Understanding FECA
Claim Denials
and
Appeal Options
Receiving a denial from the U.S. Department of Labor’s Office of Workers’ Compensation Programs (OWCP) does not necessarily mean your FECA claim is over. A claimant may have several options for challenging the decision or correcting problems with the evidence by filing an appeal asking OWCP for an additional review the claim.
Every denial is different. The best appeal option generally depends on why the claim was denied, what evidence is missing, and how much time has passed since the decision was issued.
Why Are FECA Claims Denied?
To establish a claim under the Federal Employees’ Compensation Act (FECA), the claimant must provide enough factual and medical evidence to prove each required element of the claim.
Common reasons for denial include:
The evidence does not establish that the incident or employment exposure occurred as alleged.
The injury did not occur while the employee was performing federal job duties.
The medical evidence does not contain a clear diagnosis.
The physician did not adequately explain how the employment incident or work factors caused, aggravated, accelerated, or contributed to the diagnosed condition.
The medical report is based on an incomplete or inaccurate history of injury.
The claim was not filed within the required time.
The evidence does not establish disability from work during the period claimed.
The medical evidence does not support the requested treatment, surgery, claim expansion, schedule award, or other benefit.
OWCP gave greater weight to a second-opinion or referee examination.
OWCP must issue a formal decision explaining why the claim or benefit was denied and providing information about the claimant’s appeal rights. Claimants should read the entire decision carefully and identify the specific element OWCP found was not established.
FECA Appeal Options
Depending on the type and date of the decision, a claimant may have three primary review options:
A hearing which may be conducted as an oral hearing or a review of the written record
Reconsideration
An appeal to the Employees’ Compensation Appeals Board
These options are not interchangeable. Choosing one option may affect which other options remain available, so claimants should carefully review the deadlines and requirements before filing.
Oral Hearing
A claimant may request an oral hearing before a representative of OWCP’s Branch of Hearings and Review. The request must generally be made within 30 days of the date of the decision.
Oral hearings are most often conducted by telephone. The hearing is recorded, and the testimony becomes part of the official claim record.
An oral hearing may be helpful when testimony is needed to explain how an injury occurred, describe employment duties, clarify work factors, or address disputed facts.
Review of the Written Record
Instead of appearing at an oral hearing, a claimant may request a review of the written record. This request must also generally be made within 30 days of the decision.
A hearing representative reviews the existing claim file along with any additional evidence or written arguments properly submitted during the review process. No oral testimony is taken.
A review of the written record may be appropriate when:
The important facts are already documented.
The claimant has additional medical evidence to submit.
The issues can be clearly explained through a written legal or factual argument.
Testimony is not necessary to resolve the disputed issue.
Reconsideration
A request for reconsideration asks OWCP to reopen the claim and reconsider its decision. The request must generally be received by OWCP within one year of the date of the decision.
A proper reconsideration request must be in writing, signed and dated, and must do at least one of the following:
Show that OWCP incorrectly applied or interpreted a specific point of law.
Present a relevant legal argument that OWCP has not previously considered.
Provide relevant and pertinent new evidence that OWCP has not previously considered.
Appeal to the Employees’ Compensation Appeals Board
The Employees’ Compensation Appeals Board, commonly called ECAB, is separate from OWCP. A claimant generally has 180 days from the date of OWCP’s final decision to file an ECAB appeal.
ECAB reviews the evidence that was already in the claim record when OWCP issued the decision. ECAB does not normally accept or consider new evidence.
ECAB may:
Affirm OWCP’s decision.
Reverse the decision.
Set aside the decision and return the case to OWCP for additional development or a new decision.
Remand the case for further proceedings.
An ECAB appeal may be appropriate when the existing record already supports the claim and the claimant believes OWCP misapplied the law, failed to properly evaluate the evidence, or issued a decision that was not supported by the record.
If important medical or factual evidence is still missing, reconsideration or a hearing may be more useful because those options allow the claimant to submit new evidence.
Deadlines are extremely important. Claimants should follow the appeal instructions included with their individual OWCP decision rather than relying only on general information.
How Federal Injury Services Can Help
Federal Injury Services assists injured federal employees with reviewing OWCP decisions, identifying deficiencies in the evidence, developing medical documentation, preparing written arguments, and navigating the FECA appeal process.
If you received an OWCP denial, contact Federal Injury Services as soon as possible. Appeal deadlines may begin running on the date printed on the decision.
This information is provided for general educational purposes and is not legal advice. Claimants should review the appeal rights attached to their specific OWCP decision.