1. Office of Workers’ Compensation Program Federal Aviation Administration Piedmont District Administrative Meeting June 22-26, 2015 Southern Regional Office College Park, Georgia

2. Federal Aviation Administration 2 FAA Workers’ Compensation Division (AHB-300) Anthony D. Sanchez (Tony) Team Lead for Policy and Program Management Office of Human Resource Management Office: 202-267-7204 Mobile: 202-669-5023 Fax: 202-493-4140 Email: Anthony.D.Sanchez@faa.govAnthony.D.Sanchez@faa.gov FAA Workers’ Compensation Links Workers' Compensation Webpage Workers' Compensation POCs Workers’ Compensation Forms Manager's Manual for Worker's Compensation (PDF) What a Manager Should Do When an Employee is Injured Checklist FAA Workers’ Compensation Program

3. Federal Aviation Administration 3 FAA Workers’ Compensation Program Overview The National Workers’ Compensation Program Office (WCPO) serves as the corporate program office for all Department of Transportation workers’ compensation claims. They advise injured employees and their managers of their rights and responsibilities under the Federal Employees’ Compensation Act, provide technical advice and guidance to employees and managers, and perform a variety of claims management actions to bring claims to resolution.Federal Employees’ Compensation Act All OWCP Forms are under a timeliness requirement by the Department of Labor (DOL). To ensure that this requirement is met, Human Resource Management signed a Service Line Agreement with all FAA LOBs and Staff Offices which stipulates that CA ‐ 1s and CA ‐ 2s must be received in AHB ‐ 300 within two workdays of manager's receiving claim form from an employee.AHB ‐ 300

4. Federal Aviation Administration 4 FAA Workers’ Compensation Program Overview (continued) Promptly fax all claims to FAA Office of Workers’ Compensation Program (OWCP) at (202) 267-6295 or scan and e-mail to: 9-AWA-AHR-OWCP- Claims@faa.gov. This includes all cases, regardless if worker lost time or sought treatment. Per Service Level Agreement between AHR and all LOBs – LOB managers must forward forms within 2 days.9-AWA-AHR-OWCP- Claims@faa.gov Mail all original documents to: Federal Aviation Administration National Workers’ Compensation Branch 800 Independence Avenue SW, Room 523 Washington, DC 20591 All forms are available on the Department of Labor (DOL) website except for the Authorization for Examination And/Or Treatment, Form CA ‐ 16. Form CA ‐ 16 is only issued with a CA ‐ 1. This is a controlled form. Contact the FAA OWCP office for a copy of the latest version.Department of Labor (DOL) website

5. Federal Aviation Administration 5 FAA Workers’ Compensation Program Overview (continued) Only one CA ‐ 16 is issued per injury. The manager completes the front page of the CA ‐ 16 and the employee takes the form to their physician for completion of the second page. Case numbers are available forty ‐ eight hours after a claim is received and processed by FAA OWCP. Please contact the assigned FAA OWCP HR Specialist for a case number.FAA OWCP HR Specialist

6. Federal Aviation Administration 6 Manager Responsibilities When an Employee is Injured If an employee is injured and wishes to file a claim, the first thing you need to determine is whether your employee suffered a traumatic injury or an occupational disease (see Section 4 of the Manager’s Manual for Workers’ Compensation for guidance on determining such).Manager’s Manual for Workers’ Compensation If your employee sustained a traumatic injury, he or she should be advised of his or her right to complete the employee portion (1st page) of CA-1 Form, Federal Employees’ Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation.CA-1 Form, Federal Employees’ Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation Once your employee completes this portion and you receive the form, you must complete the manager portion and fax to FAA OWCP within two business days. If your employee needs medical care, you should authorize such by completing the manager’s portion (Part A) of an Authorization for Examination And/Or Treatment, Form CA-16. However, this form should never be issued more than one week after the date of injury. FAA Workers’ Compensation Program

7. Federal Aviation Administration 7 Manager Responsibilities When an Employee is Injured If your employee has developed an occupational disease and wishes to file a claim, he or she should be advised of his or her right to complete the employee portion (1st page) of CA-2 Form, Notice of Occupational Disease and Claim for Compensation.CA-2 Form, Notice of Occupational Disease and Claim for Compensation Once your employee completes this portion and you receive the form, you must complete the manager portion and fax to FAA OWCP within two business days. A Form CA-16 cannot be issued when an employee files a Form CA-2 as medical expenses are not payable under FECA until an occupational disease claim has been accepted. FAA Workers’ Compensation Program

8. Federal Aviation Administration 8 Manager Responsibilities When an Employee is Injured Whether or not an employee chooses to file a Form CA-1 or CA-2, you must complete a Mishap Report (Form 3900-6) in the Safety Management Information System (SMIS).Mishap Report (Form 3900-6)Safety Management Information System (SMIS) From that page, select the “SMIS Input Guide” under the Support tab near the top right corner of the page, and follow the directions. As part of the mishap report that you file, you should investigate the cause(s) of the injury or illness, so that similar mishaps can be prevented in the future. If you have questions about filing the mishap report or the mishap investigation, contact your Line of Business occupational safety and health point of contact or the EOSH Performance Management Services Team (AJW-233), Grace DeLaCruz, 310-725-6590Grace DeLaCruz FAA Workers’ Compensation Program

9. Federal Aviation Administration 9 FAA Workers’ Compensation Program SMIS Safety Management Information System SMIS Website: https://smis.faa.gov/home.asphttps://smis.faa.gov/home.asp

10. Federal Aviation Administration 10 FAA Workers’ Compensation Program SMIS Safety Management Information System (continued) Resource Links FAA Occupational Safety & Health Webpage FAA Order 3900.19, Chapter 7, Mishap Reporting & Investigation (PDF) EOSH Services Group (AJW-23) Unsatisfactory Condition Report (UCR) Webpage

11. Federal Aviation Administration 11 Division of Federal Employees’ Compensation (DFEC) The Federal Employees' Compensation Act provides workers' compensation coverage to three million federal and postal workers around the world for employment-related injuries and occupational diseases. The Division of Federal Employees' Compensation (DFEC) has responsibility for administering the Act through its twelve district offices and national office.Federal Employees' Compensation Act Division of Federal Employees' Compensation (DFEC) DFEC District 6DFEC District 6 provides service to injured Federal workers, their employing agencies, and medical care providers in the states of Alabama, Florida, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. SEND ALL MEDICAL BILLS DIRECTLY to DOL OWCP at the address below or upload it to the case electronically on the ECOMP website.DOL OWCPECOMP website US Department of Labor DFEC Central Mailroom - District 6 P.O. Box 8300 London, KY 40742-8300 Note: Bills do not need to be forwarded to FAA OWCP; Copies however, should be made of any attached medical reports and forwarded to FAA OWCP. FAA Workers’ Compensation Program

12. Federal Aviation Administration 12 Division of Federal Employees’ Compensation (DFEC) Be sure to include the claim number on every page mailed to DOL OWCP. If employees/ medical providers have questions in reference to medical authorization and billing and/or reimbursement matters, please call customer service at (844) 493-1966, toll free. If employees incur medical expenses, advise their medical provider(s) to submit bills directly to the address above and not to the place of employment. This delays time in medical expenses being paid. DOL / DFEC Links Office of Workers’ Compensation Programs (OWCP) Division of Federal Employees’ Compensation (DFEC) DFEC District Offices DFEC District 6 - Jacksonville Webpage Workers’ Compensation Forms FAA Workers Compensation Program

13. Federal Aviation Administration 13 Questions FAA Workers’ Compensation Program