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When an injured federal employee or a representative of a federal employee files a notice of a claim with the Office of Workers’ Compensation the wheels of the OWCP begin to turn. Initially, FECA was passed to provide injured federal employees a system to provide them relief when wages are lost due to a work related injury. Although FECA was designed to benefit the injured federal employee, FECA quickly became a liability to the managers of federal agencies. Meaning, the budgets of certain federal agencies became consumed with workers’ compensation claims. The Federal Government soon realized that well trained supervisors and managers were needed to limit the processing of successful workers’ compensation applications.

If you have received a dated letter from the OWCP important rights may be lost if you fail to act within prescribed time periods. Appeals, reconsiderations, review of the record and oral hearings are just a few of the processes that an injured federal employee can choose when looking for answers and relief from the OWCP or ECAB.

Experienced representation is most beneficial when the OWCP denies your application for compensation or seeks to terminate or reduce the compensation benefits you already receive. With extremely rare exceptions, a claimant has thirty (30) days to respond to any of these notices. An experienced attorney can review the medical evidence in your case and, perhaps, more completely, accurately and persuasively present your case to either the OWCP or ECAB.

Perhaps OWCP has requested that you be evaluated by an OWCP Doctor. Do you know what to expect? Do you realize that OWCP has already provided a summary of your case to the Doctor that is going to evaluate you? How do you know if the summary provided to the Doctor is accurate? Minimizing federal workers’ compensation claims benefits the federal government and the OWCP. Do you think the summary of your case is told in a favorable light to you or the federal agency for which you work? Attorney Douglas Sughrue will make sure you are prepared for what lies ahead.

Learn more about :

We help Injured Federal Employees:

  • File for benefits
  • Retain their benefits when faced with termination
  • Reacquire their benefits if they were terminated
  • Obtain/develop schedule awards for loss of use of a body part(s)

We help several different types of federal employees. When a federal worker is injured on the job, their claim is either accepted, under development or denied. Usually, obvious traumatic injuries are accepted without being refuted by the employing agency. Other more subtle injuries, occupational injuries or diseases, soft tissue injuries or injuries reported after a delay are often disputed by the employing agency. These injured federal workers are the people we help. We help them by developing their claim. We help gather the necessary factual and medical evidence so that the injured federal worker can meet the burden of proof to receive the lost wage and medical benefits they deserve.

We also help federal employees injured on the job who have an accepted claim, but are facing the termination of the benefits by OWCP. Usually, OWCP begins the termination of benefits process by sending an injured federal worker with an accepted claim to a second opinion examination (SECOP). If that doctor provides an opinion that the disability has ceased or that the disability is no longer related to the accepted work factors, then the OWCP will send the injured federal employee a letter title “Proposed Termination of Benefits.” By rule/regulation the Claimant has 30 days to respond by providing factual or medical evidence contrary to the opinion of the SECOP doctor. We help those employees respond to the proposed termination by working with the injured federal employee’s doctor to develop the medical evidence which will help preserve the injured federal employee’s benefits. We also review the injured federal employee’s file to confirm that the OWCP followed proper procedures. Benefits can be retained by showing proper procedures were not followed or by providing additional medical evidence that the disability still persists.

We also help federal employees who were injured on the job and as a result of said accepted injury, lost the use of a body part. Obtaining benefits for loss of use of a body part is called requesting a scheduled award. For schedule awards, we help the claimant file for these benefits as well as appeal the denial of a schedule award. It’s important to note that a schedule award has nothing to do with lost wages and everything to do with the loss of use of a body part, meaning an injured federal employee can lose a leg and only miss a relatively short period of time. So, despite the short time off of work, OWCP will owe the Claimant a payment for loss of use of the leg. In addition, the OWCP will owe the injured federal employee medical benefits for the life of the Claimant as long as the medical benefits requested are due to the accepted work-related injury.

Please refer to the Schedule Awards page for more information.

Much of the employee’s responsibilities begin with prompt and complete disclosure of the injury to a supervisor. Even if unsure as to the seriousness of the injury, an injured federal worker needs to protect themselves from an injury that can become chronic or worsen in condition. An injured federal worker should insist on obtaining a copy of an incident report, develop a list of witnesses and seek medical care of their choosing.  Please refer to the burden
of proof
section to learn to what standard your case and evidence will be held.

After an injured federal employee returns to work (RTW) with restrictions, the IFW must always possess a copy of their work restrictions. The injured federal worker must also rely only upon themselves to stay within their medical restrictions. Often an injured federal employee discredits their own case by being “macho” or not wanting to complain or confront a supervisor with proof that a given task is beyond their medical restrictions.

The employee is responsible for establishing the essential elements of the claim. OWCP will help the employee meet this responsibility, which is termed burden of proof, by requesting evidence needed to establish the elements necessary to prove your claim if such information is not included with the original submittal.

OWCP will try to obtain any pertinent medical evidence in the possession of another Federal facility, including the employing agency, but this assistance does not relieve the employee of his or her burden of proof. Agencies are required by law to provide medical and factual evidence requested by OWCP to adjudicate a claim. Agencies and employees are always entitled to present information not specifically requested by OWCP.

When information is not submitted in a timely manner, delays in adjudicating cases and paying claims often result. To minimize such delay, OWCP will ask the employee and supervisor to submit the required evidence within a specific period, usually 30 days from the date of the request. A copy of any request to the supervisor for information will be sent to the employee, and vice versa.

The medical evidence developed for initial adjudication should provide sufficient information about the nature and extent of disability to permit adjudication of the claim for wage loss. If not, OWCP will follow the procedures for developing medical evidence for wage-loss claims in traumatic injury claims.

Once OWCP accepts a claim, the burden of proof shifts from the employee to OWCP. To rescind the acceptance of a condition or to make a retroactive determination that an employee was not disabled for a period during which compensation was paid, OWCP must demonstrate not only that an error was made but that the weight of the evidence supports a different conclusion about the merits of the claim. In practice, this means that new evidence is virtually always required to rescind an acceptance.

For more details click on the topics below:
A. Traumatic Injury Cases (Including Recurrence and Death) (see page39)
B. Occupational Disease Claims (Including Recurrence and Death) (see page 41)

Conditions of Coverage

Each claim for compensation must meet certain requirements before it can be accepted. This is true whether the claim is for traumatic injury, occupational disease or death. While the requirements are addressed somewhat differently according to the type of claim, they are always considered in the same order. An injured federal employee should be concerned about what types of evidence do they have to prove the following six elements of a claim.

1.Time (See Page 26)

2.Civil Employee (See Page 28)

3.Fact of Injury (See Page 28)

4.Performance of Duty (See Page 29)

5.Causal Relationship (See Page 32)

6.Statutory Exclusions (See Page 35)

Sughrue Law concentrates in the Federal Disability Retirement laws under CSRS and FERS. We know and understand all of the nuances of the Disability Retirement Application process — from the initial submission of the application to the Second Stage of appeal, and the final stage of appeal.

Disability does not mean you must be physically unable to work, out of action, or incapacitated; what it means is that you are no longer able to do your job in the manner in which you are required. In other words, you do not need to be “totally disabled” to be eligible for Federal or Postal Disability Retirement under FERS or CSRS.

Your Federal Disability Retirement will be carefully reviewed by The Office of Personnel Management (OPM). It is a benefit that should not be taken lightly or overlooked—this about your livelihood. Before making any decisions you should consult an attorney that is qualified to provide legal guidance for Federal Disability Retirement.

Alert: A federal employee is only eligible for federal disability up to one year after being separated from service. Please note there is a difference between applying for and electing to receive federal disability retirement benefits, call for more information.

Traumatic Injuries

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 by time and place or occurrence and member of the body affected. It must be caused by a specific event or incident or series of events or incidents within a single day or work shift. Traumatic injuries also include damage to or destruction of prosthetic devices or appliances, including eyeglasses, contact lenses, and hearing aids, if they were damaged incidental to a personal injury requiring medical services.

Occupational Disease

All instances of occupational disease must be documented. An occupational disease is defined as a condition produced in the work environment over a period longer than 1 workday or shift. It can result from systemic infection, repeated stress or strain, exposure to toxins, fumes, or other continuing conditions in the work environment. Examples are carpal tunnel syndrome or asbestosis caused by the duties or work environment.

Permanent Injuries

The Federal Employees’ Compensation Act (FECA) provides a schedule of benefits for permanent impairment of certain members, functions and organs of the body such as the eye, arm, or kidney and for serious disfigurement of the head, face or neck. For example, an award of 160 weeks of compensation is payable for total loss of vision in one eye. In addition, compensation for loss of earning capacity may be paid if the employee is unable to resume regular work because of injury-related disability. This compensation is paid on the basis of the difference between the employee’s capacity to earn wages after an injury and the wages of the job he or she held when injured. OWCP may arrange for vocational rehabilitation and provide a maintenance allowance not to exceed $200 per month. A disabled employee participating in an OWCP-approved training or vocational rehabilitation program is paid at the compensation rate for total disability. If the employee’s condition requires a constant attendant, an additional amount not to exceed $1500 per month may be allowed.

For additional information on schedule awards click here.

Temporary Total Disabilities

An employee who sustains a disabling, job-related traumatic injury may request continuation of regular pay for the period of disability not to exceed 45 calendar days or sick or annual leave. If disability continues beyond 45 days or the employee is not entitled to continuation of pay, the employee may use sick or annual leave or enter a leave without pay status and claim compensation from OWCP. When disability results from an occupational disease, the employing agency is not authorized to continue the employee’s pay, i.e., the Claimant is not able to receive continuation of pay. The employee may use sick or annual leave or enter a leave without pay status and claim compensation. Compensation for loss of wages may not be paid until after a three-day waiting period, except when permanent effects result from the injury or where the disability causing wage loss exceeds 14 calendar days. Compensation is generally paid at the rate of 2/3 of the salary if the employee has no dependents and 3/4 of the salary if one or more dependents are claimed.

The term “dependent” includes a husband, wife, unmarried child under 18 years of age, and a wholly dependent parent. An unmarried child may qualify as a dependent after reaching the age of 18 if incapable of self-support by reason of mental or physical disability, or as long as the child continues to be a full-time student at an accredited institution, until he or she reaches the age of 23 or has completed four years of education beyond the high school level.

Death Benefits

If no child is eligible for benefits, the widow or widower’s compensation is 50 percent of the employee’s pay at the time of death, if death was due to the employment-related injury or disease. If a child or children are eligible for benefits, the widow or widower is entitled to 45 percent of the pay and each child is entitled to 15 percent. If children are the sole survivors, 40 percent is paid for the first child and 15 percent for each additional child, to be shared equally. Other persons such as dependent parents, brothers, sisters, grandparents, and grandchildren may also be entitled to benefits. The total compensation may not exceed 75 percent of the employee’s pay or the pay of the highest step for GS-15 of the General Schedule, except when such excess is created by authorized cost-of-living increases.

Compensation to an employee’s surviving spouse terminates upon his or her death or remarriage. A widow or widower’s benefits continue, however, if the remarriage takes place after the age of 55. Awards to children, brothers, sisters and grandchildren terminate at the age of 18, unless the dependent is incapable of self-support, or continues to be a full-time student at an accredited institution, until he or she reaches the age of 23, or has completed four years of education beyond the high school level.

Burial expenses not to exceed $800 are payable. Transportation of the body to the employee’s former residence in the United States is provided where death occurs away from the employee’s home station. In addition to any burial expenses or transportation costs, a $200 allowance is paid for the administrative costs of terminating an employee’s status with the Federal Government.

Recurrences

A recurrence has a few definitions. A Claimant needs to understand that the medical providers may use the term “recurrence” when describing your condition, but the OWCP defines recurrence differently than most medical providers. OWCP defines a recurrence of disability as an inability to work after an employee has returned to work, caused by a spontaneous change in a medical condition which had resulted from a previous injury or illness without an intervening injury or new exposure to the work environment that caused the illness. This term also means an inability to work that takes place when a light-duty assignment made specifically to accommodate an employee’s physical limitations due to his or her work-related injury or illness is withdrawn (except when such withdrawal occurs for reasons of misconduct, non-performance of job duties or a reduction-in-force), or when the physical requirements of such an assignment are altered so that they exceed his or her established physical limitations. Recurrence of medical condition means a documented need for further medical treatment after release from treatment for the accepted condition or injury when there is no accompanying work stoppage. Continuous treatment for the original condition or injury is not considered a “need for further medical treatment after release from treatment,” nor is an examination without treatment.

Each type of injury is different. Trying to figure out what you are entitled to is not easy. There are many rules and regulations for various injuries which make it difficult to understand for what injuries you can be compensated and by how much.

Permanent Injuries
The Federal Employees’ Compensation Act (FECA) provides a schedule of benefits for permanent impairment of certain members, functions and organs of the body such as the eye, arm, or kidney and for serious disfigurement of the head, face or neck. For example, an award of 160 weeks of compensation is payable for total loss of vision in one eye.  In addition, compensation for loss of earning capacity may be paid if the employee is unable to resume regular work because of injury-related disability. This compensation is paid on the basis of the difference between the employee’s capacity to earn wages after an injury and the wages of the job he or she held when injured.  OWCP may arrange for vocational rehabilitation and provide a maintenance allowance not to exceed $200 per month. A disabled employee participating in an OWCP-approved training or vocational rehabilitation program is paid at the compensation rate for total disability. If the employee’s condition requires a constant attendant, an additional amount not to exceed $1500 per month may be allowed.

Temporary Total Disabilities
An employee who sustains a disabling, job-related traumatic injury may request continuation of regular pay for the period of disability not to exceed 45 calendar days or sick or annual leave. If disability continues beyond 45 days or the employee is not entitled to continuation of pay, the employee may use sick or annual leave or enter a leave without pay status and claim compensation from OWCP.  When disability results from an occupational disease, the employing agency is not authorized to continue the employee’s pay. The employee may use sick or annual leave or enter a leave without pay status and claim compensation.  Compensation for loss of wages may not be paid until after a three-day waiting period, except when permanent effects result from the injury or where the disability causing wage loss exceeds 14 calendar days. Compensation is generally paid at the rate of 2/3 of the salary if the employee has no dependents and 3/4 of the salary if one or more dependents are claimed. The term “dependent” includes a husband, wife, unmarried child under 18 years of age, and a wholly dependent parent. An unmarried child may qualify as a dependent after reaching the age of 18 if incapable of self-support by reason of mental or physical disability, or as long as the child continues to be a full-time student at an accredited institution, until he or she reaches the age of 23 or has completed four years of education beyond the high school level.

Death Benefits
If no child is eligible for benefits, the widow or widower’s compensation is 50 percent of the employee’s pay at the time of death, if death was due to the employment-related injury or disease. If a child or children are eligible for benefits, the widow or widower is entitled to 45 percent of the pay and each child is entitled to 15 percent. If children are the sole survivors, 40 percent is paid for the first child and 15 percent for each additional child, to be shared equally. Other persons such as dependent parents, brothers, sisters, grandparents, and grandchildren may also be entitled to benefits. The total compensation may not exceed 75 percent of the employee’s pay or the pay of the highest step for GS-15 of the General Schedule, except when such excess is created by authorized cost-of-living increases. Compensation to an employee’s surviving spouse terminates upon his or her death or remarriage. A widow or widower’s benefits continue, however, if the remarriage takes place after the age of 55. Awards to children, brothers, sisters and grandchildren terminate at the age of 18, unless the dependent is incapable of self-support, or continues to be a full-time student at an accredited institution, until he or she reaches the age of 23, or has completed four years of education beyond the high school level. Burial expenses not to exceed $800 are payable. Transportation of the body to the employee’s former residence in the United States is provided where death occurs away from the employee’s home station. In addition to any burial expenses or transportation costs, a $200 allowance is paid for the administrative costs of terminating an employee’s status with the Federal Government.

Occupational Disease
All instances of occupational disease must be documented. An occupational disease is defined as a condition produced in the work environment over a period longer than 1 workday or shift. It can result from systemic infection, repeated stress or strain, exposure to toxins, fumes, or other continuing conditions in the work environment. Examples are carpal tunnel syndrome or asbestosis caused by the duties or work environment.

Recurrences
A recurrence is defined as a spontaneous return or increase of disability due to a previous injury or occupational disease without intervening cause, or a return or increase of disability due to a consequential injury.  A recurrence differs from a new injury in that with a recurrence, no event other than the previous injury accounts for the disability. Follow-up medical care for an injury or disease which causes time loss is considered part of the original injury rather than a recurrence unless the employee was previously released from treatment.

Contact Us Now for the Help You Need Today!!
Each type of injury is different. Trying to figure out what you’re entitled to isn’t easy. There are so many rules and regulations for various injuries that it makes it difficult to understand what you can be compensated for and by how much.  

Attorney Douglas Sughrue
412-391-1629
866.525.OWCP (6927)

The Employees’ Compensation Appeals Board (ECAB) was created in 1946 by statute to hear appeals taken from determinations and awards under the Federal Employees’ Compensation Act with respect to claims of federal employees injured in the course of their employment. The Board has final authority to determine the liability of the Federal government with respect to the disability or death of employees injured in the scope of their employment. There is no further administrative or judicial appeal of ECAB decisions. The Board, by statute, consists of three Members appointed by the Secretary of Labor, one of whom is designated as Chairman of the Board and administrative manager.

The Board’s mission is to hear and decide cases on appeal from decisions of the Office of Workers’ Compensation Programs (OWCP) in an impartial and expeditious manner. The decisions of the Board are made in accordance with its statutory mandate, based on a thorough review of the case record as compiled by OWCP. Injured federal workers have the opportunity for a full evidentiary hearing with OWCP’s Branch of Hearings and Review prior to review of the record by the Board*.

Appeals

The Employees’ Compensation Appeals Board (Board) is an appellate body with jurisdiction to consider and decide appeals from the final decisions of the Office of Workers’ Compensation Programs (Office). The Board is independent of and a separate agency distinct from the Office. Once a final decision has been issued by the Office, an appeal may be filed with the Board for up to six months or 180 days from the date of the Office’s decision. The Board does not have authority to authorize requests for medical treatment or other matters relating to the claim during the processing of the appeal. The Board strives to process appeals in the order in which they are filed and as expeditiously as possible.

Representation

An appellant may be represented before the Board by an attorney, union representative, or other individual. The appellant must submit a signed statement authorizing his/her representation before the Board, either by completed items number 8 and 9 on the Application for Review (AB-1) Form or submitting a separate signed statement of authorization. All fees for legal services performed require approval of the Board. The payment of any fee approved by the Board is the responsibility of the appellant.

New Evidence

After the appeal is docketed, a request is made by the Board to the Office to forward the case record. The Board’s review of a case is limited to that evidence which was in the case record at the time the Office issued its final decision. New or additional evidence may not be submitted for consideration by the Board. Should you have new evidence you wish to have considered by the Office, a written request for reconsideration may be addressed to the district office of the Office for the area in which you reside.

Oral Argument

Oral Argument may be requested before the Board and is held only in Washington, D.C. The Board does not pay for travel or incidental expenses related to attending oral argument. The scheduling of the date for oral argument can be expected to add to the time in which the appeal is processed. If oral argument is not requested, the appeal will be considered by the Board based on the case record as submitted by the Office. Oral argument before the Board should not be confused with a hearing before an Office hearing representative. There is no provision for the introduction of new evidence or testimony or questioning of witnesses. Oral Argument is appellate in nature and must be confined to the evidence in the case record and the issues raised.  Attorney Douglas Sughrue do not recommend spending time and money requesting and attending oral argument.  Choosing oral argument is not a effective use of an injured federal employees money.

Board Decisions

The Board will issue a written decision or order in every appeal which sets forth the relevant facts of the case, the applicable law, and the reasoning upon which the Board based its action. A copy of the Board’s final decision will be sent to you and any duly authorized representative. Currently, ECAB decisions are taking between 9-12 months.  For this reason, Attorney Douglas Sughrue concentrate their efforts in front of the OWCP by submitting Reconsiderations which take approximately 90 days for the OWCP to decide.

Petition For Reconsideration

If you are not satisfied with the decision of the Board, a petition for reconsideration may be filed within 30 days from the date of the Board’s decision. The petition should set forth the error of fact or law that you think the Board made; not just that you disagree with the decision. If no petition for reconsideration is filed, the decision of the Board becomes final after 30 days. A decision of the Board is final as to the subject matter appealed and is not subject to court review. After a decision of the Board becomes final, any further request to reopen the claim must be submitted to the district office of the Office for the area in which you reside.

The Office of Workers’ Compensation Programs (OWCP) oversees four programs. The Energy Employees Occupational Illness Compensation program, the Federal Employees Compensation program, the Longshore and Harbor Workers’ Compensation program, and the Coal Mine Workers’ Compensation program.

Since the 1980’s, OWCP has evolved into an organization which is able to respond to changing circumstances, adjusting its procedures and resource commitments to address problems as they surface. Each OWCP program has a strategic plan that projects where it should be in the future to achieve its mission, and sets realistic, measurable steps for getting to that point. Each has as its foundation the following basic principles: high quality and timely claims adjudication and benefit delivery; superior customer service; and cost-effectiveness and fiscal integrity. Improvements achieved in these areas are measured against performance baselines or benchmarks, and outcomes as related to objectives are thus evaluated. OWCP rose to the challenge set by Congress in the Government Performance and Results Act by adopting goals which are challenging and require reaching out to their stakeholders to achieve results in the work outside their direct control.

The OWCP continually works to make these programs more efficient and responsive. In striving to protect worker benefits  the OWCP will work toward:

  • Minimizing the human, social and financial impact of work-related injuries.
  • Improving employer and employee representative performance in the delivery of services to injured workers and in the administration of OWCP statutes.
  • Enhancing the fiscal integrity of managed public trust funds*.