Subpart F--Continuing Benefits

Rules and Evidence

Sec. 10.500 What are the basic rules governing continuing receipt of compensation benefits and return to work?

(a) Benefits are available only while the effects of a work-related condition continue. Compensation for wage loss due to
disability is available only for any periods during which an employee's work-related medical condition prevents him or her from
earning the wages earned before the work-related injury. Payment of medical benefits is available for all treatment necessary
due to a work-related medical condition.

(b) Each disabled employee is obligated to perform such work as he or she can, and OWCP's goal is to return each disabled
employee to suitable work as soon as he or she is medically able. In determining what constitutes ``suitable work'' for a
particular disabled employee, OWCP considers the employee's current physical limitations, whether the work is available within
the employee's demonstrated commuting area, the employee's qualifications to perform such work, and other relevant factors.
(See Sec. 10.508 with respect to the payment of relocation expenses.)

Sec. 10.501 What medical evidence is necessary to support continuing receipt of compensation benefits?

(a) The employee is responsible for providing sufficient medical evidence to justify payment of any compensation sought.

(1) To support payment of continuing compensation, narrative medical evidence must be submitted whenever OWCP requests
it but ordinarily not less than once a year. It must contain a physician's rationalized opinion as to whether the specific period of
alleged disability is causally related to the employee's accepted injury or illness.

(2) The physician's opinion must be based on the facts of the case and the complete medical background of the employee, must
be one of reasonable medical certainty and must include objective findings in support of its conclusions. Subjective complaints
of pain are not sufficient, in and of themselves, to support payment of continuing compensation. Likewise, medical limitations
based solely on the fear of a possible future injury are also not sufficient to support payment of continuing compensation. See
Sec. 10.330 for a fuller discussion of medical evidence.

(b) OWCP may require any kind of non-invasive testing to determine the employee's functional capacity. Failure to undergo
such testing will result in a suspension of benefits. In addition, OWCP may direct the employee to undergo a second opinion or
referee examination in any case it deems appropriate (see Secs. 10.320 and 10.321).

Sec. 10.502 How does OWCP evaluate evidence in support of continuing receipt of compensation benefits?

In considering the medical and factual evidence, OWCP will weigh the probative value of the attending physician's report, any
second opinion physician's report, any other medical reports, or any other evidence in the file. If OWCP determines that the
medical evidence supporting one conclusion is more consistent, logical, and well- reasoned than evidence supporting a contrary
conclusion, OWCP will use the conclusion that is supported by the weight of the medical evidence as the basis for awarding or
denying further benefits. If medical reports that are equally well-reasoned support inconsistent determinations of an issue under
consideration, OWCP will direct the employee to undergo a referee examination to resolve the issue. The results of the referee
examination will be given special weight in determining the issue.

Sec. 10.503 Under what circumstances may OWCP reduce or terminate compensation benefits?

Once OWCP has advised the employee that it has accepted a claim and has either approved continuation of pay or paid
medical benefits or compensation, benefits will not be terminated or reduced unless the weight of the evidence establishes that:

(a) The disability for which compensation was paid has ceased;

(b) The disabling condition is no longer causally related to the employment;

(c) The employee is only partially disabled;

(d) The employee has returned to work;

(e) The beneficiary was convicted of fraud in connection with a claim under the FECA, or the beneficiary was incarcerated
based on any felony conviction; or

(f) OWCP's initial decision was in error.

Return to Work--Employer's Responsibilities

Sec. 10.505 What actions must the employer take?

Upon authorizing medical care, the employer should advise the employee in writing as soon as possible of his or her obligation
to return to work under Sec. 10.210 and as defined in this subpart. The term ``return to work'' as used in this subpart is not
limited to returning to work at the employee's normal worksite or usual position, but may include returning to work at other
locations and in other positions. In general, the employer should make all reasonable efforts to place the employee in his or her
former or an equivalent position, in accordance with 5 U.S.C. 8151(b)(2), if the employee has fully recovered after one year.
The Office of Personnel Management (not OWCP) administers this provision.

(a) Where the employer has specific alternative positions available for partially disabled employees, the employer should advise
the employee in writing of the specific duties and physical requirements of those positions.

(b) Where the employer has no specific alternative positions available for an employee who can perform restricted or limited
duties, the employer should advise the employee of any accommodations the agency can make to accommodate the
employee's limitations due to the injury.

Sec. 10.506 May the employer monitor the employee's medical care?

The employer may monitor the employee's medical progress and duty status by obtaining periodic medical reports. Form
CA-17 is usually adequate for this purpose. To aid in returning an injured employee to suitable employment, the employer may
also contact the employee's physician in writing concerning the work limitations imposed by the effects of the injury and
possible job assignments. (However, the employer shall not contact the physician by telephone or through personal visit.) When
such contact is made, the employer shall send a copy of any such correspondence to OWCP and the employee, as well as a
copy of the physician's response when received. The employer may also contact the employee at reasonable intervals to
request periodic medical reports addressing his or her ability to return to work.

Sec. 10.507 How should the employer make an offer of suitable work?

Where the attending physician or OWCP notifies the employer in writing that the employee is partially disabled (that is, the
employee can perform some work but not return to the position held at date of injury), the employer should act as follows:

(a) If the employee can perform in a specific alternative position available in the agency, and the employer has advised the
employee in writing of the specific duties and physical requirements, the employer shall notify the employee in writing
immediately of the date of availability.

(b) If the employee can perform restricted or limited duties, the employer should determine whether such duties are available or
whether an existing job can be modified. If so, the employer shall advise the employee in writing of the duties, their physical
requirements and availability.

(c) The employer must make any job offer in writing. However, the employer may make a job offer verbally as long as it
provides the job offer to the employee in writing within two business days of the verbal job offer.

(d) The offer must include a description of the duties of the position, the physical requirements of those duties, and the date by
which the employee is either to return to work or notify the employer of his or her decision to accept or refuse the job offer.
The employer must send a complete copy of any job offer to OWCP when it is sent to the employee.

Sec. 10.508 May relocation expenses be paid for an employee who would need to move to accept an offer of reemployment?

If possible, the employer should offer suitable reemployment in the location where the employee currently resides. If this is not
practical, the employer may offer suitable reemployment at the employee's former duty station or other location. Where the
distance between the location of the offered job and the location where the employee currently resides is at least 50 miles,
OWCP may pay such relocation expenses as are considered reasonable and necessary if the employee has been terminated
from the agency's employment rolls and would incur relocation expenses by accepting the offered reemployment. OWCP may
also pay such relocation expenses when the new employer is other than a Federal employer. OWCP will notify the employee
that relocation expenses are payable if it makes a finding that the job is suitable. To determine whether a relocation expense is
reasonable and necessary, OWCP shall use as a guide the Federal travel regulations for permanent changes of duty station.

Sec. 10.509 If an employee's light-duty job is eliminated due to downsizing, what is the effect on compensation?

(a) In general, an employee will not be considered to have experienced a compensable recurrence of disability as defined in
Sec. 10.5(x) merely because his or her employer has eliminated the employee's light-duty position in a reduction-in-force or
some other form of downsizing. When this occurs, OWCP will determine the employee's wage-earning capacity based on his
or her actual earnings in such light-duty position if this determination is appropriate on the basis that such earnings fairly and
reasonably represent the employee's wage-earning capacity and such a determination has not already been made.

(b) For the purposes of this section only, a light-duty position means a classified position to which the injured employee has
been formally reassigned that conforms to the established physical limitations of the injured employee and for which the
employer has already prepared a written position description such that the position constitutes ``regular'' Federal employment.
In the absence of a ``light-duty position'' as described in this paragraph, OWCP will assume that the employee was instead
engaged in non-competitive employment which does not represent the employee's wage-earning capacity, i.e., work of the type
provided to injured employees who cannot otherwise be employed by the Federal Government or in any well- known branch
of the general labor market.

Return to Work--Employee's Responsibilities

Sec. 10.515 What actions must the employee take with respect to returning to work?

(a) If an employee can resume regular Federal employment, he or she must do so. No further compensation for wage loss is
payable once the employee has recovered from the work-related injury to the extent that he or she can perform the duties of
the position held at the time of injury, or earn equivalent wages.

(b) If an employee cannot return to the job held at the time of injury due to partial disability from the effects of the work-related
injury, but has recovered enough to perform some type of work, he or she must seek work. In the alternative, the employee
must accept suitable work offered to him or her. (See Sec. 10.500 for a definition of ``suitable work''.) This work may be with
the original employer or through job placement efforts made by or on behalf of OWCP.

(c) If the employer has advised an employee in writing that specific alternative positions exist within the agency, the employee
shall provide the description and physical requirements of such alternate positions to the attending physician and ask whether
and when he or she will be able to perform such duties.

(d) If the employer has advised an employee that it is willing to accommodate his or her work limitations, the employee shall so
advise the attending physician and ask him or her to specify the limitations imposed by the injury. The employee is responsible
for advising the employer immediately of these limitations.

(e) From time to time, OWCP may require the employee to report his or her efforts to obtain suitable employment, whether
with the Federal Government, State and local Governments, or in the private sector.

Sec. 10.516 How will an employee know if OWCP considers a job to be suitable?

OWCP shall advise the employee that it has found the offered work to be suitable and afford the employee 30 days to accept
the job or present any reasons to counter OWCP's finding of suitability. If the employee presents such reasons, and OWCP
determines that the reasons are unacceptable, it will notify the employee of that determination and that he or she has 15 days in
which to accept the offered work without penalty. At that point in time, OWCP's notification need not state the reasons for
finding that the employee's reasons are not acceptable.

Sec. 10.517 What are the penalties for refusing to accept a suitable job offer?

(a) 5 U.S.C. 8106(c) provides that a partially disabled employee who refuses to seek suitable work, or refuses to or neglects
to work after suitable work is offered to or arranged for him or her, is not entitled to compensation. An employee who refuses
or neglects to work after suitable work has been offered or secured for him or her has the burden to show that this refusal or
failure to work was reasonable or justified.

(b) After providing the two notices described in Sec. 10.516, OWCP will terminate the employee's entitlement to further
compensation under 5 U.S.C. 8105, 8106, and 8107, as provided by 5 U.S.C. 8106(c)(2). However, the employee remains
entitled to medical benefits as provided by 5 U.S.C. 8103.

Sec. 10.518 Does OWCP provide services to help employees return to work?

(a) OWCP may, in its discretion, provide vocational rehabilitation services as authorized by 5 U.S.C. 8104. These services
include assistance from registered nurses working under the direction of OWCP. Among other things, these nurses visit the
worksite, ensure that the duties of the position do not exceed the medical limitations as represented by the weight of medical
evidence established by OWCP, and address any problems the employee may have in adjusting to the work setting. The nurses
do not evaluate medical evidence; OWCP claims staff perform this function.

(b) Vocational rehabilitation services may also include vocational evaluation, testing, training, and placement services with either
the original employer or a new employer, when the injured employee cannot return to the job held at the time of injury. These
services also include functional capacity evaluations, which help to tailor individual rehabilitation programs to employees'
physical reconditioning and behavioral modification needs, and help employees to meet the demands of current or potential
jobs.

Sec. 10.519 What action will OWCP take if an employee refuses to undergo vocational rehabilitation?

Under 5 U.S.C. 8104(a), OWCP may direct a permanently disabled employee to undergo vocational rehabilitation. To ensure
that vocational rehabilitation services are available to all who might be entitled to benefit from them, an injured employee who
has a loss of wage-earning capacity shall be presumed to be ``permanently disabled,'' for purposes of this section only, unless
and until the employee proves that the disability is not permanent. If an employee without good cause fails or refuses to apply
for, undergo, participate in, or continue to participate in a vocational rehabilitation effort when so directed, OWCP will act as
follows:

(a) Where a suitable job has been identified, OWCP will reduce the employee's future monetary compensation based on the
amount which would likely have been his or her wage-earning capacity had he or she undergone vocational rehabilitation.
OWCP will determine this amount in accordance with the job identified through the vocational rehabilitation planning process,
which includes meetings with the OWCP nurse and the employer. The reduction will remain in effect until such time as the
employee acts in good faith to comply with the direction of OWCP.

(b) Where a suitable job has not been identified, because the failure or refusal occurred in the early but necessary stages of a
vocational rehabilitation effort (that is, meetings with the OWCP nurse, interviews, testing, counseling, functional capacity
evaluations, and work evaluations), OWCP cannot determine what would have been the employee's wage-earning capacity.

(c) Under the circumstances identified in paragraph (b) of this section, in the absence of evidence to the contrary, OWCP will
assume that the vocational rehabilitation effort would have resulted in a return to work with no loss of wage-earning capacity,
and OWCP will reduce the employee's monetary compensation accordingly (that is, to zero). This reduction will remain in
effect until such time as the employee acts in good faith to comply with the direction of OWCP.

Sec. 10.520 How does OWCP determine compensation after an employee completes a vocational rehabilitation program?

After completion of a vocational rehabilitation program, OWCP may adjust compensation to reflect the injured worker's
wage-earning capacity. Actual earnings will be used if they fairly and reasonably reflect the earning capacity. The position
determined to be the goal of a training plan is assumed to represent the employee's earning capacity if it is suitable and
performed in sufficient numbers so as to be reasonably available, whether or not the employee is placed in such a position.

Reports of Earnings From Employment and Self-Employment

Sec. 10.525 What information must the employee report?

(a) An employee who is receiving compensation for partial or total disability must advise OWCP immediately of any return to
work, either part-time or full-time. In addition, an employee who is receiving compensation for partial or total disability will
periodically be required to submit a report of earnings from employment or self- employment, either part-time or full-time. (See
Sec. 10.5(g) for a definition of ``earnings''.)

(b) The employee must report even those earnings which do not seem likely to affect his or her level of benefits. Many kinds of
income, though not all, will result in reduction of compensation benefits. While earning income will not necessarily result in a
reduction of compensation, failure to report income may result in forfeiture of all benefits paid during the reporting period.

Sec. 10.526 Must the employee report volunteer activities?

An employee who is receiving compensation for partial or total disability is periodically required to report volunteer activity or
any other kind of activity which shows that the employee is no longer totally disabled for work.

Sec. 10.527 Does OWCP verify reports of earnings?

To make proper determinations of an employee's entitlement to benefits, OWCP may verify the earnings reported by the
employee through a variety of means, including but not limited to computer matches with the Office of Personnel Management
and inquiries to the Social Security Administration. Also, OWCP may perform computer matches with records of State
agencies, including but not limited to workers' compensation administrations, to determine whether private employers are
paying workers' compensation insurance premiums for recipients of benefits under the FECA.

Sec. 10.528 What action will OWCP take if the employee fails to file a report of activity indicating an ability to work?

OWCP periodically requires each employee who is receiving compensation benefits to complete an affidavit as to any work, or
activity indicating an ability to work, which the employee has performed for the prior 15 months. If an employee who is
required to file such a report fails to do so within 30 days of the date of the request, his or her right to compensation for wage
loss under 5 U.S.C. 8105 or 8106 is suspended until OWCP receives the requested report. At that time, OWCP will reinstate
compensation retroactive to the date of suspension if the employee remains entitled to compensation.

Sec. 10.529 What action will OWCP take if the employee files an incomplete report?

(a) If an employee knowingly omits or understates any earnings or work activity in making a report, he or she shall forfeit the
right to compensation with respect to any period for which the report was required. A false or evasive statement, omission,
concealment, or misrepresentation with respect to employment activity or earnings in a report may also subject an employee to
criminal prosecution.

(b) Where the right to compensation is forfeited, OWCP shall recover any compensation already paid for the period of
forfeiture pursuant to 5 U.S.C. 8129 and other relevant statutes.

Reports of Dependents

Sec. 10.535 How are dependents defined, and what information must the employee report?

(a) Dependents in disability cases are defined in Sec. 10.405. While the employee has one or more dependents, the employee's
basic compensation for wage loss or for permanent impairment shall be augmented as provided in 5 U.S.C. 8110. (The rules
for death claims are found in Sec. 10.414.)

(b) An employee who is receiving augmented compensation on account of dependents must advise OWCP immediately of any
change in the number or status of dependents. The employee should also promptly refund to OWCP any amounts received on
account of augmented compensation after the right to receive augmented compensation has ceased. Any difference between
actual entitlement and the amount already paid beyond the date entitlement ended is an overpayment of compensation and may
be recovered pursuant to 5 U.S.C. 8129 and other relevant statutes.

(c) An employee who is receiving augmented compensation shall be periodically required to submit a statement as to any
dependents, or to submit supporting documents such as birth or marriage certificates or court orders, to determine if he or she
is still entitled to augmented compensation.

Sec. 10.536 What is the penalty for failing to submit a report of dependents?

If an employee fails to submit a requested statement or supporting document within 30 days of the date of the request, OWCP
will suspend his or her right to augmented compensation until OWCP receives the requested statement or supporting document.
At that time, OWCP will reinstate augmented compensation retroactive to the date of suspension, provided that the employee
is entitled to receive augmented compensation.

Sec. 10.537 What reports are needed when compensation payments continue for children over age 18?

(a) Compensation payable on behalf of a child that would otherwise end when the child reaches 18 years of age will continue if
and for so long as he or she is not married and is either a student as defined in 5 U.S.C. 8101(17), or physically or mentally
incapable of self-support.

(b) At least twice each year, OWCP will ask an employee who receives compensation based on the student status of a child to
provide proof of continuing entitlement to such compensation, including certification of school enrollment.

(c) Likewise, at least twice each year, OWCP will ask an employee who receives compensation based on a child's physical or
mental inability to support himself or herself to submit a medical report verifying that the child's medical condition persists and
that it continues to preclude self-support.

(d) If an employee fails to submit proof within 30 days of the date of the request, OWCP will suspend the employee's right to
compensation until the requested information is received. At that time OWCP will reinstate compensation retroactive to the
date of suspension, provided the employee is entitled to such compensation.

Reduction and Termination of Compensation

Sec. 10.540 When and how is compensation reduced or terminated?

(a) Except as provided in paragraphs (b) and (c) of this section, where the evidence establishes that compensation should be
either reduced or terminated, OWCP will provide the beneficiary with written notice of the proposed action and give him or her
30 days to submit relevant evidence or argument to support entitlement to continued payment of compensation. This notice will
include a description of the reasons for the proposed action and a copy of the specific evidence upon which OWCP is basing
its determination. Payment of compensation will continue until any evidence or argument submitted has been reviewed and an
appropriate decision has been issued, or until 30 days have elapsed if no additional evidence or argument is submitted.

(b) OWCP will not provide such written notice when the beneficiary has no reasonable basis to expect that payment of
compensation will continue. For example, when a claim has been made for a specific period of time and that specific period
expires, no written notice will be given. Written notice will also not be given when a beneficiary dies, when OWCP either
reduces or terminates compensation upon an employee's return to work, when OWCP terminates only medical benefits after a
physician indicates that further medical treatment is not necessary or has ended, or when OWCP denies payment for a
particular medical expense.

(c) OWCP will also not provide such written notice when compensation is terminated, suspended or forfeited due to one of the
following: A beneficiary's conviction for fraud in connection with a claim under the FECA; a beneficiary's incarceration based
on any felony conviction; an employee's failure to report earnings from employment or self-employment; an employee's failure
or refusal to either continue performing suitable work or to accept an offer of suitable work; or an employee's refusal to
undergo or obstruction of a directed medical examination or treatment for substance abuse.

Sec. 10.541 What action will OWCP take after issuing written notice of its intention to reduce or terminate compensation?

(a) If the beneficiary submits evidence or argument prior to the issuance of the decision, OWCP will evaluate it in light of the
proposed action and undertake such further development as it may deem appropriate, if any. Evidence or argument which is
repetitious, cumulative, or irrelevant will not require any further development. If the beneficiary does not respond within 30 days
of the written notice, OWCP will issue a decision consistent with its prior notice. OWCP will not grant any request for an
extension of this 30-day period.

(b) Evidence or argument which refutes the evidence upon which the proposed action was based will result in the continued
payment of compensation. If the beneficiary submits evidence or argument which fails to refute the evidence upon which the
proposed action was based but which requires further development, OWCP will not provide the beneficiary with another
notice of its proposed action upon completion of such development. Once any further development of the evidence is
completed, OWCP will either continue payment or issue a decision consistent with its prior notice.