United States Department of Labor

Employees’ Compensation Appeals Board

__________________________________________

C.W., Appellant

and

DEPARTMENT OF THE NAVY, 

CRYPTOLOGIC WARFARE GROUP SIX, 

Annapolis, MD, Employer

__________________________________________

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Docket No. 21-0943

Issued: February 17, 2023

Appearances: Case Submitted on the Record

Appellant, pro se

Office of Solicitor, for the Director

DECISION AND ORDER

Before:

JANICE B. ASKIN, Judge

VALERIE D. EVANS-HARRELL, Alternate Judge

JAMES D. McGINLEY, Alternate Judge

JURISDICTION

On June 1, 2021 appellant filed a timely appeal from December 29, 2020, March 10, and 

May 17, 2021 merit decisions, and a March 19, 2021 nonmerit decision of the Office of Workers’

Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act1

(FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this 

case.2

1 5 U.S.C. § 8101 et seq.

2 The Board notes that, following the May 17, 2021 decision, appellant submitted additional evidence to OWCP.

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

ISSUES

The issues are: (1) whether OWCP properly suspended appellant’s wage-loss 

compensation and medical benefits pursuant to 5 U.S.C. § 8123(d), effective September 13, 2020, 

due to her failure to attend scheduled medical examinations; (2) whether OWCP has met its burden 

of proof to terminate appellant’s wage-loss compensation and medical benefits, effective 

March 28, 2021, as she no longer had disability or residuals causally related to her accepted July 1, 

2019 employment injury; (3) whether OWCP properly denied appellant’s request for 

reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a); (4) whether appellant 

received an overpayment of compensation in the amount of $2,416.38 for the period January 5, 

2020 through February 27, 2021, for which she was not at fault, resulting from failure to deduct 

appropriate health and life insurance premiums; and (5) whether OWCP properly denied waiver 

of recovery of the overpayment.

FACTUAL HISTORY

On July 22, 2019 appellant, then a 62-year-old financial technician, filed a traumatic injury 

claim (Form CA-1) alleging that on July 1, 2019 she injured her left leg when she used a turnstile 

gate while in the performance of duty. She stopped work on July 3, 2019. OWCP accepted 

appellant’s claim for left knee contusion. It paid her wage-loss compensation on the supplemental 

rolls commencing September 14, 2019, and on the periodic rolls commencing March 1, 2020.

In a July 24, 2020 letter, OWCP notified appellant that it had scheduled a second opinion 

examination on August 17, 2020 at 2:30 p.m. with Dr. Kevin F. Hanley, a Board-certified 

orthopedic surgeon, to determine the status of her accepted July 1, 2019 employment injury. The 

letter contained the date, time, and location of appellant’s appointment.3

Appellant contacted OWCP on August 17, 2020 at 2:16 p.m. to advise that she would not 

be attending the appointment schedule with Dr. Hanley at 2:30 p.m. on that date because the person 

who offered to provide her transportation had cancelled. She asserted that there were “no taxi 

services in her area or public transportation.”

By decision dated August 18, 2020, OWCP suspended appellant’s wage-loss compensation 

and medical benefits pursuant to 5 U.S.C. § 8123(d), effective September 13, 2020, due to her 

3 Appellant had previously failed to attend a July 20, 2020 appointment for a second opinion examination with

Dr. John C. Barry, a Board-certified orthopedic surgeon. In a June 23, 2020 notice, OWCP informed appellant of the 

date, time, and place of the July 20, 2020 appointment and, in a July 20, 2020 notice, it advised her that it proposed to 

suspend her compensation for failure to attend the examination scheduled for July 20, 2020. In these documents, 

OWCP informed appellant of her obligations to attend and cooperate with an OWCP-directed examination, and 

explained that her compensation benefits would be suspended under 5 U.S.C. § 8123(d) for failure to report to or 

cooperate with such an examination. Appellant contacted OWCP by telephone on July 2 and 6, 2020 indicating that, 

because of her underlying health conditions and the COVID-19 pandemic, she was uncomfortable attending the 

medical appointment. OWCP advised her to include the aforementioned information in writing, request that the 

examination be rescheduled, and accompany the request with supporting medical documentation. Despite appellant’s 

failure to attend the appointment with Dr. Barry, OWCP arranged for appellant to be examined by Dr. Hanley on 

August 17, 2020. 
3

failure, without good cause, to attend medical examinations scheduled for July 20 and 

August 17, 2020.

On August 28, 2020 appellant requested review of the written record by a representative 

of OWCP’s Branch of Hearings and Review. 

Following the August 18, 2020 suspension decision, appellant attended a second opinion 

examination with Dr. Barry on September 14, 2020 in order for OWCP to determine the extent 

and degree of any employment-related disability or residuals causally related to her accepted 

July 1, 2019 employment injury. OWCP provided Dr. Barry with a statement of accepted facts 

(SOAF) and a series of questions. It requested that he provide an opinion regarding whether 

appellant had continuing disability or residuals causally related to her July 1, 2019 employment 

injury, i.e., a left knee contusion. In a report dated September 14, 2020, Dr. Barry discussed 

appellant’s factual and medical history and reported the findings of his physical examination. He

reported that there was no antalgia, tenderness, and soft tissue swelling in appellant’s left knee.

Dr. Barry determined that her left knee contusion had resolved with no residuals. He found that 

the medical evidence did not support any additional diagnoses as being related to the accepted 

July 1, 2019 employment injury by direct cause, aggravation, acceleration, or precipitation.

Dr. Barry found that appellant did not have any work restrictions with respect to the left knee. In 

a work capacity evaluation (Form OWCP-5c) dated September 14, 2020, he indicated that she did 

not have any work restrictions.

By decision dated December 29, 2020, an OWCP hearing representative affirmed the 

August 18, 2020 suspension decision. 

OWCP then requested that Dr. Barry provide a supplemental report regarding the question 

of whether appellant had continuing disability or residuals causally related to her July 1, 2019 

employment injury. In a January 13, 2021 supplemental report, Dr. Barry indicated that 

appellant’s completely normal physical examination on September 14, 2020 without any objective 

pathologic findings on examination was the reason that he had opined that the accepted left knee 

condition had resolved and that she no longer suffered from residuals of the accepted July 1, 2019

employment injury. He advised that his opinion was based on his review of the medical records, 

the history provided by appellant, and the objective findings on physical examination. 

In a notice dated February 4, 2021, OWCP proposed to terminate appellant’s wage-loss 

compensation and medical benefits because she no longer had disability or residuals causally 

related to her accepted July 1, 2019 employment injury. It found that the weight of the medical 

opinion evidence regarding work-related disability and residuals rested with Dr. Barry’s opinion. 

OWCP afforded appellant 30 days to submit evidence or argument in writing if she disagreed with 

the proposed termination. Appellant did not submit any evidence or argument within the afforded

period.

By decision dated March 10, 2021, OWCP terminated appellant’s wage-loss compensation 

and medical benefits, effective March 28, 2021, because she no longer had disability or residuals 

causally related to her accepted July 1, 2019 employment injury.
4

On March 16, 2021 appellant requested reconsideration of the March 10, 2021 decision on

an appeal request form. She did not submit any evidence or argument in support of her 

reconsideration request. By decision dated March 19, 2021, OWCP denied appellant’s request for 

reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a).

In a federal employee’s health benefits information and certification form dated June 30, 

2020, appellant changed her health insurance enrollment code from 131 to 104 effective 

January 5, 2020.4 Payment documents in the case record show the amount of premiums deducted 

from FECA compensation commencing January 5, 2020 for health benefits insurance (HBI); basic 

life insurance (BLI), and optional life insurance (OLI). OWCP was not notified of this enrollment 

change until April 8, 2021, the date that it received this form. The case record also contains an 

Office of Personnel Management (OPM) form, signed by appellant on February 28, 2021, in which 

she elected to receive Federal Employees Retirement System (FERS) benefits in lieu of FECA 

benefits effective February 28, 2021.

In a preliminary overpayment determination dated April 15, 2021, OWCP notified 

appellant of its preliminary finding that she had received an overpayment of compensation in the 

amount of $2,416.38, for the period January 5, 2020 through February 27, 2021, because HBI, 

BLI, and OLI premiums had not been properly deducted from her compensation payments. It 

noted that, in a federal employees’ health benefits information and certification form dated 

June 30, 2020, she changed her health insurance enrollment code from 131 to 104 effective 

January 5, 2020. OWCP explained that health insurance benefit code 104 was more expensive 

than health insurance benefit code 131 and that it should have deducted BLI and OLI premiums 

based on a total annual base salary of $57,510.00, which included base pay and locality pay rate. 

However, it instead calculated BLI and OLI premiums based on an annual base salary of 

$44,471.00. OWCP noted that, based on these facts, it calculated a $2,416.38 overpayment.5

OWCP also preliminary determined that appellant was without fault in the creation of the 

overpayment. It provided her with an overpayment action request form and notified her that, 

within 30 days of the date of the letter, she could request a final decision based on the written 

evidence, or a prerecoupment hearing. OWCP also advised appellant that she could submit 

evidence challenging the fact, amount, or finding of fault, and request waiver of recovery of the 

overpayment. It requested that she complete and return a financial information questionnaire 

(Form OWCP-20) within 30 days. OWCP also requested that appellant submit supporting 

financial documentation, including copies of income tax returns, bank account statements, bills, 

pay slips, and any other records to support income and expenses. It advised her that it would deny 

waiver of recovery of the overpayment if she failed to furnish the requested financial information 

4

In section 10 of a claim for compensation (Form CA-7) dated October 11, 2019, the employing establishment had 

confirmed that appellant was enrolled in the Federal Employees Health Benefits (FEHB) program under code 131.

5 OWCP provided payment records and worksheets detailing the above-noted overpayment calculation. For the 

period January 5, 2020 through February 27, 2021, it deducted HBI premiums of $1,594.20 (instead of the proper 

amount of $3,533.46); BLI premiums of $217.35 (instead of $270.00); and OLI premiums of $791.16 (instead of 

$945.60). The difference between the amounts that were deducted and the amounts that should have been deducted 

is $2,416.38. 
5

within 30 days. Appellant did not respond to the preliminary overpayment determination within 

the afforded period.

By decision dated May 17, 2021, OWCP finalized its overpayment determination that 

appellant had received a $2,416.38 overpayment of compensation. It found that she was without 

fault in the creation of the overpayment, but that the overpayment was not subject to waiver

because she failed to provide the requested financial information.

6

LEGAL PRECEDENT -- ISSUE 1

Section 8123 of FECA authorizes OWCP to require an employee, who claims disability as 

a result of federal employment, to undergo a physical examination as it deems necessary.7 The 

determination of the need for an examination, the type of examination, the choice of locale, and 

the choice of medical examiners are matters within the province and discretion of OWCP.8 

OWCP’s regulations provide that a claimant must submit to an examination by a qualified 

physician as often and at such times and places as OWCP considers reasonably necessary.9 Section 

8123(d) of FECA and OWCP regulations provide that, if an employee refuses to submit to or 

obstructs a directed medical examination, his or her right to compensation is suspended until the 

refusal or obstruction ceases.10 OWCP’s procedures provide that, before OWCP may invoke these 

provisions, the employee is to be provided a period of 14 days within which to present in writing 

his or her reasons for the refusal or obstruction.11 If good cause for the refusal or obstruction is 

not established, entitlement to compensation is suspended in accordance with section 8123(d) of 

FECA.12

ANALYSIS -- ISSUE 1

The Board finds that OWCP properly suspended appellant’s wage-loss compensation and 

medical benefits pursuant to 5 U.S.C. § 8123(d), effective September 13, 2020, due to her failure 

to attend scheduled medical examinations. OWCP notified appellant that she was being referred 

for a second opinion examination on July 20 and August 17, 2020 with Dr. Barry and Dr. Hanley, 

respectively, to determine the status of her accepted employment-related conditions. The letters

6 With respect to the recovery of an overpayment, the Board’s jurisdiction is limited to those cases where OWCP 

seeks recovery from continuing compensation benefits. A.B., Docket No. 18-0915 (issued October 24, 2018); 

Miguel A. Muniz, 54 ECAB 217 (2002). As appellant was not in receipt of continuing compensation at the time of 

OWCP’s overpayment determination, the Board does not have jurisdiction over the method of recovery of the 

overpayment in this case. See Lorenzo Rodriguez, 51 ECAB 295 (2000); 20 C.F.R. § 10.441.

7 5 U.S.C. § 8123.

8 L.B., Docket No. 17-1891 (issued December 11, 2018); J.T., 59 ECAB 293 (2008).

9 20 C.F.R. § 10.320.

10 5 U.S.C. § 8123(d); see also 20 C.F.R. § 10.323; D.K., Docket No. 18-0217 (issued June 27, 2018).

11 Federal (FECA) Procedure Manual, Part 2 -- Claims, Developing and Evaluating Medical Evidence, Chapter 

2.810.13d (September 2010).

12 Id. at Chapter 2.810.13e.
6

also contained the date, time, and location of appellant’s appointment. OWCP informed appellant 

of her obligations to attend and cooperate with an OWCP-directed examination and explained that 

her compensation benefits would be suspended, pursuant to 5 U.S.C. § 8123(d), for failure to 

report to or cooperate with such an examination. 

Absent evidence to the contrary, a letter properly addressed and mailed in the ordinary 

course of business is presumed to have been received. This is known as the mailbox rule.13 In the 

present case, the referral documents were sent to appellant’s address of record and are presumed 

to have been received by her absent any notice of nondelivery. Appellant has not submitted 

evidence to rebut this presumption.

Appellant did not appear for either the July 20, 2020 or August 17, 2020 appointments.

With regard to the July 20, 2020 scheduled appointment with Dr. Barry, appellant contacted 

OWCP by telephone on July 2 and 6, 2020 indicating that, because of her underlying health 

conditions and the COVID-19 pandemic, she was uncomfortable attending the medical 

appointment. Although OWCP advised appellant to include the aforementioned information in 

writing, request that the examination be rescheduled, and accompany the request with supporting 

medical documentation, she did not do so. The Board finds that appellant did not provide good 

cause for her failure to attend the scheduled examination.14 

With regard to the August 17, 2020 appointment, appellant contacted OWCP on 

August 17, 2020 at 2:16 p.m. to advise that she would not be attending the appointment scheduled

with Dr. Hanley at 2:30 on that date because the person who offered to provide her transportation 

had cancelled. However, she did not provide good cause for her failure to appear in that she did 

not submit evidence showing that she was unable to get to the appointment using alternative

transportation. Appellant generally asserted that there were “no taxi services in her area or public 

transportation,” but she did not provide support for this assertion.15 

As appellant did not attend the examinations as scheduled and failed to provide good cause 

for failing to appear, the Board finds that OWCP properly suspended her wage-loss compensation 

and medical benefits in accordance with 5 U.S.C. § 8123(d), effective September 13, 2020.

16

LEGAL PRECEDENT -- ISSUE 2

Once OWCP accepts a claim and pays compensation, it has the burden of proof to justify 

termination or modification of an employee’s benefits.17 After it has determined that, an employee 

13 See R.D., Docket No. 20-1551 (issued November 8, 2021); James A. Gray, 54 ECAB 277 (2002).

14 See B.C., Docket No. 21-1327 (issued January 31, 2023); G.R., Docket No. 20-0915 (issued January 29, 2021).

15 See R.H., Docket No. 09-1195 (issued February 25, 2010) (claimant asserted he could not attend an OWCPdirected appointment because he could not drive, but his compensation was suspended as he failed to submit evidence 

showing that he was unable to get to the appointment using public transportation).

16 See G.R., Docket No. 20-0915 (issued January 29, 2021).

17 D.G., Docket No. 19-1259 (issued January 29, 2020); S.F., 59 ECAB 642 (2008); Kelly Y. Simpson, 57 ECAB 

197 (2005); Paul L. Stewart, 54 ECAB 824 (2003).
7

has disability causally related to his or her federal employment, OWCP may not terminate 

compensation without establishing that the disability has ceased or that it is no longer related to 

the employment.18 Its burden of proof includes the necessity of furnishing rationalized medical 

opinion evidence based on a proper factual and medical background.19 The right to medical 

benefits for an accepted condition is not limited to the period of entitlement for disability 

compensation.20 To terminate authorization for medical treatment, OWCP must establish that 

appellant no longer has residuals of an employment-related condition, which require further 

medical treatment.21

ANALYSIS -- ISSUE 2

The Board finds that OWCP met its burden of proof to terminate appellant’s wage-loss 

compensation and medical benefits, effective March 28, 2021, because she no longer had disability 

or residuals causally related to her accepted July 1, 2019 employment injury.

The weight of the medical evidence is represented by the thorough, well-rationalized 

opinion of Dr. Barry, OWCP’s referral physician. The September 14, 2020 and January 13, 2021 

reports of Dr. Barry establish that appellant had no disability or residuals due to her accepted 

July 1, 2019 employment injury after March 28, 2021.

In his report dated September 14, 2020, Dr. Barry discussed appellant’s factual and 

medical history and reported the findings of his physical examination. He reported that there was 

no antalgia, tenderness, and soft tissue swelling in appellant’s left knee, and determined that her

left knee contusion had resolved with no residuals. Dr. Barry found that the medical evidence did 

not support any additional diagnoses as being related to the accepted July 1, 2019 employment 

injury by direct cause, aggravation, acceleration, or precipitation. He found that appellant did not 

have any work restrictions with respect to the left knee. In a work capacity evaluation dated 

September 14, 2020, Dr. Barry indicated that she did not have any work restrictions. In a 

January 13, 2021 supplemental report, he noted that appellant’s completely normal physical 

examination on September 14, 2020 without any objective pathologic findings on examination was 

the reason that he had opined that the accepted left knee condition had resolved and that appellant 

no longer suffered from residuals of the accepted July 1, 2019 employment injury. Dr. Barry 

advised that his opinion was based on his review of the medical records, the history provided by 

appellant, and the objective findings on physical examination.

The Board has reviewed the opinion of Dr. Barry and finds that it has reliability, probative 

value and convincing quality with respect to its conclusions regarding the issue of continuing 

work-related disability and residuals. Dr. Barry provided a thorough factual and medical history 

18 See R.P., Docket No. 17-1133 (issued January 18, 2018); Jason C. Armstrong, 40 ECAB 907 (1989); Charles E. 

Minnis, 40 ECAB 708 (1989); Vivien L. Minor, 37 ECAB 541 (1986).

19 M.C., Docket No. 18-1374 (issued April 23, 2019); Del K. Rykert, 40 ECAB 284, 295-96 (1988).

20 A.G., Docket No. 19-0220 (issued August 1, 2019); A.P., Docket No. 08-1822 (issued August 5, 2009); T.P., 58 

ECAB 524 (2007); Kathryn E. Demarsh, 56 ECAB 677 (2005); Furman G. Peake, 41 ECAB 361, 364 (1990).

21 See A.G., id.; James F. Weikel, 54 ECAB 660 (2003); Pamela K. Guesford, 53 ECAB 727 (2002).
8

and accurately summarized the relevant medical evidence. He provided medical rationale for his 

opinion by explaining that appellant had no objective signs of the July 1, 2019 employment 

injury.

22

 Appellant did not submit any evidence or argument challenging the termination of her 

compensation. As there is no evidence of record that overcomes the weight accorded to Dr. Barry, 

the Board finds that OWCP has met its burden of proof.

LEGAL PRECEDENT -- ISSUE 3

Section 8128(a) of FECA vests OWCP with discretionary authority to determine whether 

to review an award for or against compensation. The Secretary of Labor may review an award for 

or against compensation at any time on his or her own motion or on application.23

To require OWCP to reopen a case for merit review pursuant to FECA, the claimant must 

provide evidence or an argument which: (1) shows that OWCP erroneously applied or interpreted 

a specific point of law; (2) advances a relevant legal argument not previously considered by 

OWCP; or (3) constitutes relevant and pertinent new evidence not previously considered by 

OWCP.24 A request for reconsideration must be received by OWCP within one year of the date 

of OWCP’s decision for which review is sought.25 If it chooses to grant reconsideration, it reopens 

and reviews the case on its merits.26 If the request is timely, but fails to meet at least one of the 

requirements for reconsideration, OWCP will deny the request for reconsideration without 

reopening the case for review on the merits.27

ANALYSIS -- ISSUE 3

The Board finds that OWCP properly denied appellant’s request for reconsideration of the 

merits of her claim pursuant to 5 U.S.C. § 8128(a).

On March 16, 2021 appellant timely requested reconsideration of OWCP’s March 10, 2021 

termination decision. She did not submit any evidence or argument in support of her 

22 See W.C., Docket No. 18-1386 (issued January 22, 2019); D.W., Docket No. 18-0123 (issued October 4, 2018); 

Melvina Jackson, 38 ECAB 443 (1987) (regarding the importance, when assessing medical evidence, of such factors 

as a physician’s knowledge of the facts and medical history, and the care of analysis manifested and the medical 

rationale expressed in support of the physician’s opinion).

23 5 U.S.C. § 8128(a); see L.D., Docket No. 18-1468 (issued February 11, 2019); V.P., Docket No. 17-1287 (issued 

October 10, 2017); D.L., Docket No. 09-1549 (issued February 23, 2010); W.C., 59 ECAB 372 (2008).

24 20 C.F.R. § 10.606(b)(3); see M.S., Docket No. 18-1041 (issued October 25, 2018); L.G., Docket No. 09-1517 

(issued March 3, 2010); C.N., Docket No. 08-1569 (issued December 9, 2008).

25 20 C.F.R. § 10.607(a). The one-year period begins on the next day after the date of the original contested 

decision. Federal (FECA) Procedure Manual, Part 2 -- Claims, Reconsiderations, Chapter 2.1602.4 (September 2020). 

Timeliness is determined by the document receipt date of the request for reconsideration as indicated by the received 

date in the Integrated Federal Employees’ Compensation System (iFECS). Id. at Chapter 2.1602.4b.

26 Id. at § 10.608(a); see D.C., Docket No. 19-0873 (issued January 27, 2020); M.S., 59 ECAB 231 (2007).

27 Id. at § 10.608(b); see T.V., Docket No. 19-1504 (issued January 23, 2020); E.R., Docket No. 09-1655 (issued 

March 18, 2010).
9

reconsideration request. By decision dated March 19, 2021, OWCP denied appellant’s request for 

reconsideration of the merits of her claim, pursuant to 5 U.S.C. § 8128(a). 

As appellant did not submit any argument in support of her reconsideration request, the 

Board finds that she did not establish that OWCP erroneously applied or interpreted a specific 

point of law, or advance a relevant legal argument not previously considered by OWCP. As she 

did not submit any evidence, the Board finds that she did not submit relevant and pertinent new 

evidence not previously considered by OWCP. Consequently, appellant is not entitled to a review 

of the merits based on the first, second, and third requirements under 20 C.F.R. § 10.606(b)(3).

The Board, therefore, finds that appellant has not met any of the requirements under 20 

C.F.R. § 10.606(b)(3). Pursuant to 20 C.F.R. § 10.608, OWCP properly denied merit review.28

LEGAL PRECEDENT -- ISSUE 4

FECA provides that the United States shall pay compensation for the disability or death of 

an employee resulting from personal injury sustained while in the performance of duty.29 When 

an overpayment has been made to an individual because of an error of fact or law, adjustment shall 

be made under regulations prescribed by the Secretary of Labor by decreasing later payments to 

which the individual is entitled.30

An employee entitled to disability compensation may continue his or her health benefits 

under the FEHB program. OPM, which administers the FEHB program, by regulation provides 

guidelines for the registration, enrollment, and continuation of enrollment for federal employees. 

In this connection, 5 C.F.R. § 890.502(a)(1) provides that an employee or annuitant is responsible 

for payment of the employee’s share of the cost of enrollment for every pay period during which 

the enrollment continues. In each pay period for which health benefits withholdings or direct 

premium payments are not made, but during which the enrollment of an employee or annuitant 

continues, he or she incurs an indebtedness to the United States in the amount of the proper 

employee withholding required for that pay period.31 The Board has recognized that, when an 

underwithholding of health benefit premiums is discovered, the entire amount is deemed an 

overpayment of compensation because OWCP must pay the full premium to OPM when the error 

is discovered.32

Under the Federal Employees’ Group Life Insurance (FEGLI) program, most civilian 

employees of the Federal Government are eligible to participate in BLI and one or more of the 

28 See supra notes 24 and 27.

29 5 U.S.C. § 8102(a).

30 20 C.F.R. §§ 10.434-10.437; J.L., Docket No. 18-0212 (issued June 8, 2018).

31 Id. at § 890.502(a)1).

32 R.M., Docket No. 19-0183 (issued November 18, 2019); James Lloyd Otte, 48 ECAB 334 (1997).
10

forms of OLI.33 The coverage for BLI is effective unless waived,34 and premiums for BLI and 

OLI coverage are withheld from the employee’s pay.35 Upon retirement or upon separation from 

the employing establishment or being placed on the FECA periodic compensation rolls, an 

employee may choose to continue BLI and OLI coverage in which case the schedule of deductions 

made will be used to withhold premiums from his or her annuity or compensation payments.36 

BLI coverage shall be continued without cost to an employee who retired or began receiving 

compensation on or before December 31, 1989.37 However, the employee is responsible for 

payment of premiums for OLI coverage which is accomplished by authorizing withholdings from 

his or her compensation.38

A 1980 amendment of 5 U.S.C. § 8706(b)(2) provided that an employee receiving 

compensation under FECA could elect continuous withholdings from his or her compensation, so 

that his or her life insurance coverage could be continued without reduction. 5 C.F.R. § 870.701 

(December 5, 1980) provided that an eligible employee had the option of choosing no life 

insurance; Option A -- basic coverage (at no additional cost) subject to continuous withholdings 

from compensation payments that would be reduced by two percent a month after age 65 with a 

maximum reduction of 75 percent; Option B -- basic coverage (at an additional premium) subject 

to continuous withholdings from compensation payments that would be reduced by one percent a 

month after age 65 with a maximum reduction of 50 percent; or Option C -- basic coverage subject 

to continuous withholdings from compensation payments with no reductions after age 65 (at a 

greater premium).39

Each employee must elect or waive Option A, Option B, and Option C coverage, in a 

manner designated by OPM, within 60 days after becoming eligible unless, during earlier 

employment, he or she filed an election or waiver that remains in effect.40 Any employee who 

does not file a Life Insurance Election with his or her employing office, in a manner designated by 

OPM, specifically electing any type of optional insurance, is considered to have waived it and does 

not have that type of optional insurance.41 When an underwithholding of life insurance premiums 

33 5 U.S.C. § 8702(a); I.J., Docket No. 1672 (issued March 10, 2020).

34 5 U.S.C. § 8702(b).

35 Id. at § 8707.

36 Id. at § 8706.

37 Id. at § 8707(b)(2).

38 Id. at § 8706(b)(3)(B). See B.B., Docket No. 17-1733 (issued March 26, 2018); S.B., Docket No. 16-1795 (issued 

March 2, 2017).

39 G.L., Docket No. 19-0297 (issued October 23, 2019); James J. Conway, Docket No. 04-2047 (issued 

May 20, 2005).

40 5 C.F.R. § 870.504(a)(1).

41 Id. at § 870.504(b).
11

occurs, the entire amount is deemed an overpayment of compensation because OWCP must pay 

the full premium to OPM upon discovery of the error.42

ANALYSIS -- ISSUE 4

The Board finds that appellant received an overpayment of compensation in the amount of 

$2,416.38 for the period January 5, 2020 through February 27, 2021, for which she was not at 

fault, resulting from failure to deduct appropriate health and life insurance premiums. 

In a preliminary overpayment determination dated April 15, 2021, OWCP notified 

appellant of its preliminary finding that she received an overpayment of compensation in the 

amount of $2,416.38 because HBI, BLI, and OLI premiums had not been properly deducted from 

her compensation payments for the period January 5, 2020 through February 27, 2021. It noted 

that, in a federal employees health benefits information and certification form dated June 30, 2020, 

appellant changed her health insurance enrollment code from 131 to 104 effective January 5, 2020. 

OWCP explained that health insurance benefit code 104 was more expensive than health insurance 

benefit code 131 and that OWCP should have deducted BLI and OLI premiums based on a total 

annual base salary of $57,510.00, which included base pay and locality pay rate. However, it

instead calculated BLI and OLI premiums based on an annual base salary of $44,471.00. OWCP

provided payment documents and worksheets explaining how it calculated the $2,416.38 

overpayment.

43

 As noted, when an underwithholding of health insurance or life insurance 

premiums occurs, the entire amount is deemed an overpayment of compensation because OWCP 

must pay the full premium to OPM upon discovery of the error.44 

The Board notes that OWCP properly calculated the amount of the overpayment and 

provided a clear and detailed explanation of the fact and amount of the overpayment. As OWCP 

failed to properly deduct HBI, BLI, and OLI premiums from January 5, 2020 through February 27, 

2021, appellant received an overpayment of compensation of $2,416.38 during this period.45

LEGAL PRECEDENT -- ISSUE 5

Section 8129 of FECA provides that an overpayment in compensation shall be recovered 

by OWCP unless incorrect payment has been made to an individual who is without fault and when 

adjustment or recovery would defeat the purpose of FECA or would be against equity and good 

42 Id. at § 8707(d).

43 OWCP provided payment records and worksheets detailing the above-noted overpayment calculation. For the 

period January 5, 2020 through February 27, 2021, OWCP deducted HBI premiums of $1,594.20 (instead of the 

proper amount of $3,533.46); BLI premiums of $217.35 (instead of $270.00); and OLI premiums of $791.16 (instead 

of $945.60). The difference between the amounts that were deducted and the amounts that should have been deducted 

is $2,416.38. 

44 See supra notes 32 and 42.

45 See J.C., Docket No. 17-1791 (issued February 23, 2018); E.H., Docket No. 15-0848 (issued July 6, 2016); V.B.,

Docket No. 15-0157 (issued March 16, 2015).
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conscience.46 Section 10.438 of OWCP’s regulations provides that the individual who received 

the overpayment is responsible for providing information about income, expenses, and assets as 

specified by OWCP. This information is needed to determine whether or not recovery of an 

overpayment would defeat the purpose of FECA or be against equity and good conscience. Failure 

to submit the requested information within 30 days of the request shall result in denial of waiver.47

ANALYSIS -- ISSUE 5

The Board finds that OWCP properly denied waiver of recovery of the overpayment.

As OWCP found appellant without fault in the creation of the overpayment, waiver must 

be considered, and repayment is still required unless adjustment or recovery of the overpayment 

would defeat the purpose of FECA or be against equity and good conscience.48 Appellant, 

however, had the responsibility to provide supporting financial information and documentation to 

OWCP.49

In its preliminary overpayment determination dated April 15, 2021, OWCP explained the 

importance of providing the completed overpayment recovery questionnaire and supporting 

financial documentation, including copies of income tax returns, bank account statements, bills, 

pay slips, and any other records to support appellant’s reported income and expenses. It advised 

her that it would deny waiver of recovery if she failed to furnish the requested financial information 

within 30 days. Appellant, however, did not submit sufficient financial documentation necessary 

for OWCP to determine if recovery of the overpayment would defeat the purpose of FECA or if 

recovery would be against equity and good conscience. She did not complete the Form OWCP20 outlining her income, assets, and expenses. The evidence of record is, therefore, insufficient to 

establish that recovery of the overpayment would defeat the purpose of FECA or be against equity 

and good conscience.50

Consequently, as appellant did not submit the information required under 20 C.F.R. 

§ 10.438 of OWCP’s regulations, OWCP properly denied waiver of recovery of the 

overpayment.51

CONCLUSION

The Board finds that OWCP properly suspended appellant’s wage-loss compensation and 

medical benefits pursuant to 5 U.S.C. § 8123(d), effective September 13, 2020, due to her failure 

to attend scheduled medical examinations. The Board further finds that OWCP properly 

46 5 U.S.C. § 8129.

47 20 C.F.R. § 10.438.

48 Id. at § 10.436.

49 Supra note 47.

50 Supra note 48.

51 See T.E., Docket No. 19-0348 (issued December 11, 2019).
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terminated appellant’s wage-loss compensation and medical benefits, effective March 28, 2021, 

and that it properly denied her request for reconsideration of the merits of her claim, pursuant to 

5 U.S.C. § 8128(a). The Board also finds that appellant received an overpayment of compensation 

in the amount of $2,416.38 for the period January 5, 2020 through February 27, 2021, for which 

she was not at fault, resulting from failure to deduct appropriate health and life insurance 

premiums, and that OWCP properly denied waiver of recovery of the overpayment.

ORDER

IT IS HEREBY ORDERED THAT December 29, 2020, and March 10 and 19, and 

May 17, 2021 decisions of the Office of Workers’ Compensation Programs are affirmed.

Issued: February 17, 2023

Washington, DC

Janice B. Askin, Judge

Employees’ Compensation Appeals Board

Valerie D. Evans-Harrell, Alternate Judge

Employees’ Compensation Appeals Board

James D. McGinley, Alternate Judge

Employees’ Compensation Appeals Board