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Injury Compensation Specialist. Training. By Eileen Padar and Janet Sonera. FECA Overview. Federal Employees’ Compensation Act passed in 1916.

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injury compensation specialist

Injury Compensation Specialist

Training

By

Eileen Padar

and

Janet Sonera

feca overview
FECA Overview
  • Federal Employees’ Compensation Act passed in 1916.
  • Provides compensation to civilian employees of the US for disability due to personal injury or disease sustained in the performance of duty.
  • Provides benefits to dependents if a work-related injury or disease causes death.
feca overview1
FECA Overview
  • Funded through agency charge-backs.
  • Remedial in nature.
  • Non-adversarial – an attorney is not required.
  • Sole remedy – a federal employee or surviving dependent is not entitled to sue the US or recover damages for injury or death under any other law.
feca overview2
FECA Overview
  • Administered by the Department of Labor, Office of Workers’ Compensation Programs, Division of Federal Employees’ Compensation.
  • National Office Organization.
  • OWCP adjudicates the claim.
  • 12 District offices.
feca overview3
FECA Overview
  • Individual cases are protected under the Privacy Act – only the employee, his/her representative and agency personnel may routinely have access to information concerning the compensation claim.
  • HIPAA does not apply to OWCP or employing agencies as it relates to information concerning the compensation claim.
  • No one may require an employee or other claimant to waive his/her right to claim benefits.
traumatic injury
Traumatic Injury
  • Wound or other condition of the body caused by external force, including stress or strain.
  • Caused by a specific event or series of events or incidents within a single work day or work shift.
slide7
CA-1
  • 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 10 work days from the date the agency received it.

DO NOT HOLD!

ca 1 agency responsibilities
CA-1 – Agency Responsibilities
  • Review for completeness.
  • Authorize medical care.
    • Form CA-16
  • Advise employee of the right to elect COP.
  • Advise employee of his/her responsibility to submit medical evidence.
medical ca 16
Medical – CA-16
  • Shall be issued within 4 hours of the claimed injury.
  • If verbal authorization is given, must be issued within 48 hours.
  • Not required to issue more than one week after the date of injury.
  • Should not be issued for Occupational Disease claims (CA-2)
medical treatment
Medical - Treatment
  • Emergency
    • When an employee sustains a work-related traumatic injury that requires medical examination, medical treatment or both, the employer shall authorize such examination and/or treatment by issuing a Form CA-16.
  • Choice of Physician
    • The employee has the right to choose their own physician.
occupational disease
Occupational Disease
  • Condition attributable to exposure to work factors over a period longer than one work day or shift.
  • COP is not provided.
  • CA-16 is not issued.
slide15
CA-2
  • Must be submitted to employing agency within 3 years of the date when the employee becomes aware, or reasonably should have been aware, of a possible relationship between the medical condition and the employment, or the date of last exposure.
  • Must be transmitted to OWCP within 10 work days from the date the agency received it.

DO NOT HOLD!

slide16
CA-2
  • Checklist
    • CA-35a – Occupational Disease in General
    • CA-35b – Hearing Loss
    • CA-35c – Asbestos-Related Illness
    • CA-35d – Coronary / Vascular Condition
    • CA-35e – Skin Disease
    • CA-35f – Pulmonary Illness (Not Asbestosis)
    • CA-35g – Psychiatric Illness
    • CA-35h – Carpal Tunnel Syndrome
ca 2a
CA-2a
  • No medical treatment is authorized at OWCP expense until the claim is adjudicated.
  • If employee was entitled to COP and 45 calendar days of COP have not been exhausted, he/she may elect to use remaining days, as long as 45 days have not elapsed since the first return to work.
  • Employee may use sick or annual leave pending adjudication of claim.
conditions of coverage
Conditions of Coverage
  • Time
  • Civilian Employee
  • Fact of Injury
  • Performance of Duty
  • Causal Relationship
conditions of coverage time
Conditions of CoverageTime
  • Employee has three years from:
    • Date of Injury
    • Date of First Awareness
    • Date of Last Exposure
conditions of coverage civilian employee
Conditions of CoverageCivilian Employee
  • FECA covers all civilian employees except for non-appropriated fund employees.
  • Temporary employees covered on the same basis as permanent employees.
  • Contract employees, volunteers, and loaned employees are covered under some circumstances.
conditions of coverage fact of injury
Conditions of CoverageFact of Injury
  • Factual – Actual occurrence of an accident, incident, or exposure in time, place, and manner alleged.
  • Medical – A medical condition diagnosed in connection with that accident, incident or exposure.
conditions of coverage performance of duty
Conditions of CoveragePerformance of Duty
  • Injury occurred while performing assigned duties or engaging in an activity reasonably associated with the employment.
  • Injury occurred on work premises.
    • Use of facilities for personal comfort.
    • Includes parking facilities owned by employer.
    • Coverage extended for a reasonable time before or after work hours.
conditions of coverage performance of duty1
Conditions of CoveragePerformance of Duty
  • Injury occurred off premises while engaging in work activities.
    • Employees are not covered en route between work and home unless the agency furnishes transportation, the employee is required to travel during a curfew or emergency or the employee is required to use their personal vehicle during the work day.
conditions of coverage performance of duty2
Conditions of CoveragePerformance of Duty
  • Other factors
    • Recreation
    • Horseplay
    • Assault
    • Harassment or Teasing
    • Idiopathic Falls
    • Emergencies
    • Union Representation
conditions of coverage performance of duty3
Conditions of CoveragePerformance of Duty
  • Recreation: an employee is considered in the performance of duty while engaged in formal recreation when either the employee is paid for participating or the recreational activity is required and prescribed as a part of the employee’s training or assigned duties.
conditions of coverage performance of duty4
Conditions of CoveragePerformance of Duty
  • Horseplay: an employee is considered to be in the performance of duty if the horseplay was of a character that could reasonably be expected where workers are thrown into personal association for extended periods of time.
conditions of coverage performance of duty5
Conditions of CoveragePerformance of Duty
  • Assault: an employee is considered to be in the performance of duty if the assault was accidental or arose out of an activity directly related to the work or work environment. An assault is not compensable if it arose out of a personal matter having no connection with the employment.
conditions of coverage performance of duty6
Conditions of CoveragePerformance of Duty
  • Harassment / Teasing: Employees who are harassed, teased or called derogatory names by coworkers are considered to be in the performance of duty provided that the reasons for the harassment or teasing are not imported into the employment from the employee’s domestic or private life.
conditions of coverage performance of duty7
Conditions of CoveragePerformance of Duty
  • Idiopathic Falls: Defined as one where a personal, non-occupational pathology causes an employee to collapse.

Injuries that can be attributed to the intervention or contribution of some hazard or special condition of the employment, including normal furnishings of an office or other workplace are compensable.

conditions of coverage performance of duty8
Conditions of CoveragePerformance of Duty
  • Emergencies: Coverage is extended to employees who momentarily step outside the sphere of their employment to assist in an emergency such as to extinguish a fire or help a person hit by a car.
conditions of coverage performance of duty9
Conditions of CoveragePerformance of Duty
  • Emotional Reaction: an employee who suffers from a medical condition resulting from factors of employment that result in an emotional reaction can be considered to be in the performance of duty.
    • Personnel actions such as the regular administrative functions of an agency (leave usage, disciplinary actions, etc.), performance ratings, performance assessments and informal discussions of performance, standing alone, are not sufficient to provide coverage under the FECA. For a personnel action to be compensable, the employee must establish an error or abuse of administrative authority by the agency. Without this showing, the emotional reaction is considered to be self-generated.
conditions of coverage statutory exclusions
Conditions of CoverageStatutory 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.
conditions of coverage causal relationship
Conditions of CoverageCausal 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.
conditions of coverage causal relationship1
Conditions of CoverageCausal Relationship
  • Direct Causation – injury or factors of employment result in condition claimed through natural and unbroken sequence.
  • Aggravation – preexisting condition worsened, either temporarily or permanently, by a work-related injury.
  • Acceleration – a work-related injury or disease may hasten the development of an underlying condition.
  • Precipitation – a latent condition that would not have manifested itself on this occasion but for the employment.
medical benefits
Medical Benefits
  • Treatment
  • CA-16
  • Preventive Care
  • Physical Therapy
  • Chiropractors
  • Surgery
  • Attendant Allowance
  • Weighing Evidence
  • Termination of
medical benefits treatment
Medical Benefits - Treatment
  • Medical services, appliances or supplies necessary to treat the work related injury.
  • Any qualified physician or hospital may provide such services, appliances and supplies.
medical physical therapy
Medical – Physical Therapy
  • Physical Therapy is authorized if prescribed by the treating physician.
  • PT is authorized for a period of 120 days from the date of injury.
  • Additional justification needed if exceeds 120 days.
    • Specific modalities.
    • Diagnosis for which therapy is administered.
    • Specific functional deficits which are to be treated.
    • Expected duration and frequency of the treatment.
    • Specific functional goals of the additional therapy.
medical chiropractors
Medical - Chiropractors
  • The services that may be reimbursed are limited to manual manipulation to correct a spinal subluxation.
    • Cost of testing performed by or required to diagnose such a subluxation are also payable.
  • A chiropractor may also provide services in the nature of physical therapy under the direction of a qualified physician.
medical surgery
Medical - Surgery
  • Emergency Surgery: Any procedure which needs to be performed promptly after the onset of a condition or injury in order to preserve life or function of an organ or body part.
  • Elective Surgery: Any procedure which is necessary for the adequate function of an organ or body part, but which does not need to be performed promptly after the onset of the condition in order to achieve its purpose.
medical surgery1
Medical - Surgery
  • Emergency
    • No prior authorization is required
  • Elective
    • Prior authorization is required.
      • Requires the name of the procedure; diagnosis of the condition; the type of surgery; and the reason surgery is needed.
      • Second opinion examination may be necessary.
medical attendant allowance
Medical – Attendant Allowance
  • OWCP will pay for the services of an attendant up to a maximum of $1,500 per month, where the need for such services has been medically documented.
medical weighing evidence
Medical – Weighing Evidence
  • District Medical Adviser
  • Second Opinion
  • Independent Medical Exam
medical weighing evidence1
Medical – Weighing Evidence
  • District Medical Adviser
    • Used when the Claims Examiner needs medical guidance to weigh the reports in file.
      • Evaluation of medical evidence and rendering of medical opinion.
      • Interpretation and clarification of other physician’s reports.
      • Has no authority to decide the facts in a case.
      • May create a conflict in medical opinion necessitating referee evaluation.
      • May represent the weight of medical evidence for Schedule Award claims.
medical weighing evidence2
Medical – Weighing Evidence
  • Second Opinion
    • Employee must submit to examination.
    • Employee may have a qualified physician, paid by him or her, present at examination.
    • Employee is not entitled to have any one else present unless authorized by OWCP.
    • OWCP may send a case file for a second opinion review where actual examination is not needed.
    • A physician who performed a fitness for duty for an Agency can not be considered a second opinion specialist.
medical weighing evidence3
Medical – Weighing Evidence
  • Referee Examination
    • A difference in medical opinion sufficient to be considered a conflict occurs when two reports of virtually equal weight and rationale reach opposing conclusions.
    • If a conflict exists between the medical opinion of the treating physician and the medical opinion of either a second opinion physician or an OWCP Medical Advisor, OWCP shall appoint a third physician to make an examination.
medical weighing evidence outcomes
Medical – Weighing Evidence – Outcomes
  • Based on its determination of the weight of the medical evidence, OWCP may:

-establish the work tolerance limitations;

-deny, terminate or reduce wage loss compensation;

-deny or terminate medical benefits;

-resolve other claims issues that hinge on medical evidence.

medical termination of
Medical – Termination of
  • OWCP may terminate medical benefits when:
    • Medical documentation supports that there is no need for further treatment.
    • Medical documentation supports that the effects of the work-related condition have ceased.
    • Employee has been convicted of fraud against the FECA.
recurrence
Recurrence
  • A spontaneous return of symptoms or increase of disability due to a previous injury or occupational disease without intervening cause, or a return or increase of disability due to a consequential injury.
  • A recurrence of a medical condition is defined as a documented need for further medical treatment for the accepted condition or injury when there is no accompanying work stoppage.
  • Wage loss resulting from the withdraw of light duty accommodation.
  • No event other than the previous injury accounts for the disability.
continuation of pay
Continuation of Pay
  • Definition
  • Eligibility
  • Calculation
  • Controversion
continuation of pay definition
Continuation of Pay - Definition
  • The continuation of the employee’s regular pay for a period not to exceed 45 calendar days of disability.
  • COP is not considered compensation and therefore is subject to income taxes, retirement and other usual payroll deductions.
continuation of pay eligibility
Continuation of Pay - Eligibility
  • Must file for a traumatic injury.
  • Must file the CA-1 within 30 days of the date of injury
  • Must begin losing time from work within 45 days of the injury.
  • May resume using unused COP within 45 days after the first return to work.
continuation of pay calculation
Continuation of Pay - Calculation
  • The pay rate for COP purposes is equal to the employee’s regular weekly pay rate.
  • Excludes overtime pay, but includes other applicable extra pay except to the extent prohibited by law.
  • Changes in pay which would have otherwise occurred during the 45 day period are to be reflected. (i.e., promotion, demotion, step increases)
continuation of pay calculation1
Continuation of Pay - Calculation
  • Full Time/Part Time – Regular Schedule
  • Part Time – Irregular Schedule
  • Intermittent, Seasonal, On-Call
cop controversion
COPControversion
  • The disability was not caused by a traumatic injury;
  • The employee is not a citizen of the United States or Canada;
  • No written claim was filed within 30 days from the date of injury;
  • The injury was not reported until after employment had been terminated;
  • The injury was not sustained while in the performance of duty;
  • The injury was caused by the employee’s willful misconduct, intent to injure or kill him/herself or another person, or was proximately caused by intoxication by alcohol or illegal drugs; or
  • Work did not stop until more than 45 days following the injury.
wage loss cola
Wage Loss – COLA
  • An injured employee is eligible for cost-of-living adjustments where injury related disability began more than one year prior to the date the cost-of-living adjustment took effect.
    • Each year, on March 1, the increase in the cost-of-living for the preceding calendar year is determined. If the injured employee has been entitled to compensation for at least one year before March 1, a cost-of-living increase is applied to the benefits.
wage loss termination of
Wage Loss – Termination of
  • Once OWCP accepts a claim, it has the burden of justifying termination of compensation benefits.
    • If compensation benefits are terminated, the right to medical benefits is not necessarily affected.
wage loss termination of1
Wage Loss – Termination of
  • Fraud Conviction
  • Refusal of Suitable Employment
  • Abandonment of Suitable Employment
  • Medical Evidence supports that the injured employee is no longer disabled from work
  • Employee has been restored to full Earning Capacity
loss of wage earning capacity
Loss of Wage Earning Capacity
  • Section 8106 of the FECA provides for a reduction in compensation to reflect a loss of wage earning capacity (LWEC) when the disability for work is partial.
    • If disability is partial, OWCP will pay 66 2/3% or 75% of the difference between the monthly pay of the job and the monthly wage-earning capacity of the claimant.
loss of wage earning capacity1
Loss of Wage Earning Capacity
  • Employee’s actual earnings may be used to calculate reduced compensation if these earnings are found to fairly and reasonably represent his or her earning capacity.
  • As a last resort, benefits will be reduced on the basis of an estimated earning capacity, based upon a job not actually held by the claimant, but performed to a reasonable extent in the commuting area and suitable to the claimant’s vocational background.
lwec shadrick formula
LWEC – Shadrick Formula
  • On March 23, 1953, the Employees’ Compensation Appeals Board established a principle to eliminate economic factors such as inflation or recession when computing the amount of monetary compensation due for partial disability.
  • According to this rule, the employee would be paid compensation based on the difference between the pay which had been determined to be his or her post-injury wage earning capacity, and the current pay for the date of injury job.
lwec modifying determination
LWEC – Modifying Determination
  • ECAB established the following criteria for modifying a formal LWEC decision (Elmer Strong, 17 ECAB 226):
    • The original rating was in error;
    • The claimant’s medical condition has changed;
    • The claimant has been vocationally rehabilitated.
return to work
Return to Work
  • CA-17
  • Light Duty Offers
  • Nurse Intervention
  • Vocational Rehabilitation
    • Rehabilitation Counselors
return to work injured workers responsibilities
Return to WorkInjured Workers’ Responsibilities
  • To seek or accept suitable employment.
  • To resume Federal employment if capable.
  • To provide physician with information on any available light duty.
return to work employer s responsibilities
Return to WorkEmployer’s Responsibilities
  • Authorize medical care.
  • If alternative positions are available for partially disabled employees, advise the employee in writing of specific duties and physical demands.
  • Where no alternative positions are available, advise the employee of any accommodations the agency can make.
return to work developing a job offer
Return to WorkDeveloping a Job Offer
  • Section 10.506 of the CFR allows an employing agency to monitor the injured employee’s medical care.
  • Employer may contact the physician in writing only.
  • Employer may contact the employee at reasonable intervals for updated medical.
return to work developing a job offer1
Return to WorkDeveloping a Job Offer
  • Employer must consider the physical or emotional restrictions placed on an employee due to a work related injury, as well as any concurrent, non-injury related ailments.
  • Agency personnel can request work restrictions directly from the physician, from an OWCP nurse, or the OWCP Claims Examiner.
  • If work restrictions differ, OWCP will determine which are appropriate.
return to work making the offer
Return to WorkMaking the Offer
  • Description of specific job duties to be performed.
  • Specific physical requirements of the position and any special demands or unusual working conditions.
  • Schedule.
  • Organizational and geographical location.
  • Date the job is first available.
  • Date by which a response to the job offer is required.
  • Provide pay information. Include grade, step and salary.
return to work making the offer1
Return to WorkMaking the Offer
  • The job must be offered in writing
  • Must be based on medical restrictions.
  • Should not include information regarding the election of OPM benefits.
  • Copy of the offer should be sent to OWCP when it is made.
  • Copy of the injured worker’s response should also be sent to OWCP.
return to work employee accepts offer
Return to WorkEmployee Accepts Offer
  • The injured worker should take the following actions:
    • Notify employer of acceptance;
    • Contact the employer for a start date and time;
    • Notify OWCP of the return to work in order to avoid overpayment; and
    • Prepare for a finding of wage earning capacity after a return to work of at least 60 days.
requesting a job suitability determination
Requesting A Job Suitability Determination
  • If the injured worker accepts the offered job, there is no need to request a job suitability determination.
  • Generally, if the injured worker has performed a job for 60 days or more and is working the number of hours he/she is capable of working, this establishes that the job fairly and reasonably represents his/her wage earning capacity. It is not necessary for OWCP to make a determination concerning the validity or suitability of the offered job in these situations.
return to work owcp s action refusal of offer
Return to WorkOWCP’s Action – Refusal of Offer
  • Determine if the job offer is valid.
    • Is it in writing?
    • Is there a description of the duties to be performed?
    • Is there a description of the physical requirements of the job?
    • Does it state the location of the job?
    • Does it state the date the job is available?
    • Does it state the date by which the employee must respond?
return to work owcp s action refusal of offer1
Return to WorkOWCP’s Action – Refusal of Offer
  • Determine if the job offer is suitable.
    • Compare the duties and the physical requirements of the job offer to the medical limitations on file.
    • Determine whether the injured worker is vocationally capable of performing the job.
    • Determine whether the kind of appointment is at least equivalent to that of the job held on the date of injury.
return to work unsuitable job offers
Return to WorkUnsuitable Job Offers
  • If the employee refuses the job, the following factors will be reviewed and the offer will be found unsuitable if:
    • The offer is less than 4 hours per day when the claimant is able to work more.
    • The position is for Seasonal employment, and the claimant was not.
    • The position is for Temporary employment, and the claimant was not.
    • Medical reports document a condition which has arisen since the compensable injury and this condition disables the claimant from accepting the offer.
return to work due process
Return to WorkDue Process
  • Letter to the injured worker notifying them that the job is suitable.
  • Give the injured worker 30 days to provide medical documentation supporting their refusal.
  • Evaluate the evidence. If found lacking, provide the employee with 15 days to accept the offer.
return to work acceptable reasons for refusal
Return to WorkAcceptable Reasons for Refusal
  • The position is withdrawn.
  • The claimant found other work which fairly and reasonably represents his/her earning capacity.
  • Medical evidence establishes that the condition has worsened and the claimant is unable to perform the duties.
  • Attending physician advises employee not to accept.
  • Claimant is unable to travel to the job because of the injury.
  • Medical condition has arisen since the compensable injury and prevents the claimant from working.
return to work unacceptable reasons for refusal
Return to WorkUnacceptable Reasons for Refusal
  • Preference for the area in which he or she currently resides.
  • Greater financial gain.
  • Spouse’s employment.
  • Family social ties to current residence.
  • Dislike of the position offered or work hours
  • Lack of promotion potential.
  • Lack of job security.
return to work unacceptable reasons for refusal1
Return to WorkUnacceptable Reasons for Refusal
  • Retirement
  • Distance of the commute
  • Lack of medical evidence to support that he/she can not tolerate the duties.
  • Personal reasons such as children.
  • Age
return to work owcp finds reasons unacceptable
Return to WorkOWCP Finds Reasons Unacceptable
  • If the claimant continues to refuse the job offer, a formal decision shall be prepared which provides full findings of facts as to why the claimant’s reasons for refusing the job are deemed unacceptable and terminates compensation.
return to work owcp finds reasons acceptable
Return to WorkOWCP Finds Reasons Acceptable
  • If the refusal is deemed justified, OWCP will notify both the claimant and the employing agency.
  • The claimant will be continued on the compensation rolls with no change in benefits.
return to work nurse intervention
Return to Work Nurse Intervention
  • Registered Nurses (RNs) under contract to OWCP
    • Meet with employees, physicians and agency representatives to ensure that proper medical care is being provided and to assist employees in returning to work.
    • Address questions and concerns about medical care, treatment plans, return-to-work dates, description of work limitations and explore availability of light or limited duty work.
return to work nurse intervention1
Return to Work Nurse Intervention
  • The RN may occasionally coordinate care with an agency nurse. As a rule, however, agencies should not assign their own nurses to work with employees simultaneously with OWCP RNs.
  • Should an employee refuse to cooperate with an OWCP nurse or refuse to make a good faith effort to obtain reemployment, OWCP may reduce or terminate compensation depending on the circumstances of the refusal.
return to work vocational rehabilitation
Return to WorkVocational Rehabilitation
  • Initial Interview
  • Placement with Previous Employer
  • Medical Rehabilitation
  • Guidance and Counseling
  • Vocational Testing and Work Evaluations
  • Placement with New Employer
  • Assisted Reemployment
  • Follow-Up Services
schedule awards
Schedule Awards
  • The Compensation Schedule (5 U.S. Code 8107) specifies periods of time for which compensation is provided for the permanent loss or loss of use of certain members, organs, and functions of the body.
    • Such loss or loss of use is known as permanent impairment and may be total or partial in extent.
    • The law does not allow for payment of a schedule award for impairment to the back, heart or brain.
      • However, a back injury may result in impairment to an appendage, which would be eligible for a Schedule Award
schedule award
Schedule Award
  • Form CA-7 is used to file claim for a schedule award.
  • OWCP evaluates the degree of impairment based on the specified edition of the American Medical Association’s Guides to the Evaluation of Permanent Impairment.
    • Current edition being used is Edition 5
schedule award1
Schedule Award
  • File must contain medical evidence which:
    • Shows that the impairment has reached a permanent and fixed state and indicates the date on which this occurred;
    • Describes the impairment so that the claims examiner can visualize the degree; and
    • Gives a percentage evaluation of the impairment (in terms of the affected member or function, not the body as a whole, except for impairment to the lungs.)
dual benefits
Dual Benefits
  • Annuity Benefits Paid by OPM
    • Death Benefits
    • Lump Sum Payment
  • Veteran’s Disability
    • VA Death Benefits
  • Social Security Act Benefits
  • Tennessee Valley Authority
  • Black Lung Benefits
  • Railroad Retirement Act Benefits
  • Department of Justice Benefits for Survivors of Federal Law Enforcement Officers
  • Benefits for Judicial Officials Assassinated in Performance of Duty
  • Severance and Separation Pay
appeal rights
Appeal Rights
  • Hearing
  • Reconsideration
  • Employees’ Compensation Appeals Board
hearing
Hearing
  • Oral Hearing
  • Review of the Written Record
hearing oral hearing
Hearing – Oral Hearing
  • Request must be made within 30 days of the formal decision.
  • Held within 100 miles of the employee’s home.
  • Informal process.
  • May be held by telephone or teleconference at the discretion of the hearing representative.
  • If the decision issued is unsatisfactory to the claimant, he or she can request a reconsideration or review by the Employees’ Compensation Appeals Board.
hearing review of the written record
Hearing – Review of the Written Record
  • Must be requested within 30 days of the formal decision.
  • Hearing representative will review the official record and any additional information submitted.
  • If the decision issued is unsatisfactory to the claimant, he or she can request a reconsideration or review by the Employees’ Compensation Appeals Board.
reconsideration
Reconsideration
  • Must be submitted within one year of the formal decision.
  • All requests for reconsideration and supporting documentation:
    • Must be submitted in writing;
    • Set forth arguments that either shows that OWCP erroneously applied or interpreted a specific point of law;
    • Advances a relevant legal argument not previously considered; or
    • Constitutes relevant and pertinent new evidence not previously considered by OWCP.
  • If the decision issued is unsatisfactory to the claimant, he or she can request another reconsideration or review by the Employees’ Compensation Appeals Board. The claimant is not entitled to request a hearing.
employees compensation appeals board ecab
Employees’ Compensation Appeals Board (ECAB)
  • Must be submitted directly to the Board within 90 days of the formal decision.
  • Review is based solely on the record at the time of the formal decision.
  • Review is limited to decisions issued within one year.
  • Decisions are binding upon OWCP and must be accepted and acted upon.
slide105
ECAB
  • Board does not have the authority to authorize medical treatment or payments for compensation.
  • Oral argument or written pleadings may be submitted.
  • If not satisfied with ECAB decision, employee can request that the Board reconsider its decision within 30 days.
third party claims
Third Party Claims
  • A party other than the US Government has some responsibility for an injury sustained by a federal employee during the performance of their duty.
  • The responsibility for identifying a potential third party liability in a given case lies jointly with the OWCP claims examiner and the Injury Compensation Specialist.
third party claims1
Third Party Claims
  • Under the FECA, when an injured employee who is entitled to compensation for the injury, recovers money or other property as a result of a suit or settlement against a third party, the injured employee has an obligation to refund, to the United States, the compensation that has been paid (excluding COP).
third party claims2
Third Party Claims
  • Employee can hire an outside attorney;
  • Employee can settle with the third party directly if the Solicitor of Labor concurs;
  • Employee can ask the agency to pursue on his/her behalf; or
  • Employee can refuse to pursue (this may result in benefits being denied).
death benefits
Death Benefits
  • Compensation Payments
  • Funeral Expenses
  • Transportation Expenses
  • Payment for termination of status as a Federal Employee
death benefits claim
Death Benefits - Claim
  • Form CA-6 Official Superior’s Report of Employee’s Death
  • Form CA-5 or CA-5b
death benefits claim1
Death Benefits - Claim
  • Must submit the following evidence:
    • Death Certificate
    • Name(s) and address(es) of next of kin
    • Marriage Certificate
    • Birth Certificate for each child
    • Divorce Decree or Death Certificate for prior marriages
    • Itemized burial bills
    • Medical certification establishing a causal relationship between the employee’s death and his/her employment
death benefits terminating status
Death Benefits – Terminating Status
  • A sum of $200 is payable to the personal representative of the decedent to reimburse the cost of terminating the decedent’s status as a federal employee.
    • A spouse is considered to be the personal representative unless incompetent.
death benefits other beneficiaries
Death Benefits – Other Beneficiaries
  • Child is defined as one who is under 18 years old, or incapable of self-support, or a full time student under age 23. (Included are stepchildren, adopted children, illegitimate children and posthumous children) (Excluded are married children and foster children).
  • Parents, grandparents, grandchildren and siblings (including stepbrothers and stepsisters, half brothers and half sisters, and brothers and sisters by adoption) are provided benefits if it can be shown that they were wholly or partly dependent on the employee at the time of death (looked to and relied upon the contributions of the employee).

Only after the entitlements of the spouse and/or children have been satisfied fully may other dependents receive benefits. Total compensation on account of death may not exceed 75%.

death benefits burial expenses
Death Benefits – Burial Expenses
  • Section 8134 of the FECA provides for the payment of burial and funeral expenses by the United States not to exceed $800.
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ACS
  • Centralized Bill Payment
  • Accessible through Internet Portal
  • Accessible through AQS