ICPA Coordinator Kay Edenburn Phone: 801.432.4243 FAX: 801.432.4700 Email: nguthro-hrs(owcp)@us.army.mil

1. ICPA Coordinator Kay Edenburn Phone: 801.432.4243 FAX: 801.432.4700 Email: nguthro-hrs(owcp)@us.army.mil

2. FECA Federal Employees’ Compensation Act • Provides compensation benefits to civilian employees and National Guard Technicians, both permanent and temporary of the U.S. federal government for disability due to traumatic injury or disease or illness in performance of duties • Provides payment of benefits to dependents for work-related death of an employee as a result of traumatic injury or occupational disease/illness • FECA provides exclusive remedy for work-related injury, disease, or death

3. DOL Department of Labor • Administers OWCP for all federal agencies • Accepts or denies claims • Adjudicates all claims • Provides for payment of claims

4. ICPA Coordinator Injury Compensation Program Administrator • Assists in submission of claims • Acts as the liaison between employee, supervisor and the DOL • Informs employees and supervisors of program benefits and requirements

5. RESPONSIBILITIES • Contact ICPA immediately of injured employee and request CA-16 Authorized for Examination And/Or Treatment • Complete and submit forms in timely manner through Electronic Data Interchange (EDI) • CA-1 and CA-2 within ten days of receipt • CA-7 within five days of receipt • Encourage safe work habits and conditions and enforce safety regulations • Advise employees on rights and responsibilities • Encourage reporting of incidents • Publicize the OWCP and employees’ responsibilities under it • Continue pay in traumatic injuries Supervisors

6. RESPONSIBILITIES • Assist employees in returning to work • Represent the agency’s interest • Challenge questionable claims • Keep in contact with employee • Help manage compensation costs • Coordinate return to work with doctor and accommodate “light duty” work when able • Coordinate personnel actions with HRO • Track Injured Employee’s Medical Status and availability for work • Investigate incidents; obtain statements; controvert questionable claims Supervisors

7. RESPONSIBILITIES • Observe health and safety regulations • Report potential and actual health, safety, and fire hazards • Report all injuries to supervisor • Obtain medical status reports from physician(s) • Provide medical provider with Claim Number • Cooperate with light duty placement • It is the claimant responsibility to monitor his/her own claim, just as he/she would if it were an insurance claim • Check the status on their bills through ACS-Web Billing Process Portal Employees

8. The FIVE provisions for filing a claim • EMPLOYMENT • TIMELINESS • PERFORMANCE OF DUTY • FACT OF INJURY • CAUSAL RELATIONSHIP

9. The FIVE provisions for filing a claim EMPLOYMENT Must be a Federal Technician at the time of injury TIMELINESS Notice of injury/disease must be filed within statutory time (3 years from the date of incident or exposure, or the date of awareness of a work relationship

10. The FIVE provisions for filing a claim PERFORMANCE OF DUTY Must have been in performance of official duties at time of incident NOT COVERED COVERED • Horseplay/assault • Recreational injuries • Travel to and from work w/fixed place of employee and fixed hours of work is NOT covered • Industrial premises • Performing assigned duties • Engaged in activities which are reasonable incidents of employment • TDY • Physical Training

11. The FIVE provisions for filing a claim FACT OF INJURY Must be able to identify the factors which caused in injury/disability • FACTUAL – Did the employee experience the incident? • MEDICAL – Does the employee have a diagnosed condition as a result of the incident? CAUSAL RELATIONSHIP Must prove federal employment cause – based on medical evidence from a physician who performed examination or provided treatment

12. The TWO types of injuries • TRAUMATIC INJURY • OCCUPATIONAL DISEASE/ILLINESS

13. TRAUMATIC INJURY • A wound or other condition of the body caused by external force, including stress or strain. • The injury must be identifiable by time and place of occurrence, and the member or function of body affected, and must be caused by a specific event or incident within a single day or work shift.

14. OCCUPATIONAL DISEASE/ILLNESS A condition produced by - - systemic infections; - continued or repeated stress or strain; - exposure to toxins, poisons, fumes, etc.; - other exposure to conditions of the work environment for two or more work shifts.

15. DOCUMENTATION For Traumatic Injury Cases: • CA1 Federal Employee’s Notice of Traumatic Injury and Claim for Continuation Pay/Compensation (electronically) • CA 7 Claim for Compensation (electronically) • CA 7aTime Analysis Form • CA 7b Leave Buy Back Worksheet • CA16 Authorization for Examination And/Or Treatment • CA17 Duty Status Report • CA 20 Attending Physician’s Report • CA 2Notice of Recurrence

16. DOCUMENTATION For Occupational Disease/Illness: • CA2 Notice of Occupational Disease • CA35 Series Specialized Occupational Disease Checklist • (It is the employee responsibility to gather documentation) • CA20 Attending Physician’s Report • CA2a

17. OWCP Benefits • Medical expenses (fee schedule) • First aid expenses • Rehabilitation • Chiropractic care (limited) • (manual manipulation of the spine to correct a subluxation as demonstrated by X-ray to exist) • Assisted Reemployment Program (Theraputic & Vocational Rehabilitation)

18. OWCP Benefits (Con’t) • Early nurse intervention • Continuation of Pay (COP) • Compensation for Lost Wages • Scheduled Benefits • Permanent Total Disability • Death Benefits

19. CA Form 16 • This form is only available from your ICPA (Injury Compensation Program Administrator) PURPOSE OF CA-16 Form CA-16 guarantees payment to the original treating physician (or any physician to whom the original treating physician refers the employee) for 60 days from date of issuance, unless OWCP terminates this authority at an earlier date. EMERGENCY In an emergency, where there is no time to complete CA-16, The supervisor may authorize medical treatment verbally and then request CA-16 from ICPA within 48 hours. The supervisor will then forward the CA-16 and other documentation to the medical facility and provide the IPCA with completed documentation. NOT ALLOWED Retroactive issuance of the CA-16 is not allowed under any other circumstance. Issuing of CA-16 if more than a week has passed since the injury, is not allowed.

20. If it is a life or death situation • dial 911 • for the Air National Guard base 117 or 911 Basic Information needed to issue CA Form 16 • Employee’s Last Name, First Name, MI • Date of injury • Employee’s Occupation • Brief description of injury I will then email approved CA Form 16 to include page 2 and CA Form 17 with all instructions (Supervisor’s will insure that blocks 8 & 9 on page 1 of CA Form 16 are completed and given to employee). If I am TDY or on vacation contact COL Burckle, MAJ Lock or Mr. Groves my District Manager. or email:NGUTHRO-HRS(OWCP)

21. Form CA-16 Packet EXAMPLE EXAMPLE Supervisor’s Signature Supervisor’s Title Only a Medical Doctor (M.D.) signature is acceptable

22. Form CA-16 Packet (Con’t) EXAMPLE EXAMPLE

23. Form CA-16 Packet (Con’t) EXAMPLE EXAMPLE

24. Form CA-16 Packet (Con’t) Return completed CA16 page 1 and 2 Completed CA 17 and any other documentation received from the Medical Provider to ICPA Coordinator as soon as possible REMINDER Only a Medical Doctor (M.D.) signature is acceptable on all medical documents

25. Forms required for follow-up appointments CA17 and CA20 The employee must ensure that he/she has the Medical Provider complete CA17 and CA20 REMINDER Only a Medical Doctor (M.D.) signature is acceptable on all medical documents

26. FOLLOW-UP VISITS If an employee requires follow up visits, his/she must have in there possession CA-17 and CA20. Medical provider must complete there portion (reminder only a Medical Doctor (MD) signature is acceptable) on the above documents. Ensure ICPA Coordinator is provided a copy, documentation will be forward to Department of Labor for further processing. EXAMPLE EXAMPLE

27. Filing Claims using Electronic Data Interchange • DoD Civilian Personnel Management Service • Injury and Unemployment Compensation Division

28. EDI Electronic Data Interchange • It has been DoD policy since July 2003 to utilize EDI when submitting claims • DOL will be monitoring agency timeliness for claim submission as a result of POWER • Defense Safety Oversight Council (DSOC) will be monitoring DoD agency timeliness and use of EDI for claim submission

29. Safety First Electronic Reporting (SAFER) • DOL has made a determination as to which claim data can be shared with an organization’s safety office in order to assist in fulfilling OSHA reporting requirements • EDI/SAFER provides the data to safety in the form of an OSHA 301 notice. This 301 notice provides safety with the data they need to start their reporting and investigations

30. EDI INFORMATION FLOW • Employee reports the injury to his/her supervisor • Supervisor and employee complete the electronic form, which is transmitted to the ICPA. Supervisors do not need any special access to file the claim electronically, only a computer with internet access • Supervisor prints completed CA1

31. EDI INFORMATION FLOW • Injured employee and supervisor sign the printed copy of CA1 • Supervisor electronically submits claim for processing • ICPA receives an email notification of the claim submission • IPCA will review and enters appropriate codes and corrects any errors. If there is an error a corrected copy of CA1 will be sent to supervisor and injured employee for signatures

32. EDI INFORMATION FLOW • IPCA will then forward claim to OWCP • IPCA will receive, via email, a copy of the OSHA 301 and forward to the appropriate Safety Office, injured employee and supervisor via email • OWCP receives claim, validates data and submits data to District OWCP for a claim number assignment

33. EDI INFORMATION FLOW • ICPA will receive an email with the claim number within 2-3 business days and provide the injured employee and supervisor the claim number via email • It is the injured employee responsibility to provide the medical provider the claim number for billing purposes

34. Employee reports the injury to his/her supervisor Supervisor and Employee complete the On-Line initiating claim form Supervisor prints completed form CA1 Injured employee signs the printed copy for employee file Supervisor electronically submits claim for processing The ICPA is notified that a claim is awaiting authentication IPCA receives OSHA 301 and forwards to Safety Supervisor and injured employee ICPA reviews the claim for accuracy, enters appropriate codes, corrects any errors and authenticates the claim Claim is forwarded to OWCP OWCP receives claim, validates data, and submits data to District OWCP for case number assignment ICPA will receive claim number and forward to supervisor and injured employee via email EDI – Electronic Data Interchange

35. On-line CA-1/CA-2 NO hand written, typed or emailed CA-1 or CA-2 will be accepted ALL CA-1 and CA-2 must be done electronically http://www.cpms.osd.mil/icuc

37. Select OK in order to access the application

38. When the initial claim entry screen appears, the employee’s SSN and DOB will be entered and type of claim form will be selected Select Enter Claim

39. Check both blocks if married and have children under 18 • White fields are required to be filled in • Yellow fields are optional and do not have to be filled in • Gray fields are informational and cannot have data entered into them Some fields require the data entered to be in a particular format. For example, phone numbers should be entered without using any () or -

40. If data is entered into a field using the wrong format, the application will not let the user move forward until the data is correctly entered. A message will be provided at the bottom of the screen to inform the user as to what needs to be done to fix the format problem.

41. The date you have entered the EDI system to create CA1 The employee’s information will be entered into the system. Pay particular attention to fields that require a date and time such as Block 10. If no time is entered in the block, the time will default to 12:00 am. DO NO USE MILITARY TIME

42. Block 13 Cause of Injury GOOD NOT SO GOOD • I as acquiring parts for the job order for the front end loader, I had to walk from the wash rack to the parts rack which is located outside the building. Due to snow and ice in and around the area I slipped and fell injuring my lower back • While walking between the maintenance shops, I slipped on an icy surface and fell backwards and landed on my back

43. Block 13 Cause of Injury GOOD NOT SO GOOD • I was playing basketball a authorized sport physical activity. I jumped for the ball and landed on someone else’s foot and rolled my left ankle • I was playing basketball and hurt my ankle

44. Block 14 Nature of Injury GOOD NOT SO GOOD • Sprain right ankle • Smashed right index finger • Laceration on left side of head • Ankle • Right finger • Cut on head

45. The employee then elects whether to use Continuation of Pay and enters the date that the claim is being entered into the EDI application

46. Enter a witness statement in this space • The witness will sign the statement when the claim form is printed • If there is no statement, leave this space blank • If the statement will not fit into the space annotate “witness statement forwarded under separate cover” in this space and fill out the witness information • Send the separate signed witness statement to the ICPA

47. Enter the required information in the appropriate fields. Paying attention to the format for data entry DO NO USE MILITARY TIME The date the employee notified supervisor of injury

48. If the supervisor does not believe the employee was injured in performance of duty, “no” should be checked and the facts that support that position should be provided . Otherwise leave the box checked “yes.” If the supervisor believes that willful misconduct was involved, “yes” should be checked and the facts that support this position provided. Otherwise leave the box checked “no”

49. Example of a third party claims would be an automobile accident in which the other driver was found to be at fault You should not have employee’s medical records due to the HEPPA act CHECK If the individual was treated at an agency facility the information in Block 32 must be provided (unique to EDI/SAFER)

50. If the agency wishes to challenge the claim, then “no” must be selected for this item and the reasons for the challenge entered into this space Enter the reason for the controversion of COP in this space.