Thursday, March 8, 2012

Claimant Needs A Formal Decision

In order to appeal one of OWCP's brilliant formal decisions, you first have to get OWCP to issue the formal decision. This is not always as easy as it sounds.

First and foremost, if OWCP has acted to terminate any benefits without a formal decision, this is a serious violation of the Federal Employees Compensation Act, (FECA) and you should immediately let OWCP and your Congressperson know this. OWCP cannot terminate or suspend your benefits without just cause, in accordance with the FECA; which requires a formal decision letting you know exactly how and why it came to its decision. The formal decision must come BEFORE OWCP terminates or suspends your benefits.

Today, I'm talking about formal decisions that you, the Claimant are attempting to get out of OWCP. For instance, you're attempting to get your claim expanded to include new or newly aggravated conditions, consequential injuries, back pay, denied travel expenses, etc...there are any number of reasons you may want and/or need a formal decision issued.

Without a formal decision, OWCP holds all the cards. Unless and until you appeal a formal decision, nothing changes, but if no formal decision is issued, there's no way you can appeal. Sounds like OWCP. You're stuck in limbo and it can seem there's nothing you can do.

This is how I get OWCP to issue a formal decision that you, the Claimant are asking for:

First, the request needs to be in writing. If you've made phone calls, document them (date, time, who you talked to, what transpired) and include them. Lay out the reason(s) you believe you're entitled to a formal decision and include any documentation/evidence. Basically, show OWCP what you're talking about, the documents you have to prove your claim, any regulation/law that backs you up and of course, all the times you've attempted to get a formal decision issued on this particular matter.

If you have multiple issues, do this for each issue. You can send them all together, but I suggest you do them separately so you don't confuse anyone.

Let OWCP know it has 30 days from the day they receive your packet to issue you a formal decision on the matter or provide you a legitimate reason why it will not issue a formal decision. I would send this Delivery Confirmation, Certified Mail, or another way that tracks your packet and proves when OWCP receives it.

If you pick up the tracking slip before you send it out, you can write that tracking number on each and every page you send (remember to make copies for your records) and then each page is tied to that tracking number. You can then prove OWCP received the documents you actually sent. You can go to the Post Office, UPS, FedEx, etc...and pick up tracking slips, Delivery Confirmation and/or Certified Mail receipts. You can pick up extras for future use.

If you do not receive your formal decision or legitimate explanation within 30 days of receipt (plus 5 days mail time to you), most people will probably tell you to climb the "food chain", Senior Claims Examiner, Supervisor, District Director, Regional Director, Secretary of Labor, even the President himself. Personally, I've found the "food chain" method to be a complete waste of time that in most cases only ends up with further delays.

I say you've given OWCP ample opportunity to respond to your written request...go directly to your Congressperson. Copy what you sent OWCP to include with your letter. Write a letter to your Congressperson and let your Congressperson know that you are only asking for OWCP to follow its own regulations by issuing a formal decision or providing you a legitimate reason why it will not. Once this is received, your Congressperson should send you a release to sign (or just call and ask that a release be sent to you).

By law, OWCP has 30 days from the date the request from your Congressperson is received to respond to your Congressperson. OWCP might not want to respond to you, but they are forced to respond to your Congressperson.

Just FYI, most Congresspeople have OWCP liaisons now and that is more than likely the person you'll be dealing with. You notify your Congressperson who sends you a release to sign, you sign and return the release and pass on your information/evidence, your Congressperson passes your information to OWCP, when OWCP recieves your Congress person's request, the 30 day clock starts ticking. Within 30 days (plus 5 days mail time), OWCP responds to your Congressperson and your Congressperson then sends you a copy of OWCP's response. Basically, you're using your Congressperson as a middleman to force OWCP to do what they're required to do.

I can tell you this, if you get your Congressperson involved, by law there's a time limit for OWCP...30 days from the date OWCP receives the Congress person's request on your behalf. OWCP should issue either a formal decision or the reason(s) it won't issue a formal decision. Formal decisions are not issued for everything, some things are just standard form letters, standard operating procedure, etc...If this is the case, you're entitled to know that. If a formal decision is required, you're entitled to actually receive the formal decision from OWCP.

The "food chain" method has no expiration date. If you give each link of the "food chain" 30 days to respond, how many links in the chain until you get a response? What if you actually do have to go the the President of the United States? How long would that take?

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