Federal Workers’ Compensation Lawyer
Injured federal workers receive benefits under the Federal Employee Compensation Act (FECA), which is administered by the Office of Workers Compensation Procedures (OWCP), which is an arm of the Department of Labor (DOL). If you are on this page, you have questions about an on-the-job injury, which has impacted yourself, a friend or family member. The following is an overview and some insights regarding the law controlling the claim. If you have specific questions, please feel free to give me a call or send me an e-mail, it is important to work with an experienced federal workers’ compensation lawyer.
Every federal employee who is injured on the job must file a claim with the employer, who will notify the OWCP, which will assign a claim number to the case. Your receipt of a claim number does not mean that the claim has been accepted, only that the Notice of Injury has been acknowledged. The appropriate Notice of Injury usually starts with either a CA-1, CA-2 or CA-2a.
I would suggest that over 95% of the questions on Federal Workers’ Compensation that I have been asked over the years are about the issues listed below. You will first see a short synopsis, and then, a discussion of each issue as you proceed down the page. Most issues have a corresponding video found on our Video FAQS page.
|FORMS||CA-1, CA-2 or CA-2a are usually filed following the injury.|
|CONTINUATION OF PAY||Paid by employer for first 45 days following an injury that occurred at one time or over the course of one shift.|
|WAGE LOSS BENEFITS||Paid by OWCP, rather than the employer, from the date of injury for injuries that are sustained over the course of more than one shift. Wage loss is also paid by the OWCP from the 46th day, onward, for the above injuries that occurred during one shift.|
|MEDICAL CARE||Authorized and paid by the OWCP.|
|SCHEDULE AWARDS||Paid by the OWCP for permanent impairment to accepted conditions.|
|APPEALS||The choice of Appeal is dependent upon the issue of Denial.|
It is important to understand that the injured worker is the moving party and bears the burden of proof on all issues to which entitlement is requested. Like most areas of government, the system is driven by FORMS.
The most utilized and relevant forms are listed below:
CA-1 – Form CA-1 functions as a notice of (1) traumatic injury and (2) initiates the claim for compensation. It must be filed with the employer within 30 days from the date the injury occurred. The traumatic injury takes place in one moment during the course of one shift. Examples of traumatic injuries include: lifting; falling; motor vehicle accident and other one-time events.
CA-2 – Form CA-2 covers claims for non–traumatic injury and should be filed within 30 days from the time that the injured worker knew or should have known that the injury was brought about by workplace activity. A non-traumatic injury takes place over more than one shift. It is usually brought about by instances of repetitive activity or exposure. Examples include: keyboard use; certain types of continuous lifting or motion activity; exposure to toxins in the workplace.
CA-2a – Form CA-2a is utilized to initiate a claim for recurrence. In that instance, the previously accepted condition was made worse by an on-the-job activity. That worsening of the condition may require additional medical care and wage loss benefits.
CA-7 – Form CA-7 is filed for the purpose of claiming compensation. The first CA-7 is usually submitted to request wage loss payments when the injured worker is unable to return to work.
If the employee suffers a non-traumatic injury, he/she would file form CA-7 immediately to request payment of wage loss since continuation of pay (COP) is not provided for non-traumatic injuries. The Form CA-7 is also utilized to request compensation on a schedule award, as approved by the OWCP.
CA-16 – Form CA-16 is a fantastic tool, which should be utilized by every injured worker who suffers a traumatic injury. It should be provided by the employer to the employee on the day of the injury. Form CA-16 requires the OWCP to pay all doctors visits and diagnostic testing performed on the employee for the first 60 days after issuance of the form. If the form is not provided and the employee does not request it within the first week, it will probably be too late.
CA-20 – Form CA-20 is completed by the treating physician for the purpose of providing medical information necessary to support the claim of the injured worker that the injury and the need for treatment are related to and caused by the workplace activity. Form CA-20 is usually submitted along with the form CA-7 to support the claimant’s request for wage loss payments.
CONTINUATION OF PAY
If the employee suffers a traumatic injury which occurs over the course of one shift on one day, he/she should request and receive continuation of pay (COP) from the employer for the first 45 days. Before the end of that time period, he/she should file the form CA-7 requesting wage loss from the OWCP to be paid from the 46th day, onward.
WAGE LOSS BENEFITS
The need for wage loss benefits arises when the injured worker is unable to return to work as a result of injuries sustained on-the-job. The Department of Labor can provide payment of lost wages from the 46th day of lost time on traumatic injuries or from the first day of lost time on non–traumatic injuries.
Lost wages are paid at a rate of two-thirds of the employee’s average wages for workers who are single and at 75% for those with dependents. For purposes of the statute, a spouse is considered as a dependent. The average wages of the individual are based upon the average of the 52 weeks prior to the date of injury. Particular payments and benefits are factored into and out of the 52-week average. Please contact me if you have specific questions on the issue.
In order to receive wage loss benefits, the injured worker must provide medical evidence that the on-the-job injury has caused or contributed to the inability to return to work or work the full number of normal hours. Many of the inquiries that we receive are in regard to the OWCP Denial of wage loss benefits with a response to the claimant that the medical evidence is insufficient to justify payment of wage loss benefits.
As the moving party, the injured worker must establish, through medical evidence, that the inability to perform the job was the result of an accepted condition, which was caused from the date of the accident or an event that flowed from that accident. The medical evidence should contain an understanding of the mechanism of injury and diagnosis of the condition corroborated by medical studies. Without the medical evidence, the Claims Examiner happily maintains the denial of the claim.
The actual reasons why a Claims Examiner may deny wage loss are numerous. If your particular issue requires additional documentation in order to receive your wage loss benefits, you may wish to contact us.
The law allows the injured worker to pick the first physician. The OWCP essentially controls the medical care after that point. It is important that your physician attempt to determine all the diagnosed conditions sooner rather than later.
We have found that the Department of Labor is much more likely to deny a diagnosed condition presented to them months, or possibly just weeks, after the date of accident. The closer in time that the diagnosis is established, the more likely that it will be accepted by the OWCP.
Usually, the first step is to diagnose the conditions caused by the on-the-job activity and to get those conditions accepted by the OWCP. The next step is to obtain the necessary treatment and care to properly address the injuries and hopefully allow the injured worker to achieve a full recovery.
Often times, a full recovery is not possible. The injured worker is left with a permanent condition, which will require ongoing treatment and/or medications for a lifetime. The OWCP will remain responsible for treatment of those injuries, but they must continue to receive regular treatment notes by the authorized physician explaining the need for the ongoing care.
We have found that the OWCP is much more likely to deny or delay big ticket treatment, including back surgeries, shoulder, hip or knee replacements. I would suggest that the reasoning is twofold. First, the obvious expense of the actual surgery and rehabilitation. Secondly, the Claims Examiner knows that those types of surgeries are for substantial injuries, which usually demand that they pay a very large schedule award for the permanent impairment that the injured worker has sustained.
We have secured millions of dollars in schedule awards over the years for clients with injuries ranging from minor impairment to multiple limb replacements. The OWCP does not like to pay schedule awards for permanent impairment but the law requires that they must if the evidence warrants the recovery.
PLEASE VIEW OUR VIDEO GALLERY AND FREQUENTLY ASKED QUESTIONS (FAQ’S) SECTION FOR MORE INSIGHT AND ANSWERS TO COMMON QUESTIONS AND ISSUES.
A schedule award is a payment based upon the percentage of permanent impairment that an injured worker has sustained to a schedule member. The payment is based upon the percentage approved compared to the total number of weeks payable. For instance, a 10% impairment to the arm will qualify for 31.2 weeks (10% of 312 weeks) of payments. The following is a list of the most often rated body parts:
|Body Part||Total Weeks available|
|Loss of Hearing|
|Loss of vision||160|
A schedule award is payable to an injured worker after he or she has reached maximum medical improvement for the injuries sustained. Maximum medical improvement (MMI) is a point at which no further long-lasting improvement is anticipated by the physician.
Generally, a physician will place an individual at MMI, once they have undergone the treatment regimen established by the physician and approved by the patient. The injured worker need not undergo all treatment and surgeries suggested by the physician. Rather, the injured worker only needs to explore the treatment with which they are comfortable.
Often times, surgeons may recommend procedures that an individual does not wish to explore at that time. If the individual chooses to forgo surgery, he or she can be placed at maximum medical improvement by the surgeon. Similarly, if the patient does not wish to undergo advanced techniques of pain management, including placement of a spinal cord stimulator, the claimant may be placed at MMI by the physician.
It is important to understand that a schedule award cannot be paid during the time that the individual receives payment of wage loss benefits from the Department of Labor. Consequently, the injured worker will usually seek a schedule award after a return to work when the entitlement to wage loss benefits has ended.
If the individual expects to remain on wage loss benefits well after being placed at maximum medical improvement, it may be helpful to consider obtaining OPM disability retirement. The law does allow the injured worker to receive the full payment of the schedule award from the OWCP and the full payment of OPM disability retirement from the Office of Personnel Management.
Many times, we have obtained schedule award payments for clients who we have previously secured OPM disability benefits, as well. In those instances, an injured worker with a spouse or children would receive 75% of their pay from the OWCP and either 60% of their pay or 40% of their pay from OPM for disability. People generally like to get paid more than 100% of their pay when they are legally allowed to do so.
I believe that many employees at the OWCP take great joy in denying claims of all types, whether they see an initial claim of injury, a request for wage loss benefits, medical care or a schedule award. It is my opinion that most of the Claims Examiners are miserable in their jobs and they take it out on the injured worker who certainly did not ask to be in such a miserable situation.
In most instances, the injured worker will have three choices of appeal. They include Request for Hearing, Request for Reconsideration or appeal to Employee Compensation and Appeals Board (ECAB).
Request for Hearing – Must be requested within 30 days of the written Decision. It can take as long as 6 to 8 months to have a hearing, which is usually held by telephone before a Hearing Representative. The Hearing Representative is not a judge but does make a written decision in your claim. The Hearing Representative is also not a physician and cannot interpret medical records. Any medical issues must still be presented to either a District Medical Advisor or be accomplished by a request for a second opinion.
Request for Reconsideration – Must be provided within one year from the date of the written Decision. This appeal is reviewed by a Senior Claims Examiner who has not seen the claim in the past. A written Decision is usually issued in approximately 90 days. Any medical issues are usually submitted to a District Medical Advisor for consideration or prompt the Senior Claims Examiner to request a second opinion or referee opinion.
Employee Compensation and Appeals Board (ECAB) – ECAB is like the Supreme Court of Federal Workers’ Compensation. Unlike the prior two appeals where the appellant can provide new evidence, ECAB can only review the evidence that was previously submitted to the OWCP. An appeal to ECAB must be made within 180 days from the date of the written Decision. It usually takes ECAB approximately one year to issue their decision.
The appeal that is chosen greatly depends upon the claim and the type of appeal. The choice of appeal is also dependent upon the timeline and the needs of the injured worker and their family. If you have questions on an appeal, you should contact a federal workers’ compensation lawyer.
If you would like a schedule award or if your claim has been denied, we can probably help. We can certainly answer your questions and clarify the issues and options that you have with the OWCP. Our fee arrangement will depend upon your particular issues, contact an experienced federal workers’ compensation lawyer for assistance today.