National Guard Bureau Office of Technician Personnel 1 Office of Workers’ Compensation Module 18...
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Transcript of National Guard Bureau Office of Technician Personnel 1 Office of Workers’ Compensation Module 18...
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Office of Workers’ Office of Workers’ CompensationCompensation
Module 18 Module 18
People First – Mission Always!People First – Mission Always!
NGB-J1-TN-OWCPNGB-J1-TN-OWCP
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Topics To Be CoveredTopics To Be Covered
• 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
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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• Supervisor Responsibilities
• Containing OWCP Costs
• Record Keeping
• Automated Systems
• Internet Resources and References
Topics To Be CoveredTopics To Be Covered
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Overview of the FECAOverview of the FECA
• Federal Employees’ Compensation Act (FECA) passed in 1916
• Benefits Provided
• DOL Chargeback System
• Remedial in nature
• Non-adversarial – an attorney is not required
• Sole remedy
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Overview of the FECA Overview of the FECA (cont’d)(cont’d)
• Program Administration
• OWCP Adjudicates Claims
• Privacy Act
• HIPAA
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Primary Benefits Provided under the FECAPrimary Benefits Provided under the FECA
• Medical Benefits
– Services, appliances, and supplies
– Treatment
– Preventive care is not authorized
– Fee Schedules
– Chiropractor
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Primary Benefits Provided under the FECAPrimary Benefits Provided under the FECA
• Continuation of Pay (COP)
– Intent is to avoid interruption of pay while the claim is adjudicated
– 45 calendar days
– Traumatic Injury - ONLY
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Primary Benefits Provided under the FECAPrimary Benefits Provided under the FECA
• Wage Loss Compensation
– Traumatic Injury
– Occupational Disease Claim
– Death
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Primary Benefits Provided under the FECAPrimary Benefits Provided under the FECA
• Schedule awards
• Vocational rehabilitation
• Loss of Wage-Earning Capacity (LWEC)
• Death Benefits
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Conditions of CoverageConditions of Coverage
– Timely Filing of Claim
– Federal Civilian Employee
– Fact of Injury
– Performance of Duty
– Causal Relationship
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Timely FilingTimely Filing
• Employee Has Three Years From:
– Date of Injury
– Date of First Awareness
– Date of Last Exposure
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Civil EmployeeCivil Employee
• FECA covers all civilian employees except for non-appropriated fund employees
• Temporary employees covered on the same basis as permanent employees
• Contract employees, volunteers, and loaned employees are covered under some circumstances
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Fact of InjuryFact of Injury
• Factual – Actual occurrence of an accident, incident, or exposure in time, place, and manner alleged
• Medical – Medical condition diagnosed in connection with that accident, incident, or exposure
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Performance of DutyPerformance of Duty
• Injury occurred while performing assigned duties or engaging in an activity reasonably associated with the employment
• Injury occurred on work premises
• Injury occurred off premises while engaging in work activity
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Causal RelationshipCausal Relationship
• Link between work-related exposure/injury and any medical condition found
• Based entirely on medical evidence provided by physicians who have examined and treated the employee
• Opinions of employee, supervisor, or witnesses not considered – nor is general medical information contained in published articles
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Causal RelationshipCausal Relationship
• Four Types
– Direct Causation
– Aggravation
– Acceleration
– Precipitation
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Statutory ExclusionsStatutory Exclusions
• Willful Misconduct – deliberate and intentional
disobedience of rules/orders – not carelessness
• Drug or Alcohol Intoxication – proximately caused the
injury
• Intent to Injure Self or Others – intent must be
established
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Initiating A Claim for a Traumatic InjuryInitiating A Claim for a Traumatic Injury
• Traumatic Injury
– 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
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Initiating A Claim for a Occupational DiseaseInitiating A Claim for a Occupational Disease
• Occupational Disease
– Condition produced over a period longer than one
workday or shift
• COP is not provided for Occupational Diseases
• CA-16 is not issued for Occupational Diseases
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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• Usually, but not always
• Back pain or strain could be either
• Injury – Sudden pain or strain from activities not a part of normal job
• Disease/illness – Gradual back pain and strain from normal job duties
A clear difference ?
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Initiating A Claim for a Traumatic InjuryInitiating A Claim for a Traumatic Injury
• Notice of Traumatic Injury – CA-1
– Employee (or someone on her/his behalf, including supervisor) completes front
– Supervisor completes back
– 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
– Must be transmitted to OWCP within ten workdays from date agency received form – DO NOT HOLD for wage calculations, supporting documentation, etc.
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Supervisor’s Role related to a Traumatic Injury ClaimSupervisor’s Role related to a Traumatic Injury Claim
• Discuss and review the facts surrounding the incident.
• Complete the supervisor and safety screens within the EDI and submit to the HRO ASAP.
• Authorize medical care if needed by completing a Medical Treatment Form CA-16
• Advise employee of the right to elect COP
• Advise employee of her/his responsibility to submit prima facie medical evidence of disability within ten calendar days or risk termination of COP
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Employee Reports the injury to his/her
supervisor
Supervisor and Employee complete the On-Line initiating claim form
Injured employee signs the printed copy for
employee file
Supervisor electronically submits claim for processing
Supervisor prints completed form
HRO reviews the claim for accuracy, enters appropriate codes, corrects any
errors and authenticates the claim
The HRO is notified that a claim is awaiting authentication
Claim is forwarded to OWCP
Claim data is then loaded into DIUCS
OWCP receives claim, validates data, and submits data to District
OWCP for case number assignment
Safety is notified of the injury
Safety and Supervisor receive an electronic
OSHA-301 form in PDF format
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Initiating A Claim for a Occupational DiseaseInitiating A Claim for a Occupational Disease
• Notice of Occupational Disease – CA-2
– Employee initiates the report of injury through the EDI
– Supervisor reviews and completes the supervisor and safety screens within the EDI and submits to the HRO
– Three year statute of limitations
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Supervisor’s Role related to a Occupational Supervisor’s Role related to a Occupational Disease ClaimDisease Claim
• Review the employee’s portion of the form and provide comments concerning the employee's statement
• Supporting Statement
• Advise employee of the right to elect sick, annual leave or LWOP, pending adjudication of the claim
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Supervisor’s Role related to a Occupational Supervisor’s Role related to a Occupational Disease ClaimDisease Claim
• Provide Appropriate Occupational Disease Checklist
– CA-35a – Occupational Disease in General
– CA-35b – Hearing Loss
– CA-35c – Asbestos-Related Illness
– CA-35d – Coronary/Vascular Condition
– CA-35e – Skin Disease
– CA-35f – Pulmonary Illness (not Asbestosis)
– CA-35g – Psychiatric Illness
– CA-35h – Carpal Tunnel Syndrome
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Wage Loss/Permanent ImpairmentWage Loss/Permanent Impairment
• An employee who can not return to work when COP ends or who is not entitled to COP may claim compensation for wage loss
• An employee who has returned to work but who still requires medical treatment during work hours may claim compensation for lost wages while undergoing or traveling to and from treatment
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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CA-7CA-7(Claim for Compensation)(Claim for Compensation)
• An employee who uses annual or sick leave to avoid interruption of income may repurchase that leave, subject to agency concurrence, if the claim is approved
• Schedule awards for permanent impairment
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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CA-20CA-20 (Attending Physician’s Report)(Attending Physician’s Report)
• 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.
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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• 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
CA-17CA-17 (Duty Status Report)(Duty Status Report)
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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• Investigate circumstances and report results to OWCP
• Must be supported by specific factual evidence
• Attach detailed statement describing circumstances behind challenge
Challenging Validity of ClaimChallenging Validity of Claim
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Challenging Validity of ClaimChallenging Validity of Claim
• Include specific evidence: witness statements, accident investigations, timecards, etc.
• Pay COP (if applicable) pending OWCP decision
• Authority to determine any aspect of claim rests with OWCP. While agency is entitled to explanation of basis for OWCP action, it must accept determination rendered.
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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APPEAL RIGHTSAPPEAL RIGHTS
• APPEAL BOARD
• RECONSIDERATION
• ORAL HEARING
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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PENALTIESPENALTIES
•Anyone who knowingly and willfully falsifies, conceals or covers up a material fact;
•Makes a false, fictitious, or fraudulent statement or representation may be subject to these penalties:
A. FINEB. 5 YEARS IMPRISONMENTC. BOTH
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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THIRD PARTY CLAIMSTHIRD PARTY CLAIMS
•Circumstances
•Agency
•Continued Benefits
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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OPMOPM•While on OWCP long-term rolls time continues to run for within grade increases and leave category changes.
•National Guard Dual Status employees are not guaranteed reemployment in the same position or its equivalent when disability is overcome and the employee can return to work within one year from the beginning of compensation.
•This one year rule does not apply to Dual Status Employees.
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Initiating A Claim for a RecurrenceInitiating A Claim for a Recurrence
• Recurrence
– 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
– No event other than the previous injury accounts for the disability
– A recurrence of a medical condition is defined as a documented need for further medical treatment for the accepted condition or injury when there is no accompanying work stoppage
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Initiating A Claim for a RecurrenceInitiating A Claim for a Recurrence
• Claim for Recurrence of Disability – CA-2a
– Employee (or someone on her/his behalf, including supervisor) completes front
– Supervisor completes back
• Submit to OWCP
• Employee should arrange for submission of factual and medical evidence described in the form instructions
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Initiating a Claim for Death BenefitsInitiating a Claim for Death Benefits• When an employee dies because of an injury incurred
in the performance of duty, the supervisor/agency should immediately notify the district office via phone or fax
• The supervisor/agency should contact any survivors, provide them with claim forms, and help them prepare the claim
• CA-5 or CA-5b used to submit claims for death benefits
• Supervisor/Agency uses form CA-6 to report the work-related death of an employee
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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CONTINUATION OF PAYCONTINUATION OF PAY
-- Traumatic injury cases only!Traumatic injury cases only!-- 45 calendar days per injury - maximum45 calendar days per injury - maximum-- Written Notice of Injury within 30 days Written Notice of Injury within 30 days from from the date of injurythe date of injury-- Medical evidence within 10 calendar Medical evidence within 10 calendar days. days. (CA-1) (CA-1)
Continuation of an employee’s regular pay Continuation of an employee’s regular pay by the employing agency by the employing agency
with no charge to sick or annual leave.with no charge to sick or annual leave.
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Controverting COPControverting COP
• Agency may controvert (not pay) COP Only if one
of the following applies:
– Disability is a result of occupational disease or
illness
– Employee comes within the exclusions of 5 USC
8101 (1) (B) or (E)
– Employee is neither a citizen nor resident of the
US or Canada
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Controverting COPControverting COP (Cont’d) (Cont’d)
– Injury occurred off the agency’s premises and the
employee was not engaged in official “off premises”
duties
– Employee’s willful misconduct, intentional harm or
death, or proximate intoxication
– Injury not reported within 30 days of injury
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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─ Indicate controversion on CA-1 and attach narrative
statement and specific evidence substantiating
controversion
─ Advise employee of controversion
─ Can also terminate COP if no prima facie medical
evidence is received within ten calendar days
Controverting COP Controverting COP (Cont’d)(Cont’d)
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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– Work stoppage first occurred more than 45 days
after the injury
– Employee reported injury after employment was
terminated
– Employee is enrolled in Civil Air Patrol, Peace
Corps, or other group covered by special
legislation
Controverting COP Controverting COP (Cont’d)(Cont’d)
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Supervisor ResponsibilitiesSupervisor Responsibilities• Encourage safe work habits and conditions and enforce
safety regulations
• Advise employees on rights and responsibilities
• Report injuries promptly
• Complete and submit forms in timely manner (EDI)
– CA-1 and CA-2 within ten workdays of receipt
– CA-7 within five workdays of receipt
• Continue pay in traumatic injuries
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Supervisor Responsibilities Supervisor Responsibilities (cont’d)(cont’d)
• Assist employees in returning to work
• Represent the agency’s interest
• Challenge questionable claims
• Keep in contact with employee
• Help manage compensation costs
• Accommodate “light duty” work when able
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Containing OWCP Costs Containing OWCP Costs
• Timely submission• Challenge Questionable Claims• Track Injured Employee’s Medical Status and
availability for work• Offer Light Duty
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Containing OWCP Costs Containing OWCP Costs
• Report injuries through EDI within ten workdays
• Submit CA-7s within five workdays
• Timely submission– enables prompt adjudication and medical
management of claim– ensures compliance with the SHARE initiative and
Federal regulations
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Containing OWCP CostsContaining OWCP Costs
• Challenge Questionable Claims
– OWCP accepts employee statement as factual unless agency provides refuting evidence
– Agency does not have post adjudicative appeal rights
– Include actual evidence rather than conjecture or opinion
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Containing OWCP CostsContaining OWCP Costs• Track Injured Employee’s Medical Status
– Maintain constant contact with employee
– Request frequent medical updates – in writing from physician
– Cooperate with OWCP nurses, Claims Examiners, Vocational Rehabilitation Specialists, and Workers’ Compensation Specialists/Injury Compensation Specialists
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Containing OWCP CostsContaining OWCP Costs
• Offer Light Duty
– Match employee’s physical limitations to your particular needs
– Can be temporary positions
– Benefits of offering light duty:• improves morale for both injured worker and remainder
of workforce
• each day employee remains out of work reduces
likelihood s/he will ever return
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Containing OWCP CostsContaining OWCP Costs
• Light Duty Offers
– Can be made verbally but must be followed-up in writing within two business days
– Must include: job description, physical demands of position, organizational and geographical location, date available, date response required
– If employee refuses, notify OWCP immediately
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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LIGHT DUTYLIGHT DUTYResponsibility of…• the supervisor to try to accommodate the return of an
employee on light duty
• the HRO to officially reassign an employee to another position if necessary
• the employee to cooperate
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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SUPERVISOR’S OWCP GOALSSUPERVISOR’S OWCP GOALS
• To minimize workplace hazards
• To minimize worker injuries & disease
• To minimize agency costs
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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Department of Labor
Laws
Regulations
National GuardBureau Policy
Union Representative
NGB OWCP Liaison
State ICPA
Safety
Occupational Health
Supervisor
The OWCP Puzzle
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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DOLDistrict Office Locations
National Guard Bureau Office of Technician Personnel National Guard Bureau Office of Technician Personnel
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LiaisonRegional assignments