What is the difference under the federal workers’ compensation system between Controverting Continuation of Pay (COP) and Challenging a Claim? Sue Wetherington put together this informative outline and commentary for us. We all appreciate learning more about how our federal system under FECA works since it is funded by the taxpayers.
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“5-Step Sequence to Coordinate Return-to-Work with ADA Compliance”
Controverting COP means: To dispute, challenge, or deny the validity of a claim for COP on the basis of one of the nine (9) reasons:
- Disability is due to an occupational disease or illness.
- Employee serves without pay or nominal pay, or is appointed to the staff of a former President, or is selected pursuant to Chapter 1221 of Title 28 and serves as a petit or grand juror, and is not otherwise an employee of the United States.
- The employee is neither a citizen nor a resident of the four untied States or Canada (i.e., a foreign national employed outside the United States or Canada).
- The injury occurred off the employer’s premises and the employee was not engaged in “authorized off premises duties.”
- The injury was caused by the employee’s willful misconduct; or by the employee’s intent to bring about the injury or death of himself/herself or another person; or by the employee’s intoxication by alcohol or illegal drugs.
- The injury was not reported on a form approved by Office of Workers’ Compensation Programs (OWCP) (usually Form CA1) within 30 days after the injury.
- The employee first stopped work more than 45 days after the injury.
- The employee first reported injury after employment ended.
- The employee enrolled in Civil Air Patrol, Peace Corps, Job Corps, and Youth Conservation Corps, work-study program, or other group covered by special legislation.
Challenging a Claim
- An Agency questioning the validity of a claim must submit the reasons in writing to OWCP. All allegations must be supported by specific factual evidence. The authority to determine any aspect of a claim rests with OWCP. (wo
An Agency would want to either Controvert COP and/or Challenge a Claim when there are circumstances questing the validity of the claim
Author: Sue Wetherington has served as President and CEO of GS&S and Associates, Inc., St. Augustine, Florida since September 1999. GS&S, founded in 1999, is comprised of experts with over 120 years of combined experience with all laws and regulations governing workers’ compensation for federal employees and helps control escalating program costs and assist in returning injured workers to productive employment. Services include Workers’ Compensation Program diagnostics, roll reduction, development of automated claims filing and tracking systems, and formulation of policy letters and job offers. Contact her at sue@gss-compsolutions.com, gss-compsolutions.com or (904) 461-5520.
WC Calculator: http://www.reduceyourworkerscomp.com/calculator.php
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers’ comp issues.
