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Office of Workers’ Compensation Programs (OWCP)

Office of Workers’ Compensation Programs (OWCP). Jed Fife 5/26/04 Senior Claims Examiner, Seattle Office Account Representative for Job Corps. Topics To Be Covered. Federal Employees’ Compensation Act (FECA) for JC Conditions of Coverage Unique to JC Students/Trainees

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Office of Workers’ Compensation Programs (OWCP)

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  1. Office of Workers’ Compensation Programs (OWCP) Jed Fife 5/26/04 Senior Claims Examiner, Seattle Office Account Representative for Job Corps

  2. Topics To Be Covered • Federal Employees’ Compensation Act (FECA) for JC Conditions of Coverage Unique to JC Students/Trainees • Initiating Claims (CA-1 versus CA-2) • Using the CA-7 and CA-16 • Containing OWCP Costs • CA1/2 and CA7 Timeliness • Internet Resources and References

  3. Overview of the FECA • Administered by Department of Labor (DOL), Division of Federal Employees’ Compensation’s (DFEC) Office of Workers’ Compensation Programs (OWCP) • OWCP adjudicates claims • 12 District Offices • Individual case files are protected under the Privacy Act – only the employee, her/his representative (if any), and agency personnel may routinely have access to a file • HIPAA doesn’t apply to OWCP or employing agencies • No one may require an employee or other claimant to waive her/his right to claim compensation under the FECA

  4. Primary Benefits Provided under the FECA • Medical Benefits • Services, appliances, and supplies prescribed or recommended by physicians which in the opinion of OWCP are likely to cure, give relief, reduce the degree or period of disability, or aid in lessening the amount of monthly compensation • Includes examination, treatment, and related services such as medications and hospitalization, as well as transportation needed to secure these services • Continuation of Pay (COP) for Traumatic Injuries • Death Benefits

  5. Conditions of Coverage • Each claim for compensation must meet certain requirements before it can be accepted – always addressed in order • Timely Filing of Claim • Federal Civilian Employee • Fact of Injury • Performance of Duty • Causal Relationship

  6. 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

  7. Performance of Duty • Trainees are covered while performing assigned duties or engaging in a reasonably associated activity • For JC, covered 24/7 because under continual supervision • Covered on center or at approved off-center locations if engaging in an authorized activity • Not covered while at home • Residential Students: Covered while on authorized leave, pass, and travel to home • Non-Residential Students: Coverage starts when they arrive on center or at other JC supervised activities

  8. Causal Relationship • Link between work-related exposure/injury and and 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

  9. Causal Relationship • Four Types • 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 employment

  10. 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

  11. Initiating A Claim for a Traumatic Injury or Occupational Disease • 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 • Occupational Disease • Condition produced over a period longer than one workday or shift (e.g. repetitive motion disorders, asbestosis) • COP is not provided for Occupational Diseases • CA-16 is not issued for Occupational Diseases

  12. Initiating A Claim:Notice of Traumatic Injury – CA-1Notice of Occupational Disease – CA-2 • Student must be put on MSWR in order to be covered by OWCP • Employee (or someone on her/his behalf, including supervisor) completes front • Supervisor completes back • Must be transmitted to OWCP within ten workdays from date agency received form – DO NOT HOLD for wage calculations, supporting documentation, etc. • 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 • CA-2 Must be submitted to employing agency within three 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

  13. Supervisor Responsibilities • Encourage safe work habits and conditions and enforce safety regulations • Advise trainees on rights and responsibilities • Report injuries promptly • Complete and submit forms in timely manner • CA-1 and CA-2 within ten workdays of receipt • CA-7 within five workdays of receipt • Code claims correctly (1142 NOT for students) • Assist with continuation of pay in traumatic injuries

  14. Initiating a Claim for Death Benefits • When a trainee 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 a trainee

  15. Containing OWCP Costs • Submit CA-1s and CA-2s within ten workdays • Submit CA-7s within five workdays • Timely submission • enables prompt adjudication and medical management of claim • ensures compliance with Safety, Health And Return-to-Employment Initiative (formerly Federal Worker 2000 initiative) and Federal regulations

  16. Containing OWCP Costs • Track Injured Trainees’ Medical Status • Maintain contact with trainee • Request periodic medical updates – in writing from physician • Cooperate with OWCP nurses, Claims Examiners, Vocational Rehabilitation Specialists, and Workers’ Compensation Specialists/Injury Compensation Specialists

  17. Why it matters… • 168,174 injuries nationwide • $2.36 billion dollars in benefits • 2.1 million Lost Production Days

  18. Safety, Health And Return-to-Employment Initiative Goals • Goal 1: Reduce total case rates by at least 3% • Goal 2: Reduce lost time case rates by at least 3% per year • Goal 3: Increase timely filing of claims by at least 5% per year • Goal 4 Reduce lost production days by at least 1% per year

  19. How Timely Are You? JOB CORPS’S FISCAL YEAR 2003: TOTAL CASES: 27 CA-1/CA-2 FILED WITHIN 14 DAYS: 79.33% ALASKA, WASHINGTON, IDAHO, OREGON, CALIFORNIA, HAWAII, NEVADA, ARIZONA SIX OFFICES FILED 100% TIMELY

  20. SHARE • OWCP/OSHA and Federal Departments will develop new strategies to: • Improve safety and health at high injury rate sites • Assist in improving timely filing of claims through electronic means • Guide agencies in providing suitable work and tools for injured workers

  21. DFEC Homepage www.dol.gov/esa/regs/compliance/owcp/fecacont.htm • Pledge to Our Customers • FECA Mission Statement • When Injured At Work (CA-11) • District Office Addresses and Telephone Contacts • Information on FECA's New Consolidated Bill Processing and Medical Authorization System • Questions and Answers about the Federal Employees' Compensation Act (Publication CA-550)   Handbook for injured workers. • Injury Compensation for Federal Employees (Publication CA-810) Handbook for employing agencies. • Federal Employee Safety and Health Return-to-work Initiative • Forms • OWCP Procedure Manual • Employees’ Compensation Appeals Board Decisions • Federal Employees' Compensation Act - Title 5 United States Code Sections 8101-8193. • Regulations Under The FECA - Title 20 C.F.R. Parts 1-25.

  22. FECA Changes • OASIS (OWCP Automated System for Imaging Services) • In April 2001 the Seattle District Office began imaging all newly filed injury claims using OASIS

  23. FECA Changes cont • In March 2002 the DFEC Central Mailroom came into existence. With few exceptions all mail is sent to the central mailroom in London, KY, including the older paper cases. We average approximately 32,000 pieces of imaged mail per month – about 1600 documents each work day.

  24. FECA Changes cont • Revamped “phone banks” • Call monitoring for quality • Central medical authorization and bill payment as of September 2, 2003 ACS 1-866-335-8319 FAX 1-800-215-4901 • New computer system “iFECS” postponed

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