FECA benefits as explained by OWCP
Now that your claim has been accepted,
you should be aware of certain
information concerning payment of bills
and compensation, authorization for
surgery, return to duty, dual benefits,
and rehabilitation services.
BILLS. You are entitled to
medical treatment and expenses related
to treatment for your injury. All
medical bills, except those from
hospitals and pharmacies, must be signed
or stamped by the physician and
submitted on Form OWCP-1500. Also know
as Form HCFA-1500, this form can be
obtained from your agency if your
physician is unfamiliar with it. If any
medical bills related to this injury
were previously returned because your
case had not been accepted, they may be
resubmitted to this Office for
consideration of payment. Travel
expenses should be submitted on SF-1012.
Bills for medical treatment may not be
paid if submitted more than one year
beyond the calendar year in which you
received the treatment or the calendar
year in which the claim was first
accepted as compensable by the Office,
whichever is later. Therefore, all bills
for payment or reimbursement, including
travel vouchers, should be submitted as
promptly as possible after you incur the
expenses. You may ask your physician to
submit bills directly to the district
office, or you may pay the doctor and
submit the paid bill for reimbursement.
Your acceptance letter states the
medical condition(s) which OWCP has
accepted as work-related. Treatment for
those conditions only should be billed
to OWCP.
CONSIDERATION: If you lose (or
expect to lose) pay because of your
injury, you should obtain Form CA-7,
Claim for Compensation on Account of
Traumatic Injury or Occupational
Disease, from your employing agency.
Complete Part A of the form and submit
to your employer for completion of Part
B. In box 6, you may claim the period
your doctor estimates that you will be
disabled for work, or until your next
medical appointment, but not more than
30 days of wage loss. In order to
minimize any possible income
interruption, your employing agency
should submit the completed Form CA-7 to
the Office on the 40th day of COP, and
should include any medical evidence in
its possession concerning the injury.
Any claim for compensation must be
supported by medical evidence of
injury-related disability for the period
you are claiming. Form CA-20, Attending
Physician’s Report, is attached to Form
CA-7 for this purpose. In any report,
your physician should specifically state
the periods during which you are unable
to perform (1) full duty and (2)
restricted duty. It is your
responsibility to arrange for the
submission of supporting medical
evidence.
If you continue to lose pay because of
work-related disability after the dates
claimed on the initial Form CA-7, you
should submit an additional Foam CA-7s,
Claim for Compensation, through your
employer for additional compensation.
Form CA-20, Attending Physician’s
Report, should accompany Form CA-7,
unless medical evidence supporting
disability for the period claimed has
already been submitted. If disability
continues you should submit through your
employer additional Forms CA-7 (and
CA-20 if needed) for each period
claimed, unless otherwise informed by
this Office.
Your employer should submit additional
Form CA-7 to OWCP approximately five
days before the end of the period
claimed in the previous Form CA-7.
SURGERY. You must obtain approval
in advance from this Office for any
surgical other than emergency surgery in
order to insure payment by OWCP. A
second opinion medical examination may
be required before surgery is
authorized. If other than emergency
surgery was performed on account of the
claimed injury before the claim was
approved, you should arrange for
submission of a report from your doctor
stating the reason why the surgery was
necessary. You should also arrange for
submission of a copy of the operative
report.
Concerning any surgery planned for the
future, you should contact this Office
at least 30 days before the doctor plans
to schedule the procedure authorization.
You should arrange for the doctors to
submit a medical report stating the need
for the surgery is authorized at the
expense of this office.
RETURN TO DUTY: If you obtain or
return to any employment, you should
notify this Office immediately. You are
not permitted to receive payments for
temporary total disability while
employed. If you receive any
compensation checks with include payment
for any period you have worked, you
should return them to us immediately to
prevent any overpayment. The employing
agency should also notify Office as soon
as you have returned to duty by calling
the telephone number shown above and
filing Form CA-3, Report of termination
of Disability and/or payment.
DUAL BENEFITS. Claimants are
prohibited from receiving compensation
for wage loss and Federal Retirement
benefits at the same time. Compensation
for wage loss includes payments for
temporary total disability and for loss
of wage-earning capacity. Claimants may,
however, receive compensation for
schedule awards and a retirement annuity
at the same time.
REHABILITATION. You are
responsible for asking your doctor
whether you can perform same work, and
for notifying your agency when your
doctor says you are able to perform some
work. If you are indefinitely disabled
for your usual job, and your agency has
not provided light duty, you are
eligible for vocational rehabilitation
services. We will attempt to arrange
work with your employing agency or a
private employer.
Continued pay or compensation may be
terminated if you refuse work which is
within your medical restrictions without
good cause, and benefits may be reduced
if you fail to cooperate with
rehabilitation and payment efforts.
PENALTY. Any person who knowingly
makes any false statement,
misrepresentation, concealment of fact,
or any other act of fraud to obtain
compensation as provided by the FECA or
who knowingly accepts compensation to
which he or she is not entitled is
subject to felony criminal prosecution
and may, under appropriate U.S. Criminal
Code provisions, be punished by a fine
or not more than $10,000 or imprisonment
for not more five years, or both.
If you have any question concerning your
case, please write or call this district
office.
