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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.