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Federal Workers' Compensation

The Office of Workers' Compensation Programs administers four major disability compensation programs which provide wage replacement benefits, medical treatment, vocational rehabilitation and other benefits to certain workers or their dependents who experience work-related injury or occupational disease.

Here is a forum for members to share and exchange experiences regarding to workers' compensation related issues.


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nutnut57  
#1 Posted : Tuesday, June 29, 2021 11:16:34 AM(UTC)

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I was told today that the billing contractor (CNSI) for OWCP is now requiring the actual receipts for meal expenses during a trip out of state (9 day trip) for a medical evaluation (this trip was authorized by DOL). My understanding per the regulations for Federal trips, payment reimbursement is for actual OR the per diem rate. The actual cannot exceed the per diem rate.

The claims examiner thought the billing contractor was interpreting the regulation differently than had been done previously.


From the FECA OWCP website:
Has anyone experienced this recently? OWCP reimburses for travel based on the Federal Travel Regulation (41 C.F.R. 300-304). Per diem reimbursement is covered in Chapter 301-11.1.c. which specifies that you must be in a travel status for more than 12 hours to be eligible for per diem reimbursement (either actual cost or per diem).

I asked the claims examiner for the regulation that CNSI is using; the billing agents did not know the regulation.
VW1  
#2 Posted : Friday, July 9, 2021 10:51:27 AM(UTC)
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Originally Posted by: nutnut57 Go to Quoted Post
I was told today that the billing contractor (CNSI) for OWCP is now requiring the actual receipts for meal expenses during a trip out of state (9 day trip) for a medical evaluation (this trip was authorized by DOL). My understanding per the regulations for Federal trips, payment reimbursement is for actual OR the per diem rate. The actual cannot exceed the per diem rate.

The claims examiner thought the billing contractor was interpreting the regulation differently than had been done previously.


From the FECA OWCP website:
Has anyone experienced this recently? OWCP reimburses for travel based on the Federal Travel Regulation (41 C.F.R. 300-304). Per diem reimbursement is covered in Chapter 301-11.1.c. which specifies that you must be in a travel status for more than 12 hours to be eligible for per diem reimbursement (either actual cost or per diem).

I asked the claims examiner for the regulation that CNSI is using; the billing agents did not know the regulation.


This is an assumption on my part, so take it for what it's worth. CNSI usually has no clue what they are talking about. I am going to assume they are telling you to provide the actual receipt because that is what the instruction page for the 957 requires. If they deny your reimbursement just because you do not have the actual receipt you will have appeal rights. Make sure you submit some type of proof of payment because they have reimbursed claimants for meals and lodging when they submitted a credit card receipt or bank statement showing the charge.

nutnut57  
#3 Posted : Tuesday, July 20, 2021 4:51:06 PM(UTC)

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Joined: 3/7/2007(UTC)
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CNSI is now quoting OWCP Procedure Manual, Part 5-0204-8(h) which states that reimbursement will be based on actual expense basis and that no per diem allowance in lieu of subsistence expenses is allowed. The manual also states "Receipts are required, whenever it is practicable to obtain them, in support of a claim for any incidental item (such as meals, lodging, hiring of special conveyance, et.) where the amount exceeds $25 and for the purchase of gas and oil when reimbursement is claimed on an actual expense basis in lieu of a mileage basis.

I then read FECA Circular 12-06, which states "If the claimant requests reimbursement for any of these services (this includes non-emergency transport meals recipient), and the charges exceed $75, a receipt must accompany the reimbursement claim. ...If the claim is less than or equal to $75, receipts are not required, and the service will pay without any manual review."


The Circular does not appear to match the wording in the Procedure Manual.


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