United States Department of Agriculture 

 Marketing and Regulatory Programs 

 Agricultural Marketing Service 

 Animal and Plant Health Inspection Service 

 Manual MRP 4791 

Workers’ Compensation Policy and Procedures Manual 

February 2009 

 
 United States Department of Agriculture 

 Marketing and Regulatory Programs 

 Agricultural Marketing Service 

 Animal and Plant Health Inspection Service 

 Manual MRP 4791 2/6/09 

WORKERS’ COMPENSATION (WC) POLICY AND PROCEDURES MANUAL

The Workers’ Compensation (WC) Policy and Procedures Manual was developed to assist 

Animal and Plant Health Inspection Service (APHIS) and Agricultural Marketing Service (AMS) 

employees when a work-related accident, injury, or illness occurs. This Manual is the only 

reference APHIS and AMS employees will need concerning the management of WC claims and 

costs. 

By organizing information regarding the Department of Labor, Office of Workers’ 

Compensation Program into one document, managers, supervisors and WC representatives 

should be better equipped to manage WC claims and costs. 

The Workers’ Compensation Policy and Procedures Manual cancels previous directives, 

administrative notices, and other Marketing and Regulatory Program publications. 

Updates for this Manual will occur annually and will incorporate employee suggestions, changes 

in legislation, and general improvements. Comments should be sent to: 

 USDA/MRP/APHIS Human Resources 

 Workplace Resolutions and Wellness Branch 

Workers’ Compensation Program Manager 

4700 River Road, Unit 124 

 Riverdale, MD 20737 

/s/ 

Gregory L. Parham 

Deputy Administrator 

MRP Business Services

Distribution: AMS, APHIS Originating Office: APHIS-MRP-HRD-WRWB
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WORKERS’ COMPENSATION POLICY AND PROCEUDRES MANUAL

Table of Contents

CHAPTER 1..................................................................................................................................1 

INTRODUCTION...........................................................................................................1 

1. PURPOSE .........................................................................................................................................1 

2. BACKGROUND...............................................................................................................................1 

3. AUTHORITIES................................................................................................................................1

4. ACRONYMS AND DEFINITIONS..........................................................................2 

CHAPTER 2..................................................................................................................................5

WORKERS’ COMPENSATION (WC) POLICY ....................................................................................5

1. POLICY.............................................................................................................................................5

2. TIMELINESS REQUIREMENTS .................................................................................................5

3. FORMS FOR WORK-RELATED INJURIES / ILLNESSES..........................................6

4. OWCP BENEFITS...........................................................................................................................7

5. CONTACTING OWCP DISTRICT OFFICES AND OBTAINING OWCP FORMS..............9

CHAPTER 3..................................................................................................................................11

WORKERS’ COMPENSATION (WC) POLICY AND RESPONSIBILITIES...................................11

1. AMS AND APHIS DEPUTY ADMINISTRATORS...................................................................11

2. MRP WORKPLACE RESOLUTIONS AND WELLNESS BRANCH (WRWB)....................11

3. MRP SUPERVISORS / MANAGERS..........................................................................................12

4. MRP EMPLOYEES.......................................................................................................................13

5. WC FIELD REPRESENTATIVES ..............................................................................................14

6. EMPLOYEE DISCIPLINARY ACTIONS..................................................................................15

7. FRAUDULENT OR FALSE CLAIMS.........................................................................................16

CHAPTER 4................................................................................................................................17

WORK-RELATED INJURIES/ACCIDENTS AND ILLNESSES .......................................................17

1. WORK-RELATED INJURIES/ILLNESSES..............................................................................17

2. WHAT TO DO WHEN INJURIED.........................................................................17

3. WHEN INJURIED ON TEMPROARY DUTY ASSIGNMENTS....................................17

4. THIRD PARTY CLAIMS .............................................................................................................19

5. TEMPORARY EMPLOYEES......................................................................................................19
ii

CHAPTER 5................................................................................................................................21

MEDICAL DOCUMENTATION AND PRIVACY ...............................................................................21

1. MEDICAL DOCUMENTATION .................................................................................................21

2. RECORDS MANAGEMENT .......................................................................................................21

3. PRIVACY REGULATIONS .........................................................................................................22

4. ACCESS TO OWCP AGENCY QUERY SYSTEM (AQS) AND AFFILIATED COMPUTER 

SYSTEM (ACS) BILLING..........................................................................................................23

5. ACCESS TO USDA WC CASE MANAGEMENT SYSTEM (CMS) DATA...........................23

CHAPTER 6................................................................................................................................24

LEAVE WITHOUT PAY (LWOP) AND REMOVAL...........................................................................24

1. FORMS REQUIRED FOR LWOP OR REMOVAL..................................................................24

2. LEAVE WITHOUT PAY ..............................................................................................................24

3. PROCEDURES FOR REQUESTING LWOP ............................................................................25

4. INITIATING REMOVAL AFTER EXTENDED LWOP ..........................................................26

5. REGULATORY AUTHORITY FOR REMOVAL.....................................................................26

CHAPTER 7................................................................................................................................28

LEAVE BUY BACK (LBB) PROCEDURES..........................................................................................28

1. FORMS REQUIRED FOR LBB...................................................................................................28

2. PROCEDURES FOR REQUESTING LBB.................................................................................28

CHAPTER 8................................................................................................................................30

RETURN TO WORK (RTW)...................................................................................................................30

1. RTW OVERVIEW.........................................................................................................................30

2. RTW – SHORT TERM CASES....................................................................................................30

3. RTW – LONG TERM MANAGEMENT GUIDELINES...........................................................31

4. LONG TERM CASE MANAGEMENT.......................................................................................31

5. VOCATIONAL REHABILITATION..........................................................................................35

6. RESTORATION RIGHTS ............................................................................................................36

7. REASONABLE ACCOMMODATION.....................................................................36

8. DISABILITY RETIREMENT......................................................................................................36

CHAPTER 9................................................................................................................................37

OFFICE OF WORKERS’ COMPENSATION PROGRAM (OWCP) BILLING PROCEDURES...37

1. AGENCY CHARGEBACK BILLING.........................................................................................37

2. EMPLOYEE MEDICAL TREATMENT BILLS........................................................................37
iii

3. EMPLOYEE MISCELLANEOUS PAYMENTS........................................................................38

4. OWCP ACS BILLING ADDRESS ...............................................................................................38

5. MEDICAL PROVIDER DIRECTLY BILLS CLAIMANT..........................................38

CHAPTER 10 ..............................................................................................................................40

PROCEDURES FOR EMERGENCY PROGRAMS.............................................................................40

APPENDIX A 

FORMS 
Page 1

CHAPTER 1 

INTRODUCTION 

1. PURPOSE 

This Chapter provides current policy and procedures on WC in the Marketing and 

Regulatory Programs’ (MRP) Agricultural Marketing Service (AMS) and the Animal and 

Plant Health Inspection Service (APHIS), as required by the Federal Employees 

Compensation Act (FECA) and the 2004 Safety, Health, and Return to Employment 

(SHARE) Presidential Initiative. 

2. BACKGROUND 

a. The FECA provides compensation benefits to civilian employees of the United 

States Federal Government for disability due to injury or illness sustained while in 

the performance of their duties. FECA provides compensation benefits to 

dependents for a work-related injury or illness that causes an employee’s death. 

FECA also provides wage replacement benefits, medical treatment, and 

vocational rehabilitation. 

b. On January 4, 2004, President Bush signed the SHARE Initiative to lower 

workplace injury and illness case rates, lower lost-time injury and illness case 

rates, increase the timely reporting of injuries and illnesses, and reduce lost days 

resulting from work injuries and illnesses. SHARE requires Federal agencies to 

meet the following goals over the next 5 years: 

 (1) Reduce the overall occurrence of injuries by 3 percent each year, 

 (2) Increase the timeliness of reporting injuries and illnesses by 5 percent each 

 year, and 

 (3) Reduce the rate of lost production days (i.e., the number of days 

 employees spend away from work) by 1 percent each year. 

3. AUTHORITIES 

 The authorities for providing WC benefits for injuries and illnesses sustained in the 

performance of official duties are contained in: 

 a. Title 5, United States Code, Chapter 81, FECA. 

 b. Title 20, Code of Federal Regulations, Chapter I, Parts 1 – 199. 
Page 2

 c. USDA Safety and Health Manual, Chapter 3, Chapter 8, dated 1996. 

 d. Safety, Health and Return to Employment Initiative (SHARE), dated 

 January 4, 2004. 

4. ACRONYMS AND DEFINITIONS 

Acronym Meaning 

AMS Agricultural Marketing Service 

APHIS Animal and Plant Health Inspection Service 

COP Continuation of Pay 

DOI Date of Injury 

DOL Department of Labor 

EMF Employee Medical File 

FECA Federal Employees’ Compensation Act 

HR Human Resources 

LWOP Leave Without Pay 

MRP Marketing and Regulatory Programs 

MN Minneapolis 

OWCP Office of Workers’ Compensation Program 

RTW Return to Work 

SHARE Safety Health and Return to Employment 

(Presidential Initiative) 

SF Standard Form 

T&A Time and Attendance 

US United States 

USDA United States Department of Agriculture 

WC Workers’ Compensation 

Chargeback. Mechanism by which costs for work-related injuries and deaths are 

assigned to employing agencies through the Department of Labor (DOL), Office of 

Workers’ Compensation Program (OWCP). Payments are made from the Employees’ 

Compensation Fund. 

Continuation of Pay (COP). Continuation of an employee’s salary for up to 45 calendar 

days of wage loss due to disability and/or medical treatment following a traumatic injury. 

DOL District Office. DOL regional office that conducts operations of OWCP, and 

maintains claimant records. 

Employee Medical File (EMF). A separate file folder, SF-66D, used to place all OWCP 

claim forms, medical information, and other documentation such as rehabilitation and 

adjudication notes. 

FECA. Federal Employees Compensation Act. 
Page 3

Leave Buy Back. Process where claimant can re-purchase personal leave used for a WC 

claim to have leave restored back to his/her Time and Attendance file. This procedure 

normally requires repaying the agency for an overpayment as personal leave is paid at 

100 percent and OWCP leave is paid at either 75 percent or 66 2/3 percent. 

Occupational Disease. Condition produced in the work environment over a period longer 

than 1 workday or shift, resulting from systemic infection; repeated stress or strain; 

exposure to toxins, poisons, or fumes; or other continuing conditions of the work 

environment. 

OWCP. Office of Workers’ Compensation Program. The Federal agency within the 

DOL having the authority to approve or deny Federal civilian employees WC claims for 

work-related injuries or illnesses. 

OWCP Claimant. An MRP employee who has become injured or ill while performing 

his/her official duties and has submitted OWCP forms to the DOL District Office. 

Nurse Intervention. A service provided by DOL where a registered nurse contacts the 

claimant to inquire about his/her injuries or illness. DOL believes that with early medical 

intervention and follow-up, the claimant can recuperate better and return to work faster. 

Each DOL District Office has a registered nurse responsible for contacting claimants. 

Temporary Employees. Employees (seasonal, intermittent, students, etc.) that are 

covered by OWCP on the same basis as permanent employees - they are guaranteed 

compensation and medical treatment until maximum medical improvement is achieved. 

Traumatic Injury. A wound or other condition of the body caused by external force, 

including stress or strain. The injury must be identifiable as to time and place of 

occurrence and member or function of the body, caused by a specific event or series of 

events, or incidents within a single day or work shift. 

Third Party Claims. Claims based on injuries/accidents that arise from non-Government 

entities. For example, an employee traveling in a Government authorized motor vehicle 

is struck by a private citizen or entity. 

Return to Work. Process where claimants are returned to work after a period of 

recuperation away from the job. Claimants can be returned to work in part-time or light 

duty positions, their position prior to the injury/illness, or a new position depending upon 

several criteria (time off from job, injury status, etc.). 

WC Representatives. Field employees within MRP assigned the collateral duty function 

to assist in WC program administration by providing advice and counsel to employees on 

WC matters. 
Page 4

WC Program Manager. The designated employee within MRP Business Services 

responsible for the development, implementation, and evaluation of a comprehensive WC 

program for MRP. 
Page 5

CHAPTER 2 

WORKERS’ COMPENSATION (WC) POLICY 

1. POLICY 

a. MRP is committed to assisting employees in receiving all benefits under FECA to 

which they are entitled and will not discipline or otherwise retaliate against 

employees for reporting an injury or illness. 

b. Supervisors must sign and forward the forms CA-1, Notice of Traumatic Injury, 

or CA-2, Notice of Occupational Injury or Illness, within 3 days to the WC 

representative. If the supervisor does not have knowledge of the injury/illness or 

was not the supervisor at the time of the injury/illness, a statement must be 

provided to this effect to support the certification statement on the OWCP forms. 

c. The CA-16, Authorization for Examination and/or Treatment, is issued only for 

traumatic injuries. Supervisors cannot issue a CA-16 if the employee has not 

requested medical treatment within 48 hours of a traumatic injury. This form 

cannot be issued retroactively. 

d. Continuation of Pay (COP) is allowed for up to 45 calendar days, beginning the 

first day after the initial traumatic injury if employees provide medical 

documentation stating they cannot resume full duty. This note must be received 

by the supervisor within 10 days of the request for COP. Employees can use COP 

intermittently during the 45-day period for medical appointments. They will be 

charged a full day for COP as COP cannot be broken down into hours. 

e. WC Representatives must review (for completeness and accuracy) and forward 

the Office of Workers’ Compensation Program (OWCP) forms and medical 

documentation within 5 days of receipt from a supervisor to the respective OWCP 

District Office. 

f. OWCP prohibits direct Agency contact with a claimant’s physician via telephone 

or in person. All Agency contact to a claimant’s physician must be in writing and 

for the purpose of monitoring an employee’s medical progress, duty status and for 

billing concerns. 

2. TIMELINESS REQUIREMENTS 

 Based on the SHARE Initiative, OWCP established timelines for submitting CA-1s, 

 CA-2s, and CA-7s. OWCP policy states that the agency must submit a: 

a. CA-1 or CA-2 within 10 days of the employee’s date of notice, box 23 on CA-1. 
Page 6

b. CA-7 within 7 days of the employee’s signature date. 

The following timelines are established to meet OWCP requirements for the timely filing of 

claims: 

 Timeline to Submit Claim Form 

Form Employee Supervisor WC Contact 

CA-1 ASAP, but up to 3 years 

from date of injury 

3 days after employee 

submits form 

5 days from receipt 

of form 

CA-2 ASAP, but up to 3 years 

from date of injury 

3 days after employee 

submits form 

5 days from receipt 

of form 

CA-7 5 days before COP expires 

or when pay stops 

3 days after employee 

submits form 

2 days from receipt 

of form 

CA-16 ASAP, with the CA-1 3 days after employee 

submits form 

5 days from receipt 

of form 

CA-17 Immediately following 

doctor’s appointment and 

every 2 weeks thereafter 

1 day after employee 

submits form 

1 day from receipt of 

form 

CA-20 Immediately following 

doctor’s appointment 

1 day after employee 

submits form 

1 day from receipt of 

form 

3. FORMS FOR WORK-RELATED INJURIES/ILLNESSES 

Form 

Number 

Form Title OWCP Web page Link 

CA-1 Notice of Traumatic Injury/Accident http://www.dol.gov/esa/regs/compliance/owcp/ca1.pdf

CA-2 Notice of Occupational 

Illness/Disease 

http://www.dol.gov/esa/regs/compliance/owcp/ca2.pdf

CA-5 Claim for Compensation by 

Widow/Widower or Children 

http://www.dol.gov/esa/regs/compliance/owcp/ca5.pdf

CA-6 Supervisor’s Notice of Employee’s 

Death 

http://www.dol.gov/esa/regs/compliance/owcp/ca2.pdf

CA-7 Claim for Compensation http://www.dol.gov/esa/regs/compliance/owcp/ca7.pdf

CA-7a Time Analysis http://www.dol.gov/esa/regs/compliance/owcp/ca7a.pdf

CA-7b Leave Buy Back http://www.dol.gov/esa/regs/compliance/owcp/ca7b.pdf

CA-16 Authorization for Medical 

Examination/Treatment 

Not available online. Obtain from local office. 

CA-17 Duty Status Report http://www.dol.gov/esa/regs/compliance/owcp/ca17.pdf

CA-20 Attending Physician’s Report http://www.dol.gov/esa/regs/compliance/owcp/ca20.pdf
Page 7

OWCP 

915 

Claim for Medical Reimbursement http://www.dol.gov/esa/regs/compliance/owcp/OW

CP-915.pdf

OWCP 

957 

Medical Travel Refund Request http://www.dol.gov/esa/regs/compliance/owcp/OW

CP-957.pdf

All other OWCP available forms can be found at: http://www.dol.gov/esa/regs/compliance/owcp/for

ms.htm

APHIS 

Form 260 

Medical Alert Card Obtain from APHIS Printing and Distribution at 

301-734-5323 

4. OWCP BENEFITS 

 This section explains the benefits of OWCP to employees who have a claim that is 

 accepted by OWCP. 

a. Job Retention and Restoration Rights. An employee who fully or partially 

recovers from work-related injury/accident within 1 year has mandatory rights to 

his/her previous job or its equivalent. If the work-related disability extends 

beyond 1 year, the Agency can remove the employee from the rolls (collaboration 

between supervisor and Employee Relations Staff.) However, the employee will 

continue to receive compensation from OWCP as long as the work-related 

disability exists and is supported by medical documentation. 

 After 1 year, when the employee recovers from the work-related disability and is 

medically released to return to duty, the employee is entitled to priority 

consideration to open vacancies. The employee must apply to be rehired within 

30 days from the date compensation ends. 

b. Federal Employee Benefits. Injured employees are entitled to the following 

 benefits when disability extends over 45 days from the date of injury: 

(1) Federal Employees Health Benefits and Federal Employees Group Life 

Insurance coverage continues for the first 365 days of LWOP while in 

receipt of OWCP compensation. Thereafter, the employee must meet the 

same requirements for FEHB/FEGLI continuation as retirees. 

 (2) Pay adjustment upon return to work, if eligible (e.g., within grade 

 increase). 

 (3) Cost of Living Increase. This applies only if on OWCP disability for 

 more than 1 year. 

c. Medical Care and Treatment. Injured employees are entitled to medical care until 

accepted medical condition is at maximum medical improvement (MMI), if the 

work-related injury/accident/illness is accepted by OWCP. Medical Care can 

include surgery, doctor’s visits, physical therapy and diagnostic tests (CAT scan, 

x-rays, MRI, etc.) and other treatment and equipment if approved by OWCP. 
Page 8

d. Schedule Award. Compensation may be provided for the permanent loss, or loss 

of use of certain body parts after the physician has determined that the injured 

employee has achieved MMI. Medical evidence is required to include a 

description of the impairment, the percentage of evaluation of impairment (loss in 

degrees of active and passive motion), and the date MMI was achieved. Form 

CA-7, Claim for Compensation, must be submitted to OWCP with the respective 

medical documentation for consideration. 

e. Vocational Rehabilitation. Disabled employees may be referred to vocational 

rehabilitation services after 1 year by the OWCP to facilitate returning to work in 

line with their physical, emotional, and educational abilities. Employees can be 

placed in positions with other Federal Agencies or the private sector. Vocational 

rehabilitations services can be requested by the attending physician, employee, 

employing agency, or OWCP. 

f. Wage Compensation. 

(1) For traumatic injuries, employees may be entitled to 45 days of 

Continuation of Pay (COP). COP is paid by the Agency and is a 

continuation of the employee’s regular pay. 

(a) When using COP, the employee’s time and attendance sheet must 

be coded “67” for Injury Leave. 

(b) All COP time must be supported with medical documentation 

stating the employee is disabled from work, due to the work related 

injury. Documentation must be received within 10 workdays of 

COP. 

(c) COP begins the day after the injury and can be used intermittently 

for the 45 day period as with physician appointments and physical 

therapy. 

(d) COP cannot be extended past 45 days. If an employee uses 3 

hours in one day for COP, the entire day is counted toward the 45 

day COP period. 

 (e) COP can only be used once per injury. 

(f) When an employee’s claim is denied and COP has been granted, 

the Agency must terminate COP and submit corrected T&A’s, 

using the employee’s annual or sick leave, or leave without pay. 
Page 9

(2) After 45 days, compensation for accepted claims will be paid at 75 percent 

to claimants with dependents and 66 2/3 percent to claimants with no 

dependents. 

(3) OWCP has the right to reduce or terminate compensation if the claimant 

fails to make a good faith effort to return to work or obtain employment 

once medically released. 

g. OWCP Death Benefits. 

(1) Death benefits may be paid to the survivors of employees whose death is 

work-related. Eligible survivors include: 

 

 (a) Spouse until death or remarriage if under age 55; 

 (b) Child/children under age 18, or over if incapable of self support 

 due to disability; 

 (c) Child/children 18-23 who has/have not completed 4 years of 

 education beyond high school and is a full-time student; and/or, 

 (d) Parent, sibling, grandparent, or grandchild who was solely or 

 partially dependent on the deceased. 

(2) Compensation payments up to $800 may be paid for funeral and burial 

expenses. And, if employee dies away from home, the cost of transporting 

the body will be paid in full. 

(3) The USDA may pay a death gratuity not to exceed $10,000, less burial 

 and administrative expenses, to the personal representative. 

(4) OWCP may pay up to $100,000 to the survivors of an employee who dies 

from injuries incurred in connection with the employee’s service with an 

Armed Force in a contingency operation. 

(5) In addition to notifying APHIS Safety and Health, the supervisor or 

administrative contact must immediately report an employee’s death to the 

Human Resources Benefits Specialist in order to process the other Federal 

benefits the employee’s beneficiaries may be entitled to 

5. CONTACTING OWCP DISTRICT OFFICES AND OBTAINING OWCP FORMS 

 DOL/OWCP District Office information can be obtained by accessing the OWCP Web 

 page at http://www.dol.gov/esa/representatives/owcp/fecacont.htm
Page 10

 OWCP claim and reimbursement forms can be accessed at 

http://www.dol.gov/esa/regs/compliance/owcp/forms.htm 
Page 11

CHAPTER 3 

WORKERS’ COMPENSATION (WC) POLICY AND RESPONSIBILITIES

1. AMS AND APHIS DEPUTY ADMINISTRATORS 

The Deputy Administrators will ensure that each AMS and APHIS program has 

employees assigned as Workers’ Compensation (WC) representatives at the field and 

headquarters level, and that the WC representatives are properly trained in the Office of 

Workers’ Compensation Program (OWCP) to assist MRP employees. 

2. MRP WORKPLACE RESOLUTIONS AND WELLNESS BRANCH (WRWB) 

a. The MRP WC Program Manager serves as the liaison with the USDA WC 

Coordinator by: 

 (1) Attending USDA, Department of Labor (DOL), and Federal interagency 

 meetings; 

 (2) Submitting annual reports; replies to Congressional inquiries, and submits 

 other reports as necessary. 

b. The MRP WC Program Manager will: 

 Administer and monitor the WC program for MRP by ensuring that: 

 (1) Changes in OWCP policy and procedures are communicated 

 promptly to the WC representatives and management. 

(2) AMS and APHIS management are informed of Agency wide WC issues, 

including progress on the 2004 Safety, Health and Return to Employment 

(SHARE) Presidential Initiative, and corrective action needed (e.g., 

training of field representatives and supervisors to ensure forms are 

completed correctly and promptly), as appropriate. 

(3) Long term cases are monitored to determine if and when employees may 

return to work. 

(4) Rehabilitation assessments when it is medically determined that 

employees have reached maximum medical improvement and employees 

cannot perform the functions of their position. 

 (5) Investigate suspected fraud and false claim cases are investigated. 
Page 12

(6) Reviews of the CA-1, Notice of Traumatic Injury, and CA-2, Notice of 

Occupational Injury or Illness, are conducted to monitor the proper 

completion of the forms (i.e., agency code, organizational and 

occupational codes, salaries, form completed in its entirety, etc.). 

(7) AMS and APHIS program are provided quarterly reports for medical and 

compensation costs, causes, types, and anatomical location of injury. 

(8) Annual reviews of the MRP WC leave without pay (LWOP) rolls are 

conducted to determine if any employees can be officially removed from 

the Agency’s employment rolls. Information will be forwarded to the 

Employee Relations Staff (ERS) for action. 

(9) All long-term stress claims are reviewed periodically. 

(10) Procedures are provided in areas of long term management, leave buy 

back, fraud, seasonal employees, and other areas that are significant to 

improve the quality of the WC program. 

3. MRP SUPERVISORS/MANAGERS 

MRP Supervisors/Managers must: 

a. Provide a CA-1 or CA-2 to the employee within 1 day of request or notification 

that an injury/illness has occurred. If necessary, the supervisor may fill out the 

CA-1 or CA-2 (e.g., when an employee has been involved in an accident and is 

hospitalized). 

b. Completely fill out the “Official Supervisor’s Report” on either the CA-1 or CA-2 

and, after making a copy, forward the original form to the WC representative 

within 3 days of receipt from the employee. 

c. Ensure that: 

(1) Employees receive time off to seek medical treatment when an injury or 

illness is sustained while performing work. (Employees may elect to use 

annual, sick, or LWOP for occupational or traumatic injuries. 

Continuation of Pay (COP) can be used for traumatic injuries, only.) 

 (2) Facts pertaining to the injury are obtained, in order to complete an injury 

 illness report (CA-1 or CA-2). 

 (3) Any witness statements should be included on the CA-1, or provide an 

 attachment. 
Page 13

 (4) If a third party (non-Government entity with no business relationship 

 with the agency) caused the injury, the name and address of the party 

 responsible will be provided on the CA-1. 

(5) A CA-17, Duty Status Report, is completed if the physician indicates that 

the employee’s injury/illness will result in 2 or more weeks of leave or 

limited/light duty. A copy of the employee’s position description should 

be provided for the physician. 

(6) Injured employees who are recuperating at home or at a medical 

institution are contacted, as appropriate, to maintain employer/employee 

communication. 

(7) Employees who are recuperating, receiving compensation, and have 

regained limited ability to work will be assigned medically appropriate 

light duty or intermittent assignments/shifts by the immediate supervisor. 

(8) Employees are officially placed in a LWOP status when OWCP places the 

employee on the Periodic or Disability Rolls by entering a Request for 

Personnel Action, SF-52. 

(9) Employees are officially removed from the Agency’s employment rolls 

after being on OWCP periodic rolls for 365 calendar days, with assistance 

from Employee Relations Staff. 

(10) Any fraudulent cases are forwarded to the MRP WC Program Manager 

 for investigation. 

4. MRP EMPLOYEES 

 MRP Employees must: 

a. All injuries/accidents/illnesses will be reported immediately to the 

supervisor/manager. Employees should complete the CA-1 or CA-2, and submit 

it to their supervisor/manager within 3 calendar days of injury or illness. If the 

employee is incapacitated, this action may be taken by someone acting on the 

employee’s behalf. 

 b. Should select their initial physician within 25 miles of their residence or official 

 duty station. 

 c. Inform their supervisors of their ability to return to work or perform light duty, 

 within 24 hours of physician approval, even for intermittent light duty 

 assignments of less than a full day. 
Page 14

d. Submit medical documentation justifying time away from the workplace in regard 

to the workplace injury. Medical documentation is required for any COP 

(including, but not limited to, diagnosis, prognosis, any work restrictions, and 

return to work date). 

e. Cooperate with efforts to be returned to work, and efforts to identify appropriate 

alternative employment or reasonable accommodation. 

f. Obtain the CA-16, Authorization for Medical Care, from supervisor if initial 

medical treatment is required. 

g. Complete all required injury forms timely (see Section 6. of this Chapter). 

h. Provide all information requested by the agency and OWCP promptly. 

i. Maintain contact with his/her supervisor and keep him/her advised of the status of 

recuperation and plans for return to work. This contact must occur on a bi-weekly 

basis, or a reasonable, less frequent period, depending upon the nature and 

severity of the employee’s condition 

j. Complete OPM - 71, Request for Leave or Absence, or equivalent form, for all 

absences that are related to workplace injury. Indicate in the Remarks block that 

leave is due to injury. 

k. Immediately report any change in medical condition or restrictions to their 

supervisor and/or Agency WC representative and OWCP Claim Examiner. 

l. Advise their physician if light duty is available that is in line with work 

 restrictions caused by the injury. 

5. WC FIELD REPRESENTATIVES 

 WC Field Representatives will: 

 a. Review the CA-1 or CA-2 after receiving it from a supervisor for accuracy and 

 completeness. 

 b. Enter the Occupational Code, Type, Source, Agency, and Site codes on the CA-1 

 or CA-2. Appendix D contains information about these codes. 

 c. Forward the CA-1 or CA-2 within 5 days of receipt from a supervisor with a copy 

 of all medical documentation, if available, to OWCP if there was lost work time 

 or medical care. 

d. Place the original CA-1 or CA-2 in the Employee Medical File Folder (EMF), 

SF-66D, if the employee did not seek medical treatment and no lost time was 
Page 15

reported. Should complications develop at a later date; the WC representative 

will forward the original to the appropriate DOL District Office. This folder 

should be retained by the WC representative at least 3 years. See Chapter 4 of 

this Manual for record retention information. 

e. Maintain contact with the employee and provide assistance, as needed, to 

complete any additional OWCP forms. Case folders for employees who 

 resign or retire must be archived to the National Records Center (NRC) in 

 Kansas City, Kansas. 

f. Keep a file of all records sent to the NRC including the employee’s full name, 

Social Security Number, claim number, and date of injury. 

g. Review for accuracy (i.e., unmatched cases, cases that do not belong to the 

agency) the quarterly OWCP report and report any errors, closed cases, or fraud 

indicators. 

h. Review the DOL Agency Query System receipt data with the claimant forms to 

verify the accuracy of OWCP information. If incorrect, the WC representative 

must notify OWCP within 30 days for corrections. After 30 days, the WC 

representative must notify the MRP WC program manager who will work with 

the USDA WC program manager to resolve the issue. 

i. Immediately report to the MRP WC program manager any suspected fraud or 

 false claims. 

j. Ensure that supervisors are aware of the time requirement to officially remove 

employees from the Agency’s employment rolls after being on OWCP Periodic 

Rolls for 365 calendar days. 

k. Work with Human Resources Benefit’s Specialist to ensure that the injured 

employee’s benefits are transferred to OWCP after 6 months of being on OWCP’s 

Periodic Rolls (health insurance and life insurance), or as soon as requested by 

OWCP. 

l. Monitor both long and short term cases and ensure medical information is 

 updated. 

m. Complete the agency-required training on privacy and security. 

6. EMPLOYEE DISCIPLINARY ACTIONS 

a. An employee facing disciplinary action and coincidentally has an injury or 

accident is not a reason to disagree with the claim. If the injury or accident 

occurred, the supervisor must provide factual documentation on why he/she 

disagrees with the nature of the accident or injury. OWCP reviews the claim 
Page 16

based on whether or not the injury/accident occurred while in the performance of 

official duties. OWCP does not get involved with personnel issues. 

b. If disciplinary actions are processed before the injury or accident, disciplinary 

action can be initiated after a WC claim has been filed. 

c. It is strongly advised to delay the actual disciplinary action (suspension, 

reprimand, etc.) until the employee returns to work from medical restrictions. 

d. Once the employee returns to full-time duty and has been medically released by 

his/her doctor, the disciplinary action can be dispensed. 

7. FRAUDULENT OR FALSE CLAIMS 

a. DOL-OWCP has the sole responsibility for determining whether or not an injury 

or illness claim is valid. Supervisors are cautioned against assuming this role in 

any way. 

b. Any person charged with the responsibility for making reports in connection with 

an injury or illness is subject to a fine of no more than $500, or imprisonment for 

no more than 1 year, or both, if that person: 

 (1) Willfully fails, neglects, or refuses to make such reports; 

 (2) Knowingly files a false report; 

 (3) Induces, compels, or directs an injured employee to forego filing a claim; 

 or 

 (4) Willfully retains any notice, report, or paper required in connection with 

 an injury. 

c. Any person who makes a false statement to obtain compensation, or who accepts 

unearned compensation, is subject to a fine of no more than $10,000 or 

imprisonment for no more than 5 years, or both. 

 In addition, administrative penalties may be imposed, up to and including removal 

 from Federal service. 

d. OWCP benefits can be terminated for providing false information and OWCP can 

rule for employee to repay benefits. 

e. The Agency may dispute an employee’s right to COP (and/or the validity of the 

claim as a whole) on other grounds. Any such objection should be supported by 

factual evidence such as witness statements, pictures, accident investigation 

reports, or time sheets. 
Page 17

CHAPTER 4 

WORK-RELATED INJURIES/ACCIDENTS AND ILLNESSES 

1. WORK-RELATED INJURIES/ILLNESSES 

a. The Office of Workers’ Compensation Program (OWCP) has defined two types 

of injuries/accident/illnesses which require different forms to substantiate a workrelated injury. 

b. One type of injury is considered a traumatic injury, defined as an injury/accident 

that can be identified by a specific date, time and location. For example a slip, 

trip or fall is considered a traumatic injury. 

c. In contrast is the occupational illness or disease that occurs over a period of time 

and cannot be attributed to a specific date, time or location. Repetitive injuries 

most often fall in this category. 

2. WHAT TO DO WHEN INJURED 

a. All work-related injuries/accidents/illness should be reported immediately by 

 submitting a written notice of injury on form CA-1 for traumatic injuries, or form 

 CA-2 for an occupational disease or illness. 

 b. Provide medical documentation to support your claim, as the burden of proof is 

 the employee’s responsibility. 

c. Return to work as soon as your doctor allows you to do so. It is the employee’s 

responsibility to inform your doctor that light duty is available to assist you 

during your transition back to full time duty status. 

d. Table 1 provides graphic details on the WC process for filing a claim. 

3. WHEN INJURED ON TEMPORARY DUTY (TDY) ASSIGNMENTS 

a. When employees are on official temporary duty assignments, they are not

covered under OWCP for the entire period. Employees are only covered while in 

performance of their official duties if involved in an injury/accident. 

b. Employees should obtain meals from the duty station location, if available. If an 

employee decides to travel from the duty station location to obtain a meal and is 

injured or involved in an accident, they must show how the injury/accident is 

related to their official duties. 
Page 18

c. If an employee is injured while eating in an establishment away from the hotel, it 

 is considered a third party injury. 

Table 1 Filing a WC Claim 

Seek medical attention as 

appropriate. 

NO 

Obtain CA-1 and CA-16 from 

supervisor. 

YES 

Complete Sections 1-15 and sign/date 

the form. 

Complete all fields. 

Witness statement (if any) is 

CHAPTER 16. 

Complete all fields.

Present CA-1 to supervisor for 

completion. 

ASAP 

Supervisor completes CA-1 and forwards it 

to the respective WC representative within 

 3 days of receipt. 

 Sign and date. 

WC representative reviews for 

completeness and sends to 

OWCP within 5 days of 

receipt. 

Injured while performing official 

work duties? 
Page 19

d. If an employee sustains an injury while on the premises of the TDY site, the 

injury may be considered a third party claim, depending on the circumstances. 

Employees should file a claim, provide all substantiating documentation and 

forward to OWCP for adjudication. 

e. If attendance at an evening event is required in the performance of official duties, 

i.e. dinner event with dignitaries, such an event is considered in performance of 

official duties and would be covered as an OWCP claim. 

f. A copy of the AD-202, Travel Authorization, must be attached with the either the 

CA-1 or CA-2 to document the official travel status of the employee. 

4. THIRD PARTY CLAIMS 

a. Third party claims are considered claims based on injuries/accidents that arise 

from non-government entities. For example, an employee is traveling in a 

government authorized motor vehicle and is struck by a private citizen or entity. 

b. MRP employees who perform inspection and regulatory duties are frequently on 

the property of private organizations and citizens. These inspections are 

considered in performance of official duties and injuries/accidents on these 

locations are not considered third party claims. 

c. For third party claims OWCP will cover employees for the first 30 days of 

injury/accident to provide immediate medical care. However, 

(1) OWCP expects the employee to recoup medical expenses and loss time 

compensation (wages) from third party through private litigation. 

 (2) OWCP is paid first when litigation is settled. 

 (3) OWCP can provide attorney fees, if attorney submits formal requests for 

 advance payment. 

d. Employees cannot come back to OWCP for compensation after a settlement has 

been received. 

5. TEMPORARY EMPLOYEES 

Temporary employees (seasonal, intermittent, students, etc.) are covered by OWCP on 

the same basis as permanent employees in that they are guaranteed compensation and 

medical care until maximum medical improvements achieved. 

a. If the employee is injured while performing official duties and has to be absent 

from work as a result, do not terminate. If the medical evidence indicates the 
Page 20

employee is partially disabled and can return to work with restrictions, offer them 

a light duty assignment and/or provide accommodations. 

b. Make sure the light duty assignment is compatible with the employee’s medical 

limitations. Also, provide OWCP with a copy of the light duty assignment. 

c. Weekly pay rate is based on the average weekly earnings during the full 12-month 

 period immediately preceding the date of injury. 

d. Once the employee’s condition improves and the physician states that their 

 medical limitations can be lifted, return the employee immediately to full duty 

 and notify OWCP. 
Page 21

CHAPTER 5 

MEDICAL DOCUMENTATION AND PRIVACY

1. MEDICAL DOCUMENTATION 

a. The Office of Workers’ Compensation Program (OWCP) bases their decisions on 

the medical evidence provided by attending physicians in the adjudication of 

claims. Therefore, medical documentation is required for all WC claims that 

involve loss time and medical care. It is the responsibility of the injured 

employee to provide this documentation to the supervisor. 

b. A physician’s note on a prescription pad or a standard form stating “under my 

care” does not contain sufficient documentation for the work-related injury. 

Sufficient documentation is considered a narrative statement from the attending 

physician who is treating the injury/illness containing the following information: 

(1) Presenting condition – an initial assessment of the condition. 

 (2) Diagnosis. 

 (3) Prognosis. 

 (4) Course of Treatment (diagnostic tests, rest, etc.). 

 (5) Work restriction/limitations. 

 (6) Time off necessary; if so, return to work date. 

 (7) Referrals or next appointments. 

c. After the initial documentation has been presented, the employee must provide biweekly medical progress updates, using OWCP CA-17, Duty Status Report, until 

the employee is released to return back to work. 

2. RECORDS MANAGEMENT 

a. All employee records regarding a work-related injury or illness will be kept in the 

 SF-66D, Employee Medical File Folder (EMF). In accordance with the Privacy 

Act, the EMF must be kept locked and in a secure place as it contains confidential 

information, and the EMF must be kept separate from general personnel file 

folders. 

b. A separate file folder must be kept for each injury/accident claim with all related 

documents. 
Page 22

c. All information in the EMF is considered confidential and cannot be released to 

 any parties. 

d. All requests for copies of the EMF (i.e., from attorneys representing the 

employee) must be directed to the Legislative and Public Affairs, Freedom of 

Information Act office.

3. PRIVACY REGULATIONS 

a. The Privacy Act is a legal requirement to maintain confidentiality of the 

claimant’s injury and medical status. Based on the provisions of the Privacy Act, 

supervisors, WC Field Representatives and other employees involved with a WC 

claim: 

(1) Cannot discuss restrictions/accommodations or medical condition with 

other employees/staff. 

(2) Must restrict access of medical information to only those who have a 

specified need. 

b. OWCP regulations (20 CFR, 10.506) state that the claimant’s employer cannot 

contact the claimant’s physician by phone. 

(1) Requests for information to employee’s physician must be made in 

writing. 

(2) Copy of correspondence must be sent to employee and OWCP. 

(3) He/she must first attempt to obtain medical information from employee if 

 it will adversely affect rights, benefits or privileges. 

c. The Health Insurance Portability and Accountability Act (HIPPA) of 1990 

protects Personal Identifiable Information (PII) which is any piece of information 

which can potentially be used to uniquely identify, contact, or locate a single 

person. 

d. When requesting claim information via fax, e-mail only use the last four (4) digits 

of claimant’s Social Security Number, the entire claim number, and the claimants 

first and last name. The exception to this is when sending forms to OWCP; 

OWCP forms must contain the full SSN. 

e. FAX and LAN phone lines are considered the most secure method of transmission 

 of PII. 
Page 23

f. For more information about the above mentioned regulations, the following links 

 to the Web sites are provided. 

(1) Privacy Act http://www.usdoj.gov/oip/privstat.htm

(2) HIPPA http://www.hhs.gov/ocr/privacysummary.pdf

4. ACCESS TO OWCP AGENCY QUERY SYSTEM (AQS) and AFFILIATED 

 COMPUTER SYSTEM (ACS) BILLING 

Access to the OWCP AQS and ACS systems is restricted to Agency personnel directly 

associated with the WC program. Access to these systems cannot be shared with other 

personnel or used as “office access”. 

5. ACCESS TO USDA WC CASE MANAGEMENT SYSTEM (CMS) DATA 

a. Data is distributed quarterly from the SHEWB staff to each AMS Division or 

APHIS Program Unit RMS or AO office. These offices then assume full 

responsibility for the privacy of the information and must distribute accordingly 

to the offices that are in need of the data. 

b. Budget offices will only have cost data distributed. If the budget office requires 

more information, the distributing office must ensure that only the required 

information is shared. 

c. When data is distributed, it must be sent using a method that ensures 

confidentiality. 
Page 24

CHAPTER 6 

LEAVE WITHOUT PAY (LWOP) AND REMOVAL 

1. FORMS REQUIRED FOR LWOP OR REMOVAL 

a. OWCP Form CA-7, Claim for Compensation 

b. SF-52, Request for Personnel Action. 

2. LEAVE WITHOUT PAY 

a. Employees absent from work due to a workplace injury may elect to be placed in 

an LWOP status. The request for LWOP is made by the employee and approved 

by the supervisor, with appropriate medical documentation. If the employee does 

not return to work within 365 calendar days from the date of absence from the 

compensable injury, the Agency can remove the employee from the Agency 

employment rolls. 

NOTE: Employees filing claims for traumatic injuries may be entitled to up to 45 days of 

Continuation of Pay (COP). After the 45 days of COP expires an employee can be 

placed on LWOP. 

b. Employees should be advised to use LWOP and be placed on Office of Workers’ 

Compensation Program (OWCP) rolls instead of using their personal sick or 

annual leave. 

When an employee uses LWOP, he/she must submit a CA-7, Claim for 

Compensation, to OWCP, thus notifying OWCP that he/she has not recovered for 

the work-related injury and continues to be out of work. This allows OWCP to 

monitor the case, and, if necessary, assign a contract nurse to assist the employee 

in returning to work. 

(1) Employees may elect to use sick and/or annual leave, pending approval of 

a workplace injury by OWCP. If the employee uses leave and the 

compensation claim is approved by OWCP, they may later, with the 

concurrence of the employing agency, claim compensation for the period 

of disability and “buy back” the leave used. Leave is then re-credited to 

the employee’s account after the employee pays the difference between 

OWCP leave and Agency leave. 

(2) If the employee elects to use their personal leave after the 45 days of COP 

have expired, the WC representative must notify OWCP in writing that the 

employee has not returned to work and request that an OWCP nurse be 

assigned to the case. 
Page 25

c. Employees electing LWOP will receive compensation from OWCP and will be 

paid at the OWCP rate of 75 percent if they have dependents and 66 2/3 with no 

dependents. 

d. When an employee elects LWOP, they will not be able to contribute to Thrift 

Saving Plan, and will have to directly arrange for premium payments to Flexible 

Spending Accounts, Federal Long Term Insurance Plan and Federal employees 

Dental and Vision Insurance Plans. 

 Federal Employees Health Benefits (FEHB) and Federal Employees Group Life 

Insurance premiums may be deducted from OWCP compensation payments. If 

FEHB is not transferred to OWCP by HRO, the employee will be billed for the 

premiums. 

e. CA-7s should be submitted every 2 weeks to the supervisor to avoid interruption 

of regular pay. A completed CA-17, Duty Status Report, should be submitted 

along with the CA-7 showing work restrictions and disability. If the CA-17 is not 

used medical documentation must be submitted with the CA-7. 

(1) The supervisor must forward the CA-7, CA-17, or other medical 

documentation to the WC Representative immediately. 

(2) The WC Representative must forward the CA-7, CA-17, or other medical 

documentation within 7 days of the dated CA-7. 

3. PROCEDURES FOR REQUESTING LWOP 

a. The employee initiates a request in writing for LWOP if he/she has been absent 

because of a workplace injury/illness. The request must include medical 

documentation verifying the reason for the absence and the duration. The 

supervisor reviews and authorizes the SF-52 and then submits the form via the 

Personnel Action Tracking System. 

 b. The supervisor must include a not-to-exceed (NTE) date on the SF-52. This date 

 is dependent on the medical information from the employee’s physician. 

 c. It is very important that the supervisor indicate in the remarks section of the 

 SF-52 that the employee is receiving compensation due to a workplace 

 injury. This ensures that the employee’s benefits will be protected. 

 d. The supervisor completes another SF-52 to request an extension of LWOP if the 

 employee does not return to work before the original NTE date is due to expire. 

 The medical documentation to extend the LWOP should be given to the 

 supervisor before the NTE date of the prior LWOP request. 
Page 26

 e. If the employee is ready to return to work within 1 year from the date of 

 absence due to compensable injury, the supervisor needs to initiate an SF-52, 

 Return to Duty, to place the employee back in pay status. The medical 

 documentation must verify the employee is able to return to work. 

4. INITIATING REMOVAL AFTER EXTENDED LWOP 

a. If an employee has not returned to work within 365 calendar days of the date of 

absence due to compensable injury, the supervisor should contact the servicing 

Employee Relations Specialist (ERS) for assistance in removing the employee 

from Agency employment rolls. He/she should also contact the Servicing 

Benefits Specialist (SBS) to request that disability retirement information be sent 

directly to the employee. 

NOTE: An employee may apply for disability retirement at any time when it has been 

medically determined that he/she is disabled from useful and efficient service in the 

current position and the disability is expected to last at least 1 year. Contact your SBS for 

information. 

 b. The supervisor should notify the MRP WC Program Manager that actions have 

 been initiated to remove the employee from agency rolls, in conjunction with 

 ERS. 

c. Even though the employee has been removed from the agency rolls, the employee 

will continue to receive wage loss compensation until the employee has achieved 

maximum medical improvement. It is imperative that the WC representative 

continue to monitor the case and ensure that medical information is updated. 

d. If the employee was on a career or career conditional appointment, and isable to 

return to work after one year, the employee must be given priority consideration 

for restoration to the position, or an equivalent position, if an application is made 

within 30 days from when compensation ceased. 

Former career or career conditional employees who cannot be placed through the 

RPL are eligible for selection priority in other Federal agencies under the 

Interagency Career Transition Assistance Program. 

5. REGULATORY AUTHORITY FOR REMOVAL 

 a. Title 5, Code of Federal Regulations, Sections: 

 (1) 339.203, Physical Requirements. 

(2) 353.301, Restoration Rights. 

(3) 353.106, Personnel Actions During Employee’s Absence. 
Page 27

 b. MRP Human Resources Desk Guide Subchapter 4630, Absence and Leave. 
Page 28

CHAPTER 7 

LEAVE BUY BACK (LBB) PROCEDURES 

In certain instances employees may have to use their leave before being placed on Office of 

Workers’ Compensation Program (OWCP) periodic rolls for wage compensation. In most 

instances employees should be using LWOP and Form CA-7, Claim for Compensation, to 

officially notify OWCP that they are disabled and unable to work. 

The Agency shall process employee initiated claims for leave buy back in accordance with 

applicable law, rule and government-wide regulation. 

1. FORMS REQUIRED FOR LBB 

 a. CA-7, Claim for Compensation. Form used requesting LBB or LWOP for 

 accepted Workers’ Compensation injury/accident claims. 

 b. CA-7a, Time Analysis Form. An optional form used when there are intermittent 

 dates of leave used, or when more than one continuous period of leave is claimed. 

 c. CA-7b, Leave Buy Back Worksheet, Certification and Election. Explains how 

 leave is repurchased and asks the agency representative (WC representative) to 

 estimate the amount of compensation payable. 

2. PROCEDURES FOR REQUESTING LBB 

 a. The employee initiates request to his/her supervisor to repurchase leave used for 

 medical care and/or disability resulting from an accepted job-related illness 

 OWCP claim. 

 b. The employee completes the forms and submits to his/her direct supervisor. For 

 all dates where LBB is requested, medical documentation is required to show the 

 employee was under medical care. 

 c. The supervisor reviews the forms and submits them to the time and attendance 

 (T&A) clerk to perform a leave audit verifying the leave. 

d. The T&A clerk forwards the CA-7 and CA-7a to the WC representative who 

 completes the CA-7b. Once this is completed the WC representative will contact 

the employee who then decides whether or not to repurchase the leave. 

 e. If the employee signs the CA-7b to repurchase leave, the WC representative will 

 sign the form as Agency representative and use the following address for the 

 7B.II. Agency address: 
Page 29

 USDA APHIS MRP Business Services, Leave and Compensation Team 

 Butler Square, 5th Floor 

 100 North Sixth Street 

 Minneapolis, MN 55403 

f. The WC representative sends the original CA-7, CA-7a, and CA-7b to the 

respective OWCP District Office. Copies must be sent to MN-Leave and 

Compensation Team (LCT) and the originating office, with one copy on file with 

the WC representative. 

g. Once MN-LCT has received a check from OWCP, they will verify the 

information and then send the check, the AD-343, a copy of CA-7, CA-7a, and 

CA-7b to the National Finance Center (NFC), by overnight receipt, for 

processing. 

 h. NFC will process the check and notify the employee of the amount of leave re- 

 purchased. 

i. The MN-LCT receives notification from NFC that the employee’s bill has been 

paid in full. The MN-LCT then requests the originating office to perform an 

updated leave audit to show the current leave amounts to make the proper 

corrections. 

 j. The originating office will forward a copy of the updated leave audit to 

 MN-LCT. 

k. The MN-LCT will adjust the employee’s leave, and will notify the timekeeper 

and the employee that the leave has been repurchased. The timekeeper will adjust 

the leave balances in the time and attendance system. 
Page 30

CHAPTER 8 

RETURN TO WORK (RTW) 

1. RTW OVERVIEW 

a. MRP is committed to returning OWCP claimants to work at their original or a 

modified (light duty) job as soon as possible, including any period of 

Continuation of Pay (COP), to reduce time lost due to a work-related injury or 

illness. 

b. A claimant with an OWCP case open less than 1 year may receive nurse 

intervention services. After the first 45 days of injury a Department of Labor 

(DOL) nurse may be assigned to review the claimant’s case. The nurse will 

contact the claimant, the physician, and the WC program manager to find out 

about the employee’s injury, his/her progress, and any pertinent information to 

help facilitate return to work. 

 c. Cases open more than 1 year are reviewed bi-annually by the DOL District Office 

 to determine medical status, rehabilitation potential, and RTW eligibility. 

 d. The following RTW procedures have been developed for short and long 

 term cases. 

2. RTW – SHORT TERM CASES 

 After an employee has provided medical documentation of the need to be out of work for 

 a period of time, the supervisor and WC representative must: 

a. Review the medical documentation to determine if the documentation is 

sufficient. The documentation must have an RTW date and must state that the 

employee is out of work due to the work-related injury. 

b. Provide the employee and the physician a copy of the employee’s position 

description and CA-17, Duty Status Report, and request that it be submitted every 

2 weeks. 

c. Inform the employee and the physician that light duty, part-time work, and 

 accommodations are available. 

d. Submit all CA-17s and medical documentation to OWCP when received. 
Page 31

e. Return employee to duty when medically released. An employee cannot RTW 

prior to the RTW date on medical documentation as doing so can hinder his/her 

recovery or worsen his/her condition. 

f. An employee has mandatory rights to the position he/she left, or an equivalent 

position, in the original commuting area, when returning to work within 1 year 

from the date compensation began. 

 

 The supervisor must submit an SF-52, Request for Personnel Action, Return to 

Duty, to Human Resources. 

3. RTW – LONG TERM MANAGEMENT GUIDELINES 

 After an employee has provided medical documentation that he/she can return to work 

 after extended absence from work, the supervisor and WC representative must: 

a. Review the medical documentation to determine if the documentation is 

sufficient. The documentation must have an RTW date and must state that the 

employee is out of work due to the work-related injury. 

b. Provide the employee and the physician a copy of the employee’s position 

 description and CA-17, Duty Status Report. 

c. Inform the employee and the physician that light duty, part-time work, and 

 accommodations are available. 

d. Submit all medical documentation to OWCP when received. 

e. Return employee to duty when medically released. An employee cannot RTW 

prior to the RTW date on medical documentation as doing so can hinder the 

employee’s recovery or worsen their condition. The supervisor must submit an 

SF-52, Request for Personnel Action, Return to Duty, to Human Resources. 

f. Meet with the employee to discuss a work schedule, any needed training, and 

 work expectations. 

4. LONG TERM CASE MANAGEMENT 

These guidelines have been developed to provide assistance to WC representatives on 

long term case management to ultimately return the employee back to work. 

 a. Determine Potential for RTW. 

(1) The first step in determining an employee’s potential for RTW is to 

prioritize cases by using the Rating Scale. The major factor that can 

determine the potential for returning to work is the date of injury. If the 
Page 32

injury occurred within 5 years the potential of returning the employee 

back to work is greater than returning an employee who was injured 20 

years ago. 

(2) Now, separate cases into groups in relation to date of injury, age, and type 

of injury sustained. Consider strains and sprains first, and then move to 

the more extensive injuries. Also consider the physical requirements of 

the date of injury position. This process will give you an idea of where to 

begin and help to determine which employees are likely to return to work. 

Needs of the agency, length of time on periodic rolls, cost liability, 

physical limitations, and educational background also should be 

considered. 

(3) Once you have prioritized your cases, give them a rating based on how 

soon compensation can be terminated. Cases that have the most potential 

for reemployment should be first on your list. Start with Group 1 cases 

that have the highest rating and: 

 (a) Obtain current medical evidence. 

 (b) Obtain the date of injury job description. 

 (c) Determine if the employer is capable of re-employment. 

 (d) Determine what type or if any job modifications may be needed 

 and if the modification would be feasible for the agency. 

 Remember that OWCP has limited resources so you will want to pursue 

 cases with the most potential for savings. 

(4) Review case files through the Agency Query System (AQS) to determine 

status. For example, if a case is placed in PN status, the employee has 

been determined to have no possible wage earning capacity and very little 

chance of returning to work so make this a low priority (see Appendix B). 

(5) In addition, identify employees who are currently working in a light duty 

capacity and return them to full duty whenever medically possible. 

Remember to notify OWCP when an employee has been in light duty 

status more than 3 months. 

 b. Current Medical Information Needed. 

(1) Review case files and obtain current medical information annually. If you 

do not have current medical data, you can request it from the physician or 

OWCP. You can use the OWCP 5, Medical Evaluation, to obtain medical 

information from the physician. 
Page 33

(2) Remember that all communications with the physician must be in writing. 

If you receive feedback from the doctor, send the claimant and the OWCP 

copies of any such correspondence. Once you receive updated medical 

information, review clinical findings and determine if you can return the 

employee to work. 

 (3) If you request medical updates from OWCP, indicate that the agency 

 would like to offer suitable work, so that they will respond to you sooner. 

 OWCP has up to 30 days to respond to your inquiry. 

(4) OWCP may authorize a functional capacity evaluation (FCE) to assess the 

employee’s work limitations. This is an evaluation performed by a 

physician or a licensed physical or occupational therapist. The FCE 

evaluates an individual’s physical capability and identifies his/her 

limitations so appropriate restrictions can be prescribed and the agency 

can identify suitable work. It will also help the Agency to determine if the 

medical restrictions are “temporary” or “permanent.” If permanent, it will 

have to be determined by the agency if developing a modified job offer 

would create an undue hardship. 

 (5) The FCE can take a few months to accomplish. OWCP must first set up 

 an appointment and then notify the employee of the date and time. The 

 employee is given a time frame to respond to OWCP as to whether 

 the date is acceptable. 

 (6) If the employee does not notify OWCP of any problems making the 

 appointment and does not show up at the scheduled appointment, OWCP 

 can charge the employee for the visit. 

(7) Send the employee notification that OWCP benefits will be terminated 

unless he/she can show otherwise. 

 (8) If medical restrictions are permanent you should consider OWCP 

 vocational rehabilitation. 

c. Job Modification. 

(1) While the agency is awaiting correspondence back from OWCP on the 

FCE, it should begin looking at the employee’s position description at the 

time of the injury/accident and if it can be modified to accommodate the 

employee if light duty or part time status is required. 

 (2) If the position is not appropriate for light duty or part-time status, work 

 with Human Resources to evaluate vacant positions to determine which 

 ones can be modified for light duty or part-time status. 
Page 34

d. Job Offer Needed. 

(1) Let OWCP know that the agency is interested in returning the employee to 

work and willing to make a job offer. To make a job offer, you will need 

medical evidence describing the employee’s medical limitations. Once 

you receive the medical information, evaluate and determine if the 

limitations will improve or are permanent. If permanent, determine how 

severe the restrictions are and decide whether developing a modified job 

offer would create an undue hardship on the agency. If you decide to 

prepare a modified position description, present a written job offer that is 

compatible with the employee’s medical limitations (see Appendix B, 

Long Term Management Rating Scale). 

(2) The job offer should include a description of the duties to be performed; 

the specific physical requirements of the position, and any special 

demands of the workload or unusual working conditions; the geographical 

location of the job; the date on which the job will be available, and date by 

which a response to the job offer is required. In addition, make sure you 

consider the claimant’s physical abilities and educational background 

when creating the position. Human Resources must sign the job offer and 

the employee must accept or decline the position in writing. 

(3) If OWCP determines that the job offer is suitable and the employee 

declines the position, the employee’s benefits can be terminated. OWCP 

must be notified that the employee declined the position, so all 

correspondence must be forwarded immediately. 

(4) Once the agency has determined that a position is available for the 

employee, and the attending physician has determined that the employee 

can RTW, the program should write to OWCP that a position is available, 

and enclose a copy of the position description. 

 e. RTW Offer Accepted. 

 (1) If the employee accepts the offer, formally establish an RTW date 

 and provide OWCP with all correspondence as soon as possible. This 

 helps to avoid overpayment of compensation. 

(2) Realize that the employee has been out of work for several years/decades 

and needs to get acclimated to the work place. Prior to the employee’s 

report date, arrange for an RTW conference. The employee, workers’ 

compensation contact and the employee’s supervisor are among those who 

should attend so that any remaining issues or concerns can be addressed 

prior to the actual RTW. Make sure the employee is completely informed 
Page 35

of his/her responsibilities and work expectations (leave procedures, lunch 

breaks, etc.). Consult the WC Program Manager for guidance. 

 (3) Make sure you meet all work limitations or modifications. You don’t 

 want to aggravate his/her injury. 

 f. RTW Offer Denied. 

 (1) If the employee rejects the work offer, provide all documentation to 

 OWCP requesting a termination of benefits. 

 (2) Monitor AQS bi-weekly to determine if benefits have been terminated. 

5. VOCATIONAL REHABILITATION 

a. If you have an employee that has reached maximum medical improvement and 

you cannot provide accommodations, you should consider vocational 

rehabilitation. This program provides vocational evaluation, testing, training, and 

placement services with either the original employer or a new employer. 

b. Vocational rehabilitation can conduct FCEs which helps to customize individual 

programs to employee needs and meet demands of current or potential jobs. 

OWCP will consider an employee for this program if requested by the attending 

physician, the employee, or the employing agency. In addition, OWCP will 

routinely consider a case for rehabilitation if the agency cannot reemploy the 

employee. 

 c. Keep in mind that if the employee is placed in a lower-paying job the agency will 

 be responsible for paying the difference in salary. 

 d. In addition, if a career employee is placed in a job with the private sector he/she 

 will lose his/her Federal benefits. 

e. The supervisor and Human Resources should try to find suitable employment 

within the agency before requesting vocational rehabilitation. This can be 

accomplished by reviewing an updated resume to ascertain eligible positions the 

employee may be qualified to perform. 

 f. If the employee refuses to participate in vocational rehabilitation when directed 

 by OWCP without good cause, OWCP will eliminate monetary compensation. 

 During this process, continue to follow-up with OWCP until you have resolution. 
Page 36

6. RESTORATION RIGHTS

 a. If medically released after 365 calendar days from the day compensation began, 

 the employee is entitled to priority consideration to the former position or an 

 equivalent one. 

b. If compensation ceases, for other than medical release (fraud, refusal to accept a 

position), the employee has the right to apply for a position within 30 days of the 

date compensation ceases. The Agency has no obligation to hire employees 

whose OWCP benefits were terminated for fraud or refusal to accept a suitable 

job offer. 

7. REASONABLE ACCOMMODATION 

a. Sometimes the claimant’s injury will result in permanent damage leading to a 

permanent disability. During the course of treatment for all injuries, the Agency 

should continually monitor the need to advise the Reasonable Accommodation 

Program Manager of the claimant’s status and possible need for reasonable 

accommodations to continue the claimant’s successful job performance. 

b. For additional information contact the Agency Designated Official. 

8. DISABILITY RETIREMENT 

a. When an employee is permanently disabled and unlikely to return to work, the 

employee should be advised to apply for disability retirement under the Civil 

Service Retirement System (CSRS) or the Federal Employees Retirement System 

(FERS), preferably before being separated from employment. However, the 

application may be made up to 1 year following separation from employment. 

The employee (or the supervisor) should contact the servicing HR Benefits 

Specialist for information and assistance. 

b. An individual who is approved and eligible for an annuity under the CSRS or 

FERS, and is also eligible for OWCP compensation, may not receive both 

benefits concurrently. The individual will make an election between them and if 

one benefit is terminated, the other may be reinstated. 

c. It is important that an employee apply for disability retirement because an 

approved disability retirement protects the individual’s right to the retirement 

benefit and continued insurance, and protects the employee’s survivor’s right to 

the survivor annuity and continued insurance, as applicable. 
Page 37

CHAPTER 9 

OFFICE OF WORKERS’ COMPENSATION PROGRAM (OWCP) BILLING 

PROCEDURES 

1. AGENCY CHARGEBACK BILLING 

a. The Federal Employees Compensation Act (FECA) program is financed by the 

Employees Compensation Fund, which consists of monies appropriated by 

Congress or through agencies’ operating revenues. OWCP furnishes agencies 

with statements of payments made from the Fund for injuries, illness, or death 

benefits to employees based on the OWCP fiscal year, July 1 through June 30. 

The statement represents charges the Agency will incur in 2 years. 

b. Resource Management Staff or Administrative Officers will receive a quarterly 

report which identifies all OWCP claimant cases and charges that appear on the 

chargeback bill. This report must be reviewed to determine: 

 (1) Any disputes, errors, or omissions. 

 (2) If compensation costs exceed medical costs. Cases with little to no 

 medical and high compensation costs require an in-depth review. 

c. Each WC representative must verify the report and notify MRP WC of any 

disputes, errors, or omissions (e.g., any case or cost that does not belong within 

the respective organizational code), within 15 days of receiving the quarterly 

chargeback bill. MRP WC will submit requests for changes to the USDA WC 

Program Manager, within 2 weeks of receipt of the reported disputes. 

2. EMPLOYEE MEDICAL TREATMENT BILLS 

a. An employee must provide his/her medical providers the OWCP claim number to 

enable the provider to bill OWCP for the rendered service and receive prompt 

payment. 

b. Medical providers must use the OWCP/HFCA 1500 Health Insurance Form for 

billing OWCP or the UB 92, Health Insurance Claim Form. 

c. To ensure prompt billing the following information is helpful to medical 

providers: 

(1) Claim number and date of injury. 

(2) Accepted condition code (ICD9). 
Page 38

 d. Medical bills will not be paid if submitted to OWCP on or before December 31 of 

 the following calendar year in which the expenses were incurred. 

3. EMPLOYEE MISCELLANEOUS PAYMENTS

a. Employees must use the CA-915, Claim for Medical Reimbursement, for 

reimbursement for pharmacy expenses, office visits payments or over the counter 

medical supplies. Receipts must be attached to the form. Submit the form 

directly to OWCP for payment. 

b. Employees must use the CA-957, Medical Travel Refund Request, for 

reimbursement of travel expenses, local transportation, tolls, telephone charges, 

and any food expenses related to the work injury/accident. Submit the form 

directly to OWCP for payment. 

4. OWCP ACS BILLING ADDRESS 

 a. Copies of billing documents must be sent to: 

 DOL, OWCP 

 PO Box 8300 

 London, KY 47252 

 b. Physicians and medical providers must directly bill OWCP Affiliated Computer 

 System (ACS) using HCFA 1500, Health Insurance Form, and UB-92, Health 

 Insurance Claim Form. 

5. MEDICAL PROVIDER DIRECTLY BILLS CLAIMANT 

 For employees who are billed by the hospital or physician for services denied or partially 

 paid by OWCP, here are a few citations. 

 OWCP 1500, Health Insurance Claim Form (back of form). 

Signature or Physician or Supplier. Your signature in item 31 indicates your 

agreement to accept the charge determination of OWCP on covered services as payment 

in full, and indicates your agreement not to seek reimbursement from the patient of any 

amount not paid by OWCP for covered services as the result of the application of its fee 

schedule or related tests for reasonableness (appeals are allowed). 

 UB-92, Health Insurance Claim Form (back of form). 

Signature of Provider: Your signature in Block 85 indicates your agreement to accept 

the charge determination of OWCP on covered services as payment in full, and indicates 

your agreement not to seek reimbursement from the patient of any amount not paid by 

OWCP for covered services as the result of the application of its fee schedule or related 
Page 39

tests for reasonableness (appeals are allowed). Your signature in Block 85 also indicates 

that the services shown on this form were provided, and that the billing information 

submitted is both complete and accurate. Finally, your signature indicates that you 

understand that any false claims, statements or documents, or concealment of a material 

fact, may be prosecuted under applicable Federal or State laws. 

 20 Code of Federal Regulations, Part 10, CHAPTER 10.801(d). 

By submitting a bill and/or accepting payment, the provider signifies that the service for 

which reimbursement is sought was performed as described and necessary. In addition, 

the provider thereby agrees to comply with all regulations set forth in this subpart 

concerning the rendering of treatment and/or the process for seeking reimbursement for 

medical services, including the limitation imposed on the amount to be paid for services. 

 20 Code of Federal Regulations, Part 10, CHAPTER 10.801(e). 

In summary, bills submitted by providers must: be itemized on the Health Insurance 

Claim Form (for physicians OWCP 1500), the UB-92 (for hospitals), or the Universal 

Claim Form (for pharmacies); contain the signature or signature stamp of the provider; 

and identify the procedures using HCPCS/CPT codes, RCC, or NDC. Otherwise, OWCP 

may return the bill to the provider for correction and resubmission. 

 20 Code of Federal Regulations, Part 10, CHAPTER 10.813. 

A provider whose fee for service is partially paid by OWCP as a result of the application 

of its fee schedule or other tests for reasonableness in accordance with this part shall not 

request reimbursement from the employee for additional amounts. 
Page 40

CHAPTER 10 

PROCEDURES FOR EMERGENCY PROGRAMS 

1. The Incident Command Center (Financial Management) will: 

 a. Ensure there are ample CA-1, Notice of Traumatic Injury, and CA-16, 

 Authorization for Medical Treatment, forms available for employees. The APHIS 

 Safety, Health and Employee Wellness Branch has prepared 250 packages for 

 distribution to injured employees. 

b. Post the CA-10, What Should I Do If I Am Injured, poster. 

c. Review the CA-1 after employees and supervisors have completed their 

respective portion to: 

(1) Ensure both the employee and supervisor have signed the CA-1. 

(2) Ensure all medical documentation, witness statements, and any other 

 documentation are attached to the CA-1. 

d. Forward all information immediately to the respective Marketing and Regulatory 

Programs (MRP) program unit contact as identified for each MRP program unit. 

2. The WC Program Manager and Specialist will: 

 a. Establish an agency chargeback code for the EP. 

 b. Provide the EP and WC representatives with the agency chargeback codes. 

c. Track all accidents and injuries based on submitted claim forms in a spreadsheet 

for statistical analysis. The database will contain the following fields: 

(1) Employee Name. 

 (2) Date of injury. 

 (3) Anatomical location of injury. 

 (4) Cause of injury. 

 (5) City and State where injury occurred. 

 (6) Employee job title. 
Page 41

 (7) Time of injury. 

 d. Provide a statistical analysis of the data to EP management every 2 weeks with 

 safety recommendations. 

 e. Process any claims from other USDA or Federal agencies. 

 (1) Forward claim to respective Department of Labor, Office of Workers’ 

 Compensation Program (OWCP) District Office. 

 (2) Maintain employee information in SF-66D, Employee Medical File. 

 (3) Monitor claim to ensure employee receives appropriate medical attention, 

 returns to work, and all bills are mailed to OWCP in London, KY. 

 (4) Send a copy of claim to claimant’s originating office. 

 f. Provide any guidance, training, and oversight regarding OWCP and processing 

 claims. 

 g. Pursue emergency funding for payment of medical bills for claims that are not 

 accepted by OWCP. 

3. WC Representatives will: 

a. Process all claims received from the Emergency Program (EP). 

b. Forward claim to the respective Department of Labor, Office of Workers’ 

Compensation Program (OWCP) District Office. 

 c. Maintain employee information in SF-66D, Employee Medical File. 

 d. Monitor claim to ensure the employee receives appropriate medical attention, 

 returns to work, and all bills are mailed to OWCP in London, KY. 

 e. If the claim is denied, work with the employee and OWCP to ascertain the reason 

 and assist in providing relevant information to claim acceptance. 

 f. If the claim is denied after appeal rights, send all bills to the WC Program 

 Manager for special processing. 
APPENDIX A 

FORMS 

 
United States Department of Agriculture 

Marketing and Regulatory Programs 

When Injured at Work Checklist – 

Traumatic Injury 

Employee: 

 Forms I need: 

 CA-1, Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay 

 and 

 CA-16, Authorization for Examination and/or Treatment 

 I went to the doctor/emergency room within 48 hours of my accident/injury and used a 

 CA-16. 

 The doctor completed page 2 of the CA-16 and returned it to me. 

 I completed and submitted the CA-1 and CA-16 to my supervisor, with all medical 

 documentation. 

 I have a doctor’s note stating when I can return to work if the doctor determined that I cannot 

 work for a period of time because of my accident/injury (this is required for Continuation of Pay). 

Supervisor: 

 Once I was notified of the employee’s accident/injury, I made sure the employee had a: 

 CA-1, Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay, 

 and 

 A doctor’s note stating when he/she will need to be on leave and a return to work date. 

 (This is required for Continuation of Pay.) 

 I have reviewed the CA-1, and I: 

 Agree with what the employee has written regarding the accident/injury. 

 Disagree with what the employee has written regarding the accident/injury. Therefore, I 

 am providing a written statement describing the events to the best of my knowledge. 

 When the employee submitted the CA-1 and/or CA-16 to me, I signed the forms where indicated 

 for supervisor’s signature, within 3 days of receiving the forms. 

 I forwarded the forms to the appropriate WC representative. 

MRP Form 25 

MAR 2009 
AGENCY QUERY SYSTEM (AQS) CODES 

AQS Code Meaning 

UD Case Under Development 

PR Periodic Roll payment 

PS Schedule Award payment – periodic or lump sum 

PN Periodic roll payments and determined to have no wage earning 

capacity 

PW Partial Wage capacity or actual earnings (reduced compensation – 

employee may be working in a position earning less wages than at 

time of injury salary 

WEC Wage Earning Capacity 

DE Monthly payments to at least one beneficiary of a Deceased 

Employee 
United States Department of Agriculture 

Marketing and Regulatory Programs WC Long – Term Management 

Claim Number: OWCP District Office: 

Claimant Name: 

Date Correspondence Sent: Reason: 

Date Response Received: Response / Action: 

Date Correspondence Sent: Reason: 

Date Correspondence Received: Response / Action: 

Date of Investigation: Reason: 

Date Report Received: Reason / Action: 

OWCP Action Date Outcome 

IME 

2nd Opinion 

Referral 

Voc. Rehab 

Reemployment Date Cost Savings 

 Part - Time 

 Light Duty 

Return to Work 

 Full - Time 

Schedule Award 

Elected OPM Disability 

Benefits Terminated 

Updated By: Date: 

Updated By: Date: 

Updated By: Date: 

Updated By: Date: 

MRP Form 26 

MAR 2009 
United States Department of Agriculture 

Marketing and Regulatory Programs WC Short – Term Management 

Claim Number: OWCP District Office: 

Claimant Name: 

Date Correspondence Sent: Reason: 

Date Response Received: Response / Action: 

Date Correspondence Sent: Reason: 

Date Correspondence Received: Response / Action: 

Action Date Outcome 

CA-17 

CA-17 

CA-17 

CA-17 

LWOP / Surgery SF-52 – Outgoing LWOP 

 SF-52 – Return to Work 

OWCP Action Date Cost Savings 

 Part - Time 

 Light Duty 

Return to Work 

 Full - Time 

Schedule Award 

Benefits Terminated 

MRP Form 27 

MAR 2009 
United States Department of Agriculture 

Marketing and Regulatory Programs WC Telephone Log 

Claimant: Claim Number: 

Date: 

OWCP Contact: Claim Examiner 

 Customer Service 

CE Name: 

WC Representative: 

Notes: 

Date: 

OWCP Contact: Claim Examiner 

 Customer Service 

CE Name: 

WC Representative: 

Notes: 

Date: 

OWCP Contact: Claim Examiner 

 Customer Service 

CE Name: 

WC Representative: 

Notes: 

Date: 

OWCP Contact: Claim Examiner 

 Customer Service 

CE Name: 

WC Representative: 

Notes: 

MRP Form 28 

MAR 2009 
United States Department of Agriculture 

Marketing and Regulatory Programs Long-Term Management Ra

Last Name First Name DOI DOB Age Injury Priority Grou

1 2 3 

MRP Form 29 

MAR 2009