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New Claim or Recurrence Claim

If a federal worker, who has an accepted workers’ compensation claim, suffers another similar injury on the job, he may face a difficult decision. He can submit a claim for a new injury or submit a notice of recurrence of the injury previously accepted by OWCP.

The situation often arises when a worker returns to work following a period of disability and finds he must stop work because of medical reasons. The question then is which claim a claims examiner will most likely approve—a form CA-1 for a new traumatic injury or a CA-2 for a new occupational disease or a CA-2a for a recurrence.

A recurrence claim is when a medical condition, from a previous injury or occupational illness, undergoes a material worsening without an intervening injury or a renewed exposure to the work environment that caused the original illness. (However, a stress claim always requires a new claim.) A recurrence claim can also be when an accepted consequential injury condition acts up and forces a claimant off work. A recurrence claim is straightforward when the employer withdraws its light work accommodation for the injured worker.

I always advise clients not to stop work without a good report from a doctor that states the medical condition has objectively worsened to the point that the patient can’t continue on the job. OWCP will not pay wage-loss compensation if it decides a claimant stopped work without good medical reasons. OWCP does not view fear of re-injury and increased pain as good reasons to stop work.

Over the years I’ve had to determine whether a new claim or a recurrence claim is appropriate in a particular case. I most often come down on the practical side and suggest to the injured worker that he submit a new claim. I tend to follow this approach even if the new injury is actually an aggravation of the original work injury.

The reason is that with a new claim, a claimant need not worry about the existence of objective medical evidence specifically showing a worsening of the original injury. The claimant only needs to establish that an injury has occurred in the performance of duty and that the injury is recorded by the employer and supported by medical documentation.

Simply, my experience is that OWCP denies recurrence claims more readily than new claims.

Of course, the facts of each case will rule the best approach. Do not use the above discussion solely to make a choice between a new or recurrence claim. But keep in mind the following: do not to stop work with the thought of filing a recurrence claim unless you are sure your doctor can document that your work-related condition has worsened and that you must stop work.

March 2010

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