Train the Trainer - Federal Employees

Kristin Coyle
VISN 1 Lead WC Specialist
Course Objectives
• Overview of the Federal Employees’
Compensation Act (FECA)
• Primary Benefits Provided under the FECA
• Types of Injuries and Initiating Claims
• Conditions of Coverage
• COP and Controversion
Overview of the FECA
• Federal Employees’ Compensation Act (FECA) passed in 1916
• Provides compensation benefits to civilian employees of the
US for disability due to personal injury or disease sustained in
the performance of duty
• Provides benefits to dependents if a work-related injury or
disease causes an employee’s death
• Coverage is extended to Federal employees regardless of the
length of service or position held. Probationary, temporary,
term, part-time, are all covered.
• Pre-existing diseases and illnesses aggravated, accelerated or
precipitated by the employment are also covered.
Overview of the FECA (cont)
• All kinds of injuries and diseases may be covered if they occur
in the performance of duty. However, benefits cannot be paid
if injury or death is caused by willful misconduct or intent to
injure oneself or another.
• Sole (Exclusive) remedy – a Federal employee or surviving
dependent is not entitled to sue the US or recover damages
for injury or death under any other law
• Funded through agency chargebacks
• Remedial in nature
• Non-adversarial – an attorney is not required
Overview of the FECA (cont)
• Administered by Department of Labor (DOL), Division of Federal
Employees’ Compensation’s (DFEC) Office of Workers’
Compensation Programs (OWCP). (12 District Offices)
• OWCP adjudicates claims
• Individual case files are protected under the Privacy Act – only the
employee, her/his representative (if any), and agency personnel
may routinely have access to a file
• HIPAA doesn’t apply to OWCP or employing agencies
OWCP District Offices
The jurisdictions of the 12 OWCP District Offices are as follows:
District 1 – Boston, MA (covers claims for CT, ME, MA, NH, RI and VT)
District 2 – New York, NY (claims for NJ, NY, PR and the VI)
District 3 – Philadelphia, PA (claims for DE, PA,WV and parts of MD)
District 6 – Jacksonville, FL (claims for AL, FL, GA, KY, MS, NC, SC and TN)
District 9 – Cleveland, OH (claims for IN, MI and OH)
District 10 – Chicago, IL (claims for IL, MN and WI)
District 11 – Kansas City, MO (claims for AR, IA, KS, MO, NE and DOL employees)
District 12 – Denver, CO (claims for NM, CO, MT, ND, SD, UT and WY)
District 13 – San Francisco, CA (claims for AZ, CA, HI and NV)
District 14 – Seattle, WA (claims for AK, ID, OR and WA)
District 16 – Dallas, TX (claims for LA, OK and TX)
District 25 – Washington, DC (claims for parts of MD, VA and DC)
Medical Benefits
Compensation Benefits
Death Benefits
Other Benefits
Primary Benefits Provided under the FECA
• Medical Benefits
– Services, appliances, and supplies prescribed or recommended by
physicians which in the opinion of OWCP are likely to cure, give relief,
reduce the degree or period of disability, or aid in lessening the
amount of monthly compensation
– Includes examination, treatment, and related services such as
medications and hospitalization, as well as transportation needed to
secure these services
– Preventive care is not authorized
Initial Choice of Physician
The Agency should advise the employee of the right to
his or her initial choice of physician. The Agency must
allow the employee to select a qualified physician, after
advising him or her of those physicians excluded under
subpart I of this part. 20 CFR 10.300 (d)
Any qualified physician may provide initial treatment of a
work-related injury in an emergency.
20 CFR 10.825(b)
CA-16 Issuance
• Authorizes medical treatment for a traumatic injury for 60
days from the date of injury, unless terminated sooner by
• This form is not automatic, criteria must be met
• Must be provided in traumatic injury claims within 4 hours,
but not more than 7 calendar days after an injury
• Agency questions the validity of a claim it can be indicated on
the CA-16
• The Agency may refuse to issue a CA-16 if more than a week
has passed since the injury
20 CFR 10.300(b)
– Check with your local WCO to see who issues this at your
• Duty Status Report – interim medical report about employee’s
fitness for duty and work capabilities
• May be issued initially with CA-16
• Supervisor/Agency completes agency portion by describing
physical requirements of the employee’s job and noting the
availability of light or limited duty
• Agency can send to physician at any time during life of claim –
but not more than once a week
• OWCP5 would be another form to use if this is not available.
Once the Agency learns of a traumatic injury
sustained by an employee, it shall advise the
employee of the right to receive COP, and the
need to elect among COP, annual leave, sick
leave, or leave without pay, for any period of
20 CFR PART 10.211(b)
Continuation of Pay (COP)
– Continuation of regular pay for up to 45 calendar days of wage loss due to
disability and/or medical treatment after a traumatic injury
– Intent is to avoid interruption of pay while the claim is being processed for
acceptance or denial by OWCP
– Subject to usual deductions from pay, such as income tax, retirement,
allotment, etc.
– Entitlement is not automatic
– The Workers’ Compensation Office (WCO) or someone in HR is responsible
for the authorization of COP, but check with your local facility
– Supervisor responsible for ensuring once authorized by WCO, that
timekeeper post COP appropriately
– Time lost on the day or shift of the injury does not count towards COP.
They should be placed on Administrative leave (AA) 20 CFR 10.215(a)
Primary Benefits Provided under the FECA
• Wage loss compensation
– Temporary Total Disability - continues as long as medical
evidence supports total disability
– Injured worker who returns to work can receive
compensation for time lost due to medical appointments,
physical therapy, and/or reduced work hours based on
medical restrictions
– 66 2/3% of salary without dependents and 75% of salary
with dependents
Primary Benefits Provided under the FECA
• Schedule awards
– Compensation for specific periods of time for permanent
loss, or loss of use, of certain members and functions of
the body
– Partial loss or loss of use of members and functions is
compensated on a proportional basis
– Must have reached maximum medical improvement
– Based on pay rate used for compensation purposes
– 66 2/3% of salary without dependents and 75% of salary
with dependents
Primary Benefits Provided under the FECA
• Vocational rehabilitation
– Main purpose is it provides vocational rehabilitation
services to assist disabled employees in returning to
gainful employment consistent with physical, emotional,
and educational abilities
– May be requested by attending physician, employee, or
employing agency
– Compensation may be reduced or terminated for
employee’s failure to participate or to make a good faith
effort to obtain employment
– Other benefits under this program can also assist in other
areas such as medical services and transportation.
Release of Records
• IMPORTANT TO REMEMBER: The privacy of FECA case files are
governed by DOL/GOVT1, they do not fall under the VA System
of Records
• Absent a court order of competent jurisdiction or written release
from the claimant, information may only be used pursuant to
DOL’s interpretation of routine use published in DOL/GOVT-1
and in a manner that is compatible with which the record was
• You cannot use information in the case file for issues such as:
EEO’s, disability retirement, reasonable accommodations, etc
without the employee written consent to use this information
for that purpose.
• Files are maintained by DOL, they have the complete file.
• DOL/GOVT-1 is available on the DOL website.
Benefit Entitlement
To claim benefits under the FECA, an
employee who has sustained an injury or
occupational disease which he or she believes
to be work related must give notice of the
injury or condition in writing on Form CA1/CA-2
20 CFR 10.100 AND 10.101
Compensation Rights Waiver
No employer or other person may require an
employee or other claimant to enter into any
agreement either before or after an injury or
death, to waive his or her right to claim
compensation under the FECA.
No waiver of compensation rights shall be
20 CFR 10.15
Criminal and Civil Penalties
A number of statutory provisions make it a
crime to file a false or fraudulent claim or
statement with the Government in
connection with a claim under the FECA, or to
wrongfully impede a FECA claim.
20 CFR PART 10.16
Timeframe for Submitting Claims to OWCP
OWCP Must receive the completed CA-1/CA-2
within 10 workdays from the date the
employee electronically and wet ink sign the
front of the form
If a claim is submitted late to OWCP it counts
against the Medical Center Directors and the
VISN Directors lag time performance
CA-1:Traumatic Injury-Definition
– Wound or other condition of the body caused by
external force, including stress or strain
– Caused by specific event or series of events or
incidents within a single day or work shift
Initiating A Claim for a Traumatic Injury
• Notice of Traumatic Injury – CA-1
– Employee (or someone on her/his behalf, including
supervisor) completes page 1; Supervisor completes page
– Must be submitted to employing agency within 30 days of
date of injury to be eligible for COP – however can be
submitted up to three years after the injury
– Supervisor must have knowledge within 30 days of injury
even if filed 3 years later to be timely.
– Must be transmitted to OWCP within ten workdays from
date injured employee signs the form – WCO cannot hold
for wage calculations, supporting documentation, etc.
– DOL has 45 days from the date they receive to make a
decision on the claim, unless placed in an administrative
CA-2: Occupational Disease-Definition
– Condition produced over a period longer than one
workday or shift (e.g., repetitive motion disorders,
asbestosis, stress)
– COP is not provided for Occupational Diseases
– CA-16 is not issued for Occupational Diseases
Supervisor’s Role related to a Occupational
Disease Claim
• Review pg 1 of CA-2 for completeness and assist employee in
correcting any errors or omissions and then complete pg 2 of
the CA-2
• Review the employee’s portion of the form and provide
comments concerning the employee's statement
• Prepare a supporting statement to include exposure data, test
results, copies of previous medical reports, and/or witness
statements – depending on the nature of the case
• Advise employee of the right to elect sick or annual leave or
LWOP, pending adjudication of the claim
• DOL has 90 days on basic OD claims and 180 on extended OD
claims to render a decision.
Reportable Claims
• Medical Charge against OWCP
• Disability for work beyond the day or shift of injury
• The need for more than two appointments for
medical examination within agency and/or treatment
leading to loss from work
• Future disability
• Permanent Impairment
• Any claim where treatment is with outside medical
Reportable Claims (cont)
• Payment of Continuation of Pay pursuant 5
U.S.C. 8118
• Any CA2: Notice of Occupational Disease
needs to be submitted
Note: The employer should not wait for
submittal of supporting evidence before
sending the form to OWCP
Non-Reportable Claims
If none of the reportable claim criteria apply,
Form CA1 shall be retained as a permanent
record in the Employee Medical Folder in
accordance with the guidelines established by
the Office of Personnel Management (OPM)
20 CFR PART 10.110 (3) (d)
Requirements for entitlement
FECA does not cover exposure-type cases such as:
• Tuberculosis; Sharp exposures; HIV
No coverage for the exposure as there has been no
medical condition diagnosed yet
• These claims must be placed in the employee health
• If diagnosed later due to the exposure coverage will be
afforded retroactively
• These cases should be forwarded to OWCP once a
condition has been diagnosed.
Disputing Claims
If an Agency disagrees with any aspect of the
injured employee’s claim, it must submit a
statement to OWCP that specifically describes
the factual allegation or argument with which
it disagrees and provide evidence or argument
to support its position. The employer may
include supporting documents such as witness
statement, medical reports or records, or any
other relevant information. 20 CFR 10.117
NOTE: If the Agency does not submit a written
explanation to support the dispute or disagreement,
OWCP may accept the injured workers’ claim of
injury as established!
Also, the Agency cannot delay sending the claim to
OWCP because it disagrees with aspects of the claim
or to compel the injured employee to change or
withdraw the claim.
20 CFR 10.117b
Death Benefits
• OWCP District Office must be notified immediately
via fax or telephone
• Supervisor must complete form CA-6 and submit to
OWCP within 10 workdays after knowledge by
Supervisor of an employee’s work related death
• CA-5 form must be completed within 30 days, if
possible, but no later than 3 years (widow, widower,
• CA-5b (Parents, brothers, sisters, grandparents,
Evidence Needed to Establish Claim
5 Basic Requirements
Civil Employee
Fact of Injury
Performance of Duty
Causal Relationship
Conditions of Coverage
• Time
– 3 years from date of injury, first awareness or
• Civil Employee
– temporary employees covered on the same basis
• Fact of Injury
– actual occurrence of event
– a diagnosed medical condition as a result
Conditions of Coverage
• Performance of Duty
”premises rule”
outside working hours/30 minutes
official time for representational functions
parking facilities
agency housing
lunch hour
travel status
• Causal Relationship
– connection between injury/medical condition
– based on medical evidence
Performance of Duty
Employees who are injured while exercising or participating in a
recreational activity during authorized lunch or break periods in a
designated area of the employing establishment premises have the
coverage of the Act whether or not the exercise or recreation was part
of a structured Physical Fitness Program (PFP). Injuries which occur
during the use of fitness and recreational facilities furnished by the
employing establishment outside of official work hours, on or off the
premises, are not compensable if the employee was not participating
in a structured PFP.
The mere fact that the employing establishment allows employees to
use its facilities on their own time does not create a sufficient
connection to the employment to bring any resulting injury within the
coverage of the Act.
OWCP Nurse Purpose
• Coordinate Medical Care
• Obtain Work Restrictions
• Assist Claims Examiner in resolving medical issues
that may arise
• Visit the worksite
• Ensure duties don’t exceed medical limitations
• Address any problems the employee may have in
adjusting to the work setting (FECA Manual 2-0811-6)
Group Injuries
When possible, where two or more employees
are injured in the same incident, such as an
explosion or auto accident, or by the same
substance, such as contaminated drinking
water, the entire group of cases should be
adjudicated by the same Claims Examiner in
order to ensure uniformity of action.
FECA PM 2-0800-12
Notifying District Office-Group Injuries
NOTE: Your Facility Workers’ Compensation
Office will notify OWCP District Office that
services your Agency to determine their
process for submitting group injury
information and the information required
from the Agency
Workers’ Comp and Incarceration
 If a injured employee is incarcerated in a State or
Federal jail, prison, penal institution or other
correctional facility due to a State or Federal
conviction, he or she forfeits all rights to
compensation benefits during the period of
 Entitlement to compensation benefits resumes
once incarceration ends, but the benefits
suspended during incarceration is not restored
Incarceration (cont)
• If the injured worker has eligible dependents,
OWCP will pay compensation to them at a
reduced rate during the period of his or her
incarceration as it relates to 5 U.S.C. 8133(a)
(1) through (5)
• The employing agency shall provide OWCP any
information or documentation they may have
concerning such matters. 20 CFR PART 10 (10.18)

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