Understanding OWCP Injury Compensation: Key Terms and Processes

Injury compensation is a very complex subject, the Federal Employees’ Compensation Act (FECA), is administered by the Office of Workers’ Compensation Programs (OWCP). In OWCP’s administration of the FECA there are many terms used by OWCP that are addressed below that are commonly used by OWCP.

Core OWCP Claimant Terms

• First, Claimant – A person who files a claim for a government benefit.
• Next, Burden of proof — The claimant, and not OWCP, has the burden of proving entitlement to benefits, this occurs after the claim has been filed and is with the CE for decision.

OWCP Eligibility Criteria (Five Steps)

To determine eligibility, OWCP follows five steps:

1. Coverage: Confirm the claimant qualifies as an employee under FECA.
2. Timely Filing: Check that the claimant met all time limits.
3. Fact of Injury: Whether a personal injury actually occurred. The term injury includes all diseases proximately caused by the employment. This is a two-part process, fact of injury factual (did the injury occur), fact of injury, medical (is there a medical diagnosis).
4. Performance of Duty: Show the injury occurred while working.
5. Causal Relationship: Whether the disability claimed is causally related to a personal injury sustained in the performance of duty—or to conditions of employment. The term “causal relationship” includes direct cause as well as aggravation, acceleration (hastening) and/or precipitation.

Choosing Physicians and Benefits

i. Choice of physician:

The claimant has a right to initial free choice of treating physician but must take steps to exercise that right. Restrictions apply—including limitations on the services of chiropractors.

ii. Choice of benefits:

In traumatic cases, the claimant chooses continuation-of-pay (COP) or leave; in occupational cases, chooses compensation or leave. COP covers up to 45 calendar days, then compensation may begin.

iii. Waiting period:

There is a three-day waiting period (without pay) before compensation begins.

Medical Evidence and Disability Types

• Medical Evidence: Compensation is payable only when supported by medical evidence that shows that the disability is causally related to the injury or conditions of employment. Medical evidence must also contain medical rationale (medical reasoning) in all but the most obvious situations.
• Types of Disability: Disability can be temporary total (no work at all); temporary partial (work is possible within medical limitations); permanent total; or permanent partial (the claimant has an earning capacity although unemployable in the job held at time of injury).

Compensation, Survivor Benefits, and CPI Adjustments

• Compensation for Wage Loss – Usually pays 66 ⅔ % of the pre-injury wage, or 75 % if the employee has dependents, within set maximum and minimum limits.

• Survivor Benefits – Provide 50 % to a spouse with no child, 45 % plus 15 % per child (up to 75 %) when children exist, or 40 % for one child and 15 % per additional child when no spouse exists.

• CPI Adjustments – The system adds cost-of-living increases automatically each March for claimants on the periodic roll.

Schedule Awards and Controversion

• Schedule Awards – OWCP pays these when maximum medical improvement (MMI) shows permanent loss of function; awards do not overlap wage-loss payments.

• Controversion – An employing agency may deny COP for reasons listed in 20 CFR § 10.220 but must notify the claimant under § 10.221.

Return-to-Work and Earning Capacity

• Return to Work – Light duty:  This occurs when the claimant is still improving needing restrictions to return to work. Permanent job offer occurs when the claimant requires restrictions and has medically improved where the work-related condition is stable, but claimant cannot return to their date of injury job.
• Earning Capacity Determinations: OWCP reduces compensation when a partially disabled employee can earn wages. Using the Shadrick Formula, staff compare current earning ability with pre-injury wages:
  
  

  • LWEC – Applies after a claimant returns to lower-pay work.

  • CWEC – Applies when vocational rehab shows the claimant could earn in private work even if not employed.

Dual Benefits and Key Medical Exam Terms

• Dual Benefits – OWCP compensation cannot overlap most OPM or certain VA benefits; Social Security may adjust.

• AP (Attending Physician) – The claimant’s primary treating doctor.

• SECOP (Second Opinion Exam) – OWCP orders a new exam when the AP report lacks detail.

• IME (Referee Exam) – OWCP appoints an impartial specialist to settle conflicting medical opinions; the referee’s report generally carries the most weight.

Appeal Rights for OWCP Decisions

There are provisions for hearings, reconsideration, and appeals in disallowed cases—all with time limits.

1. Hearing and Review: The FECA (5 U.S.C. 8124(b)) states that a claimant not satisfied with a formal decision is entitled to a hearing by an BHR representative if the request is made within 30 days of the date of the decision.
2. Employees’ Compensation Appeals Board (ECAB): Claimants must file an application for review by ECAB within 180 days from date of decision.
3. Reconsideration : An application for reconsideration must be received by OWCP within one year of the date of OWCP’s decision for which review is sought.

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