BONNEVILLE POWER ADMINISTRATION

**HUMAN RESOURCES, DIVERSITY, AND EEO**

**Portland, Oregon**

**PERSONNEL LETTER NO. 810-1 DATE: June 8, 1999**

**SUBJECT: Injury Compensation and Occupational Disease Program**

**I. PURPOSE**

> The purpose of this Personnel Letter is to establish procedures for
> the management of BPA\'s injury compensation and occupational disease
> program consistent with the Department of Labor (DOL), Office of
> Workers\' Compensation Program (OWCP) requirements.

This Personnel Letter supersedes the following issuance:

> A. PL 810-1, Form CA-16, Request for Examination and Treatment
>
> (On-The-Job-Injury) dated 01-29-88;
>
> B. PL 810-2, Procedures for the Implementation and Evaluation of the
> BPA Injury Compensation Program dated 10-14-87.

**II. SCOPE**

> This chapter covers all BPA permanent and temporary employees injured,
> affected by an occupational disease, or killed while in the
> performance of their duties. Coverage may not apply if (1) willful
> misconduct of the employee; (2) intention of the employee to bring
> about injury or death to self or another; or (3) intoxication (alcohol
> or drug related) causes the injury or death.
>
> Volunteers, personal services contractors, loaned personnel, or
> individuals in similar circumstance may be covered by the provision of
> this letter. The Department of Labor will make coverage determinations
> on a case-by-case basis. All other contractors working for BPA are
> covered under their own corporate business Workers Compensation Plan,
> in accordance with State law.

**III. REFERENCES**

> A. 20 CFR Part 10 - Claims for Compensation Under the Federal
> Employee\'s Compensation Act (FECA).

B. 29 CFR Part 1910 - Occupational Health and Safety Act (OSHA)

C. BPAM 180 Safety and Health Program

D. BPAM 181 Accident Investigation and Reporting

> E. BPA Personnel Letter No. 339-7, Medical Evaluation of Employees &
> Applicants

**IV. POLICY**

> The BPA is committed to maintaining the health and safety of its
> employees. All employees must ensure that work is performed in a safe
> manner and potential problems are identified immediately. When an
> employee is injured on the job or incurs an illness as the result of
> his/her employment at BPA, it is BPA policy to provide the employee
> assistance in obtaining medical care and to restore the employee to
> gainful employment as soon as possible.

# V. DEFINITIONS

> A. **[Traumatic Injury]{.underline}**: A wound or other condition of
> the body caused by external force including stress or strain. The
> injury must be identifiable by time and place of occurrence and member
> or function of the body affected. It must be caused by a specific
> event or by incidents within a single day or work shift. Traumatic
> injury includes damage to or destruction of contacts, eyeglasses,
> medical braces, artificial limbs, and other prosthetic devices that
> must be replaced or repaired.
>
> B. **[Occupational Disease]{.underline}:** A condition produced by or
> within the work environment over a period longer than one day or work
> shift. It may result from systemic infection, repeated stress or
> strain, exposure to toxins, poisons, or fumes, or other continuing
> conditions of the work environment.
>
> C. **[Physicians:]{.underline}** The term physician includes licensed
> medical doctors, surgeons, osteopathic practitioners, podiatrists,
> dentists, clinical psychologists, optometrists, and chiropractors
> within the scope of their practice as defined by State law. The term
> physician includes chiropractors only to the extent that their
> reimbursable services are limited to treatment consisting of manual
> manipulation of the spine to correct a subluxation as demonstrated by
> X-ray to exist and subject to regulation by the Secretary of Labor.
> Naturopaths, massage therapists, faith healers, and other
> practitioners of the healing arts are not recognized as physicians
> within the meaning of the law.
>
> D. **[Continuation of Pay (COP):]{.underline}** The continuation of an
> employee\'s regular salary for up to 45 calendar days of wage loss due
> to disability and/or medical treatment following a traumatic injury.
> COP is not authorized for occupational disease.
>
> E. **[Controversion of a Claim:]{.underline}** To dispute, challenge
> or deny the validity of a claim for COP or an OWCP claim.

F.  **[Light Duty]{.underline}:** Work assignments within an employee\'s
    regular job classification designed to conform to the physical
    capabilities of an employee; or, work assignments especially
    selected for an injured employee who cannot fully perform his/her
    regular job. A light duty job may be an existing position or a
    temporarily created position with duties and responsibilities within
    the capabilities of the injured employee. Light duty work shall
    exist on a temporary basis for the purpose of allowing the injured
    worker to recover sufficiently to return to his/her own position or
    to be assigned permanently to another position consistent with any
    permanent physical limitations or restrictions.

G.  **[Scheduled Award]{.underline}:** Compensation provided for
    specified periods of time for the permanent loss, or loss of use, of
    each of certain members, organs, and functions of the body.

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VI. **RESPONSIBILITIES**

# A. [Employees]{.underline}: It is the responsibility of each employee to report all job connected injuries to the supervisor within 24 hours using Form CA-1 (for traumatic injuries) or CA-2 (for occupational illnesses). Reports of injuries must be complete and specific. Employees will submit Workers\' Compensation claims, and subsequent documentation to support the claim, through the supervisor. Employees, through the duration of the claim, must:

> 1\. Seek appropriate medical care immediately, or at the first
> opportunity to do so;
>
> 2\. Obtain and complete all appropriate injury forms and related
> information in a timely and accurate manner;
>
> 3\. Establish, by medical and factual evidence, that their employment
> caused or aggravated their injuries or disease, and promptly transmit
> medical information from the physician to the supervisor;
>
> 4\. Inform the physician that light duty assignments are available if
> there is an inability to perform the full range of the position;

5.  Obtain statements from the physician for release from duty, ability
    to perform light duty, and/or release for duty.

# 

# B. [Managers and Supervisors:]{.underline} It is the responsibility of management to ensure that an injured employee receive prompt medical assistance, advice as to the benefits available under FECA, and assistance in preparing and submitting claims. The supervisor is responsible for providing information relative to the injury and the circumstances surrounding the accident. Supervisors are required to send all forms and reports through the OWCP Case Manager

# (CHR - PSB-2). Supervisors must:

> 1\. Arrange for timely and appropriate medical treatment for injured
> employees;
>
> 2\. Promptly furnish injury claim information to the employee and
> assist employees with claim filing and obtaining benefits;
>
> 3\. Promptly complete and submit required claim forms and related
> documents pertaining to the injury;
>
> 4\. Facilitate return-to-work efforts by identifying or developing
> light duty assignments within the physical limitations of the injured
> employee; best efforts will be made to find or establish a light duty
> position in the same organization and location as the permanent
> position; however, in some circumstances this may not be possible;
>
> 5\. Modifying or creating a position at the same rate of pay if the
> employee has permanent limitations, or, if not feasible at the same
> rate of pay, modify or create a position with a lower rate of pay;
>
> 6\. Ensure that the employee's time is reported accurately.
>
> C. **[Nurses, Headquarters and Ross:]{.underline}** At locations where
> a health unit is available, injured or ill employees may report for
> assessment, first-aid treatment, and referral when indicated. If
> necessary, the employee will be given assistance in arranging
> transportation to a local hospital emergency room or to the
> employee\'s personal medical doctor. (Need for an ambulance is
> determined by medical staff; other determinations, such as return to
> work, are the responsibility of the manager/supervisor). Hospital,
> ambulance, and physician fees are the responsibility of the employee
> unless the illness or injury is job-connected and covered by OWCP.
>
> D. **[OWCP Case Manager (OCM):]{.underline}** The OCM is responsible
> for following procedures set forth by the agency and the DOL, and for
> advising managers, employees, and coordinators on required case action
> and precedent setting situations. The OCM conducts periodic
> reconciliation with DOL files to ensure files are complete, adequately
> maintained, and that the agency and/or DOL are taking appropriate
> action. The OCM ensures that employees who incur injury or illness are
> expeditiously and fully informed of their benefits, procedures, and
> obligations under FECA, and that assistance is afforded to them in
> preparing and submitting claims and supporting documents. The OCM
> works directly with the manager to establish light duty, interim, or
> return to duty assignments to ensure that injured employee is returned
> to work as soon as medically prudent. The OCM is also responsible for
> reporting any suspected fraud to the DOL.
>
> E. **[OWCP Case Coordinator(s) (OCC):]{.underline}** The OCC is
> responsible for working with the Case Manager and Benefits Program
> Manager to provide direct assistance to managers and employees in
> completion of required forms, obtaining documentation in support of
> Workers\' Compensation claims, and in establishing light duty,
> interim, and return to duty assignments. The OCC ensures that case
> files are complete, adequately maintained, and that the agency and/or
> DOL are taking appropriate action. Coordinators are also responsible
> for reporting any suspected fraud to the DOL.

F. **[Benefits Program Manager (BPM):]{.underline}** The BPM provides
oversight, program guidance, evaluation, and direction to the OCM and
OCC, and establishes case management standards for BPA staff involved
with the injury compensation program.

> G. **[Manager, Personnel Services:]{.underline}** The Manager,
> Personnel Services, is responsible for assuring that the obligations
> of the agency are promptly and efficiently discharged. The Manager
> will ensure that adequate resources are assigned to achieve the
> objectives of the Workers\' Compensation Program through the Benefits
> Program Manager (BPM).
>
> H. **[Safety Office:]{.underline}** The Safety Staff is responsible
> for working with line managers to develop and coordinate plans and
> programs designed to minimize job-related accidents and illnesses.
> Staff members investigate situations that have resulted in, or portend
> employee injury or illness; maintain records and statistical data on
> job-related injuries and illnesses; and coordinate BPA-wide efforts to
> assure a safe work environment.

VII. **WORK ENVIRONMENT**

> For the workplace to be a safe and healthy environment, managers and
> supervisors must establish an effective safety and health program to
> prevent accidents from occurring. They must also integrate safety into
> the work performance of the employees they supervise. It is only
> through these initiatives and the efforts of all employees that costs
> for the OWCP program will be contained and/or reduced.

**VIII. OWCP CLAIM PROCEDURES**

> All claims will be processed in accordance with the procedures
> established by the Department of Labor, Office of Workers'
> Compensation. Appendix 1 of this PL describes typical claim procedures
> for traumatic injury; Appendix 2 covers procedures for occupational
> disease.

**IX. RETURN TO WORK**

> The majority of injuries sustained by employees are not major;
> consequently, the employee normally can return to work either the same
> day or within a few days. BPA's objective is to ensure that all
> employees whose ability to work is impacted by a traumatic injury or
> occupational disease return to the workplace immediately, or as soon
> as medically feasible. Each situation is unique, and the supervisor
> will work with the OCM, employee, medical professionals, and others to
> attempt to:

A. Return the employee to the original position of record.

> B. Temporarily or permanently modify the duties of the present
> position if the employee cannot perform all of the duties of the
> present.

C.  C. Assign other duties within the office or in another office;

> D. Identify other assignments consistent with the limitations
> stipulated by the
>
> medical professional.

# BENEFITS

The OWCP provides benefits for injured employees which includes medical
expenses, on-going medical care, vocational rehabilitation, continuation
of pay, wage compensation, death benefits, and burial expenses. Specific
information on coverage and eligibility for benefits under OWCP is
published by DOL. The OCM can assist the supervisor and employee in
identifying which benefits are applicable and the appropriate procedures
to request coverage.

X.  **LEAVE BUY BACK**

> Injured employees have the option of using sick leave, annual leave,
> and/or
>
> leave-without-pay and claiming compensation from OWCP. If a claim for
> compensation has been accepted by OWCP, the employee may request to
> buy back the leave used and have it restored to his/her leave account.
> Requests for leave buy back must be submitted within one year of the
> date the leave was used.

**XII. DEATH GRATUITY PAYMENT**

> PL 104-208, Section 651 of the Omnibus Consolidated Appropriations
> Act, authorizes payment up to \$10,000 as a death gratuity. Payment
> may be made to the personal representative of an employee who dies
> from an injury sustained in the line of duty, or who dies after
> separation from service, if the death is the result of any injury
> sustained in the line of duty. The gratuity is not payable if there is
> evidence of willful misconduct.
>
> The amount of the total gratuity available under this authority and
> other related authorized payments, specifically 5 U.S.C. 8133 (f), 5
> U.S.C. 8135(a), funeral and burial expenses, and section 312 of P.L.
> 103-332, cannot exceed \$10,000. The gratuity is not reduced by any
> other amounts, including other benefits payable under FECA.
>
> The personal representative of an employee will usually be the
> formally designated executor or administrator of the employee's estate
> under State law.

**XIII. CASES INVOLVING LIABILITY OF A THIRD PARTY**

> An employee or beneficiary claiming compensation must attempt to
> settle all
>
> third-party claims arising out of an injury or death. The OCM will
> assist an employee with OWCP procedures relative to third-party
> claims.

**XIV. RECONSIDERATION**

> An employee may submit new evidence to OWCP and ask OWCP to reconsider
> any determination made by one of its offices. This request is made to
> the Director of OWCP in writing and must state clearly the grounds
> upon which it is based. Reconsideration requests must be made within
> one year of the date of the initial OWCP decision.

**XV. HEARINGS**

> An employee who is not satisfied with an OWCP decision may ask for a
> hearing before an OWCP representative. The request for a hearing is
> made to the Director of OWCP within 30 days after the OWCP decision
> concerning the employee\'s claim.

**XVI. APPEALS**

> An employee may ask the Employees\' Compensation Appeals Board to
> review final decisions by OWCP. The appeal must be filed within 90
> days of the date of the final determination by OWCP.

**XVII. REPORTS AND RECORDKEEPING**

#### 

#### A. [Case Management:]{.underline} The Department of Labor retains the official file for all OWCP claims. The agency retains a working copy of the file for the purpose of facilitating claim submission, monitoring status of claims, cost tracking, and return to work.

> B **[DOL Chargeback Report:]{.underline}** This report will be sent on
> a quarterly basis by the DOL, through the Department to the Case
> Manager. The report will be reviewed to verify that BPA is charged
> only for its own employees. If errors are discovered, corrective
> action will be taken.
>
> C. **[COP Report:]{.underline}** This report will be sent on a
> quarterly basis to the Case Managers and Coordinators. The report will
> be reviewed to determine the number of injured employees who have
> returned to work in a light/modified duty capacity, or to their
> original position of record.
>
> D. Periodic reports will be provided to managers to ensure awareness
> and status of OWCP activity in their organizations.

Godfrey C. Beckett

Manager, Human Resources, Diversity, and EEO

**Appendix 1**

**Outline for Claim Procedures**

**CA-1 - TRAUMATIC INJURY**

The following steps are used when an employee has sustained a traumatic
injury. It is not necessary that they are followed sequentially,
however, they must all be completed.

A. **[Reporting Requirements]{.underline}**

> 1\. Within 24 hours after the injury occurs, the supervisor must
> notify the OWCP Coordinator or OWCP Case Manager. The Case Manager or
> Coordinator will be able to provide any additional guidance needed.
>
> 2\. The employee must complete the first page of the Federal
> Employee\'s Notice of Traumatic Injury and Claim for Continuation of
> Pay/Compensation Form (CA-1) and submit it to the supervisor who will
> complete the second page. The CA-1 must be completed by the employee
> as soon as possible but no later than 30 days from the date of the
> injury. Instruction on how to complete the claim form is attached as
> Appendix 3.

B. **[Medical Care]{.underline}**

> 1\. The supervisor must authorize medical treatment using Form CA-16,
> Authorization for Examination and/or Treatment. This form is used if
> the injury is work related and reported within 24 hours.
>
> If necessary, the supervisor will make the doctor\'s appointment and
> arrange for transportation to the facility. See section 3.a. below,
> for additional information.
>
> 2\. Provide the employee with a copy of the Instructions to Injured
> Employee (Appendix 3).
>
> 3\. Provide the employee with an injury packet containing the
> following forms, along with a letter (Appendix 4) for the doctor.
> Injury packets are available from the OWCP Case Manager or OWCP
> Coordinator or the HR Intranet site.
>
> a\. CA-16, Authorization for Examination and/or Treatment\--The
> supervisor or other designated official completes the front of the
> CA-16 within 4 hours of the request. If it is doubtful that the
> employee\'s condition is work related, the supervisor should indicate
> this on the form by checking Block B. The supervisor should also
> consult with the OWCP Case Manager or Coordinator.
>
> In an emergency situation where there is no time to authorize a Form
> CA-16, the supervisor may verbally authorize medical treatment and
> forward the authorized CA-16 to the medical facility within 48 hours.
> **SPECIAL CARE MUST BE EXERCISED IN ISSUING THIS FORM SINCE
> \"AUTHORIZATION\" GUARANTEES PAYMENT OF MEIDCAL BILLS FOR UP TO 60
> DAYS OR UNTIL OWCP WITHDRAWS THE AUTHORIZATION**.
>
> b\. CA-17, Duty Status Report\--the CA-17 describes the physical
> requirements for an individual\'s position/job and, upon completion by
> the physician, provides the agency with fitness for duty information.
> The supervisor completes Part A of the form prior to giving it to the
> employee. The employee must return this form to the supervisor
> immediately after the doctor\'s appointment or by the following day.
>
> It is advisable to prepare CA-17\'s in advance for positions with high
> incidence of traumatic injury and for large groups of like employees.
>
> c\. OWCP-1500, Health Insurance Claim Form. This form is used by the
> physician to bill the Department of Labor. If the physician\'s office
> does not have this billing form, please contact your Case Manager or
> Coordinator.
>
> d\. Position Description/Job Standard\--A copy of the current position
> description or job standard should be included in the package that the
> employee takes to the doctor.
>
> C. **[Investigation of Accident]{.underline}**
>
> 1\. The supervisor or his/her designee should investigate the accident
> to determine how the injury occurred. At a minimum, the following
> questions should be asked in order to obtain the facts of the case:

-   What happened?

-   When did it happen?

-   Where did it happen?

-   How did the accident occur?

-   Why did it happen?

-   Who witnessed the accident?

-   What corrective action should be taken?

> 2\. If, as a result of the investigation, it is determined that the
> injury was work related, the supervisor should:
>
> a\. Review the Employee Data Section of form CA-1 for completeness and
> accuracy and assist the employee in correcting any deficiencies.
>
> b\. Complete the supervisor\'s report on the reverse side and sign the
> form.
>
> c\. Advise the employee of continuation of pay (COP) entitlement.
>
> d\. Provide the employee the Acceptance of Claim Notification Page
> (from the form)
>
> e\. Submit the CA-1 and supporting documentation to the OWCP Case
> Manager or Coordinator within 24 hours after receiving it from the
> employee.
>
> 3\. If the supervisor has evidence that the accident is not work
> related, then he/she should:
>
> a\. Advise the employee that continuation of pay will be controverted
> (disputed). The supervisor should indicate in Block 35 of the
>
> CA-1 that the claim will be controverted and should provide a detailed
> description in support of the controversion.
>
> b\. Submit form CA-1 and supporting documentation to the OWCP Case
> Manager or Coordinator for further processing.
>
> 4\. Report of Accident - The supervisor should complete all safety
> accident forms as required by BPA. Assistance may be requested from
> the Safety Office.

D. **[Injury but no Medical Expense]{.underline}**

> When an employee is injured on the job but no medical expense is
> incurred, the CA-1 should be completed and sent to the OWCP Case
> Manager or Coordinator to retain in the employee OWCP file. This will
> provide appropriate documentation should a future incident occur.

**Appendix 2**

**Outline for Claim Procedures**

**CA-2 - OCCUPATIONAL DISEASE**

The following procedures apply when an employee believes that that
he/she has sustained an occupational disease.

> A. Complete Form CA-2, Notice of Occupational Disease and Claim for
> Compensation, Employee Data Section, and submit it to the supervisor.
>
> B. The supervisor should provide to the employee an Injury Packet
> containing the forms listed below. Injury packets are available from
> the OWCP Case Manager or OWCP Coordinator or the HR Intranet site.
>
> 1\. Form CA-35 A-H, Occupational Disease Checklists, Appendix 10 for
> the disease claimed. The supervisor should also explain to the
> employee the need for detailed information and the requirement to
> furnish the supporting medical and factual documentation requested on
> the checklist. This information must accompany the form when it is
> submitted.
>
> 2\. Form CA-17, Duty Status Report\--The supervisor completes part A
> of the form prior to giving it to the employee. The employee must
> return this form to the supervisor immediately after the doctor\'s
> appointment or by the following day.
>
> 3\. When the CA-2 and the supporting documentation are received, the
> supervisor should:
>
> a\. Review the Employee Data Section for completeness and accuracy and
> assist the employee in correcting any deficiencies noted.
>
> b\. Complete the supervisor\'s report on the reverse side of the form
> and sign it.
>
> c\. Provide comments on the employee\'s statement as required by the
> instructions for the CA-2.
>
> d\. Sign and return to the employee, the receipt attached for Form
> CA-2. Provide a copy of the CA-2 to the employee if he/she requests
> it.
>
> e\. Advise the employee of the right to elect sick or annual leave or
> leave without pay, pending adjudication of the claim.
>
> f\. Submit the completed Form CA-2 and the supporting documentation to
> the OWCP Case Manager or Coordinator for further processing.
>
> 4\. Report of Accident\--The supervisor should complete any BPA safety
> accident reporting requirements.
>
> C. If the claim is accepted by OWCP, the employee may file a CA-7,
> Claim for Compensation, for pay compensation, to repurchase leave,
> scheduled award, and/or for travel to and from the doctor\'s facility
> if appropriate. Time code 162, leave without pay while compensated by
> OWCP, should be used by the employee for the hours claimed on the
> CA-7. The supervisor should provide these forms to the employee, and
> if necessary, complete the supervisor\'s part of the form and submit
> it to the OWCP Case Manager and/or Coordinator for further processing.
>
> D. Form CA-7 will be used by the employee to claim continuing
> compensation after the initial period claimed, or to claim additional
> periods of leave repurchase and/or entitlement to a Scheduled Award.
>
> E. Continuation of Pay (COP) does not apply to an occupational
> disease. Once the claim is accepted by the Department of Labor, pay
> compensation may be applicable. Employees should contact the OCM or
> OCC for procedures for submitting claims.
>
> F. **CA-16, Authorization for Examination and/or Treatment, will not
> be issued to the employee**. The employee is responsible for payment
> of all medical bills until such time as the claim is accepted by OWCP.
>
> G. **Occupational Disease but no Medical Expense.** When an employee
> sustains an occupational disease, but no medical expense is incurred,
> the CA-2 should be completed and sent to the OWCP Case Manager or
> Coordinator to retain in the employee OWCP file. This will provide
> appropriate documentation should a future incident occur.

**Appendix 3**

**Instructions to Injured Employee**

The following are instructions to assist you: (1) in completing the
appropriate paperwork related to your injury; (2) in obtaining medical
treatment; and (3) in meeting your responsibility with regard to light
duty.

The procedures to be used for filing a claim for a work-related injury
will depend on whether the injury is a traumatic injury or an
occupational disease. Obtain the appropriate injury packet depending on
the nature of your injury from your supervisor, your administrative
support specialist, or from your servicing personnel office. The
following are the procedures for each:

A. **[Traumatic Injury: Injuries occurring within one work
shift]{.underline}**

> 1\. Complete items 1-15 on the CA-1, Federal Employee\'s Notice of
> Traumatic Injury and Claim for Continuation of Pay/Compensation.
>
> 2\. Read item #15 carefully. You are entitled to Continuation of Pay
> (COP) for up to 45 calendar days of disability as evidenced by your
> medical documentation. This time is not charged against your sick
> leave or annual leave. You may elect sick leave or annual leave if you
> wish. If you change your election of leave within one year, the agency
> will convert past periods of leave to COP, providing there is adequate
> medical documentation.
>
> 3\. Sign the CA-1, and submit it to your supervisor. Request that the
> receipt of the Notice of Injury be completed and provided to you for
> your records.

B. **[Occupational Disease: Injuries developed over more than one work
shift]{.underline}**

> 1\. Complete Form CA-2, items 1-18 and submit the form to your
> supervisor, along with the information required on form 35A-H,
> whichever is appropriate for the occupational disease that you have
> claimed.
>
> 2\. Request that your supervisor complete the Receipt of Notice of
> Occupational Disease or Illness and provide a copy to you for your
> records.

C. **[Medical Documentation:]{.underline}**

> 1\. You MUST provide your supervisor with form CA-17 (Duty Status
> Report) after your doctor\'s appointment or no later than the next
> business day.
>
> 2\. A CA-17 is also required for every medical examination performed
> as a result of your on-the-job injury. This includes emergency room
> examinations and all subsequent doctors visits.
>
> 3\. Any time loss as a result of your on-the-job injury must be
> reported to your supervisor. This includes any time for medical
> appointments or subsequent absences due to the injury

D. **[Medical Treatment]{.underline}**

> 1\. Immediate medical care may be provided by a doctor other than a
> physician of your choosing. This doctor is not considered your first
> choice. The first choice physician is the doctor chosen by you for
> follow-up treatment. Once this physician has been selected, you may
> change physicians only with the prior approval of the Office of
> Workers\' Compensation Programs (OWCP) or by referral from the first
> choice physician.
>
> 2\. Any medical treatment that is required due to an on-the-job injury
> must be obtained in a timely manner. Whenever medical care is
> required, you must designate the physician you have selected to
> provide such care. If you cannot be seen on the same date by that
> doctor, you may be required to provide the name of another doctor who
> will then be contacted to arrange for immediate treatment.
>
> NOTE: Chiropractors may be selected as a treating physician; however,
> you should be aware that not all chiropractic services are covered by
> OWCP. The law limits chiropractic treatment to manual manipulation of
> the spine to correct a subluxation as demonstrated by x-ray.

E. **[Light Duty]{.underline}**

> 1\. All injured employees will be given a form entitled Notice of
> Employee Responsibilities.
>
> 2\. You are required to:
>
> a\. Inform your physician that light duty work is available for you if
> you are unable to perform your regular work.
>
> b\. Find out from your physician the first day you can return to work.
>
> 3\. Failure to report for Light Duty, when you have been found fit for
> such an assignment, may result in a denial of your workers'
> compensation benefits.

**Appendix 4**

**Sample Physician Statement**

**Note: Type on BPA Letterhead**

Treating Physician

Subject: Light Duty

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is
being referred to you for treatment of a

job-related injury, illness, or disease. Bonneville Power
Administration\'s policy is to provide light duty to all employees with
a work-related injury, illness, or disease whenever possible.

We will provide work for the employee within the medical limitations
that you stipulate. The employee does not have to perform his/her
regular job. We will accommodate all limitations short of total bed
rest.

Please complete the enclosed Office of Workers\' Compensation Program
Form CA-17, Duty Status Report, and give it to the employee to return to
his/her supervisor. BPA will use this information to identify a suitable
light duty assignment within the employee\'s physical restrictions. In
addition, attached is a copy of the employee\'s position description or
job standard.

If you have any questions, please contact me at
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.

Thank you for your assistance and cooperation.

Supervisor, Manager, or OWCP Case Coordinator

Attachments

1\. CA-17 Duty Status Report

2\. Position Description