OWCP OVERRULES FEDERAL EMPLOYER WHO BLAMED EMPLOYEE FOR INJURY; BENEFITS AWARDED
FEDERAL EMPLOYER BLAMES EMPLOYEE FOR INJURIES WHEN MACHINE FELL ON HIM.
In this OWCP federal workers' compensation claim, the federal employee had just been dismissed from an employee meeting when he was walking back to his assigned work area. He and another employee were approached by a supervisor who asked them to move a vending machine out of a contractors office to another area. While moving the machine, the machine toppled over and fell onto the employee shattering his leg and causing other serious injuries.
The employee filed a claim for federal workers' compensation for his injuries with the OWCP.
The federal employer contested the claim. The federal employer argued that since the vending machines were owned by an outside contractor, the employees had no permission to move the machines. The federal employer also argued that moving the machine was not part of the employees assigned work duty and had occurred outside his assigned work area.
The OWCP agreed with the federal employer and denied the injured employee's claim for compensation.
We appealed the OWCP's denial of benefits.
On appeal we showed and argued that the claimant was directly injured on the job while acting under the orders of a supervisor. We also presented legal authority showing that performance of duty expressly provides that employees who are directly engaged in performing the duties of their jobs are covered by the Federal Employees Compensation Act (FECA) regardless of whether the work is performed on the agency's premises or at an alternative worksite. There is no statement (such as a 'safety checklist') that can be signed by the employee to negate this coverage. As always, any affirmative defense of 'willful misconduct' must be substantiated by the evidence that the employee disobeyed an order that was routinely enforced. We also showed regulation that provides that an employee who has a fixed place of employment, and is injured on the premises of the employer, has the protection of the FECA when:
(1) The employee was performing assigned duties, or
(2) The employee was engaged in an activity reasonably incident to the employment such as:
(a) personal acts for comfort,convenience and relaxation,
(b) Eating meals and snacks on the premises and
(c) Taking authorized coffee breaks, or
(3) The injury occurred while the employee was on the premises.
Based on these legal arguments and authorities, as well as witness statements and medical evidence, the OWCP subsequently overruled the employer agency, vacated its prior decision denying benefits and awarded the federal employee full compensation and benefits coverage for his on the job injuries.
OWCP VACATES DENIAL OF "FACT OF INJURY" AND ACCEPTS INJURY CLAIM
Three Years Later OWCP Reverses Decision and Awards Compensation Benefits to Injured Worker
The evidence required to prove a claim is only that necessary to convince the OWCP that the conclusion drawn is rational and sound
In this OWCP claim the federal employee was injured more than 3 years ago while working as a screener for the Transportation Security Administration. She promptly sought medical treatment and timely filed her claim for federal workers compensation benefits. Not until 2009 did the OWCP review her claim and then issued a decision denying her claim for compensation. The OWCP argued that the claimant failed to submit sufficient medical evidence showing that she was injured on the job. The OWCP argued that she failed to show proof of "fact of injury". The claimant timely appealed and requested and oral hearing. A hearing was held and in 2010 the OWCP again denied her claim due to lack of proof of "fact of injury".
The claimant appealled again. The OWCP denied again.
The claimant then approached this office and requested assistance on her next appeal to OWCP.
Reviewing the case from the start I found that the OWCP had mischaracterized the definition of "fact of injury" in the claim. I argued that the OWCP was not clear whether it had denied the claim due to discrepancies in the medical evidence (of which none existed) so as to cast doubt whether the injury actually occurred or had the OWCP denied the claim due to a lack of submission of medical evidence.Establishing whether an injury, traumatic or occupational was sustained in the performance of duty as alleged, i.e., 'fact of injury," and establishing whether there is a causal relationship between the injury and any disability and/or specific condition for which compensation is claimed, i.e., "causal relationship," are distinct elements of a compensation claim. While the issue of "causal relationship" cannot be established until "fact of injury" is established, acceptance of fact of injury is not contingent upon an employee proving a causal relationship between the injury and any disability and/or specific condition for which compensations is claimed. I argued that the OWCP wrongfully intermingled the the separate and distinct issues of "fact of injury" and "causal relationship" such that there is not a competent or clear reason made by the Office that adequately supports the denial of the claim.
I then obtained and submitted new additional medical evidence supporting the claimant's claim of injury and ongoing medical treatment.
Upon review of these arguments, the OWCP fully agreed that it had erred in denying this claim of injury.The OWCP found that the medical evidence of file does implicate that the claimed condition is causally related to federal employment the opinion on causal relationship has been supported with affirmative evidence, the physicians explained by medical rationale and provided an accurate medical and factual background. Although compensation awards must be based on reliable, probative and substantial evidence, the evidence required is only that necessary to convince the adjudicator that the conclusion drawn is rational and sound; it is not necessary that the evidence be so conclusive as to establish causal connection beyond all possible doubt. Where the relative circumstances strongly suggest a causal relationship and where the medical evidence also supports a causal relationship, appellant has met his burden of proof.
The decision denying injury was reversed and the claim accepted with compensation benefits awarded.
