Workers’ Compensation Supervisory Training U.S. Department of

Workers’ Compensation Supervisory Training U.S. Department of the Interior Office of Human Resources

Office of Human Resources Training Objectives Overview of the Federal Employees’ Compensation Act (FECA). Understand the basics of Workers’ Compensation under FECA: o o Types of benefits Process for submission of a claim Understand the Supervisor’s role and the steps to take when an employee reports an injury or illness. Identify potential fraudulent claims. Understand the importance of communicating with the injured employee. Identify duties for injured employees’ with physical limitations. 2

Office of Human Resources Supervisor’s Role The supervisor plays a critical role in the workers’ compensation process. A supervisor’s actions will determine whether an employee’s claim is timely filed as required under the Federal Employees Compensation Act (FECA). A supervisor is also instrumental in making the initial notification and determination of the facts pertaining to an on-the-job injury. This notification is vital to the Workers’ Compensation Specialist (WCS) so that proper actions can be taken with regard to the injury. A supervisor’s failure to take the proper actions can have an adverse impact on an agency’s workers’ compensation program. This training covers the basics of the workers’ compensation program. It will provide the supervisor with a working knowledge of the program fundamentals so that the proper actions can be taken when an employee is injured on the job. Additional information can be obtained by contacting the Bureaus WCS. 3

Office of Human Resources Frequently Used Acronyms CBY – Chargeback Year (July-June) CE – Claims Examiner COP – Continuation of Pay DOL – Department of Labor FECA – Federal Employees Compensation Act OWCP – Office of Workers’ Compensation Programs MMI – Maximum Medical Improvement RTW – Return to Work SECOP – Second Opinion SMIS – Safety Management Information System MC – Medical Only (Case accepted) VR – Vocational Rehabilitation WCS – Workers’ Compensation Specialist 4

Frequently Used Forms Office of Human Resources There are a number of forms that are required when filing a workers’ compensation claim. Not every form will be required for every injury. CA-1: Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation. o Injury occurs within 1 working day or shift. CA-2: Notice of Occupational Disease and Claim for Compensation. o Injury or illness/disease occurs over a period of time (more than 1 working day or shift). CA-7: Claim for Compensation. o Used to claim compensation for lost wages or schedule award. CA-7a: Time Analysis Form. o Used in conjunction with the CA-7 when there is intermittent time. CA-16: Authorization for Examination and/or Treatment. CA-20: Attending Physician’s Report. CA-17: Duty Status Report – Used to specify job requirements to physician. Physician also uses form to identify the employee’s work restrictions. CA-35: Evidence Required in Support of a Claim for Occupational Disease. Forms used initially in traumatic injury claims include: CA-1, CA-7, CA-16, CA-17, CA-20 Forms used initially in occupational illness claims include: CA-2, CA-7, CA-35 5

Office of Human Resources FECA Overview The Federal Employees’ Compensation Act (FECA) was passed in 1916 to provide benefits in the event that a Federal civilian employee is injured or killed while in the performance of their duties. It establishes a non-adversarial procedure administered by the Department of Labor, Office of Workers’ Compensation Program (OWCP). Benefits paid under FECA are initially paid by the Department of Labor (DOL) and charged back to the bureau. The bureau then reimburses the DOL for the benefits paid to its employees. Bills are two years in arrears. Employees can appeal OWCP decisions, employers cannot. 6

Office of Human Resources OWCP Overview Administered by Department of Labor (DOL), Division of Federal Employees’ Compensation’s (DFEC), Office of Workers’ Compensation Programs (OWCP): o OWCP adjudicates (decides if a claim is valid) claims o 12 District Offices Individual case files are protected under the Privacy Act: o Only employee, her/his representative (if any), and WCS routinely have access to the file. o HIPAA doesn’t apply to OWCP or employing agencies. A claimant cannot be directed to either file or waive her/his right to file a under the FECA. 7

Office of Human Resources When to Disclose OWCP Information There will be times when you will need to discuss the Workers' Compensation claim of an employee with other agency personnel. The Department of Labor regulations govern the disclosure of this information. FECA CIRCULAR NO. 09–05 August 26, 2009 “The Office of Workers’ Compensation Programs (OWCP) has determined that records covered by DOL/GOVT-1 may not be used in connection with a personnel action absent consent of the subject of the record." Workers’ Compensation information is to be used for only Workers’ Compensation purposes unless authorized by the employee. The information cannot be used for purposes such as disciplinary action, removal, or the EEO complaint process without the consent of the injured employee. The information, however, can be used to determine placement opportunities for the employee. So while you cannot provide information to a Labor Relations Specialist working on a proposed removal, you can provide pertinent information to the Staffing Specialist working on a placement for the employee. If you are in doubt as to whether you can release information, just say no, and then check with the WCS for direction. The WCS understands the rules governing release of information and can provide you with clear guidance. 8

Office of Human Resources Coverage under FECA An employee may be covered under FECA if, while in the performance of their duties, they sustain a traumatic injury or occupational illness. This includes death caused by the injury or illness. Coverage includes aggravation, precipitation and acceleration of a preexisting non-work related condition. It also includes damage to or destruction of medical braces, artificial limbs and other prosthetic appliances as long as the damage or destruction occurred in the performance of duty. Simple exposure to an infectious disease without the occurrence of a work-related injury does not afford coverage. Similarly, fear of exposure to an infectious agent does not entitle the employee to benefits if no definable injury has occurred. 9

Office of Human Resources Requirements for Coverage Simply submitting a claim does not mean it is automatically accepted by OWCP. All claims must meet the following five requirements in order to be accepted: o o o o o Timeliness Federal/Civilian Employee Fact of Injury Performance of duty Causal relation 10

Timeliness Office of Human Resources A claim is timely if filed: Traumatic Injury - within 3 years of the date of injury. The employee has 3 years to submit the claim form to their employer. An employee that gets injured on 4/5/2018 will have until 4/5/2021 to file a claim to be considered timely filed by OWCP. Not meeting this requirement could jeopardize the claim's acceptance by OWCP. Occupational Illness - within 3 years from first date of awareness or last date of exposure, whichever occurs later. An employee files a claim for Carpal Tunnel Syndrome. They became aware of the condition five years ago. They are filing a claim now because they are retiring. They have continued to perform the same duties up until their retirement. Since their date of last exposure will be the later date, this date will be used to determine whether the claim was timely filed. If the employee files within three years of their retirement date then they will have met the timeliness requirement. 11

Federal/Civilian Employee Office of Human Resources Any civilian employee in any branch of Federal government, including temporary employees, are covered. Part-time, seasonal and intermittent employees are covered. Volunteers performing job duties similar to Federal employees are usually covered. Independent contractors or employees of independent contractors are usually not covered, but the contract would need to be reviewed. Non-Appropriated Fund employees are generally not covered. Special legislation provides coverage to Peace Corps and VISTA volunteers; Federal petit or grand jurors; volunteer members of the Civil Air Patrol; Reserve Officer Training Corps Cadets; Job Corps, Neighborhood Youth Corps, and Your Conservation Corps enrollees. 12

Fact of Injury Office of Human Resources Fact of injury has two components Factual – Does the evidence support that the injury occurred? oThe evidence must support that an incident occurred at work. This evidence can be as simple as an employee or witness statement. For this requirement the employee needs to establish that something happened. oThe agency can assist in gathering factual evidence. Medical – Does the employee have a diagnosed condition? oThe mere occurrence of an incident at work does not establish a compensable claim. The employee must also show, through medical evidence, that they have a diagnosed condition. An employee that trips and falls must not only provide the factual evidence of the incident but they must also provide medical evidence that provides a diagnosis. oClaimant has the burden to provide medical evidence. 13

Office of Human Resources Performance of Duty The facts must demonstrate that the injury, incident or exposure did arise out of and in the course of employment for it to be considered in the performance of duty. The employee does not have to be performing an essential duty to be covered. A mechanic does not have to be working on a car when injured in order to be covered. A mechanic can be attending agency directed training or eating lunch on the agency premises and be covered for an injury. If you have questions as to whether an employee was injured in the performance of duty contact your bureau Workers’ Compensation Specialist for guidance before you submit the claim to OWCP. 14

Office of Human Resources Causal Relationship Provides a link between the work-related incident and the medical condition being claimed. This is different than fact of injury. To support fact of injury the employee needs to provide evidence of a diagnosed condition. With causal relationship, the employee has to prove that the diagnosed condition is a result of the claimed incident at work. This is a subtle but important difference. Can only be proven by medical examination and/or testing from a physician that has examined the employee. Opinions of employee, supervisor, or witnesses are not considered. 15

Challenging/Controverting Validity of a Claim Challenge must be based on facts: Office of Human Resources o Being a poor performer is not an adequate reason. Supervisor can challenge a portion of a claim or the entire claim. If the entire claim is challenged the bureau is asserting that the claim does not meet one or more of the five requirements. There is no format or form for a challenge: o o It is simply a narrative write-up of the facts. The suspicious claim that isn’t challenged may become the bureaus million-dollar claim in the future. When you are in doubt as to whether to challenge a claim, contact your WCS as soon as possible. The Department of the Interior has only one opportunity to challenge/controvert a suspicious claim, and that is before the claim is adjudicated. Challenging/controverting a claim is different than challenging COP. 16

Potential Topics that may Impact Validity of a Claim Office of Human Resources Premises – Did the injury occur on the agency premises? Recreation – Did the injury occur during recreational activities? Union Duties – Did the injury occur during the performance of Union Duties? To & From Work – Did the injury occur while the employee was traveling to or from work? Misconduct/Horseplay – Was the injury the result of misconduct or horseplay? Intoxication – Was the proximate cause of the injury the employee’s intoxication? Idiopathic Falls – Was there a medical reason for the employee’s fall? (i.e. seizure) Travel Status – Did the injury occur while the employee was in a travel status? When you are in doubt as to whether to challenge/controvert a claim, contact your WCS as soon as possible. OWCP has sole responsibility for determining whether or not an injury or illness claim is valid. 17

Traumatic Injury (CA-1) vs. Occupational Disease (CA-2) 1 of 2 Office of Human Resources Before reviewing the CA-1 or CA-2, the Supervisor should understand the difference between traumatic injuries and occupational diseases. Traumatic injuries are submitted using a CA-1: Traumatic injuries occur within one working day or shift. Identifiable as to a time and place of occurrence. May be entitled to an Authorization for Examination and/or Treatment. Issue CA-16 authorizing medical care (request CA-16). Eligible for Continuation of Pay (COP) if claim filed within 30 days of injury. OWCP must receive the claim within 10 working days from the date the supervisor receives notification in order for the agency to meet regulatory timeliness requirements. 18

Traumatic Injury (CA-1) vs. Occupational Disease (CA-2) 2 of 2 Office of Human Resources Occupational disease/illness claims are submitted using a CA-2: These diseases/illnesses develop over the course of more than one work shift/day. (Common examples of occupational diseases/illnesses are hearing loss, carpal tunnel, and lateral epicondylitis (Tennis Elbow). Produced by continued or repeated exposure to work environments or elements or repetitive work activities/movements. Not entitled to an Authorization for Examination and/or Treatment (CA16) or COP. Use appropriate CA-35 form as a guide to providing documentation to OWCP. The form provides a listing of documentation that needs to be submitted by both employee and employer. A number of conditions have a specialized CA35 form to use. (Do not wait for the submission of supporting documents before initiating the CA-2) Must use leave and private insurance until DOL approves claim. 19

Office of Human Resources Authorizing Treatment using CA-16 Form The CA-16 form guarantees payment for medical treatment for a period of 60 days from the Date Of Injury (DOI). It is to be used for traumatic injuries only and not for occupational disease/illness claims. Employees are entitled to an initial selection of treating physician. (Only one CA-16 can be issued per injury) Check with the WCS at your bureau for specific guidance as to who issues the CA-16. If your bureau requires the supervisor to fill out the form then follow the following guidelines: oFill out the information on the front and sign the form within 4 hours of the time of injury (if possible). If this is not possible, authorize treatment by phone and send the form to the medical facility within 48 hours. oNever give an employee a blank CA-16. It is like handing someone a blank check. Keep blank CA-16 forms under strict control for this reason. oIssuance of the CA-16 is at the bureaus discretion if the employee reports the injury more than one week from the DOI. oIf you have doubts regarding the validity of the claim then annotate that on the form. 20

Types of Benefits Office of Human Resources Medical benefits (including transportation expenses): o Preventive care is not authorized. Continuation of Pay (COP): o Continuation of regular pay for up to 45 calendar days of wage loss due to disability and/or medical treatment after a traumatic injury. o Intent is to avoid interruption of pay while the claim is being adjudicated. o Employer pays – Subject to usual deductions from pay. Wage loss compensation (CA-7). o Temporary Total Disability: Continues as long as medical evidence supports disability. Injured employee 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. o Compensation: 66 2/3% of salary without dependents. 75% of salary with dependents. Retention rights (One year from injury or disability) USC § 8151(b)(1). 21

Types of Benefits cont. Office of Human Resources Schedule awards: o Compensation for specific periods of time for permanent loss, or loss of use, of certain members and functions of the body. o Must have reached maximum medical improvement (MMI). o Based on pay rate used for compensation purposes. Vocational rehabilitation: o Provides vocational rehabilitation services to assist disabled employees in returning to gainful employment consistent with physical, emotional, and educational abilities. o May be requested by attending physician, employee, or employing agency. o Compensation may be reduced or terminated for employee’s failure to participate or to make a good faith effort to obtain employment. Survivor benefits if employee dies as a result of injury. Loss of Wage-Earning Capacity: o When medical evidence shows an employee is no longer totally disabled and medical evidence determines s/he can perform duties in reduced number of hours or lower-paying job, compensation is paid on the basis of loss of wage-earning capacity. 22

Office of Human Resources Knowledge Check John is one of your employees. It is Wednesday morning around 11:00 a.m. when he asks to speak to you. He shares with you that he thinks he pulled something in his knee while lifting heavy boxes this morning. He doesn’t want to make a big deal about this and thinks that if he went home and put a heating pad on his knee he should be fine. You know John has had knee problems for a couple of years related to a baseball accident. What type of injury has John described to you? (Answer can be found in the notes sections of this slide.) A. Traumatic Injury B. Occupation Disease/Illness 23

What would you do? Office of Human Resources What do you tell John? (Answer can be found in the notes sections of this slide.) A. Send John home and tell him you hope he feels better B. Explain to John that he will have to take sick leave since he has a pre-existing knee condition C. Explain to John that he can either take leave or file a workers’ compensation claim and request time off under FECA D. None of the above 24

Office of Human Resources Fraud Indicators Supervisors should contact their WCS if there is a belief the worker’s claim is not legitimate. Some “Red Flags” or fraud indicators a supervisor should be on the lookout for are: o Unexplained time delay in reporting the injury or seeking medical care. o Lack of witnesses to an injury that occurred in an area where it should have been observed. o The witness supporting the employee’s version of the injury frequently serves as a witness for other injuries. o Injured employee is facing a disciplinary action, RIF, management directed transfer/downgrade or retirement. o Injury occurred in conjunction with a weekend, holiday, or scheduled leave. o Injury occurred after a leave request was denied. o Employee’s account of how the injury occurred changes or is inconsistent with the medical evidence. o Several family members are on OWCP. o Employee has other outside employment. 25

Cost of Workers Compensation Office of Human Resources Workers’ Compensation cases have cost the Department of the Interior 52 million for CBY 2017 (CBY July 1, 2016 – June 30, 2017) o A significant number of cases contributing to these costs are due to “aged cases,” the injured employee never returned to work. o Bureaus receive their chargeback bill two years in arears. o Injured workers may receive compensation benefits for the rest of their lives which in turn creates continued costs to the bureau. Supervisors have an impact on the chargeback bill: o o o o o Return injured employees back to work as soon as medically possible. Maintain constant contact with employees. Track medical status. Keep workers comp and employee relations separate. Do not view workers comp as a retirement system. 26

Office of Human Resources What Supervisor Should Do When an Injury Occurs Ensure the injured employee seeks medical treatment (note: supervisor cannot deny or direct an employee to seek medical treatment). Inform the employee of their right to select treating physician or facility. Contact bureau’s WCS and request a CA-16 if the injury requires immediate medical attention. If after duty hours, contact WCS first business day after the injury. May be sent to the medical facility within 48 hours. Do not mandate, stop or impede the filing of a claim. Sign and date a statement noting any inconsistencies with the injury. 27

Office of Human Resources Continuation of Pay (COP) Eligibility COP is the continuation of an employee’s regular pay for a period not to exceed 45 calendar days. The employee’s regular pay includes any night or shift differential and various kinds of premium pay (but not Sunday or overtime pay). To be eligible for COP the employee must: o File a Traumatic Injury claim. Occupational Illness claims are not entitled to COP. o File the claim within 30 days from the DOI. o Begin any lost time within 45 days from the DOI. COP is a counted in calendar days. The employee is entitled to 45 calendar days of COP. This includes weekends, holidays. Time off covered under COP does not have to be continuous. Any portion of a day charged to COP will count as one day of entitlement. Up to 4 hours of COP is allowed for routine medical examinations. 28

Office of Human Resources Documentation Needed to Support COP Entitlement Time off covered by COP must be supported by medical documentation. The employee initially has 10 calendar days to provide medical documentation supporting time off work. If the employee does not provide the medical documentation within this time period, then COP can be stopped. Must amend any and all time used to S/L, A/L or LWOP. Once the employee provides the medical documentation, COP will be given retroactively to the date it was first stopped. 29

Office of Human Resources Controverting COP Controvert is a term used to dispute or challenge an employee’s entitlement to COP. There are certain instances when the bureau can controvert paying COP. Contact your WCS for guidance on specific instances. If you believe that an employee is not entitled to COP contact your WCS before you submit the claim. Unless there is formal decision denying COP entitlement, the bureau must pay COP. OWCP makes the final determination of COP eligibility. 30

Office of Human Resources Employee Remains Incapacitated Following COP Period After entitlement to COP ends, the employee may claim compensation from OWCP by submitting (CA-7/CA-7a) or use leave (A/L, S/L). If an employee elects to claim compensation from OWCP the following applies: o Employee will be in a Leave without pay (LWOP) status for the period claiming compensation. o Total disability – Employee submits CA-7 & direct deposit forms via ECOMP. o Partial disability – Employee submits CA-7, CA-7a & direct deposit forms via ECOMP. o SF-52 Request for Personnel Action must be submitted when LWOP continues for 80 continuous hours or more and the employee is expected to receive compensation. Contact your HR personnel for guidance. 31

Office of Human Resources Supervisor’s Responsibilities Provide caring support to the employee. Advise employee to seek prompt medical attention if needed. Authorize medical care if needed by completing a Medical Treatment Form CA-16 within four hours of request whenever possible. o May refuse to issue a CA-16 if more than a week has passed since the injury. o If you are controverting the injury check box 6(b)(2). Make the decision to challenge a claim based on individual knowledge and available information. Complete Supervisor section within 10 calendar days from employee initiating claim to comply with timeliness deadlines. o Don’t wait for medical documentation prior to completing o Wet signature is required in block 38 of CA-1 form Advise employee of the right to elect COP, rather than use leave. Make the decision on whether to controvert COP. Advise employee of her/his responsibility to submit medical evidence of disability within ten calendar days or risk termination of COP. 32 Verify injured employee’s time card is coded accurately.

Office of Human Resources Supervisor Responsibilities Maintain contact with the injured employee and request periodic updates on the prognosis and duration of the medical condition. Request CA-17 from WCS. Supervisor responsible for completing side A. Accommodate work restrictions if needed when capacity to return to work is determined. Make sure employee is working within medical restrictions. Identify and secure light or limited duty. Work with HR and WCS to secure a permanent position when needed. Know when to submit a Request for Personnel Action. Contact HR to submit a personnel action if needed. Maintain contact with the injured employee. Request updated medical when needed until employee is released to full duty: o CA-17 Duty Status Report. o CA-20 Attending Physician Report. o OWCP-5c Work Capacity Evaluation. 33

Office of Human Resources Following up with Employee It is important for the supervisor to maintain contact with the employee after a work related injury. When an employee is out of work due to an injury, the supervisor should call the injured employee at home ask them how they are doing and obtain the following information: o Limitations the doctor may have placed on the employee. o Validation of when/if the employee can return to work. o Whether the employee informed the treating physician about light duty availability. o Request medical documentation to support time off from work. If an SF-52 action was processed to place an employee in LWOP, contact HR to coordinate the processing of an SF-52 action returning employee to duty. This action is imperative to ensure no lapse in pay and/or benefits. 34

Office of Human Resources What if the Injured Employee has Restrictions? Ensure employee has a medical release from treating physician. The injured employee’s treating physician may clear the employee for work, but with certain limitations. Supervisor must accommodate the restrictions. If the restrictions are permanent or the supervisor cannot accommodate the temporary restrictions, the job may need to be permanently or temporally modified to comply with the doctors orders. If the supervisor is unable to accommodate the work restrictions the supervisor should contact the WCS to seek further guidance. 35

Office of Human Resources What if the Employee Returns PartTime? If an employee has been medically released to return to work but has temporary limitations, a verbal light duty offer may be given but must be followed up by written offer containing required information. Employee may submit a completed CA-7, CA-7a for LWOP for loss of wages. The employee can use their own leave for hours not worked with the option to buy their leave back (LBB). Verify employees timesheet coincides with requested leave. Work with your WCS to identify a temporary accommodation or permanent reassignment. 36

Office of Human Resources What if the Employee is unable to Return to their Regular Duties? An injured employee may be able to perform some level of work. Supervisor will need to work with HR and the WCS to locate a job or create “job duties” that fall within the employee’s work restrictions. Remember, your bureau is paying the employee’s wages whether they are working or staying at home. It is the responsibility of every supervisor to return the injured employee back to work and minimize workers’ compensation costs to the bureau. 37

Office of Human Resources RECAP of the Supervisor’s Role in Workers’ Compensation Assist injured employee immediately and within guidelines as soon as possible. Issue CA-16 if appropriate. Complete the supervisors portion of the claim. Review all claims submitted for injury or illness within 10 working days. Report all red flags or potential fraud to the WCS . Partner with the WCS to get the injured employee back to work as soon as possible. 38