QUESTIONS AND ANSWERS
Concerning Benefits of the Federal Employees' Compensation Act (FECA)
General Information/Definitions
Continuation of Pay
Compensation for Wage Loss
Leave Buy Back
Appeal Rights
Health/Life Insurance
Survivors
General Information/Definitions
What is the Federal Employees' Compensation Act?
The Federal Employees' Compensation Act (FECA) is a law which provides compensation and medical benefits to civilian employees of the United States for disability due to personal injury (including occupational disease) sustained while in the performance of duty. Damage to or destruction of medical braces, artificial limbs, and other prosthetic devises incidental to a personal injury is also compensable. The FECA also provides for the payment of benefits to dependents if job-related injury or disease causes the employee's death.
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Who administers the FECA?
The FECA is administered by the Office of Workers' Compensation Programs (OWCP), U.S. Department of Labor, through district offices located throughout the United States. Each Postal Service Injury Compensation Specialist will have the address of the district office which serves a particular geographic area.
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Are all work injuries covered under the FECA?
All injuries, including disease proximately caused, aggravated, accelerated, or precipitated by employment, sustained while in the performance of duty by employees of the U.S. Postal Service are covered.
The employee must provide medical and factual evidence to establish the essential elements of the claim, i.e., that the claim was filed within the statutory time requirements of the FECA, the injured or deceased person was an employee within the meaning of the FECA, the employee sustained an injury or disease, the employee was in the performance of duty when the injury occurred, and the condition found resulted from the injury. Benefits cannot be paid if injury or death is caused by willful misconduct of the injured employee, by intent to bring about the injury or death of oneself or another, or by intoxication of the injured employee.
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Are only regular, full-time employees eligible for FECA benefits?
No. FECA coverage is extended to Federal employees regardless of the length of time on the job or the type of position held. There are some differences to how compensation rates are calculated, but that will be addressed in another question.
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Is it necessary to report all injuries that occur at work, even minor injuries such as a scratched finger or bumped knee?
All injuries should be reported, since a seemingly minor injury may develop into a more serious condition. For protection, the employee should file a report of the injury with the immediate supervisor when it occurs. Benefits cannot be paid unless an injury is reported.
In the situation of a seemingly minor injury, a CA-1 should be filed with the supervisor. The claim will be treated as a "First Aid" case and retained at the District office in the employee's file with the Injury Compensation Specialist. The CA-1 is not forwarded to OWCP at this time. However, if a more serious condition arises as a result of this "First Aid" injury, the original CA-1 should be forwarded to OWCP for processing of entitlement to benefits.
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How is a "Traumatic Injury" defined?
A traumatic injury is defined as a wound or other condition of the body caused by external force, including stress or strain. The injury must be identifiable as to time and place of occurrence and member or function of the body affected. It must be caused by a specific event or incident or series of events or incidents within a single day or work shift. Traumatic injuries include damage to or destruction of prosthetic devices or appliances, including eyeglasses and hearing aids if they were damaged incidental to a personal injury requiring medical services. (Reference: January 14, 1995 magazine article)
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An employee may be exposed to toxic fumes, poisonous plants, or insects that cause injury. Are injuries from these hazards considered traumatic?
Yes, if the injury is the result of one day's exposure. If the exposure continues beyond one day or one shift it would be an occupational illness.
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What is the definition of an "Occupational Disease or Illness"?
An occupational disease or illness is defined as a condition produced in the work environment over a period longer than one workday or shift. It may result from systemic infection, repeated stress or strain, exposure to toxins, poisons, fumes or other continuing conditions of the work environment. (Reference: January 28, 1995 magazine article)
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Is a pre-existing condition that is aggravated by factors of employment covered by FECA?
Disease and illnesses aggravated, accelerated or precipitated by the employment are covered. The employee must submit medical and factual evidence that establishes that the employment aggravated, accelerated, or precipitated the condition. OWCP defines the following types of causal relationships:
- Direct Causation - this type of relationship is shown when the injury or factors of employment, through a natural and unbroken sequence, results in the condition claimed (i.e., a fractured arm sustained in a fall would be considered a direct result of the fall).
- Aggravation - This kind of relationship occurs if a pre-existing condition is worsened, either temporarily or permanently, by an injury arising in the course of employment (i.e., a back injury may aggravate a claimant's pre-existing degenerative disk disease, and compensation would be payable for the duration of the aggravation as medically determined).
- Acceleration - An employment related injury or illness may hasten the development of an underlying condition (i.e., a claimant's diabetes may be accelerated by a work schedule which is so erratic that it prohibits the regular food intake required for this condition).
- Precipitation - A latent condition which would not have manifested but for the employment (i.e., tuberculosis may be latent for a number of years, then become manifest due to renewed exposure in the work place).
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Is a recurrence of an employment related disability covered by FECA?
Yes. If an injured employee is again disabled as a result of the original injury or occupational disease, there is coverage under FECA. The recurrence should be reported by completing Form CA-2a, "Notice of Employee's Recurrence of Disability and Claim for Pay/Compensation." (Reference: May 20, 1995 magazine article). OWCP defines the following:
- Recurrence of Medical Condition - this term is defined as the documented need for further medical treatment after release from treatment for the accepted condition when there is no work stoppage.
- Recurrence of Disability - This term includes certain kinds of work stoppages which occur after an employee has returned to work after a period of disability. It includes a work stoppage caused by: a) a spontaneous material change demonstrated by objective findings, in the medical condition which resulted from a previous injury or occupational illness without intervening injury or new exposure to factors causing the original injury; b) a return or increase of disability due to an accepted consequential injury; or c) withdrawal of a limited duty assignment. This withdrawal must have occurred for reasons other than misconduct or non-performance of job duties.
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Is there a specific form to be used for reporting an injury?
Form CA-1, "Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay / Compensation" is the form to use when reporting a traumatic injury.
Form CA-2, "Federal Employee's Notice of Occupational Disease and Claim for Compensation" is the form for reporting an occupational disease. In addition, the employee should be given two copies of the appropriate checklist, Form CA-35a - h, for the disease claimed (specific checklists have been devised for various conditions in order to facilitate submission of evidence).
CA-35A "Evidence Required in Support of a Claim for Occupational Disease"
CA-35B "Evidence Required in Support of a Claim for Work-Related Hearing Loss"
CA-35C "Evidence Required in Support of a Claim for Asbestos-Related Illness"
CA-35D "Evidence Required in Support of a Claim for Work-Related Coronary/Vascular Condition"
CA-35E "Evidence Required in Support of a Claim for Work-Related Skin Disease"
CA-35F "Evidence Required in Support of a Claim for Work-Related Pulmonary Illness (not asbestosis)
CA-35G "Evidence Required in Support of a Claim for Carpal Tunnel Syndrome"
CA-35H "Evidence Required in Support of a Claim for Work-Related Psychiatric Illness"
Instructions attached to Forms CA-1 and CA-2 should be followed carefully. Form CA-1 should be filed as soon as possible, but no later than 30 days following the injury, and Form CA-2 should be filed within 30 days from the date the employee realized the disease or illness was caused or aggravated by the employment. (Exhibit 4: Forms Listing Chart)
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Can someone besides the employee complete a notice of injury?
Yes. Forms CA-1 and CA-2 may be completed by another person, including the supervisor, acting on behalf of an injured employee who is incapacitated. The person making the report should complete and sign the Form CA-1 or CA-2, and should then submit it to the employee's supervisor.
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Is an employee considered to be in performance of duty for compensation purposes 24 hours a day while in travel status?
An employee in travel status is covered 24 hours a day for all activities that are reasonably incident to the employment being performed in such status. This does not include travel for union business. It only covers travel required by the U.S. Postal Service.
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Is an employee covered by compensation if injured while going to and from work?
Employees are not generally covered by the FECA for injuries sustained before they reach or after they have left Government premises. Exceptions to this rule include situations where the agency furnishes transportation to and from work, where the employee is required to travel during a curfew or an emergency, or where the employee is required to use his/her automobile during the work day. An employee who believes a particular injury is an exception to the general rule should file a claim with OWCP.
A rural letter carrier is considered to be in the performance of duty while driving his/her own vehicle between home and the Post Office and between the Post Office and home, provided the record shows that the Post Office required him/her to furnish the vehicle for handling the mail. As you will note, this coverage only involves the drive to and from the Post Office in a direct line of travel. If you are making stops on the way to the Post Office outside of the direct line of travel, you may jeopardize your coverage under FECA, unless this practice was known and authorized by the Post Office. You would not be compensated for an injury sustained prior to getting into the car to head to work. If you are delivering mail in an LLV, you would not be covered under FECA on the ride to and from work.
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Are recreational injuries covered under the FECA?
An employee is covered while engaged in recreation which he or she is required to perform as a part of training or assigned duties or which occurs in pay status. Employees engaged in informal recreation, such as jogging, while on the employing agency's premises may also be covered, as may employees injured while engaged in activities approved in a documented individual plan developed under a formal agency-managed physical fitness program. Under other circumstances, the agency must explain what benefit it derived from the employee's participation, the extent to which the agency sponsored or directed the activity, and whether the employee's participation was mandatory or optional.
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Is an employee entitled to compensation if injured while on coffee break?
Generally speaking, if an employee is on Government premises for the purpose of performing service and is injured, there is coverage under FECA. Otherwise, complete information regarding the absence from the premises will have to be obtained before a determination can be made.
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Is an employee covered by FECA if injured while at lunch?
If the employee is on Government premises for the purpose of performing service and is injured while at lunch, coverage will be extended. Injuries which occur during lunch hour off the premises are not ordinarily covered unless the employee is in travel status or is performing regular duties off premises. As a rural carrier you would be considered to be performing regular duties off premises during a regularly scheduled lunch break. However, if you veer from a direct line of travel for lunch breaks, you would not automatically be covered for any injury sustained, unless this practice was known and authorized by the Post Office.
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What must an employee do to receive benefits when injured at work?
An employee injured at work should do the following:
- Report the injury immediately to the supervisor and obtain first aid as necessary;
- If further medical treatment is needed, obtain authorization (Form CA-16) from the supervisor for treatment by a physician or hospital of the employee's choice.
- Complete a written report (Form CA-1 or CA-2) and submit it to the supervisor (someone else may complete the report on the employee's behalf) as soon as possible, but not later than 30 days of the date of injury or illness;
- Furnish the supervisor with medical evidence of a disabling traumatic injury within 10 workdays of claiming continuation of pay (COP).
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Does an employee need an attorney or other representative in order to file a claim for compensation?
No. If desired, however, the employee may obtain the services of an attorney or other representative. If representation is obtained, the employee should not pay any fee for services in connection with the claim until OWCP has approved the amount of fee, unless the payment is made to an escrow account pending OWCPs fee approval. OWCP will not, however, pay the fee or be a party to its collection.
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Is there a time limit for filing notice of injury and claim for compensation?
Yes. A claim for compensation must be filed within three years of the date of the injury. If a claim is not filed within three years, however, compensation may still be allowed if written notice of injury was given within 30 days or the employing agency had actual knowledge of the injury within 30 days after occurrence. 5 USC 8122 outlines timely filing requirements for occupational disease claims.
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How long can I expect it to take for my claim to be adjudicated by OWCP?
OWCP District offices are required to maintain control of case adjudication, compensation and bill payments, and responses to priority inquiries. The standards and goals are as follows:
| Processing of a Traumatic Injury: |
Processing Occupational Illness: |
| 85% within 45 days |
70% within 180 days |
| 95% within 120 days |
90% within 300 days |
| 99% within 180 days |
98% within 365 days |
| Medical Payments: |
Compensation Payments: |
| 75% within 28 days |
80% within 14 days |
| 95% within 60 days |
85% within 45 days |
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Does the employing agency have the authority to approve or disallow a claim?
No. Only OWCP has the authority to adjudicate a claim for compensation. While the employing agency has a role in paying or withholding COP, this action is reviewed in every case by OWCP.
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What key items need to be addressed when filing a claim with OWCP?
There are five basic elements to a "prima facie" case. "Prima Facie" is defined by OWCP to represent a claim that is valid at first glance.
- Time: written notice of injury or death must be filed within 30 days after the occurrence of the injury or death. Original claim for compensation for disability must be filed within 3 years after the occurrence of injury or death. (5 USC 8122 for occupational disease claims)
- Civil Employee: generally this is not a concern. The completion of the supervisor's portion of the claim form is all the proof needed by OWCP.
- Fact of Injury: must show that the accident claimed did in fact occur at the time and place and in the manner alleged and caused a documented medical condition. In Occupational Illness claims, where the claim is not based on a specific incident, the claimant must also submit sufficient evidence to identify fully the particular work conditions alleged to have caused the disease and show that he/she was exposed to the conditions claimed.
- Performance of Duty: must show not only that an injury occurred, but that he/she was performing official duties (or activity appropriately related to employment) at the time of injury.
- Causal Relationship: the question of causal relationship is a medical issue which usually requires reasoned medical opinion for resolution. Basically, your physician has to state a clear diagnosis of your condition, provide all diagnostic test results, and show how your employment caused or contributed to your condition.
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If an employee qualifies for disability retirement under the Civil Service Retirement Act, does this automatically mean that the employee is qualified to receive compensation benefits?
No. To be eligible for compensation benefits, it must be established that an employee is disabled for regular work as the result of an employment related injury. The Office of Personnel Management will consider disability whether it is employment related or not.
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How much does compensation coverage cost a Federal employee?
No salary deductions are made for compensation coverage under the FECA. Coverage is extended if the person qualifies as an employee of the Federal Government and if the injury falls within the purview of the Act.
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If an employee sustains a job-related injury and also suffers damage to personal property, such as clothing, can the employee be paid for such loss?
Except for prosthetic devises or appliances, the FECA contains no provision for reimbursement for loss of personal property. The employee may claim reimbursement for personal property from his or her employing agency under the Military and Civilian Personal Property Act of 1964, 31 USC 240.
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What is the penalty of filing a false a claim?
Federal law (18 USC 1920) provides: "Whoever makes, in an affidavit or report required by section 8106 of title 5 in a claim for compensation under subchapter I or chapter 81 of title 5, a statement, knowing it to be false, is guilty of perjury and shall be fined not more than $10,000 or imprisoned not more than five years, or both" (or $10,000 and 10 years for conspiracy to commit fraud).
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What recourse does an employee have if his or her supervisor refuses to accept a notice of injury or claim for compensation?
OWCP should be notified of such refusal. Federal law also provides in 18 USC 1922 that: "Whoever, being an officer or employee of the United States charged with the responsibility for making the reports of the immediate superior specified by section 8120 of title 5, willfully fails, neglects, or refuses to make any of the reports, or knowingly files a false report, or induces, compels, or directs an injured employee to forego filing of any claim for compensation or other benefits provided under subchapter I of chapter 81 of title 5 or any extension or application thereof, or regulations prescribed thereunder, shall be fined not more than $500 or imprisoned not more than one year, or both."
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National Rural Letter Carriers’ Association | Serving with a Smile
