Office of Workers' Compensation Programs (OWCP)

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Division of Federal Employees' Compensation (DFEC)

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Types of Injuries How to File Claims Evidence Needed for Your Claim How Claims are Processed Medical Care Continuation of Pay (COP) Compensation for Temporary Total Disability Return to Work Dual Benefits Penalty How to Contact OWCP

District Office 2 — New York — How to file a claim

Our Purpose

The Federal Employee's Compensation (FEC) program provides Federal employees who sustain work-related injury or illness with benefits such as medical care, wage loss replacement and help in returning to work. The Federal Employees' Compensation Act, or FECA, (5 U.S.C. 8101 et seq.) is administered by OWCP.

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Types of Injuries

Injuries are either traumatic or occupational. 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 as to time and place of occurrence and member or function of the body affected, and caused by a specific event or series of events within a single day or work shift. Occupational disease or illness is produced by systemic infections; continued or repeated stress or strain; exposure to toxins, poisons, fumes, etc.; or other continued and repeated exposure to conditions of work environment over a longer period of time. A longer period of time means anything beyond a single day or work shift.

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How to File Claims

Report every injury to your supervisor immediately. Submit written notice of injury on Form CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, if you sustained a traumatic injury. Submit written notice of injury on Form CA-2, Notice of Occupational Disease and Claim for Compensation, if the injury was an occupational disease or illness. Obtain claim forms from your Federal employing agency (may also be obtained from OWCP). Complete the front page of the claim form and submit it to your employing agency. Your employing agency will complete the back page and forward the claim to OWCP.

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Evidence Needed for Your Claim

Traumatic injury. Form CA-1 should describe clearly how the injury occurred using a supplemental statement, if necessary. A medical report that includes a history of how the injury occurred, findings, diagnosis, and an explanation of how your condition is related to the injury must be submitted with the claim.

Occupational disease or illness. Occupational diseases or illnesses are usually much more complex than traumatic injuries and require more extensive evidence. A narrative statement should be submitted by the injured worker along with a comprehensive narrative medical report. This is particularly important for emotional conditions. Your statement should describe specific work factors that you believe caused your medical condition. Specific details must be provided and the use of general terms should be avoided. For example, if you do a lot of lifting, describe the types of material lifted, weights, how often lifting is required, and the type of lifting. For emotional conditions, you must describe specific events, dates, those involved, and how the event(s) caused your condition. Vague and general statements are not acceptable.

Medical reports for occupational disease or illness claims must include a history, findings, a diagnosis, and an explanation of how specific work factors are related to the condition. For emotional conditions, the medical report should be from a psychiatrist or licensed psychologist (note: an MFCC is not considered a licensed psychologist under FECA). The report should be in narrative form and include a history, findings, a diagnosis, and explain how your condition is related to specific factors of your employment. It is insufficient for the treating physician to merely state that your condition is work related. The physician should provide a rationalized opinion on how your condition is related to specific factors of employment.

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How Claims are Processed

Your employing agency forwards claims to OWCP within 10 working days. Claims are received in OWCP, and claims data is entered into a computer. Claims are then routed to the Claims Sections for processing. Claims for traumatic injury are processed within 45 days, and claims for occupational disease or illness are processed within 180 days. Claims for occupational orthopedic injury are usually processed within 90 days. In order to process claims in a timely manner, it is important for injured workers to submit a detailed statement on how the injury occurred and a complete medical report (see Evidence Needed for your Claim above).

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Medical Care

If your claim is accepted, FECA provides a broad range of medical benefits and services needed to treat the accepted injury.

Initial choice of physicians. You have the right to choose your physician. If that physician refers you to a specialist, OWCP will honor that referral, as long as it is for the work-related condition. If you wish to change physicians, you must request approval from OWCP. Send a letter to OWCP stating your reasons for wanting this change, along with the name, address, and specialty of the physician to whom you wish to change. OWCP will not pay bills from physicians whom we have not approved, other than your first choice of physicians.

Chiropractic care. The FECA recognizes chiropractors as physicians only to the extent that their reimbursable services are limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist, and the X-ray must be taken within a reasonable time after the injury.

Physical therapy. If your injury requires physical therapy, the request for authorization may be faxed to (800)215-4901. The physician's office can also call (866)335-8319. These numbers are toll free.

Surgery. OWCP must approve in advance any surgery other than emergency surgery (that is, a procedure which must be performed right away to preserve life or the function of an organ or body part).

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Continuation of Pay (COP)

If you suffered a traumatic injury, you are probably entitled to receive continuation of your regular pay (COP) for up to 45 calendar days. Your employing agency pays COP, and all usual deductions from your salary will be made. Form CA-1 must be filed within 30 days of the injury in order to be entitled to COP. If you suffered an occupational disease or illness, you are not entitled to receive COP. COP is for traumatic injury only.

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Compensation for Temporary Total Disability

If you lose, or expect to lose, pay (beyond 45 days for traumatic injury) because of your injury, you should:

Obtain Form CA-7, Claim for Compensation on Account of Traumatic Injury or Occupational Disease, from your employing agency.

Complete the front of the form (Part A). In box 6, you may claim the period that your doctor thinks you will be disabled for work, or until your next medical appointment, up to 30 days of wage loss into the future.

Give the form to your supervisor or injury compensation specialist for completion of the back of the form (Part B). To minimize any interruption of income, your employing agency should submit the completed Form CA-7 to the FEC District Office on the 40th day of COP and should include any medical evidence in its possession concerning the injury.

If you continue to lose pay because of work-related disability after the dates claimed on Form CA-7, you should:

Obtain and complete additional CA-7 Forms and submit them every two weeks.

Ask your physician to complete Form CA-20, Attending Physician's Report (attached to Form CA-7), unless medical evidence supporting disability for the period claimed has already been submitted.

Give Forms CA-7 and CA-20 to your supervisor or injury compensation specialist for submission to OWCP, preferably about 5 days before the end of the period claimed on Form CA-7.

If disability continues, submit additional Forms CA-7 (and Forms CA-20 if needed) through your employer for each period claimed, unless OWCP informs you otherwise.

Compensation is based on 2/3 of your salary (including premiums such as night pay and Sunday pay, but not overtime) if there are no dependents, or 3/4 of your salary with dependents.

If leave was used for time lost from work due to injury, it may be possible to repurchase the leave by filing a Form CA-7, as described above. Both compensation and leave cannot be paid for the same period. Leave used must be repaid to the employing agency. Any compensation due is usually paid to the employing agency to help repay the leave, and the remaining difference is paid by the injured worker. Please keep in mind that leave is 100% of pay, and compensation is only 3/4 or 2/3, and the difference must be paid out-of-pocket by the injured worker.

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Return to Work

OWCP Nurse Services. Depending upon the kind of injury you have and how severe it is, OWCP may ask a contract registered nurse to contact you concerning your recovery and return to work. The nurse may contact you by telephone or pay you a personal visit. The nurse will discuss your medical progress with you and address any problems you may be having in returning to work. If necessary, he/she will coordinate with other OWCP personnel, your physician, and your employing agency.

Vocational Rehabilitation Services. You are responsible for asking your doctor when you can return to work and for advising your employing agency when your doctor says you can work in some capacity. If OWCP determines that you are indefinitely disabled for your usual job, and your agency has not provided light duty, you are eligible for vocational rehabilitation services. The goal of such services is reemployment with your employing agency, another Federal agency, or a private employer.

By law, OWCP may terminate your COP or compensation if you refuse (without good cause) to accept work which is within your medical restrictions. Also, OWCP may reduce your benefits if you fail to cooperate with vocational rehabilitation and placement efforts.

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Dual Benefits

You may not receive Federal retirement benefits and compensation for wage loss for the same periods of time. Compensation for wage loss includes payments for temporary total disability and for loss of wage-earning capacity. You may, however, receive compensation for schedule awards and retirement annuities for the same period.

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Penalty.

Any person who knowingly makes any false statement, misrepresentation, concealment of fact, or any other act of fraud to obtain compensation, as provided by FECA, or who knowingly accepts compensation to which he or she is not entitled, is subject to felony criminal prosecution and may, under appropriate U.S. criminal code provisions, be punished by a fine of not more than $10,000 or imprisonment for not more than 5 years, or both.

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How to Contact OWCP (Click here for Contact Information)

Additional information about the topics above is contained in Pamphlet CA-550, Questions and Answers About FECA, and Publication CA-11, When Injured at Work.