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Continuation of Pay (COP)

Continuation of Pay (COP). Presentation for Agency Representatives February 15, 2007 Elizabeth Way U. S. Department of Labor Branch of Technical Assistance. Topics to Be Covered. COP Defined Eligibility for COP Controverting COP Terminating COP Calculating COP Determining Dates

brennan-saunders
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Continuation of Pay (COP)

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  1. Continuation of Pay (COP) Presentation for Agency Representatives February 15, 2007 Elizabeth Way U. S. Department of Labor Branch of Technical Assistance

  2. Topics to Be Covered • COP Defined • Eligibility for COP • Controverting COP • Terminating COP • Calculating COP • Determining Dates • Counting COP Days • COP Examples • Light Duty and COP • References

  3. COP Defined • Continuation of regular pay for up to 45 calendar days of wage loss due to disability and/or medical treatment after a traumatic injury • Intent is to avoid interruption of pay while the claim is adjudicated • Subject to usual deductions from pay, such as income tax, retirement, allotments, etc. • Decision to use leave over COP is not irrevocable. Employee who uses leave can later elect COP within one year of the leave usage or date the case is accepted by OWCP, whichever is later.

  4. Continuation of Pay - Eligibility • Must be a traumatic injury • Must file the CA-1(or notice of injury) within 30 days of the date of injury • Must begin losing time from work within 45 days of the injury.

  5. Nine Reasons for Controverting COP • Agency may controvert (not pay) COP ONLY if one of the following applies: • Disability is a result of occupational disease or illness • Employee comes within the exclusions of 5 USC 8101 (1) (B) or (E) (volunteers) • Employee is neither a citizen nor resident of the US or Canada • Injury occurred off the agency’s premises and the employee was not engaged in official “off premises” duties

  6. Nine Reasons for Controverting COP - continued • Employee’s willful misconduct, intentional harm or death, or proximate intoxication • Injury not reported within 30 days of injury • Work stoppage first occurred more than 45 days after the injury • Employee reported injury after employment was terminated • Employee is enrolled in Civil Air Patrol, Peace Corps, or other group covered by special legislation

  7. Unacceptable Reasons for Controverting COP • Injury was not witnessed • Employee was careless • Employee is a “bad” employee and doesn’t deserve any benefits

  8. Controverting COP • Indicate controversion on CA-1 and attach narrative statement and specific evidence substantiating controversion • Advise employee of controversion • Can also terminate COP if no prima facie medical evidence received within ten calendar days • OWCP reviews COP controversion and can overturn it and require that COP be paid. Agency is provided with explanation of basis for decision.

  9. Terminating COP • Where the employer has paid COP, it may be stopped only when at least one of the following occurs: • Medical evidence is not received within 10 calendar days after the claim is submitted • Medical evidence shows that the employee is not disabled from his/her regular position • Medical evidence shows that the employee is capable of performing light duty, and the employee has refused a suitable written job offer

  10. Terminating COP - continued • Employee returns to work with no loss of pay • Employee’s period of employment expires • OWCP directs the employer to stop • COP has been paid for 45 days

  11. Calculating COP • 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)

  12. COP – Regular Schedule • For full or part time workers (permanent or temporary) who work the same number of hours each week of the year, the weekly pay rate is the hourly pay rate (A) in effect on the date of injury multiplied by (x) the number of hours worked each week (B): • A x B = Weekly Pay Rate

  13. COP – Irregular Schedule • For part-time workers who do not work the same number of hours each week, but who do work each week of the year, the weekly pay rate is an average of the weekly earnings established by dividing (/) the total earnings from the year immediately preceding the injury (A) by the number of weeks worked in that year (B): • A / B = Weekly Pay Rate

  14. COP – Intermittent, Seasonal, On-Call • The weekly pay rate is the average weekly earnings established by dividing (/) the total earnings during the full 12 month period immediately preceding the date of injury (A) by the number of weeks (or partial weeks) worked during the year (B) (that is A / B); or 150 times the average daily wage earned in the employment during the days employed within the full year immediately preceding the date of injury divided by 52 weeks, whichever is greater.

  15. COP – Determining Dates • The first day of COP is the day following the date of injury (DOI) where there is immediate time loss • If there is immediate time loss on the DOI and if the employee was injured during official work hours, time lost on DOI is charged to Administrative Leave • If employee is injured before work hours and there is immediate time loss, the first day of COP is the DOI • If disability wasn’t immediate, the timeline begins on the first return to work date – so long as that was within 45 days of the DOI 

  16. COP – Determining Dates • If continual disability for work begins within 45 days after the first return to work, and all 45 days of COP haven’t been used, COP continues until 45 days of COP have been used   • If the disability for work was intermittent, COP can be used only up to 45 calendar days after the first return to work – even if less than 45 days of COP have been used (Procedure Manual §2-0807- 6)

  17. COP - Counting Days • COP looks at calendar days, not just work days • Using any part of a day towards COP makes it a COP day (1 hr COP to see MD = 1 day COP) • Time lost must be certified by physician – read medical carefully for disability for work dates • COP is charged for weekends and holidays if medical evidence shows IW was disabled on those days • Determining factors for COP are disability for work or absence for obtaining medical care for injury

  18. COP - Counting Days – Example 1 • Worker is injured on 6/1 • Disability starts on 6/2 • Worker returns to full time limited duty on 6/14. • Disability returns on 6/22 and is continual.

  19. COP Calendar – Example 1 June July

  20. COP - Counting Days – Example 1 • Used 12 days COP for 6/2 – 6/13 • 6/14 is first RTW date • 6/22 – disability resumes and is continuous • Can use balance of 33 days of COP because continual disability is within 45 days of first RTW • 45th of COP is 7/24

  21. COP - Counting Days – Example 2 • Worker is injured on 6/1. • Disability starts on 6/1. Physician certifies IW disabled through 6/13. • Worker returns to full time limited duty on 6/14. Physician wants IW to attend PT on Tuesdays and Thursdays for the next 2 weeks. • Physician certifies another 10 days of disability starting 7/1. • IW returns to full time limited duty on 7/12. • Physician takes IW off work again starting 7/30.

  22. COP Calendar – Example 2 June July

  23. COP - Counting Days – Example 2 • Used 12 days COP for 6/2 – 6/13 • 6/14 is first RTW date • Uses 4 more days of COP for PT – making 16 days of COP used through 6/24 • Uses 10 more days of COP 7/1 – 7/11 – total of 26 days of COP used through 7/12 • Not eligible for COP for period of disability starting 7/30 because 7/30 is more than 45 days after 1st RTW.

  24. Light Duty and COP • IW may be charged COP when assigned to light duty if the light duty job is • Assigned by a personnel action; and • Is a bonafide position with a job description; and • Is classified at a lower pay level than the pay level of the job the employee held when injured; or a lower grade or rate of pay than IW’s preinjury job; or is on a different schedule which causes a loss of salary or premium pay authorized as part of the IW’s normal work week (e.g. Sunday premium or night differential)

  25. Light Duty and COP • IW may not be charged COP if an agency assigns IW to limited or light duty in the absence of a personnel action unless it results in loss of salary or premium pay as a result of being on a different schedule

  26. COP References • OWCP Procedure Manual – Part 2 – 807 – on web at http://www.dol.gov/esa/regs/compliance/owcp/INDEXofResources.htm#bookmark3 • CA-810 – Chapter 5 • CA – 550 – Chapter D • Injury Compensation Specialist Training – on CD or on web at http://www.dol.gov/esa/owcp/share/Shareppt/ppt.aspx

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