Exhibit: CA-1009

When a claim for OWCP benefits has been accepted by the Department of Labor, the injured worker should be given Publication CA 1009. This publication is titled "Now That Your Claim Has Been Accepted..." In some instances, claims examiners neglect to provide this publication to each and every claimant. The following is a reprint of CA 1009.

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Now that your claim has been accepted...

Now that your claim has been accepted, you will need information about payment of medical bills and compensation, and about your responsibilities in returning to work. You may also need to know about requesting authorization for surgery, avoiding situations where you receive benefits from more than one Federal agency, and obtaining rehabilitation services, including visits or telephone calls from nurses and counselors working for the Office of Workers' Compensation Programs (OWCP).

This pamphlet is designed to answer your basic questions about these subjects. You may obtain more detailed information from the OWCP district office handling your claim.

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Medical Payments
Compensation Payments

Medical Payments

You are entitled to medical treatment for your accepted condition, up to the amount specified by the fee schedule used by the Office of Workers' Compensation Programs (OWCP).

• Medical bills from providers other than hospitals and pharmacies must be submitted on Form OWCP-1500 (also known as HCFA-1500). This form may be obtained from your agency if your physician does not have it. The physician must sign the form (a signature stamp may also be used).
• Hospital changes should be submitted on Form UB-82.
• Travel expenses should be submitted on Form SF-1012.

If any medical bills related to this injury were previously returned because your case had not been accepted, they may be resubmitted to the district office for consideration of payment.

Bills for medical treatment may not be paid if submitted more than one year beyond the calendar year in which you received treatment, or the calendar year in which OWCP first accepted the claim as compensable, whichever is later. Therefore, you should submit all bills for payment or reimbursement, including travel vouchers, as soon as possible after you incur the expense. You may ask your physician to submit bills directly to the district office, or you may pay the doctor and submit the paid bill for reimbursement.

Your acceptance letter states the medical condition(s) which OWCP has accepted as work related. Treatment for those conditions only should be billed to OWCP. If a health benefits carrier has paid medical bills for your accepted condition, you will need to provide a copy of your statement of benefits from the carrier before OWCP will reimburse you or the carrier.

Instructions for submission of bills to OWCP:

1. Medical provider may only submit bills for the accepted work-related condition. These must include both a verbal description of the diagnosis and the ICD-9 codes. Bills for non work-related conditions are not payable by OWCP.
2. All providers other than hospitals must submit bills on a HCFA-1500 form.
3. The provider's federal tax ID must be on the bill along with the full address.
4. Hospitals must submit bills on a UB-82 form.
5. Chiropractic care is only payable when the accepted condition is subluxation of the spine; only office visit, X-ray and manipulation are covered by OWCP.
6. Each bill must show the condition treated, the date of service, and the treatment performed. Don not submit "Balance Forward" bills. They will be discarded.
7. Providers must include ICD-9 diagnosis codes and AMA CPT codes to describe their services. They may not use state W/C codes. (Dentists, home nurses, hospital inpatient care and medical appliances do not require coding but do require advance approval by OWCP).
8. The provider's bill should only show services that are not yet paid.
9. Both the claimant and the provider should sign the bill in the appropriate blocks.
10. The provider must submit office notes and medical records for visits; failure to do so may cause non-payment on an otherwise payable bill.
11. The FECA case number must be on the bill.

Instructions for submission of reimbursement requests to OWCP:

1. You must submit a fully completed HCFA-1500 or UB-82 along with proof of payment. The is required for all reimbursements including but not limited to your doctor, therapist, supplier (for appliances such as canes, crutches, hearing aid batteries) or hospitals.
2. Proof of payment consists of photocopies of front and back of the canceled check, credit card receipt, a computer generated statement showing patient payment, or paid receipt with the full address of the provider.
3. The bills you submit for reimbursement have the same requirements as those submitted by the provider.
4. Pharmacy (drug) reimbursements are made by submitting the original label which must include the name of the drug, dosage, prescribing doctor, and claimant's name.
5. Travel vouchers may only be submitted for obtaining medical treatment or supplies (wheelchairs, canes, etc.) The voucher must include the origin, destination, and reason for travel. Travel other than directly to and from treatment is not payable. Tolls or parking will not be paid without original receipts. You should also include the time travel begins and ends. All travel vouchers will be matched with provider dates of service.
6. Your case number must be on the bill.

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Compensation Payments

If you lose, or expect to lose, pay 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 your doctor thinks that you will be disabled for work, or until your next medical appointment, not to exceed 30 days of wage loss into the future.
• Give the form to your supervisor or compensation specialist for completion of the back of the form (Part B). To minimize any possible interruption of income, your employing agency should submit the completed Form CA-7 to the district office on the 40th day of continuation of pay (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, your should:

• Obtain and complete Form CA-8, Claim for Continuing Compensation on Account of Disability.
• Arrange for your physician to complete Form CA-20a, Attending Physician's Supplemental Report (attached to Form CA-8), unless medical evidence supporting disability for the period claimed has already been submitted.
• Give Forms CA-8 and CA-20a to your supervisor or compensation specialist for submission to OWCP, preferably about five days before the end of the period claimed on Form CA-7.

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