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------=_NextPart_001_0027_01C9A25C.ABC47640-- ------=_NextPart_000_0024_01C9A25C.ABC47640 Content-Type: application/octet-stream Content-Transfer-Encoding: base64 Content-Location: http://www.wmal.org/div2.gif R0lGODlhAwILALMAAP8AAP8AKf9CAP9jKf+EAP+EQv+ElP+UAP+UIf+UKf+UY/+UlP/OhP/OlP/O zv///ywAAAAAAwILAEAE/vDJSau9OOvNu/9gKI5kaZ5oqq5s675wLM90bd94ru98fwWAoHAIkASA RGFj4kgOAxIH0gmNTpNVqVM4OW4B1cdxTB4by2gmunxem63u4/lbtH7DV6yEDmbSw1pbeH97hEZ3 WXlEE3xLhXR2X118kU6OYnFyD1KZXZl4n4d3Eg18dYFbKQ6rqxqsrRivDq6vGbK0rLa3sbW6uby/ wLAXu8KzxsfEDcsNyRUODQYLy84Uxca+w8S928Hd2s/X4d4W4tbc39Xn5OvsTObv7hPL0wzqm8vS zdn3Hg1TR+5dCcDgwr8h+yx4CRJQ4ZWEFRaCsfeDiMAyFB2SuUThH5mM/hExqjuo5KKQhgot/gAI ksICImEoSCTYb2BBCySDQOwIcKeok/dyAvD5SEhQIkTFPLlZQWjSmS1JYcTgcUzUNmOClkkKk6nL gRw9fRwZxIfZs2jTql3Ltq3bt3Djyp1Lt67duzglMqzW4OWTatJgBqgWYEGemBL8nhzcVC8YwFgI uwFsuAzfypYrSEMT9gFmMnz1opxgIHJTwzA5ctIj0zHj00ko27x82IJihj4DL+WbJPdtMK/n/QZA uevl3rbRRO3LGXDzjp9BN7VUQVBY5khDIEqmCLgzKqPBYAmuVHBw8eZlgk8GfLLYNc4yJauKxlkp 89wVvSG1npH+AAJcTtIdGBz9F9x9h2lS1GLn9TcJfvMIEhN6sUXo4AN0fCcIexc+QF9mWK3Bk3tS xXGMR+NxdMclEtrHBV4wxijjjDTWaOONOOao44480hABAAA7 ------=_NextPart_000_0024_01C9A25C.ABC47640 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://www.wmal.org/burden.htm Western Michigan Area Local
Use your brower's back button to navigate = between=20 workers comp pages.

Click on underlined links for further explanation = of=20 element

Burden of Proof
Excerpt from Publication CA-810

The employee is responsible for establishing the essential elements of = any OWCP=20 claim. Department of Labor will help the employee to meet this=20 responsibility, which is termed burden of proof, by requesting = evidence=20 needed to establish these elements if such information is not = included=20 with the original submittal.

When information is not submitted in a timely manner, delays in = adjudicating cases and paying claims often result. To minimize = such=20 delays, the employee and supervisor should submit the required = evidence=20 within a specific period, usually within 30 days.

A. Traumatic Injury Cases (Including Recurrence and = Death).

(1) The factual evidence required from an employer in a = traumatic case=20 often concerns the circumstances of the injury. By anticipating = the=20 information that OWCP will need, supervisors should contribute to = the=20 efficient handling of the claim. Each submittal of forms should = contain a=20 clear description of how the injury occurred, including the time = and=20 place, whether it happened during working hours, the presence of=20 witnesses, etc.

If this information is not included in the original submittal, = OWCP=20 will request it. If it is not received, OWCP will process the case = on the=20 basis of the evidence submitted by the employee, as follows:

(a) If the employee's statement is sufficiently detailed and/or = credible, OWCP will accept the statement and adjudicate the case=20 accordingly.

(b) If the employee's statement is not sufficient and/or = credible, the=20 case will be denied for the reason that one or more of the five basic elements = required to=20 approve a claim has not been established.

(2) Medical evidence in possession of the agency (USPS) may = also be=20 requested.

(a) In an unadjudicated case, the supervisor should submit = copies of=20 medical records pertaining to the injury and any relevant = pre-existing=20 condition at the time of initial submittal to OWCP. OWCP will = request this=20 evidence of the agency if it is not sent with the original = submittal.

(b) In an accepted case, if the employee receives continuing = care from=20 an agency physician (or its contract provider), the supervisor = should=20 include supporting medical evidence for disability with claims = submitted.=20

If the file contains prima facie (self evident) medical = evidence of=20 disability for the period claimed but additional support is = needed, OWCP=20 will authorize payment for a reasonable period and request the = evidence=20 from the employer. If another claim is received and the previously = requested evidence has not been submitted, OWCP will again = authorize=20 payment of compensation for a reasonable period and refer the = employee to=20 a medical specialist for examination.

(3) Information needed to make payment will usually include the = employee's salary and the days of LWOP claimed. Agencies can speed = payment=20 by advising OWCP if the pay rate includes elements of pay such as = night=20 and Sunday differential. If so, OWCP will need to know whether the = employee has received the increments regularly (in which case the = biweekly=20 amount should be stated) or sporadically (in which case the = employee's=20 entire earnings in the relevant pay category for the year = preceding the=20 injury should be stated).

Where the pay rate is in question, OWCP will begin paying = compensation=20 using the lower salary and request clarification from the = supervisor. If a=20 second request is necessary, OWCP will advise the employee that=20 documentation is needed to support the higher pay rate and ask for = any=20 documentation in his or her possession. If the agency fails to = reply and=20 the employee submits adequate documentation (e.g., pay stubs), = OWCP will=20 adjust compensation. Until sufficient documentation is received = from the=20 supervisor or the employee, compensation will be paid at the lower = rate.

Where the days and hours of LWOP are in question, OWCP will = request=20 clarification asking for form CA7. Any follow-up request will also = advise=20 the employee of the need for documentation and invite him or her = to submit=20 a detailed account for the period in question. Form CA7 includes = the=20 physician=92s report form CA20. This must be completed when asking = for=20 payment.

B. Occupational Disease Claims (Including Recurrence and=20 Death).

(1) OWCP's requirements for factual information vary according = to the=20 type and severity of the medical condition involved. Simple = occupational=20 disease claims, for example a claim for poison ivy where the job = duties=20 involved exposure to the plant, and the medical evidence confirmed = the=20 diagnosis, require less evidence to adjudicate.

The information specified in the instructions on Form CA-2 and = on the=20 evidence checklist appropriate to the disease in question should = be sent=20 with the initial submittal. If sufficiently detailed descriptions = of how=20 the condition developed are not received, OWCP will request the=20 information needed for adjudication.

If the information is not received, OWCP will process the case = on the=20 basis of the evidence submitted by the employee. As with traumatic = injury=20 cases, if that evidence is sufficient and/or credible, OWCP will = accept=20 the employee's statements and adjudicate the case accordingly. If = the=20 evidence is not sufficient and/or credible, OWCP will deny the = case=20 because one or more of the five=20 basic elements required to approve a case has not been=20 established.

(2) An agency medical facility sometimes provides medical = examination=20 and treatment. If additional evidence about such treatment is = needed from=20 the agency, OWCP will advise the employee that OWCP is attempting = to=20 obtain it, but that the burden of proof still rests upon the = employee and=20 that he or she should also try to obtain that evidence.

(3) As with traumatic injury cases, payment information needed = from the=20 agency will likely include the employee's pay rate and the days of = LWOP=20 claimed, and OWCP will use the procedures described above for = obtaining=20 such information in traumatic injury cases. The medical evidence = developed=20 for initial adjudication should provide sufficient information = about the=20 nature and extent of disability to permit adjudication of the = claim for=20 wage loss. If not, OWCP will follow the procedures for developing = medical=20 evidence for wage-loss claims in traumatic injury cases.

You have the burden of proof. You must effectively communicate = your=20 needs to your physician when asking for documentation.

Remember: You are responsible for your own claim. NOT = management; NOT=20 the union. You must insure the accuracy of the information and = must=20 provide suitable documentation. Management is responsible for = providing=20 and submitting forms. Unfortunately, management=92s knowledge of = worker=92s=20 comp issues is severely limited; so don=92t expect a lot of help = from your=20 supervisor. Keep records and copies of everything.



Home

Webmeister=20 Jennifer Amos. =A9 Western Michigan Area Local
E-mail Jennia1957@aol.com with comments = or=20 suggestions

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