War Hazard Compensation Act Federal Provisions tutorial part 2 of 2 Podcast 57

Simplifying FECA Bulletin No. 24-06: A New Streamlined Process for War Hazards Compensation Act (WHCA) Claims

CLAIM FOR REIMBURSEMENT OF BENEFIT PAYMENTS AND CLAIMS EXPENSE  

                  UNDER THE WAR HAZARDS COMPENSATION ACT

The U.S. Department of Labor has introduced a new process to speed up decisions on claims made under the War Hazards Compensation Act (WHCA). This process allows insurance companies to submit suggested claim decisions, which the Office of Workers’ Compensation Programs (OWCP) can approve if they meet all legal requirements. This change aims to make claim reimbursement  processing faster and more efficient.

With a few exceptions, the DBA incorporates the provisions of the Longshore and Harbor Workers’ Compensation Act (LHWCA). The War Hazards Compensation Act (WHCA) applies to DBA employees who are injured as a result of hostile actions. 42 U.S.C. §§ 1701 – 1717. While WHCA claims can be considerably substantial, the statute provides a detailed set of procedures and requirements which, if performed properly, allow the employer or carrier to see 100% reimbursement of such claims including allocated and unallocated expenses  from the government. 

The WHCA provides financial coverage for employees injured or killed due to war-related hazards while working under the Defense Base Act. If an injury or death occurs because of a war risk hazard, private insurance carriers or self-insured employers can seek reimbursement for the benefits they have already paid out, such as:

 Disability and death benefits                                                                                                 Funeral and burial costs                                                                                                         Medical expenses                                                                                                                     Other necessary claim processing costs

The OWCP, through its Division of Federal Employees’, Longshore, and Harbor Workers’ Compensation (DFELHWC) division, reviews and decides whether a claim qualifies for reimbursement through the guidelines established in the Defense Base Act.

The rules for requesting reimbursement under the WHCA are highly detailed and lengthy. Applications must be well-documented and include essential evidence that are outlined in the federal rules outlined in the DBS. For more information click on the transcript. 

The podcast Dr. Taylor’s contact information is:
https://fedcompconsultants@protonmail.com If you need a medical provider or assistance with an OWCP /  DOL claim in Tampa, Pensacola Florida or Mobile Alabama    you can make an appointment to see Dr. Taylor, or Dr. Sullivan   at the clinic at  FWC Medical Centers. To mak

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Transcript

Welcome to another episode of Federal Workers Compensation Coffee break Podcast. I am your host Dr. Taylor. I am an OWCP & Federal Health Care compliancy consultant who has been assisting hospitals, doctor’s offices and physician clients for over 30 years in the work comp arena. I have taught Federal Workers Compensation seminars for medical people for most of my career. I also assist medical offices, surgical centers and hospitals with billing, collections and authorization difficulties with OWCP workers compensation. I decided to offer this podcast for free to give back to government workers and future doctors who want to participate in Federal Workers Compensation claims by doing a podcast to assist with all types of topics of government related healthcare filings. This podcast is intended to assist medical providers, attorneys and injured workers successfully navigate all of the relevant provisions afforded injured federal employees. 

 The only thing I ask for from you the listeners…is that if you find this information to be helpful ….PLEASE like, share with co-workers or leave a review of the  podcast for others to be able to find this subject matter material on the internet and maybe send me an email to let me know that you benefitted from this free information. 

Here at this podcast we discuss all sorts of topics related to federal  workers compensation, Department of Labor, OWCP, FECA ACT, FERS, longshore-maritime, DOD contractors, VA benefits. I cover these relevant topics in a short coffee break style format (modeled after the lunch and learn style) to assist you, the government employee/contractor with filing your claim, understanding your rights, responsibilities & relevant rules and provisions

Today’s podcast is a special edition version mini-series that is mostly for a special subset of injured federal workers and contractors that work in civil service support roles of the military in war theaters around the world. If you don’t know this about my practice I have been treating veterans, contractors, civil service contractors and ex-military that work as civil contractors in support roles that are in theaters of war. This is a special set of federal employees and contractors who have a special set of dual coverage benefits for medical and disability benefits under federal law provisions. Not many people treat these types of injuries and understand how to work within this dual benefit framework. I do this podcast hoping that more lawyers and physicians will want to participate in assisting these types of federal injuries. I also do this to assist the federal employees that are injured in this type of war hazard areas in finding solutions to qualifying for the maximum benefits allowed under the federal workers compensation provisions. 

So, today is part 2 of a 2 part series where we are covering the 2nd part of the recent update to the insurance carriers  claim process in late 2024 to the War Times Hazard Compensation Act  that has some  key changes to the dual benefit process of coverage by both OWCP, Longshore and War Times Hazard Compensation Act and how to qualify for the dual eligibility benefits.  This is the first announcement on this special subject in years so I thought I would cover this. This is a two part series that involves a part one general explanation of this dual benefit system in podcast episode 56. Please stop and go back and listen to the first episode before listening to this edition because you will be lost as I cover the recent FECA changes to this dual coverage for qualified federal employees and contractors that work in these war hazard environments … Let’s dive in and cover all of it….READY….OK…

Let’s get our coffee started and start on this huge new announcement!

Simplifying FECA Bulletin No. 24-06: A New Streamlined Process for War Hazards Compensation Act (WHCA) Claims

CLAIM FOR REIMBURSEMENT OF BENEFIT PAYMENTS AND CLAIMS EXPENSE  

                  UNDER THE WAR HAZARDS COMPENSATION ACT

The U.S. Department of Labor has introduced a new process to speed up decisions on claims made under the War Hazards Compensation Act (WHCA). This process allows insurance companies to submit suggested claim decisions, which the Office of Workers’ Compensation Programs (OWCP) can approve if they meet all legal requirements. This change aims to make claim reimbursement  processing faster and more efficient.

With a few exceptions, the DBA incorporates the provisions of the Longshore and Harbor Workers’ Compensation Act (LHWCA). The War Hazards Compensation Act (WHCA) applies to DBA employees who are injured as a result of hostile actions. 42 U.S.C. §§ 1701 – 1717. While WHCA claims can be considerably substantial, the statute provides a detailed set of procedures and requirements which, if performed properly, allow the employer or carrier to see 100% reimbursement of such claims including allocated and unallocated expenses  from the government. It’s as close as you can get to maximize receiving 100% of owed benefits & money, if done correctly. 

The WHCA provides financial coverage for employees injured or killed due to war-related hazards while working under the Defense Base Act. If an injury or death occurs because of a war risk hazard, private insurance carriers or self-insured employers can seek reimbursement for the benefits they have already paid out, such as:

Disability and death benefits

Funeral and burial costs

Medical expenses

Other necessary claim processing costs

The OWCP, through its Division of Federal Employees’, Longshore, and Harbor Workers’ Compensation (DFELHWC) division, reviews and decides whether a claim qualifies for reimbursement through the guidelines established in the Defense Base Act.

Ok… this is the part I want you to pay particular attention to. There are multiple payors in these types of claims. There is additional participation of private insurance carriers that are paid for by the employee agency for secondary coverage for medical and disability settlements that is uniquely & completely different from the standard OWCP process. All U.S. government contractors and subcontractors are required by federal law to obtain workers’ compensation coverage through private insurance carriers for civilian employees who work overseas. The WHCA provides full federal reimbursement of contractor costs for injury or death claims related to “war-risk hazard” pursuant to a worker’s compensation claim. The main purpose of the WHCA is to shift the costs of overseas workers’ compensation from contractors and subcontractors to the U.S. government In typical OWCP injury cases, OWCP is the sole arbitrator of medical and disability benefits. However, under WHCA, private insurance carriers act as secondary payors, covering additional benefits related to war-risk hazards. They handle the initial costs and then seek reimbursement for reasonable and necessary claims expenses associated with processing the request. The purpose of this podcast is to explain how to understand how to maximize qualifications of eligibility for benefits that are afforded the injured worker by both OWCP & the private insurance carrier coverage provided by the employee agency. The injured employee has two different payor sources to submit reimbursements, payments etc but the individual private insurance carrier has more streamlined ways in this new outlined process to be reimbursed for some or all of those secondary payments. This new FECA bulletin assists these private insurance carriers with reimbursements.

Under Section 104 of the WHCA, private insurance carriers or self-insured employers may seek reimbursement for payments made in conjunctions with a WHCA-covered injury. 20 CFR 61.100 states “The Office shall reimburse any carrier that pays benefits under the Defense Base Act or other applicable workers' compensation law due to the injury, disability or death of any person specified in Sec. 61.1(a), if the injury or death for which the benefits are paid arose from a war-risk hazard. The amount to be reimbursed includes disability and death payments, funeral and burial expenses, medical expenses, and the reasonable and necessary claims expense incurred in processing the request.”

What’s Changing?

In an effort to improve efficiency, OWCP has introduced an alternative streamlined process that allows private insurance carriers to submit their own proposed acceptance decisions when they file a WHCA reimbursement claim (Form CA-278). These documents function like legal briefs, outlining:

The facts of the claim

How the law applies to those facts

The reasoning behind why the claim should be approved

If the proposed decision meets all legal and evidentiary requirements, OWCP claims examiners (CEs) can approve the claim by adopting the carrier’s proposed decision.

How This Works

When an insurance carrier submits Form CA-278 for reimbursement, they can choose to include a proposed decision document.

The CE reviews the proposed decision and checks the supporting evidence.

If the claim meets all requirements and the proposed decision is accurate, the CE may adopt it as the official approval letter.

If the claim is approvable but the CE finds issues with the proposed decision, the CE will modify it or draft a new approval letter.

If the claim is not approvable, the CE will follow standard procedures to develop the case further or issue a denial.

Why This Matters

Faster claim processing: This change reduces wait times for insurance carriers seeking reimbursement.

More efficient use of resources: Instead of OWCP writing every decision from scratch, they can adopt well-supported proposals, freeing up time for more complex cases.

Clearer decisions: The use of structured legal briefs ensures claims are backed by strong evidence and logical reasoning.

Conclusion

This new approach is entirely voluntary for insurance carriers, but it offers a way to streamline and accelerate the reimbursement process for WHCA claims. OWCP will retain this policy until further updates or revisions are made to the FECA Procedure Manual.

So, this new FECA bulletin is assisting  the claim reimbursement for insurance carriers. These insurance carriers have lawfirms that represent them in these reimbursement of WHCA cases. The federal law, rules and provisions are not easy to navigate for the insurance carriers, so they outsource these claim reimbursement claims to lawfirms that are experts in federal law. But, notice how OWCP-DFEC is streaming the reimbursement process for insurance carrier reimbursements but notice the void and absence of bulletin assistance for you…the injured federal worker. 

Now listen up closely… this is the most important part of this presentation to remember. I have been dealing with these claims for decades. In my honest opinion you, the injured federal employee that is injured in war hazard qualified areas need a lawfirm to assist you to maximize you settlement of benefits. This is a niche part of medical and federal law provisions that is highly specialized and even if you have medical providers who know how to make the proper medical presentations for qualifying for WHCA benefits, you need legal assistance to present your case appropriately through the rigid and laborious rules and law process of qualification filings. 

Let me explain why I have come to this conclusion over the years of dealing with eligibility qualifications for WHCA Reimbursements

The rules for requesting reimbursement under the WHCA are highly detailed and lengthy. Applications must be well-documented and include essential evidence such as proof of liability (insurance policy or self-insurance certificate), compensation orders (if applicable), medical reports, claim forms, invoices for medical and other expenses, and proof of payment.

Additionally, each submission requires a cover letter explaining how the WHCA applies, a summary of the Act’s provisions being relied upon, and an evidentiary statement that demonstrates the loss resulted from a “war-risk hazard.” Supporting documentation often includes military or local police reports, news articles, employer statements, and medical reports detailing the incident in patient histories. Having a thorough understanding of the term “war-risk hazard” is essential for a successful claim.

Once a claim is submitted, the Division of Federal Employees’ Compensation (DFEC) will notify the applicant of acceptance, denial, or the need for additional documentation within 60 to 90 days. I have found that process to actually take years in most cases. In some cases, part of a claim may be accepted while other portions are denied or require further review. Once DFEC division of OWCP reaches a determination, Form SF-104 is issued, signed, and returned, which triggers the reimbursement of the approved amount. Notably, there is no appeal process beyond DFEC’s decision per 20 C.F.R. § 61.102(d), making accuracy critical from the outset.

The Complexity of WHCA Reimbursement Claims

Filing a WHCA reimbursement claim is a complex and demanding process. Success requires persistence and attention to detail in compiling and submitting extensive documentation. Each claim undergoes a meticulous review, and ensuring compliance with all requirements is crucial.

So, as a long time participant in this arena I honestly believe that federal employees, just like the insurance carriers, require assistance with legal professionals experienced in subrogation law for the best chance of securing a full and maximal recovery. These legal specialists navigate the bureaucratic challenges, ensuring that every aspect of a claim meets the stringent criteria for approval. Given the financial significance of war hazard reimbursement claims, relying on dedicated experts can streamline the process and improve the likelihood of a successful outcome. For example I have had a couple of case that were denied as WHCA dual claims that were not in foreign war hazard areas but were stateside and were injured in a designated terrorist attack. In recent appeal decisions, the Department of Labor has determined that injuries as result of terrorist attacks are, in fact, covered under the Act. Terrorist activity is defined as requiring the act of an individual or group with a political agenda hostile to the U.S. That is an expansion of the legislation that was adjudicated through a lawfirm. That injured employee would never have won that case without legal assistance. That is my 2 cents on this war hazard compensation reimbursement process. Trust me, you need help to navigate these type of claims. 

Well that does it for this episode of Federal Workers Comp Coffee break  Podcast 

If you think that you or someone you know may be eligible for dual benefits under the war time hazard compensation act feel free to email me for more assistance. I also recommend you do an internet search for law firms that assist with these highly specialized cases as well.  

So, I want to thank you for listening and want to remind you to share this podcast with other federal workers you think would benefit from this information. Also be kind enough to leave a review on the platform you found this podcast, like or subscribe to any of the major podcast platforms or our YouTube channel so others will also find this information. Also if you need an approved medical provider for your DOL -OWCP Or Longshore case in Florida you can still find me in Tampa   and Pensacola. To make a consultation with me to discuss your case or if you know someone if Florida who is recently injured you can call the clinic at 813-215-4356 or 813-877-6900 or go  to our website at https://fedcompconsultants.com/   & https://mrtherapycenter.com/  Also if you are in  another state and you want me to assist you with claim questions or assistance for your  doctor you can email me at fedcompconsultants@protonmail.com 

Ok… I think that is enough for today…I need to warm up this coffee and get going. As usual I want to thank all of you who put on that uniform, that badge, deliver that mail, take care of our veterans and make this government run… a big thank you. I do this for free just for you…We could not do this  without all of the work all of you out there do…so this is my big  thank you. And remember if you  have an injured federal claim and you need assistance….I am  here to help!.

See you next time.

Off to get my coffee!