Use your brower's back button to navigate between
workers comp pages.

Click on underlined links for further explanation of
element

Burden of Proof
Excerpt from Publication CA-810

The employee is responsible for establishing the essential elements of any OWCP
claim. Department of Labor will help the employee to meet this
responsibility, which is termed burden of proof, by requesting evidence
needed to establish these elements if such information is not included
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
delays, the employee and supervisor should submit the required evidence
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
often concerns the circumstances of the injury. By anticipating the
information that OWCP will need, supervisors should contribute to the
efficient handling of the claim. Each submittal of forms should contain a
clear description of how the injury occurred, including the time and
place, whether it happened during working hours, the presence of
witnesses, etc.

If this information is not included in the original submittal, OWCP
will request it. If it is not received, OWCP will process the case on the
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
accordingly.

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

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

(a) In an unadjudicated case, the supervisor should submit copies of
medical records pertaining to the injury and any relevant pre-existing
condition at the time of initial submittal to OWCP. OWCP will request this
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
an agency physician (or its contract provider), the supervisor should
include supporting medical evidence for disability with claims submitted.

If the file contains prima facie (self evident) medical evidence of
disability for the period claimed but additional support is needed, OWCP
will authorize payment for a reasonable period and request the evidence
from the employer. If another claim is received and the previously
requested evidence has not been submitted, OWCP will again authorize
payment of compensation for a reasonable period and refer the employee to
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
by advising OWCP if the pay rate includes elements of pay such as night
and Sunday differential. If so, OWCP will need to know whether the
employee has received the increments regularly (in which case the biweekly
amount should be stated) or sporadically (in which case the employee's
entire earnings in the relevant pay category for the year preceding the
injury should be stated).

Where the pay rate is in question, OWCP will begin paying compensation
using the lower salary and request clarification from the supervisor. If a
second request is necessary, OWCP will advise the employee that
documentation is needed to support the higher pay rate and ask for any
documentation in his or her possession. If the agency fails to reply and
the employee submits adequate documentation (e.g., pay stubs), OWCP will
adjust compensation. Until sufficient documentation is received from the
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
clarification asking for form CA7. Any follow-up request will also advise
the employee of the need for documentation and invite him or her to submit
a detailed account for the period in question. Form CA7 includes the
physician’s report form CA20. This must be completed when asking for
payment.

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

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

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

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

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

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

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

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

Home

Webmeister
Jennifer Amos. © Western Michigan Area Local
E-mail [email-masked] with comments or
suggestions