3 $510,423 per day $323,728 per day LOST PRODUCTIVITY! VHA workers’ compensation chargeback in CBY 2013$323,728 per dayPortion of VHA chargeback that relates to disability wage lossLOST PRODUCTIVITY!
4 Objectives At the end of this session, you will better understand: Impact your role has on injured employees, mission, and cost to your organizationHow you as a supervisor can prevent employee injuriesImportance of thorough investigations of all incidentsHow to communicate with workers’ compensation staffYour role in return-to-work managementTimekeeping practices for injured employeesHow to protect information related to on-the-job injuries
6 Impact of Workers’ Compensation EmployeeSelf ActualizationPersonal Growth & FulfillmentEsteem NeedsSelf Esteem, Self Respect, & Self ConfidenceBelongingness & LoveFriendship, Intimacy, & FamilyAbraham Maslow was a humanistic psychologist who believed that every person has these five basic needs. His theory is that a person does not feel the second need until the demands of the first have been satisfied, nor the third until the second has been satisfied, and so on.Safety NeedsPersonal, Financial, Health, & Well BeingBiological and Physiological NeedsBasic Necessity– Air, Food, Drink, Shelter, Warmth & SleepMaslow’s Hierarchy of Needs
7 Impact of Workers’ Compensation Agency MissionStaff reductions when employee is disabled from workOver-hiring when employee is out for 365 daysAdditional HR activity to ensure entitlements to injured workersOvertime requirements for healthy employeesLOSS OF PATIENT CARE RESOURCESINABILITY TO SERVE OUR VETERANS THE BEST WE CAN
8 Impact of Workers’ Compensation Agency BudgetChargeback CostsContinuation of PayIndirect Cost
9 Impact of Workers’ Compensation Chargeback CostsEmployees Compensation Fund (Congressional Appropriation)DOL-OWCP pays medical bills and compensation on accepted claimsDOL-OWCP charges back the cost to the Agency every year, including an administrative feeAgency has two fiscal years to pay the billRepayment is returned to the Employees Compensation FundFunds future year payments from Employees Compensation FundEach Administration pays its share of the cost
10 Impact of Workers’ Compensation Continuation of PayFECA provides that the employer must continue the employee's regular pay during any periods of resulting disability, up to a maximum of 45 calendar days.Entitlement to 45 days must start within 45 days from DOIEmployer paid at 100% of the employees salary which is subject to taxes and all other payroll deductions that are made from regular income.The employer, not OWCP, pays COP.
11 Impact of Workers’ Compensation Continuation of Pay (COP)Employer has the right to ‘controvert’ COP entitlementIf a claim is denied by OWCP, COP is rescinded, Employee must elect AL, SL or LWOP in lieu of COPEmployees are not automatically entitled to COPEligibility requirements applyMust file a CA-1 for a traumatic injuryClaim must be filed within 30 days from the date of injuryMust have lost time within 45 days from injury
12 Impact of Workers’ Compensation Indirect CostOvertime – Results in 2.5 times salary for same serviceReplacement receives overtimeInjured employee receives COP or disability compensationOver-hiring – Recruitment, on-boarding, & TrainingApproximately 27% of employee salary
14 WC Program ImportanceDid you know that long-term disability recipients…Receive up to 75% of their salary – TAX FREE when on compensation?Receive Cost of Living Adjustment(COLA), or raises while Federal wages are frozen?Based on CPI - inflationary indicator that measures the change in the cost of a fixed basket of products and services.For 2013, the CPI increase was 1.7%May be exempt from paying mortgages or car loansIf employee pays for disability insurance on their own.
15 WC Program ImportanceYour roles and responsibilities to the WC ProgramPre-Injury responsibilitiesInvestigation of incidentsCommunication with workers’ compensation staffTimely completion and forwarding of claim formsProactive participation in return-to-work effortsAppropriately document injury-related timekeepingProtecting workers’ compensation data
17 Pre-Injury Responsibilities Eliminating Hazards in the workplace is your BEST method of preventing injuries and illnessesEnforce VA OSH rules, regulations, and standards within your area of responsibility.Identify unsafe and unhealthy conditions and practices in the workplace and take prompt corrective action.Encourage employee suggestions on how to improve Occupant Safety and Health.
18 Pre-Injury Responsibilities Observation of employee work practices and constructive guidance is just as importantEnsure employees under your supervision are:Trained to perform their work safely and such training is properly documentedAware of the hazards, if any, involved in their normal work functions, and that such training is properly documented.Initiate progressive disciplinary action, as appropriate, against employees who repeatedly violate safe work practices and procedures.
19 Pre-Injury Responsibilities Near Miss incidents serve as a ‘dress rehearsal’ for injuries and illnesses in the workplace“There is one Serious Injury for every 600 near miss incidents”Frank Bird – US Safety Researcher110 – Minor Injuries30 – Property Damage600 – Near Misses
21 Investigation of Incidents SupervisorGather facts related to the incidentObtain witness statements if necessaryCommunicate findings to Safety and WCP staffComplete VA Form 2162, Incident Report within 3 working days.Safety OfficerDesignated point of contact for secondary incident investigationServes as consultant in work-related accident investigations.The WCP staffCollaborates with employee, supervisor, and SafetyDetermines relevant facts of the caseTransmits the case to DOL, if appropriate
22 Investigation of Incidents Office of Workers’ Compensation Program (OWCP)Exclusive authority to administer, interpret and enforce FECASole adjudication authority for FECA processesWhen an employee disagrees with a decision made by OWCP, they may appeal to OWCPLiability under FECA is exclusive and instead of all other direct judicial proceedings, civil actions, or under a Federal tort liability statute.
23 Investigation of Incidents Step 1:Determine if emergency treatment is required!Ensure that employees under your supervision receive prompt and appropriate medical attention in the event of an injury or illness.Such medical services are offered—not mandatory.
24 Investigation of Incidents Step 2: Gather facts related to the incidentDetermine causal and contributing factorsCausal Factor - Any behavior, omission, or deficiency that if corrected, eliminated or avoided probably would have prevented the incident or injury.Contributing Factor - Any behavior, omission, or deficiency that sets the stage for an incident or increases the severity of injuries or extent of property damages.Identify necessary corrective actions
25 Investigation of Incidents Investigating for Causal and Contributing FactorsWho – Was involved or witnessed?What – Occurred or was seen?Where – Did it occur, and where were witnesses?When – Did this occur or when was it reported?Why, Why, Why, Why, Why?Any other factors relative to the incident?
26 Investigation of Incidents Step 3: Document investigation on VA Form 2162Step 4: Determine OSHA RecordabilityStep 5: Collaborate with WC staff on findingsStep 6: Implement corrective actions
27 Investigation of Incidents Implement Corrective ActionsCorrecting hazards prevents future injuries and illnesses!
29 Communication with WC Staff Your facility WC staff has no authority to accept or deny workers’ compensation claimsHowever, they are able to provide objective evidence of dispute for consideration by the OWCPFindings from your incident investigation may either support or refute an employee’s statement on CA-1 or CA-2.
30 Communication with WC Staff Disputing an employee’s claimWC staff submits a letter of dispute to OWCPDescribe the factual allegation or argument to support disagreementProvide evidence or argument to support the agency’s positionInclude supporting documents such as witness statements, medical reports or records, or any other relevant information.Timeliness is key! Dispute must be submitted to OWCP:CA-1: With the notice of traumatic injury or deathCA-2: Within 30 calendar days from the date notice of occupational disease or death is received from the claimant.
31 Communication with WC Staff Disputing an employees claim (continued)If a letter of dispute is not submitted appropriately, OWCP may accept the claimant's report of injury as established.A disagreement with an aspect of the claimant's report is not cause to:Delay forwarding the claim to OWCPCompel or induce the claimant to change or withdraw the claim.
32 Communication with WC Staff Discussion Points with WC StaffHas employee established burden of proof – 5 Elements?Timely Filed (3 year statue of limitations)Employee of the United StatesFact of InjuryPerformance of DutyCausal Relationship
33 Communication with WC Staff Fact of Injury may be questioned if:Employee statements and investigation findings are inconsistentEvidence of a previous injury to the same part of the bodyThere is a delay in reporting the injuryYou have knowledge of other employment or reserve dutyThere are documented past violations of safe work practicesNotification of misconduct or pending termination was givenLeave requests during injury period have been denied
34 Communication with WC Staff Performance of Duty may be questioned if:The injury occurred outside of working hoursThe employee was not performing assigned duties at the time of injuryThe injury occurred off premises?The injury occurred during a recreational activityHorseplay, willful misconduct were involvedInjury was a result of a vehicular accidentInjury was the result of an assault
35 Communication with WC Staff Employees are considered to be in the Performance of Duty on premises including steps, sidewalks and parking lots owned, controlled or managed agency:During work hours and/or on breaksOutside working hoursUsually considered 30 minutes before or after working hoursNot extended to employees who are visiting the premises for non-work-related reasons.Performing representational functions entitling them to official time are covered.Injuries to employees engaged in the internal business of a labor organization are not covered.
36 Communication with WC Staff Causal Relationship is a medical determination usually addressed by the OWCP Claims Examiner.Communicate with the WC staff if you have concerns that the medical condition identified by the employee is not causally related to the claimed injury.The following Statutory Exclusion should also be addressed with the WC staffWillful misconductAlcohol or drug impairment involvedIntent to injure self or others
37 Communication with WC Staff In cases of work-related employee deathNotify the Facility Workers’ Compensation Office immediately to report a death due to a work-related traumatic or occupational disease-facility workers’ compensation office will notify OWCP immediately via telephone or faxComplete form CA-6, Official Superior’s Report of Employee’s Death, immediately so facility workers’ compensation office can submit to OWCP within 10 workdays from notification
39 Claim Initiation Process SupervisorWC StaffProvide Guidance and Counsel to Injured EmployeesCommunicate Employee Rights and ResponsibilitiesProvide Notice of Choice of PhysicianProvide Release of Information DocumentInvestigate IncidentDispute Questionable ClaimsEmergency Treatment (if needed)Authorize use of CA-16Respond to Development Letters & Requests from OWCP timelyEnsure Leave Requests are MadeAuthorize use of COP if applicablePeriodically Check on EmployeeTrack OWCP Pending Actions
40 Injury-Related Timekeeping SupervisorWC StaffEnsure Entitlement to COPEnsure Leave Requests are MadeTrack COP Day CountEnsure Appropriate Leave is UsedAuthorize Requests for COPForward Medical to WC StaffControvert COP when applicableNotify Employee of ControversionNotify Employee when Controversion UpheldRequest Election of Other LeaveRescind COP when Case DeniedReview COP Cost for Facility
41 Claim Initiation Process For Traumatic Injuries:Advise the injured employee of his or her right to file for workers’ compensation benefits using Form CA-1.Complete the required fields of the VA 2162, the Incident Report within 5 days.Complete the required fields of the supervisory portion of the Form CA-1 within 3 days of signing by the employee.Do not delay injury claim completion while waiting for other documents or disputes to be completed.Again, you need the medical documentation to know which applies. If you don’t have it, call Occupational Health and ask that they provide you with the information.
42 Claim Initiation Process A claims is not complete until:Employee has electronically signedSupervisor has electronically signedThe claim form has been printed and both the employee’s and supervisor’s wet ink signature has been obtainedA claim will not be transmitted/submitted to OWCP without wet ink signature
43 Claim Initiation Process Here’s the fine print:No employer or other person may require an employee or other claimant to enter into any agreement, either before or after an injury or death, to waive his or her right to claim compensation under the FECA. No waiver of compensation rights shall be valid. 20 CFR 10.15A number of statutory provisions make it a crime to file a false or fraudulent claim or statement with the government in connection with a claim under the FECA, or to wrongfully impede a FECA claim. See 20 CFR 10.16, Title 18 U.S. C. section 287, , and 1922.Administrative proceedings may be initiated under the Program Fraud Civil Remedies Act of 1986 (PFCRA), 31 U.S.C , to impose civil penalties and assessments against persons who make, submit, or present, or cause to be made, submitted or presented, false, fictitious or fraudulent claims or written statements to OWCP in connection with a claim under FECA. 29 CFR Part 22
44 Claim Initiation Process 18 U.S.C False or withheld report concerning FECAWhoever, being an officer or employee of the United States charged with the responsibility for making the reports of the immediate superior specified by section 8120 of title 5, willfully fails, neglects, or refuses to make any of the reports, or knowingly files a false report, or induces, compels, or directs an injured employee to forego filing of any claim for compensation or other benefits provided under subchapter I of chapter 81 of title 5 or any extension or application thereof, or willfully retains any notice, report claim, or paper which is required to be filed under that subchapter or any extension or application thereof, or regulations prescribed thereunder, shall be fined under this title or imprisoned not more than one year, or both.
46 Return to Work Management SupervisorWC StaffIdentify Transitional Job DutiesProvide Written Job OfferMonitor Transitional Duty to Ensure Restrictions are not ExceededNotify WC of Updated RestrictionsUpdate Written Job OfferProvide Release of Information DocumentMonitor any Leave upon RTWMonitor Medical for RTW ChangesNotify WC Staff-IOD Leave UsedRequest Medical to Support Leave
47 Return to Work Management Transitional duty must be made available to injured employeesThe transitional assignment must be provided in writing to the injured employee with the option of accepting or declining the offer. (initial in verbal is okay- f/u with written.)Transitional duties should align with medical restrictions. Transitional job offer should not exceed days without modification—This depends on severity of the injury.
48 Return to Work Management When medical restrictions are received from the physician, you will be asked by the WC staff for the following information:Description of duties to be performedPhysical requirements for those dutiesLocation where job will be performedSalary information for transitional jobDate that the job is availableWork schedule for the jobDate response to job offer is dueIf moving expenses will be paid
49 Return to Work Management Notify your Facility Workers’ Compensation Office immediately if you believe an injured employee is off work as a result of a work injury, don’t take it for granted they are
50 Return to Work Management If a claim is denied by OWCPNotify employee of their right to request reasonable accommodation within 30 days of denial of claimEngage the Reasonable Accommodation specialist at your facility for assistance
51 Return to Work Management Supervisors SHOULD NOT:Send an employee home because transitional duties are not availableAllow an injured employee to perform transitional duty without a written job offerTreat injured employees differently than you treat other employees. An injury is not a “get out of jail free” card.
52 Return to Work Management Supervisors SHOULD NOT: (continued)Allow an employee to dictate what duties he or she feels he/she can or cannot doWithhold taking appropriate administrative or disciplinary actions against an injured employeeImpede employee’s election to take annual, sick leave or leave without pay for time lost because of a job- related injury
53 Return to Work Management Retention Rights – Separation from Agency RollsUnder 5 U.S.C. 8151, an employee who recovers within 1 year of starting compensation has mandatory rights to his or her old position or its equivalent, regardless of whether he or she is still on the Agency rollsIf full recovery occurs after 1 year, or the employee is considered partially recovered, he or she is entitled to priority consideration as long as application is made within 30 days of the date compensation ceasesEmployees incur no loss of benefits which they would have received but for the injury or disease.5 CFR Section 353, 301, 302, and 303
55 Protecting Employee Data VA Systems of RecordCreated or amended as needed to meet the legislative requirements of the Privacy Act of 1974SORNs (System of Record Notices) are in place to protect employee data.VA Systems of Record DO NOT cover employee workers’ compensation recordsDOL/GOVT-1 System of RecordsProtects records relating to claims for benefits filed under the FECA, including any copies maintained by an employing agencyThis system of records is maintained by and under the control of OWCP, and, as such, all records covered by DOL/GOVT-1 are official records of OWCP.
56 Protecting Employee Data Confidentiality of WC RecordsAll records relating to claims for benefits, including copies of such records maintained by an employer, are considered confidential and may not be released, inspected, copied or otherwise disclosed except as provided below:Freedom of Information ActPrivacy Act of 1974DOL/GOVT-1 if such release is consistent with the purpose for which the record was created.
57 Protecting Employee Data Storage and Use of WC DocumentsWorkers’ Compensation related documents must be stored in locked cabinets inside of a locked roomThe use of the information collected must be connected in some way with the compensation claimAgencies may not use copies of information from claim files for these purposes without written consent of the injured employee:a) In connection with EEO complaintsb) Disciplinary actionsc) Other administrative actions
58 Protecting Employee Data Employee Right to RepresentationMay appoint one individual to represent his or her interest in the claim processAppointment must be in writingThere can be only one representative at any one timeMay authorize any individual to represent him or her in regard to a claim under the FECAA Federal employee may act as a representative only:On behalf of immediate family members provided no fee is chargedWhile acting as an officially sanctioned union official provided no fee or gratuity is charged.