Difference between revisions of "FECA"
(New page: As a returned Volunteer, you may be eligible for certain benefits under the Federal Employees' Compensation Act (FECA) if the illness or injury is related to your activities as a Volunteer...)
Revision as of 10:04, 5 July 2007
As a returned Volunteer, you may be eligible for certain benefits under the Federal Employees' Compensation Act (FECA) if the illness or injury is related to your activities as a Volunteer, or is incurred during overseas service. FECA is administered by the Office of Workers' Compensation Programs (OWCP), U.S. Department of Labor (DOL). OWCP, not the Peace Corps, decides whether you qualify for medical treatment and compensation under this Act.
To file a claim for FECA benefits with OWCP, contact the Peace Corps Post-Service Unit at 800.424.8580, ext. 1540 or 202.692.1540 to obtain the appropriate forms.
When contacting the Post-Service Unit, please provide your current phone number, address, email address, and any other pertinent contact information. You should then return the claim forms, "employee" statements, and post-service medical documentation from your current physician to the Post-Service Unit:
1111 20th Street, NW
Washington, DC 20526
The Post-Service Unit will in turn submit your claim to OWCP along with substantiating documentation from your health record. Thereafter, your claim is handled exclusively by OWCP.
While OWCP will decide whether or not you qualify for benefits, the Peace Corps Post-Service Unit is here to help you obtain the benefits for which you are eligible under the FECA program. Your attention to detail in documenting your claim, providing complete physician reports, and complying with the requirements for bill submission can help expedite your claim and reimbursement of medical fees.
- 1 Benefits and Requirements
- 2 Exclusions
- 3 How to File a Claim
- 4 Medical Claims
- 5 Dental Claims
- 6 Recurrence of a Condition or Disability
- 7 Disability Compensation
- 8 Filing Your Claim
- 9 What Happens After You File
- 10 If OWCP Requests More Information
- 11 If Your Claim Is Denied
- 12 Medical Payments
- 13 A Note on Medical Providers
- 14 Frequently Asked Questions
- 14.1 How do I complete the forms?
- 14.2 What is needed in a medical report?
- 14.3 How long will it take for my claim to be approved by OWCP?
- 14.4 When will I get my compensation check?
- 14.5 How much money will I receive if my claim is approved for compensation?
- 14.6 Will my bills be paid?
- 14.7 How long will my benefits under the FECA program last?
- 14.8 What if my address changes?
- 14.9 Do I need an attorney to obtain benefits under FECA?
- 14.10 My health care provider did not receive full payment from OWCP and now I am being billed. Why does this happen?
- 14.11 I live outside the United States. May I still receive FECA benefits?
- 14.12 OWCP is asking me for a job description for my Peace Corps service. What do I do?
- 14.13 One of my bills was rejected by OWCP. What should I do?
- 15 Forms and Instructions
- 16 Instructions for Travel Reimbursement
- 17 External Links
Benefits and Requirements
Under FECA the benefits available for both illnesses and injuries resulting from your Peace Corps activities include:
- Compensation for lost wages due to disability
- Medical and dental care
- Schedule awards for the loss or loss of use of organs or other body parts
- Rehabilitation for disabled Volunteers
- Certain burial costs and survivor benefits
To receive any of these benefits, you must establish that you were a Volunteer at the time you contracted your illness or were injured. Additionally, the medical evidence must show that the illness was contracted or the injury sustained while overseas or in the performance of duty. In situations where a condition pre-existed Volunteer service, medical evidence must demonstrate that your Volunteer service aggravated, accelerated or precipitated that disease, illness or condition.
OWCP requires that you apply for benefits within three years after your related Volunteer service ended, or the date on which you first became aware that your condition resulted from your Volunteer service. OWCP will consider claims submitted after three years if it determines a waiver of the requirement for timely filing is merited under the applicable law.
The following conditions are excluded from coverage:
- Conditions caused by willful misconduct
- Conditions caused by the Volunteer's intention to bring about the injury or death of self or another
- Conditions proximately caused by the intoxication of the injured Volunteer
- Injuries occurring or illnesses contracted in the United States that were not related to the performance of Peace Corps duties
How to File a Claim
The Peace Corps Post-Service Unit helps returned Volunteers file FECA claims. If you think that you have a medical or dental claim under FECA, call or make an appointment with the Peace Corps Post-Service Unit at 800.424.8580, ext. 1540 or 202.692.1540 to obtain Form CA-1 or Form CA-2.
You may also download forms online at: http://www.dol.gov/libraryforms/formsbynum.asp
Form CA-1 is for an accident or incident that occurred in the course of one day. Form CA-2 is for an illness or a condition that took more than one day to develop.
The following sections will explain the procedures for filing medical, dental, recurrence, and disability claims.
Obtain a detailed medical report from your current physician. This report must be signed by the physician. These reports should include, where applicable, diagnosis, treatment rendered, dates of treatment, prognosis, any x-ray or lab results, and a reasoned opinion on the relationship of the condition to your service with The Peace Corps. Admission and discharge summaries are required for all hospitalizations. Physician name, address, and contact information are required. If your treatment plan includes surgery, your physician should submit a request for authorization of surgery with the medical report.
Complete Form CA-1 or Form CA-2. In the back of this handbook example completed forms are provided. Analyze your illness or injury and include all the information pertinent to your case. Complete one original claim form for each diagnosis or condition. You must complete, sign, and date each form.
Write an "employee" statement to accompany Form CA-2 that includes a detailed history of the disease or illness from the date it started; complete details of the conditions believed to be responsible for the disease or illness; a description of specific exposures to substances or stressful conditions causing the disease or illness, including locations where exposure or stress occurred, as well as the number of hours per day and days per week of such exposure or stress; and identification of the part of the body affected. Include a statement indicating whether you ever suffered a similar condition. If so, provide full details of onset, history, and medical care received, along with names and addresses of physicians who rendered treatment. A separate employee statement should be submitted for each disease or illness for which you file a claim.
If you desire reimbursement of medical expenses, you must get approval in advance from OWCP for any procedure other than emergency surgery. Emergency surgery is defined by OWCP as any procedure that needs to be performed promptly to preserve life or the function of an organ or body part. Have your doctor send a report stating the name of the surgical procedure, diagnosis of the specific condition to be treated by the surgery, expected results, and the reason the surgery is needed. If any tests were performed, copies of the results, such as radiology reports, must be provided. OWCP may require medical review and in some cases may ask for a second opinion before deciding whether to approve reimbursement.
If you need dental treatment for a condition related to your Volunteer service, ask your dentist for a treatment plan and a written estimate. Have your dentist send the plan, x-rays, and estimate to the Peace Corps Post-Service Unit at:
1111 20th Street NW
Washington, DC 20526
where the Peace Corps dental consultant will review them.
If the Peace Corps dental consultant approves the plan, the Peace Corps will authorize and pay for dental treatment under $1,000. If your dental treatment is estimated to be more than $1,000, you must file a claim with the OWCP. You should complete the CA-2 form, including the employee statement, and send it to the Post-Service Unit along with dental x-rays and an itemized estimate of the costs of the treatment. If you consult more than one dentist, you should submit an estimate from each one.
Recurrence of a Condition or Disability
Cases may be closed by OWCP when there is no indication of long-term disability or need for further medical care. If your case is closed and you experience recurrent difficulties due to an accepted illness or injury and require medical treatment, you must file a claim for recurrence. To do this, file Form CA-2a with the Peace Corps Post-Service Unit. Include a personal statement updating the claims examiner on your condition (this is called a bridging statement) and your medical provider's reasoned opinion that the recurrent difficulty is due to the service-related illness or injury.
If your service-related illness or injury causes you to become disabled for work for any length of time after completion of Volunteer service, please call the Peace Corps Post-Service Unit for a "Claim for Compensation," Form CA-7.
Complete the employee's section of Form CA-7 and have your doctor complete "Attending Physician's Report," Form CA-20. Please return all original forms to the Peace Corps Post-Service Unit. This office will complete the employer's section and submit the paperwork to OWCP on your behalf. Once your claim has been approved, you are eligible to apply for compensation (if totally disabled) from the day following Volunteer service or the onset of the disability, if it is later, until your doctor supplies medical documentation that you have recovered. Check to make sure that Section 2 on the "Claim for Compensation" (Form CA-7) and #17 of the "Attending Physician's Report" (Form CA-20) are in agreement. If your disability extends beyond the date that you originally submitted, you may call the Post-Service Unit for additional forms.
Your compensation payments will be authorized only after your medical claim has been accepted and only if your medical documentation from a physician supports the claim of total disability for more than four days.
Filing Your Claim
Forward your claim forms and all supporting documents to:
Post-Service Unit, 5th Floor
Attn: Workers' Compensation
1111 20th Street, NW
Washington, D.C. 20526
We strongly recommend that you keep a copy of each document for your records.
For further information about FECA and the Department of Labor, see the DOL and OWCP websites at: www.dol.gov/ www.dol.gov/esa/owcp_org.htm
What Happens After You File
- The Post-Service Unit at Peace Corps headquarters will complete the back of the Form CA-1 or CA-2 and forward the original to OWCP along with your employee statement.
- OWCP will send you a postcard with your assigned claim number when it receives your claim forms. Receipt of this claim number does not mean your claim has been accepted.
- The Post-Service Unit will notify you by letter when it has submitted your Peace Corps medical documentation to OWCP.
- OWCP will send you a formal letter to let you know the status of your claim. This may take from four to ten weeks. If, after ten weeks, you have not heard from OWCP about a decision on your claim, you may contact the Post-Service Unit for a progress report.
- If you cannot work, for any length of time, because of your service-related illness, call the Post-Service Unit for Form CA-7, "Claim for Compensation."
- After your claim is adjudicated, the OWCP may send your case file to the District Office that handles claims in your geographic area. Once you have been notified that your file has been transferred, send all of your future correspondence to:
U.S. Department of Labor
DFEC Central Mailroom
P.O. Box 8300
London, KY 40742-8300
If OWCP Requests More Information
If you receive a request for additional information from OWCP, you should respond promptly. Claimants are usually given 30 days to respond to a request for information.
In many cases, OWCP states that the submitted materials are not sufficient to determine whether the claimed condition is caused by Volunteer service. This question must be clarified by a physician. In these cases, we recommend that you provide your physician with the OWCP letter and ask for a response in writing. Contact the Post-Service Unit or OWCP if you need to clarify the request for additional information.
If Your Claim Is Denied
If your claim is denied, you will receive a formal letter of explanation together with information about your appeal rights. OWCP provides three avenues of appeal: reconsideration by the OWCP District Office, an oral hearing or review of the written record by an OWCP representative, and a review by the Employees' Compensation Appeals Board (ECAB). Requesting reconsideration or an OWCP hearing does not rule out a later review by ECAB.
Our experience has shown that if you can obtain the additional medical documentation to address the issues set forth in the denial letter, reconsideration is the fastest and most efficient appeal process. You may not pursue more than one form of appeal at a time. If you have questions about the best way to appeal, call the Peace Corps Post-Service Unit or OWCP.
When your case has been accepted, you will be notified by mail. At that time, you may submit to OWCP all medical bills relating to your condition. If any medical bills related to your illness or injury were previously returned to you because your case had not been accepted yet, you may resubmit them at this time.
Please note that bills must be submitted within one year of the date of service or the acceptance of the claim. If you have a large number of charges, we recommend that you send them to OWCP regularly, rather than once a year. This will allow for faster and more accurate processing.
Medical bills from providers other than hospitals and pharmacies must be submitted on the "Health Insurance Claim Form," HCFA-1500. Most providers have this form, which is also used for Medicare billing. Forms should be itemized, signed, dated, and include the provider's tax identification number. These forms must be accompanied by medical reports for each date of service.
Dental bills should also be submitted on Form HCFA-1500. Although OWCP will also accept American Dental Association (ADA) forms, use of these forms may slow your provider's reimbursement.
Pharmacy bills must be submitted on a Universal Claim Form, which your pharmacy will supply. If you have an accepted condition, the pharmacy may bill OWCP directly for medications associated with that condition. An example of this form is provided in the Forms and Instructions section of this handbook.
Hospital charges should be submitted on Form UB-92. This is a standard hospital form.
If you have already paid the charges for a service and need reimbursement, obtain Form CA-915 from the Post-Service Unit and attach the appropriate billing form, such as for a hospital charge, a prescription, or a medical bill. If you need more forms, the CA-915 may be downloaded at: http://www.dol.gov/libraryforms/formsbynum.asp
Travel expenses should be submitted on Standard Form (SF) 1012. OWCP provides reimbursement of reasonable and necessary travel expenses related to medical treatment for accepted conditions. The SF 1012 and instructions for submitting travel vouchers are available from the Post-Service Unit or on the Web at: http://www.dol.gov/esa/owcp_org.htm and http://www.dol.gov/libraryforms/formsbynum.asp
A Note on Medical Providers
Physician Choice - Initially, you choose your physician. After that, if you wish to change your physician, you must present your reasons in writing to OWCP and request permission. You should provide the name, address, and specialty of the physician to whom you wish to change. If you do not obtain permission to change physicians, you may be held liable for any bills incurred. OWCP will honor referrals to appropriate specialists by your approved physician as long as they are for the accepted work-related condition.
Chiropractic Care - If you receive chiropractic care, only charges for manual manipulation of the spine to correct a subluxation demonstrated by x-ray will be covered. OWCP will not cover other chiropractic treatments.
Mental Health Professionals - If you receive care from a mental health professional, OWCP requires that this professional be a psychiatrist or a clinical psychologist. OWCP will not reimburse you for fees paid to other mental health professionals.
Frequently Asked Questions
How do I complete the forms?
Read the instructions provided by OWCP on the back of the form. For clarification refer to the examples in this handbook. Contact the Post-Service Unit if you need further assistance.
What is needed in a medical report?
The directions for the content of a medical report from your doctor are provided on the back of the CA forms. The reports should include, where applicable, diagnosis, treatment rendered, dates of treatment, prognosis, any x-rays or lab results, and a reasoned opinion on the relationship of the condition to your service with Peace Corps. In cases involving long-term disability, OWCP requires regular medical reports on your treatment program and progress.
How long will it take for my claim to be approved by OWCP?
It usually takes four to ten weeks for claims to be approved. Difficult claims or claims for the aggravation of a pre-existing condition may take longer. Many variables affect the time it takes OWCP to adjudicate a claim. Thorough documentation is the most effective means to obtain timely action.
When will I get my compensation check?
After your medical condition is accepted by OWCP, you and your physician must complete Forms CA-7 and CA-20 for wage loss compensation. Forward both forms to the Peace Corps Post-Service Unit. The Post-Service Unit will complete their portion of the CA-7 form and submit both forms to OWCP. You will receive your compensation check after your medical claim has been approved, you and your doctor have completed Forms CA-7 and CA-20, the Peace Corps Post-Service Unit has completed the back of the CA-7, and the OWCP claims examiner confirms your disability.
How much money will I receive if my claim is approved for compensation?
Congress decided that returned Volunteers should be considered to be at the lowest step (Step 1) of grade 7 of the General Schedule (GS). Compensation does not include locality pay. This wage replacement is not taxed. For example, in 2000 a GS-7/1 earns $26,470. If a returned Volunteer has no dependents, compensation is 66 2/3 percent of this amount or approximately $1,470 per month. If the returned Volunteer has dependents, the benefit is 75 percent of the GS-7/1 salary or approximately $1,654 per month. Volunteer Leaders are reimbursed at a different rate and should contact the Post-Service Unit to obtain that information.
Will my bills be paid?
After your claim is approved, the OWCP will pay all medical bills for services that pertain to your accepted condition. Bills from physicians, dentists, labs, and other medical providers must be submitted on the Form HCFA-1500. OWCP will, however, accept ADA forms for dental claims. In-patient hospital charges must be submitted on Form UB-92, which hospitals have in stock. If you have already paid your bill and need reimbursement, complete Form CA-915 and attach the appropriate form, such as the HCFA-1500 or the UB-92 mentioned above, and submit the forms to OWCP.
How long will my benefits under the FECA program last?
There is no time limit. Medical benefits and compensation payments for accepted conditions will continue as long as medical documentation supports that your Peace Corps-related problem continues. It is very important that your provider submit medical reports along with any bills. This assures documentation of the need for continued benefits.
What if my address changes?
Notify OWCP and the Peace Corps Post-Service Unit in writing. All change of address notices must bear your signature. Please include your claim number, social security number, and telephone number.
Do I need an attorney to obtain benefits under FECA?
No. The services of an attorney or legal representative are not needed to obtain FECA benefits. If you wish to engage an attorney or legal representative, you do so at your own expense. In such cases Peace Corps advises contacting the OWCP to obtain information related to claimant representation. A signed statement authorizing the person to represent you is needed before OWCP can release any of your medical information.
My health care provider did not receive full payment from OWCP and now I am being billed. Why does this happen?
OWCP uses a schedule of maximum allowable medical charges. Providers agree to the OWCP fee schedule when they sign the HCFA-1500 billing form. You are not responsible for amounts charged in excess of this fee schedule.
I live outside the United States. May I still receive FECA benefits?
Yes. There are, however, some differences in the claims process outside the U.S. Official government forms are not required for billing purposes because there is no mechanism for direct payment to medical providers overseas. To claim reimbursement, you must submit the medical reports, translated into English, and the bills, calculated in American dollars, and attach them to a completed Form CA-915. The use of a direct deposit account in the United States may improve the timeliness and safety of reimbursements and other compensation.
OWCP is asking me for a job description for my Peace Corps service. What do I do?
The Description of Service (DOS) completed by you and signed by the Country Director, is considered your job description. If you did not complete a DOS, contact the desk officer for your country of service to initiate the process. If you completed a DOS but have not received your copy, contact Volunteer and Staff Payroll Services to obtain a copy.
One of my bills was rejected by OWCP. What should I do?
When OWCP rejects a bill, it gives the provider, whether a hospital, physician, or dentist, a reason for the rejection in what is called an explanation of benefits (EOB) notice. The EOB also provides instructions for resubmitting the bill, which you or your medical provider should follow. If your provider receives a second rejection notice, you may need to contact OWCP directly to resolve the issue.
Forms and Instructions
You may download any of the commonly used forms at: http://www.dol.gov/libraryforms/formsbynum.asp
For sample forms, contact the Peace Corps Post-Service Unit. Form HCFA-1500 (bill submission), Form CA-915 (reimbursement of medical expenses), and SF 1012 (travel reimbursement) may be copied.
- CA-1: Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation
- CA-2: Notice of Occupational Disease and Claim for Compensation
- CA-7: Claim for Compensation
- CA-20: Attending Physician's Report
- CA-915: Claimant Medical Reimbursement Form
- HCFA-1500: Health Insurance Claim Form
- OWCP-957: Travel Voucher
Instructions for Travel Reimbursement
Travel should be undertaken by the shortest route. A claimant who uses a vehicle will be reimbursed at the standard mileage rate for government travel, which is currently 32.5 cents per mile. Under any other circumstance the claimant should use public conveyance such as a bus or subway unless the claimant's medical condition requires the use of a taxi or specially equipped vehicle.
Form OWCP-957 should be used to claim reimbursement for travel expenses. All items will be reimbursed on the basis of actual expense; a per diem allowance is not payable. Wages and travel expenses of an attendant to accompany the claimant may be approved if the medical condition is such that travel cannot be accomplished otherwise. Authorization for this expense should be obtained from OWCP in advance of the travel.
You may copy the OWCP-957, front and back, for your use. Contact the Post-Service Unit or OWCP if you need additional information.
FECA Official US Peace Corps Website