United States Department of Labor

Employees’ Compensation Appeals Board

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M.R., widow of T.R., Appellant

and

DEPARTMENT OF HOMELAND SECURITY, 

U.S. CUSTOMS & BORDER PROTECTION, 

Carrizo Springs, TX, Employer

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Docket No. 18-0480

Issued: March 22, 2019

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

PATRICIA H. FITZGERALD, Deputy Chief Judge

ALEC J. KOROMILAS, Alternate Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JURISDICTION

On January 3, 2018 appellant filed a timely appeal from a December 11, 2017 merit 

decision of the Office of Workers’ Compensation Programs (OWCP).1 Pursuant to the Federal 

Employees’ Compensation Act2(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has 

jurisdiction over the merits of this case.3

 

1 On her application for review (Form AB-1) appellant requested an oral argument pursuant to 20 C.F.R. § 501.5(b). 

By order dated February 15, 2019, the Board exercised its discretion and denied appellant’s request finding that the 

appeal could be adequately addressed in a decision based on a review of the case record. Order Denying Request for 

Oral Argument, Docket No. 18-0480 (issued February 15, 2019).

2 5 U.S.C. § 8101 et seq.

3 The Board notes that appellant submitted additional evidence on appeal. However, the Board’s Rules of 

Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that was before 

OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board for the first 

time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional evidence for 

the first time on appeal. Id.
2

ISSUE

The issue is whether OWCP properly suspended appellant’s compensation benefits,

effective January 7, 2018, for failure to complete a Form CA-12 as requested.

FACTUAL HISTORY

On September 12, 2014 appellant filed a claim for compensation by widow, widower, 

and/or children (Form CA-5) in connection with her husband’s September 12, 2014 death. The 

deceased employee, a 34-year-old border patrol agent, was involved in a September 12, 2014 

employment-related motor vehicle accident. Following the head-on collision with another 

motorist, the employee was airlifted to a nearby military hospital and later died of his injuries 

during surgery.4

By decision dated May 6, 2015, OWCP accepted appellant’s claim. It paid appellant 

compensation, beginning September 13, 2014. OWCP placed her on the periodic compensation 

rolls, effective January 10, 2016. 

On November 2, 2016 OWCP began to periodically request appellant to provide the 

information as requested in the enclosed claim for continuance of compensation under FECA 

(Form CA-12) in order for OWCP to decide whether her survivor benefits should continue, or be 

adjusted. It notified her that she had to fully answer all questions on the form and return the 

statement within 30 days, or her benefits would be suspended pursuant to 20 C.F.R. § 10.414. The 

letters were sent to a post office box in El Dorado, Texas. 

In an April 3, 2017 CA-110 memorandum of telephone call, OWCP noted that appellant 

had called to inform OWCP that she planned to submit a change of address, and that she would be 

requesting a copy of her compensation history.

On June 6, 2017 an OWCP benefit statement mailed to appellant at the same post office 

Box in El Dorado, Texas was received as “return to sender.” The U.S. Postal Service markings on 

the envelope indicated a forwarding address for appellant in San Angelo, Texas.

On July 3 and 27, and September 11 and 25, 2017, OWCP benefit statements mailed to 

appellant’s post office box in El Dorado, Texas were each received as “return to sender.” The U.S. 

Postal Service markings on the envelopes indicated a forwarding address for appellant in Leander, 

Texas.

By letter dated October 12, 2017, OWCP requested that appellant complete the enclosed 

Form CA-12 within 30 days, or her benefits would be suspended pursuant to 20 C.F.R. § 10.414. 

 

4 The reported cause of death was “blunt force injuries complicating cardiomegaly (an enlarged heart).”
3

The letter was mailed to appellant’s post office box in El Dorado, Texas. On November 6, 2017 

the October 12, 2017 letter was received by OWCP as “return to sender.”

5

By decision dated December 11, 2017, OWCP suspended appellant’s compensation 

benefits, effective January 7, 2018, due to her failure to complete the Form CA-12 which had been 

sent to her address in Leander, Texas. It noted that if she were to complete and return the enclosed 

copy of the Form CA-12, her compensation benefits would be restored retroactively to the date

they were suspended.

LEGAL PRECEDENT

If a beneficiary is receiving compensation benefits due to an employee’s death, OWCP will 

ask him or her to complete a report once each year using a Form CA-12.6 The report requires the 

beneficiary to note changes in marital status and dependents. If the beneficiary fails to submit the 

form (or written equivalent) within 30 days of the date of request, OWCP shall suspend 

compensation until the requested form or equivalent written statement is received. The suspension 

will include compensation payable for or on behalf of another person (for example, compensation 

payable to a widow on behalf of a child). When the form or statement is received, compensation 

will be reinstated at the appropriate rate retroactive to the date of suspension, provided the 

beneficiary is entitled to such compensation.

ANALYSIS

On October 12, 2017 OWCP issued a letter to appellant requesting that she complete the 

enclosed Form CA-12 within 30 days. It advised her that, if she did not complete the requested 

information within the time allotted, her benefits would be suspended pursuant to 20 C.F.R. 

§ 10.414. OWCP addressed the letter to a post office box in El Dorado, Texas, and it was returned

to sender as undeliverable to OWCP on or about November 6, 2017. In the absence of evidence 

to the contrary, it is presumed that a notice mailed in the ordinary course of business was received 

in due course by the intended recipient.7 This presumption is commonly referred to as the 

“mailbox rule.”

8

 It arises when the record reflects that the notice was properly addressed and duly 

mailed.9 The presumption is rebutted where there is evidence of nondelivery or other evidence 

that supports that the addressee did not receive the correspondence.10

 

5 On October 19 and November 17, 2017 additional OWCP benefit statements mailed to appellant’s post office box 

in El Dorado, Texas were received by OWCP as “return to sender.” The U.S. Postal Service markings on the envelopes 

indicated a forwarding address for appellant in Leander, Texas.

6 20 C.F.R. § 10.414.

7 Kenneth E. Harris, 54 ECAB 502, 505 (2003).

8

Id.

9

Id.

10 J.B., Docket No. 17-1164 (issued September 11, 2017).
4

In this case, OWCP sent a series of correspondences including the October 12, 2017 letter 

and enclosed Form CA-12 to her post office box in El Dorado, Texas. All of those documents 

were subsequently “returned to sender” (OWCP) indicating a forwarding address in Leander, 

Texas. As appellant did not receive a copy of the October 12, 2017 letter and Form CA-12, she 

was unaware that she needed to complete and return the form to OWCP within 30 days. 

Accordingly, the Board will reverse the December 11, 2017 suspension decision. OWCP shall

reinstate appellant’s compensation retroactive to January 7, 2018.

CONCLUSION

The Board finds that OWCP improperly suspended appellant’s compensation, effective 

January 7, 2018.

ORDER

IT IS HEREBY ORDERED THAT the December 11, 2017 decision of the Office of 

Workers’ Compensation Programs is reversed.

Issued: March 22, 2019

Washington, DC

Patricia H. Fitzgerald, Deputy Chief Judge

Employees’ Compensation Appeals Board

Alec J. Koromilas, Alternate Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board