Office of Workers’ Compensation

Topics To Be Covered Overview of the Federal Employees’ Compensation Act (FECA) Primary Benefits Provided under the FECA Types of Injuries and Initiating Claims Conditions of Coverage COP and Controversion 2

Supervisor Responsibilities Containing OWCP Costs Automated Systems Internet Resources and References Topics To Be Covered 3

Overview of the FECA Federal Employees’ Compensation Act (FECA) passed in 1916 Benefits Provided Remedial in nature Non-adversarial – an attorney is not required 4

Overview of the FECA (cont’d) Program Administration DOL / OWCP Adjudicates Claims Privacy Act HIPAA 5

Primary Benefits Provided under the FECA Medical Benefits –Treatment of Injury – Preventive care is not authorized –Fee Schedules –Chiropractor 6

Primary Benefits Provided under the FECA Continuation of Pay (COP) –Intent is to avoid interruption of pay while the claim is adjudicated –45 calendar days –Traumatic Injury - ONLY 7

Primary Benefits Provided under the FECA –Traumatic Injury –Occupational Disease Claim –Death 8

Primary Benefits Provided under the FECA Schedule awards Vocational rehabilitation Death Benefits 9

Conditions of Coverage –Timely Filing of Claim –Federal Civil Service Employee –Fact of Injury –Performance of Duty –Causal Relationship with medical 10

Timely Filing Employee Has Three Years From: –Date of Injury –Date of First Awareness –Date of Last Exposure 11

Civil Service Employee FECA covers all Federal Civil Service and Federal Civilian Employees except for non-appropriated fund employees Temporary employees covered on the same basis as permanent employees and indefinite Contract employees, volunteers, and loaned employees are covered under some circumstances 12

Fact of Injury Factual – Actual occurrence of an accident, incident, or exposure in time, place, and manner alleged Medical – Medical condition diagnosed in connection with that accident, incident, or exposure 13

Performance of Duty Injury occurred while performing assigned duties or engaging in an activity reasonably associated with the employment Injury occurred on work premises Injury occurred off premises while engaging in work activity 14

Causal Relationship Link between work-related exposure/injury and any medical condition found Based entirely on medical evidence provided by physicians who have examined and treated the employee Opinions of employee, supervisor, or witnesses not considered – nor is general medical information contained in published articles 15

Statutory Exclusions Willful Misconduct – deliberate and intentional disobedience of rules/orders – not carelessness Drug or Alcohol Intoxication – proximately caused the injury Intent to Injure Self or Others – intent must be established 16

Initiating A Claim for a Traumatic Injury Traumatic Injury –Wound or other condition of the body caused by external force, including stress or strain –Caused by specific event or series of events or incidents within a single day or work shift 17

Initiating A Claim for a Traumatic Injury Notice of Traumatic Injury – CA-1 –Employee (or someone on her/his behalf, including supervisor) completes front –Supervisor completes back –Must be submitted to employing agency within 30 days of date of injury to be eligible for COP – however can be submitted up to three years after the injury –Must be transmitted to OWCP within ten workdays from date agency received form – DO NOT HOLD for wage calculations, supporting documentation, etc. 18

Supervisor’s Role related to a Traumatic Injury Claim Have employee seek medical attention. Discuss and review the facts surrounding the incident. Report injury or illness to safety and HRO. Complete the supervisor and safety screens within the EDI for CA-1 or CA-2 and submit to the HRO. Advise employee of her/his responsibility to submit medical evidence of disability within 10 work days, claim on file within 30 work days of injury or risk termination of COP 19

Initiating A Claim for a Occupational Disease Occupational Disease –Condition produced over a period longer than one workday or shift –Exposure over time longer than one workday –Authorize medical care, process CA-2 COP is not provided for Occupational Diseases CA-16 is not issued for Occupational Diseases 20

Supervisor’s Role related to a Occupational Disease Claim Review the employee’s portion of the form and provide comments concerning the employee's statement Supply supporting documents if available Advise employee of the right to elect sick, annual leave or LWOP, pending adjudication of the claim 21

Wage Loss/Permanent Impairment An employee who can not return to work when COP ends or who is not entitled to COP may claim compensation for wage loss on CA-7 An employee who has returned to work but who still requires medical treatment during work hours may claim compensation for lost wages while undergoing or traveling to and from treatment 22

CA-7 (Claim for Compensation) An employee who uses annual or sick leave to avoid interruption of income may repurchase that leave, subject to agency concurrence, if the claim is approved Claim for compensation of loss wages Request Schedule awards for permanent impairment 23

CA-16 Authorization for Examination Covers the member for medical billing purposes for 60 days of coverage. Form is used for injuries requiring follow up treatment. Member / Supervisor completes first copy, Provider completes second copy, forward back to HRO. 24

CA-17 (Duty Status Report) Interim medical report about employee’s fitness for duty and work capabilities May be issued initially with CA-16 Supervisor/Agency completes agency portion by describing physical requirements of the employee’s job and noting the availability of light or limited duty Agency can send to physician at any time during life of claim – but not more than once a week 25

CA-20 (Attending Physician’s Report) Submitted to OWCP along with CA-7 for wage loss or leave buy back Requests information on diagnosis, prognosis, history of injury, prima facie statement of causal relationship, etc. 26

Challenging Validity of Claim Investigate circumstances and report results to HRO Include specific evidence: witness statements, accident investigations, timecards Must be supported by specific factual evidence Attach detailed statement describing circumstances behind challenge 27

APPEAL RIGHTS ORAL HEARING WITHIN 30 DAYS RECONSIDERATION WITHIN 1 YR ECAB APPEAL BOARD WITHIN 180 DAYS FROM DATE OF DECISION 28

PENALTIES Anyone who knowingly and willfully falsifies, conceals or covers up a material fact; Makes a false, fictitious, or fraudulent statement or representation may be subject to these penalties: A. FINE B. 10 YEARS IMPRISONMENT C. BOTH 29

Initiating a Claim for Death Benefits When an employee dies because of an injury incurred in the performance of duty, the supervisor/agency should immediately notify the district office via phone or fax The supervisor/agency should contact any survivors, provide them with claim forms, and help them prepare the claim CA-5 or CA-5b used to submit claims for death benefits Supervisor/Agency uses form CA-6 to report the work-related death of an employee 30

Containing OWCP Costs Challenge Questionable Claims –OWCP accepts employee statement as factual unless agency provides refuting evidence –Agency does not have post adjudicative appeal rights –Include actual evidence rather than conjecture or opinion 31

Containing OWCP Costs Offer Light Duty –Match employee’s physical limitations to your particular position needs –Can be reassigned to temporary position –Benefits of offering light duty: improves morale for both injured worker and remainder of workforce each day employee remains out of work reduces likelihood s/he will ever return 32

QUESTIONS? 33

AGENCY WEBSITE General information on OWCP: ACS website (bill processing and authorization information): ACS Customer Service: (850) ACS Bill payment/reimbursement/authorizations: (866) Your Injury Compensation Program Administrators (ICPA): SGT Stephen Clemente OWCP Additional Information