8/14/2019 Department of Labor: owcp
1/41
Inspectors General
Symposium
History and Overview of FECAShelby Hallmark, Director
OWCP
Stephanie L. SemmerChief, Branch of Technical Assistance
http://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htmhttp://www.dol.gov/index.htm8/14/2019 Department of Labor: owcp
2/41
FECA Benefit Obligations
Fiscal Years 1995- 2005
$-
$500
$1,000
$1,500
$2,000
$2,500
1995 1997 1999 2001 2003 2005
Compensation BenefitsMedical Benefits
(in millions)
*
FY 1996 includes one-time accounting adjustment of +$85 million.
8/14/2019 Department of Labor: owcp
3/41
Total Compensation
$1,000,000
$251,000,000
$501,000,000
$751,000,000
$1,001,000,000
$1,251,000,000
$1,501,000,000
$1,751,000,000
$2,001,000,000
$2,251,000,000
$2,501,000,000
USPS
Navy
Army
VA
DHS
AirForce
Tran
sportation
Justice
USDA
DOD
Interior
SSA
Education
Total
Chargeback04
Chargeback05
8/14/2019 Department of Labor: owcp
4/41
Total Compensation
$0
$25,000,000
$50,000,000
$75,000,000
$100,000,000
$125,000,000
$150,000,000
$175,000,000
$200,000,000
$225,000,000
$250,000,000
N
avy
A
rmy
VA
DHS
AirForce
Transporta
tion
Jus
tice
USDA
D
OD
Inte
rior
SSA
Educa
tion
Chargeback 04
Chargeback 05
8/14/2019 Department of Labor: owcp
5/41
Periodic Roll Management
Project begun in FY 1992
Made permanent in FY 1999
Approx. 120 FTE
Total savings over $1.6 BILLION so
far
8/14/2019 Department of Labor: owcp
6/41
Long-term Disability Roll
46,000
46,500
47,000
47,500
48,000
48,500
49,000
49,500
50,000
1
9
9
6
1
9
9
7
1
9
9
8
1
9
9
9
2
0
0
0
2
0
0
1
2
0
0
2
2
0
0
3
2
0
0
4
2
0
0
5
2
0
0
6
Fiscal Year
End-of-Period Snapshot
8/14/2019 Department of Labor: owcp
7/41
Return-to-Work Activity
0
1,500
3,000
4,500
6,000
7,5009,000
10,500
12,000
13,500
15,000
16,500
1995 1997 1999 2001 2003 2005
Nurse InterventionsReturns to Work
8/14/2019 Department of Labor: owcp
8/41
162
1
54
157
164
167
1641
7318718
919
5
100
120
140
160
180
200
4Q,
'96
'97 '98 '99 '00 '01 '02 '03 '04 '05
F i s c a l Y e a r
CalendarDays
Lost Production Days in QCMCases
Measured w/i 1st Year from the Date Wage Loss Began
8/14/2019 Department of Labor: owcp
9/41
56.0
147.2
61.9
147.6
134.4
56.1 54.3 57.1
148.8
0
20
40
60
80
100
120
140
160
USPS (non-SHARE) All Other Gov't
R
ateper100E
mployees
FY03FY04
FY05FY06 GoalFY06 Q1
Goal 4 - Lost Production
Days
NoGoal
8/14/2019 Department of Labor: owcp
10/41
Safety, Health, and Return-to
Employment (SHARE) Initiative
Federal Executive Branch initiative announced in
Presidential memo dated January 9, 2004 Runs FY 2004 - FY 2006 Establishes 4 Goals
To reduce Total Case Rates by at least 3% per year
To reduce Lost Time Case Rates by at least 3% per year
To improve the timely filing of injury and illness notices by
at least 5% per year
To reduce the rates of lost production days due to injuriesand illnesses by at least 1% per year
8/14/2019 Department of Labor: owcp
11/41
56.0
147.2
61.9
147.6
134.4
56.1 54.3 57.1
148.8
0
20
40
60
80
100
120
140
160
USPS (non-SHARE) All Other Gov't
R
ateper100E
mployees
FY03FY04
FY05FY06 GoalFY06 Q1
Goal 4 - Lost Production
Days
NoGoal
8/14/2019 Department of Labor: owcp
12/41
Goal 4 - Lost Production
DaysMajor Agency
0
25
50
75
100
125
150
175
200
225
250
275
Navy
Army
VA
AirF
orce
DOT
Trea
sury
TVA
U
SDA
DOD
Ju
stice
Interior
HHS
L
abor
Comm
erce
DHS
SSA
HUD
All-LessU
SPS
FY03
FY04
FY05
G
8/14/2019 Department of Labor: owcp
13/41
Goal 4 - Lost ProductionDays
Major Agency FY06 Goal vs. Actual
0
25
50
75
100
125
150
175
200
225
Navy
Army
VA
A
irForce
DOT
T
reasury
TVA
USDA
DOD
Justice
Interior
HHS
Labor
Commerce
DHS
SSA
HUD
All-Les
sUSPS
FY06 Goal
FY06 Q1
8/14/2019 Department of Labor: owcp
14/41
49.6%
88.7%
61.4%
79.0%
92.5%
70.9%
57.4%
93.1%
69.9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
USPS (non-SHARE) All Other Gov't
FY03
FY04FY05
FY06 Goal
FY06 Q1
Goal 3 - CA-1/CA-2 Timeliness(filed in 14 calendar days)
No
Goal
8/14/2019 Department of Labor: owcp
15/41
FECA Reform
Incentives
Conversion benefit for retirementaged claimants
Setting compensation at 70% for allclaimants
Change the schedule award to allowfor payment during the wage lossperiod
8/14/2019 Department of Labor: owcp
16/41
FECA Reform
Equity and fixes
Restore waiting period
Allow for subrogation of COP for Third
Party claimsUpdate disfigurement and burial
payments
Pay all schedule awards at averagesalary rate (GS-11 step 3)
8/14/2019 Department of Labor: owcp
17/41
FECA Reform
Applies to new claims only
Strengthens the program while
maintaining generous benefits
Projected savings of $591.6 millionover the next 10 years
8/14/2019 Department of Labor: owcp
18/41
FECA Reform
Current status: pending transmission
Seeking sponsors
Assistance welcome
8/14/2019 Department of Labor: owcp
19/41
Questions?
8/14/2019 Department of Labor: owcp
20/41
Topics To Be Covered Overview of the Federal Employees Compensation Act
(FECA)
Chargeback System
Primary Benefits Provided under the FECA
Claims Processing
Case Management
Containing OWCP Costs
Internet Resources and References
8/14/2019 Department of Labor: owcp
21/41
Overview of the FECA
Federal Employees Compensation Act (FECA) passed in 1916
Provides compensation benefits to civilian employees of the USfor disability due to personal injury or disease sustained in theperformance of duty
Provides benefits to dependents if a work-related injury ordisease causes an employees death
Funded through agency chargebacks
Sole remedy a Federal employee or surviving dependent isnot entitled to sue the US or recover damages for injury ordeath under any other law
Administered by the Office of Workers CompensationPrograms Division of Federal Employees Compensation
8/14/2019 Department of Labor: owcp
22/41
Chargeback
FECA is financed by the Employees Compensation Fund,which consists of monies appropriated by Congress or
contributions by agencies from operating revenues
The chargeback system is the mechanism by which the costs ofcompensation for work-related injuries are assigned to agenciesfor the fiscal accounting period which runs from July to June
All compensation claims are identified as belonging to aparticular agency based on the agency code entered intoOWCPs system when the case is created
OWCP provides each agency with a quarterly report listing allcases and costs for which charges will appear on the yearlychargeback bill
8/14/2019 Department of Labor: owcp
23/41
Primary Benefits Provided
under the FECAContinuation of Pay (COP)
Medical benefits
Wage loss compensation
Schedule awards
Vocational rehabilitation
Loss of Wage-Earning CapacityDeath benefits
8/14/2019 Department of Labor: owcp
24/41
Types of Injury Claims
Traumatic Injury CA-1
Occupational Disease CA-2
Recurrence CA-2a
Consequential
Intervening
Death CA-5 and CA-6
8/14/2019 Department of Labor: owcp
25/41
Controverting COP
The agency may controvert 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
Injury occurred off the agencys premises and the employee
was not engaged in official off premises duties
8/14/2019 Department of Labor: owcp
26/41
Controverting COP
continued Employees willful misconduct, intentional harm or
death, or proximate intoxication
Injury not reported within 30 days of injury
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
Ch ll i V lidi f
8/14/2019 Department of Labor: owcp
27/41
Challenging Validity of a
Claim If the validity of a claim is in question, the agency should
provide a detailed statement describing circumstances behindchallenge
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.
8/14/2019 Department of Labor: owcp
28/41
Claims Processing
A person claiming compensation must
submit the essentials of a prima facie case,
which are as follows
Timely Filing of Claim
Federal Civilian Employee
Fact of Injury
Performance of Duty
Causal Relationship
8/14/2019 Department of Labor: owcp
29/41
Conditions of Coverage
Timely Filing
Employee Has Three Years From:
Date of Injury
Date of First Awareness
Date of Last Exposure
Civil Employee FECA covers all civilian employees except for non-
appropriated fund employees Contract employees, volunteers, and loaned
employees are covered under some circumstances
8/14/2019 Department of Labor: owcp
30/41
Fact of Injury
Factual Actual occurrence of an accident,
incident, or exposure in time, place, andmanner alleged
Medical Medical condition diagnosed inconnection with that accident, incident, orexposure
8/14/2019 Department of Labor: owcp
31/41
Performance of Duty
Injury occurred while performing assigned
duties or engaging in an activity reasonablyassociated with the employment
Injury occurred on work premises
Injury occurred off premises while engaging inwork activity
8/14/2019 Department of Labor: owcp
32/41
Causal Relationship
Link between work-related exposure/injury and
and 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
8/14/2019 Department of Labor: owcp
33/41
OWCP Responsibilities
OWCP has the obligation to aid in the
processing and adjudicating of a claim
Advising the claimant and the agency ofprocedures for establishing a claim,including detailed instructions for developingthe evidence
Requesting all evidence necessary toadjudicate the case
Identifying potential third party cases so thatattempts at recovery may begin
Making prompt decisions
8/14/2019 Department of Labor: owcp
34/41
OWCP Responsibilities
Once a claim is adjudicated, claims
examiners are responsible for the followingcase management activities
Focus on Return to Work Initiate Interventions and Services
Request Medical Information
Follow up with the assigned Field Nurse orRehabilitation Specialist
Bring the Case to Resolution
8/14/2019 Department of Labor: owcp
35/41
Agency 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
CA-1 and CA-2 within ten workdays of receipt
CA-7 within five workdays of receipt
Continue pay in traumatic injuries
8/14/2019 Department of Labor: owcp
36/41
Agency Responsibilities
Assist employees in returning to work
Represent the agencys interest
Challenge questionable claims (controvert)
Keep in contact with employee
Help manage compensation costs
Accommodate light duty work when able
8/14/2019 Department of Labor: owcp
37/41
Containing OWCP Costs
Submit CA-1s and CA-2s 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
8/14/2019 Department of Labor: owcp
38/41
Containing OWCP Costs
Controvert/Challenge Questionable Claims
OWCP accepts employee statement asfactual unless agency provides refutingevidence
Notify OWCP of any information you believeto be pertinent to the claim. This wouldinclude things such as past history of
injuries, outside activities, etc. Include actual evidence rather than
conjecture or opinion
8/14/2019 Department of Labor: owcp
39/41
Containing OWCP Costs
Track Injured Employees Medical Status
Maintain constant contact with employee
Request frequent medical updates in
writing from physician
Cooperate with OWCP nurses, ClaimsExaminers, Vocational RehabilitationSpecialists, and Workers CompensationSpecialists/Injury Compensation Specialists
8/14/2019 Department of Labor: owcp
40/41
Containing OWCP Costs
Offer Light Duty
Match employees physical limitations to yourparticular needs
Create temporary positions where none exist
Benefits of offering light duty:
improves morale for both injured worker and
remainder of workforce each day employee remains out of work reduces
likelihood he/she will ever return
8/14/2019 Department of Labor: owcp
41/41
Top Related