A question that FECA claimants sometimes ask is OWCP reduced my check saying I can work, now my condition is worse, can my check be reinstated?

In a FECA claim, OWCP will sometimes determine that you have the ability to earn wages and reduce your check. Sometimes the person is actually working, other times, they send you a notice that they have selected a make believe job, and reduced your check based upon the amount of make believe money you supposedly can earn in that make believe job. If later your condition worsens, for instance you need a surgery or your doctors are explaining that your condition is worse, you may be able to prove to OWCP that you are no longer employable and get your full wage loss benefits reinstated. Recently, a person came to me whose check was reduced in 2006. In 2009 OWCP sent this person to their selected doctor who advised that the person was unemployable and needed surgery. Since that time the person has undergone four more surgeries. Yet OWCP claims examiners never informed the person that due to the OWCP selected doctor saying that the work injury had worsened that she could request modification, nor did OWCP inform the person when the four surgeries were approved over the last eight years that each of those events should have triggered the person's wages being restored. When I became involved in the case, OWCP claims examiners continued to resist reinstating the full wage loss for many months, but finally agreed to reinstate full lost wages retroactive to 2009. If your check has been reduced by way of a decision in which OWCP claimed you were able to have earnings, and your condition has worsened to the point that you are no longer employable, that decision can most certainly be modified and your full wage loss benefit can be reinstated.

OWCP has created a new prior authorization policy opioid medication prescriptions for claimants who are identified as newly receiving these medications

OWCP’s Division of Federal Employees’ Compensation (DFEC) has implemented a new prior authorization policy for some opioid medication prescriptions for claimants who are identified as newly receiving these medications under the Federal Employees’ Compensation Act (FECA) Program. Injured workers with accepted FECA claims will, after an initial 60 day period of opioid medication, be required to have a physician-completed Letter of Medical Necessity (also referred to as LMN or Form CA-27) fully completed by an enrolled provider prior to authorization of continued opioid medication by DFEC.  Incomplete CA-27s will be returned to the provider without further processing.  Authorizations for opioid prescriptions will be limited to a maximum of 60 days, with initial fills and refills to be issued in no more than 30-day supplies. Providers should only offer the patient the amount that the physician believes the patient will need.  Providers should utilize “partial fills” for schedule II and schedule III opioids.  As part of the new opioid policy, no more than two opioids will be permitted for a single case.  Additionally, compounded medications containing opioids will require a completed and approved LMN prior to dispensing, effective June 26, 2017.

The Letter of Medical Necessity (LMN/Form CA-27) is accessible to OWCP-registered providers on the ACS website (http://owcp.dol.acs-inc.com/portal/main.do)  and must be completed by the treating physician and submitted electronically. Instructions on how to submit the LMN are available on the Latest Developments section of the ACS website.

Additionally, DFEC recently issued FECA Bulletin No. 17-07 which provides further information on the new policy. This Bulletin can be found at https://www.dol.gov/owcp/dfec/regs/compliance/DFECfolio/FECABulletins/FY2016-2020.htm#FECAB1707