Dealing with the US Department of Labor
The Executive Branch of the US Government administers the following agencies that you will be dealing with. Here's a summary:
USDOL: US Department of Labor determines whether you can get medical care for your health issues. They have claims examiners that examine your case.
ACS: Affiliated Computer Services manages the payment of bills for the USDOL.
FECA/OWCP (Federal Employees Compensation Act / Office of Workers' Compensation Programs) is the Federal agency that is part of the USDOL that determines if you may and entitles you to receive loss of wages (disability).
US Treasury Department is the Federal agency that produces the medical bill reimbursement or loss of wage checks to you.
Peace Corps is the agency that pays your medical bills directly while you are in the field, during medical evacuation, and upon your initial return to the US. Then your medical bills are processed by the US Department of Labor where you will have a Federal Claims Examiner. Those bills and any disability payments actually still come out of the Peace Corps' budget.
After you establish that you have a health issue resulting from or aggravated by service that requires further treatment, you move from the jurisdiction of the Peace Corps to the auspices of the US Department of Labor (USDOL) where you need to file a Federal Employees Compensation Act (FECA) claim.
If you are unable to work either temporarily or permanently (or donít know) you should file a disability claim. You can receive disability income because you can't work if you are eligible.
The Peace Corps also has a website with instructions about how to file a claim for benefits through FECA as well as how to submit the proper paperwork with the US Department of Labor/Office of Workers' Compensation Programs. Before you try to tackle this system on your own, ask the Peace Corps Post Service Unit for help.
Navigating the Systems:
If you are a medical provider, refer them here for instructions.
If you are an RPCV needing to file a claim, read below. Most forms they will need can be found here along with instructions. Go to Forms and Links and then select FECA.
- First, notify the Post Service Unit Medical division if you have a health issue: Phone 202-692-1540 (option #7), Fax: 202-692-1541, email@example.com. Ask them for help.
- For an Accident: Submit a CA-1 form for an accident that happened on a certain day. The CA-1 can be downloaded here.
- For an Illness: Submit a CA-2 form for an illness that developed over time. The CA-2 can be downloaded here.Unfortunately, the forms do not really apply to Peace Corps Volunteers or the types of illnesses or injuries or work duties we often have. You will need to ask the Post Service Unit (PSU: 202-692-1540 / firstname.lastname@example.org) for help in this area.
- Keep Copies of everything and if possible, scan them into your computer with back-ups. Documents frequently get misplaced by the USDOL and up in the wrong office. It is really up to you to keep track. Beginning the process in an organized manner putting documents in files or binders will help. Sometimes multiple submissions of the same paperwork by you will be required.
- Claim Approved by the USDOL? If it is, you will receive a case number and your claim will be maintained in a regional office. Be sure to inquire whom your claims examiner is and what his/her phone number is. It is also advisable to obtain the name of that person's supervisor. Sometimes they can find out more information than the claims examiner can obtain. Your claim number will become as important as your Social Security number in this process.
- Follow-up With Both the Peace Corps and OWCP to ensure that your paperwork has been received. If something is lacking you may not be notified. Always call and double check. Again, keep copies.
- Notify the Peace Corps Post Service Unit (email@example.com) of any and all problems in writing so they can become aware of what changes are necessary and where improvements need to be made and so that they can help you. Please keep them up to date on your health and needs.
- What Is Covered? Every medical appointment and procedure related to your approved condition should be covered as long as you are treated by an MD, PhD, DO, qualified laboratory or hospital. Chiropractic may or may not be covered depending on your condition. Make sure you know what diagnosis IDC-9/10 codes are covered for your particular claim. Be aware that the USDOL makes mistakes.
- Familiarize Yourself with the USDOL (Federal Workers' Compensation Programs) System: Even if Peace Corps is helping you, it is good to understand some of this bureaucracy. If you go to the USDOL/OWCP website you can get an overall sense of the system. Remember that you will be dealing with Federal Workers' Compensation and not state Workers' Compensation. Your medical practitioners will probably assume you have state comp and not federal, so remember to remind them. You may also speak with a live person At the USDOL by calling Monday through Friday from 8 - 8 EST at: 1-866-4-USA-DOL (1-866-487-2365) or TTY: 1-877-889-5627. Always have your claim number ready.
- Have your healthcare practitioner review this information. Enroll Your Medical Providers in ACS (Affiliated Computer Services: 850-558-1818): In order to be paid by the USDOL, your providers must be enrolled in ACS, a division of the Xerox Corporation, which oversees the pre-authorization of medical forms, monitors bill payments for medical and pharmaceutical claims for the US Department of Labor/Office of Workers' Compensation Programs. Your healthcare provider should go here to learn how to submit claims.
- Submit USDOL documents and bills and educate your healthcare provider: You can now submit documents directly to the USDOL once you have a claim by going to this website. Or you can submit them to the snail mail address at: Office of Worker Compensation Programs, US Department of Labor, PO Box 8300, London, KY 40742-8300. Your medical team must always bill for diagnoses (ICD 9/10 codes) the USDOL claims examiner has deemed related to your injury/illness. Your provider should go to this site.
- Once Your Claim Is Approved, you may see what bills have been paid by accessing the website of Affiliated Computer Services. After you get to the site, click FECA and Claimant and then enter your claim number to see if bills have been paid. Again, you will need to enter the provider's ACS number to obtain this information. It is suggested that you keep each provider's ACS number in your address book for reference. You may want to give your medical provider the ACS website, as well, so that they can also access information about payments (and potential billing problems).
- If Your Medical Bills Are Not Being Paid, or if they are repeatedly denied for different reasons each time in a seemingly random fashion and you have contacted them, you should immediately contact the PSU (202-692-1540 / firstname.lastname@example.org). The ACS division for medical bills can be reached at: 850-558-1818 from 8-8 EST Monday through Friday. Be sure to speak with a live person and write down the date and reference number of your call and the representative.
- If Your Pharmacy Bills Are Not Being Paid, call the ACS division for pharmacy at: 866-664-5581 from 8-8 EST Monday through Friday. Again, be sure again, to write down everything and always ask for a supervisor if you are not obtaining the information you need. If you are really frustrated you can also contact one of your state's two US Senators because they have a department that deals specifically with Federal issues. You can send them copies of your requests or issues and they will send those directly on to the USDOL. Contact the Senator's office to find out who is in change of dealing with the US Department of Labor and address all correspondence to this person's attention. This can be an effective process when all else fails. Hopefully, asking the Peace Corps Post Service Unit now will keep this step from being necessary now.
- You can check to see what had been paid by going to this site for instructions.
- If You Need Physical Therapy or Pre-Approval For Medical Procedures you must submit the medical pre-authorization form to ACS by fax. Again, phone them a few days later to ensure that it has been received. Ask what pre-authorization number has been assigned for that treatment and inform your practitioner that that number must be listed in box 23 of the HCFA CMS 1500 form. The pre-authorization form for physical therapy can be downloaded and also submitted to ACS by fax. Other forms can be found on the ACS general website under forms and links and FECA.
- Get Support: The system is cumbersome, often slow, arduous and very complicated. But you have a right to your benefits by law. Get the Peace Corps, friends and family to help if you are overwhelmed, and try to deal with the systems on your healthier days, not when you are the sickest and most run-down.
- We are in the process of getting the NPCA involved in recruiting some RPCVs nationwide to volunteer to help in the support process.