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Recurrence of Disablity (Not re-occurrence)

A recurrence of disability is defined as a spontaneous return or increase of disability due to a previous injury or occupational disease without intervening cause, or a return or increase of disability due to a consequential injury (defined in Chapter 3-5). A recurrence of disability differs from a new injury in that with a recurrence, no event other than the previous injury accounts for the disability.

A recurrence of medical condition is defined as a documented need for further medical treatment after release from treatment for the accepted condition or injury when there is no accompanying work stoppage. Continuous treatment for the original condition or injury is not considered a "need for further medical treatment after release from treatment," nor is an examination without treatment.

In other words, follow-up medical care for an injury or disease, which causes time loss, is considered part of the original injury rather than a recurrence unless the employee was previously released from treatment.

If your condition has not improved since the "original injury" and there is nothing but the "original injury" to blame for your condition, it is a recurrence. If your pain worsens after performing a particular action such as lifting or pulling then it may be a new injury requiring a CA1.

A Recurrence of Disability is a work stoppage caused by one of the following:

  • a spontaneous return of the symptoms of a previous injury or occupational disease without intervening cause;
  • a return or increase of disability due to a consequential injury (defined as one which occurs due to weakness or impairment caused by a work-related injury);
  • withdrawal of a specific light duty assignment when the employee cannot perform the full duties of the regular position. This withdrawal must have occurred for reasons other than misconduct or non-performance of job duties.

    IF A NEW INJURY OR EXPOSURE TO THE CAUSE OF AN OCCUPATIONAL ILLNESS OCCURS, AND DISABILITY OR THE NEED FOR MEDICAL CARE RESULTS, A NEW FORM CA-1 OR CA-2 SHOULD BE FILED. This is true even if the new incident involves the same part of the body as previously affected.

    What Do You Do?

    Your supervisor is obligated to provide you with the necessary forms if you choose to file a claim. S/he is also obligated to process these forms in a timely manner.

    First, if a recurrence of disability develops, the employee and supervisor should complete Form CA-2a and submit it to OWCP. The employee may elect to use sick or annual leave pending adjudication of the claim for recurrence.

    Second, The employee should arrange for submittal of the factual and medical evidence described in the instructions attached to form CA-2a, paying particular attention to the need for "bridging" information which describes his or her condition and job duties between the original injury and the recurrence.

    Ordinarily, no medical treatment is authorized at OWCP expense until a claim for recurrence is accepted. At its discretion the district office may, however, authorize an emergency medical examination.

    Continuing Claim for Wage Loss--Form CA 7. Form CA 7 and CA 7a must be used to file a claim for continuing compensation due to a recurrence. During the period of disability, a new Form CA 7 and CA 7a should be submitted every two weeks, unless otherwise instructed.

    Documentation

    Arrange for your attending physician to submit a detailed medical report. The report should include: dates of examination and treatment; history as given by you; findings; results of x-ray and laboratory tests; diagnosis; course of treatment; and the treatment plan. The physician must also provide an opinion, with medical reasons, regarding causal relationship between your condition and the original Injury. Finally, the physician should describe your ability to perform your regular duties. If you are disabled for your regular work, the physician should identify the dates of disability and provide work tolerance limitations.

    You are responsible for establishing the essential elements of the claim as described in Chapter 3 of CA-810. OWCP will help the employee to meet this responsibility, which is termed burden of proof, by requesting evidence needed to establish these elements if such information is not included with the original submittal.

    Keep in mind, when information is not submitted in a timely manner, delays in adjudicating cases and paying claims often result. To minimize such delays, OWCP will ask the employee and supervisor to submit the required evidence within a specific period, usually 30 days from the date of the request. A copy of any request to the supervisor for information will be sent to the employee, and vice versa.

    A recurrence of disability is probably the most misunderstood and difficult claim to file.

    General Forms: CA 2a and CA 7, CA 7a when claiming lost wages.

    Tip: Try to submit your claim and supporting documentation at the same time.

    Remember: You are responsible for your claim. NOT management; NOT the union. You must insure the accuracy of the information and must provide acceptable documentation.

    Management is responsible for providing and submitting forms. Unfortunately, management's knowledge of workman's comp issues is severely limited; so don't expect a lot of help from your supervisor. Keep records and copies of everything.