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Page created 09/06/05

"The NRLCA/VARLCA does not provide representation for OWCP claims and recommends referring OWCP questions to Mike Watson and Associates, an Oregon firm that specializes in OWCP. Their phone number is 503-653-2911."

 

Monday Night's OWCP Seminar

2005 National Convention

Minneapolis, MN

By DEBORAH WEATHERSBEE

VA RLCA Delegate

The national convention had various seminars scheduled.  I attended the OWCP Seminar on Monday evening.  It was conducted by Peter Krah, Technical Advisor, Branch of Technical Assistance/ESA, US Department of Labor.  The seminar was well attended, with many asking questions specific to their injury.  Time did not allow for all questions to be answered.

Mr. Krah stated that 93 percent of postal claims are submitted within the required time frames.  He stated that the postal service does a good job compared to other agencies.

The Federal Employees' Compensation Act (FECA) is administered by the Office of Workers' Compensation Programs (OWCP) of the U.S. Department of Labor.  It provides compensation benefits to civilian employees of the United States for disability due to personal injury sustained while in the performance of duty or to employment related disease.   Temporary employees are covered on the same basis as permanent employees.

To be eligible for benefits, employees must prove five basic elements: 

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1.      The claim was filed within specified time limits.

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2.      The employee is a civilian employee covered by FECA.

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3.      The employee has sustained an injury or disease.

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4.      The injury or disease occurred during the performance of duty.

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5.      There was a causal relationship between the injury or disease and the employee's condition.

Covered employees are entitled to benefits for two major types of conditions:  traumatic injuries and occupational diseases.  A traumatic injury is defined as a wound or other condition of the body caused by external force, including stress or strain.  For an incident to be classified as a traumatic injury, it must be identifiable by the time and place of occurrence and part of the body affected.  It must be caused by a specific event or series of events within a single day or work shift.   Traumatic injuries include damage to prosthetic devices, such as eyeglasses and hearing aids, if they were damaged incidental to a personal injury that required medical services. 

OWCP defines an occupational disease as a condition produced in the work environment over a period longer than one work day or shift.  It may result from systemic infection, repeated stress or strain, exposure to toxins, poisons, or fumes, or other continuing conditions in the workplace.  FECA covers preexisting diseases and illnesses that are aggravated by workplace conditions.  Workers must submit evidence that their employment aggravated, accelerated, or precipitated the condition.

    An employee is entitled to medical, surgical and hospital services and supplies needed for treatment of an injury, as well as transportation for obtaining care.  The injured employee has the initial choice of physician and may select any qualified local physician or hospital to provide necessary treatment, or may use agency medical facilities, if available.  Except for referral by the attending physician, any change in the treating physician after the initial choice must be authorized by OWCP.  Otherwise, OWCP will not be liable for the expenses of treatment.

In case of injury, obtain first aid or medical treatment even if the injury is minor.  For traumatic injuries, ask your employer to authorize medical treatment on Form CA‑16 BEFORE you go to the doctor.   Take Form CA‑16 when you go to the doctor, along with Form OWCP‑1500, which the doctor must use to submit bills to OWCP.  Your employer may authorize medical treatment for occupation disease ONLY if OWCP gives prior approval.

Submit bills promptly, as bills for medical treatment may not be paid if submitted to OWCP more than one year after the calendar year in which you received the treatment or in which the condition was accepted as compensable.

Report every injury to your supervisor.  Submit written notice of your injury on Form CA‑1 if you sustained a traumatic injury or Form CA‑2 if the injury was an occupational disease or illness.  Form CA‑1 must be filed within 30 days of the date of injury to receive continuation of pay (COP) for a disabling traumatic injury.  COP may be terminated if medical evidence of the injury‑related disability is not submitted to your employer within ten (10) workdays.  YOU ARE RESPONSIBLE FOR ENSURING THAT SUCH MEDICAL EVIDENCE IS SUBMITTED TO YOUR EMPLOYING AGENCY. 

Form CA‑2 should also be filed within 30 days.  Any claim which is not submitted within three years will be barred by statutory time limitations unless the immediate superior had actual knowledge of the injury or death within 30 days of occurrence.

File Form CA‑7, Claim for Compensation on Account of Traumatic Injury or Occupational Disease, if you cannot return to work because of your injury and you are losing (or expect to lose) pay for more than three days.  Give the form to your supervisor seven to ten days before the end of the COP period, if you receive COP. 

If you are not entitled to COP, submit Form CA‑7 when you enter or expect to enter a leave without pay status.   All wage loss claims must be supported by medical evidence of injury‑related disability for the period of the claim.

If you continue to lose pay after the dates claimed on Form CA‑7, submit Form CA‑8, Claim for Continuing Compensation on Account of Disability, through your employer to claim additional compensation until you return to work or until OWCP advises the CA‑8 forms are no longer needed.  You are NOT required to use your sick or annual leave before you claim compensation. 

If you choose to use your leave, you may be able to claim compensation for periods of leave that are restorable under the rules of the employing agency.  Employees should use Forms CA‑7a and CA‑7b for this.

Return to work as soon as allowed by your doctor.   If your employing agency gives you a written description of a light‑duty job,  you must provide a copy to your doctor and ask if and when you can perform the duties described.   If your agency is willing to provide light work, you  must ask your doctor to specify your work restrictions.  COP or compensation may be terminated if you refuse work that is within your medical restrictions without good cause, or if you do not respond within specified time limits to a job offer from your agency.

Compensation is paid by the Office of Worker's Compensation, not the U.S. Postal Service.  There is a delay in receiving compensation benefits, usually 90 ‑ 120 days.  Compensation is paid at the rate of 75 percent of your salary if you have dependents, or 66 and 2/3 percent of your salary if you do not have dependents.  Compensation payments are not subject to taxes.  You must be in a leave‑without‑pay status to receive compensation benefits. 

Compensation is claimed by completing Form CA‑7 and providing a breakdown of the hours missed from work.  You must report all outside income to OWCP when completing these forms.

    Conditions of coverage include performance of duty.  The injury must have occurred while performing your assigned duties or engaging in an activity reasonably associated with the employment.  The  injury must have occurred on work premises, which includes parking facilities  owned by the employer. 

Workers, such as letter carriers, who perform services away from the agency's premises may be entitled to FECA benefits for off‑premises injuries.  Coverage is extended for a reasonable time before or after work hours, usually 15‑30 minutes before or after your shift.   Employees are not covered en route between work and home unless the agency furnishes transportation, the employee is required to travel during a curfew or emergency, or the employee is required to use their personal vehicle during the work day.

Circumstances not governed by the premises rules include:  Recreation, Horseplay, Assault, Harassment or Teasing, Idio­pathic Falls, Emergencies, Union Representation.

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Recreation:  An employee is considered in the performance of duty while engaged in formal recreation when either the employee is paid for participating or the recreational activity is required and prescribed as a part of the employee's training or assigned duties.

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Horseplay:  An employee is considered to be in the performance of duty if the horseplay was of a character that could reasonably be expected where workers are thrown into personal association for extended periods of time.

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Assault:  An employee is considered to be in the performance of duty if the assault was accidental or arose out of an activity directly related to the work or work environment.  An assault is not compensable if it arose out of a personal matter having no connection with the  employment.

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Harassment/Teasing:  Employees who are harassed,  teased or called derogatory names by coworkers are considered to be in the performance of duty provided that the reasons for the harassment or teasing are not imported into the employment from the employee's domestic or private life.

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Idiopathic Falls:  Defined as one where a personal, non‑occupational pathology causes an employee to collapse.  Injuries that can be attributed to the intervention or contribution of some hazard or special  condition of the employment, including normal furnishings of an office or other  workplace are compensable.

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Emergencies:  Coverage is extended to employees who momentarily step outside the sphere of their employment to assist in an emergency such as to extinguish a fire or help a person hit by a car.

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Union Representation:  Employees performing representational functions, which entitle them to official time, are in the performance of duty.  Activities relating to the internal business of the union organization, such as soliciting new members or collecting dues, are not included.

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Emotional Reaction:  An employee who suffers from a  medical condition resulting from factors of employment that result in an emotional reaction can be considered to be in the performance of duty.  Personnel actions such as the regular administrative functions of an agency (leave usage, disciplinary actions, etc.), performance ratings, performance assessments and informal discussions of performance,  standing alone, are not sufficient to provide coverage under the FECA.  For a personnel action to be compensable, the employee must establish an error or abuse of administrative authority by the agency. Without this showing, the emotional reaction is considered to be self generated.

OWCP may deny benefits if the circumstances of a case indicates willful misconduct, not carelessness, intention to bring  about the injury or death of oneself or another, or intoxication.  The  employing agency or OWCP personnel must assert and prove these factors.

To be eligible for FECA benefits, an employee must also establish the first condition of coverage B that his or her injury or disease is related to the claimed medical condition.  Unlike fact of injury, causal  relationship involves establishing a connection between the injury and the  condition found. 

This factor is based entirely on medical evidence provided by physicians who have examined and treated the employee.   Opinions of the employee, supervisor, or witness are not considered, nor is general medical information contained in published articles.

An injury or disease may be related to employment factors in any one of four ways:

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1.      Direct causation.  This refers to situa­tions where the injury or factors of employment result in the condition claimed through a natural and unbro­ken sequence.

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2.      Aggravation.  If a preexisting condition is worsened, either temporarily or permanently, by a work‑related injury, that condition is said to be aggravated.

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3.      Acceleration.  A work‑related injury or disease may hasten the development of an underlying condition, and accelera­tion is said  to occur when the ordinary course of the disease does not account for the speed with which a condition develops.

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4.      Precipitation.  This term refers to a latent condition that would not have manifested itself on this occasion but for the employment.

If your case is denied, you are entitled to the reason in writing.  Your benefits are still intact if you retire or you are fired.  ACS (Accelerated Central System-Bill Processing Unit) handles bill payments and authorizations.  Two web sites are:

www.dol.gov/esa/ and http://owcp.dol.acs-inc.com/portal/main.do

The Federal Employees' Compensation Act (FECA) provides for the payment of a Schedule Award.  Schedule Awards are defined as an award of compensation payable for a set number of weeks for the loss or loss of use of a part of the body, whether total or partial.

The degree of impairment is established by medical evidence and expressed as a percentage loss of the member involved.   Permanent impairment may originate either within the affected member (i.e., loss of use of your arm in a carpal tunnel syndrome claim) or another part of the  body (i.e., a back injury may result in impairment to a leg for which a Schedule Award would be payable).

A claimant may also receive an Award for more than one part of the body in connection with a single injury, i.e., a back injury may result in impairment to a leg and an arm.

An injured worker should only apply for a Schedule Award after having reached maximum medical improvement and are back to work full time (even in a limited duty capacity) or retiring.

The Department of Labor will not pay compensation for wage loss (i.e., time in LWOP being paid by OWCP) and a Schedule Award at the same time.  However, if the injury occurred on or after Sept. 13, 1957, the Schedule Award may be paid concurrently with benefits under the U.S. Civil Service Retirement Act.  In order to apply for a Schedule Award, you would need to submit a CA‑7 and check the "Yes" box in question 5.

The treating physician should be advised to use the American Medical Association's Guide to the Permanent Impairment, Fourth  Edition, and to report findings in accordance with those guidelines.

To support a Schedule Award, the file must contain competent medical evidence which:

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1.      Shows that the impairment has reached a permanent and fixed state and indicates the date on which this occurred (date of maximum medical improvement).

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2.      Describes the impairment in sufficient detail for the Claims Examiner to visualize the  character and degree of disability; and

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3.      Gives the percentage evaluation of the impairment (in terms of the affected member or function, not the body as a whole, except for impairment to the lungs).

The treating physician should also provide a detailed description of the impairment which includes, where applicable, the loss in degree of active and passive motion of the affected member or function, the amount of any atrophy or deformity, decreases in strength or disturbances of  sensation, or other pertinent description of impairment.

Once all of the medical evidence has been submitted to OWCP, the Claims Examiner will review the file for completeness and forward the entire case file to the District Medical Advisor for verification.  If there is no conflict, you will be notified of the details concerning your  Schedule Award.  If there is a conflict, the Claims Examiner will schedule a second opinion or contact the physician for clarification.