The Federal Employment Compensation Act

• All medical costs associated with covered injuries or conditions without any cost-sharing, co-payments, or use of private insurance by the beneficiaries. Once your claim is allowed, you will begin to receive benefits to compensate for your injury or illness. First, FECA will cover all proper and necessary medical treatment, including surgery, rehabilitation, and prescriptions.

• Basic disability benefits are equivalent to two-thirds of the wage that the injured employee received before the disability. And if the worker has any dependents, the benefits rise to 75% of the pre-disability wage to account for the need to provide for those dependents.

• Disability benefits that are paid for the period of time that the beneficiary remains disabled or for the life of the injured employee. If the beneficiary has suffered a traumatic injury, the injured worker can receive a continuation of their full pay for the first 45 days off work. If you’re unable to return to work within 45 days, FECA will begin to pay for lost wages. The amount of compensation you’ll receive will depend on the severity of your permanent disability and how it affects your future earning capacity.

• Vocational rehabilitation services or retraining to help the beneficiary return the workforce after the injury or illness.

• Cash benefits for eligible dependents of federal workers killed as a result of a work-related injury or accident. These are based on the employee’s wages in addition to benefits for the funeral expenses

• Disability benefits provided by schedules stipulated by statute and regulation for individuals with specific permanent partial disabilities.

Coverage under FECA is provided to civil officers or employees in any branch of the federal government including an employee or officer of an agency completely owned by the Government of the United States. FECA does not cover individuals employed by private government contractors. Employees covered include those in the judicial, legislative, or executive branches of the government. Both part-time and full-time employees are covered, as are individuals serving on federal juries and those doing volunteer work. Coverage also extends to certain groups of employees, including:

• Federal petit or grand jurors

• Peace Corps and VISTA volunteers

• Local and state law enforcement officers acting in a federal capacity and circumstances involving crimes against the United States

• Members of the Civil Air Patrol and Coast Guard Auxiliary

• Job Corps

• Reserve Officer Training Corps Cadets

• Youth Conservation Corps enrollees

• Neighborhood Youth Corps.

For an injury or illness to be covered by the FECA, it must have been caused by employment. This means that you must have been injured in the performance of duty or you must have developed an illness due to your working conditions and hazardous inherent in your work. Injuries and illnesses that occur outside the course and scope of employment are not covered under the FECA. Activities that may be considered to be outside the course and scope of employment include recreational outings, commuting to and from work, and activities for personal reasons. Injuries that occur during meals and rest breaks are also covered.

There is no list of diseases and injuries that are covered or not covered under the FECA. So long as you’re a covered federal employee under Federal Employees’ Compensation Act and you’re injured on the job, you are eligible to obtain workers’ compensation benefits irrespective of your condition.

However, an employee may not be able to obtain these benefits if the injury, illness, or death was caused by:

• Willful misconduct of the injured worker

• Employees proximate intoxication or working under the influence of alcohol or drugs

• Employee’s intention to bring about injury or death to him/herself or another person

Moreover, any individual who fraudulently applies for or receives FECA benefits and is consequently convicted of a felony loses his/her rights to all FECA benefits for any form of injury sustained on or before the conviction date. If an individual is jailed, imprisoned, or confined in an institution by virtue of a felony conviction, the FECA benefits are suspended for the same duration of confinement and may not be recovered.

The form that an individual will be required to fill out will depend on whether the worker suffers from an “occupational disease” or a “traumatic injury.”

• Traumatic injury: This is a wound or other body conditions caused by an external force including, strain and stress. For an injury to be considered traumatic, it must affect a specific function or part of the victim’s body and must have occurred at a specific time and place. Furthermore, the injury should be as a result of a specific incident or event, or a series of incidents or events that occur within a single work shift or single work day. For example, falling off a ladder while working on a job would result in a traumatic injury.

• Occupational disease/illness: This is a condition that develops over a period longer than a single work shift or workday and occurs as a result of the work environment. The condition may be brought about by infection, repeat exposure to toxins, repeated stress or strain, fumes, poisons or other continuing conditions of the work environment. For example, repetitive stress injury caused by typing on the same computer over a long period of time would be considered an occupational disease for the purpose of FECA workers’ comp benefits.

In determining whether an injury is occupational or traumatic, the main factor that’s considered is the length of exposure and not the cause of the injury or the resulting medical condition. For example, if a worker is exposed to toxic chemical fumes for one day and develops a medical condition, the incident is deemed a traumatic injury. But, if the same worker is exposed to toxic fumes for over a month, the incident is deemed an occupational disease.

When reporting a traumatic injury, employees use Form CA-1, which is the “Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Compensation/Pay”. Conversely, an employee would use Form CA-2, which is the “Notice of Occupational Disease and Claim for Compensation” when reporting an occupational disease.

There are time limits for reporting an injury to the federal employer for the purpose of receiving worker’s comp benefits under the FECA. Form CA-1 must be filed within 30 days of the injury. On the other hand, Form CA-2 must be filed with the federal employer within 30 days of the date that the employee knew or should have reasonably known that the injury was caused or worsened by the employment. The injured employee may obtain the forms from the employer or the OWCP. On receiving the form, the employer is required to fill out the employer section of the form and send the completed forms to OWCP within a period of 10 workdays.

The OWCP processes and adjudicates all FECA claims. Initial decisions on claims are based on the type of evidence provided by the injured employee and their treating physician. In some cases, the OWCP may order a claimant to undergo a medical examination conducted by a doctor contracted by the federal government. The claimant may also be required to attend medical visits in the company of an OWCP’s representative (usually a nurse). The representative may as well visit privately with the claimant’s treating physician and report his/her opinion to the OWCP.

If an employee is not happy with the claims verdict, he/she may seek an OWCP review of the record of its verdict or request a hearing before OWCP. If the decision made after the hearing or review process is still not satisfactory, the employee can make a final appeal to the Employees’ Compensation Appeals Board (ECAB) within 90 days of OWCP’s decision. Once the ECAB makes a decision, it is final, cannot be subjected to judicial review, and cannot be appealed. Also, the ECAB makes a ruling based on the evidence of record at the time of issuing the decision, meaning that the claimant may not be in a position to present new/additional evidence.

Requirements of a Claim

For the purposes of making a FECA claim, medical and factual evidence must be provided to establish five basic elements:

• The injured or deceased individual was a federal employee eligible for FECA,

• The time limit set by the FECA to file a claim was observed,

• The employee was executing his/her duty when the incident(s) leading to the claim occurred,

• The employee developed a medical condition in a particular manner, and

• The medical condition found occurred as a result of the incident(s) leading to the claim.

Time Limit for Filing a FECA Claim

When a federal employee within the meaning of the FECA suffers an injury or dies, a claim for benefits must be filed within three (3) years of the date of injury or death. However, if the claim is based on a latent disability or occupational disease, such as a condition caused by prolonged exposure to a toxic substance, the time limit begins when the employee is disabled and knows or reasonably should know that the condition is work-related. If the claim isn’t filed within the three-year period, the injured employee may still receive compensation if he/she submitted a written notice within 30 days of being injured or the employer was aware of the injury within 30 days after the event occurred.

• Medical Benefits

  An employee is entitled to medical benefits meant to cover medical treatment, surgery, medications, therapies, devices, supplies, and transportation costs for obtaining care. A FECA beneficiary has the choice of selecting any qualified local hospital or physician to provide medical treatment. But if the employee chooses to change the treating physician after the initial choice, he/she must seek authorization from the OWCP, except for referral by the attending physician. Without OWCP’s authorization, the expenses of treatment will not be covered.

  A physician, in this case, refers to podiatrists, surgeons, clinical psychologists, osteopathic practitioners, chiropractors, optometrists, and dentists within the scope of their practice. If the physician selected is excluded from participating, the employee will be advised of the exclusion and the need to choose another physician. If OWCP accepts the claim, medical treatment for accepted conditions will be paid for, including treatment received before acceptance.

• Permanent Effects

  A schedule of benefits is provided by the FECA for permanent impairment of certain functions, organs, or parts of the body such as the kidney, arm, or eye, or for severe disfigurement of the neck, face, or head. As provided by the schedules set by regulations and statutes, these benefits are paid for a given number of weeks. The permanent effects benefits are also known as “Schedule Awards.” For instance, a federal employee who suffers a total loss of vision in one eye may receive an award of 160 weeks. In addition, the employee may receive compensation for loss of earning capacity if he/she is unable to return to work as a result of injury-related disability. The compensation, in this case, is the difference between the wages of the job that the employee held when he/she got injured and his/her capacity to earn wages following the injury. An additional amount of up to $1500 per month may be paid if the employee requires a constant attendant because of his/her condition.

• Temporary Total Disability

  In cases involving disabling, work-related traumatic injury, the beneficiaries can receive a continuation of their full regular pay for the first 45 days of disability. But if the disability continues for a period longer than 45 calendar days or the employee is not eligible for continuation, the worker may use sick or annual leave. Conversely, if the employee has suffered a disabling occupational disease, the continuation of regular pay does not apply. Compensation for loss of wages is paid after three (3) days, except in situations where the disability exceeds 14 days or the permanent effects result from the injury. Generally, temporary total disability benefits are paid at the rate of 2/3 of the worker’s pre-disability wages, and 3/4 of the pre-disability wages if the employee has one or more dependents. Dependents include unmarried children under 18 years of age, wife, husband, and a wholly dependent parent.

• Death Benefits

  If a federal employee dies due to a work-related injury or disease, his/her survivors are eligible for the compensation benefits below:

  • If no child is eligible for benefits or the deceased employee had a spouse with no children, the widow or widower is qualified for compensation equivalent to 50 percent of the employee’s monthly pay at the time of death.

  • If there’s a child or children qualified to receive benefits, the spouse is entitled to obtain a monthly benefit equivalent to 45 percent of the deceased employee’s monthly wage at the time of death. Each child is entitled to 15 percent of the pay.

  • If the employee’s sole survivors are children, the first child will receive 40 percent of the wages and each additional child will receive 15 percent of the pay.

  • Other individuals such as dependent brothers, sisters, parents, grandchildren, and grandparents may also be eligible to receive benefits up to a maximum family benefit of 75 percent of the employee’s pay. The dependents may also receive up to 75 percent payment of the highest step for GS-15 of the General Schedule.

  Payment of death benefits to a surviving spouse stops if he/she remarries or upon his/her death. The benefits, however, continue for life if the spouse remarries after the age of 55. Benefits to children, grandchildren, brothers, and sisters cease at the age of 18 or 23 if the dependent is still in school or is not capable of self-support.

  Funeral costs of up to $800 are payable. The federal government will also cover the costs of transporting the body from the place of death to the employee’s former residence in the United States. In addition to any burial and transportation costs, personal representative of the deceased employee will receive a $200 allowance for administrative work of terminating the departed employee’s relationship with the Federal Government.

• Vocational Rehabilitation

  The OWCP contracts vocational rehabilitation counselors to provide services such as training programs, vocational testing, guidance and counseling, and placement help to federal employees who are partially disabled and can’t resume regular work. Each of the aforementioned services is provided for a definite period of time. Training programs may be approved by OWCP if there’s no successful placement with the Federal employer and training would significantly help the worker’s earning capacity. Training programs are only provided to workers who need it to get a suitable job.

  Typically, a program may on-the-job-training and/or classroom training. The costs may include supplies, books, tuition, as well as monthly maintenance allowance that don’t exceed $200. An employee in a vocational rehabilitation approved by the OWCP receives benefits at the compensation rate for total disability. Cooperation with vocational rehabilitation efforts is important. If a disabled employee declines to undertake early stages of vocational rehabilitation, OWCP postulates that vocational rehabilitation would have enabled the employee to maintain his wage-earning capacity and return to work, unless there’s something to prove the contrary. In this case, compensation is reduced to zero. If the employee refuses to complete the OWCP-approved training, after the identification of suitable work, OWCP assumes that if the employee completed the program, he/she would have been able to earn wages in the new job. For this reason, OWCP reduces compensation to be equivalent to the probable amount the employee would have earned in the identified position.

If you’re a federal employee who’s been injured on the job and need assistance with a FECA claim, the lawyers at Workers Compensation Attorney Law Firm are ready to advocate your rights and help you with your claim. For years, we’ve been committed to helping injured workers obtain the full amount of benefits to which they are entitled under the Federal Employees Compensation Act.

Our attorneys have the skills and experience to help you gather records and complete the required forms without any omissions or discrepancies. We can work with to ensure that your claim is accurate, complete, and file on time. The Workers Compensation Attorney Law Firm stands ready to provide you with superior legal services and stand up against government entities. We can also help you resolve problems with your case if your claim was denied.

Call our workers compensation attorney today at 310-956-4277 or fill out our online contact form to schedule a free initial consultation to receive legal counsel.