Inspectors General Symposium

History and Overview of FECA
Shelby Hallmark, Director OWCP Stephanie L. Semmer Chief, Branch of Technical Assistance

FECA Benefit Obligations
Fiscal Years 1995- 2005
(in millions)

$2,500 $2,000 $1,500 $1,000 $500 $1995 1997 1999 2001 2003 2005
FY 1996 includes one-time accounting adjustment of +$85 million.

*
Compensation Benefits Medical Benefits

Total Compensation
$2,501,000,000 $2,251,000,000 $2,001,000,000 $1,751,000,000 $1,501,000,000 $1,251,000,000 $1,001,000,000 $751,000,000 $501,000,000 $251,000,000 $1,000,000 USDA SSA USPS Transportation Education Air Force Justice Interior Total Army DHS Navy DOD VA

Chargeback 04 Chargeback 05

Total Compensation
$250,000,000 $225,000,000 $200,000,000 $175,000,000 $150,000,000 $125,000,000 $100,000,000 $75,000,000 $50,000,000 $25,000,000 $0 Navy

Chargeback 04 Chargeback 05

Army

Air Force

USDA

SSA

Transportation

Education

DHS

Justice

DOD

Interior

VA

Periodic Roll Management
Project begun in FY 1992 Made permanent in FY 1999 Approx. 120 FTE Total savings over $1.6 BILLION so far

Long-term Disability Roll
End-of-Period Snapshot
50,000 49,500 49,000 48,500 48,000 47,500 47,000 46,500 46,000 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006

Fiscal Year

Return-to-Work Activity
16,500 15,000 13,500 12,000 10,500 9,000 7,500 6,000 4,500 3,000 1,500 0 1995 1997 1999

Nurse Interventions Returns to Work
2001 2003 2005

Lost Production Days in QCM Cases
Measured w/i 1st Year from the Date Wage Loss Began
200

5 19

18

Calendar Days

18

7 17 3 4

180 160 140 120 100

9

7

16

4 16

16

16

2
4 15
'03 '04

4Q, '96

'97

'98

'99

'00

'01

'02

15
'05

Fiscal Year

7

Goal 4 - Lost Production Days
160 140 Rate per 100 Employees 120 100 80 60 40 20 0 USPS (non-SHARE) All Other Gov't 147.6 147.2 134.4 148.8
FY03 FY04 FY05 FY06 Goal FY06 Q1

No Goal

56.0

61.9

56.1

54.3

57.1

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 injuries and illnesses by at least 1% per year

Goal 4 - Lost Production Days
160 140 Rate per 100 Employees 120 100 80 60 40 20 0 USPS (non-SHARE) All Other Gov't 147.6 147.2 134.4 148.8
FY03 FY04 FY05 FY06 Goal FY06 Q1

No Goal

56.0

61.9

56.1

54.3

57.1

100

125

150

175

200

225

250

275

25

50

75

0 Navy Army VA Air Force DOT Treasury TVA USDA DOD Justice Interior HHS Labor Commerce DHS SSA HUD All - Less USPS

Major Agency
FY05 FY04 FY03

Goal 4 - Lost Production Days

Goal 4 - Lost Production Days
Major Agency – FY06 Goal vs. Actual
225 FY06 Goal 200 175 150 125 100 75 50 25 0 Army Air Force All - Less USPS VA TVA USDA Treasury Justice Interior Labor Navy Commerce DOT HHS DOD DHS SSA HUD FY06 Q1

Goal 3 - CA-1/CA-2 Timeliness
(filed in 14 calendar days)
100% 90% 80%
79.0% 88.7% 92.5% 93.1%
FY03 FY04 FY05 FY06 Goal FY06 Q1

70%
70.9%

60% 50% 40% 30% 20% 10% 0%

69.9% 57.4%

61.4%

No Goal

49.6%

USPS (non-SHARE)

All Other Gov't

FECA Reform
Incentives
“Conversion benefit” for retirement aged claimants Setting compensation at 70% for all claimants Change the schedule award to allow for payment during the wage loss period

FECA Reform
Equity and fixes
Restore waiting period Allow for subrogation of COP for Third Party claims Update disfigurement and burial payments Pay all schedule awards at average salary rate (GS-11 step 3)

FECA Reform
Applies to new claims only Strengthens the program while maintaining generous benefits Projected savings of $591.6 million over the next 10 years

FECA Reform
Current status: pending transmission Seeking sponsors Assistance welcome

Questions?

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

Overview of the FECA
Federal Employees’ Compensation Act (FECA) passed in 1916 Provides compensation benefits to civilian employees of the US for disability due to personal injury or disease sustained in the performance of duty Provides benefits to dependents if a work-related injury or disease causes an employee’s death Funded through agency chargebacks Sole remedy – a Federal employee or surviving dependent is not entitled to sue the US or recover damages for injury or death under any other law Administered by the Office of Workers’ Compensation Program’s Division of Federal Employees’ Compensation

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 of compensation for work-related injuries are assigned to agencies for the fiscal accounting period which runs from July to June All compensation claims are identified as belonging to a particular agency based on the agency code entered into OWCP’s system when the case is created OWCP provides each agency with a quarterly report listing all cases and costs for which charges will appear on the yearly chargeback bill

Primary Benefits Provided under the FECA
Continuation of Pay (COP) Medical benefits Wage loss compensation Schedule awards Vocational rehabilitation Loss of Wage-Earning Capacity Death benefits

Types of Injury Claims
Traumatic Injury – CA-1 Occupational Disease – CA-2 Recurrence – CA-2a Consequential Intervening Death – CA-5 and CA-6

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 agency’s premises and the employee was not engaged in official “off premises” duties

Controverting COP – continued
Employee’s 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

Challenging Validity of a Claim
If the validity of a claim is in question, the agency should provide a detailed statement describing circumstances behind challenge 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.

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

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 nonappropriated fund employees Contract employees, volunteers, and loaned employees are covered under some circumstances

Fact 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

Performance 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

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

OWCP Responsibilities
OWCP has the obligation to aid in the processing and adjudicating of a claim
Advising the claimant and the agency of procedures for establishing a claim, including detailed instructions for developing the evidence Requesting all evidence necessary to adjudicate the case Identifying potential third party cases so that attempts at recovery may begin Making prompt decisions

OWCP Responsibilities
Once a claim is adjudicated, claims examiners are responsible for the following case management activities
Focus on Return to Work Initiate Interventions and Services Request Medical Information Follow up with the assigned Field Nurse or Rehabilitation Specialist Bring the Case to Resolution

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

Agency Responsibilities
Assist employees in returning to work Represent the agency’s interest Challenge questionable claims (controvert) Keep in contact with employee Help manage compensation costs Accommodate “light duty” work when able

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

Containing OWCP Costs
Controvert/Challenge Questionable Claims OWCP accepts employee statement as factual unless agency provides refuting evidence Notify OWCP of any information you believe to be pertinent to the claim. This would include things such as past history of injuries, outside activities, etc. Include actual evidence rather than conjecture or opinion

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, Claims Examiners, Vocational Rehabilitation Specialists, and Workers’ Compensation Specialists/Injury Compensation Specialists

Containing OWCP Costs
Offer Light Duty
Match employee’s physical limitations to your particular 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

Highlights of DFEC Homepage
www.dol.gov/esa/regs/compliance/owcp/fecacont.htm
Pledge to Our Customers FECA Mission Statement When Injured At Work (CA-11) District Office Addresses and Telephone Contacts Information on FECA's New Consolidated Bill Processing and Medical Authorization System Questions and Answers about the Federal Employees' Compensation Act (Publication CA-550) Handbook for injured workers. Injury Compensation for Federal Employees (Publication CA-810) Handbook for employing agencies. Federal Employee Safety and Health Return-to-work Initiative Forms OWCP Procedure Manual Employees’ Compensation Appeals Board Decisions Federal Employees' Compensation Act - Title 5 United States Code Sections 8101-8193. Regulations Under The FECA - Title 20 C.F.R. Parts 1-25.