Presentation on theme: "FEDERAL INJURY COMPENSATION OVERVIEW How Does the Process Work"— Presentation transcript:
1 FEDERAL INJURY COMPENSATION OVERVIEW How Does the Process Work FEDERAL INJURY COMPENSATION OVERVIEW How Does the Process Work? How Does It All Fit Together?20 CFRDOLFECAOWCPAPWUINJUREDEMPLOYEEELM 540EL 505USPSPrepared by Human Relations Director Sue Carney
2 Message from APWU President Burrus and TABLE OF CONTENTSMessage from APWU President Burrus andHuman Relations Director Susan M. CarneyTOPIC SLIDE No.OWCP StatisticsWhat It’s All AboutWho’s Involved In The Claim ProcessResponsibilitiesImmediate SupervisorUSPS Injury Compensation SpecialistAssistance By APWUFive Basic Requirements For Successful ClaimTime LimitsCivilian EmployeeFact of InjuryPerformance of DutyCausal RelationshipCite Reference Chart: Five Basic Requirements
3 TABLE OF CONTENTS(continued)TOPIC SLIDE No.Types of ClaimsTraumatic Injury Definition (Form CA-1)Occupational Disease Definition (Form CA-2)Recurrence Definition (Form CA-2A)Cite Reference Chart: Three Types of ClaimsTraumatic InjuryForm CA-16 Authorization for Examination/TreatmentCite Reference Chart: Traumatic Injury (Form CA-16)Continuation Of Pay (COP)Cite Reference Chart: Traumatic Injury: COPControversion with COP WithheldCite Reference Chart: Traumatic Injury: COP WithheldStopping COP Which Has Already BegunCite Reference Chart: Traumatic Injury: COP StoppedClaim for Compensation (Forms CA-7, CA-20)Cite Reference Chart: Claim for CompensationLeave Buy Back (Form CA-7b)Cite Reference Chart: Leave Buy Back (CA-7b)
4 TABLE OF CONTENTS(continued)TOPIC SLIDE No.Return To Work CapabilityMedical RestrictionsCite Reference Chart: Return to Work Capability (Medical Restrictions)Job Offers (Limited Duty/Rehab)Cite Reference Chart: Job OffersRights and BenefitsSelection of PhysicianPostal Physician or Contract EquivalentUSPS May Require Medical ExaminationPhysician Changes & ReferralsCite Reference Chart: Selection of PhysicianProviding Supporting EvidenceEmployee’s StatementMedical ReportsSample Medical Report Traumatic InjurySample Medical Report Occupational DiseaseOWCP Criteria For Evaluating Medical ReportsOWCP Directed Medical ExamsSecond OpinionsReferee Specialist
5 TABLE OF CONTENTS(continued)TOPIC SLIDE No.Postal Service: Fitness for DutyMedical PrivacySchedule AwardCite Reference: Schedule AwardChallenging Formal OWCP DecisionsOral HearingReview of the Written RecordReconsiderationReview by ECABDefinitionsWork Limitation Due To PainSeparation DisabilityDisability RetirementMedical Bill Payment and Medical Authorization Process
6 TABLE OF CONTENTS(continued)TOPIC SLIDE No.OWCP InformationFederal Employees Compensation Act (FECA), Title 5, Chapter 81Code of Federal Regulations, Claims for Compensation under FECA, Parts 10 and 25Questions and Answers About FECA, CA 550Injury Compensation for Federal Employees, CA 810When Injured at Work, Guide for Federal Employees, CA 11OWCP FormsOWCP- Information (Handbooks and Manuals)U.S. Dep’t of Labor, Self-Instructional Injury Compensation Specialist Training VideoELM 540, Injury Compensation ProgramEL 505, Injury CompensationLetters, MOUS, and Step 4 DecisionsLetters:Letter from USPS Labor Relations At Headquarters—Services Policy for Employeesthat Sustained On-the-job injuries A1USPS Sample Letter—Limited Duty Assignments and MOU from Headquarters. A2Letter from USPS Labor Relations—Local Management . . .Limited Duty A6Letter from USPS Labor Relations—Use of Medical Reports A9Letter from USPS. Management’s Discrimination of limited duty vs.light duty assignments A14Letter from USPS Labor Relations Discipline for Safety Rule Violation A27
7 TABLE OF CONTENTS(continued)TOPIC SLIDE No.National Pre-Arb Settlement:Limited Duty Assignments A3Limited Duty FTRE with varying report times A5Job Related First Aid Injuries A8Step 4 Decisions:Separation from Postal Service for reasons of disability A4Reporting an accident A7Fitness for duty on-the-job injury or illness A10Availability of CA-8 Forms A11Limited Duty—Violation of ELM Provisions A12Locally developed form supplementing data on Form A15Use of Locally generated forms A16Outside party paying medical expenses compensation forms A17Employee can’t be compelled during non-working hours A18Light duty/limited duty signing Overtime Desired List A19Completing form 2488 is voluntary (employee) A20CA17 usually adequate for medical information A21Completing PS Form 3971, Continuation of Pay (COP) A22Limited Duty Employee Coverage by CBR A23
8 TABLE OF CONTENTS(continued)TOPIC SLIDE No.Step 4 Decisions (continued):Agreement Violation of Permanently Reassigned Work in another craft A24Removal from bid while on Limited Duty A25Limited Duty Withdrawal with subsequent Notice of Proposed Removal A26MOUs:(NALC) Limited Duty Grievance Representation A13
9 OFFICE OF WORKERS’ COMPENSATION (OWCP) STATISTICS Approximately 175,000 Workers’ Compensation ClaimsAre Filed Annually.Of These, 85,000 Are Filed By USPS Employees,Representing More than 10% Of The USPS Workforce.Generally, 90% Of Simple Traumatic Claims And60% Of Simple Occupational Claims Are Accepted.In 2003, These Claims Cost The USPS Over $1.5 Billion.The Future Liability For These Employee Injuries IsAlmost $7 Billion.Prepared by Human Relations Director Sue Carney
10 WHAT IT’S ALL ABOUT? 10.0 541.1 Ch. 1 A-1 § 8149 Ch.1 Time LimitsFECA Q&AELMOWCP FormsFECA5 U.S.C 8120 CFRELMEL 505CA 550Q&A10.0541.1Ch. 1A-1§ 8149Ch.1Federal Employee Compensation Act (FECA)20 Code of Federal Regulations (CFR)Employee Labor Relations Manual (ELM)EL 505, Injury Compensation
11 WHO’S INVOLVED IN THE CLAIM PROCESS? Under The Department Of Labor, The Employment Standards Administration Oversees OWCP.Within OWCP, The Division Of Federal Employees’ Compensation (FEC) Decides Injury Claims. They Are The Determining Office.In The USPS, The Injury Compensation Specialist (ICS) Is Responsible For Sending Claims To OWCP. The USPS Injury Compensation Office And Their Representatives Are Not An Extension Of OWCP. They Are The Control Point And Have No Authority To Adjudicate Claims.The USPS Supervisor Forwards Claim Forms To The ICS.
12 RESPONSIBILITIES OF THE IMMEDIATE SUPERVISOR Immediately Ensuring That Appropriate Medical Care Is Provided.Form CA-1 (Traumatic), Or Form CA-2 (Occupational)Provide Form To Employee (Complete Receipt And Give To Employee).On The Same Day As Received, Complete And Forward Form CA-1 OrForm CA-2 To The ICS [ELM ].Permit Employee To Select A Physician/Hospital Of Choice [ELM ].If Traumatic Injury Prevents Employee From Working Must Advise EmployeeOf Right To Choose Continuation Of Pay (COP) [ELM ].Cannot Cause An Employee To Forgo Filing A Claim, Or Refuse To Process It[ELM ] .
13 RESPONSIBILITIES OF THE USPS INJURY COMPENSATION SPECIALIST Go SeeDr.Completes Employer Portions Of Forms CA-16 And CA-17.Advises Employee Whether Continuation Of Pay (COP) Will Be Controverted.Advises Employee If COP Will Not Be Paid.Provides Copy Of Completed CA-1, CA-2 Or CA-2a To Employee And CopyOf All Correspondence Between USPS And Employee’s Physician.[ELM ].Submits Form CA-1, CA-2, Or CA-2a To OWCP Within 10 Working Days. [ELM ].If Traumatic Injury (CA-1) Must Promptly Authorize Medical Care By IssuingEmployee Form CA-16 Within 4 Hours Of Receiving Notice Of Claimed Injury.[ELM ].
14 ASSISTANCE BY APWU Member And Non-Member: If Language Of Collective Bargaining Agreement (CBA) Or AHandbook Or Manual (e.g., ELM 540, EL 505) Has Been ViolatedBy The USPS Make Grievance Decision. Grievances Cannot BeFiled Against OWCP.Member Only:Provide Information About OWCP Procedures And Appeals.You Do Not Have To Be Employee’s “Authorized OWCPRepresentative” To Assist Them With Their Claim.
15 FIVE BASIC REQUIREMENTS FOR SUCCESSFUL CLAIM In The Order They Are Considered:Time LimitsCivilian EmployeeFact Of InjuryPerformance Of DutyCausal Relationship(continued)
16 FIVE BASIC REQUIREMENTS (continued) Time LimitsWritten Notice Must Be Given Within 3 Years Of Injury Or Onset Of Medical Condition.Latent (Not Evident) Disability—Must Be Given Within 3 Years Of Reasonably Knowing Condition Caused By Work Activity.Civilian EmployeeAll USPS Employees Including Casuals And TEs Are CivilianFederal Employees.(continued)
17 FIVE BASIC REQUIREMENTS (continued) Fact Of InjuryTwo Elements Must Be Met:Occurrence Of EventThe Employee Must Have Actually Experienced The Accident,Event Or Employment Factor.Determined On The Basis Of Factual Evidence, Including Statements From The Employee, The Supervisor, And Any Witnesses.An Injury Does Not Have To Be Witnessed To Be Compensable.(continued)
18 FIVE BASIC REQUIREMENTS: (continued)Fact Of InjuryExistence Of Medical ConditionThe Accident Or Employment Factor Resulted In An InjuryOr Disease. However, Employment Is Not Required To BeThe Sole Factor To Have Caused An Injury Or Disease,Only A Contributing Factor.Determined On The Basis Of The Attending Physician’s Statement That A Medical Condition Is Present ThatCould Be Related To The Incident Though The MedicalReport Does Not Have To Relate The Condition To TheIncident.Simple Exposure Does Not Constitute An Injury.(continued)
19 FIVE BASIC REQUIREMENTS (continued) Performance Of Duty Usually Injury/Illness Must Occur While At Work.Must Be Performing Expected Job Duties.Breaks And “Lunches” Covered If On Premises.For Most APWU Crafts Driving To And From WorkOrdinarily Not Covered.(continued)
20 FIVE BASIC REQUIREMENTS (continued) Causal Relationship Physician Must State To A “Reasonable Medical Certainty” That Work Activity Caused Or ContributedTo The Diagnosed Condition.Physician Must Provide Medical Reasoning (Rationale) To Support Opinion Of Causal Relationship (How Physician Came To The Conclusion That There IsA Causal Relationship Between The Injury And The Workplace).(continued)
21 FIVE BASIC REQUIREMENTS FECA5 USC20 CFRELMEL 505CA 550Q&A§812210.10010.101Exh. 4-6C-2§8101.(1)10.5(h)b.A-3C-3§8101.(5)10.115(c)c.C-4§8102.(a)10.115(d)dC-5toC-910.115(e)eC-10Time LimitsCivilian EmployeeFact Of InjuryPerformance Of DutyCausal Relationship
22 THREE TYPES OF CLAIMS: TRAUMATIC, OCCUPATIONAL, AND RECURRENCE Traumatic Injuries (Form CA-1) Go seeDr.A Medical Condition Caused By A Specific IncidentOr Series Of Incidents In A Single Work Day/Shift.Specific As To When And Where It Happened.Specific As To Part Of The Body Injured.Filed As Traumatic Not By Type Of Medical Condition,But Because Injury Happened On A Single Work Day/Shift.May Choose COP If Injury Reported On Form CA-1Within 30 Days Of The Injury.(continued)
23 THREE TYPES OF CLAIMS Traumatic Injury (continued) USPSComplete CA-1 To Give Notification.USPS Has Ten (10) Working Days To Submit CA-1To OWCP.COP – If Eligibility Requirements Are Met.CA-1 States Employer Statement And Physician’sMedical Report Are Required.Follow Instructions On CA-1 To Satisfy Requirements.(continued)
24 THREE TYPES OF CLAIMS (continued) Occupational Disease Or Illness (Form CA-2) Go seeDr.A Medical Condition Caused By Work Activity Occurring Over More Than A Single WorkDay/Shift.No Entitlement To COP Or Form CA-16.Filed As An Occupational Not By Type OfMedical Condition But Because It HappenedOver More Than One Work Day/Shift.(continued)
25 THREE TYPES OF CLAIMS (continued) Occupational Disease/Illness (Form CA-2) Complete CA-2 To Give Notification.USPS Has 10 Working Days To Submit CA-2 To OWCPNo COP Entitlement.File CA-7 For Wage Loss CompensationCA-16 (Issuance Very Rare. USPS May Issue OnlyAfter Obtaining Approval From OWCP).(continued)
26 THREE TYPES OF CLAIMS (continued) Recurrence (Form CA-2A) Go seeDr.Recurrence Of DisabilitySpontaneous Worsening Of An Accepted Condition WithoutAn Intervening Event.Worsening: Unable To Continue Working The Same AmountOf Hours After Returning To Work, e.g., 40 Hours To 30 Hours,Call-Out Due To Work-Related Injury.If Accepted Condition Is Worsened By Work Activity, File ANew Traumatic Or Occupational Claim. May Be Entitled ToCOP If Traumatic.(continued)
27 THREE TYPES OF CLAIMS Recurrence Go seeDr.Recurrence Of Disability (continued)USPS Withdrawal Of Limited Duty/Rehab Job.Any Reduction In Job Hours.Recurrence Of A Need For Medical TreatmentWith No Work Stoppage (Also Reopening A“Closed Claim”).If No Longer Seeing Physician But Need AdditionalMedical CareContinuous Treatment Is Not “Additional” TreatmentSimple Examination By Physician Is Not “Treatment”(continued)
28 THREE TYPES OF CLAIMS Recurrence (continued) Go seeDr.May Be Entitled To Any COP Balance If OriginalInjury Traumatic.Must Provide A Detailed Factual Statement (ComplyFully With Instructions On Form CA-2a).Medical Evidence Must Establish That The RecurrenceOf Inability To Work Is Causally Related To The OriginalAccepted Injury.After Returning To Work From Original Disability, OnlyOWCP Can Declare A Subsequent Absence Compensable,i.e., An “IOD”.(continued)
30 TRAUMATIC INJURY OWCP Form CA-16 “Authorization For Examination/Treatment” USPSIssued For Traumatic Injuries Requiring Medical Care.Authorizes Medical For 60 Days Unless OWCP Stops Authorization.Employee Chooses Physician.Must Be Issued To Employee Within 4 Hours Of Receiving Notice Of Claimed Injury (Within 48 Hours If Initial Authorization Is Verbal).Not Issued If More Than One Week From Injury Date.(continued)
31 TRAUMATIC INJURY OWCP Form CA-16 “Authorization For Examination/Treatment” (continued) USPSAuthorization Includes Subsequent Physicians When Original Physician Refers.Issuance Required Even If USPS Doubts Injury.Not Required For First Aid When Employee VoluntarilyAccepts Postal/Contract Physician (Maximum 2 Visits).Not Required For Simple Hazard Exposure WithoutMedical Condition.(continued)
32 TRAUMATIC INJURY OWCP FORM CA16 “Authorization For Examination/Treatment” USPSFECA5 USC20 CFRELMEL 505CA 550Q&A§8103(b)10.300(a)545.21Ch. 3.3B-1.(c.)10.300(c)E-2§8103(a)10.300(d)Ch. 3.10E-310.300(b)E-110.301543.310.30210.303(a)545.23Authorizes Medical Care60 Day MaximumEmployee Selects PhysicianWithin 4 HoursWithin One Week Of InjuryReferral To Different PhysicianUSPS Doubts InjuryFirst Aid By Postal/ContractHazard Exposure
33 TRAUMATIC INJURY Continuation Of Pay USPSCOP Is The Continuation Of Employee’s Regular Salary ForWage Loss Due To Disability And/Or Medical Treatment.It’s Intended To Eliminate Interruption Of The Employee’sIncome While OWCP Processes The Claim.It Includes N/D, S/P And Holiday Pay.COP Is Not Considered Compensation.Is Employer Paid.Is Subject To Deductions For Income Tax, Retirement, Etc.Employee Is In Pay Status.(continued)
34 TRAUMATIC INJURY Continuation Of Pay (continued) USPSNot Available For Occupational Injuries (Form CA-2).Must File CA-1 Within 30 Days Of Injury.Must Begin Losing Time From Work Within 45 Days Of Injury.Employee’s Choice To Use COP—Should Not Be Required To UseS/L Or A/L. If Unaware COP Was An Entitlement/ Choice, EmployeeHas One Year (From Date Of Use) To Request Adjustment.Must Provide Prima Fascia Medical Evidence Of Disability (InabilityTo Work) Within 10 Days Of When COP Begins In Order For COPTo Continue.45 Calendar Day Entitlement.Day Of Injury Not Counted As COP (Paid As Administrative Leave).(continued)
35 TRAUMATIC INJURY Continuation Of Pay (continued) USPSMust Begin Using Any Balance Of COP Within 45 Days Of First Return To Work (RTW)—RTW From Disability Not Date Of Injury.COP May Be Used Beyond 45 Day RTW Time Limit Provided Employee Begins Using COP Balance No Later Than The 45th Day From Their RTW And Disability Continues Without Interruption.If Disability Extends Beyond COP Period, File For Compensation.May Use COP For Medical Treatment/Examination Time. Employee Required To RTW To Complete Work Shift Unless Disabled.COP Is Counted By Days Not Hours. Partial Days Of COP Count As A Full Day Of COP.May Later Request COP After Using SL/AL Once Claim Is Approved.If OWCP Denies Claims COP Must Be Repaid (May Use SL/AL).
36 TRAUMATIC INJURY Continuation Of Pay USPSTRAUMATIC INJURY Continuation Of PayFECA5 USC20 CFRELMEL 505CA 550Q&A§8118(a)10.205(a)(1)aD-1(a)(2)bExh. 4.16D-4(f)10.205(a)(3)c541.2.dD-4(g)10.210(b)baCh. 13.1D-5a§8118(b)10.200(a)10.200(b)545.71Ch. 110.215(a)541.2.d (2)Ch. 13.410.224543.41ChNot For “Occupationals”File Within 30 DaysLose Time Within 45 DaysMedical Within 10 Days45 Day EntitlementDay Of Injury Not CountedRepayment(continued)
38 TRAUMATIC INJURY Controversion With COP Withheld Go seeDr.The USPS Can Controvert (Challenge, Dispute) AnOWCP Claim. However, OWCP Makes The FinalDecision As To Whether A Claim Is Accepted Or Denied.The USPS Can Controvert And Deny Payment OfCOP Only For The Following Reasons:The Disability Was Not Caused By A Traumatic Injury;The Employee Is Not A Citizen Of The U.S. Or Canada;No Written Claim Was Filed Within 30 Days From TheDate Of Injury;(continued)
39 TRAUMATIC INJURY: CONTROVERSION WITH COP WITHHELD (continued) Go seeDr.The Injury Was Not Reported Until After Employment Has Been Terminated;The Injury Occurred Off The Employing Agency’s Premises AndWas Not Otherwise Within The Performance Of Official Duties;The Injury Was Caused By The Employee’s Willful Misconduct,Intent To Injure Or Kill Himself/Herself Or Another Person, OrWas Proximately Caused By Intoxication By Alcohol Or IllegalDrugs;First Absence Caused By The Injury Was More Than 45 DaysAfter The Date Of Injury.(continued)
40 TRAUMATIC INJURY COP Withheld FECA5 USC20 CFRELMEL 505CA 550Q&A§8118(b)10.220(a)(a)Exh. 4.16D-4 (a)10.220(b)D-4 (c)10.220(c)(b)D-4 (f)10.220(d)(c)D-4 (h)10.220(e)(d)D-4 (d)10.220(f)(e)D-4 (e)10.220(g)(f)D-4 (g)Not A Traumatic InjuryNot A Citizen Of U.S.No Claim Within 30 DaysInjury Not Reported PriorTo Termination NoticeInjury Off Premises AndNot In Performance Of DutyWillful Misconduct, IntentTo Injure, IntoxicationFirst Absence More Than45 Days After Injury
41 TRAUMATIC INJURY Stopping COP Which Has Already Begun USPSAfter COP Has Been Started It May Be Stopped Only In The Following Circumstances:Medical Evidence Which On Its Face Supports Inability ToWork Due To The Workplace Injury Is Not Received Within10 Calendar Days After Claim Is Submitted;Medical Evidence From Employee’s Physician ShowsEmployee Not Disabled;Employee Not Totally Disabled And Employee RefusesWritten Job Offer That Is Approved By Employee’s Physician;(continued)
42 TRAUMATIC INJURY Stopping COP Which Has Already Begun (continued) USPSEmployee Returns To Work With No Loss Of Pay;Specific Term Of Employment Ends;Termination Of Employment Established Prior To Injury;OWCP Directs Employer To Stop COP;And/Or COP Paid For 45 Calendar Days.
43 TRAUMATIC INJURY COP Stopped FECA5 USC20 CFRELMEL 505CA 550Q&A10.222(a)(1)aExh. 4-16D-5 (a)10.222(a)(2)b10.222(a)(3)cD-5 (b)D-910.222(a)(4)d10.222(a)(5)eD-5(c)10.222(b)fD-610.222(a)(6)gExh. 4.1610.222(a)(7)hNo Medical Evidence Within 10 DaysMedical Evidence Shows No DisabilityMedical Evidence Shows Partial Disability And JobOffer RefusedEmployee Returns To Work With No Pay LossTerm Of Employment EndsTermination Of EmploymentOWCP Directs45 Days Paid
44 CLAIM FOR COMPENSATION (Form CA-7) (Form CA-20) Submit Form CA-7 To Supervisor Every Two WeeksAnd Send Form CA-20, “Attending Physician’s Report”To OWCP.Wage Loss Compensation Is Paid At Two-Thirds OfPay Rate If No Dependents And Three-Fourths If OneOr More Dependents.Compensation Is Based On Pay Rate On Day Of InjuryOr First Disability, Whichever Is Greater.(continued)
45 CLAIM FOR COMPENSATION (continued) Night Differential, Sunday Premium And Holiday PayAre Included In Pay Rate, But Overtime Is Excluded.Compensation Is Tax Free. The Only Deductions ArePremiums For Health Insurance And Optional Life Insurance.Payable After Three Day Wait (Non-Work Day, Non-Pay Status), But Waiting Period Waived If Total Disability Exceeds 14 Days.(continued)
46 CLAIM FOR COMPENSATION (continued) Postal Service Must Submit CA-7 To OWCP NotMore Than 5 Working Days After Receipt FromEmployee.An Employee Is In A Leave Without Pay (LWOP)Status When Receiving Wage Loss CompensationFrom OWCP.Employees In A LWOP Status For Any Reason DoNot Accrue Sick Or Annual Leave Nor Can TheyParticipate In The Thrift Savings Plan.(continued)
47 CLAIM FOR COMPENSATION (continued) Time Spent In A LWOP Status For Purpose OfReceiving OWCP Compensation Is Computed AsCreditable Service For Retirement.Once Pay Rate For Compensation Is EstablishedIt Does Not Change (No Negotiated COLAs OrRaises), Unless Employee Returns To WorkFor More Than 6 Months Of Regular Full TimeEmployment .(continued)
48 CLAIM FOR COMPENSATION FECA5 USC20 CFRELMEL 505CA 550Q&A10.102(b)(1)545.82§8105§811010.401(b)Ch.1F-9§811410.5(s)541.2.i§8114(e)F-14F-28G-110.401(a)545.83F-4Submit Form CA-7⅔ Or ¾ Pay RatePay Rate At TimeOf InjurySunday Premium,Night Differential,Holiday Pay, Not OTTax FreeThree Day Wait(continued)
49 CLAIM FOR COMPENSATION (continued) FECA5 USC20 CFRELMEL 505CA 550Q&A10.111(c)545.82Ch. 4.10Exh eedExh.11.9e§8101(4)Five Working Days,USPS To OWCPLWOP For CompensationNo Leave Accrual In LWOPCreditable ServiceFor RetirementNo Contractual Increase In Compensation Pay Rate
50 LEAVE BUY BACK (Form CA-7b) A Leave Buy Back (LBB) Program Is At The DiscretionOf The Employer. It Is Not An OWCP Requirement.If Employees Use Sick Or Annual Leave While WaitingFor Their Claim To Be Approved By OWCP They MayApply To Buy It Back.The USPS Will Not Process A LBB Request For LeaveUsed After A Claim Has Been Approved.File Local Grievance, Hold Pending Adjudication Of National Grievance (Q98C-4Q-C ).(continued)Prepared by Human Relations Director Sue Carney
51 LEAVE BUY BACK (continued) When Paid Leave Is Bought Back, The Original PeriodOf Leave Use Is Retroactively Changed To LWOPWhich Will Result In A Downward Adjustment OfLeave For Every 80 Hours Of LWOP.LBB May Have Income Tax Implications, ConsultIRS Or Tax Advisor [Form CA-7b Worksheet].(continued)
52 LEAVE BUY BACK (continued) LBB Must Be Initiated Within 1 Year Of RTW Or Within 1 Year Of OWCP Approval Of Claim, Whichever Is Later.Cannot Buy Back Leave If No Longer A USPS Employee.If LBB For Previous Year Exceeds Allowable CarryoverThe Excess Will Be Forfeited.The Employee Must Pay The USPS The DifferenceBetween Paid Leave (100% Of Wage) And The Compensation Amount (66 ⅔% Or 75% Of The Wage) [Form CA-7b Worksheet].(continued)Prepared by Human Relations Director Sue Carney
53 LEAVE BUY BACK Discretionary Program FECA5 USC20 CFRELMEL 505CA550Q&AF-7F-8f545.84Ch.13.19Exh a(a)Ex e(6)aDiscretionary ProgramFor Leave Used While Waiting For Claim Adjudication By OWCPNo LBB Of Leave Used After Claim ApprovedInitiate Within 1 year(continued)
54 Leave Buy Back (continued) FECA5 USC20 CFRELMEL 505CA 550Q&Af545.84bExh abExh e.(6)Ch.13.19c.Exh e(6)No LBB If No Longer USPS EmployeeCannot Exceed Maximum Leave Carry-OverRetroactiveConversion To LWOP Will Change Leave Balance
55 RETURN TO WORK CAPABILITY Medical Restrictions Form CA-17, “Duty Status Report,” Is Normally Used.Treating Physician Completes “Side B” In Detail.Physician Should Provide Specific Details If UsingGeneral Language Such As “No Repetitive Activity.”Employees Must Advise Their Physicians That TheUSPS Will Accommodate Work Limitations And Must Also Advise The USPS Of These Limitations.(continued)
56 RETURN TO WORK CAPABILITY Medical Restrictions (continued) Medical Restrictions Also Apply To Your ActivitiesOutside The Workplace.The USPS May Contact Your Physician (In WritingOnly, Must Send Copy To You) Concerning Your WorkLimitations And Possible Job Assignments.(continued)
57 RETURN TO WORK CAPABILITY Medical Restrictions FECA5 USC20 CFRELMEL 505CA 550Q&A10.506545.52Ch. 4-16Ch. 4-17D-910.515545.33H-1Form CA-17Advise PhysicianAnd USPSContact With YourPhysician
58 JOB OFFERS Limited Duty/Rehab Limited Duty Job Offer = Temporary Medical RestrictionsRehab Job Offer = Long Term/Permanent Medical RestrictionsMaximum Medical Improvement (MMI) AchievedMMI Declared By PhysicianAn Employee Who Is Capable Of Performing Core DutiesOf Their Bid (With Or Without Modification) Is Not Considered A Limited Duty/Rehab.(continued)
59 JOB OFFERS Limited Duty/Rehab (continued) The Job Offer May Be Made Verbally As Long As WrittenJob Offer Is Provided Within 2 Business Days.To Be Considered Suitable By OWCP The Job Offer Must Include:Description Of The Duties;Description Of The Specific Physical Requirements;Location Of The Job;Effective Date;Pay Rate;The Date By Which The Job Offer Must Be Accepted/Refused.(continued)
60 JOB OFFERS Limited Duty/Rehab (continued) If The Job Offer Is Not Accepted, OWCP Will ThenReview The Offered Work To Determine SuitabilityCompensation Will Be Continued Until Final OWCP Decision.If Considered Suitable, Employee Will Have 30 DaysTo Accept Job Or Present Evidence Of Unsuitability.If OWCP Determines The Reasons Are Unacceptable, The Employee Has 15 Days To Accept The Job.No Further Evidence Will Be Considered By OWCP.(continued)
61 JOB OFFERS Limited Duty/Rehab (continued) USPS Should Minimize Any Adverse Or DisruptiveImpact On The Employee.If There Is Adequate Work Available Within Employee’s Craft, Facility, And Regular Hours, Then The EmployeeMust Be Assigned To That Work.All Concurrent Medical Conditions Whether Or NotCaused By Or Related To The Accepted ConditionMust Also Be Included In Medical Suitability Determinations.(continued)
63 (continued) RIGHTS AND BENEFITS LWOP For Compensation Is Credited For Computing Retirement Credit (Years Of Service) (ELM ).However, If Working Partial Days (e.g., Working 6Hours With Compensation For 2 Hours) CurrentOPM Policy Is That The Full-Time Annuity (Salary)Rate Will Be Prorated (Reduced) According ToPercentage Of LWOP Hours (EL505, Exhibit 11.9e).(continued)
64 RIGHTS AND BENEFITS (continued) No Leave Accrual When In A LWOP Status. However, Leave Accrual Rate (4, 6, 8, Hours/Pay Period) Is Not Affected By LWOP For Compensation (ELM ).No Deferral Of Step Increase For LWOP For Compensation (ELM ).No Thrift Savings Plan When In LWOP (ELM ).(continued)
65 RIGHTS AND BENEFITS (continued) An Employee In A Limited Duty/Rehab Job Can:Work Overtime If Within Restrictions(EL 505, Exhibit 7.1, Q&A);Bid If Meet Physical Requirements Of Bid Position(EL 505, Exhibit 11.9b);Convert To Full-Time If Capable Of Performing CoreDuties (With Or Without Modification) Of Vacant Position(Step 4, , I90C-4I-C ).
66 SELECTION OF PHYSICIAN Injured Employees Always Have The Right To ChooseTheir Treating Physician Or Medical Facility.Non-Emergency: The Employee May Select A PhysicianOr Hospital Within Approximately 25 miles. A SupervisorIs Not Authorized To Accompany The Employee.(A Chiropractor Is A Physician Under FECA Only ForManual Manipulation Of A Subluxation Of The SpineDemonstrated By X-Ray To Exist.)(continued)
67 SELECTION OF PHYSICIAN (continued) Emergency: Sent To Nearest Available Physician Or Hospital, Or To Physician Or Hospital Chosen By The Employee. A Supervisor May Accompany The EmployeeTo Ensure Prompt Medical Treatment.Animal Bites And Eye Injuries Are Always Considered Emergencies. If There Is Doubt As To The EmergentNature Of An Injury, It Is Treated As An Emergency.Physician Providing Emergency Care Is Not ConsideredThe Employee’s Treating Physician.(continued)
68 SELECTION OF PHYSICIAN (continued) Postal Physician Or Contract Equivalent May Provide Medical Treatment Not To Exceed Two VisitsIf:Employee Accepts Treatment;Treatment Complies With EL-806 And With OWCP RegulationsAnd Directives.If Treatment Exceeds Two Visits:That Provider Becomes Employee’s Treating Physician.(continued)
69 SELECTION OF PHYSICIAN Postal Physician Or Contract Equivalent (continued) Choosing A Contract Doctor As Your Treating Physician Is Probably Not In Your Best Interest.More Obliged To Their Employer (The USPS) ThanTo The Employee.Employee Sacrifices Doctor-Patient Confidentiality.Doctor Legally Can Share Any Information With The USPS.(continued)
70 SELECTION OF PHYSICIAN (continued) USPS May Require Employee To Be Examined By Their “Contract Doctor”Employee Does Not Have To Accept Their Recommended Course Of Treatment.Employee Does Not Have To Accept The “Contract Doctor” As Their Treating Physician.Such Examination May Not Delay Employee’s Initial Medical Treatment With Their Own Doctor.(continued)
71 SELECTION OF PHYSICIAN USPS May Require Employee To Be Examined By Their “Contract Doctor” (continued)If Exam Goes Beyond Employee’s Regular Work Hours, Employee May Request Through Their Supervisor To Leave. If Denied, Employee Should Request OvertimePay.Employee Should Not Be Required To Sign Any Guarantor Or Medical Release Forms.(continued)
72 SELECTION OF PHYSICIAN Physician Changes & Referrals (continued) To Ensure Payment Of A Medical Bill, An Employee Changing Physicians Should Write To OWCP Providing The Reason For The Change And The Name And Address Of Both The New Physician And The Previous One.Referral By A Physician To A Specialist Is Not A Change Of Physician. Get The Referral In Writing And Send A Copy To OWCP.(continued)
73 SELECTION OF PHYSICIAN FECA5 USC20 CFRELMEL 505CA 550Q&A§810310.300(d)545.41Ch. 3.2E-3E-4545.44Ch. 3.910.311541.2 m (1)E-510.316(a) (b)E-1110.324545.43545.45EmergencyDefinitionNon-EmergencyChiropractorChange OfPhysicianContract Doctor
74 PROVIDING SUPPORTING EVIDENCE The Greater The Complexity Of The Medical Condition Being Claimed, The Greater Is The Need For Thorough And Detailed Evidence.Claims For Occupational Disease/Illness Normally Require More Complete Evidence.One Of The Most Common Reasons For Claims Being Denied Is The Lack Of A Clear And Persuasive Medical Opinion Regarding Causal Relationship Between Specific Work Activity And The Diagnosed Condition.(continued)
75 PROVIDING SUPPORTING EVIDENCE (continued) Employee’s Statement Traumatic InjuryDescribe In Detail How And Why The Injury Occurred.Give Appropriate And Specific Details.Give A Complete Description Of The Condition(s) Resulting From Your Injury.Occupational Disease/IllnessProvide A Detailed History Of The Medical Condition From The Date It Started.Give Specific Details About The Employment Activity Which You Believe Caused The Condition.(continued)
76 PROVIDING SUPPORTING EVIDENCE Employee’s Statement Occupational Disease/Illness (continued)Describe Specific Exposures To Substances Or Stress Causing The Disease/Illness.Identify The Part Of The Body Affected.Provide A Statement As To Whether Ever Suffered A Similar Condition. If So, Provide Full Details.Give A Complete And Detailed Description Of The Current Disease/Illness(continued)
77 PROVIDING SUPPORTING EVIDENCE Employee’s Statement (continued) RecurrenceDescribe In Detail Your Medical Condition Since Returning To Work.Provide A Listing Of The Nature And Frequency Of All Medical Treatment Received.Describe Specifically How And When The Recurrence Happened.Identify ALL Injuries/Illnesses Which Have Been Experienced Between Date Of Return To Work After The Original Injury And The Recurrence.(continued)
78 PROVIDING SUPPORTING EVIDENCE (continued) Medical Reports Traumatic/Occupational/RecurrenceDates Of Examination Or Treatment.History Of Work Activity And The Claimed Condition As Provided By Employee.Results Of X-rays, Laboratory Tests, MRIs, EMGs, Etc.Specific Medical Diagnosis.Opinion With Medical Reasoning Explaining The Basis Of Such Opinion Regarding Whether The Condition Was Caused Or Aggravated By Employment (Statement Of Causality).(For Recurrence, Such Opinion Should Address The Causal Relationship Between The Current Condition And The Original Injury).
79 MEDICAL REPORTS (20 CFR 10.330, ELM 545.51) USPSAll Claims Reported To OWCP Require A Medical ReportDetailed And Thorough Medical Evidence Is One Of TheMost Important Aspects Of A ClaimA Good Medical Report Should Include (See Sample Reports Traumatic, Occupational):A History Of The Specific Work Activity Surrounding TheMedical Condition;Dates Of Examination And Treatment;(continued)
80 MEDICAL REPORTS (continued) USPSPhysical Findings Including Results Of Diagnostic Testing;Specific Diagnosis;Course Of Treatment;A Description Of All Medical Conditions Whether Work-RelatedOr Not;Treatment Provided Or Recommended For The Claimed Condition;The Physician’s Opinion With Medical Reasons Regarding Causal Relationship Between The Diagnosed Condition And Specific Work Activities And/Or Work Incidents;Whether The Employee Can Perform Any Type Of Work;Prognosis For Recovery (Full Or Partial).(continued)
81 MEDICAL REPORTS (continued) USPSForm CA-16 May Be Used For Initial Medical Report,Form CA-20 May Also Be Used For Initial Report And Subsequent Reports (Use Of These Forms Is Not Mandatory).A Medical Report May Be Made In Narrative Form OnThe Physician’s Letterhead Stationery.Medical Reports Should Bear The Physician’s SignatureOr Signature Stamp.(continued)
82 MEDICAL REPORTS (continued) USPSThe Medical Report Is Submitted Directly To OWCP(Keep A Copy For Yourself).The Postal Service May Request A Copy From OWCP.Form CA-17 Is Normally Used To Obtain Periodic ReportsRegarding The Employee’s Medical RestrictionsAnd Degree Of Disability.
83 EXAMPLE OF A THOROUGH MEDICAL REPORT: TRAUMATIC INJURY (PHYSICIAN’S LETTERHEAD STATIONERY) USPSTo Whom It May Concern:On January 25, 2004 I examined Mr. Ricardo Velasquez. Mr. Velasquez, who is a Postal Service employee,works 3:30 PM to 11:00 PM at the Northland Processing and Distribution Center. He stated that at approximately6:10 PM he was pushing a loaded mail container which weighed approximately 310 pounds up a small inclinewhen it started to tip to the right. Mr. Velasquez quickly moved to the right side of the container raising his rightarm and placing his right hand at the top of the container. He pushed against the container, preventing it fromtipping over and held it upright for a few seconds until two co-workers came to his assistance and helped rightthe container. Mr. Velasquez felt no immediate pain and finished his work shift without incident. However, aftersleeping several hours Mr. Velasquez woke up with a moderate to severe pain in his right shoulder area. AnMRI was performed (see attached report) and it demonstrated a partial tear of the supraspinatus ofapproximately 1.7centimeters proximal to the humerus.The patient will be treated conservatively with physical therapy and ultrasound. He has no other complaintsor symptoms. He can return to work but should not use his right arm to lift more than 5 pounds, nor should hereach above shoulder height with his right arm.In my medical opinion the above described traumatic work place incident caused the rotator cuff tear whichwas demonstrated by the referenced MRI report. Mr. Velasquez’ use of his right arm to keep the containerupright caused a sudden loading of the right shoulder rotator cuff, especially the external rotators whichwere attempting to keep the humeral head centered in the glenoid causing macrotrauma to the supraspinatusas described above.Mr. Velasquez has a good prognosis for recovery. I will examine his progress at the end of four weeks ofphysical therapy.(Signed By Physician)
84 EXAMPLE OF A THOROUGH MEDICAL REPORT: OCCUPATIONAL DISEASE (PHYSICIAN’S LETTERHEAD STATIONERY) USPSTo Whom It May Concern:On January 25, 2004 I examined Ms. Brenda Starr. Ms. Starr, who is a Postal Service Employee, works 3:30 PM to11:00 PM at the Northland Processing and Distribution Center. Ms. Starr, who is 5’4” tall, holds the positionof automation clerk. She describes the physical activity of a normal work day as follows: for approximately twohours at a time, two times a day, she repeatedly lifts trays of mail, which she estimates as weighing lbs.,over shoulder height to place them in a storage container. She has been performing this work for approximatelythree years.Ms. Starr complains that for the past two weeks she is awakened at night with moderate to severe pain in her right shoulder area. An MRI was performed (see attached report) and it demonstrated a partial tear of the supraspinatusof approximately 1.7 centimeters proximal to the humerus.The patient will be treated conservatively with physical therapy and ultrasound. She has no other complaints or symptoms. She can return to work, but should not use her right arm to lift more than 5 pounds, nor should shereach above shoulder height with her right arm.In my medical opinion the above described repetitive work performed at the Postal Service caused the rotator cufftear which was demonstrated by the MRI report. Ms. Starr’s repetitive lifting overhead caused constant fatiguingof the rotator cuff muscles (especially the external rotators) as they attempted to keep the humeral head centeredin the glenoid, resulting in chronic inflammation and microtrauma resulting in the injury to the supraspinatus as described above. Ms. Starr has a good prognosis for recovery. I will evaluate her progress at the end of 4 weeksof physical therapy.(Signed by Physician)
85 OWCP CRITERIA FOR EVALUATING MEDICAL REPORTS When A Claims Examiner (CE) Must Determine TheRelative Value Of Medical Evidence They Ask TheFollowing Questions:Is The Physician A Specialist In The Appropriate Field?Is The Physician’s Opinion Based On A Complete And Accurate Medical History?What Are The Nature And Extent Of Medical Findings?Is The Physician’s Opinion Well-Reasoned (Rationalized)?Is The Opinion Speculative Or Equivocal (Uncertain)?
86 OWCP DIRECTED MEDICAL EXAMS Second Opinions The Attending Physician Is Ordinarily The Primary SourceOf Medical Information And The First Line For Medical Questions From The CE.If The Physician Does Not Respond Or The ResponseIs Equivocal, A Second Opinion May Be Requested ByThe CE (An OWCP Second Opinion Exam Cannot Be Initiated By The Claimant).The Claimant Must Submit To An OWCP Mandated Examination As Often And At Such Times As OWCP Considers Necessary [20 CFR ].(continued)
87 OWCP DIRECTED MEDICAL EXAMS Second Opinions (continued) The Medical Opinion Determined By The CE To HoldMore Probative Value (Using The Criteria DescribedPreviously) Will Be Used To Determine Entitlement[20 CFR ].If Two Medical Reports Of Virtually Equal Weight AndRationale Reach Opposing Conclusions A MedicalConflict Exists [20 CFR , 20 CFR ].An Employee Scheduled For A Second Opinion ExamShould Write To OWCP And Request A Copy Of: TheMedical Report, The Statement Of Accepted Facts, TheQuestions The Physician Is Asked To Answer (And TheAnswers).(continued)
88 OWCP DIRECTED MEDICAL EXAMS (continued) Referee Specialist Exam (Impartial Medical Exam) When Equally Well-Reasoned Medical Reports Support Inconsistent Conclusions About An Issue Under Consideration, OWCP Will Schedule A Referee Exam [20 CFR ].A Physician Who Has Had No Prior Connection With The Case Who Is Qualified In The Appropriate Specialty Will Be Selected By OWCP [20 CFR ].Results Of The Referee Examination Will Be Given “Special Weight” By OWCP [20 CFR ].(continued)
89 OWCP DIRECTED MEDICAL EXAMS Referee Specialist Exam (Impartial Medical Exam) (continued) An Employee Scheduled For A Referee Exam ShouldWrite To OWCP And Request Copies Of: The MedicalReport, The Statement Of Accepted Facts, The QuestionsThe Physician Is Asked To Answer (And The Answers).
90 POSTAL SERVICE FITNESS-FOR-DUTY The Postal Service Has Authority Independent Of FECATo Require A Fitness For Duty (FFD) Examination, And Nothing In The Law Changes That Right. Such ExamShall Not Interfere With The Employee’s Initial ChoiceOf Physician, Treatment Or Issuance Of Form CA-16[20 CFR ].Such A FFD Report If Submitted To OWCP Must Receive Due Consideration, And If Its Findings Or Conclusions Differ Materially From The Treating Physician’s The CE Should Schedule A Second Opinion.(continued)
91 POSTAL SERVICE FITNESS-FOR-DUTY (continued) A Postal Service Installation Head, Human Resources Manager, Or Designee Is Authorized To Approve A FFD Exam. [ELM ].If The FFD Conflicts With Findings Of The TreatingPhysician No Administrative Action May Be TakenTo Change The Employee’s Employment StatusUntil Resolution By OWCP [ELM ].Employees And/Or Their Physicians Should RequestA Copy Of The FFD Examination.
92 MEDICAL PRIVACY Medical Reports Should Be Sent Directly To OWCP, The Postal Service May Request Copies From OWCP[20 CFR ].The Postal Service May Submit Relevant MedicalEvidence In Its Possession, Or Which It May AcquireThrough Investigation. However, The Privacy Act AppliesTo Any Such Effort [20 CFR ].The Postal Service May Contact The Treating PhysicianIn Writing, But Not By Telephone Or Personal Visit (For Limited Reasons) [20 CFR , ELM ].(continued)
93 MEDICAL PRIVACY (continued) When Such Communication Takes Place The Postal Service Must Send A Copy To OWCP And TheEmployee, As Well As A Copy Of The Physician’s Response Upon Receipt [20 CFR , ELM ].The Postal Inspection Service May Receive Restricted Medical Information Upon Written Request.The Signing Of A Medical Release For Postal ServiceUse Is Voluntary. (Step 4 Decision, PS Form 2488)(continued)
94 MEDICAL PRIVACY (continued) Form CA-17, “Duty Status Report,” May Be Used ToObtain Interim Medical Reports Regarding Return ToWork Capability [20 CFR , ELM ].OWCP Related Medical Records May Be Made AvailableTo Supervisors Who Have A Legitimate Need To Know.These Records Are Confidential, Must Be Kept UnderStrict Control And Stored In Locked File Cabinets.
95 SCHEDULE AWARDCompensation For The Permanent Loss Or Loss Of Use (Permanent Impairment) Of Specified Members, Functions And Organs Of The Body.An Employee Who Has Reached Maximum Medical Improvement And Has A Permanent Impairment To APart Of The Body May File For A Schedule Award.A Physician Must Determine The Percent Of Impairment Using The American Medical Association’s Guides To The Evaluation Of Permanent Impairment, Fifth Edition.(continued)
96 SCHEDULE AWARD (continued) A Schedule Award And Wage Loss CompensationCannot Be Paid At The Same Time, For The SamePart Of The Body. Therefore, Application For TheSchedule Award Ordinarily Occurs After Return ToFull Time Employment Or After Retirement.By Law A Schedule Award Cannot Be Paid For Brain,Heart, Or Back (Spine) Impairments. Other Members, Functions And Organs That Are Permanently ImpairedAs A Result Of These Exclusions Are Still Payable.(continued)
97 SCHEDULE AWARD (continued) A Form CA-7, “Claim For Compensation,” MustBe Completed Unless One Has Previously Been Submitted.The Award Is Tax-Free And Paid At Your WageLoss Compensation Rate For The Specified NumberOf Weeks Equivalent To Your Percentage OfPermanent Impairment.(continued)
98 SCHEDULE AWARD (continued) Formula Is:Your Specified Number Of Weeks (Maximum NumberOf Compensation Weeks Assigned To An Anatomical Member) X (Your Percentage Of Impairment) X (Your Amount Of Wage Loss Compensation) = Schedule Award.Example:100% Loss Of Use For The Arm = 312 Weeks Of CompensationDetermined Your Loss Of Use Is 20% = 62.4 WeeksYour Weekly Rate Of Pay Is $1000 Per WeekYou Have Dependents So You Are Compensated At 75% Or $750$750 X 62.4 Weeks = Schedule Award(continued)
99 SCHEDULE AWARD Back (Spine) FECA 5 USC 20 CFR ELM EL 505 CA 550 Q&A §810710.404p. 11F-2310.404(c)F-26F-2510.404(a)(b)F-24Schedule Award ForPermanent ImpairmentUse AMA, GuidesCannot Get CompensationAnd Award SimultaneouslyNot For Brain, Heart, OrBack (Spine)Specific Number Of WeeksAt Compensation RateCompensation ScheduleFor Anatomical Member
100 CHALLENGING FORMAL OWCP DECISIONS OWCP Will Enclose A Description Of Appeal Rights WithEvery Formal Decision. The Choices Are:Hearing (Oral And Written)ReconsiderationEmployees’ Compensation Appeals Board (ECAB)You May Not Request Two Forms Of Appeal At The Same Time.Be Sure To Send Your Appeal To The Right Address.Time Limits For Appeal Begin To Run On The Date Of The Decision Letter.The Date Of Your Appeal Is Determined By The Postmark Of Your Appeal Letter.(continued)
101 CHALLENGING FORMAL OWCP DECISIONS (continued) Branch Of Hearings And Review Oral HearingRequest Must Be Made Within 30 Days OfDecision. [20 CFR ].Conducted By An OWCP Hearing RepresentativeWithin Commuting Area Where The Claimant Lives.Probably More Than 3-4 Months Before Hearing IsScheduled.Claimant Notified At Least 30 Days In Advance OfThe Time And Place. [20 CFR ].(continued)
102 CHALLENGING FORMAL OWCP DECISIONS Branch Of Hearings And Review Oral Hearing (continued)Claimant States Argument And Provides Any New Evidence [20 CFR ].Postal Service May Attend, But Not Give Argument.[20 CFR ].Probably More Than 3 Months Or More After HearingIs Held Before A Decision Is Issued.May Request A Reconsideration Of An Oral Hearing Decision.(continued)
103 CHALLENGING FORMAL OWCP DECISIONS Branch Of Hearings And Review (continued) Review Of The Written RecordRequest Must Be Made Within 30 Days OfDecision [20 CFR ].Conducted By An OWCP Hearing RepresentativeIn Washington, DC, After Claim File Is Sent ToThem [20 CFR ].New Evidence And/Or Argument May Be Submitted(No Oral Testimony) [20 CFR ].(continued)
104 CHALLENGING FORMAL OWCP DECISIONS Branch Of Hearings And Review Review Of The Written Record (continued)Branch Policy Is To Issue A Decision Within 120Days Of Receipt Of Claim File.May Request A Reconsideration Of A Review OfThe Written Record Decision.
105 CHALLENGING FORMAL OWCP DECISIONS Reconsideration Request Must Be Made Within One Year Of TheDate Of The Decision [20 CFR ].Must Be In Writing, Contain Argument And/OrEvidence Showing An Erroneous ApplicationOf Law Or Advancing A New Legal Argument,And Must Constitute Relevant New EvidenceNot Previously Submitted [20 CFR ].(continued)
106 CHALLENGING FORMAL OWCP DECISIONS Reconsideration (continued) Sent To The OWCP District Office Where The Original DecisionWas Made [20 CFR ].A Claims Examiner Different From The One Who Made TheOriginal Decision Will Conduct The Review [20 CFR ].OWCP’s Policy (Not A Requirement Of Law) Is To Issue ADecision Within 90 Days.An Employee Who Has Previously Requested A Reconsideration Cannot Appeal That New Merit Decision To The Branch OfHearings And Review [20 CFR ]. However, A New Reconsideration May Be Requested.A Decision Refusing To Conduct A Reconsideration May OnlyBe Appealed To ECAB.(continued)
107 CHALLENGING FORMAL OWCP DECISIONS (continued) Employees’ Compensation Appeals Board (ECAB) [20 CFR ]Final Decisions Of OWCP May Be Appealed To ECABWithin 90 Days Of The Decision Being Appealed.For Good Cause Shown ECAB May Waive The90-day Time Limit And Accept An Appeal Up ToOne Year From The Date Of Decision BeingAppealed.No New Evidence Will Be Considered By ECAB.The Board Consists Of Three Members AppointedBy The Secretary Of Labor.It Takes Approximately Months To Receive ADecision From ECAB.
108 DEFINITIONS ACCELERATION—A Medical Process By Which Workplace Activity Has Increased The Speed Of An Expected Worsening Of A Progressive Pre-Existing Condition.AGGRAVATION—A Medical Process By Which Workplace ActivityHas Worsened The Severity Of A Pre-Existing Medical Condition.TEMPORARY—A Worsening For A Specific Period Of TimeUltimately Returning To Previous Medical Status.PERMANENT—An Irreversible Worsening With No Return ToPrevious Medical Status.(continued)
109 DEFINITIONS (continued) CONSEQUENTIAL INJURY—A New Medical Condition Caused ByA Weakness Or Impairment Resulting From An Accepted WorkplaceInjury Or Illness. Can Be To The Same Or To A Different Part OfThe Body. No Special Claim Form Needed, Submit To OWCP AFull Narrative Medical Report Detailing The New Condition And ItsConnection To The Original Accepted Condition.(continued)
110 DEFINITIONS (continued) IDIOPATHIC FALL—A Fall Caused By A Non-Work Related MedicalCondition (e.g., Epilepsy, Diabetes) And The Subsequent Injury WasCaused By Contact With The Floor. However, If The Injury WasCaused By Workplace Equipment Or Furnishing, Then That InjuryIs Compensable, But The Medical Condition Causing The Fall Is Not.An Injury Caused By A Fall Which Is Unexplained, But Not Idiopathic,And Occurs In Performance Of Duty Is Compensable Even If TheInjury Is Caused By The Floor.(continued)
111 DEFINITIONS (continued) INTERVENING INJURY— A Non-Work Injury To The Same Part OfThe Body Previously Accepted As A Compensable Workplace Injury.The Original Injury Must Still Contribute To The Disability Caused ByThe New Non-Work Condition. No Special Claim Form Needed,Submit A Full Narrative Medical Report To OWCP Detailing The NewCondition And Its Connection To The Original Accepted Condition.PRECIPITATION—A Medical Process By Which Workplace ActivityHastens The Occurrence Of A Medical Condition Or Causes It ToHappen Unexpectedly Or Sooner Than Normal.
112 WORK LIMITATION DUE TO PAIN Ordinarily, OWCP Does Not Accept Pain As Justification For Not Working.Pain Is Considered To Be A Symptom Of An Underlying Medical Problem. Therefore, OWCP Wants A Medical Diagnosis Of The Underlying Condition Which Is Causing The Pain.However, If There Is No Physical Basis For The Pain And It Is Not Exaggerated, Or Produced Voluntarily Or Falsely, Then The Condition Could Be Designated As “Psychogenic Pain Disorder.”This Diagnosis Would Have To Result From An Accepted Medical Condition And Would Be Filed As A Consequential Injury.
113 SEPARATION—DISABILITY [ELM 545.9] This Is Not A Disability Retirement.An Employee May Be Issued A Disability Separation If That Employee:Has Been In Continuous LWOP For A Year, AndIs Not Likely To Return In The Next 6 Months, AndThe Separation Is Approved By USPS Headquarters.An Employee Who Partially Or Fully Recovers After Separation Has Certain Restoration Rights Enforceable Through The Merit System Protection Board (MSPB)[ELM And 546.4].
114 DISABILITY RETIREMENT OPM Makes Decisions Regarding Disability Retirement Based On Whether An Employee Has A Medical Condition, Work Related Or Not, Which Prevents That Employee From Performing Useful And Efficient Service In The Job The Employee Was Hired To Perform.OWCP Makes Decisions Regarding Wage Loss Compensation Based On Whether An Employee Has An Accepted Workplace Medical Condition Which Prevents That Employee From Performing Any Type Of Medically Suitable Work.Each Agency Makes Independent Decisions.A Claimant Who Is Receiving OWCP Wage Loss Compensation From OWCP Can Retire, Waive The OPM Retirement Annuity, And Continue To Receive Compensation For As Long As OWCP Determines The Claimant Continues To Be Disabled.(continued)
115 DISABILITY RETIREMENT (continued) Application For Disability Retirement Must Be Received By OPMWithin One Year Of Separation.A FERS Employee Applying For Disability Retirement Must AlsoApply For Social Security Disability Benefits.Under OPM Regulations An Employee Receiving A Disability AnnuityCan Work In A Non-Government Job And Earn Up To 80% Of TheCurrent Salary Of The Previous USPS Job.A Claimant Receiving Compensation Who Is Separated From TheUSPS, Or Who Has Dependents And Is In Poor Health And/Or OfAdvanced Age, Should Seriously Consider Filing For Retirement.Do Not Make A Decision Before Receiving Pre-Retirement CounselingFrom The USPS, And, If Applicable, The Social Security Administration.
116 OWCP MEDICAL BILL PAYMENT AND AUTHORIZATION FOR MEDICAL PROCEDURES OWCP Has Contracted With ACS, A Private Sector Firm,To Administer Bill Payments And Medical Authorizations.The Web Site Is TheInteractive Voice Response (IVR) Phone NumberIs The Customer Service NumberIs (850) (Mon-Fri, 8 AM-8PM, ET). ThisNumber Is Not Toll Free.Medical Providers Must Enroll. They May Do So ThroughThe Above Web Site. Providers And Claimants MayReview Bill Pay And Authorization Status At The AboveWeb Site.(continued)
117 OWCP MEDICAL BILL PAYMENT AND AUTHORIZATION FOR MEDICAL PROCEDURES (continued) Medical Bills Are First Mailed To First Health/USPS,P.O. Box 23808, Tucson, AZ WhereThey Are Reviewed And Forwarded To ACS (OWCP).OWCP Still Is The Final Decision-Making Authority Regarding Entitlement To All Medical Benefits.
118 OWCP INFORMATION Federal Employees’ Compensation Act (FECA), Title 5, Chapter 81Code Of Federal Regulation, Claims For CompensationUnder FECA, Part 10 and 25Questions And Answers About FECA, CA 550Injury Compensation For Federal Employees, CA-810When Injured At Work, Guide For Federal Employee, CA11
119 OWCP FORMSCA Federal Employee's Notice Of Traumatic Injury And Claim For Continuation Of PayCA Notice Of Occupational Disease And Claim For CompensationCA-2a Notice Of RecurrenceCA Claim For Compensation By Widow, Widower, And/Or ChildrenCA Official Superior’s Report Of Employee’s DeathCA-7/20 Claim For Compensation/Attending Physician’s ReportCA-7a Time Analysis FormCA-7b Leave Buy Back (LBB) Worksheet Certification And ElectionCA Authorization (Employer Issued) For Examination And/Or TreatmentCA Duty Status ReportCA Claimant Medical Reimbursement Form
120 OWCP INFORMATION (continued) U.S. Department of Labor, Office of Workers’ Compensation Programs, Self-Instructional Video: Injury Compensation Specialist Training.” ThisVideo Presentation Was Created For Use ByThe Federal Employing Agencies. Please BeVery Aware When Reviewing This TrainingTool, The Presentor Is Speaking To The Agency Representative, Not The Injured Worker.ELM 540, Injury Compensation ProgramEL 505, Injury Compensation
121 LETTERS, MOUs AND STEP 4 DECISIONS A1 Letter From USPS Labor Relation At Headquarters. On theServices Policy for Employees that Sustained On-The-JobInjuriesA2 USPS Sample Letter. Limited Duty Assignments and MOUfrom HeadquartersA3 National Pre-Arb Settlement. When an employee has partially overcome a compensable disability, the USPS must make everyeffort toward assigning the employee to limited duty consistentwith the employee’s medically defined work limitation tolerances(see ). In assigning such limited duty the USPS shouldminimize any adverse or disruptive impact on the employee.The following considerations must be made in effecting suchlimited duty assignments.(continued)
122 LETTERS, MOUs AND STEP 4 DECISIONS (continued) A4 Step 4 Decision. Grievant has been determined medicallyunable to perform the duties of a letter carrier. As he hasdeclined the opportunity to be permanently reassigned toduties which he can perform in another Craft the employerhas no alternative, at this time, other than to consider hisseparation from the Postal Service for reasons of disability. However, he is not precluded from filling an application fordisability retirement if he should choose to do so.A5 National Pre-Arb Settlement. Full-time regular employeeson limited duty will not be scheduled day-to-day with varying reporting times.(continued)
123 LETTERS, MOUs AND STEP 4 DECISIONS (continued) A6 Letter from USPS Labor Relation at Headquarters. Statesthat local management will Instruct employees on light orlimited duty to perform only duties which are permitted bythe instructions of the physicianA7 Step 4 Decision. An employee may be required to reportan accident on the day it occurs however completion of theappropriate forms will be in accordance with applicable rulesand regulation and need not be on the day of the accident(continued)
124 LETTERS, MOUs AND STEP 4 DECISIONS (continued) A Management Instruction EL Job-Related First Aid InjuresA Letter from USPS Labor Relations at Headquarters. OWCP Useof Medical Reports Submitted by employing AgenciesA10 Step 4. The following procedures apply only to fitness-for-duty determinations incident to an on-the-job injury or illness.Fitness-for-duty determinations for other purposes are notcovered by this instruction.A11 Step 4. Management's instructions requiring employees onlimited duty to pick up CA-8 forms during daytime hours at theInjury Compensation Office violates the National Agreement.The said Forms will be made available to employees in limitedduty status on all tours.(continued)
125 LETTERS, MOUs AND STEP 4 DECISIONS (continued) A12 Step 4. Whether management’s assignment of limited dutyIn this case violated the provisions of ELM, SectionA13 MOU between APWU, USPS and NALC. For example, if aletter carrier craft employee is given a limited duty assignmentin the clerk craft, and grieves that assignment, the employeewill be represented by the NALC. If a clerk craft employee isgiven a limited duty assignment in the letter carrier craft, andgrieves that assignment, the employee will be represented bythe APWU.(continued)
126 LETTERS, MOUs AND STEP 4 DECISIONS (continued) A14 Step 4. Letter from USPS. The union alleges thatmanagement discriminates against employees injured off dutyin violation of Article 13 of the collective bargaining agreement, when limited-duty assignments are granted preference overlight-duty assignmentsA15 Step 4. The issue in this grievance is whether management violated the National Agreement when it used a locally developed form to supplement the data provided on Form 3996A16 Step 4. Use of locally generated formsA17 Step 4. Even if you are injured and an outside party wants topay for the medical expenses you must still fill out compensation forms(continued)
127 LETTERS, MOUs AND STEP 4 DECISIONS (continued) A18 Step 4. It is agreed that an employee cannot be requiredor compelled by the Postal Service to undergo a scheduledmedical examination and/or treatment, during nonworking hours.A19 Step 4. Whether employees on light duty or limited dutymay sign the Overtime Desired list.A20 Step 4. Completion of PS Form 2488 by the employee isvoluntaryA21 Step 4. CA-17 is usually adequate for medical informationon an injured employee Completion of PS Form 2488 bythe employee is voluntary(continued)
128 LETTERS, MOUs AND STEP 4 DECISIONS (continued) A22 Step 4. Whether management may require an employee tocomplete PS Form 3971 to receive Continuation of Pay (COP)A23 Step 4. Are limited duty employees covered by the collectivebargaining agreementA24 Step Whether management violated the Agreement when,the grievant was permanently reassigned work in another craft.(continued)
129 LETTERS, MOUs AND STEP 4 DECISIONS (continued) A25 Step 4. Management removing employees permanentlyfrom their bid while on Limited dutyA26 Step 4. Whether management violated the NationalAgreement when it withdrew the grievant from limited dutyand issued a Notice of Proposed removalA Letter from USPS Labor Relation at Headquarters.Discipline for safety rules violations