The following provides general information to employees, supervisors and managers on the AOC Worker’s Compensation Program and the FECA.
Choice of Physician: An employee has the right to an initial choice of physician. After that, the employee must have OWCP pre-authorized approval. If an employee is dissatisfied with their physician, he/she must state the reasons in writing to the OWCP and request permission to change physicians. He/she needs to provide the name, address and speciality of the new physician. The employee may be held liable for any bills incurred without prior approval. OWCP will honor written referrals to appropriate specialists by the employee’s approved treating physician as long as they relate to the accepted work-related injury.
Medical Reports/Records: Complete medical records are extremely important for an evaluation of a claim and bill payments. It is necessary to have all examining physicians send copies of their record(s) and test(s) to the Workers’ Compensation Program Unit (WCPU). This should include hospitalization records, radiology reports, nerve condition tests, etc. In cases involving long-term disability, regular medical reports are required for the WCPU/OWCP to keep current on the progress of the employee’s treatment program, medications for employee’s accepted condition, etc.
Surgery Approval: An employee (claimant) must obtain prior approval from OWCP for any surgical procedure other than emergency surgery. Emergency surgery is defined as any procedure, which needs to be performed promptly after the onset of a condition in order to preserve life or function of an organ or body part. A claimant should have his/her doctor submit a report stating the name of the surgical procedure and estimated recovery time. If tests were performed, copies of the test results, radiology reports, etc. must be provided to the WCPU. OWCP may conduct a medical review at any time, and in some cases a second opinion will be necessary.
Physical Therapy: The original treating physician may authorize physical therapy up to 120 days. Any therapy in excess of 120 days requires further justification to DOL before it will be approved. To obtain approval, the primary treating physician should describe deficits to be treated, specific functional goals of additional therapy, and the specific modalities and procedures to be used.
Fitness Centers: We have been informed that Centers do not have qualified/certified personnel to provide therapy for employees who suffered a work-related injury or occupational illness/disease for which a physician has prescribed physical therapy. Therefore, fitness centers should not be used to provide therapy for employees who have suffered a work-related injury or illness/disease.
Compensation: Compensation is paid for periods of disability supported by medical evidence. During the partial disability period, the AOC will provide a temporary short-term limited duty work assignment but it is the employee’s responsibility to return to work. The employee must advise his/her supervisor as soon as possible any prescribed physical limitations due to the injury or disease.
Long-Term Disability: In cases of long-term disability, the WCPU will transfer AOC employees to OWCP’s Periodic Rolls, and assume certain deductions when issuing benefits every 28 days until the employee can return to work. CA-7 forms must be sent in periodically to the WCPU to support continued eligibility of benefits.
Change Of Address: If a claimant’s mailing address changes, he/she should notify OWCP and WCPU promptly in writing of the change; such notices must bear the claimant's signature.
Missing Checks: Payments are keyed into the computer system in OWCP, but are actually issued by the Treasury on specific days of the week. If a claimant did not receive a payment, the claimant should wait 10 days, then request a tracer action on the missing check to OWCP in writing with the claimant's signature. Claimants need to specifically identify the missing check and send the requests to OWCP, who, in turn, must direct the action to the Treasury. Estimated response time for Treasury is about six weeks.
Health Benefits: In cases involving long-term disability, health benefits will be transferred to OWCP. Open season for changes to health benefits plans occur in November and December of each year. Claimants need to look for changes in deductions for health benefits in the first pay period in January of each year. The information that will be sent to the claimants by their health providers will advise them of new rates and effective dates if they must make a change. Any questions regarding health and life insurance benefits should be directed to HR’s Employee Benefits and Services Branch. They can be reached at 202-226-2548.
Cost of Living Increases: Cost of living increases are given each March 1st based on the Consumer Price Index (CPI). A claimant must be disabled for at least one year to be eligible for any cost of living increase.
Bills: To facilitate prompt and accurate processing of employee’s bills, please submit bills HCFA -1500 or UB-92) to the AQS, P.O. Box 8300, London, KY, 40742-8300, with the claimant’s OWCP case file number on the right hand side of the bill.
Fee Schedule: OWCP uses a schedule of maximum allowable medical charges. The rates are determined based on customary rates in different geographic areas. OWCP’s maximum allowable medical charges are equal to or better than the fees allowed by Blue Cross and Blue Shield. Employees are not to be charged for the amount in excess of the allowable medical charges. Providers in violation may be excluded from participation in the federal workers’ compensation program.
Forms: Bills for treatment of an employee’s accepted condition need to be submitted on Standard AMA billing form, HCFA-1500. Most doctors have this form or can obtain it through the Medicare carrier of the area. The medical provider must itemize services for each date separately, using AMA (not state) CPT codes for services performed; provide tax identification number, and sign and date the bill. The same holds for claimants’ paid deductible charges for which the claimant is seeking reimbursement.
Hospital Bills: They should be submitted on a form UB-92, itemized fully, and submitted with admissions and discharge medical summaries and dates.
Pharmacy Bills: They must be submitted on form CA-915, "Claimant Medical Reimbursement Form", and may be accompanied by original bills/receipts. Several different pharmacies may be represented on one CA-915 form. Tax identification numbers may be written in above the pharmacy name. Please do not submit bills on small pieces of paper. If the receipt is small, tape (not staple) it to a full size sheet of paper with claimant’s name, social security number, and case file number indicated in the upper right hand corner. Bills can now be expressed to OWCP when pharmacies call 1-800-388-2316, and provide the employee’s DOL file/claim number.
Chiropractic Care: Charges for chiropractic care are limited to charges for manual manipulation of the spine for correction of a subluxation demonstrated by X-ray. Other modes of treatment will not be covered and are the claimant’s responsibility.
Time Limitations: Bills must be submitted within one year of the date of service or the acceptance of the claim. If a claimant has a large number of bills to submit, it would enable timelier processing and more accurate payments to submit them upon receipt rather than saving them for any time period.
Nurse Intervention: In addition to offering vocational rehabilitation services to employees with extended disabilities in order to return them to employment consistent with their abilities, OWCP is now offering these case-management services to certain claimants during their initial 30 days of COP.
Attorneys and Representatives: The service of an attorney or representative are not needed to obtain benefits under the FECA. However, a claimant may authorize any individual to represent him/her under the FECA, unless that individual’s service as a representative would violate any legal applicable provision; i.e., 18 U.S.C. 205 and 208. If a claimant obtains such services, he/she must send a signed statement to OWCP authorizing the attorney or representative to represent him/her before OWCP can release information to that person.
Fees for Attorney/Representative Service: Claimants are solely responsible for paying fees and other charges. OWCP will not reimburse the claimant, nor is OWCP in any way liable for the amount of the fee.
Fee Application Approval: The Employees’ Compensation Appeals Board (ECAB) is an appellant level that is not associated with OWCP. If an attorney before the ECAB represents a claimant, ECAB has the sole authority to process an attorney fee request. (Refer to the "Workers’ Compensation Appeal Rights" segment on our website.) ECAB must approve any fee to a claimant for such representation based on an itemized statement showing the work done. OWCP does not honor contingency fee agreements and claimants should not pay any fee prior to OWCP’s approval.
