OWCP - DOL Initial Claims Processing Tutorial

FECA Bulletin NO. 26-04The annual cost of living increase for FECA claimants is now calculated by comparing the base month from the prior year to the base month of the current year, with the percentage of increase adjusted to the nearest one-tenth of 1 percent. 5 U.S.C. §8146(a) establishes the base month for the FECA CPI as December. The CPI increase, as determined by BLS, is 2.6 percent. The increase is effective March 1, 2026, and is applicable where disability or death occurred before March 1, 2025.. The maximum compensation rates1, which must not be exceeded, are as follows: $10,268.81 per month                                                                                                            $9,478.88 each four weeks (disability payments)                                                          $2,369.72 per week                                                                                                             $473.94 per day (for a 5 day week)FECA Bulletin NO. 26-03When an over payment is identified, the FECA program issues a preliminary finding to the claimant outlining the amount of the overpayment and how it was calculated, the reason for the overpayment, and a determination regarding whether the claimant was found to be with or without fault in the creation of the overpayment. The claimant can submit additional evidence or request a pre-recoupment hearing. After reviewing the evidence submitted, or the pre-recoupment hearing, the FECA program issues a final decision addressing waiver, and if the overpayment cannot be waived, directs repayment. See 20 CFR §10.431-440. For more click on show transcript..If you need an approved  medical provider for your DOL -OWCP Or Longshore case in Florida you can still  find me in  Pensacola and central Texas. To make a consultation with me to discuss your case or if you know someone if Florida who is recently injured you can call the clinic at 813-215-4356 or in Texas at  737-358-9307 or go  to our website at https://fedcompconsultants.com/   &   https://fcwtexas.com/ A For responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

Why Injured Federal Workers Must Communicate Directly with the Claims Examiner (Phone & ECOMP) for successful claims processing and reimbursements— Provider Contact Is Only a CourtesyThis episode address modern OWCP commication break downs and costly delay avoidance. Under FECA and OWCP procedures:The injured worker is the party to the claim.Most evidentiary burdens, development deadlines, and response obligations fall on the claimant and not the clinic or providers. Direct communication from the injured worker (phone or written submissions via ECOMP) triggers specific procedural expectations based on rules and provisions with internal tracking at OWCP .Contact initiated by or on behalf of the medical provider is not governed by the same mandates. It is essentially a courtesy that the claims examiner may or may not extend. Recent years it is obvious that claims examiners are overburdened with much more work and the OWCP is running very slow and poorly. The administration has put a system in place to assist this process by outsourcing some of the new claims processing with assigning a nurse from Sedgiwick or Gensis to “assist” with the claim. The nurses come from a state workers compensation model that is very different than federal workers compensation. They have a mandate to get your back to work and are not very helpful or knowledgeable on OWCP procedure rules and provisions. They are not very helpful most of the time with your case management needs because your requested assistance exceeds their mandate. So if they are not helpful and your agency does not respond to your clinic and doctor’s requests uploaded into ECOMP… what do you do to move these along and get answers and successful processing of your claims related matter?. The answer is very simple …you the injured federal employee are the SOLUTION that can get things done quicker because the federal guideline have deadlines and rules that they have to respond to you. For more information click on the episode transcript. The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant & DOL expert for Oberheiden Law Firm.  Dr. Taylor’s contact email information is:Dr. Taylor's educational podcast utilizes his experience and history as a DOL - OWCP provider and his years of consulting and teaching all things federal workers compensation related. This is an educational short form format for learning how to successfully file federal workers compensation claims.If you need an OWCP approved medical provider, You can make a  a consultation with me to discuss your case or if you know someone in Pensacola Florida, Alabama,  or Texas who is recently injured you can call the clinic at 813-215-4356 or in Texas call the clinic at 737-358-9307  or go  to our website at https://fedcompconsultants.com/    &  https://fcwtexas.com/ Also if you are in  another state and you want me to assist  you with claim questions or assistance for your  doctor you can email me at [email protected] or send me a message on the website at fedcompconsultants.comFor responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

This episode is an OWCP training session physicians who want to work with OWCP and federal Workers Compensation or patients who are looking to provide their physician assistance in filing a recurrence of disability. This episode outlines  completing a proper Recurrence of Disability medical narrative to support a OWCP injured worker who is filling a CA-2A Recurrence of Disability form. So, if you’re a treating OWCP provider this is an important episode for you to take notes and if you are an injured federal worker and you think that you have sustained a recurrence of disability and your doctor’s reports are not working…or you are receiving the classic, “Claims Examiner excuse of Insufficient evidence” …this is the episode transcript you want to take to your doctor.In the OWCP response letters requesting treating physician to respond to a series of  questions,  OWCP requires response explanation to a series of questions. Typically these involve the following- first, what qualifies for a recurrence of disability and what are the requirements that need to be satisfied for a medical narrative supporting document when a patient is filing a CA-2A form for a recurrence of disability. What should a worker provide to OWCP if that workers cannot continue to perform their current work requirements and/or light duty due to increasing pain and dysfunction to their original injury or increasing pain and dysfunction to a new body part that is being aggravated by the inability to use their original body part injury? What is right way to handle this scenario when modified duty has to be changed due to a deterioration in their original condition or an adjacent body part without a new injury? Is this a recurrence of disability? The answer is yes. For the second part of the OWCP treating physician’s questions OWCP requires an OWCP treating physician’s medical narrative explanation to support a CA-2A recurrence of disability…I will give the exact 8 bulletin points that need to be in the medical narrative. For more information click on the transcript.The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant & DOL expert for Oberheiden Law Firm.  Dr. Taylor’s contact email information is:If you need an OWCP approved medical provider, You can make a  a consultation with me to discuss your case or if you know someone in Pensacola Florida, Alabama,  or Texas who is recently injured you can call the clinic at 813-215-4356 or in Texas call the clinic at 737-358-9307  or go  to our website at https://fedcompconsultants.com/    &  https://fcwtexas.com/ Also if you are in  another state and you want me to assist  you with claim questions or assistance for your  doctor you can email me at [email protected] or send me a message on the website at fedcompconsultants.comhttps://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_emailFor responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

 A growing problem that injured federal workers keep running into: employing agencies that try to short-circuit the OWCP process by offering modified duty straight to the injured employee—or handing them agency medical-clearance forms—while deliberately leaving the claims examiner out of the loop. That’s not just poor practice. In many cases it violates the Federal Employees’ Compensation Act.”Core Problem with this process first under the OWCP and FECA ACT rules: Agencies are increasingly making written or verbal modified-duty offers directly to the injured worker (or the treating physician) without concurrent notice to, or approval by, the OWCP claims examiner.They often attach arbitrary return-to-work deadlines and imply that failure to report will result in loss of compensation or disciplinary action.Separately, agencies are giving injured workers their own “medical clearance” or fitness-for-duty forms and instructing the worker to have the OWCP-authorized physician complete them—again without routing the form through the claims examiner for suitability review.Both practices are becoming routine and are being used to pressure workers off the compensation rolls while not following OWCP procedures. For more click on the show transcript...The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant & DOL expert for Oberheiden Law Firm.  If you need an OWCP approved medical provider, You can make a  a consultation with me to discuss your case or if you know someone in Pensacola Florida, Alabama,  or Texas who is recently injured you can call the clinic at 813-215-4356 or in Texas call the clinic at 737-358-9307  or go  to our website at https://fedcompconsultants.com/    &  https://fcwtexas.com/ Also if you are in  another state and you want me to assist  you with claim questions or assistance for your  doctor you can email me at [email protected] or send me a message on the website at fedcompconsultants.comFor responses email Dr. Taylor at [email protected] TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_emailFor responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

Today we’re talking about a common challenge: when an OWCP second opinion (SECOP) doctor gives an opinion you disagree with, leaves key questions unanswered, or when the claims examiner misinterprets the report.You don’t have to accept incomplete or unclear medical evidence. There are established procedures under the FECA Act, the DFEC Procedure Manual, and related guidance that allow you (or your treating physician) to push for clarification through a supplemental report. Let’s walk through the steps.Section 1: When a Supplemental Report Makes SenseOWCP often refers claimants for a second opinion exam (authorized by 5 U.S.C. §8123) to clarify the accepted condition, disability status, work capacity, treatment needs, or other issues.Common scenarios where a supplemental report is appropriate:The report is equivocal, lacks sufficient rationale, or fails to address the specific medical questions posed.It contains incomplete information or overlooks key records.The claims examiner (CE) appears to misinterpret the findings.New evidence from your treating physician creates a need for the second opinion doctor to review and respond.For more information click on the show's transcript...The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant & DOL expert for Oberheiden Law Firm.  If you need an OWCP approved medical provider, You can make a  a consultation with me to discuss your case or if you know someone in Pensacola Florida, Alabama,  or Texas who is recently injured you can call the clinic at 813-215-4356 or in Texas call the clinic at 737-358-9307  or go  to our website at https://fedcompconsultants.com/    &  https://fcwtexas.com/ Also if you are in  another state and you want me to assist  you with claim questions or assistance for your  doctor you can email me at [email protected] or send me a message on the website at fedcompconsultants.comFor responses email Dr. Taylor at [email protected] responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

What Is the Bruner Presumption?Facing a potential adverse action due to a medical issue as a federal employee can be incredibly difficult and stressful. However, a powerful but often underutilized tool — the Bruner Presumption — can significantly strengthen your FERS disability retirement application if you understand the ins and outs of this tool in your disability application. Stemming from the 1993 Federal Circuit case Bruner v. OPM, this presumption kicks in when your agency takes an adverse action (like removal or termination) based on your medical inability to perform the essential functions of your job.The Game-Changer: Burden ShiftingNormally, you carry the full burden of proving to OPM that you’re disabled and unable to do your job. But with the Bruner Presumption, your agency’s own action becomes prima facie evidence of disability. This shifts the burden from you proving your disability to the agency along with OPM must now produce their evidence to disprove your entitlement. It’s a major strategic advantage.For more information click on the show's transcript...For more information on this topic click on the show transcript...The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant & DOL expert for Oberheiden Law Firm. If you need an OWCP approved medical provider, You can make a  a consultation with me to discuss your case or if you know someone in Pensacola Florida, Alabama,  or Texas who is recently injured you can call the clinic at 813-215-4356 or in Texas call the clinic at 737-358-9307  or go  to our website at https://fedcompconsultants.com/    &  https://fcwtexas.com/ Also if you are in  another state and you want me to assist  you with claim questions or assistance for your  doctor you can email me at [email protected] or send me a message on the website at fedcompconsultants.comFor responses email Dr. Taylor at [email protected] the showFor responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

This episode is an emailer asking a question and being answered in the podcast episode. The scenario the emailer presented for an injured federal employee is the following:An injured worker  came in her OWCP doctor's office  for an urgent care visit appointment due to her shoulder being in severe pain and cannot raise it. This shoulder injury is an accepted condition and she is on modified duty. She has been working 8 hours with restrictions but today has been removed from work for 5 days. In circumstances like this, would she file a CA-2A for recurrence of disability? My second question would be, if a patient is removed from work due to worsening of an injury whether it be 2 days or 30 days, is a CA-2A filed? Great question: Here is what the FECA ACT says about this …(DFEC) FECA Part 1 Chapter 1-0400 Sub-sec: 9A Recurrence of Disability is a work stoppage caused by:1. A return or increase of disability due to a consequential injury (defined as one which occurs due to weakness or impairment caused by a work-related injury);2. Withdrawal of a specific duty assignment when the employee cannot perform the full duties of the regular or limited duty position.For more information on this topic click on the show transcript...The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant & DOL expert for Oberheiden Law Firm.  If you need an OWCP approved medical provider, You can make a  a consultation with me to discuss your case or if you know someone in Pensacola Florida, Alabama,  or Texas who is recently injured you can call the clinic at 813-215-4356 or in Texas call the clinic at 737-358-9307  or go  to our website at https://fedcompconsultants.com/    &  https://fcwtexas.com/ Also if you are in  another state and you want me to assist  you with claim questions or assistance for your  doctor you can email me at [email protected] or send me a message on the website at fedcompconsultants.comFor responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP #1 Federal Workers Compensation Podcast & #6 National Workers Compensation Podcast:For responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

There is recent evidence that OWCP (under the U.S. Department of Labor) has increasingly began to outsource significant portions of claims-related services for FECA (federal workers' compensation) to third-party vendors, including private companies traditionally known for state workers' compensation claims management. This is a change in the entire structure of the FECA and OWCP government division's responsibilities. OWCP has been slowly outsourcing divisions of OWCP to outside contracts in the form of third party vendors. This began with  medical bill processing (e.g., past transitions to vendors like CNSI now called ACCENTRA) and  medical authorizations.  This began when OWCP decided to outsource the pharmacy benefits to an outside corporate vendor called OPTUM, a pharmacy benefit manger to manage all of OWCP's pharmacy benefits. We can expect to see an increasing amount of companies continue to be added for specifically handling broad OWCP claims adjudication, the overall trend of outsourcing to experienced private-sector TPAs vendors from the state workers’ comp ecosystem is now the wave of the future. For more information read the show transcript. The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant & DOL expert for Oberheiden Law Firm.  If you need an OWCP approved medical provider, You can make a  a consultation with me to discuss your case or if you know someone in Pensacola Florida, Alabama,  or Texas who is recently injured you can call the clinic at 813-215-4356 or in Texas call the clinic at 737-358-9307  or go  to our website at https://fedcompconsultants.com/    &  https://fcwtexas.com/ Also if you are in  another state and you want me to assist  you with claim questions or assistance for your  doctor you can email me at [email protected] or send me a message on the website at fedcompconsultants.com For responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP #1 Federal Workers Compensation Podcast & #6 National Workers Compensation Podcast:For responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

CHALLENGING VALIDITY OF OWCP CLAIMS –If the validity of a claim is questioned, the Agency supervisor should investigate the circumstances and report the results to OWCP. However, filing of the claimshould not be delayed whether the claim is disputed or what OWCP calls controverted. A. Allegations Must be supported by factual evidence.1) Different Versions of incident by several witnesses, whose accountsdiffer, should provide supervisor with written statements of theirinformation.2) Previous Injury – Agency should request statements from witnesses ifon the date on the claimed injury the appearance of a previouscondition or injury.3) Time Frame – Agency should provide written statement if the injury isreported after a lapsed time from the reported date of injury.4) Outside of Employment – If employed outside of the agency andinjury is claimed, supervisor should inquire about the duties of theother employment and report it to OWCP.B. Notifications and Decisions – for more information click on the show transcript!The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant for Oberheiden Law Firm.  If you need an OWCP approved medical provider, You can make a  a consultation with me to discuss your case or if you know someone in Pensacola Florida, Alabama,  or Texas who is recently injured you can call the clinic at 813-215-4356 or in Texas call the clinic at 737-358-9307  or go  to our website at https://fedcompconsultants.com/    &  https://fcwtexas.com/ Also if you are in  another state and you want me to assist  you with claim questions or assistance for your  doctor you can email me at [email protected] or send me a message on the website at fedcompconsultants.comSupport the showFEEDSPOT TOP #1 Federal Workers Compensation Podcast & #6 National Workers Compensation Podcast:For responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email

OWCP CLAIMS PROCESSING –Certain procedures and responsibilities have to be accomplished once theforms and information have reached OWCP for appropriate adjudication ofclaim.A. Initial Processing –Once claim is received with all supporting documentation (when possible)claim number will be assigned to the case. OWCP will notify theemployee and agency once claim has been received. Uncontrovertedclaims with medical bills totaling less than $1500 will be administrativelyclosed by OWCP. Thos claims not meeting that criteria will be assigned toa claims examiner for formal adjudication. When additional information isrequired, the claims examiner will notify the employee by letter in ECOMP with a copy to all parties to the claim. For more information click on the podcast transcript.The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant for Oberheiden Law Firm.  If you need an OWCP approved medical provider, You can make a  a consultation with me to discuss your case or if you know someone in Pensacola Florida, Alabama,  or Texas who is recently injured you can call the clinic at 813-215-4356 or in Texas call the clinic at 737-358-9307  or go  to our website at https://fedcompconsultants.com/    &  https://fcwtexas.com/ Also if you are in  another state and you want me to assist  you with claim questions or assistance for your  doctor you can email me at [email protected] or send me a message on the website at fedcompconsultants.comFor responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP #1 Federal Workers Compensation Podcast & #8 National Workers Compensation Podcast:https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_emailFor responses email Dr. Taylor at [email protected] the showFEEDSPOT TOP 10 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f2_featured_email