# Presentation: 171282

## OWCP Training for Supervisors

**Presented by FAA Office of Human Resources Management**

## Objectives

**Provide a broad background of the Federal workers’ compensation program**
**Provide supervisors information to assist their injured employees filing a claim**
**Discuss cost containment and return to work strategies**

## Topics of OWCP Overview

**What is the FECA?**
**Provisions of the FECA**
**Conditions of Coverage**
**Types of Injuries and Claim Forms**
**COP and Controversion**
**Filing a Claim for Compensation**
**Containing OWCP Costs**
**Resources and References**

## FECA

**Federal Employees’ Compensation Act (FECA) passed in 1916**
**Exclusive Remedy**
**Non-adversarial**
**Administered by Department of Labor (DOL), Office of Workers Compensation Programs (OWCP)**
**Benefits paid by DOL, charged back to FAA **

## Provisions of FECA

**Medical Benefits**
**Continuation of Pay (COP)**
**Wage Loss Compensation**
**Schedule Awards**
**Vocational Rehabilitation**
**Death/Burial Expenses**

## Conditions of Coverage

**Timely Filing of Claim**
**Federal Civilian Employee**
**Fact of Injury**
**Performance of Duty**
**Causal Relationship**

## Timely Filing

**Employee Has Three Years From:**
**Date of Injury**
**Date of First Awareness**
**Date of Last Exposure**

## Federal Employee

_**5 U.S.C. 8108 (1) (a) defines a Federal employee as**_**:**
**A civil officer or employee in any branch of the government of the United States, including an officer or employee of an instrumentality wholly owned by the United States**

## Fact of Injury

**Two Components **
**Factual: occurrence of accident/exposure at the time, place, and manner alleged**
**Medical: condition diagnosed in connection with untoward event**
**Agency should assist in gathering of factual evidence only**

## Performance of Duty

**Injury must result from regular or specially assigned duties or a requirement imposed by the position (out of and in the course of employment)**
**POD issues include TDY, industrial premises, recreation and exercise programs, administrative or personnel actions**

## Performance of Duty cont.

_**Temporary duty (TDY)**_
**Coverage afforded 24/7 for activities incidental to the mission**
**Coverage excluded when employee diverts from duty for a personal errand**

## Performance of Duty cont.

_**Industrial Premises**_
**Employee with fixed place of employment covered if on premises**
**Off premises injuries can be covered if:**
**employee on special mission or errand **
**employee’s regular duties require him to be away from duty station**
**employee on TDY**

## Performance of Duty cont.

_**Recreation and Exercise Programs**_
**Coverage provided when:**
**Employment requires participation to maintain level of fitness**
**law enforcement officers**
**Employer sponsored the event or obtained some level of benefit from employee’s participation**

## Performance of Duty cont.

_**Administrative and Personnel Actions**_
**No FECA coverage afforded unless action taken was erroneous or abusive**
**Examples:**
**leave usage**
**performance appraisals**
**adverse actions**

## Causal Relationship

**Link between work-related exposure and medical condition being claimed**
**Four Types:**
**Direct Causation**
**Aggravation**
**Acceleration**
**Precipitation**

## Statutory Exclusions

**Willful Misconduct**
**Drug or Alcohol Intoxication**
**Intent to Injure Self or Others**

## Scenario One

**    ****A runway inspector files an OWCP claim  alleging that while returning to his duty station from lunch his privately owned vehicle was struck across the street from the agency owned parking garage causing a neck sprain.  Did this injury occur in the performance of duty?**
**	****	****	****Yes****	****	****	****No**

## Scenario Two

-     **An air traffic controller filed a stress claim for a mental condition which resulted from an operational error in which two planes nearly collided.  Following an investigation the employee was removed from the boards and placed in an administrative position.  The employee stated on his claim form that his stress resulted from the fact that he almost cost dozens of people their lives.   Is this incident considered performance of duty?**
**	****	****	****Yes****	****	****	****No**** **

## Scenario Three

-     **A program analyst on TDY tripped over a bump on the sidewalk and fell on her knee while returning to her hotel from dinner. The restaurant was located four blocks from the hotel and the employee admitted having two glasses of wine with dinner. Would this incident be considered performance of duty? **
**	****	****	**
**Yes****	****	****	****No**

## Types of Injuries and Claim Forms

## Traumatic Injury

**Injury caused by specific event or series of events occurring during one workshift**
**Eligibility for COP**

## Filing a Traumatic Injury Claim

**CA-1: Notice of Traumatic Injury**
**must be transmitted to DOL within 10 workdays of receipt from employee**
**CA-16: Authorization for Examination**
**guarantees payment of medical expenses for 60 days**
**All forms must be filed in accordance with bargaining agreement as appropriate**

## Occupational Disease

**Condition produced over a period longer than one work day or shift (e.g. repetitive motion disorders, sick building syndrome)**
**No eligibility for COP**

## Filing an Occupational Disease Claim

**CA-2: Notice of Occupational Disease**
**must be transmitted to DOL within 10 workdays of receipt from employee**
**CA-35 a-h: Occupational Disease Checklist**
**All forms must be filed in accordance with bargaining agreement as appropriate**

## COP and Controversion

## COP - Basic Requirements

**Traumatic Injury **
**Injury reported on CA-1 within 30 days**
**Prima facie medical evidence within 10 calendar days from the date of filing**
**Disability begins within 45 days**

## Controverting COP

**Withhold COP**
**must be for one of nine reasons cited on CA-1**
**indicate controversion on CA-1 and attach narrative statement and specific evidence substantiating controversion**
**advise employee **
**can also terminate COP if no prima facie medical evidence within 10 days**

## Nine Reasons for Controverting COP

**Disability not caused by traumatic injury**
**Employee is a volunteer working without pay, or for nominal pay, or a member of the office staff of a former President**
**Employee is not a citizen of the U.S. or Canada**
**Injury occurred off agency’s premises and employee was not involved in official duties**

## Controverting COP cont.

**“****Statutory Exclusions”**
**Injury not reported on CA-1 within 30 days of the injury**
**Work stoppage began 45 days or more following the injury**
**Injury first reported after employment was terminated**
**Employee enrolled in Civil Air Patrol, Peace Corps, or other similar groups**

## Challenging Validity of Claim

**Claim doesn’t meet one of five conditions of coverage**
**attach detailed statement describing circumstances behind challenge**
**include specific evidence: witness statements, accident investigations, timecards, etc. **
**pay COP pending OWCP decision**

## Scenario Four

-    **A budget analyst alleges that he developed carpal tunnel syndrome due to repetitive typing and mouse usage during his seventeen year career. He contacts you to file an OWCP claim. Which form do you advise him to file? **
**	****	****	****a) CA-1  ****	****	****b) CA-2**

## Scenario Four cont.

-    **The employee indicates that he is disabled from working, requests COP, and provides you medical documentation substantiating his inability to work, all on the day he files his claim. Is he entitled to COP for his absence from work?**
**	****	****	****Yes****	****	****	****No**

## Scenario Five

-     **An employee suffers a traumatic injury while lifting heavy boxes during an office move on January 31. She continued working until February 24 at which time she filed form CA-1, provided medical documentation substantiating that she was disabled, and went home. Is she entitled to COP during her absence from work?**
**	****	****	****Yes****	****	****	****No****	****	**

## Scenario Six

-      **An employee claims he slipped and fell in the bathroom and suffered a back injury. He immediately goes home claiming disability although he didn’t appear to be in distress. Two of his co-workers tell you they heard the employee state that his brother was moving and he planned on finding a way to take off to assist in the move. The employee has a negative leave balance. What do you do with the claim?**
**	****a) Controvert COP **
**	****b) Challenge the claim and pay COP pending DOL adjudication**
**	****c) Refuse to allow the employee to file a claim**
**	****d) Order the employee back to work and provide him the name of your neighbors moving company to assist with the move**

## Filing a Claim for Wage Loss Compensation

**CA-7: Claim for Compensation**
**must be received by DOL within 5 workdays**
**CA-20: Attending Physician’s Report**
**CA-17: Duty Status Report**

## CA-7

**Claim for Compensation**
**used for filing for wage loss compensation, leave buy back, schedule award**
**Two Parts**
**employee completes front**
**supervisor/HRMD completes back**
_**Must **_**be transmitted to OWCP within five workdays of date of receipt from employee**

## CA-7 continued

**When to File**
**wage loss compensation: expiration of COP/commencement of LWOP and subsequent biweekly intervals of LWOP**
**leave buy back: within one year of date leave used or claim accepted, whichever is later**
**include CA-7a and CA-7b in package to OWCP **
**schedule award: maximum medical improvement**

## Containing OWCP Costs

## Containing OWCP Costs

**2003 OWCP Costs  **
**FAA: $88.3 million chargeback**
**sixth highest bill in Federal government**
**increase of 0.5%**
**Government-wide: $2.3 billion chargeback**
**increase of 4.5%**

## Cost Containment Strategies

**Submit Notice of Injury/Illness within 10 workdays and Claim for Compensation within five workdays**
**enables prompt adjudication and medical management of claim**
**ensures compliance with SHARE initiative and Federal regulations **

## Cost Containment Strategies cont.

**Controvert/Challenge Questionable Claims**
**OWCP accepts employee statement as factual unless agency provides refuting evidence **
**agency does not have post adjudicative appeal rights: **_**now is the time to submit contrary evidence on questionable claims**_
**include actual evidence rather than conjecture or opinion**

## Cost Containment Strategies cont.

**Track Injured Employees’ Medical Status**
**maintain **_**constant contact**_** with employee**
**request frequent medical updates**
**can contact physician in writing at any time**
**cooperate with OWCP nurses, claims examiners,  vocational rehabilitation specialists, HRMD workers’ compensation specialists, and Flight Surgeons**

## Cost Containment Strategies cont.

_**Offer Light Duty**_
**Match employees’ physical limitations to your particular 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 **

## Cost Containment Strategies cont.

**Light Duty Offers**
**Can be made verbally but must be followed-up in **_**writing**_
**Must include: job description, physical demands of position, organizational and geographical location, date available, date response required**
**If employee refuses, notify OWCP **_**immediately**_

## Importance of Proactive Case Management

**35 year old employee earning FAA average salary of $79,500 will accrue over $4.7 million in wage loss compensation if never returned to work**
**35 year old Air Traffic Controller earning average salary of $98,300 will accrue $5.8 million in wage loss compensation if never returned to work**
**Based on 2001 data. Adjusted for inflation, assuming 70 year life expectancy**

## References

**HRMD Workers’ Compensation Specialist**
**FAA Supervisors’ Manual for OWCP**
**5 U.S.C. 8101 et seq. (FECA)**
**20 C.F.R. Parts 10 and 25 (OWCP Regs)**
**CA-810: Injury Comp for Fed Employees**
**CA-550: Federal Injury Comp Q&A**
**Federal Procedure Manual Part 2**
**Decisions of the ECAB**

## Internet Resources

**DOL Website **
**http://www.dol.gov/esa/regs/compliance/owcp/fecacont.htm**
**FAA Website**
**http://www.faa.gov/ahr**

## Questions and Answers