managing leave due to owcp february 25 – 27, 2014 va best practices in federal workers’...
TRANSCRIPT
MANAGING LEAVE DUE TO OWCP
FEBRUARY 25 – 27, 2014
VA BEST PRACTICES IN FEDERAL WORKERS’ COMPENSATION: SUPERVISOR LEVEL COURSE
Course Description
This session will discuss Continuation of Pay (COP) entitlement and eligibility for COP. It will provide a basis for managing agency COP through an understanding of COP entitlement, methods of authorization and how to calculate or count COP days.
It will also address the use of Leave without Pay, Annual Leave and Sick Leave after the COP period in connection with a claim.
Course Objectives
Determine eligibility and entitlement to COP.
Identify reason(s) for controverting COP.Identify valid reason(s) for terminating COP.Discuss the appropriate use of leave for
medical appointments and disability.Discuss the issues of coordination with
timekeeping and fiscal.Discuss ensuring that timecards reflect the
appropriate leave status
History
The first Workers Compensation Regulations were enacted in 1910. It was an Insurance Program approved because of high risk jobs, and a Progressive Political Climate. They wanted to establish an insurance plan to protect the family of the injured worker.
This opened the gate for Old Age Insurance and Unemployment Insurance.
The 1974 amendments to the FECA Program introduced the concept of Continuation of Pay.
COP Defined
COP is the continuation of regular pay for up to 45 calendar days of wage loss due to disability and/or medical treatment after a work related traumatic injury.
The intent of COP is to avoid interruption of pay while the claim is adjudicated by the Claims Examiner.
What does COP Include / Exclude?
COP Includes: All regular pay deductions including income tax,
retirement, allotments, etc. Night differential Scheduled changes in pay – Promotions, step
increases, etc
COP Excludes: Overtime Holiday Pay Saturday and Sunday Premium pay unless the
employee actually worked on that day
Eligibility and Entitlement
The injury must be a traumatic injury.The employee must file a CA-1 (or Notice of
Injury) within 30 days of the date of injury.The employee must begin losing time for
disability or medical appointments within 45 days of the injury.
COP cannot be paid if employee is separated from agency.
If the light duty job excludes extra pay (night differential) COP is tracked for payment of this benefit up to 45 days (lost element of pay).
Do I Controvert or Dispute COP
The Agency may terminate or not begin COP only if the controversion is clearly based on one of the following nine categories.
OWCP makes the final determination and can overturn the Agency Controversion and require that COP be paid.
9 Reasons to Convert COP
1. Disability results from an occupational disease. (example: Carpal Tunnel Syndrome)
2. The employee is excluded by 5 USC 8101 (1) B or E. This section of the law deals mostly with volunteers (unpaid) to the Federal Government.
3. The employee is neither a citizen nor a resident of the United States or Canada.
4. The injury occurred off the employing premises and the employee was not involved in “official off premises duties”.
9 Reasons to Convert COP (Continued)
5. The injury was caused by the employee’s willful misconduct, intent to bring about injury or death to self or another person, or was proximately caused by employee intoxication.
6. The injury was not reported within 30 days.
7. Work stoppage first occurred more than 45 days following the injury.
9 Reasons to Convert COP (Continued)
8. The employee initially reports the injury after his or her employment has been terminated.
9. The employee is enrolled in the Civil Air Patrol, Peace Corp, Job Corp, Youth Conservation Corp, Work Study Programs or other similar groups. This means they are not entitled to COP. They are entitled to compensation.
Other Reasons to Dispute
Evidence provided in the accident investigation does not match the injury claimed.
Medical evidence does not support a diagnosis (ICD9) that can be connected to the work related event claimed. (Pain)
Evidence of pre-existing medical condition.
When can I terminate COP?
• Employee has not filed a CA-1 or notice.• Medical evidence is not receive within 10
days• Medical evidence shows the employee is not
disabled for regular work.• Medical evidence shows employee is capable
of performing light duty and the employee has refused a written job offer.
• OWCP directs the Agency to stop COP.• 45 calendar days of COP has been paid.
What is Appropriate Medical Documentation?
• Date of examination. • History of injury. (Reported by employee)
• Medical evidence supporting total or partial disability resulting from the claimed injury.
• Medical evidence should provide details of restricted activity and date of return to work.
• Document must be signed by a physician.
Insufficient Medical for COP
An off work slip indicating an employee is totally disabled, with a to and from date is not sufficient to continue COP past the 10 calendar days.
The physician has to provide medical evidence supporting disability is a result of the alleged injury.
Light Duty Job Offers-Why and How To
Refusal to provide light duty work in writing to a partially disabled employee that has been released to return to modified work during a COP period requires the agency to pay COP.
Job Offer should include: Start date; Scheduled days and hours, location; Salary (note same pay); Description of duties assigned; Physical requirements needed to perform work; Supervisor’s signature; and the employee’s signature noting acceptance or refusal.
My Employee Elected Sick Leave - Not COP?
Just above the signature line on the CA-1 the employee must choose to be paid either sick leave or COP if their injury should incur lost time.
An employee may elect to use accumulated sick or annual leave instead of COP. This will not extend the COP period.
The employee can request to have their leave changed to COP within 1 year of acceptance of the claim. 20 CFR 10.206(a), 206(b)
Calculating AA and COP
Authorized Absence (AA): This is paid on the day of a traumatic injury if the employee is disabled for work for the remainder of their shift, or if they leave work for medical treatment on the day of injury.
An employee can be paid AA if they complete a CA-1, and require absence from work on the day of injury and during the same shift.
A claim is not considered lost time if only AA is used on the day of injury.
Calculating COP
• If the traumatic injury occurs prior to the beginning of the tour of duty, COP is authorized for time away from work on the date of injury.
• The COP period of eligibility begins after the first return to duty date.
• If the employee becomes disabled again within the 45 days of entitlement. The employer will pay any of the remaining 45 days of entitlement.
• COP is counted by calendar days; not work days
Calculating COP Continued…
There are 3 possibilities for a first return to duty date.
1.Employee returns on date of injury.2.Employee received AA and returns to work
on the next scheduled day following the date of injury.
3.The employee is place off work on the day of injury, and returns to duty between the second and 44th calendar day following the initial date of injury.
Calculating COP Continued
• Use of any part of a work day counts as 1 calendar day COP ( 2 hours COP for doctor visit = 1 calendar day COP).
• If the employee is disabled for Friday and Monday and not schedule Saturday and Sunday, continue calendar for 4 days of COP but pay for is for 2 days.
• Holiday Pay is paid as a holiday, but counted as a COP day.
Calculating COP Continued
If the employee’s regular pay includes night differential, and they are scheduled light duty during the day, they are entitled to 45 days of COP that pays what they would have earned for the loss of night differential pay only. Lost elements of pay for Saturday and Sunday schedules cannot be paid unless they work on Saturday or Sunday. (COP only)
Managing Timecards, Payroll, and DFAS
COP should not be approved unless authorized by the Control Point (Usually Human Resources). Authorization can be transmitted by email, scan document, or a letter signed by the official designated to authorize COP with identified dates and hours of eligibility.
The employee can enter sick leave in VISTA and notate it is for an on-job-injury. The timekeeper can change the sick leave to COP which is backed up and approved by the employee’s supervisor.
Managing Timecards, Payroll, and DFAS
Night Differential is paid by recording the original schedule that includes night pay. The timekeeper will make a notation that the employee was detailed to the day shift and identify hours and schedule actually worked.
The timekeeper will also notate the number of hours authorized for an absence during the day shift, and indicate if the absence was connected to a medical appointment, or disability connected to the injury.
Managing Timecards, Payroll, and DFAS
Physician Pay for leave used is for a full day. If the physician has a scheduled appointment for COP, place them on regular scheduled hours and notate the physician used 4 hours COP to attend a medical appointment.
Remember Payroll deadlines for COP.Check an recheck COP timecards for accuracy.Make immediate adjustments when errors
occur, and follow-up with payroll if a debt is incurred due to an overpayment or rescinded COP.
The employee may change rescinded COP to sick or annual leave if a balance is available.
Employer Responsibilities
The supervisor is responsible for initiating the CA-1 and notifying the employee they have 10 days to submit appropriate medical documentation.
The supervisor is responsible for advising the employee of light duty availability and COP eligibility.
The supervisor and Human Resources Office are responsible to inform the employee of any decision to controvert or dispute a claim, and provide the basis for doing so. OWCP will not uphold the termination of pay if the agency fails to notify the employee of a pending controversion. The employee must be provided the opportunity to respond to the reasons addressed by the Agency, and time to provide additional documentation if requested. OWCP has 30 days to adjudicate a CA-1 claim.
Employee Responsibilities
The employee is responsible for completion of form CA-1 as soon as possible, but no later than 30 days.
The employee is responsible for providing medical evidence and to cooperate with OWCP’s development of their claim. They are also responsible for providing an accurate history of their condition including prior or pre-existing diagnosed conditions that are similar.
The employee is responsible for selecting a physician that will provide work limitations with a return to duty date.
The employee must provide their physician with a copy of any modified light duty assignments offered, and request when they can return to modified work . Failure to notify the physician of a refused written light duty assignment that is considered suitable is a sufficient reason to terminate COP.
OWCP Absence After COP
If the employee is expected to be off work beyond 45 days, Human Resources will notify the supervisor and employee how to file for Compensation.
(Recommended) The employee elects Leave without Pay (LWOP) for time lost due to the injury and files Form CA-7 and CA-7a to OWCP to be paid lost wage compensation by OWCP.
(Not recommended) The employee can use their sick leave and annual leave and file a CA-7 for a Leave Buy Back (LBB) through DFAS
Leave Without Pay (LWOP)
The employee should elect LWOP if the claim is accepted and the physician has provided documentation for the employee to be off work.
After filing the CA-7 and CA-7a, OWCP will pay the employee most often within two weeks.
The Human Resources Specialist or Fiscal Officer must certify that all time claimed on form CA-7 is for LWOP before submitting the claim to OWCP.
An overpayment will be declared by OWCP if the employee is paid by the Agency and OWCP.
Leave Buy Back (LBB)
The employee may use their sick leave and/or annual leave for lost time due to a work related injury. Often an employee will elect to use leave when their claim is pending approval and they are not eligible for compensation.
For LBB, the employee must pay the Agency the difference between what they were paid by the Agency and what they would receive for compensation
There must be medical documentation supporting the inability to work as a result of the accepted medical condition for any period where LBB is claimed.
Leave Buy Back (LBB)
When the claim is approved, the employee files the CA-7 and CA-7a for a LBB.
Payroll calculates the amount the employee will need to pay in order to have their leave restored on a CA-7b.
DFAS sets up an account for OWCP to pay their portion of the LBB, and bills the claimant for their portion.
Leave is restored when both payments are received by DFAS.
LWOP for Workers Compensation
A Form 50 is placed in the OPF indicating the employee was paid by OWCP and that OWCP deducted health benefits and life insurance during the period of absence.
An employee does not earn leave or receive holiday pay while they are on LWOP. They cannot file for benefits they did not earn.
LWOP for Workers Compensation
LWOP does not affect: Service Computation Dates Within Grade Increases (WGI) Time in Service requirements for leave accrual Health Insurance Life Insurance Retirement Credit
LWOP does affect: Eligibility to participate in Thrift Savings Plan (TSP) AL/SL accruals
Family Medical Leave Act (FMLA)
An employee is not required to invoke FMLA for LWOP used with a work related claim. If the work related claim is denied and the employee remains off work in a LWOP status, they should be notified they may file the forms requesting FMLA.
Reasonable Accommodation
An employee can file a request for a reasonable accommodation, and a work related claim at the same time. They are separate requests and should remain separate in both processes.
The OWCP Claims Examiner may rate a job offer suitable, and stop OWCP compensation when the employee refuses to return to work. For the same job offer, EEOC might find the offer not suitable based on legal requirements identified with reasonable accommodation guidelines.
If the OWCP claim is denied and disability continues, the employee should be advised to file for a reasonable accommodation.
Contact Information
Nicole KelschVA Medical Center Lake City, FL 32025
(386) 755-3016 [email protected]