Medical Treatment

Employee Medical Treatment

You are entitled to medical treatment from a physician of your choice.  If you elect to receive medical treatment, you can request that Form CA-16, Authorization for Medical Treatment be issued to you as long as your request for medical treatment occurs within a week from the initial injury.  Form CA-16 should not be issued for CA-2 (occupational disease/illness) claims.  Occupational Medical Services can issue Form CA-16 to you.  Form CA-16 should then be given to your doctor at the initial visit. 

Except for a referral made by the initial treating physician, any change in treating physicians must be authorized by DOL/OWCP.  A written request should be submitted to DOL/OWCP which should explain the reasons for the request.  Requests for change of physicians should be sent to:  U.S. Department of Labor, DFEC Central Mailroom, P.O. Box 8300, London, KY  40742-8300.

Chiropractic services under FECA may be reimbursable but are limited to treatment consisting of manual manipulation of the spine to correct a subluxation as demonstrated by x-ray.  A chiropractor can only certify disability when a claimant has a subluxation.

Bills/Authorizations for Medical Services

You will need to notify your physician that you have filed a workers' compensation claim and you should not use your private insurance carrier.  Any authorization for specific medical treatment procedures, including surgery, beyond your initial care must be obtained from ACS (Affiliated Computer Services) who are contract representatives of DOL/OWCP.  ACS can be reached at 844-493-1966.  All bills should be forwarded directly to DOL-OWCP after you receive your claim number.  The address is:  U.S. Department of Labor, DFEC Central Mailroom, P.O. Box 8300, London, KY 40742-8300.  Bills should be submitted on Form HCFA-1500, Health Insurance Claim Form (hospitals must use the UB-92 form) and must be accompanied by the corresponding medical report(s).  You and your medical provider can check the status of your medical bills at ACS/FECA. Please note:  All providers must be enrolled with ACS in order to receive payment for services rendered.  Providers can use the link provided above to enroll. In addition, your medical provider can use this link to request and check status of authorizations for medical treatment/surgeries.  Medical providers should contact ACS directly regarding any bill or authorization inquiries/denials.  Please understand that any bills that are denied for payment become your responsibility.

Reimbursements

If you incur out-of-pocket expenses pertaining to your work-related injury, you can request reimbursement by completing Form OWCP-915, Claim for Medical Reimbursement.  Reimbursement claims for prescription medications are to be accompanied by a Universal Claim Form or other pharmacy statement showing the name of the drug, NDC code, quantity provided, cost, prescribing physician, and date the prescription was filled.  Reimbursement claims for medical services, appliances or supplies must be accompanied by Form HCFA-1500 showing the individual charges and must be signed by the medical provider.

You can request reimbursement for transportation expenses for traveling to and from medical appointments by completing Form OWCP-957, Medical Travel Refund Request.   Receipts documenting your expenses, if applicable, should also be provided.

Reimbursement request forms should be mailed to:  U.S. Department of Labor, DFEC Central Mailroom, P.O. Box 8300, London, KY  40742-8300.

Medical Documentation

Medical reports from the attending physician are required  These reports should include: 

  • dates of examination and treatment;
  • history given by the employee;
  • physical findings;
  • results of diagnostic tests;
  • diagnosis;
  • course of treatment;
  • description of any other condition found but not due to the claimed injury;
  • treatment given or recommended for the claimed injury;
  • physician’s opinion, with medical reasons, as to the causal relationship between the diagnosed condition(s) and the factors or conditions of employment;
  • extent of disability affecting the employee’s ability to work due to the injury;
  • prognosis for recovery; and
  • all other material findings.

Form CA-16 may be used for the initial medical report as well as Form CA-20, Attending Physician’s Report.  The CA-20 can also be used for subsequent reports; however, reports may also be made in narrative form on the physician’s letterhead stationery.

You or your provider may upload documents to ECOMP which are appropriate for incorporation into the official case record, such as letters, witness statements, medical reports, or any other documentation pertinent to the claim. Documents may be uploaded by the claimant or anyone with an interest in the case, including representatives, medical providers and employing agency personnel. You will need the official case number, date of birth and date of injury associated with the target case in order to use the upload function.

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