department of labor: owcp

8/14/2019 Department of Labor: owcp

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Inspectors General

Symposium

History and Overview of FECAShelby Hallmark, Director

OWCP

Stephanie L. SemmerChief, Branch of Technical Assistance
http://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htm


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FECA Benefit Obligations

Fiscal Years 1995- 2005

$-

$500

$1,000

$1,500

$2,000

$2,500

1995 1997 1999 2001 2003 2005

Compensation BenefitsMedical Benefits

(in millions)

*

FY 1996 includes one-time accounting adjustment of +$85 million.


3/41

Total Compensation

$1,000,000

$251,000,000

$501,000,000

$751,000,000

$1,001,000,000

$1,251,000,000

$1,501,000,000

$1,751,000,000

$2,001,000,000

$2,251,000,000

$2,501,000,000

USPS

Navy

Army

VA

DHS

AirForce

Tran

sportation

Justice

USDA

DOD

Interior

SSA

Education

Total

Chargeback04

Chargeback05


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Total Compensation

$0

$25,000,000

$50,000,000

$75,000,000

$100,000,000

$125,000,000

$150,000,000

$175,000,000

$200,000,000

$225,000,000

$250,000,000

N

avy

A

rmy

VA

DHS

AirForce

Transporta

tion

Jus

tice

USDA

D

OD

Inte

rior

SSA

Educa

tion

Chargeback 04

Chargeback 05


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Periodic Roll Management

Project begun in FY 1992

Made permanent in FY 1999

Approx. 120 FTE

Total savings over $1.6 BILLION so

far


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Long-term Disability Roll

46,000

46,500

47,000

47,500

48,000

48,500

49,000

49,500

50,000

1

9

9

6

1

9

9

7

1

9

9

8

1

9

9

9

2

0

0

0

2

0

0

1

2

0

0

2

2

0

0

3

2

0

0

4

2

0

0

5

2

0

0

6

Fiscal Year

End-of-Period Snapshot


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Return-to-Work Activity

0

1,500

3,000

4,500

6,000

7,5009,000

10,500

12,000

13,500

15,000

16,500

1995 1997 1999 2001 2003 2005

Nurse InterventionsReturns to Work


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162

1

54

157

164

167

1641

7318718

919

5

100

120

140

160

180

200

4Q,

'96

'97 '98 '99 '00 '01 '02 '03 '04 '05

F i s c a l Y e a r

CalendarDays

Lost Production Days in QCMCases

Measured w/i 1st Year from the Date Wage Loss Began


9/41

56.0

147.2

61.9

147.6

134.4

56.1 54.3 57.1

148.8

0

20

40

60

80

100

120

140

160

USPS (non-SHARE) All Other Gov't

R

ateper100E

mployees

FY03FY04

FY05FY06 GoalFY06 Q1

Goal 4 - Lost Production

Days

NoGoal


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Safety, Health, and Return-to

Employment (SHARE) Initiative

Federal Executive Branch initiative announced in

Presidential memo dated January 9, 2004 Runs FY 2004 - FY 2006 Establishes 4 Goals

To reduce Total Case Rates by at least 3% per year

To reduce Lost Time Case Rates by at least 3% per year

To improve the timely filing of injury and illness notices by

at least 5% per year

To reduce the rates of lost production days due to injuriesand illnesses by at least 1% per year


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56.0

147.2

61.9

147.6

134.4

56.1 54.3 57.1

148.8

0

20

40

60

80

100

120

140

160


R

ateper100E

mployees

FY03FY04

FY05FY06 GoalFY06 Q1


Days

NoGoal


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DaysMajor Agency

0

25

50

75

100

125

150

175

200

225

250

275

Navy

Army

VA

AirF

orce

DOT

Trea

sury

TVA

U

SDA

DOD

Ju

stice

Interior

HHS

L

abor

Comm

erce

DHS

SSA

HUD

All-LessU

SPS

FY03

FY04

FY05

G


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Goal 4 - Lost ProductionDays

Major Agency FY06 Goal vs. Actual

0

25

50

75

100

125

150

175

200

225

Navy

Army

VA

A

irForce

DOT

T

reasury

TVA

USDA

DOD

Justice

Interior

HHS

Labor

Commerce

DHS

SSA

HUD

All-Les

sUSPS

FY06 Goal

FY06 Q1


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49.6%

88.7%

61.4%

79.0%

92.5%

70.9%

57.4%

93.1%

69.9%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%


FY03

FY04FY05

FY06 Goal

FY06 Q1

Goal 3 - CA-1/CA-2 Timeliness(filed in 14 calendar days)

No

Goal


15/41

FECA Reform

Incentives

Conversion benefit for retirementaged claimants

Setting compensation at 70% for allclaimants

Change the schedule award to allowfor payment during the wage lossperiod


16/41

FECA Reform

Equity and fixes

Restore waiting period

Allow for subrogation of COP for Third

Party claimsUpdate disfigurement and burial

payments

Pay all schedule awards at averagesalary rate (GS-11 step 3)


17/41

FECA Reform

Applies to new claims only

Strengthens the program while

maintaining generous benefits

Projected savings of $591.6 millionover the next 10 years


18/41

FECA Reform

Current status: pending transmission

Seeking sponsors

Assistance welcome


19/41

Questions?


20/41

Topics To Be Covered Overview of the Federal Employees Compensation Act

(FECA)

Chargeback System

Primary Benefits Provided under the FECA

Claims Processing

Case Management

Containing OWCP Costs

Internet Resources and References


21/41

Overview of the FECA

Federal Employees Compensation Act (FECA) passed in 1916

Provides compensation benefits to civilian employees of the USfor disability due to personal injury or disease sustained in theperformance of duty

Provides benefits to dependents if a work-related injury ordisease causes an employees death

Funded through agency chargebacks

Sole remedy a Federal employee or surviving dependent isnot entitled to sue the US or recover damages for injury ordeath under any other law

Administered by the Office of Workers CompensationPrograms Division of Federal Employees Compensation


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Chargeback

FECA is financed by the Employees Compensation Fund,which consists of monies appropriated by Congress or

contributions by agencies from operating revenues

The chargeback system is the mechanism by which the costs ofcompensation for work-related injuries are assigned to agenciesfor the fiscal accounting period which runs from July to June

All compensation claims are identified as belonging to aparticular agency based on the agency code entered intoOWCPs system when the case is created

OWCP provides each agency with a quarterly report listing allcases and costs for which charges will appear on the yearlychargeback bill


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Primary Benefits Provided

under the FECAContinuation of Pay (COP)

Medical benefits

Wage loss compensation

Schedule awards

Vocational rehabilitation

Loss of Wage-Earning CapacityDeath benefits


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Types of Injury Claims

Traumatic Injury CA-1

Occupational Disease CA-2

Recurrence CA-2a

Consequential

Intervening

Death CA-5 and CA-6


25/41

Controverting COP

The agency may controvert 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) Employee is neither a citizen nor resident of the US or

Canada

Injury occurred off the agencys premises and the employee

was not engaged in official off premises duties


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Controverting COP

continued Employees 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

Ch ll i V lidi f


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Challenging Validity of a

Claim If the validity of a claim is in question, the agency should

provide a detailed statement describing circumstances behindchallenge

Include specific evidence: witness statements, accident

investigations, timecards, etc.

Pay COP (if applicable) pending OWCP decision

Authority to determine any aspect of claim rests with OWCP.

While agency is entitled to explanation of basis for OWCP

action, it must accept determination rendered.


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Claims Processing

A person claiming compensation must

submit the essentials of a prima facie case,

which are as follows

Timely Filing of Claim

Federal Civilian Employee

Fact of Injury

Performance of Duty

Causal Relationship


29/41

Conditions of Coverage

Timely Filing

Employee Has Three Years From:

Date of Injury

Date of First Awareness

Date of Last Exposure

Civil Employee FECA covers all civilian employees except for non-

appropriated fund employees Contract employees, volunteers, and loaned

employees are covered under some circumstances


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Fact of Injury

Factual Actual occurrence of an accident,

incident, or exposure in time, place, andmanner alleged

Medical Medical condition diagnosed inconnection with that accident, incident, orexposure


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Performance of Duty

Injury occurred while performing assigned

duties or engaging in an activity reasonablyassociated with the employment

Injury occurred on work premises

Injury occurred off premises while engaging inwork activity


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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


33/41

OWCP Responsibilities

OWCP has the obligation to aid in the

processing and adjudicating of a claim

Advising the claimant and the agency ofprocedures for establishing a claim,including detailed instructions for developingthe evidence

Requesting all evidence necessary toadjudicate the case

Identifying potential third party cases so thatattempts at recovery may begin

Making prompt decisions


34/41

OWCP Responsibilities

Once a claim is adjudicated, claims

examiners are responsible for the followingcase management activities

Focus on Return to Work Initiate Interventions and Services

Request Medical Information

Follow up with the assigned Field Nurse orRehabilitation Specialist

Bring the Case to Resolution


35/41

Agency Responsibilities

Encourage safe work habits and conditions and enforce safety

regulations

Advise employees 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

Continue pay in traumatic injuries


36/41

Agency Responsibilities

Assist employees in returning to work

Represent the agencys interest

Challenge questionable claims (controvert)

Keep in contact with employee

Help manage compensation costs

Accommodate light duty work when able


37/41


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 the SHARE

initiative and Federal regulations


38/41


Controvert/Challenge Questionable Claims

OWCP accepts employee statement asfactual unless agency provides refutingevidence

Notify OWCP of any information you believeto be pertinent to the claim. This wouldinclude things such as past history of

injuries, outside activities, etc. Include actual evidence rather than

conjecture or opinion


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Track Injured Employees Medical Status

Maintain constant contact with employee

Request frequent medical updates in

writing from physician

Cooperate with OWCP nurses, ClaimsExaminers, Vocational RehabilitationSpecialists, and Workers CompensationSpecialists/Injury Compensation Specialists


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Offer Light Duty

Match employees physical limitations to yourparticular needs

Create temporary positions where none exist

Benefits of offering light duty:

improves morale for both injured worker and

remainder of workforce each day employee remains out of work reduces

likelihood he/she will ever return


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