Source: https://www.dol.gov/owcp/dfec/regs/compliance/DFECfolio/FNHB-PT1/
Timestamp: 2019-04-19 07:15:20+00:00

Document:
1. Purpose. The Office of Workers' Compensation Programs (OWCP), Division of Federal Employees' Compensation (DFEC) administers a Nurse Intervention Program to utilize nurse case managers to assist with the medical recovery and return to work (RTW) efforts of the Injured Worker (IW). This effort involves a collaborative process between the IW, Claims Examiner (CE), Field Nurse (FN), treating physician/medical provider(s) and the employing agency (EA).Assignment of a FN typically occurs during the early disability phase of a work injury, but may occur at later stages as well.
This handbook is intended is to be used by all OWCP/DFEC contracted FNs certified with the Nurse Intervention Program handling cases in connection with the Federal Employees' Compensation Act (FECA), 5 U.S.C. 8101 et seq; 20 CFR Part 10. Its purpose is to provide FNs with information necessary to understand and adhere to performance expectations in assigned cases.
a. Nurse Case Management is a specialty within the nursing profession which provides a process for the delivery of health care services via assessment, planning, facilitation and advocacy to meet health care needs of the clients being served. This process promotes quality of care and cost effective delivery of health care services. Case management roles vary among the different health care delivery systems and organizations, however, the goals of nurse case management remain consistent across all practice settings: promote client health and wellness and appropriate use of service resources.
For the nurse working in the field of workers' compensation, the nurse case management process may offer unique challenges. The nurse may encounter issues and circumstances that may seem to compete with the nurse case management process utilized in other practice settings. For instance, when providing services within a workers' compensation arena, the nurse needs to be cognizant of other involved participants. While the IW is the focus for services, the nurse case management process needs to work within the structure of the workers' compensation programs' regulations as well as its policies and procedures.
(1) A nurse providing nurse case management services for the OWCP Nurse Intervention Program serves as a representative for the OWCP/DFEC, which administers the provisions of the FECA. When implementing policies and procedures, the OWCP/DFEC must approach the provision of services in a non–adversarial, unbiased manner. The nurse is expected to deliver nurse case management services in the same manner.
(2) As a contractor of the OWCP/DFEC, the nurse is required to follow the policies of the OWCP/DFEC while providing support to the IW. OWCP expects expeditious handling of injury cases assigned at every stage of the nurse intervention process. There may be instances where the FN feels an IW would benefit from ongoing nurse services but from a program standpoint, the case needs to be moved on to the next stage of the disability management process (e.g. vocational rehabilitation). It is expected that the nurse will support program decisions and provide assistance with transitioning the case to the next stage of the disability management process.
(3) A FN may not use his/her association with the Government, including business contacts obtained through any work with the Government, to try to obtain personal benefits or favors for his/herself, friends, relatives, or business associates.
A FN may not use any Government affiliation for personal gain or for that of others, or use that affiliation in any manner to endorse a product service or enterprise.
(4) A FN is a contractor for OWCP/DFEC, but the Department of Labor's Office of the Solicitor cannot provide legal advice to a FN. Because the United States cannot defend or indemnify a contractor such as a FN in a lawsuit arising out of FN activities in connection with the FECA program, the FN may wish to consider obtaining liability insurance.
c. Structure. This handbook begins with a brief overview of the OWCP/DFEC program and structure and relevant portions of the FECA. The remainder of the handbook is devoted to the OWCP Nurse Intervention Program structure, policies and guidelines.
a. Exclusive Remedy. Benefits provided under the FECA constitute a sole remedy against the United States for work-related injury or death. A Federal employee covered under the statute is not entitled to sue the United States or recover tort damages for such injury under any other law. Proceedings under the FECA are non- adversarial.
The IW is entitled under the FECA to select a physician of his/her choice to provide treatment. The provider must meet the definition of "physician" under the FECA (which includes certain services provided by chiropractors and clinical psychologists) and must not have been excluded from payment under the program. Physicians employed by, or under contract to, the employing agency (EA) may examine the IW at the EA's facility, however, the IW's choice of physician must be honored and treatment by the IW's physician must not be delayed for the purpose of obtaining an EA directed medical examination.
20 C.F.R. §10.505 explains that the employer should make all reasonable efforts to place the employee in his or her former or an equivalent position in accordance with 5 U.S.C. 8151 if the employee has fully recovered after one year. 20 C.F.R §353.301 provides an overview of restoration rights for fully recovered and partially recovered employees. The Office of Personnel Management (OPM) has jurisdiction and is responsible for enforcing this section. If an IW has issues pertaining to restoration rights he/she should contact the EA or OPM.
medical provider(s) use all available tools to ensure medical recovery (to the extent possible) and facilitate a sustainable return to work (RTW). This includes, but is not limited to, utilizing services of contracted FNs and RCs.
c. When the medical evidence shows that total disability has ended, DFEC will make every reasonable effort to arrange for re-employment of the IW. These efforts always start initially with the EA. In the event that the EA is unable to offer suitable re-employment, however, DFEC attempts to place the IW with a new employer.
d. To assist with the RTW efforts, DFEC uses nurse intervention and vocational rehabilitation as the primary avenues to pursue re-employment of the IW.
a. 20 CFR §10.310 outlines the basic rules for obtaining medical care and references FNs specifically.
b. 20 CFR §10.500 provides the basic rules governing continuing receipt of compensation benefits and return to work.
(2) Each disabled employee is obligated to perform such work as he or she can. OWCP's goal is to return each disabled employee to work as soon as he or she is medically able. In determining what work qualifies under 5 U.S.C. 8115 for determining the wage-earning capacity for a particular disabled employee, OWCP considers all relevant factors, including the employee's current physical limitations, whether the work is available within the employee's demonstrated commuting area and the employee's qualifications to perform such work.
(3) A disabled employee who refuses to seek or accept suitable employment within the meaning of 5 U.S.C. 8106(c)(2) is not entitled to compensation.
(4) Payment of medical benefits is available for all treatment necessary due to a work-related medical condition.
c. 20 CFR §10.517 outlines the penalties for refusing to accept a suitable job offer.
(1) 5 U.S.C. 8106(c) provides that a partially disabled employee who refuses to seek suitable work, or refuses to or neglects to work after suitable work is offered to or arranged for him or her, is not entitled to compensation. An employee who refuses or neglects to work after suitable work has been offered or secured for him or her has the burden to show that this refusal or failure to work was reasonable or justified.
(2) After providing the two notices described in §10.516, OWCP will terminate the employee's entitlement to further compensation under 5 U.S.C. 8105, 8106, and 8107 on all claims where the injury occurred prior to the termination decision, as provided by 5 U.S.C. 8106(c)(2). However, the employee remains entitled to medical benefits as provided by 5 U.S.C. 8103.
d. 20 CFR §10.518 outlines the services OWCP provides to help employees return to work.
e. 20 CFR §10.519 describes what actions OWCP will take if an employee refuses to undergo vocational rehabilitation.
(1) Where a suitable job has been identified, OWCP will reduce the employee's future monetary compensation based on the amount which would likely have been his or her wage-earning capacity had he or she undergone vocational rehabilitation. OWCP will determine this amount in accordance with the job identified through the vocational rehabilitation planning process, which includes meetings with the OWCP nurse and the employer. The reduction will remain in effect until such time as the employee acts in good faith to comply with the direction of OWCP.
(2) Where a suitable job has not been identified, because the failure or refusal occurred in the early but necessary stages of a vocational rehabilitation effort (that is, interviews, testing, counseling, functional capacity evaluations, and work evaluations), OWCP cannot determine what would have been the employee's wage-earning capacity.
(3) Under the circumstances identified in paragraph (b) of this section, in the absence of evidence to the contrary, OWCP will assume that the vocational rehabilitation effort would have resulted in a return to work with no loss of wage-earning capacity, and OWCP will reduce the employee's monetary compensation accordingly (that is, to zero). This reduction will remain in effect until such time as the employee acts in good faith to comply with the direction of OWCP.
f. 20 CFR §10.521 outlines the effect an election of retirement benefits will have on benefits if such election is made during a vocational rehabilitation effort.

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