TIP OF THE WEEK - November 3, 2014 1 “Excessive, extravagant, or wrongful use of FECA in a manner contrary to its legal intent to acquire additional benefits.

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Presentation transcript:

TIP OF THE WEEK - November 3, “Excessive, extravagant, or wrongful use of FECA in a manner contrary to its legal intent to acquire additional benefits for personal gain.”

Scenario: 2 If you have a question or topic for Tip of the Week, contact your District 6 Liaison, Jacksonville, FL  OWCP accepts injured worker’s (IW) claim for a Rotator cuff injury and the claimant is placed on the periodic rolls for temporary total disability.  The claimant undergoes surgery to repair the rotator cuff.  A year later the claimant is still off work temporary total disability (TTD) and the treating physician (TP) indicates he is unable to explain the claimant’s continued pain complaints. The TP further states that the claimant indicates “he is unable to perform his date of injury (DOI) job due to his condition.”  The employing agency (EA) has received communication that the claimant is not disabled and is out doing all sorts of activities (no details provided). Is this Abuse or Fraud? Reference: Department of Defense Instruction, DoD Civilian Personnel Management System: Injury Compensation V810, section Reference: ECAB FECA PM: Chapter , Fact of Injury para, 5:

Answer: A determination cannot be made based on the information provided. Further development of the medical condition is needed. What steps could the EA take?  Write the treating physician and advise that light duty work is available, explain that the EA is committed to providing suitable employment to its injured workers. Provide the TP with OWCP-5 and ask for restrictions.  If no response is received from the TP within 30 days then the EA could ask the CE if this case is in posture for SECOP.  If warranted the EA could also make a referral to the investigative unit.  If the investigative unit provides a report and/or other evidence (video surveillance) this information is to be submitted to OWCP via the appropriate channels.  OWCP will determine if this information should be included with evidence submitted to SECOP medical examiner.  Contact your liaison for assistance to help determine the next appropriate action(s). If you have questions or a topic for the Tip of the Week contact your District 6 Liaison, Jacksonville FL 3