Get Your Free Initial Consultation
Denials
When OWCP Denies a Claim or Benefit
Not every OWCP decision means the same thing. Some letters ask for more information. Others formally deny part or all of a claim. Before choosing any review option, it helps to identify exactly what was denied, which element failed, and what review path is available. A careful reading of the decision often answers those questions.
Contact Us
Differentiating Letters
Development Letter vs. Formal Denial
A development letter is not a denial. It is a request from the Claims Examiner (CE) for additional information, medical evidence, or clarification. Responding to a development letter is usually part of the claims process. A formal OWCP decision is different. It explains what was accepted and what was denied, and it includes appeal rights. The formal decision is generally the document that starts the appeal deadlines and review options.
Reading the Decision
It’s a mistake to focus on the outcome and skip the reasoning. A decision should identify accepted and rejected facts, the specific element that failed, the evidence considered, and the appeal-rights section. The failed element is usually the key. OWCP may accept that an event occurred but deny a causal relationship. It may accept employment status but reject performance of duty. The decision should identify where the claim broke down. The evidence section also matters. Compare the documents listed in the decision to what was actually submitted. Sometimes an important report appears nowhere in the discussion.
Formal Decisions
Decision letters start deadlines. Development letters request information but do not start the appeal clock.Failed Elements
This is what you need to identify. The denial often calls out missing requirements, rather than the entire claim.Review
Different deadlines, decision-makers, and evidence rules apply to each option.Partial Denials
These affect benefits. Compensation follows accepted conditions, not conditions that were rejected.Next Steps
The Three Review Paths and Their Clocks
There are different paths for review after a formal OWCP decision. These are not interchangeable, and they are not unlimited. Choosing the wrong initial path, or filing an appeal before identifying the actual cause of the denial, can waste an opportunity to strengthen the record.
Not every review option is available for every decision. Requesting reconsideration first eliminates the right to an oral hearing or review of the written record on that same decision. Read the appeal rights carefully before choosing a path.
New Evidence and Where It Belongs
Both the Branch of Hearings and Review (BHR)—through an oral hearing or review of the written record—and OWCP’s reconsideration process allow new evidence. This may include additional medical reports, factual statements, or other information addressing the reason for denial. ECAB does not consider new evidence when deciding the merits of an appeal. It reviews the record that was before OWCP when the decision was issued.
Choosing the appropriate review option requires evaluating the legal and factual issues, the evidence available, and which review options remain open. Expected processing times and the urgency of the employee’s circumstances also matter. These considerations help determine which available path is most appropriate for the particular claim.
Partial Acceptance
A decision is not always all-or-nothing. OWCP may accept one condition while denying another. For example, a lumbar strain may be accepted, whereas a disc herniation may be denied. Both conditions can appear in the same medical history, but they may receive different treatment under the claim. This distinction matters because benefits follow accepted conditions. Medical treatment, compensation, and future claim issues may depend on exactly which diagnoses were accepted and which were rejected.
When an Appeal Is Not the Right Next Step
Not every denial should be appealed. Some denials involve a problem that additional evidence is unlikely to fix. Examples may include situations where the employee was not a covered federal employee or when the event plainly did not occur in the performance of duty. The goal is to understand whether the record can actually be improved.
Request a Candid Review
Decisions can lead to a point where you’re unsure what to do. A formal decision can start a 30-day hearing deadline. A denial might appear to misstate the medical evidence. Other decisions may ignore a strong report that was already submitted, or a claim has new medical evidence that addresses a failed element. If you have a situation similar to one of these, contact Aumiller Lomax for a free telephone consultation. Have the decision available during the call so we can discuss the reason for the denial, relevant deadlines, available review options, and whether representation would be helpful.
Partner With a Team That Understands the System