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September 1991, Vol. 114,
No. 9
Federal Employees' Compensation Act
Sound medical
evidence: key to FECA claims
Herbert A. Doyle, Jr.
The 75th anniversary of the Federal Employees' Compensation Act (FECA) provides an opportunity to discuss the role of detailed medical evidence in the adjudication of claims. This article examines the medical information the Office of Workers' Compensation Programs (hereinafter referred to as the Office.), the Department of Labor agency responsible for administering FECA, requires to determine that an injury or illness is work-related and thus qualifies the claimant for Federal compensation benefits.
Although there are no statistical data on the role of medical evidence in the adjudication of claims, persons who are experienced with such claims will undoubtedly agree that benefits are denied more because of a lack of proper medical evidence than for any other reason. Claimants must provide medical proof that they qualify for benefits. When the injury or illness is not obvious, a definitive medical statement from an appropriate physician containing the physician's opinion and supporting medical rationale is mandatory.
As in other workers' compensation laws, medical evidence is an essential part of claims filed under FECA, assuming that Office examiners have determined that the injured, ill, or deceased employee is covered by FECA; the claim was filed within FECA's time limitations; and the incidents or factors described as the basis of the claim are work-related.
First, the claimant must prove that an injury has occurred or a medical condition has manifested itself. A medical report from a qualified physician showing a clear and conclusive diagnosis is necessary.
Second, the claimant must prove that the medical condition was caused by a work incident (history of injury) or factors of employment (conditions of employment). Cause, as used in FECA, includes direct cause, aggravation, acceleration (hastening), or precipitation. Hence, a physician's report must show that a causal relationship exists between the medical condition and the work incident or factors of employment.
This excerpt is from an article published in the September 1991 issue of the Monthly Labor Review. The full text of the article is available in Adobe Acrobat's Portable Document Format (PDF). See How to view a PDF file for more information.
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