You’ve submitted all the information described in our article entitled, “What You Must Prove to Win Your Federal Workers Compensation Claim,” but the Office of Workers Compensation Programs (OWCP) still denied your case, stopped paying a claim that they had already approved or reduced the payment amount.
To announce these adverse actions, the OWCP might have issued you a “notice of proposed termination of compensation benefits” or even a “notice of termination of compensation benefits.”
Maybe the OWCP sent you a job suitability letter and then a “notice of disqualification from compensation,” because it believes you can now work; therefore, in the agency’s eyes, you need no further compensation.
You got one of these notices or others that resulted in denial of benefits, discontinued payments or reduced checks. What do you do now?
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You can contest adverse decisions such as a denial or discontinuance of a claim. The OWCP calls these “formal decisions” and offers three types of appeals. They are,
Reconsideration. You can ask for a reconsideration by writing to the district office which made the initial formal decision within one year of receiving that determination. If you do that, you must state why you are appealing or, in legal jargon, the grounds upon which you’re basing it. You must also provide either new evidence not introduced during the initial claims process or an argument that the OWCP misinterpreted the law.
After receiving your reconsideration, the agency will issue another formal determination and tell you your appeals rights.
Hearing. You can request a hearing within 30 days after you received a formal decision unless you’ve already asked for a reconsideration. That means you can’t have both a reconsideration and a hearing. How do you know which type of appeal to request? Simply discuss you choices with us in a no-cost or obligation consultation. Call…
If you select a hearing, you can choose between orally presenting your case before an office representative or you may request a review of the written record, not both. Here’s another crucial decision you must make. We can help.
After reviewing the information you provide in your hearing, the agency will issue a formal decision, which you can appeal.
Review by the Employee Compensation Appeals Board (ECAB). This is the highest organization that hears federal workers’ compensation appeals. It reviews decisions made from hearings and reconsiderations. The ECAB only examines the case record and will consider no new evidence.
The OWCP’s “Injury Compensation for Federal Employees” manual states that, “…Employees are usually notified by letter about such matters as approval or denial of surgical procedures or other forms of medical care, and payment of medical bills by OWCP. Appeal rights are not usually included in such determinations, but formal decisions may be issues on such matters if requested.”
What, exactly does that mean?
It means that the OWCP might deny you needed medical treatment or another important benefit and then prevent you from appealing by calling their determination something other than a “formal decision.” Remember, you may appeal only “formal decisions.”
You may obtain further information by consulting this federal publication. But if you think you need professional assistance or just want to talk to a friendly, knowledgeable human being, we’re here to help you exerciseall your rights. You may start the process by calling us for a free, no-obligation or pressure consultation at…