to work, with or without limitations

 

Q: Is it proper procedure for a Postal Service supervisor to accompany an injured employee to the employee’s physician of choice in non-emergency situations?

A: Absolutely not. Such action is expressly prohibited by 543.223 of the Postal Service’s Employee and Labor Relations Manual.

 

Q: Can the Postal Service compel me to be examined by my physician of choice during non-work hours?

A: No, there is no authority in the FECA, OWCP’s regulations, or the Postal Service’s Employee and Labor Relations Manual which would enable a Postal Service installation to require an injured employee to undergo examination or treatment by any physician, including a Postal Service medical officer or contract physician, during non-work hours.

 

Q: Can the Postal Service require that I be examined by a postal medical officer or contract physician before I am examined and treated by my physician of choice?

A: Yes, provided the examination is performed promptly after your report of injury and does not interfere with the issuance of Form CA-16 (“Request for Examination and Treatment”) to your physician; your right to seek prompt examination and treatment from your physician; or with the examination and treatment by your physician.

 

Q: Will I be paid for a holiday if it falls on a day while I am receiving continuation-of-pay (COP) as a result of an on-the-job injury?

 

A: Yes. COP is provided for a period of time not to exceed 45 calendar days, not work days; and therefore includes holidays, weekends, scheduled days off, etc.

 

Q: I have been receiving OWCP compensation benefits for three years. If I elect to receive disability retirement benefits from the Office of Personnel Management (OPM) in place of continued OWCP compensation benefits, will the three years count toward my retirement benefits?

A: No. The FECA, at 5 USC 8151(a), provides that an employee receiving OWCP compensation benefits must return to work with his or her former employing agency (or another Federal agency) in order to receive credit toward retirement for the time he or she was compensated by OWCP.

 

Q: Will my spouse receive OWCP benefits if I die as a result of my OWCP-accepted cardiovascular condition?

A: Yes—but only if the medical evidence clearly shows and OWCP accepts that the death was caused, accelerated (hastened) or precipitated by the employment-related condition—and not another factor (e.g., kidney failure unrelated to the cardiovascular condition).

 

Q: Are my OWCP compensation benefits subject to cost-of-living adjustments (COLAs); and, if so, how are they computed?

A: OWCP beneficiaries do receive COLAs—based on changes in the Consumer Price Index for Wage Earners and Clerical Workers (CPI-W). In order to qualify for an OWCP COLA, the beneficiary must be in receipt of compensation for more than one year prior to March 1, the annual date on which OWCP COLA increases take effect. A COLA increase is also applicable in a death case where the injury occurred one year or more prior to March 1, although the death occurred less than one year prior to March 1.

An OWCP COLA is equal to the percentage change in the CPI-W for the 12 months of the preceding calendar year—computed by calculating the percentage change in the CPI-W from December to December (e.g., the March 1988 COLA increase was based on the percentage change in the CPI-W between December 1986 and December 1987). If a disabled employee is receiving OWCP compensation benefits based on a recurrent pay rate, the recurrent pay rate must be in effect for one year before the employee qualifies for a COLA.

 

Q: My annual leave balance is being reduced each pay period while I am in receipt of OWCP compensation benefits. Is this proper?

A: In order to receive compensation benefits, an employee must be in leave without pay (LWOP) status; and an employee in LWOP status does not accrue annual (or sick) leave. Because the Postal Service credits each full-time employee at the beginning of the leave year with the total number of annual leave hours the employee will earn for that leave year, the employee’s leave credits must be appropriately reduced if the employee enters LWOP status equivalent to at least one full pay period.

 

Q: Must I provide a medical report showing that I am able to return to work when I recover from an on-the-job injury?

A: The Postal Service’s Employee & Labor Relations Manual provides, in part, at 864.41-42: “Employees returning to duty after 21 days or more of absence due to illness or serious injury require medical certification. Employees must submit medical evidence of their ability to return to work, with or without limitations…In cases of occupational illness or injury, the employee will be returned to work upon certification from the treating physician, and the medical report will be reviewed by a medical officer or contract physician as soon as possible thereafter.”

 

Q: Can the Postal Service require me to submit to a fitness-for-duty examination when I am returning from an on-the-job injury—when I provided a medical report from my attending physician certifying that I can return to full duty?

A: Yes. The Postal Service’s ELM (see above), provides at 547.34(b) that a fitness-for-duty examination can be initiated at any time to determine the status of an injured employee.

The ELM also provides, at 864.32 “Management can order fitness-for-duty examinations at any time and repeat, as necessary, to safeguard the employee or coworker. Specific reasons for the fitness-for-duty should be stated by the referring official.”

 

Q: I was injured in an auto accident when I was on a direct route to my attending physician’s office for purposes of follow-up treatment based on an on-the-job injury. Can I receive OWCP benefits for this second injury?

A: Yes. An employee who is injured while traveling to or from home or work for the purpose of undergoing authorized examination or treatment for a work-related injury or disease is covered by the FECA. Similarly, an employee confined to an OWCP-authorized hospital has coverage for any new injury or disease which occurs as a result of the hospital’s care (i.e., if the medical care causes a second injury or condition, the resulting disability is compensable).

 

Q: OWCP is charging interest on an overpayment of compensation benefits. Is this proper?

A: Overpayments of OWCP compensation benefits have been subject to interest charges effective with passage of the Debt Collection Act of 1982 (P.L. 97-385); however, implementation was delayed until 1985. The interest rate changes at the beginning of each calendar year and the current rate (effective January 1, 1988) is 6.0 percent.

 

Q: My claim was denied by OWCP because I sustained an “idiopathic fall.” Can you explain?

 

A: An idiopathic fall is a fall that occurs because of an employee’s internal physical condition (e.g., epilepsy) as opposed to a fall caused by an external object or factor (e.g., a slip or trip). In such cases, OWCP follows this policy:

· If an employee has a pre-existing condition, the condition itself caused the fall and the employee hit no intervening object when falling, then the injury resulting from the fall (like the pre-existing condition) is not compensable.

· If such an employee hits an intervening object when falling or falls from one level to another (e.g., from a ladder), or if the cause of the fall is unknown, then the employee is covered by the FECA—but only for the injury resulting from the fall.

For example, a letter carrier who suffers an epileptic attack while working, falls to the floor, and suffers a head injury would not be eligible for OWCP benefits. If this same letter carrier hit a case as he or she fell, the resulting head injury would be covered by the FECA.

 

Q: Are workers’ compensation benefits payable by OWCP subject to federal tax?

A: No—based on the specific authority of the Internal Revenue Code (26 USC 104).

 

Q: My physician has written to OWCP and said that my medical condition is probably related to my work as a letter carrier. Why is OWCP questioning his opinion?

A: “Probably” is speculative and not acceptable to OWCP. A claim must be supported by medical evidence that clearly shows that the employee’s medical condition is causally related to the employment factors identified as the basis of the claim.

Medical opinions which contain the words “might be,” “may be,” or “could be” are almost worthless because they are not definitive—i.e., they are speculative. Note: A medical opinion must not only be definitive—but must contain the physician’s medical reasons (medical rationale) for the opinion provided.

 

Q: I have been receiving OWCP compensation benefits for many years because I cannot work anymore. My physician is very annoyed by OWCP’s requests for periodic medical reports. Why does OWCP keep requesting periodic reports?

A: FECA benefits, like all workers’ compensation benefits, are not considered to be retirement benefits. With some rare exceptions, the FECA provides benefits only for as long as there is continuing medical proof of employmentrelated disability for work—hence OWCP’s periodic (usually yearly) requests for medical updates.

The principal exceptions are described in the FECA itself which, at 5 USC 8105, provides that “the loss of use of both hands, both arms, both feet, or both legs, or the loss of sight of both eyes, is prima facie permanent total disability.”

Other exceptions are based on individual OWCP determinations to the effect that the disability, combined with age and other factors, is so severe as to permanently disqualify the injured employee for all work—and not just the work being performed at the time of injury. Being disabled for all work means just that—the results of the injury are so severe that the employee cannot perform any type of remunerative employment.

 

Q: I would like to have a copy of the medical report sent to OWCP by a physician selected by OWCP as a “second opinion specialist.” The doctor refused to give me a copy. Can I obtain a copy from OWCP?

A: Yes. Based on your written request, OWCP will send a copy to you or to your authorized representative (in certain cases, such as a psychiatric report, OWCP will only send the copy to your representative or your attending physician).

Note: Employees are entitled to obtain a copy of any medical report obtained by OWCP, including reports by Postal Service physicians and OWCP-selected “impartial medical specialists”—or any other document within the employee’s OWCP compensation case file.

 

Q: I am receiving compensation benefits from OWCP for an employment-related injury. Will my spouse receive benefits from OWCP if I die?

A: Only if your death is causally related to the OWCP-accepted medical condition. If you die from other causes (e.g., a heart attack having no relationship to a back disability), OWCP’s compensation benefits will cease as of the date of your death and your spouse will receive no benefits from OWCP. Your spouse may, however, be entitled to survivors benefits from the Office of Personnel Management—provided your spouse is eligible.

 

Q: I have been told that OWCP uses computers in conjunction with computers in other government agencies to determine if employees are receiving dual benefits—or working. Is this true?

A: Yes. OWCP and the Office of Personnel Management run computer matches of their respective rolls for purposes of identifying situations where beneficiaries are receiving prohibited dual benefits (only OWCP schedule award benefits are payable concurrently with OPM benefits).

The Postal Service and OWCP engage in computer matches with the goal of identifying postal employees who are actively working and are also listed by OWCP as debtors based on FECA overpayments.

There are also numerous other computer match programs which OWCP engages in—as part of a continuing monitoring of the OWCP compensation rolls.

 

Q: I slipped and fell on the steps of a patron’s house—an elderly lady who has always been very pleasant to me. OWCP says I must sue her as the third party responsible for my injury. Must I?

A: The FECA provides OWCP with the authority to require you to prosecute the third party responsible for your injury—or to assign your right to prosecute to OWCP. In addition, and as the result of an agreement between OWCP and the Postal Service, the Postal Service has been given the right to accept assignments of the right to prosecute. The penalty for refusing to prosecute or to assign your right to prosecute is loss of compensation benefits (you are not, however, required to assign your right to prosecute to the Postal Service if you decide to prosecute in your own name).

 

Q: I am partially disabled as a result of an on-the-job injury and my Postal Service employment was terminated some time ago. OWCP has been paying compensation benefits to me for several years on the basis of a loss in earning capacity. The Postal Service has now requested that I report for a medical examination to see if I can return to work. Must I do so?

A: Compensation based on a loss of earning capacity reflects a determination by OWCP that your disability is partial—not total—and the FECA specifies that a partially disabled employee is not entitled to compensation if the employee refuses to seek work or refuses or neglects to work after suitable work is offered. Consequently, it is best to cooperate with the Postal Service because if you do not, your refusal may be used by the Postal Service to try to convince OWCP that you have refused suitable work.

 

Q: I slipped and fell on the workroom floor, injuring my right arm and back. No permanent disability resulted and I received continuation-of-pay (COP)—and compensation benefits for my time off. Can I obtain additional compensation for my pain and suffering?

A: No. Pain and suffering is not compensable as such under the FECA. Pain may, however, be a factor in arriving at the amount of a schedule award payable to an employee who suffers the permanent total or partial loss or loss of use of certain statutorily listed (scheduled) members, organs, or functions of the body.

 

Q: My compensation payments were delayed for several months through no fault of my own or that of my employing agency. Will OWCP pay me interest?

A: No. There is no provision in the FECA for interest payments on compensation that has been delayed. Congress would have to enact, and the President sign, legislation to permit interest payments.

 

Q: Who can represent me in a claim for FECA compensation benefits—and who pays the representative for his or her services.

A: The FECA provides that an employee or survivor may authorize an individual to represent the employee or survivor before any proceeding under the Act. Any knowledgeable member of the NALC can represent an employee or survivor. Should the employee or survivor select an attorney or other representative who charges a fee for the representation service, the amount of the fee must be approved by OWCP based on an itemized statement submitted by the representative showing the necessary work done. A contract between the employee or survivor and the representative for the payment of an agreed sum or a sum based on a contingency contract will not be recognized by OWCP. Once approved by OWCP, payment of the fee is a matter between the employee or survivor and the representative. The OWCP can neither direct the payment of or assist in the collection of a legal fee (i.e., payment of the fee is the responsibility of the employee or survivor.

 


Federal Workers Compensation Consultants

Workers Compensation and Disability Retirement Specialists

9639 N. Armenia Avenue

Tampa, Florida 33612

Telephone 813-931-1984

Fax 813-931-4905

bill.hackney@verizon.net

lenny.perez@verizon.net

vivi.perez@verizon.net

http://www.federal-workers-comp.com

Se Habla Espanol – 813-931-1984

_______________________________________________________

Copyright © 2011 Federal Workers Compensation Consultants

Website Design by SunWebMarketing.com
Free Review of Your Schedule Award

Recently our experts have been finding systematic mistakes in the way the federal government has been paying OWCP Schedule Awards to injured federal workers. We have been able to identify these mistakes in about 60% of the cases we have been asked to review.

The result is that we have been able to recover additional money for those injured federal workers. How can you determine if your OWCP Schedule Award has been paid correctly?  Let us help you.

To read more, click here.