If the Office of Workers Compensation Programs (OWCP) denies a FECA claim, the District Office’s decision should clearly state the reasons why the claim was denied. A common reason for denial is that the evidence submitted by the claimant does not satisfy the claimant’s burden of proof. Often a claim is denied because the medical evidence does not establish that the claimant’s medical condition was caused by a compensable (or work-related) factor. The OWCP requires the claimant to submit a report that provides medical rationale. A doctor’s report has to do more than state that the claimant’s medical condition is work-related. The OWCP requires a report that explains how the claimant’s work duties (or other compensable factors) contributed to or caused the medical condition.
If the OWCP denies a claim, the claimant should be provided notice of three rights of appeal: 1) Appeal to the Branch of Hearings and Review; 2) Appeal to Employees’ Compensation Appeals Board (ECAB); or 3) Reconsideration to the District Office. Deciding which appeal right to pursue is important and should be discussed with a competent FECA attorney. It is important to timely submit your appeal.
HEARINGS BEFORE THE BRANCH OF HEARINGS AND REVIEW
A claimant may request a hearing to challenge the denial of his or her claim. A claimant has only 30 days from the date of the Decision to request an oral hearing or a review of the written record. Hearings are often useful because a Hearing Representative from outside the District Office that denied the claim will evaluate the Decision. The claimant may submit new evidence at the hearing, either through live testimony or documents. The Hearing Representative will usually ask questions. Oral hearings are particularly useful if there is some question over how a certain incident occurred. In addition, oral hearings are helpful to advance legal arguments and to define the issues. If the claimant opts to waive his/her right to appear before a Hearing Representative, a claimant may also request that the Branch of Hearings and Review conduct a Review of the Written Record. Unless a decision is reversed, a claimant will only have one chance at a hearing (that is not the case with the other two options below).
REQUESTS FOR RECONSIDERATION
A claimant has one year from the date of the Decision to file a Request for Reconsideration. The Request for Reconsideration must be received by the OWCP within the one year deadline. A Request for Reconsideration must be supported by new and relevant evidence and/or a new legal argument not previously considered by OWCP in its Decision denying the claim. Reconsideration Requests are handled by senior or supervisory claims examiners located in the same District Office that issued Decision denying the claim.
APPEAL TO THE EMPLOYEES’ COMPENSATION APPEALS BOARD (ECAB)
A claimant may appeal any Decision issued either by the District Office or the Branch of Hearings and Review to the ECAB. In conducting is review of the case, the ECAB will not consider new evidence. Therefore, the only time to file an appeal to ECAB is if there is no new evidence that would support a claimant’s claim. ECAB appeals make sense if there is no new evidence or if the claimant is alleging that OWCP failed to follow its own procedures.
It seems obvious that the claimant needs to provide evidence to prove entitlement to OWCP benefits, but by reviewing the Orders and Decisions issued by the Employees’ Compensation Appeals Board (ECAB) one can readily see that many claims are denied for lack of sufficient evidence. This is true even where the ECAB appeal has been handled by an attorney. There are very few circumstances were an ECAB appeal should be made where the evidence of record fails to establish the necessary elements of a claim. ECAB Decisions are posted on the ECAB’s website at: http://www.dol.gov/ecab/decisions/main.htm
CONSULT WITH A FECA ATTORNEY
In evaluating your appeal rights, carefully consider what new evidence you can submit in support of your claim. However, before you can ascertain the value of any new evidence, you first have to understand the legal issues. You should consult with a qualified FECA attorney to determine which appeal option would afford the greatest likelihood of a successful appeal.