What Happens After You File

What Happens After You File?

The Injury Compensation Program Administrator (ICPA) will review your claim and complete necessary portions of the Federal Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation (CA-1) or Notice of Occupational Disease and Claim for Compensation (CA-2) form and forward your claim electronically to the Office of Workers' Compensation Programs (OWCP) along with your employee statement. The ICPA will therefore receive a claim number for your claim within two business days of the submission.

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.

If you receive a request for additional information from OWCP (also called development letters), respond promptly. Claimants are usually given 30 days to respond to a request for information. If you are still in theater at the time the letter arrives and you do not reply, your claim will be denied. However, you can contact your ICPA and request his/her assistance.

If you have not heard from OWCP about a decision on your claim, you may contact the ICPA for a progress report.

If you cannot work for any length of time because of your deployed or overseas service-related illness or injury call the ICPA for a copy of Claim for Compensation (CA-7) form. If your claim is accepted, OWCP will process the CA-7 and pay compensation benefits as appropriate.

After your claim is adjudicated in the Cleveland District Office, OWCP may send your case file to another District Office for on-going case management. The responsible District Office is based on your home address. You can visit the DOL website at http://www.dol.gov/owcp/dfec/ for a list of all the District Offices. Once you have been notified that your file has been transferred, you may send all of your future correspondence to:

U.S. Department of Labor
DFEC Central Mailroom
P.O. Box 8300
London, KY 40742-8300


When sending correspondence to OWCP, please ensure that the claim number is clearly marked on each page being sent. You may also upload documents using the DOL’s ecomp system – https://www.ecomp.dol.gov.

If OWCP Requests More Information

If you receive a request for additional information from OWCP (also called developmental letters), respond promptly. Claimants are usually given 30 days to respond to a request for information. If you are still in theater at the time the letter arrives and you do not reply, your claim will be denied. However, you can contact your ICPA and request his/her assistance.

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 ICPA or OWCP.

Medical Payments

If 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. Always make sure that your claim number is written on each page of the document you are sending.

Medical bills for employees working overseas can be faxed to the Cleveland District Office at 216-357-5464 or mailed to:

United States Department of Labor/OWCP
1240 East 9th Street, Room 851
Cleveland, OH 44199
ATTENTION: DAVID WOODS
DO NOT OPEN IN MAILROOM


The Claims Examiner will complete the appropriate worksheet and forward all bills for processing. Foreign bills should never be sent to the central mail room address or through ACS, the automated billing system.

Please note that, to be considered for payment, bills must be submitted by the end of the calendar year after the year when the expense was incurred, or by the end of the calendar year after the year when OWCP first accepted the claim as compensable, whichever is later. 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 the 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.

Hospital charges should be submitted on Form UB-04. This is a standard hospital form.

If you have already paid the charges for a service and need reimbursement, obtain Claim for Medical Reimbursement Form (OWCP-915) from the ICPA or from the following DOL websites:

http://www.dol.gov/owcp/dfec/index.htm and

http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm.

Attach the appropriate billing form, such as for a hospital charge, a prescription, or a medical bill to the OWCP-915.

Inquiries regarding bills or reimbursements (with the exception of bills for overseas employees) may be addressed to DOL at: 866-335-8319 or from the following DOL website: http://owcp.dol.acs-inc.com. Billing questions for foreign bills should be addressed to the responsible Claims Examiner at OWCP.

Travel expenses should be submitted on Medical Travel Refund Request Form (OWCP-957). OWCP provides reimbursement of reasonable and necessary travel expenses related to medical treatment for accepted conditions. The OWCP-957 Form, and instructions for submitting travel vouchers, are available from your ICPA or from the following DOL websites:

http://www.dol.gov/owcp/dfec/index.htm and

http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm.

Deployed civilians or those civilians working overseas who are injured and treated in theater continue to be eligible for treatment in a Military Treatment Facility (MTF). This care is provided at no cost to the employee. If he or she elects continued treatment at a MTF due to the injury, such treatment is provided without charge; policy guidance issued by the Deputy Secretary of Defense on 9-24-07 states that "deployed Department of Defense (DOD) civilians who later identify compensable illnesses, diseases, wounds or injuries under the DOL OWCP programs also are eligible for treatment in an MTF or private sector medical facility at no cost to them." Similar guidance is found in DOD Directive 1404.10, Section 4g.

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. As a deployed civilian or a civilian working overseas you are eligible to use the MTF while in theater and once you return to your home state.

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.

Supporting Directives

– Assistant Secretary of Defense Memorandum, Jan 08, 1997, Subject: Medical Care Costs for Civilian Employees Deployed in Support of Contingency Operations

– Deputy Secretary of Defense Memorandum, Sep 24, 2007, Subject: Policy Guidance for Provision of Medical Care to Department of Defense Civilian Employees Injured or Wounded While Forward Deployed in Support of Hostilities

– Department of the Army Memorandum, May 15, 2008, Subject: Provisions of Medical Health Screening and Medical Care to Federal and Department of Defense (DOD) Civilian Employees Injured or Wounded While Forward Deployed in Support of Hostilities in Iraq and Afghanistan

– DOD Directive 1404.10, Jan 23, 2009, Subject: DOD Civilian Expeditionary Workforce

Department of Defense
Defense Civilian Personnel Advisory Service
HR Operational Programs & Advisory Services
Benefits and Worklife Division
Injury Compensation & Unemployment Compensation Branch
4800 Mark Center Drive, Suite 05G21
Alexandria, VA 22350-1100

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