Injury compensation claims must always be managed by control offices at management levels above that of the injured employee.
Designated control office and control point claim management relationships are as follows:
The district manager establishes a control office to handle injury compensation program administration.
At installations where there is no injury compensation control office, the district manager or installation head designates an appropriate control point individuals responsible for coordination of injury compensation activities with the injury compensation control office. (See 541.2g for instructions on designating a control point.)
Control offices ensure that control point personnel are properly trained to review cases. Control point personnel must not, under any circumstances or for any reason, delay timely submission of reports or claim forms to the control office. Human resources specialists serving as control points at major installations may be given authority by the control office to manage and submit claims directly to OWCP.
When an employee sustains a work–related traumatic injury that requires medical examination, medical treatment, or both, the control office or control point must authorize such examination and/or treatment by issuing a Form CA–16. Form CA–16 is used for all traumatic injuries requiring medical attention. The control office or control point must advise the employee of the right to an initial choice of physician (see 543.3). The control office or control point must promptly authorize medical treatment by issuing the employee a properly executed Form CA–16 within 4 hours of the claimed injury. If the control office or control point gives verbal authorization for care, Form CA–16 should be issued within 48 hours. The control office or control point is not required to issue a Form CA–16 more than one week after the occurrence of the claimed injury.
Exception: Issuance of Form CA–16 is not required for job–related first aid injuries where initial medical care is provided by either a postal physician or a contract physician and the employee voluntarily accepts this care (see 545.43).
In cases of occupational disease or illness, the control office or control point contacts OWCP district office for instructions if treatment authorization is requested by the employee.
Simple exposure to a workplace hazard, such as an infectious agent, does not necessarily constitute a work–related injury entitling an employee to medical treatment under FECA. The control office or control point should not use a Form CA–16 to authorize medical testing for an employee who has merely been exposed to a workplace hazard unless the employee has sustained an identifiable injury or medical condition as a result of that exposure.
FECA does not authorize payment for preventive measures such as vaccines and inoculations. However, OWCP can authorize treatment for the following conditions:
- Complications from preventive measures that are provided or sponsored by the agency, such as an adverse reaction to prophylactic immunization.
- Actual or probable exposure to a known contaminant due to an injury, thereby requiring disease–specific measures against infection. Examples include the provision of tetanus antitoxin or booster toxoid injections for puncture wounds; administration of rabies vaccine for a bite from a rabid or potentially rabid animal; or appropriate measures where exposure to human immunodeficiency virus (HIV) has occurred.
- Conversion of tuberculin reaction from negative to positive following exposure to tuberculosis in the performance of duty. In this situation, the appropriate therapy may be authorized.
- Where injury to one eye has resulted in loss of vision, periodic examination of the uninjured eye to detect possible sympathetic involvement of the uninjured eye at an early stage.
Upon authorization of medical care, the control office or control point advises the employee, in writing, of the obligation to return to work as soon as possible. The term return to work refers to work in the employee’s bid assignment or work in other locations and positions. Notification to the employee must include the following:
- If a specific alternative position is available, the control office or control point must advise the employee in writing of the specific duties and physical requirements of the position.
- If no specific alternative position is necessary, the control office or control point should advise the employee of any change the agency can make to the employee’s permanent assignment to accommodate the employee’s limitations due to the injury.
To be considered suitable by OWCP, the job offer must include the following:
- A description of the duties of the position.
- A description of the specific physical requirements of the position and any special demands of the workload or unusual working conditions.
- The organizational and geographical location of the job.
- The effective date of the position.
- The date the employee must accept or refuse the job offer.
- Pay rate information for the offered position.
The job offer may be made verbally, as long as a written job offer is provided to the employee within 2 business days of the verbal job offer.
The employee is responsible for the following:
- Ensuring that the treating physician specifies work limitations and provides them to the control office or control point.
- Providing the treating physician with a description of any specific alternative positions offered.
- Ensuring a prompt response from the treating physician with an opinion on whether and how soon the employee can be expected to return to work in any capacity, either an offered position or offered modified duties.
- Seeking and accepting suitable work.
An employee needing emergency treatment must be sent to the nearest available physician or hospital or to a physician or hospital chosen by the employee or the employee’s representative. The physician who provides emergency treatment is not considered the employee’s initial choice of physician.
A supervisor may accompany the employee to the doctor’s office or hospital to make certain that the employee receives prompt medical treatment.
Animal bites or eye injuries are always considered medical emergencies. In the event that there is doubt as to the emergent nature of the injury, it should be handled as an emergency.
Initial medical examination and/or treatment must be authorized in accordance with FECA provisions and applicable OWCP regulations and policies governing medical care. (See 545.2 for control office or control point instructions on authorizing medical examination or treatment.)
A postal physician or contract equivalent may provide initial medical treatment not to exceed two office visits if:
- The employee accepts such treatment.
- Treatment complies with Handbook EL–806, Health and Medical Service, and with OWCP regulations and directives.
In a nonemergency situation, if an employee does not accept treatment at a Postal Service occupational health services office or contract facility, the employee may select a physician or hospital within approximately 25 miles of his or her home or worksite. The physician’s office should be contacted by telephone by the control office or control point to determine if the physician is available and will accept the employee for treatment under FECA. If not, the employee must select another qualified physician or hospital.
A postal supervisor is not authorized to accompany the employee to a medical facility or physician’s office in nonemergency situations.
Although the injured employee selects an outside physician for initial medical treatment, in nonemergency situations he or she may be required first to be examined by a postal physician or contract equivalent. In such instances:
- The examination must be performed promptly following the report of injury.
- Form CA–16, Authorization for Examination and/or Treatment, must be issued to the employee’s physician of choice promptly following the report of injury, as specified in 545.2.
- The examination must in no way interfere with the employee’s right to seek prompt examination and/or treatment from a physician of choice.
If treatment with a contract physician will exceed two visits, the employee may continue treatment with a postal or contract physician provided the employee designates that person as his or her physician of choice.
Form CA–16, Authorization for Examination and/or Treatment, must be completed in accordance with 545.2.
In all cases reported to OWCP, a medical report from the attending physician is required. The report should bear the physician’s signature or signature stamp. OWCP may require an original signature on the report. The employee’s treating physician or hospital must, as soon as possible after medical examination or treatment is received, submit a report indicating the extent of disability affecting the employee’s ability to work due to the injury. Use of OWCP medical report forms is not required. Form CA–16 may be used for the initial medical report, and Form CA–20 may be used for the initial report and for subsequent reports. The report may also be made in narrative form on the physician’s letterhead stationery. The report must be submitted directly to OWCP by the physician or the employee. The control office or control point may request a copy of the report from OWCP or the physician.
In claims involving COP, medical evidence supporting disability resulting from a claimed traumatic injury, including a statement as to when the employee can return to his or her date–of–injury job, must be provided to the control office or control point within 10 calendar days after the employee files the claim. (See 545.724 for COP entitlement.) PS Form 2488, Authorization for Medical Report, may be used to obtain release of a medical report from the attending physician.
The medical report should include:
- Dates of examination and treatment.
- History given by the employee.
- Physical findings.
- Results of diagnostic tests (MRI, CAT scans, etc.).
- Diagnosis.
- Course of treatment.
- A description of any other conditions found but not due to the claimed injury.
- The treatment given or recommended for the claimed injury.
- The physician’s opinion, with medical reasons, as to causal relationship between the diagnosed conditions and the factors or conditions of the employment.
- The extent of disability affecting the employee’s ability to work due to the injury.
- The prognosis for recovery.
- All other material findings.
The control office or control point must monitor the employee’s medical progress and determine return to work capability by obtaining periodic medical reports. Form CA–17 may be used for this purpose. This form:
- Enables the Postal Service to provide the attending physician of an employee injured on duty with a brief summary of that employee’s normal work duties.
- Provides a checklist of physical requirements to permit the attending physician to indicate to the Postal Service what types of duties an injured employee may safely perform, and with what limitations. The control office or control point completes Part A of Form CA–17 before it is issued to the attending physician for completion. Particular attention should be given to Item 7, Description of Regular Work.
- Is used to facilitate an injured employee’s return to suitable employment.
To aid in returning an injured employee to suitable employment, the control office or control point may also contact the employee’s physician in writing concerning the work limitations imposed by the effects of the injury and possible job assignments. However, FECA prohibits contacting the physician by telephone or through a personal visit except for administrative purposes such as determining whether a fax has been received or ascertaining the date of a medical appointment. A copy of all written correspondence to the employee’s physician and any response received must be sent to the OWCP and the employee. The employee may be contacted at reasonable intervals to request periodic medical reports concerning return to work potential.
Postal Service personnel must not interfere with the medical care prescribed by the employee’s attending physician. Questions concerning the duration or type of medical treatment may be referred to the postal physician, occupational health nurse administrator, or contract physician for review.
If the employee’s treating physician or hospital is unable to predict an employee’s work capacity on either a short–term or long-term basis, the control office or control point may request information from OWCP. If the OWCP response does not explain the situation, a fitness–for–duty examination may be recommended to the installation head, Human Resources manager, or designee as provided in 545.61.
The Injury Compensation manager or authorized control office or control point personnel must refer to OWCP on a case–by–case basis, recommendations and supporting documentation regarding:
- Change of the treating physician.
- Use of a medical consultant or specialist by OWCP to clarify medical opinion and/or resolve a material difference in medical opinion.
- Employee’s achievement of maximum medical improvement.
- Employee’s fitness for full or limited duty.
Any disagreement or delay regarding the recommendations or proposals made to OWCP may be brought to the attention of OWCP district director through the area human resources analyst for injury compensation.
The fact that an injured or ill employee is scheduled for a series of treatments or appointments with a physician or hospital does not, by itself, establish that the employee is not fit for duty in the interim. Control office or control point personnel may recommend to the installation head, Human Resources manager or designee at any time, upon medical justification, that any employee being treated by a physician or hospital be required to undergo a fitness–for–duty examination. An installation head, Human Resources manager, or designee is authorized to approve a fitness–for–duty examination.
The following procedures apply only to fitness–for–duty determinations relative to an on-the-job injury or illness. Fitness–for–duty determinations for other purposes are not covered by this instruction.
A fitness–for–duty examination is not limited to the employee’s regular duties, but should be based on whether the employing installation has any alternative duties available that the employee may safely perform.
A fitness–for–duty examination may include the parts of the anatomy being treated provided the examination in no way disturbs or interferes with the treatment regimen.
The results of this examination must be brought to the attention of the OWCP district office for consideration.
If the results of the fitness–for–duty examination disagree with the findings of the attending physician, and the disagreement cannot be resolved with the attending physician, the matter, along with justification for the Postal Service’s position, is referred by the control office or control point to OWCP for resolution. No administrative action may be taken to change the employee’s compensation or employment status until the medical issue is settled by OWCP.
FECA provides that the employer must continue regular pay during periods of disability up to a maximum of 45 calendar days for eligible employees who sustain traumatic injuries. Employees are not required to use their own sick or annual leave, unless the provisions of 545.73 or 545.74 apply.
To be eligible for COP, an employee must:
- Have a traumatic injury.
- File Form CA–1 within 30 days of the date of the injury and elect COP.
- Begin losing time from work within 45 days of the injury.
In recurrence of disability cases, an employee is eligible for any balance of the 45 days of entitlement to COP not used during prior periods of disability provided that:
- The employee completes Form CA–2a and elects to receive COP.
- OWCP did not deny the original claim for disability.
- The disability recurs and the employee stops work within 45 days of the time he or she first returned to work following the initial period of disability.
- Pay has not been continued for the entire 45 days.
FECA excludes authorization of COP to members of the following groups:
- Persons rendering personal service to the United States similar to the service of a civil officer or employee of the United States, without pay or for nominal pay.
- Volunteers.
- Individuals in work–study programs.
- Grand or petit jurors (unless otherwise federal employees).
To ensure continuing eligibility for COP, an employee must:
- Complete and submit Form CA–1 to the employing agency as soon as possible, but no later than 30 days from the date the traumatic injury occurs.
- Ensure that medical evidence supporting disability resulting from the claimed traumatic injury is provided to the employer upon receipt from the attending physician, but no later than 10 calendar days after filing the claim for COP. The report from the physician must include a statement as to when the employee can return to the date–of–injury job.
- Ensure that relevant medical evidence is submitted to OWCP and cooperate with OWCP in developing the claim.
- Ensure that the treating physician specifies work limitations and provides them to the employer.
- Provide the treating physician with a description of any specific alternative positions offered by the Postal Service to the employee and ensure that the treating physician responds promptly to the control office or control point with an opinion as to whether and how soon the employee can perform that or any other specific duties.
Controversion means to dispute, challenge, or deny the validity of a claim. The Postal Service may controvert a claim by completing the indicated portion of Form CA–1 and submitting detailed information in support of the controversion to OWCP (see 545.75).
The Postal Service controverts (i.e., challenges or disputes validity) a claim and does not authorize COP when any one of the following circumstances is present:
- The disability was not caused by a traumatic injury.
- No written claim was filed within 30 days from the date of injury.
- The injury was not reported until after employment had been terminated.
- The injury occurred off the employing agency’s premises and was otherwise not within the performance of official duties.
- The injury was caused by the employee’s willful misconduct or intent to bring about injury or death to self or another person, or was proximately caused by the employee’s intoxication by alcohol or illegal drugs.
- The first absence caused by the injury occurred 45 days or more after the injury.
In all situations, except as described in 545.732 above, the employer may controvert entitlement to COP, but must continue the employees regular pay pending a final determination by OWCP. OWCP has the exclusive authority to determine questions of entitlement and all other issues relating to COP.
After payment of COP is initiated, it may be stopped only when one of the following circumstances is present:
- Medical evidence supporting disability due to a work–related injury is not received within 10 calendar days after the claim is submitted (unless the results of the accident investigation shows disability to exist).
- The medical evidence from the treating physician shows that the employee is not disabled from the date–of–injury position.
- Medical evidence from the treating physician shows that the employee is not totally disabled and the employee refuses a written job offer that is approved by the attending physician.
- The employee returns to work with no loss of pay.
- The employee’s period of employment expires or employment is otherwise terminated as established prior to the date of injury (i.e., a casual or other employee with a specific term of employment). (See explanation in 545.743.)
- Termination of employment is established prior to the date of injury.
- OWCP directs the employer to stop COP.
- COP has been paid for 45 calendar days.
The control office or control point must file a controversion with OWCP setting forth the basis on which COP is stopped, no later than the effective date of the termination.
COP may not be interrupted or stopped because of a disciplinary action, unless a preliminary notice was issued to the employee before the date of injury and the action becomes final or otherwise takes effect during the COP period.
In cases where casuals or other employees with specific terms of employment are injured, COP is awarded only through the end of their appointment; for example, if a casual employee is hired for 90 days and becomes injured on the 85th day, then COP is covered only through the 90th day; or, if an employee is hired for an appointment not to exceed 90 days and the appointment is changed to 60 days because of lack of work prior to the date that the injury occurred, then COP is awarded through the 60th day.
Note: If an employee is terminated as per 545.741 or 545.742, such an employee may file for compensation effective the date of termination.
Proper identification of controverted claims is essential to permit the OWCP to give these claims priority in processing and to avoid the possibility of substantial, erroneous payments of regular pay. If a written explanation of the controversion is not submitted, OWCP may accept as factual the employee’s report of injury.
When a claim is controverted, the control office or control point must ensure that the following actions are taken:
- CA–1 must be properly completed and the controversion package must be adequately documented. Item 36 on the CA–1 should be clearly marked and a full explanation for the basis of the controversion provided.
- Each case must be tailored to the facts; form letters and repetitive formats must be avoided. All controversion packages must be transmitted to OWCP district office by a cover letter with detailed information on the reasons for the controversion.
- If additional information in support of the controversion is to be sent at a later date under a separate cover, this must be stated along with the date this information will be submitted in the cover letter and in Item 36 on the CA–1 before the package is submitted to OWCP district office.
- Submission of Form CA–1 to OWCP must not be delayed, under any circumstances, pending the collection of data to support a controversion. Form CA–1 must be promptly sent to OWCP office with a notation on the CA–1 and a cover letter advising that the claim is being controverted and that information to support the controversion is forthcoming.
- The employee, employee beneficiary, or representative must be furnished with a written explanation for the basis of the controversion.
Proceedings conducted with respect to claims filed under FECA are not adversarial in character. Accordingly:
- The Postal Service does not have the right to actively participate in the claims adjudication process. However, the Postal Service may investigate the circumstances surrounding an injury to an employee and the extent of the disability (e.g., the Postal Service may investigate an employee’s activities where it appears the employee who is alleging total disability may be performing other employment or the employee may be engaging in activities that would indicate less than total disability).
- The Postal Service has the responsibility to submit to OWCP, at any time, all relevant and probative factual and medical evidence in its possession or evidence that it may acquire through investigation or other means. OWCP considers and acts upon all evidence submitted by the Postal Service and informs the claimant, the claimant’s representative, and the Postal Service of such action.
- In those instances where the Postal Service contests a claim at the time of the initial submission and the claim is subsequently approved, OWCP must notify the Postal Service of the rationale for approving the claim.
If a controversion is denied by OWCP, the control office or control point may submit a copy of the CA–1 and all other relevant documents to the area human resources analyst for injury compensation, or designee, for review and any necessary resubmission, if warranted. Cases that are not resolved to the satisfaction of field management may be forwarded to the area human resources analyst for injury compensation with a request for further action.
In the event of an overpayment, OWCP determines the period of absence from the job that resulted in the overpayment in the course of adjudication of the claim. The control office or control point and the employee are notified of the period of disability that is approved by OWCP.
If medical evidence shows that disability resulting from a traumatic injury is expected to continue beyond 45 days of COP and compensation from OWCP is desired after the expiration of the 45–day period, the employee and the control office or control point personnel give the employee a Form CA–7 by day 30 of the COP period. The employee completes the front side of the Form CA–7 and the control office or control point completes the reverse side. The completed form and any accompanying medical documentation is then filed with the OWCP district office by day 40 of the COP period.
Note: An employee may file Form CA–7 to claim compensation for initial periods of disability for which there is no entitlement to COP.
If the disability is a result of an occupational disease or illness, a Form CA–7 is completed and submitted to OWCP not more than 5 working days after receipt from the employee.
In instances of either traumatic injury or occupational disease or illness, subsequent claims of compensation for periods of disability beyond the initial period of compensation are also made on Form CA–7. Employees are responsible for submitting the CA–7. Without receipt of such a claim, OWCP has no knowledge of a continuing wage loss. Therefore, while disability continues:
- The employee submits a claim using Form CA–7 every 2 weeks until the employee is otherwise instructed by OWCP.
- The employee completes and signs the face of the form and the control office or control point completes the reverse side.
- The employee is responsible for submitting or arranging for the submission of medical evidence in support of the claim (see 545.33 and 545.51).
- The control office or control point forwards the completed Form CA–7 and any other accompanying medical reports to OWCP within 5 working days upon receipt from the employee.
The employee is advised that there is a waiting period of 3 calendar days before OWCP compensation begins, unless the disability extends beyond 14 calendar days. The 3–day waiting period may not be satisfied by using sick or annual leave; the employee must be in a nonpay status.
The waiting period applies as follows:
- In the case of an occupational disease or illness, compensation is not payable for the first 3 days of disability, unless the disability extends beyond 14 calendar days.
- In the case of traumatic injury, the 3–day waiting period begins immediately after the end of the 45–day COP period, unless the disability continues for more than 14 calendar days after the expiration of the 45–day COP period.
An employee may use sick or annual leave after the COP period expires, or during a period of disability due to an occupational injury. In such cases, the employee may be entitled to buy back the leave with compensation payments (see 512.923). The control office is responsible for informing employee, in writing, that:
- The buy–back must be initiated within 1 year of the return to duty, or within 1 year of the date OWCP approved the claim, whichever is later.
- Employees who are being separated because of disability or other reasons cannot buy back leave after they are off the rolls of the Postal Service.
An employee who suffers job–related injury or illness for which OWCP compensation is being received should be granted leave without pay because of injury on duty (LWOP/IOD) for an initial period of up to 1 year from the date OWCP compensation begins.
In considering the action to take in matters involving extended leave, the control office or control point evaluates the information contained in the employee’s injury compensation file and does one of the following:
- Authorizes a fitness–for–duty examination as provided in 545.6.
- Extends LWOP/IOD for an additional period, at the end of which an additional determination must be made. If the employee is unable to return to work at the end of the 1–year period on LWOP/IOD, the LWOP/IOD may be extended for successive additional periods of up to 6 months. Extensions are granted only if it appears that the employee is likely to return to work within the period of the extension.
- If it is not likely that the employee will be able to return to work at the end of 1 year of LWOP/IOD or during the authorized extended period, the employee may be separated. Before any employee who is on the rolls of OWCP can be separated, the requesting official must submit a comprehensive report to the manager of Health and Resource Management at Headquarters through the area human resources analyst for injury compensation with appropriate recommendations and documentation. The employee must be retained on the rolls of the Postal Service pending approval from Headquarters.
After receiving permission from the Health and Resource Management manager at Headquarters, the requesting official initiates the separation action in accordance with 365.
