OWCP TRAINING

1
OWCP TRAINING

• Prepared by Stephen Gilbert
• Southwest Region OWCP Advocate

2
Topics of OWCP Overview

• What is the FECA?
• Provisions of FECA
• Conditions of Coverage
• Types of Injuries and Claim Forms
• Filing a Claim for Compensation
• Internet Resources and References

3
FECA

• Federal Employees Compensation Act (FECA) passed
  in 1946
• Exclusive Remedy
• Non-adversarial
• Administered by Department of Labor (DOL), Office
  of Workers Compensation Programs (OWCP)

4
Provisions of FECA

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

5
Wage Loss Compensation

• After COP ends or from beginning of pay loss
• - W/O Dependents 66 2/3
• - Dependents 75
• 3 day waiting period except when disability last
  more than 14 days. Where COP is paid, the 3 day
  waiting period begins the 45th day of COP.

6
Conditions of Coverage

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

7
Timely Filing

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

8
Federal Employee

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

9
Fact of Injury

• Two Components
• Factual occurrence of accident/exposure at the
  time, place, and manner alleged
• Medical condition diagnosed in connection with
  untoward event

10
Performance of Duty

• The Appeals Board (ECAB) has consistently held
  that the injury, incident, or exposure must arise
  out of and in the course of employment
• POD issues include harassment, horseplay, TDY,
  industrial premises, recreation, misconduct

11
Causal Relationship

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

12
Statutory Exclusions

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

13
Types of Injuries and Claim Forms
14
Types of Injuries and Claim Forms

• Traumatic Injury CA-1
• Occupational Disease CA-2
• Recurrence CA-2a

15
Traumatic Injury

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

16
Filing a Traumatic Injury Claim

• CA-1 Notice of Traumatic Injury
• CA-16 Authorization for Examination

17
CA-1

• Notice of Traumatic Injury
• Two Parts
• employee completes front
• supervisor/HRMD completes back
• Notice must be given to Sup. Not later than 30
  days from DOI.
• Must be transmitted by Agency to OWCP within 10
  workdays from date agency received form

18
CA-16

• Authorization for Examination/Treatment
• Guarantees payment of all non-invasive procedures
  and routine treatment/examination for 60 days
  after traumatic injury
• Supervisor completes front of form, physician
  completes back

19
CA-16 continued

• Issued to employee within four(4) hours of injury
• If verbal authorization given may be issued
  within 48 hours
• Not required past one week
• Does NOT authorize exercise equipment, surgery
  etc.

20
Occupational Disease

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

21
Filing an Occupational Disease Claim

• CA-2 Notice of Occupational Disease
• CA-35 a-h Occupational Disease Checklist

22
CA-2

• Notice of Occupational Disease/Illness
• Two Parts
• employee completes front
• supervisor/HRMD completes back
• Detailed medical report
• Must be transmitted by Agency to OWCP within 10
  workdays

23
CA-35 (a-h)

• Occupational Disease Checklist
• Lists information required from both employee and
  supervisor
• Forms exist for seven different conditions and
  general occupational disease claims

24
Recurrences

• Defined as a spontaneous return or increase of
  disability due to a previous injury or
  occupational disease without intervening cause,
  or a return or increase of disability due to a
  consequential injury.
• Differs from new injury in that no other event
  other than previous injury accounts for the
  disability.

25
Filing a Recurrence Claim

• Employee and Supervisor complete form CA-2a.
• Factual and medical evidence submitted
• Particular attention to the need for bridging
  information which describes his/her condition and
  job duties between the original injury and the
  recurrence.

26
COP and Controversion

27
COP - Basic Requirements

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

28
COP

• Regular pay, including night or shift
  differential, holiday or other extra premium pay
• DOES NOT INCLUDE SUNDAY PAY

29
Controverting COP vs. Challenging Validity of
Claim

• Controverting withhold COP
• must be for one of nine reasons cited on CA-1
• advise employee

30
Controverting COP vs. Challenging Claim,
continued.

• The injury occurred off the employing agency's
  premises and the employee was not engaged in
  official "off-premises" duties
• The employee comes within the exclusions of 5USC
  8101 (1) (B) or (E) -this does not apply to ATCS
• The employee is not a citizen or resident of the
  USA

31
Controverting COP vs. Challenging Claim,
continued.

• The employee caused the injury by his/her willful
  misconduct, or the employee intended to bring
  about his or her injury or death or that of
  another person, or the employee's intoxication
  was the proximate cause of the injury
• The injury was not reported on a form approved by
  OWCP (usually Form CA-1) within 30 days of the
  injury

32
Controverting COP vs. Challenging Claim,
continued.

• 6. The employee first reported the injury
  after employment was terminated
• 7. The disability is a result of an
  occupational disease or illness
• 8. The employee is enrolled in the Civil Air
  Patrol, Peace Corps, Job Corps, Youth
  Conservation Corps, work-study program, or other
  group covered by special legislation.

33
Controverting COP vs. Challenging Claim,
continued.

• 9. Work stoppage first occurred more than 45
  days after the injury
•  

34
Terminating COP

• Medical evidence is not submitted within 10
  workdays
• Employee is no longer disabled
• -employee refuses a suitable offer of light or
  limited-duty work
• OWCP notifies Agency that pay should be
  terminated
• 45 day period expires

35
Controverting COP vs. Challenging Claim,
continued.

• Challenging validity claim doesnt meet one of
  five conditions of coverage
• attach detailed statement describing
  circumstances behind challenge
• include specific evidence witness statements,
  accident investigations, timecards, etc.
• pay COP pending OWCP decision

36
Filing a Claim for Compensation

• CA-7 Claim for Compensation
• CA-20 Attending Physicians Report
• CA-17 Duty Status Report

37
CA-7

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

38
CA-7 continued

• When to File
• wage loss compensation expiration of
  COP/commencement of LWOP and subsequent biweekly
  intervals of LWOP
• schedule award maximum medical improvement

39
CA-7 continued

• leave buy back within one year of date leave
  used or claim accepted, whichever is later
• include CA-7a and CA-7b in package to OWCP
• CA-7a - Time Analysis Form
• CA-7b - Leave Buy Back Worksheet/Certification
  and Election.

40
CA-7 continued

• If it appears that the employee will go beyond
  the 45 days Continuation of Pay, he/she, and the
  agency, should complete Form CA-7, Claim for
  Compensation and submit to his/her OWCP district
  office by at least the 40th calendar day of COP.

41
CA-20

• Attending Physicians Report
• Attached to CA-7
• Submitted to OWCP along with CA-7 for wage loss
  or leave buy back
• Requests information on diagnosis, prognosis,
  history of injury, prima facie statement of
  causal relationship, etc.

42
CA-17

• Duty Status Report
• Provides OWCP and supervisor with interim medical
  report regarding employees work capacities
• Agency can send to physician at any time during
  life of claim

43
Appeals

• Hearing
• - Oral
• - Review of the Written Record
• Reconsideration
• ECAB Appeal

44
Hearing

• Oral
• - Submit within 30 days of the decision.
• - Must be made before any request for
  reconsideration
• - Takes approximately 6 months
• - Face to face presentation of your case.

45
Reconsideration

• One year from the date of decision.
• Additional evidence or legal argument that will
  establish your claim.
• Must clearly state the grounds upon which
  reconsideration is being requested, and be
  accompanied by relevant evidence not previously
  submitted.

46
ECAB

• All available evidence that would establish your
  claim has already been submitted.
• Will only review evidence received prior to the
  date of decision.
• Request made within 90 days from the date of
  decision.

47
ARTICLE 75INJURY COMPENSATION

• Section 5. If the employee incurs medical expense
  or loses
• time from work beyond the date of injury,
  including time
• lost obtaining examination and/or treatment
  from the
• employing agency medical facility, the
  Employer shall
• submit Form CA-1 to the OWCP District Office
  as soon as
• possible but no later than ten (10) working
  days from
• the date of the receipt of the CA-1 from the
  employee. CA-1 and CA-2 forms shall not be held
  for receipt of supporting documentation.

48
ARTICLE 75INJURY COMPENSATION

• Section 6. If, due to an administrative delay by
  the Employer in submitting an employees CA-1
  form to the OWCP District Office, a case has not
  been adjudicated within 45 calendar days of date
  of injury, the employee will be placed on
  administrative leave for a period commensurate
  with the administrative delay in submitting the
  form.

49
ARTICLE 75INJURY COMPENSATION

• Section 9. The Employer may only controvert
  claims for Continuation of Pay (COP) in
  accordance with 20 CFR 10.203. When requested,
  copies of the completed Form CA-1 showing
  controversion and all accompanying detailed
  information the Employer submits in support of
  the controversion shall be provided to the
  employee.

50
STRESS CLAIMS

• To determine whether a federal employee has
  sustained a traumatic injury in the performance
  of duty, it must first be determined whether a
  "fact of injury" has been established.  First,
  the employee must submit sufficient evidence to
  establish that he or she actually experienced the
  employment incident at the time, place and in the
  manner alleged. Second, the employee must submit
  sufficient evidence, generally only in the form
  of medical evidence, to establish that the
  employment incident caused a personal injury.

51
STRESS CLAIMS

• In case of a traumatic stress claim put the
  following verbiage on the CA-1
• "Out of and in the course of my Federal
  employment as an Air Traffic Control Specialist,
  I suffered a traumatic emotional condition when
  two aircraft (or other specifics) under my
  control came in a close proximity to each other
  forcing me to take action"

52
References

• 5 U.S.C. 8101 et seq. (FECA)
• 20 C.F.R. Parts 10 and 25 (OWCP Regs)
• CA-810 Injury Comp for Fed Employees
• CA-550 Federal Injury Comp QA
• Federal Procedure Manual Part 2
• Decisions of the ECAB

53
Internet Resources

• http//www.dol.gov/esa/owcp_org.htm
• OWCP Addresses and Telephone Numbers
• CA-810 and CA-550
• OWCP Program Procedures and Policy Guidance
• ECAB Decisions
• www.fedworkerscomp.net

54
Contact Information

• Email sgilbert_at_natca.net
• Home Phone [phone]
• Cell 817.475.0780
• Pager 800.266.0895 PIN-18700