Created by APWU Human Relations Department Director, Sue Carney 1 FEDERAL INJURY COMPENSATION OVERVIEW How Does the Process Work? How Does It All Fit Together?

1 Created by APWU Human Relations Department Director, Sue Carney

FEDERAL INJURY COMPENSATION OVERVIEW

How Does the Process Work?How Does It All Fit Together?

20 CFRDOL

FECA

OWCP APWUINJURED

EMPLOYEE

ELM 540

EL 505

USPS


TABLE OF CONTENTS

Message from APWU President Burrus and

Human Relations Director Susan M. Carney

TOPIC SLIDE No.

OWCP Statistics 9

What It’s All About 10

Who’s Involved In The Claim Process 11

Responsibilities

Immediate Supervisor 12

USPS Injury Compensation Specialist 13

Assistance By APWU 14

Five Basic Requirements For Successful Claim 15

Time Limits 16

Civilian Employee 16

Fact of Injury 17

Performance of Duty 19

Causal Relationship 20

Cite Reference Chart: Five Basic Requirements 21


TABLE OF CONTENTS

(continued)

TOPIC SLIDE No.

Types of Claims

Traumatic Injury Definition (Form CA-1) 22

Occupational Disease Definition (Form CA-2) 24

Recurrence Definition (Form CA-2A) 26

Cite Reference Chart: Three Types of Claims 29

Traumatic Injury

Form CA-16 Authorization for Examination/Treatment 30

Cite Reference Chart: Traumatic Injury (Form CA-16) 32

Continuation Of Pay (COP) 33

Cite Reference Chart: Traumatic Injury: COP 36

Controversion with COP Withheld 38

Cite Reference Chart: Traumatic Injury: COP Withheld 40

Stopping COP Which Has Already Begun 41

Cite Reference Chart: Traumatic Injury: COP Stopped 43

Claim for Compensation (Forms CA-7, CA-20) 44

Cite Reference Chart: Claim for Compensation 48

Leave Buy Back (Form CA-7b) 50

Cite Reference Chart: Leave Buy Back (CA-7b) 53


TABLE OF CONTENTS

(continued)

TOPIC SLIDE No.

Return To Work Capability

Medical Restrictions 55

Cite Reference Chart: Return to Work Capability (Medical Restrictions) 57

Job Offers (Limited Duty/Rehab) 58

Cite Reference Chart: Job Offers 62

Rights and Benefits 63

Selection of Physician 66

Postal Physician or Contract Equivalent 68

USPS May Require Medical Examination 70

Physician Changes & Referrals 72

Cite Reference Chart: Selection of Physician 73

Providing Supporting Evidence 74

Employee’s Statement 75

Medical Reports 79

Sample Medical Report Traumatic Injury 83

Sample Medical Report Occupational Disease 84

OWCP Criteria For Evaluating Medical Reports 85

OWCP Directed Medical Exams

Second Opinions 86

Referee Specialist 88


TABLE OF CONTENTS

(continued)

TOPIC SLIDE No.

Postal Service: Fitness for Duty 90

Medical Privacy 92

Schedule Award 95

Cite Reference: Schedule Award 99

Challenging Formal OWCP Decisions 100

Oral Hearing 101

Review of the Written Record 103

Reconsideration 105

Review by ECAB 107

Definitions 108

Work Limitation Due To Pain 112

Separation Disability 113

Disability Retirement 114

Medical Bill Payment and Medical Authorization Process 116


TABLE OF CONTENTS

(continued)

TOPIC SLIDE No.

OWCP Information 118

Federal Employees Compensation Act (FECA), Title 5, Chapter 81

Code of Federal Regulations, Claims for Compensation under FECA, Parts 10 and 25

Questions and Answers About FECA, CA 550

Injury Compensation for Federal Employees, CA 810

When Injured at Work, Guide for Federal Employees, CA 11

OWCP Forms 119

OWCP- Information (Handbooks and Manuals) 120

U.S. Dep’t of Labor, Self-Instructional Injury Compensation Specialist Training Video

ELM 540, Injury Compensation Program

EL 505, Injury Compensation

Letters, MOUS, and Step 4 Decisions 121

Letters:

Letter from USPS Labor Relations At Headquarters—Services Policy for Employees

that Sustained On-the-job injuries. A1

USPS Sample Letter—Limited Duty Assignments and MOU from Headquarters. A2

Letter from USPS Labor Relations—Local Management . . .Limited Duty A6

Letter from USPS Labor Relations—Use of Medical Reports A9

Letter from USPS. Management’s Discrimination of . . . limited duty vs.

light duty assignments . A14

Letter from USPS Labor Relations Discipline for Safety Rule Violation A27


TABLE OF CONTENTS

(continued)

TOPIC SLIDE No.

National Pre-Arb Settlement:

Limited Duty Assignments A3

Limited Duty FTRE . . . with varying report times. A5

Job Related First Aid Injuries A8

Step 4 Decisions:

Separation from Postal Service for reasons of disability A4

Reporting an accident A7

Fitness for duty . . . on-the-job injury or illness A10

Availability of CA-8 Forms A11

Limited Duty—Violation of ELM Provisions A12

Locally developed form supplementing data on Form 3996 A15

Use of Locally generated forms A16

Outside party paying medical expenses . . . compensation forms A17

Employee can’t be compelled . . . during non-working hours A18

Light duty/limited duty signing Overtime Desired List A19

Completing form 2488 is voluntary (employee) A20

CA17 usually adequate for medical information A21

Completing PS Form 3971, Continuation of Pay (COP) A22

Limited Duty Employee Coverage by CBR A23


TABLE OF CONTENTS

(continued)

TOPIC SLIDE No.

Step 4 Decisions (continued):

Agreement Violation of Permanently Reassigned Work in another craft A24

Removal from bid while on Limited Duty A25

Limited Duty Withdrawal with subsequent Notice of Proposed Removal. A26

MOUs:

(NALC) Limited Duty Grievance Representation A13


OFFICE OF WORKERS’ COMPENSATION (OWCP)

STATISTICS

Approximately 175,000 Workers’ Compensation Claims

Are Filed Annually.

Of These, 85,000 Are Filed By USPS Employees,Representing More than 10% Of The USPS Workforce.

Generally, 90% Of Simple Traumatic Claims And 60% Of Simple Occupational Claims Are Accepted.

In 2003, These Claims Cost The USPS Over $1.5 Billion.

The Future Liability For These Employee Injuries Is Almost $7 Billion.


WHAT IT’S ALL ABOUT?

• Federal Employee Compensation Act (FECA)

• 20 Code of Federal Regulations (CFR)

• Employee Labor Relations Manual (ELM)

• EL 505, Injury Compensation

FECA

5 U.S.C 81

20 CFR ELM EL 505 CA 550

Q&A

10.0 541.1 Ch. 1 A-1

§ 8149 Ch. 1

Ch.1

Ch. 1

FECA Q&A

OWCP Form

s

Time Limits

ELM


WHO’S INVOLVED IN THE CLAIM PROCESS?

Under The Department Of Labor, The Employment Standards Administration Oversees OWCP.

Within OWCP, The Division Of Federal Employees’ Compensation (FEC) Decides Injury Claims. They Are The Determining Office.

In The USPS, The Injury Compensation Specialist (ICS) Is Responsible For Sending Claims To OWCP. The USPS Injury Compensation Office And Their Representatives Are Not An Extension Of OWCP. They Are The Control Point And Have No Authority To Adjudicate Claims.

The USPS Supervisor Forwards Claim Forms To The ICS.


RESPONSIBILITIES OF THE

IMMEDIATE SUPERVISOR

Immediately Ensuring That Appropriate Medical Care Is Provided.

Form CA-1 (Traumatic), Or Form CA-2 (Occupational)

Provide Form To Employee (Complete Receipt And Give To Employee).

On The Same Day As Received, Complete And Forward Form CA-1 Or Form CA-2 To The ICS [ELM 544.11].

Permit Employee To Select A Physician/Hospital Of Choice [ELM 545.21].

If Traumatic Injury Prevents Employee From Working Must Advise Employee Of Right To Choose Continuation Of Pay (COP) [ELM 544.112].

Cannot Cause An Employee To Forgo Filing A Claim, Or Refuse To Process It [ELM 544.11] .


RESPONSIBILITIES OF THE USPS INJURY

COMPENSATION SPECIALIST

Completes Employer Portions Of Forms CA-16 And CA-17.

Advises Employee Whether Continuation Of Pay (COP) Will Be Controverted.

Advises Employee If COP Will Not Be Paid.

Provides Copy Of Completed CA-1, CA-2 Or CA-2a To Employee And Copy Of All Correspondence Between USPS And Employee’s Physician. [ELM 544.12].

Submits Form CA-1, CA-2, Or CA-2a To OWCP Within 10 Working Days. [ELM 544.212].

If Traumatic Injury (CA-1) Must Promptly Authorize Medical Care By Issuing Employee Form CA-16 Within 4 Hours Of Receiving Notice Of Claimed Injury.[ELM 545.21].

Go See Dr.


ASSISTANCE BY APWU

● Member And Non-Member:

If Language Of Collective Bargaining Agreement (CBA) Or A

Handbook Or Manual (e.g., ELM 540, EL 505) Has Been Violated

By The USPS Make Grievance Decision. Grievances Cannot Be

Filed Against OWCP.

● Member Only:

Provide Information About OWCP Procedures And Appeals.

You Do Not Have To Be Employee’s “Authorized OWCP

Representative” To Assist Them With Their Claim.


FIVE BASIC REQUIREMENTS FORSUCCESSFUL CLAIM

In The Order They Are Considered:

● Time Limits

● Civilian Employee

● Fact Of Injury

● Performance Of Duty

● Causal Relationship

(continued)


FIVE BASIC REQUIREMENTS(continued)

Written Notice Must Be Given Within 3 Years Of Injury Or Onset Of Medical Condition.

Latent (Not Evident) Disability—Must Be Given Within 3 Years Of Reasonably Knowing Condition Caused By Work Activity.

Civilian Employee

All USPS Employees Including Casuals And TEs Are Civilian Federal Employees.

(continued)

Time Limits


Two Elements Must Be Met:

Occurrence Of Event

The Employee Must Have Actually Experienced The Accident, Event Or Employment Factor.

Determined On The Basis Of Factual Evidence, Including Statements From The Employee, The Supervisor, And Any Witnesses.

An Injury Does Not Have To Be Witnessed To Be Compensable.

(continued)


Fact Of Injury


Existence Of Medical Condition

The Accident Or Employment Factor Resulted In An Injury

Or Disease. However, Employment Is Not Required To Be

The Sole Factor To Have Caused An Injury Or Disease,

Only A Contributing Factor.

Determined On The Basis Of The Attending Physician’s Statement That A Medical Condition Is Present That

Could Be Related To The Incident Though The Medical

Report Does Not Have To Relate The Condition To The

Incident.

Simple Exposure Does Not Constitute An Injury.(continued)

FIVE BASIC REQUIREMENTS:(continued)

Fact Of Injury



Performance Of Duty

Usually Injury/Illness Must Occur While At Work.

Must Be Performing Expected Job Duties.

Breaks And “Lunches” Covered If On Premises.

For Most APWU Crafts Driving To And From Work Ordinarily Not Covered.

(continued)



Causal Relationship

● Physician Must State To A “Reasonable Medical Certainty” That Work Activity Caused Or

Contributed To The Diagnosed Condition.

● Physician Must Provide Medical Reasoning (Rationale) To Support Opinion Of Causal Relationship (How

Physician Came To The Conclusion That There Is

A Causal Relationship Between The Injury And The Workplace).

(continued)


FIVE BASIC REQUIREMENTS

● Time Limits

● Civilian Employee

● Fact Of Injury

● Performance Of Duty

● Causal Relationship

FECA

5 USC20 CFR ELM EL 505

CA 550

Q&A

§812210.100

10.101

542.112

542.122

542.132Exh. 4-6 C-2

§8101.(1) 10.5(h) 542.21.b. Exh. 4-6A-3

C-3

§8101.(5) 10.115(c) 542.21.c. Exh. 4-6 C-4

§8102.(a) 10.115(d) 542.21.d Exh. 4-6

C-5

to

C-9

§8101.(5) 10.115(e) 542.21.e Exh. 4-6 C-10


THREE TYPES OF CLAIMS:TRAUMATIC, OCCUPATIONAL,

AND RECURRENCE Traumatic Injuries (Form CA-1)

A Medical Condition Caused By A Specific Incident Or Series Of Incidents In A Single Work Day/Shift.

Specific As To When And Where It Happened. Specific As To Part Of The Body Injured. Filed As Traumatic Not By Type Of Medical Condition,

But Because Injury Happened On A Single Work Day/Shift.

May Choose COP If Injury Reported On Form CA-1Within 30 Days Of The Injury.

(continued)

Go see Dr.


THREE TYPES OF CLAIMSTraumatic Injury

(continued)

Complete CA-1 To Give Notification.

USPS Has Ten (10) Working Days To Submit CA-1 To OWCP.

COP – If Eligibility Requirements Are Met.

CA-1 States Employer Statement And Physician’s Medical Report Are Required.

Follow Instructions On CA-1 To Satisfy Requirements.

(continued)

USPS


THREE TYPES OF CLAIMS(continued)

Occupational Disease Or Illness (Form CA-2)

● A Medical Condition Caused By Work Activity Occurring Over More Than A Single Work

Day/Shift.

● No Entitlement To COP Or Form CA-16.

● Filed As An Occupational Not By Type Of

Medical Condition But Because It Happened

Over More Than One Work Day/Shift.

(continued)

Go see Dr.



Occupational Disease/Illness(Form CA-2)

● Complete CA-2 To Give Notification. USPS Has 10 Working Days To Submit CA-2 To OWCP

● No COP Entitlement. File CA-7 For Wage Loss Compensation

● CA-16 (Issuance Very Rare. USPS May Issue Only

After Obtaining Approval From OWCP).

(continued)



Recurrence(Form CA-2A)

Recurrence Of Disability

● Spontaneous Worsening Of An Accepted Condition Without An Intervening Event.

Worsening: Unable To Continue Working The Same Amount Of Hours After Returning To Work, e.g., 40 Hours To 30 Hours, Call-Out Due To Work-Related Injury.

If Accepted Condition Is Worsened By Work Activity, File A New Traumatic Or Occupational Claim. May Be Entitled To COP If Traumatic.

(continued)

Go see Dr.


THREE TYPES OF CLAIMSRecurrence

Recurrence Of Disability (continued)

USPS Withdrawal Of Limited Duty/Rehab Job.

Any Reduction In Job Hours.

Recurrence Of A Need For Medical Treatment With No Work Stoppage (Also Reopening A “Closed Claim”).

If No Longer Seeing Physician But Need Additional Medical Care

Continuous Treatment Is Not “Additional” Treatment Simple Examination By Physician Is Not “Treatment”

(continued)

Go see Dr.


THREE TYPES OF CLAIMSRecurrence

(continued)

● May Be Entitled To Any COP Balance If Original Injury Traumatic.

Must Provide A Detailed Factual Statement (Comply Fully With Instructions On Form CA-2a).

Medical Evidence Must Establish That The Recurrence Of Inability To Work Is Causally Related To The Original Accepted Injury.

After Returning To Work From Original Disability, Only OWCP Can Declare A Subsequent Absence Compensable, i.e., An “IOD”.

(continued)

Go see Dr.


THREE TYPES OF CLAIMS

Traumatic Injury (Form CA-1)

Occupational Disease (Form CA-2)

Recurrence (Form CA-2a)

FECA

5 USC20 CFR ELM EL 505

CA 550 Q&A

§8101 (5)10.5 (ee)

10.100

541.2.r

542.11

544.112

544.2

545.21

Exh. 5.1

Ch. 3-6

Ch. 4-1

B-3

§8101 (5)10. 5 (q)

10.101

541.2.j

542.12

Ch. 3.7

Exh. 5.1

Ch. 4-8

B-3

B-4

10.5 (x)

10.5 (y)

10.104

541.2.p

541.2.q

542.13

544.22

Ch. 3.8

Ch. 5

B-8

B-9


TRAUMATIC INJURY OWCP Form CA-16

“Authorization For Examination/Treatment”

Issued For Traumatic Injuries Requiring Medical Care.

Authorizes Medical For 60 Days Unless OWCP Stops Authorization.

Employee Chooses Physician.

Must Be Issued To Employee Within 4 Hours Of Receiving Notice Of Claimed Injury (Within 48 Hours If Initial Authorization Is Verbal).

Not Issued If More Than One Week From Injury Date.

(continued)

USPS


TRAUMATIC INJURY OWCP Form CA-16 “Authorization For

Examination/Treatment” (continued)

Authorization Includes Subsequent Physicians When Original Physician Refers.

Issuance Required Even If USPS Doubts Injury.

Not Required For First Aid When Employee Voluntarily Accepts Postal/Contract Physician (Maximum 2 Visits).

Not Required For Simple Hazard Exposure Without Medical Condition.

(continued)

USPS


TRAUMATIC INJURYOWCP FORM CA16

“Authorization For Examination/Treatment”

Authorizes Medical Care

60 Day Maximum Employee Selects Physician

Within 4 Hours

Within One Week Of Injury

Referral To Different Physician

USPS Doubts Injury

First Aid By Postal/Contract

Hazard Exposure

FECA

5 USC 20 CFR ELM EL 505

CA 550

Q&A

§8103(b) 10.300(a) 545.21 Ch. 3.3 B-1.(c.)

10.300(c) E-2

§8103(a) 10.300(d) Ch. 3.10 E-3

10.300(b) 545.21 Ch. 3.10 E-1

10.300(b) 545.21 E-1

10.301 543.3 E-2

10.302

545.21 Ch. 3.10

10.303(a) 545.23

USPS


TRAUMATIC INJURY Continuation Of Pay

● COP Is The Continuation Of Employee’s Regular Salary For

Wage Loss Due To Disability And/Or Medical Treatment.

● It’s Intended To Eliminate Interruption Of The Employee’s

Income While OWCP Processes The Claim.

● It Includes N/D, S/P And Holiday Pay.

● COP Is Not Considered Compensation.

● Is Employer Paid.

● Is Subject To Deductions For Income Tax, Retirement, Etc.

● Employee Is In Pay Status.

(continued)

USPS



(continued)

Not Available For Occupational Injuries (Form CA-2).

Must File CA-1 Within 30 Days Of Injury.

Must Begin Losing Time From Work Within 45 Days Of Injury.

Employee’s Choice To Use COP—Should Not Be Required To UseS/L Or A/L. If Unaware COP Was An Entitlement/ Choice, Employee Has One Year (From Date Of Use) To Request Adjustment.

Must Provide Prima Fascia Medical Evidence Of Disability (InabilityTo Work) Within 10 Days Of When COP Begins In Order For COP To Continue.

45 Calendar Day Entitlement.

Day Of Injury Not Counted As COP (Paid As Administrative Leave).

(continued)

USPS



(continued)

Must Begin Using Any Balance Of COP Within 45 Days Of First Return To Work (RTW)—RTW From Disability Not Date Of Injury.

COP May Be Used Beyond 45 Day RTW Time Limit Provided Employee Begins Using COP Balance No Later Than The 45th Day From Their RTW And Disability Continues Without Interruption.

If Disability Extends Beyond COP Period, File For Compensation.

May Use COP For Medical Treatment/Examination Time. Employee Required To RTW To Complete Work Shift Unless Disabled.

COP Is Counted By Days Not Hours. Partial Days Of COP Count As A Full Day Of COP.

May Later Request COP After Using SL/AL Once Claim Is Approved.

If OWCP Denies Claims COP Must Be Repaid (May Use SL/AL).

USPS



Not For “Occupationals”

File Within 30 Days Lose Time Within 45

Days

Medical Within 10 Days

45 Day Entitlement

Day Of Injury Not Counted

Repayment

(continued)

FECA


CA 550

Q&A

§8118(a) 10.205(a)(1)542.122

545.721.aD-1

10.205 (a)(2) 545.721.b Exh. 4.16 D-4(f)

10.205(a)(3)545.721.c

541.2.dExh. 4.16 D-4(g)

10.210(b)

545.724.b

545.74.a

541.2.d

Ch. 13.1 D-5a

§8118(b)10.200(a)

10.200(b)

541.2.d

545.71

Ch. 1

Ch. 13.1D-1

10.215(a) 541.2.d (2) Ch. 13.4

10.224 543.41 Ch. 13.11

USPS



(continued)

Begin Within 45 Days Of RTW

Using Balance (Uninterrupted)

Disability Goes Beyond COP

Physician Visits

Remaining COP

May Request COP Later

FECA


CA 550

Q&A

10.205(a)(3)541.2.d

545.721.cExh. 4-16 D-4 (g.)

10.207 545.722 Ch. 13.1

10.401(a)545.81

545.83Exh. 3-5.a D-7

Ch. 13.4

§8118(d) 10.224 543.41

10.206 543.42.c Exh. 3.5.a

USPS


TRAUMATIC INJURY Controversion With COP Withheld

The USPS Can Controvert (Challenge, Dispute) An OWCP Claim. However, OWCP Makes The Final Decision As To Whether A Claim Is Accepted Or Denied.

The USPS Can Controvert And Deny Payment Of COP Only For The Following Reasons:

The Disability Was Not Caused By A Traumatic Injury;

The Employee Is Not A Citizen Of The U.S. Or Canada;

No Written Claim Was Filed Within 30 Days From The Date Of Injury;

(continued)

Go see Dr.


TRAUMATIC INJURY: CONTROVERSION WITH

COP WITHHELD (continued)

The Injury Was Not Reported Until After Employment Has Been Terminated;

The Injury Occurred Off The Employing Agency’s Premises And Was Not Otherwise Within The Performance Of Official Duties;

The Injury Was Caused By The Employee’s Willful Misconduct, Intent To Injure Or Kill Himself/Herself Or Another Person, Or Was Proximately Caused By Intoxication By Alcohol Or Illegal Drugs;

First Absence Caused By The Injury Was More Than 45 Days After The Date Of Injury.

(continued)

Go see Dr.


TRAUMATIC INJURY COP Withheld

Not A Traumatic Injury

Not A Citizen Of U.S.

No Claim Within 30 Days

Injury Not Reported Prior To Termination Notice

Injury Off Premises AndNot In Performance Of Duty

Willful Misconduct, Intent To Injure, Intoxication

First Absence More Than 45 Days After Injury

FECA


CA 550

Q&A

§8118(b) 10.220(a) 545.732(a) Exh. 4.16 D-4 (a)

10.220(b) D-4 (c)

10.220(c) 545.732(b) D-4 (f)

10.220(d) 545.732(c) D-4 (h)

10.220(e) 545.732(d) D-4 (d)

10.220(f) 545.732(e) D-4 (e)

§8118(b) 10.220(g) 545.732(f) Exh. 4.16 D-4 (g)


TRAUMATIC INJURY Stopping COP Which Has Already Begun

After COP Has Been Started It May Be Stopped Only In The Following Circumstances:

Medical Evidence Which On Its Face Supports Inability To

Work Due To The Workplace Injury Is Not Received Within

10 Calendar Days After Claim Is Submitted;

Medical Evidence From Employee’s Physician Shows

Employee Not Disabled;

Medical Evidence From Employee’s Physician Shows

Employee Not Totally Disabled And Employee Refuses

Written Job Offer That Is Approved By Employee’s Physician;

(continued)

USPS


TRAUMATIC INJURY Stopping COP Which Has Already

Begun(continued)

Employee Returns To Work With No Loss Of Pay;

Specific Term Of Employment Ends;

Termination Of Employment Established Prior To Injury;

OWCP Directs Employer To Stop COP;

And/Or COP Paid For 45 Calendar Days.

USPS


TRAUMATIC INJURY COP Stopped

No Medical Evidence Within 10 Days

Medical Evidence Shows No Disability

Medical Evidence Shows Partial Disability And Job Offer Refused

Employee Returns To Work With No Pay Loss

Term Of Employment Ends

Termination Of Employment

OWCP Directs

45 Days Paid

FECA


CA 550

Q&A

10.222(a)(1) 545.741.a Exh. 4-16 D-5 (a)

10.222(a)(2) 545.741.b

10.222(a)(3) 545.741.cD-5 (b)

D-9

10.222(a)(4) 545.741.d

10.222(a)(5) 545.741.e D-5(c)

10.222(b) 545.741.f D-6

10.222(a)(6) 545.741.g Exh. 4.16

10.222(a)(7) 545.741.h Exh. 4.16


CLAIM FOR COMPENSATION (Form CA-7)

(Form CA-20)

● Submit Form CA-7 To Supervisor Every Two Weeks And Send Form CA-20, “Attending Physician’s Report” To OWCP.

● Wage Loss Compensation Is Paid At Two-Thirds Of Pay Rate If No Dependents And Three-Fourths If One Or More Dependents.

● Compensation Is Based On Pay Rate On Day Of Injury Or First Disability, Whichever Is Greater.

(continued)


CLAIM FOR COMPENSATION(continued)

● Night Differential, Sunday Premium And Holiday PayAre Included In Pay Rate, But Overtime Is Excluded.

● Compensation Is Tax Free. The Only Deductions Are Premiums For Health Insurance And Optional Life Insurance.

● Payable After Three Day Wait (Non-Work Day, Non-Pay Status), But Waiting Period Waived If Total Disability Exceeds 14 Days.

(continued)


CLAIM FOR COMPENSATION

(continued)

● Postal Service Must Submit CA-7 To OWCP Not More Than 5 Working Days After Receipt From

Employee.

● An Employee Is In A Leave Without Pay (LWOP) Status When Receiving Wage Loss Compensation From OWCP.

● Employees In A LWOP Status For Any Reason Do Not Accrue Sick Or Annual Leave Nor Can They Participate In The Thrift Savings Plan.

(continued)



(continued)

● Time Spent In A LWOP Status For Purpose Of

Receiving OWCP Compensation Is Computed As

Creditable Service For Retirement.

● Once Pay Rate For Compensation Is Established

It Does Not Change (No Negotiated COLAs Or

Raises), Unless Employee Returns To Work

For More Than 6 Months Of Regular Full Time

Employment .

(continued)



● Submit Form CA-7

● ⅔ Or ¾ Pay Rate

● Pay Rate At Time Of Injury

● Sunday Premium, Night Differential,Holiday Pay, Not OT

● Tax Free

● Three Day Wait(continued)

FECA


CA 550

Q&A

10.102(b)(1) 545.82

§8105

§811010.401(b) Ch.1 F-9

§8114 10.5(s) 541.2.i Ch.1

§8114(e) Ch.1 F-14

F-28

G-1

10.401(a) 545.83 F-4


CLAIM FOR COMPENSATION(continued)

● Five Working Days, USPS To OWCP

● LWOP For Compensation

● No Leave Accrual In LWOP

● Creditable Service For Retirement

● No Contractual Increase In Compensation Pay Rate

FECA


CA 550

Q&A

10.111(c)545.812

545.82Ch. 4.10

Exh. 514.4.4.e

512.311.e

546.143.d Exh.11.9e

§8101(4)


LEAVE BUY BACK (Form CA-7b)

● A Leave Buy Back (LBB) Program Is At The Discretion Of The Employer. It Is Not An OWCP Requirement.

● If Employees Use Sick Or Annual Leave While Waiting For Their Claim To Be Approved By OWCP They May Apply To Buy It Back.

● The USPS Will Not Process A LBB Request For LeaveUsed After A Claim Has Been Approved.

File Local Grievance, Hold Pending Adjudication Of National Grievance (Q98C-4Q-C01208677).

(continued)


LEAVE BUY BACK (continued)

● When Paid Leave Is Bought Back, The Original Period

Of Leave Use Is Retroactively Changed To LWOP

Which Will Result In A Downward Adjustment Of

Leave For Every 80 Hours Of LWOP.

● LBB May Have Income Tax Implications, Consult

IRS Or Tax Advisor [Form CA-7b Worksheet].

(continued)


LEAVE BUY BACK (continued)

● LBB Must Be Initiated Within 1 Year Of RTW Or Within 1 Year Of OWCP Approval Of Claim, Whichever Is Later.

● Cannot Buy Back Leave If No Longer A USPS Employee.

● If LBB For Previous Year Exceeds Allowable Carryover

The Excess Will Be Forfeited.

● The Employee Must Pay The USPS The Difference

Between Paid Leave (100% Of Wage) And The Compensation Amount (66 ⅔% Or 75% Of The Wage) [Form CA-7b Worksheet].

(continued)


LEAVE BUY BACK

FECA


CA550

Q&A

F-7

F-8

543.42.f

545.84

Ch.13.19

Exh. 13.19a

512.923(a)

Ex.514.4.e(6)

543.42.f

545.84.aExh. 13.19a

• Discretionary Program

• For Leave Used While Waiting For Claim Adjudication By OWCP

• No LBB Of Leave Used After Claim Approved

• Initiate Within 1 year(continued)


Leave Buy Back (continued)

FECA


CA 550

Q&A

543.42.f

545.84bExh. 13.19a

512.923.b

Exh. 514.4.e.(6)

Ch.13.19

Exh. 13.19a

512.923.c.

Exh. 514.4.e(6)Exh. 13.19a

No LBB If No Longer USPS Employee

Cannot Exceed Maximum Leave Carry-Over

Retroactive Conversion To LWOP Will Change Leave Balance


RETURN TO WORK CAPABILITY

Medical Restrictions

● Form CA-17, “Duty Status Report,” Is Normally Used.

Treating Physician Completes “Side B” In Detail. Physician Should Provide Specific Details If Using

General Language Such As “No Repetitive Activity.”

● Employees Must Advise Their Physicians That The

USPS Will Accommodate Work Limitations And Must Also Advise The USPS Of These Limitations.

(continued)



Medical Restrictions(continued)

● Medical Restrictions Also Apply To Your Activities

Outside The Workplace.

● The USPS May Contact Your Physician (In Writing

Only, Must Send Copy To You) Concerning Your Work

Limitations And Possible Job Assignments.

(continued)



Medical Restrictions

FECA


CA 550

Q&A

10.506 545.52Ch. 4-16

Ch. 4-17D-9

10.515 545.33 H-1

10.506 545.52

● Form CA-17

● Advise Physician And USPS

● Contact With Your Physician


JOB OFFERSLimited Duty/Rehab

● Limited Duty Job Offer = Temporary Medical Restrictions

● Rehab Job Offer = Long Term/Permanent Medical Restrictions

Maximum Medical Improvement (MMI) Achieved MMI Declared By Physician

● An Employee Who Is Capable Of Performing Core Duties Of Their Bid (With Or Without Modification) Is Not Considered A Limited Duty/Rehab.

(continued)



(continued)

● The Job Offer May Be Made Verbally As Long As Written Job Offer Is Provided Within 2 Business Days.

● To Be Considered Suitable By OWCP The Job Offer Must Include:

Description Of The Duties; Description Of The Specific Physical Requirements; Location Of The Job; Effective Date; Pay Rate; The Date By Which The Job Offer Must Be

Accepted/Refused.

(continued)



(continued)

● If The Job Offer Is Not Accepted, OWCP Will Then

Review The Offered Work To Determine Suitability

Compensation Will Be Continued Until Final OWCP Decision.

If Considered Suitable, Employee Will Have 30 Days

To Accept Job Or Present Evidence Of Unsuitability.

If OWCP Determines The Reasons Are Unacceptable, The Employee Has 15 Days To Accept The Job.

No Further Evidence Will Be Considered By OWCP.

(continued)



(continued)

● USPS Should Minimize Any Adverse Or Disruptive

Impact On The Employee.

● If There Is Adequate Work Available Within Employee’s Craft, Facility, And Regular Hours, Then The Employee

Must Be Assigned To That Work.

● All Concurrent Medical Conditions Whether Or Not

Caused By Or Related To The Accepted Condition

Must Also Be Included In Medical Suitability Determinations.

(continued)



FECA


CA 550

Q&A

10.507(c) 545.32Ch. 7.4

Exh. 7.1

10.507(d) 545.32Ch. 7.4

Ch. 11.8H-4

10.516 546.64Ch. 7.5

Ch. 11.12

546.142 Exh. 7.1

546.622 Ch. 11.4

● Job Offer

● Suitability

● OWCP Review

● Adverse Or Disruptive Impact

● All Concurrent Conditions


RIGHTS AND BENEFITS

● LWOP For Compensation Is Credited For Computing Retirement Credit (Years Of Service) (ELM 546.143).

However, If Working Partial Days (e.g., Working 6 Hours With Compensation For 2 Hours) Current OPM Policy Is That The Full-Time Annuity (Salary) Rate Will Be Prorated (Reduced) According To Percentage Of LWOP Hours (EL505, Exhibit 11.9e).

(continued)


RIGHTS AND BENEFITS(continued)

● No Leave Accrual When In A LWOP Status. However, Leave Accrual Rate (4, 6, 8, Hours/Pay Period) Is Not Affected By LWOP For Compensation (ELM 514.24).

● No Deferral Of Step Increase For LWOP For Compensation (ELM 422.33).

● No Thrift Savings Plan When In LWOP (ELM 592.91).

(continued)


RIGHTS AND BENEFITS(continued)

● An Employee In A Limited Duty/Rehab Job Can:

Work Overtime If Within Restrictions

(EL 505, Exhibit 7.1, Q&A);

Bid If Meet Physical Requirements Of Bid Position

(EL 505, Exhibit 11.9b);

Convert To Full-Time If Capable Of Performing Core

Duties (With Or Without Modification) Of Vacant Position

(Step 4, 9-10-97, I90C-4I-C 93046587).


SELECTION OF PHYSICIAN

● Injured Employees Always Have The Right To Choose

Their Treating Physician Or Medical Facility.

● Non-Emergency: The Employee May Select A Physician

Or Hospital Within Approximately 25 miles. A Supervisor

Is Not Authorized To Accompany The Employee.

(A Chiropractor Is A Physician Under FECA Only For

Manual Manipulation Of A Subluxation Of The Spine

Demonstrated By X-Ray To Exist.)

(continued)


SELECTION OF PHYSICIAN(continued)

● Emergency: Sent To Nearest Available Physician Or Hospital, Or To Physician Or Hospital Chosen By The Employee. A Supervisor May Accompany The Employee

To Ensure Prompt Medical Treatment.

● Animal Bites And Eye Injuries Are Always Considered Emergencies. If There Is Doubt As To The Emergent

Nature Of An Injury, It Is Treated As An Emergency.

● Physician Providing Emergency Care Is Not Considered

The Employee’s Treating Physician.(continued)


SELECTION OF PHYSICIAN (continued)

Postal Physician Or Contract Equivalent

● May Provide Medical Treatment Not To Exceed Two Visits

If:

Employee Accepts Treatment; Treatment Complies With EL-806 And With OWCP Regulations

And Directives.

● If Treatment Exceeds Two Visits:

That Provider Becomes Employee’s Treating Physician.

(continued)


SELECTION OF PHYSICIANPostal Physician Or Contract

Equivalent(continued)

● Choosing A Contract Doctor As Your Treating Physician Is Probably Not In Your Best Interest.

More Obliged To Their Employer (The USPS) Than

To The Employee.

Employee Sacrifices Doctor-Patient Confidentiality.

Doctor Legally Can Share Any Information With The USPS.

(continued)


SELECTION OF PHYSICIAN(continued)

USPS May Require Employee To Be Examined By Their “Contract Doctor”

● Employee Does Not Have To Accept Their Recommended Course Of Treatment.

● Employee Does Not Have To Accept The “Contract Doctor” As Their Treating Physician.

● Such Examination May Not Delay Employee’s Initial Medical Treatment With Their Own Doctor.

(continued)


SELECTION OF PHYSICIAN USPS May Require Employee To Be Examined By Their “Contract Doctor”

(continued)

● If Exam Goes Beyond Employee’s Regular Work Hours, Employee May Request Through Their Supervisor To Leave. If Denied, Employee Should Request Overtime

Pay.

● Employee Should Not Be Required To Sign Any Guarantor Or Medical Release Forms.

(continued)


SELECTION OF PHYSICIANPhysician Changes & Referrals

(continued)

● To Ensure Payment Of A Medical Bill, An Employee Changing Physicians Should Write To OWCP Providing The Reason For The Change And The Name And Address Of Both The New Physician And The Previous One.

● Referral By A Physician To A Specialist Is Not A Change Of Physician. Get The Referral In Writing And Send A Copy To OWCP.

(continued)


SELECTION OF PHYSICIAN

FECA


CA 550

Q&A

§8103 10.300(d) 545.41 Ch. 3.2 E-3

Ch. 3.2 E-4

§8103 545.44 Ch. 3.9 E-3

10.311 541.2 m (1) Ch. 3.9E-4

E-5

10.316(a) 10.316(b)

E-11

10.324545.43

545.45E-3

• Emergency

• Definition

• Non-Emergency

• Chiropractor

• Change Of Physician

•Contract Doctor


PROVIDING SUPPORTING EVIDENCE

● The Greater The Complexity Of The Medical Condition Being Claimed, The Greater Is The Need For Thorough And Detailed Evidence.

● Claims For Occupational Disease/Illness Normally Require More Complete Evidence.

● One Of The Most Common Reasons For Claims Being Denied Is The Lack Of A Clear And Persuasive Medical Opinion Regarding Causal Relationship Between Specific Work Activity And The Diagnosed Condition.

(continued)



(continued)

Employee’s Statement

● Traumatic Injury

Describe In Detail How And Why The Injury Occurred.

Give Appropriate And Specific Details.

Give A Complete Description Of The Condition(s) Resulting From Your Injury.

● Occupational Disease/Illness

Provide A Detailed History Of The Medical Condition From The Date It Started.

Give Specific Details About The Employment Activity Which You Believe Caused The Condition.

(continued)



Employee’s Statement

● Occupational Disease/Illness (continued)

Describe Specific Exposures To Substances Or Stress Causing The Disease/Illness.

Identify The Part Of The Body Affected.

Provide A Statement As To Whether Ever Suffered A Similar Condition. If So, Provide Full Details.

Give A Complete And Detailed Description Of The Current Disease/Illness

(continued)



Employee’s Statement (continued)

● Recurrence

Describe In Detail Your Medical Condition Since Returning To Work.

Provide A Listing Of The Nature And Frequency Of All Medical Treatment Received.

Describe Specifically How And When The Recurrence Happened.

Identify ALL Injuries/Illnesses Which Have Been Experienced Between Date Of Return To Work After The Original Injury And The Recurrence.

(continued)



(continued)

Medical Reports

● Traumatic/Occupational/Recurrence

Dates Of Examination Or Treatment.

History Of Work Activity And The Claimed Condition As Provided By Employee.

Results Of X-rays, Laboratory Tests, MRIs, EMGs, Etc.

Specific Medical Diagnosis.

Opinion With Medical Reasoning Explaining The Basis Of Such Opinion Regarding Whether The Condition Was Caused Or Aggravated By Employment (Statement Of Causality).

(For Recurrence, Such Opinion Should Address The Causal Relationship Between The Current Condition And The Original Injury).


MEDICAL REPORTS(20 CFR 10.330, ELM 545.51)

● All Claims Reported To OWCP Require A Medical Report

● Detailed And Thorough Medical Evidence Is One Of The

Most Important Aspects Of A Claim

● A Good Medical Report Should Include (See Sample Reports Traumatic, Occupational):

A History Of The Specific Work Activity Surrounding The

Medical Condition; Dates Of Examination And Treatment;

(continued)

USPS


MEDICAL REPORTS(continued)

Physical Findings Including Results Of Diagnostic Testing; Specific Diagnosis; Course Of Treatment; A Description Of All Medical Conditions Whether Work-Related

Or Not; Treatment Provided Or Recommended For The Claimed Condition; The Physician’s Opinion With Medical Reasons Regarding Causal Relationship Between The Diagnosed Condition And Specific Work Activities And/Or Work Incidents;

Whether The Employee Can Perform Any Type Of Work; Prognosis For Recovery (Full Or Partial).

(continued)

USPS



● Form CA-16 May Be Used For Initial Medical Report,

Form CA-20 May Also Be Used For Initial Report And Subsequent Reports (Use Of These Forms Is Not Mandatory).

● A Medical Report May Be Made In Narrative Form On

The Physician’s Letterhead Stationery.

● Medical Reports Should Bear The Physician’s Signature

Or Signature Stamp.

(continued)

USPS



● The Medical Report Is Submitted Directly To OWCP

(Keep A Copy For Yourself).

● The Postal Service May Request A Copy From OWCP.

● Form CA-17 Is Normally Used To Obtain Periodic Reports

Regarding The Employee’s Medical Restrictions

And Degree Of Disability.

USPS


EXAMPLE OF A THOROUGH MEDICAL REPORT:

TRAUMATIC INJURY(PHYSICIAN’S LETTERHEAD STATIONERY)

USPS

To Whom It May Concern:

On January 25, 2004 I examined Mr. Ricardo Velasquez. Mr. Velasquez, who is a Postal Service employee,

works 3:30 PM to 11:00 PM at the Northland Processing and Distribution Center. He stated that at approximately

6:10 PM he was pushing a loaded mail container which weighed approximately 310 pounds up a small incline

when it started to tip to the right. Mr. Velasquez quickly moved to the right side of the container raising his right

arm and placing his right hand at the top of the container. He pushed against the container, preventing it from

tipping over and held it upright for a few seconds until two co-workers came to his assistance and helped right

the container. Mr. Velasquez felt no immediate pain and finished his work shift without incident. However, after

sleeping several hours Mr. Velasquez woke up with a moderate to severe pain in his right shoulder area. An

MRI was performed (see attached report) and it demonstrated a partial tear of the supraspinatus of approximately 1.7centimeters proximal to the humerus.

The patient will be treated conservatively with physical therapy and ultrasound. He has no other complaints

or symptoms. He can return to work but should not use his right arm to lift more than 5 pounds, nor should he reach above shoulder height with his right arm.

In my medical opinion the above described traumatic work place incident caused the rotator cuff tear whichwas demonstrated by the referenced MRI report. Mr. Velasquez’ use of his right arm to keep the container

upright caused a sudden loading of the right shoulder rotator cuff, especially the external rotators which

were attempting to keep the humeral head centered in the glenoid causing macrotrauma to the supraspinatusas described above.

Mr. Velasquez has a good prognosis for recovery. I will examine his progress at the end of four weeks of

physical therapy.

(Signed By Physician)


EXAMPLE OF A THOROUGH MEDICAL REPORT:

OCCUPATIONAL DISEASE(PHYSICIAN’S LETTERHEAD STATIONERY)

USPS

To Whom It May Concern:

On January 25, 2004 I examined Ms. Brenda Starr. Ms. Starr, who is a Postal Service Employee, works 3:30 PM to 11:00 PM at the Northland Processing and Distribution Center. Ms. Starr, who is 5’4” tall, holds the position of automation clerk. She describes the physical activity of a normal work day as follows: for approximately two hours at a time, two times a day, she repeatedly lifts trays of mail, which she estimates as weighing 20-30 lbs.,over shoulder height to place them in a storage container. She has been performing this work for approximately three years.

Ms. Starr complains that for the past two weeks she is awakened at night with moderate to severe pain in her right shoulder area. An MRI was performed (see attached report) and it demonstrated a partial tear of the supraspinatusof approximately 1.7 centimeters proximal to the humerus.

The patient will be treated conservatively with physical therapy and ultrasound. She has no other complaints or symptoms. She can return to work, but should not use her right arm to lift more than 5 pounds, nor should she reach above shoulder height with her right arm.

In my medical opinion the above described repetitive work performed at the Postal Service caused the rotator cufftear which was demonstrated by the MRI report. Ms. Starr’s repetitive lifting overhead caused constant fatiguing of the rotator cuff muscles (especially the external rotators) as they attempted to keep the humeral head centeredin the glenoid, resulting in chronic inflammation and microtrauma resulting in the injury to the supraspinatus as described above. Ms. Starr has a good prognosis for recovery. I will evaluate her progress at the end of 4 weeks of physical therapy.

(Signed by Physician)


OWCP CRITERIA FOR EVALUATING

MEDICAL REPORTS

● When A Claims Examiner (CE) Must Determine The

Relative Value Of Medical Evidence They Ask The

Following Questions:

Is The Physician A Specialist In The Appropriate Field?

Is The Physician’s Opinion Based On A Complete And Accurate Medical History?

What Are The Nature And Extent Of Medical Findings?

Is The Physician’s Opinion Well-Reasoned (Rationalized)?

Is The Opinion Speculative Or Equivocal (Uncertain)?


OWCP DIRECTED MEDICAL EXAMS

Second Opinions

● The Attending Physician Is Ordinarily The Primary Source Of Medical Information And The First Line For Medical

Questions From The CE.

● If The Physician Does Not Respond Or The Response Is Equivocal, A Second Opinion May Be Requested By The CE (An OWCP Second Opinion Exam Cannot Be

Initiated By The Claimant).

● The Claimant Must Submit To An OWCP Mandated Examination As Often And At Such Times As OWCP Considers Necessary [20 CFR 10.320].

(continued)



Second Opinions (continued)

● The Medical Opinion Determined By The CE To Hold More Probative Value (Using The Criteria Described Previously) Will Be Used To Determine Entitlement [20 CFR 10.321].

● If Two Medical Reports Of Virtually Equal Weight And Rationale Reach Opposing Conclusions A Medical Conflict Exists [20 CFR 10.321, 20 CFR 10.502].

● An Employee Scheduled For A Second Opinion Exam Should Write To OWCP And Request A Copy Of: The

Medical Report, The Statement Of Accepted Facts, The Questions The Physician Is Asked To Answer (And The Answers).

(continued)



(continued)

Referee Specialist Exam (Impartial Medical Exam)

● When Equally Well-Reasoned Medical Reports Support Inconsistent Conclusions About An Issue Under Consideration, OWCP Will Schedule A Referee Exam [20 CFR 10.502].

● A Physician Who Has Had No Prior Connection With The Case Who Is Qualified In The Appropriate Specialty Will Be Selected By OWCP [20 CFR 10.321].

● Results Of The Referee Examination Will Be Given “Special Weight” By OWCP [20 CFR 10.502].

(continued)



Referee Specialist Exam (Impartial Medical Exam)

(continued)

● An Employee Scheduled For A Referee Exam Should Write To OWCP And Request Copies Of: The Medical Report, The Statement Of Accepted Facts, The Questions The Physician Is Asked To Answer (And The Answers).


POSTAL SERVICE FITNESS-FOR-DUTY

● The Postal Service Has Authority Independent Of FECATo Require A Fitness For Duty (FFD) Examination, And Nothing In The Law Changes That Right. Such Exam Shall Not Interfere With The Employee’s Initial Choice Of Physician, Treatment Or Issuance Of Form CA-16 [20 CFR 10.324].

● Such A FFD Report If Submitted To OWCP Must Receive Due Consideration, And If Its Findings Or Conclusions Differ Materially From The Treating Physician’s The CE Should Schedule A Second Opinion.

(continued)


POSTAL SERVICE FITNESS-FOR-DUTY

(continued)

● A Postal Service Installation Head, Human Resources Manager, Or Designee Is Authorized To Approve A FFD Exam. [ELM 545.61].

● If The FFD Conflicts With Findings Of The Treating Physician No Administrative Action May Be Taken To Change The Employee’s Employment Status Until Resolution By OWCP [ELM 545.64].

● Employees And/Or Their Physicians Should Request A Copy Of The FFD Examination.


MEDICAL PRIVACY

● Medical Reports Should Be Sent Directly To OWCP, The Postal Service May Request Copies From OWCP [20 CFR 10.331].

● The Postal Service May Submit Relevant Medical Evidence In Its Possession, Or Which It May Acquire Through Investigation. However, The Privacy Act AppliesTo Any Such Effort [20 CFR 10.118].

● The Postal Service May Contact The Treating Physician In Writing, But Not By Telephone Or Personal Visit (For Limited Reasons) [20 CFR 10.506, ELM 545.52].

(continued)


MEDICAL PRIVACY(continued)

● When Such Communication Takes Place The Postal Service Must Send A Copy To OWCP And The

Employee, As Well As A Copy Of The Physician’s Response Upon Receipt [20 CFR 10.506, ELM 545.52 ].

● The Postal Inspection Service May Receive Restricted Medical Information Upon Written Request.

● The Signing Of A Medical Release For Postal Service

Use Is Voluntary. (Step 4 Decision, PS Form 2488)(continued)


MEDICAL PRIVACY(continued)

● Form CA-17, “Duty Status Report,” May Be Used To Obtain Interim Medical Reports Regarding Return To Work Capability [20 CFR 10.331, ELM 545.52].

● OWCP Related Medical Records May Be Made Available To Supervisors Who Have A Legitimate Need To Know.

● These Records Are Confidential, Must Be Kept Under Strict Control And Stored In Locked File Cabinets.


SCHEDULE AWARD

● Compensation For The Permanent Loss Or Loss Of Use (Permanent Impairment) Of Specified Members, Functions And Organs Of The Body.

● An Employee Who Has Reached Maximum Medical Improvement And Has A Permanent Impairment To A Part Of The Body May File For A Schedule Award.

● A Physician Must Determine The Percent Of Impairment Using The American Medical Association’s Guides To The Evaluation Of Permanent Impairment, Fifth Edition.

(continued)


SCHEDULE AWARD(continued)

● A Schedule Award And Wage Loss Compensation Cannot Be Paid At The Same Time, For The Same Part Of The Body. Therefore, Application For The Schedule Award Ordinarily Occurs After Return To Full Time Employment Or After Retirement.

● By Law A Schedule Award Cannot Be Paid For Brain, Heart, Or Back (Spine) Impairments. Other Members,

Functions And Organs That Are Permanently Impaired As A Result Of These Exclusions Are Still Payable.

(continued)



● A Form CA-7, “Claim For Compensation,” Must Be Completed Unless One Has Previously Been Submitted.

● The Award Is Tax-Free And Paid At Your Wage Loss Compensation Rate For The Specified Number Of Weeks Equivalent To Your Percentage Of Permanent Impairment.

(continued)



● Formula Is:

Your Specified Number Of Weeks (Maximum Number Of Compensation Weeks Assigned To An Anatomical Member) X (Your Percentage Of Impairment) X (Your Amount Of Wage Loss Compensation) = Schedule Award.

Example:

100% Loss Of Use For The Arm = 312 Weeks Of Compensation Determined Your Loss Of Use Is 20% = 62.4 Weeks Your Weekly Rate Of Pay Is $1000 Per Week You Have Dependents So You Are Compensated At 75% Or $750 $750 X 62.4 Weeks = Schedule Award

(continued)


SCHEDULE AWARD

• Schedule Award For Permanent Impairment

• Use AMA, Guides

• Cannot Get Compensation And Award Simultaneously

• Not For Brain, Heart, Or Back (Spine)

• Specific Number Of Weeks At Compensation Rate

• Compensation ScheduleFor Anatomical Member

FECA


CA 550

Q&A

§8107 10.404 541.133 p. 11 F-23

10.404

10.404(c) p. 11 F-26

F-25

§810710.404(a)

10.404 (b)p. 11

F-23

F-24

F-24


CHALLENGING FORMAL OWCP DECISIONS

● OWCP Will Enclose A Description Of Appeal Rights WithEvery Formal Decision. The Choices Are: Hearing (Oral And Written) Reconsideration Employees’ Compensation Appeals Board (ECAB)

● You May Not Request Two Forms Of Appeal At The Same Time.

● Be Sure To Send Your Appeal To The Right Address.● Time Limits For Appeal Begin To Run On The Date Of The

Decision Letter.● The Date Of Your Appeal Is Determined By The Postmark Of

Your Appeal Letter.(continued)



(continued)

Branch Of Hearings And Review

Oral Hearing

● Request Must Be Made Within 30 Days Of Decision. [20 CFR 10.616].

● Conducted By An OWCP Hearing Representative Within Commuting Area Where The Claimant Lives.

● Probably More Than 3-4 Months Before Hearing Is Scheduled.

● Claimant Notified At Least 30 Days In Advance Of The Time And Place. [20 CFR 10.617].

(continued)




Oral Hearing (continued)

Claimant States Argument And Provides Any New Evidence [20 CFR 10.617].

Postal Service May Attend, But Not Give Argument. [20 CFR 10.621].

Probably More Than 3 Months Or More After HearingIs Held Before A Decision Is Issued.

May Request A Reconsideration Of An Oral Hearing Decision.

(continued)



Branch Of Hearings And Review(continued)

Review Of The Written Record

Request Must Be Made Within 30 Days Of Decision [20 CFR 10.616].

Conducted By An OWCP Hearing RepresentativeIn Washington, DC, After Claim File Is Sent To Them [20 CFR 10.618].

New Evidence And/Or Argument May Be Submitted (No Oral Testimony) [20 CFR 10.618].

(continued)




Review Of The Written Record (continued)

Branch Policy Is To Issue A Decision Within 120 Days Of Receipt Of Claim File.

May Request A Reconsideration Of A Review Of The Written Record Decision.



Reconsideration

Reconsideration

Request Must Be Made Within One Year Of The Date Of The Decision [20 CFR 10.607].

Must Be In Writing, Contain Argument And/Or Evidence Showing An Erroneous Application Of Law Or Advancing A New Legal Argument, And Must Constitute Relevant New Evidence Not Previously Submitted [20 CFR 10.605].

(continued)


CHALLENGING FORMALOWCP DECISIONS

Reconsideration (continued)

● Sent To The OWCP District Office Where The Original Decision Was Made [20 CFR 10.605].

● A Claims Examiner Different From The One Who Made The Original Decision Will Conduct The Review [20 CFR 10.609].

● OWCP’s Policy (Not A Requirement Of Law) Is To Issue A Decision Within 90 Days.

● An Employee Who Has Previously Requested A Reconsideration Cannot Appeal That New Merit Decision To The Branch Of Hearings And Review [20 CFR 10.616]. However, A New Reconsideration May Be Requested.

● A Decision Refusing To Conduct A Reconsideration May Only Be Appealed To ECAB.

(continued)



(continued)

Employees’ CompensationAppeals Board (ECAB) [20 CFR 10.625]

●Final Decisions Of OWCP May Be Appealed To ECAB Within 90 Days Of The Decision Being Appealed.

●For Good Cause Shown ECAB May Waive The 90-day Time Limit And Accept An Appeal Up To One Year From The Date Of Decision Being Appealed.

●No New Evidence Will Be Considered By ECAB.●The Board Consists Of Three Members Appointed By The Secretary Of Labor.●It Takes Approximately 12-18 Months To Receive A Decision From ECAB.


DEFINITIONS

ACCELERATION—A Medical Process By Which Workplace Activity Has Increased The Speed Of An Expected Worsening Of A Progressive Pre-Existing Condition.

AGGRAVATION—A Medical Process By Which Workplace Activity Has Worsened The Severity Of A Pre-Existing Medical Condition.

● TEMPORARY—A Worsening For A Specific Period Of Time Ultimately Returning To Previous Medical Status.

● PERMANENT—An Irreversible Worsening With No Return To Previous Medical Status.

(continued)


DEFINITIONS(continued)

CONSEQUENTIAL INJURY—A New Medical Condition Caused By

A Weakness Or Impairment Resulting From An Accepted Workplace

Injury Or Illness. Can Be To The Same Or To A Different Part Of

The Body. No Special Claim Form Needed, Submit To OWCP A

Full Narrative Medical Report Detailing The New Condition And Its

Connection To The Original Accepted Condition.

(continued)



IDIOPATHIC FALL—A Fall Caused By A Non-Work Related Medical

Condition (e.g., Epilepsy, Diabetes) And The Subsequent Injury Was

Caused By Contact With The Floor. However, If The Injury Was

Caused By Workplace Equipment Or Furnishing, Then That Injury

Is Compensable, But The Medical Condition Causing The Fall Is Not.

An Injury Caused By A Fall Which Is Unexplained, But Not Idiopathic,

And Occurs In Performance Of Duty Is Compensable Even If The

Injury Is Caused By The Floor.

(continued)



INTERVENING INJURY— A Non-Work Injury To The Same Part Of

The Body Previously Accepted As A Compensable Workplace Injury.

The Original Injury Must Still Contribute To The Disability Caused By

The New Non-Work Condition. No Special Claim Form Needed,

Submit A Full Narrative Medical Report To OWCP Detailing The New

Condition And Its Connection To The Original Accepted Condition.

PRECIPITATION—A Medical Process By Which Workplace Activity

Hastens The Occurrence Of A Medical Condition Or Causes It To

Happen Unexpectedly Or Sooner Than Normal.


WORK LIMITATION DUE TO PAIN

● Ordinarily, OWCP Does Not Accept Pain As Justification For Not Working.

● Pain Is Considered To Be A Symptom Of An Underlying Medical Problem. Therefore, OWCP Wants A Medical Diagnosis Of The Underlying Condition Which Is Causing The Pain.

● However, If There Is No Physical Basis For The Pain And It Is Not Exaggerated, Or Produced Voluntarily Or Falsely, Then The Condition Could Be Designated As “Psychogenic Pain Disorder.”

● This Diagnosis Would Have To Result From An Accepted Medical Condition And Would Be Filed As A Consequential Injury.


SEPARATION—DISABILITY[ELM 545.9]

● This Is Not A Disability Retirement.● An Employee May Be Issued A Disability Separation If That

Employee:

Has Been In Continuous LWOP For A Year, And

Is Not Likely To Return In The Next 6 Months, And

The Separation Is Approved By USPS Headquarters.

An Employee Who Partially Or Fully Recovers After Separation Has Certain Restoration Rights Enforceable Through The Merit System Protection Board (MSPB)

[ELM 546.3 And 546.4].


DISABILITY RETIREMENT

● OPM Makes Decisions Regarding Disability Retirement Based On Whether An Employee Has A Medical Condition, Work Related Or Not, Which Prevents That Employee From Performing Useful And Efficient Service In The Job The Employee Was Hired To Perform.

● OWCP Makes Decisions Regarding Wage Loss Compensation Based On Whether An Employee Has An Accepted Workplace Medical Condition Which Prevents That Employee From Performing Any Type Of Medically Suitable Work.

● Each Agency Makes Independent Decisions.

● A Claimant Who Is Receiving OWCP Wage Loss Compensation From OWCP Can Retire, Waive The OPM Retirement Annuity, And Continue To Receive Compensation For As Long As OWCP Determines The Claimant Continues To Be Disabled.

(continued)


DISABILITY RETIREMENT(continued)

● Application For Disability Retirement Must Be Received By OPM

Within One Year Of Separation.

● A FERS Employee Applying For Disability Retirement Must Also

Apply For Social Security Disability Benefits.

● Under OPM Regulations An Employee Receiving A Disability Annuity

Can Work In A Non-Government Job And Earn Up To 80% Of The

Current Salary Of The Previous USPS Job.

● A Claimant Receiving Compensation Who Is Separated From The

USPS, Or Who Has Dependents And Is In Poor Health And/Or Of

Advanced Age, Should Seriously Consider Filing For Retirement.

● Do Not Make A Decision Before Receiving Pre-Retirement Counseling

From The USPS, And, If Applicable, The Social Security Administration.


OWCP MEDICAL BILL PAYMENT AND

AUTHORIZATION FOR MEDICAL PROCEDURES

● OWCP Has Contracted With ACS, A Private Sector Firm, To Administer Bill Payments And Medical Authorizations.

● The Web Site Is www.owcp.dol.acs-inc.com. The Interactive Voice Response (IVR) Phone Number Is 1-866-335-8319. The Customer Service Number Is (850) 558-1818 (Mon-Fri, 8 AM-8PM, ET). This Number Is Not Toll Free.

● Medical Providers Must Enroll. They May Do So Through The Above Web Site. Providers And Claimants May Review Bill Pay And Authorization Status At The Above Web Site.

(continued)


OWCP MEDICAL BILL PAYMENT AND AUTHORIZATION

FOR MEDICAL PROCEDURES(continued)

● Medical Bills Are First Mailed To First Health/USPS, P.O. Box 23808, Tucson, AZ 85734-3808 Where They Are Reviewed And Forwarded To ACS (OWCP).

● OWCP Still Is The Final Decision-Making Authority Regarding Entitlement To All Medical Benefits.


OWCP INFORMATION

● Federal Employees’ Compensation Act (FECA),

Title 5, Chapter 81

● Code Of Federal Regulation, Claims For Compensation

Under FECA, Part 10 and 25

● Questions And Answers About FECA, CA 550

● Injury Compensation For Federal Employees, CA-810

● When Injured At Work, Guide For Federal Employee, CA11


OWCP FORMS

● CA-1 Federal Employee's Notice Of Traumatic Injury And Claim For Continuation Of Pay

● CA-2 Notice Of Occupational Disease And Claim For Compensation

● CA-2a Notice Of Recurrence

● CA-5 Claim For Compensation By Widow, Widower, And/Or Children

● CA-6 Official Superior’s Report Of Employee’s Death

● CA-7/20 Claim For Compensation/Attending Physician’s Report

● CA-7a Time Analysis Form

● CA-7b Leave Buy Back (LBB) Worksheet Certification And Election

● CA-16 Authorization (Employer Issued) For Examination And/Or Treatment

● CA-17 Duty Status Report

● CA-915 Claimant Medical Reimbursement Form


OWCP INFORMATION(continued)

● U.S. Department of Labor, Office of Workers’ Compensation Programs, Self-Instructional Video: Injury Compensation Specialist Training.” This

Video Presentation Was Created For Use By

The Federal Employing Agencies. Please Be

Very Aware When Reviewing This Training Tool, The Presentor Is Speaking To The Agency Representative, Not The Injured Worker.

● ELM 540, Injury Compensation Program

● EL 505, Injury Compensation


LETTERS, MOUs AND STEP 4 DECISIONS

● A1 Letter From USPS Labor Relation At Headquarters. On the Services Policy for Employees that Sustained On-The-Job Injuries

● A2 USPS Sample Letter. Limited Duty Assignments and MOU from Headquarters

● A3 National Pre-Arb Settlement. When an employee has partially overcome a compensable disability, the USPS must make every effort toward assigning the employee to limited duty consistent with the employee’s medically defined work limitation tolerances (see 546.32). In assigning such limited duty the USPS should minimize any adverse or disruptive impact on the employee. The following considerations must be made in effecting such limited duty assignments.

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● A4 Step 4 Decision. Grievant has been determined medically

unable to perform the duties of a letter carrier. As he has

declined the opportunity to be permanently reassigned to

duties which he can perform in another Craft the employer

has no alternative, at this time, other than to consider his

separation from the Postal Service for reasons of disability. However, he is not precluded from filling an application for

disability retirement if he should choose to do so.

● A5 National Pre-Arb Settlement. Full-time regular employees on limited duty will not be scheduled day-to-day with varying reporting times.

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● A6 Letter from USPS Labor Relation at Headquarters. States

that local management will Instruct employees on light or

limited duty to perform only duties which are permitted by

the instructions of the physician

● A7 Step 4 Decision. An employee may be required to report

an accident on the day it occurs however completion of the

appropriate forms will be in accordance with applicable rules

and regulation and need not be on the day of the accident

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● A8 Management Instruction EL5409. Job-Related First Aid Injures

● A9 Letter from USPS Labor Relations at Headquarters. OWCP Use

of Medical Reports Submitted by employing Agencies

● A10 Step 4. The following procedures apply only to fitness-for-duty determinations incident to an on-the-job injury or illness.

Fitness-for-duty determinations for other purposes are not

covered by this instruction.

● A11 Step 4. Management's instructions requiring employees on limited duty to pick up CA-8 forms during daytime hours at the Injury Compensation Office violates the National Agreement. The said Forms will be made available to employees in limited duty status on all tours.

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● A12 Step 4. Whether management’s assignment of limited duty In this case violated the provisions of ELM, Section 546.14

● A13 MOU between APWU, USPS and NALC. For example, if a letter carrier craft employee is given a limited duty assignment

in the clerk craft, and grieves that assignment, the employee will be represented by the NALC. If a clerk craft employee is

given a limited duty assignment in the letter carrier craft, and grieves that assignment, the employee will be represented by

the APWU.

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● A14 Step 4. Letter from USPS. The union alleges that

management discriminates against employees injured off duty

in violation of Article 13 of the collective bargaining agreement, when limited-duty assignments are granted preference over

light-duty assignments

● A15 Step 4. The issue in this grievance is whether management violated the National Agreement when it used a locally developed form to supplement the data provided on Form 3996

● A16 Step 4. Use of locally generated forms

● A17 Step 4. Even if you are injured and an outside party wants to

pay for the medical expenses you must still fill out compensation forms

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● A18 Step 4. It is agreed that an employee cannot be required

or compelled by the Postal Service to undergo a scheduled

medical examination and/or treatment, during nonworking hours.

● A19 Step 4. Whether employees on light duty or limited duty may sign the Overtime Desired list.

● A20 Step 4. Completion of PS Form 2488 by the employee is voluntary

● A21 Step 4. CA-17 is usually adequate for medical information on an injured employee Completion of PS Form 2488 by

the employee is voluntary

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● A22 Step 4. Whether management may require an employee to complete PS Form 3971 to receive Continuation of Pay (COP)

● A23 Step 4. Are limited duty employees covered by the collective bargaining agreement

● A24 Step 4. Whether management violated the Agreement when, the grievant was permanently reassigned work in another craft.

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● A25 Step 4. Management removing employees permanently

from their bid while on Limited duty

● A26 Step 4. Whether management violated the National

Agreement when it withdrew the grievant from limited duty

and issued a Notice of Proposed removal

● A27 Letter from USPS Labor Relation at Headquarters.

Discipline for safety rules violations

Documents

Created by APWU Human Relations Department Director, Sue Carney 1 FEDERAL INJURY COMPENSATION OVERVIEW How Does the Process Work? How Does It All Fit Together?