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Five Basic Elements

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The employee must provide medical and factual evidence to establish ALL five basic elements:

  • The claim was filed within the time limits set by the FECA;

    A notice must be filed within three years of the date of injury. However, if a claim is not filed within three years, compensation may still be paid if written notice of injury was given within 30 days, or the employer had actual knowledge of the injury within 30 days after it occurred.

  • The injured or deceased person was an employee within the meaning of the FECA:

    The FECA covers all civilian Federal employees as described in question A-3. Contract employees, volunteers, and loaned employees are covered under some circumstances. Federal employees who are neither citizens nor residents of the United States or Canada are covered subject to certain special provisions governing their pay rates and computation of compensation payments.

  • The employee actually developed a medical condition (or damaged a prosthesis) in a particular way; fact of injury.

    It must be shown that the employee actually sustained an injury or illness. Two factors are involved:

    (a) Did an incident occur at the time and place and in the manner claimed? This is determined on the basis of factual evidence, including statements from the employee, the supervisor, and any witnesses. An injury need not be witnessed to be compensable.

    (b) Is a medical condition present which may be related to the incident? This is determined on the basis of the attending physician's statement.

  • The employee was in the performance of duty when the event(s) leading to the claim occurred;

    Usually, the injury or illness must occur on the employer's premises during working hours while the employee is performing assigned duties or engaging in an activity which is reasonably associated with the employment. Workers who perform assigned duties away from the employer's premises are also covered.

  • The medical condition found resulted from the event(s) leading to the claim.

    A medical connection between the injury and the condition found must be shown, based entirely on medical evidence provided by physicians who have examined and treated the employee.

    Opinions of the employee, supervisors or witnesses are not considered, nor is general medical information in published articles. The fact that a condition appears during Federal employment does not establish causal relationship between the two. Likewise, the employee's belief that work factors caused or aggravated the condition does not establish causal relationship.

    Where a pre-existing condition involving the same part of the body is present, the physician must provide a medical opinion which states both the effects of the work-related condition and those of the pre-existing condition.

    Excerpts from Publication CA-550, Q&A

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