Federal Workers’ Compensation First Line Supervisor Course. Gold Nuggets Of Medical Issues. February 25-27, 2014 Phoenix, AZ. David L. Hull, MBA Program Manager Federal Workers’ Compensation Program U.S. Department of Veterans Affairs.
First Line Supervisor Course
February 25-27, 2014 Phoenix, AZ
David L. Hull, MBA
Federal Workers’ Compensation Program
U.S. Department of Veterans Affairs
1. Is the medical condition work-related or non-work-related?
Work-related injuries are covered by the Federal Employees Compensation Act (FECA) and the rules to follow are found in 20 CFR Part 10. It does not matter if the HR Specialist, supervisor or manager feels like the condition is NOT work-related, these rules must be followed if the employee CLAIMS the condition is work-related. The Office of Workers Compensation Programs, U.S. Department of Labor, will make all decisions regarding claims of work-related medical conditions.
2. Does the medical condition define the employee as a 'qualified handicapped employee under the Americans With Disabilities Act as Amended (ADAAA)?
Non-work-related medical conditions, where the employee requires modification of their job to accommodate a significant disability is covered by the Americans With Disabilities Act as Amended (ADAAA) and 29 CFR 1614.203. In order to be entitled to coverage under this statute, the employee must suffer from a medical condition that 'substantially impairs a major life function'.
3. Does the employee's position have properly established medical qualifications or physical requirements?
For those Federal employees who hold positions that require medical qualifications or physical requirements, maintenance of certain heath criteria is mandatory to hold their position. These medical qualification requirements may be found in the Office of Personnel Management's Operating Manual, Section VI or in the Human Resources section of the employing agency for those standards that were developed locally.
Remember, granting benefits or accommodations to employees who do not qualify, results in reduced staffing efficiency; reduced morale in employees who must perform the work of the employee receiving unearned benefits; and may well cause discrimination complaints of disparate treatment by other employees who were not afforded similar benefits for similar reasons.
5 USC 8145 - The Secretary, U.S. Department of Labor, through the Director, Office of Workers’ Compensation Programs (OWCP), has the exclusive authority to administer, interpret and enforce the provisions of the Federal Employee Compensation Act (FECA).
To provide compensation and medical benefits to civilian employees of the federal government for personal injury or illness sustained while in the performance of duty.
FECA ≠ Retirement
U.S. POSTAL SERVICE$1,305,072,082
DEPARTMENT OF THE NAVY$ 222,803,441
DEPARTMENT OF VETERANS AFFAIRS $ 199,368,470
DEPARTMENT OF THE ARMY$ 166,731,441
HOMELAND SECURITY $ 183,968,314
DEPARTMENT OF THE AIR FORCE $ 126,470,302
DEPARTMENT OF JUSTICE $ 115,768,099
DEPARTMENT OF TRANSPORTATION $ 93,651,731
DEPARTMENT OF AGRICULTURE $ 72,364,968
DEPARTMENT OF DEFENSE$ 66,517,347
DEPARTMENT OF THE INTERIOR $58,871,646
DEPARTMENT OF TREASURY $55,002,740
TENNESSEE VALLEY AUTHORITY $46,824,653
SOCIAL SECURITY ADMINISTRATION $25,601,751
HEALTH AND HUMAN SERVICES $27,225,954
DEPARTMENT OF LABOR $18,154,430
DEPARTMENT OF COMMERCE $17,032,174
GENERAL SERVICES ADMINISTRATION$13,169,364
PEACE CORPS $14,591,288
U.S. DEPARTMENT OF ENERGY $9,219,999
HOUSING AND URBAN DEVELOPMENT $7,285,615
DEPARTMENT OF STATE $9,435,510
FEDERAL JUDICIARY $7,061,743
GOVERNMENT PRINTING OFFICE $5,367,160
SMITHSONIAN INSTITUTION $4,460,990
ENVIRONMENTAL PROTECTION AGENCY $4,509,635
DEPARTMENT OF EDUCATION $1,677,212
CORP. FOR NATIONAL & COMMUNITY SVC $1,033,106
EXECUTIVE OFFICE OF THE PRESIDENT $1,001,204
Total compensation and medical bills paid for all injured Federal employees in chargeback year 2011:
An increase of $78,561,259 over 2012
In seeking benefits under FECA, there are five essential elements of an acceptable claim and the employee/claimant has the burden of providing the facts that establish these elements. They are:
Timely filed - The claim was timely filed within the applicable time limitation period of the Act;
Civil Employee - The individual is an "employee of the United States" within the meaning of FECA;
Fact of Injury – Occurrence of event and resulting medical condition
Performance of Duty - An injury was sustained in the performance of duty as alleged;
Causal Relationship - Disability and/or a specific condition for which compensation is claimed is causally related to Federal employment.
Was the injury caused by:
These are Statutory Bars to Coverage
“An employee who is separated for misconduct and whose removal is wholly unconnected to the work-related injury is not entitled to further compensation benefits.”
OWCP Publication CA-810, Chapter 8, paragraph 8-9
In all cases, a medical report from the attending physician should include:
(a) Dates of examination and treatment;
(b) History given by the employee;
(c) Physical findings;
(d) Results of diagnostic tests;
(f) Course of treatment;
(g) A description of any other conditions found but not due to the claimed injury;
(h) The treatment given or recommended for the claimed injury;
(i) The physician's opinion, with medical reasons, as to causal relationship between the diagnosed condition(s) and the factors or conditions of the employment;
(j) The extent of disability affecting the employee's ability to work due to the injury;
(k) The prognosis for recovery; and
(l) All other material findings.
20 CFR 10.330
An acceptable diagnosis must include the following information:
(a) The history of the medical condition, including references to findings from previous examinations, treatment, and responses to treatment;
(b) Clinical findings from the most recent medical evaluation, including any of the following, which have been obtained: findings of physical examination; results of laboratory tests; X-rays; EKGs and other special evaluations or diagnostic procedures.
(c) Diagnosis, including the current clinical status;
(d) Prognosis, including plans for future treatment and an estimate of the expected date of full or partial recovery;
(e) An explanation of the impact of the medical condition on overall health and activities, including the basis for any conclusion that restrictions or accommodations are or are not warranted, and where they are warranted, an explanation of their therapeutic of risk avoiding value;
(f) An explanation of the medical basis for any conclusion that indicates the likelihood that the individual is or is not expected to suffer sudden or subtle incapacitation by carrying out, with or without, accommodation, the tasks or duties of a specific position.
(g) Narrative explanation of the medical basis for any conclusion that the medical condition has or has not become static or well stabilized and the likelihood that the individual may experience sudden or subtle incapacitation as a result of the medical condition.
(g) continued - Subtle incapacitation means gradual, initially imperceptible impairment of physical or mental function, whether reversible or not, which is likely to result in performance or conduct deficiencies. Sudden incapacitation means abrupt onset of loss of control of physical or mental function.
5 CFR 339.104
Oftentimes, medical information provided by an employee, does not provide sufficient detail with which the employer might construct light duty offers, alternate duty assignments, or modifications to existing positions, that would meet the employee’s physical limitations.
5 CFR Part 339
5 CFR 339.301 (c)
5 CFR 339.303 (a)
5 CFR 339.303 (b)
5 CFR 339.303 (b)
5 CFR 339.304
20 CFR 10.502
“A person who claims benefits has the burden of establishing the essential elements of his claim, including the fact that he sustained an injury while in the performance of duty, and that he had disability as a result. As part of this burden the employee must presentrationalized medical opinion evidence, based on a complete factual and medical background, showing a causal relationship between the injury and the disability.”
Daniel R. Hickman, 34 ECAB 1220(1983)
“Agency Medical Exams must be processed correctly and in accordance with applicable statutes and regulations. There must be a logical, work-related basis for all requests for Agency Medical Exams and other medical information, lest the employing agency be found guilty of discrimination.”
Bell v. Henderson (Postmaster General) EEOC Appeal #01974429 3/6/00
“Where a person has a pre-existing condition which is not disabling, but which becomes disabling because of aggravation causally related to the employment, then regardless of the degree of such aggravation, the resulting disability is compensable. If the medical evidence reveals that an employment factor contributes in any wayto the employee's condition, the condition is considered to be employment related.”
Arnold Gustafson, 41 ECAB 131 (1989)
“A claimant may not use the EEO process to launch a collateral attack on the workers compensation process.”
Story v USPS, EEOC 05960314 (10/18/96)
“The Commission has recognized that an agency has the right to represent its position and interest in the OWCP Forum, and will not review decisions, which would require it to judge the merits of a workers compensation claim.”
Hogan EEOC 05940407
The Commission stated: “…it is well established that an Agency has an obligation to controvert an employee’s workers compensation claim where there is a dispute as to the employee’s entitlement.”
Andel v. USPS EEOC 01975337
Non-work-related medical conditions
29 CFR 1614.203
“Employing Agencies should ensure that a documented review of the provisions relating to Reasonable Accommodation is prepared, particularly with regard to work-related aggravations of pre-existing medical conditions. Such a review may aid in the determination as to whether the employee is eligible for permanent accommodation under disability laws, should the medical condition prove to be severe enough to warrant such a review.” 29 CFR 1614.203
In support of a claim for compensation, the employee is responsible for submitting, or arranging for the submittal of:
The need for __________ medical information is paramount.
The causal relationship between a medical condition and factors of employment:
Brief medical notes, such as 'Off work six weeks', written on prescription note pads, are acceptable forms of evidence for employees seeking workers' compensation benefits.
A benefit for Federal employees is that they must be given a different job when he or she can simply no longer perform the job for which hired, if they become medically disabled.
Who is responsible for establishing the essential elements of the claim?