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WORKERS' COMPENSATION FOR FEDERAL EMPLOYEES

DAO 202-810:WORKERS' COMPENSATION FOR FEDERAL EMPLOYEES
Number: DAO 202-810
Effective Date: 2017-04-21

SECTION 1.  PURPOSE.

.01     This Department Administrative Order (DAO) outlines authorities, establishes policies, and describes responsibilities for administration and management of the centralized operation of the Workers’ Compensation Program under the Federal Employees’ Compensation Act (FECA).

.02     This Order is a general revision that: 

a.       Defines responsibilities related to workers’ compensation.

b.       Defines responsibilities for the mandatory use of the U.S. Department of Labor, Office of Workers’ Compensation Programs (DOL/OWCP) Employees’ Compensation Operations and Management Portal (ECOMP) for processing (e.g., filing, reviewing, adjudicating, approving, delivering benefits, controverting, and tracking) workers’ compensation claim forms electronically.

c.       Identifies DOL/OWCP as responsible for administering the Federal Government’s FECA program, including the Department of Commerce (Department) workers’ compensation program.

d.       Clarifies the requirement to use the Department selected contractors to provide workers’ compensation claims processing support, case management, and liaison services, as well as manage the Department’s Workers’ Compensation Pharmacy Benefits Program for all Departmental organizations and bureaus.

Note: See the “Workers’ Compensation: How to File a Claim” webpage to identify the Department’s current Workers’ Compensation and Pharmacy Benefit Program management contractors.

e.       Clarifies requirements for the implementation of the Workers’ Compensation Return-to-Work (RTW) Program and the application of effective case management practices for promoting increased employee return to work.

f.     Modifies the definition and streamlines operation of the Department’s Leave Buy Back Program.

g.     Highlights the need to detect and report fraud, waste, and abuse.

h.     Generally updates the Order.

 

SECTION 2.  AUTHORITY.

.01       The authority for providing compensation benefits to Federal employees for injuries and illnesses sustained while in the performance of duty is governed by FECA, as amended, 5 United States Code (U.S.C.) § 8101 et seq.  This Act is administered by the Secretary of Labor through the Office of Workers’ Compensation Programs (OWCP).

.02       Administrative regulations implementing FECA are set forth in Title 20, Code of Federal Regulations (CFR) Parts 1, 10, and 25.

 

SECTION 3.  REFERENCES.

.01       The following references apply to this Order:

a.         Compensation for Work Injuries, 5 U.S.C., Chapter 81.

b.         20 CFR Parts 1, 10, and 25, Administrative regulations implementing FECA.

c.         29 CFR Part 1960, Basic Program Elements for Federal Employee Occupational Safety and Health Programs and Related Matters.

d.         DAO 209-3, “Injury, Illness, Accident/Incident, Fatality and Motor Vehicle Accident Reporting and Investigation.”

e.         DAO 209-4, “Occupational Safety and Health Program.”

f.          Office of Human Resources Management webpage: Workers’ Compensation: How to File a Claim.

g.         Office of Human Resources Management, Human Resources (HR) Bulletin 189 (fiscal year (FY) 14), “Employees’ Compensation Operations and Management Portal (ECOMP)”; August 6, 2014.

h.         Office of Human Resources Management, HR Bulletin 182 (FY14), “Workers’ Compensation Return-to-Work Program”; April 7, 2014.

i.          Broadcast – “Change to Workers’ Compensation Contract” (July 22, 2015).

j.          DOL/OWCP ECOMP.

k.         DOL/OWCP ECOMP – “How to File a Form” (Workers’ Compensation Claim Form instructions).

l.          DOL/OWCP ECOMP – “Filing Forms as an Injured Worker,” training module.

m.        DOL/OWCP ECOMP – “Reviewing Forms as a Supervisor,” training module for reviewing claim forms.

n.         DOL/OWCP ECOMP – “Agency Reviewer,” user guide training module.

o.         DOL/OWCP “Division of Federal Employees’ Compensation (DFEC),” Injury Compensation Specialist (ICS) training modules.

p.         “Injury Compensation for Federal Employees, Publication CA-810,” prepared by the Office of Workers’ Compensation Programs, Employment Standards Administration, DOL.

q.         “Questions and Answers about the Federal Employees’ Compensation Act (FECA),” Publication CA-550, Revised July 2002, prepared by the Office of Workers’ Compensation Programs, Employment Standard Administration, DOL.

 

SECTION 4.  APPLICABILITY AND SCOPE.

This Order applies to all Department operating units, bureaus, agencies, offices, and other organizations or components.

Note:  Operating units, bureaus, agencies, and offices may develop supplementary Workers’ Compensation claims information, reporting procedures, and instructions to complement and enhance this Order and incorporate that information into their training and other communication.

 

SECTION 5.  POLICY.

.01       The Department maintains a centrally managed workers’ compensation program through the use of DOL/OWCP’s ECOMP system and the case management activities of the workers’ compensation contractor that serve to: assist in the effective use of ECOMP for filing and processing workers’ compensation claims and related documents in a timely and efficient manner; manage claims; provide liaison functions with DOL/OWCP; provide benefits to eligible employees, or their dependents or survivors; and work closely with injured employees and supervisors to return employees to work as soon as medically able. 

.02       The Department requires all operating units and employees to use ECOMP for filing, processing, and tracking all workers’ compensation claim forms electronically, and incorporates by reference the requirements of HR Bulletin 189 (FY14) on ECOMP.
.03       When appropriate, the Department and its bureaus will work to: challenge claims that seem unrelated to workplace injuries or illnesses or otherwise appear to be spurious; and offset the costs of injuries caused by a third party by seeking reimbursement.

.04       The Department will notify DOL/OWCP of errors that include inaccurate reporting, overpayments, and death of claimants.

.05       The Department will limit workers’ compensation costs by aggressively working to implement the “Workers’ Compensation Return-to-Work Program” (HR Bulletin 182 (FY14) is hereby incorporated by reference) and return all disabled employees to work as soon as possible after the injury or illness and within the treating physician's restrictions.
.06       Bureau leadership will minimize workers’ compensation costs to the extent possible through focusing on return-to-work opportunities and oversight of Department chargeback reports by:

a.         Reviewing old claims to identify claims that are no longer eligible for benefits and can be resolved.
b.         Identifying claims with return-to-work potential.

c.         Identifying jobs that are suitable for claimants’ medical limitations and making offers to the affected claimants to return to work.

d.         Reviewing new claims and challenging those that are questionable with respect to facts of injury or work-relatedness.

e.         Working with newly injured claimants to bring them back to work as soon as medically feasible in order to reduce Continuation of Pay (COP) costs.

 

SECTION 6.  DEFINITIONS.

.01       The following definitions are applicable to this Order:

a.         Agency Reviewer (AR).  The Agency Reviewer in ECOMP is responsible for reviewing FECA claim forms before submission to the contractor selected by the Department to provide workers’ compensation claims processing support.  Also, the AR is frequently the bureau’s or operating unit’s designated workers’ compensation specialist or ICS.

b.         Benefits.  Payment of medical expenses and compensation for wage loss for an employee who has suffered a work-related injury or occupational illness/disease.  Benefits also include payment to dependents of employees who die from work-related injuries or illnesses.

c.         Burden of Proof.  Under FECA, the claimant is assigned the responsibility to establish through evidence the five basic requirements of a claim, including:  time, civil employee, fact of injury, performance of duty, and causal relationship.  This responsibility is known as the “burden of proof.”

d.         Centralized Workers’ Compensation Program.  Use of the single Employees’ Compensation Operations and Management Portal—ECOMP—to electronically file the appropriate workers’ compensation claim forms, assist in claims processing, approval, and tracking claims status. ECOMP is operated by DOL/OWCP.

e.         Chargeback Report.  A statement prepared by DOL that details the medical and compensation costs paid for each agency workers’ compensation claim during the reporting period.  The statement is submitted to the agency quarterly.

f.          Claimant.A Department employee whose claim has been filed electronically through the DOL/OWCP ECOMP.

g.         Continuation of Pay.  The process by which an eligible employee’s regular pay may continue for up to forty-five (45) calendar days of wage loss due to disability and/or medical treatment after a traumatic injury.  COP is not paid in cases of occupational illness.

h.         Controversion.  The process by which a supervisor or an agency recommends to DOL, Office of Workers' Compensation Programs (OWCP), that COP be denied.

i.          ECOMP.  The centralized online portal is used to submit, approve, and track the Department’s workers’ compensation claims.
j.          Leave Buy-Back.  A program that allows an injured worker to repurchase leave used in association with a work-related disability.  An employee may initially elect to use annual or sick leave during the period of disability.  Later, the injured worker may claim compensation for the period of disability and “buy-back” the leave used as follows:  the “buy-back” leave period must exceed forty (40) hours (no leave “buy-back” for less than forty (40) hours); the “buy-back” must be requested within 1 year of usage following the acceptance of the disability claim.

Note:  The one-year (1) “buy-back” request period limit is extended if the claim was originally denied and then approved.  The one-year (1) request period limit starts with the approval date of the claim.

k.         Light Duty.  Those duties and responsibilities that are outside an employee’s regular position, but that meet the employee’s current work capabilities as identified by a physician.  They may be performed for a full work shift or for shorter time periods.

l.          Limited Duty.  Specific duties and responsibilities of an employee’s regular position that meet the employee’s current work capabilities as identified by a physician.  These duties may include all or part of the employee’s regular job assignment.  They may be performed for a full work shift or for a shorter time period.

m.        Workers’ Compensation Contractor.  The contractor selected by the Department to provide workers’ compensation claims processing support, case management, and liaison services for all Departmental organizations and bureaus.

n.         Pharmacy Benefit Program Manager.  The contractor selected by the Department to manage the Department’s Workers’ Compensation Pharmacy Benefits Program.

o.         Third Party.  A work-related injury caused by a private party or a “third party” and not the Department.  When an injury is caused by a private party, the employee may be required by DOL to bring a claim against the party causing the injury.  (For example, an employee is injured in an automobile accident that was caused by a private citizen.)

p.         Periodic Roll Claims.  If medical reports indicate that disability will continue for at least sixty (60) days after COP, DOL/OWCP places the employee on the periodic roll and compensation payments are automatically paid by DOL/OWCP every twenty-eight (28) days with appropriate medical documentation.  An injured employee will receive seventy-five (75) percent (tax free) of his/her salary in compensation payments if, at the time of the injury, the employee has dependents.  An injured employee will receive sixty-six and two-thirds (66 2/3) percent (tax free) of his/her salary in compensation payments if he/she has no dependents.  Employees on the periodic roll who are made suitable offers of employment must accept these offers.

q.         Short Term Claims.  Term for claims from the time of injury until the employee is placed on the periodic roll.  Employees with Short Term Claims who are made suitable offers of employment must accept these offers.

r.          Suitable Job Offer.  An offer of employment determined by the OWCP to comport with an employee’s work-related medical restrictions.

s.         Traumatic Injury.  A wound or other condition of the body caused by a specific event or series of events or incidents in a single workday or shift.  Such condition must be caused by external force, including stress or strain, which is identifiable as to time and place of occurrence and member or function of the body affected.  Examples of traumatic injury include:  dog bite, knee strain after a trip and fall, neck strain after an auto accident, or a broken ankle after a slip on ice.

t.          Workers’ Compensation Specialist or ICS.  An appropriately trained and skilled individual designated to assist bureau or operating unit management to effectively administer the workers’ compensation program.  Frequently, the Workers’ Compensation Specialist also is designated as the bureau’s or operating unit’s AR. Further, at a minimum, the Workers’ Compensation Specialist must successfully complete the DOL/OWCP DFEC ICS and the DOL/OWCP ECOMP training modules.

u.         Work-Related Occupational Illness, or Work-Related Occupational Disease.  A condition produced by an exposure in the work environment over a period longer than one (1) workday or shift. It may result from systemic infection, repeated stress or strain, or conditions of the work environment.

 

SECTION 7.  RESPONSIBILITIES.

.01       Departmental Office of Human Resources Management (OHRM).  OHRM will:

a.         Serve as the Department’s chief liaison office with DOL/OWCP through the Director for Human Resources Management ((HRM) or designated staff member). 

b.         Centrally administer the Department’s Workers’ Compensation Program through the mandatory use of ECOMP and be responsible for development of overall program policies.

c.         Manage program operations and provide oversight of the Department’s currently selected workers’ compensation contractor. 

.02       Office of Occupational Safety and Health (OOSH).  OOSH will:

a.         Establish program operating policies, procedures, and guidelines that ensure effective and efficient management of the Workers’ Compensation Program in areas including:

1.         Designate a representative to coordinate routine program-related activities, including ECOMP use-related activities with DOL/OWCP.

2.         Coordinate ECOMP operation, training, and use-related matters with operating units, the workers’ compensation contractor, supervisors, claimants, and the pharmacy benefit program managing contractor.

3.         Provide claims and case management assistance by:  conducting quarterly roll claims’ reviews for compensation through monitoring medical evidence and claim status; counseling employees with their periodic roll claims; and coordinating with employees, supervisors, physicians, and the workers’ compensation contactor to collect and submit through ECOMP complete claims-related documentation.  When appropriate, challenge questionable claims and refer possible fraudulent claims to the OOSH Workers’ Compensation Program and the Office of the Inspector General (OIG).

4.         Assist operating units and their injured or ill employees in participating in the Department’s optional Workers’ Compensation Pharmacy Benefits Program.

5.         Assist operating units and their injured or ill employees in pursuing their options under the Department’s leave buy-back program.  Under the program, an employee with a work-related disability may initially elect to use annual or sick leave in association with and during the period of disability.  Later, the disabled employee may claim compensation for the period of disability and repurchase or “buy-back” the leave used as follows:  the buy-back leave period must exceed forty (40) hours (no leave buy-back for less than forty (40) hours); and the buy-back must be requested within one (1) year of usage following the acceptance of the disability claim.

Note:  The one-year (1), buy-back request period limit is extended if the claim was originally denied and then approved.  The one-year (1) request period limit starts with the approval date of the claim.

6.         Provide return-to-work assistance through implementation of the Workers’ Compensation Return-to-Work Program by pursuing job modification(s) or other means of enabling employees to work within their restrictions; requesting vocational rehabilitation assistance where indicated; and coordinating re-employment efforts with the workers’ compensation contractor and DOL/OWCP, which may cross organizational lines and reach outside the agency.

7.         Provide compensation cost monitoring by reviewing and tracking compensation costs and savings; reporting to the OHRM Director, Chief Financial Officer, and operating units the cost savings of the Department; and providing chargeback reports to the Office of Financial Management (OFM) for compensation benefits paid for work-related injuries and deaths.

b.         Provide necessary liaison with DOL/OWCP, including:

1.         Reviewing DOL/OWCP hearing transcripts and providing to DOL relevant evidence and arguments supporting the Department’s position, as appropriate.

2.         Reviewing and reconciling charges for compensation benefits billed to the Department by DOL/OWCP.

3.         Reviewing the Social Security Administration rolls periodically (e.g., yearly) to identify claimants who have died and notifying DOL/OWCP of claimants’ status.

4.         Notifying DOL/OWCP of the Department’s position on specific third-party claims for reimbursement and monitoring the recovery efforts through the final reimbursement.

5.         Providing an assigned Medical Review Officer to act as the Department’s representative, as necessary, in obtaining information from referral physicians to reconcile DOL/OWCP cases.

c.         Accommodating partially recovered injured employees by maintaining contact with them and their supervisor, and affording them light or limited duty, as warranted by their respective medical documentation.

d.         Establishing an employee assignment team (at the discretion of the OOSH Director) to identify potential return-to-work cases and, through contact with affected supervisors, identifying and obtaining suitable light or limited duty employment.

e.         Providing or coordinating workers’ compensation training to appropriate stakeholders.

f.          Detecting, investigating, and reporting fraud, waste, and abuse in the Workers’ Compensation Program.

.03       Office of Financial Management.  OFM will:

a.         Record DOL/OWCP charges in appropriate suspense account(s).

b.         Issue bills based on any distributions made by OHRM to appropriate operating units, at the lowest practicable level.  For example, the lowest practicable level may be the first-line supervisors.

c.         Maintain appropriate records (subsidiary listing of charges and distributions for suspense accounts).

.04       Workers’ Compensation Contractor will:

a.         Be responsible for all the terms and conditions described in its contract.

b.         Receive new claims (injury, occupational, and death); process claims; verify information included on the claims forms; identify and request the claimant or affected supervisor to provide any additional or missing claims-related information; calculate and controvert COP as appropriate; verify pay for compensation; process and verify leave buy-back requests; obtain current medical restrictions; participate in hearings and reviews; resolve medical reimbursement issues; and provide short/long-term claims management.

c.         Provide coordination and liaison with the Department’s optional Workers’ Compensation Pharmacy Benefits Program.

d.         Provide claims management support to employees who become injured or ill on the job and are off duty as a result by removing the medical and psychosocial barriers to recovery and foster employee satisfaction and timely return to work. 

e.         Verify diagnosis, prognosis, and work status, and answer any clinical questions the employee may have.  Throughout the employees’ absence from work, the workers’ compensation contractor Nurse Case Manager (NCM) will monitor clinical activities to ensure that the employee’s recovery is progressing and that the care he/she is receiving is efficient and effective and consistent with accepted treatment guidelines. In addition, the NCM will provide the Department with the information and support necessary to ensure that employees are able to return to safe and productive work in as timely a manner as possible. 

f.          Perform periodic roll case management, as assigned.

g.         Detect, investigate, and report fraud, waste, and abuse in the Workers’ Compensation Program.  Report any detected fraud, waste, and abuse in the Workers’ Compensation Program to the OOSH Workers’ Compensation Program and to the OIG.

.05       Bureau or Operating Unit Management.  Bureau or operating unit management will:

a.         Allocate appropriate resources for the implementation of an effective workers’ compensation program, including:  designating a skilled workers’ compensation specialist and safety coordinator/manager; ensuring that the workers’ compensation specialist and safety coordinator/manager are appropriately trained and have the skills to effectively administer the workers’ compensation program; have the skills to effectively administer the operating unit’s Return-to-Work Program; and work closely with affected supervisors to return injured workers to productive work as soon as they are medically able.

b.         Develop and submit an annual Return-to-Work Program plan in accordance with the guidelines included in the Workers’ Compensation Return-to-Work Program (HR Bulletin 182 (FY 14)).  The plan is to be submitted to the Director, OHRM and the OOSH Director by August 31 of each calendar year.

c.         Develop and submit a quarterly report of the operating unit’s open workers’ compensation cases in accordance with the guidelines included in the Workers’ Compensation Return-to-Work Program (HR Bulletin 182 (FY14)).  The reports are to be submitted to the OOSH Director within one (1) week after the end of the quarter.

d.         Develop and implement a protocol to document all Return-to-Work Program-related actions taken.  A review of these actions and their associated documentation should be included in the operating unit’s quarterly, open workers’ compensation case reports.

.06       Bureau or Operating Unit Workers’ Compensation Specialists.  Workers’ compensation specialists will:

a.         Assist bureau or operating unit management and employees who suffered a work-related traumatic injury or illness in filing and processing workers’ compensation claim forms through use of ECOMP, as well as obtaining and submitting related medical and work status documents in a timely and efficient manner.

b.         Coordinate with the injured or ill employee’s supervisor to direct them in completing the appropriate ECOMP training courses.

c.         Review claimants’ workers’ compensation forms for completeness and accuracy, and identify and request claimants or affected supervisors to provide any additional or missing claims-related information.

d.         Forward the appropriately completed workers’ compensation claims forms to the workers’ compensation contractor for further review, case management, and submission to DOL/OWCP using ECOMP.

e.         Assist bureaus or operating units and their injured employees in pursuing their options under the Department’s leave buy-back program.

f.          Provide case management assistance.  Examples of case management activities include, but are not limited to:  reviewing and verifying claims; identifying and requesting claimants or affected supervisors to provide any additional or missing claims-related information; controverting COP requests, when appropriate; processing leave buy-back requests; conducting periodic roll claims reviews through monitoring medical evidence and work status, etc.

g.         Provide return-to-work assistance through implementation of the Return-to-Work Program by developing the annual return-to-work plan and quarterly status reports.

h.         Provide compensation cost monitoring by reviewing, analyzing, and tracking DOL/OWCP quarterly chargeback reports for compensation benefits paid for work-related injuries and deaths and when appropriate, compensation savings.

i.          Assist bureau or operating unit management in preparing the annual Return-to-Work Program Plan and the quarterly open workers’ compensation cases reports, including a list of the actions taken to return disabled employees to work.

j.          Provide an employee who sustained a work-related traumatic injury or illness, has initiated a CA-1 or CA-2 claim, and needs a prescription filled, with a temporary First Fill card along with instructions for filling out the card.  Assist the employee in completing the First Fill card.

k.         Provide assistance in detecting, investigating, and reporting fraud, waste, and abuse in the Workers’ Compensation Program.  Report any detected fraud, waste, and abuse in the Workers’ Compensation Program to the OOSH Workers’ Compensation Program and to the OIG.

l.          Complete the DOL/OWCP DFEC Injury Compensation Specialist and the DOL/OWCP ECOMP online training modules.

m.        Report to the OOSH Workers’ Compensation Program any fraud, waste, and abuse in the workers’ compensation activities of his/her bureau or operating unit.

.07       Supervisors and Managers.  Supervisors and managers will:

a.         Assist an employee who has reported a work‑related injury or illness to:  obtain appropriate medical attention as quickly as possible; report injuries to bureau workers’ compensation specialists, where these are in place; complete the appropriate portions of online Form CD-137, Report of Incident, Injury, Illness, Motor Vehicle Accident, Property Damage, or Fatality (or bureau-specific equivalent); and use DOL/OWCP ECOMP for electronically filing the appropriate workers’ compensation claim forms.

b.         Follow the instructions of DAO 209-3 (as well as any additional bureau incident reporting procedures, if applicable and/or appropriate) to complete the online CD-137, Report of Incident, Injury, Illness, Motor Vehicle Accident, Property Damage, or Fatality (or equivalent) within
twenty-four (24) hours of the incident, and submit a signed copy of the report to the Bureau Safety Manager/Coordinator within five (5) working days.  Then, follow the distribution of copies requirements of Section 8 of DAO 209-3.

c.         Provide an employee who sustained a work-related traumatic injury or illness, has initiated a CA-1 or CA-2 claim, and needs a prescription filled, with a temporary First Fill card along with instructions for filling out the card.  Assist the employee in completing the First Fill card.

d.         Conduct a thorough investigation of the incident and identify corrective action to prevent a recurrence.

e.         Ensure injured employees are advised that workers’ compensation guidance is available from the bureau workers’ compensation specialists, the workers’ compensation contractor, and OOSH.

f.          Use ECOMP to complete the supervisor’s section of Forms CA-1 (for traumatic injury) or CA-2 (for occupational disease) and any other required DOL/OWCP form within ten (10) working days of receiving the employee’s injury or illness notification, and in accordance with DOL/OWCP operating guidance. 

g.         Coordinate with the workers’ compensation contractor, the bureau workers’ compensation specialist, and the injured employee’s timekeeper to modify the time and attendance reports for COP or compensation, as appropriate.

h.         Send a copy of the injured or ill employee’s current payroll history (job title, pay schedule, pay rate, etc.) and Pay Period Time & Attendance Report to get employee’s work schedule information at the time of the initial claim form’s completion (for CA-1s, CA-2s and CA-7s and COP tracking purposes) to the workers’ compensation contractor, bureau workers’ compensation specialist, and OWCP for informational purposes.         

i.          Provide all relevant information to the workers’ compensation contractor and bureau workers’ compensation specialist in relation to questionable claims, and, where appropriate, controvert COP in accordance with regulatory guidelines.

j.          Provide any additional factual evidence to the workers’ compensation contractor and the bureau workers’ compensation specialist as required by DOL/OWCP in its adjudication of claims.

k.         Provide the treating physician with information on available light or limited duty jobs.

l.          Provide light and/or limited duty work if the employee cannot return to the original position; and maintain regular contact with, and advise the employee in writing of the availability of light and/or limited duty (job offer).

m.        Serve on a Workers’ Compensation Program-related return-to-work team when requested to do so by the OOSH Director.

n.         Provide regular training and notices to employees regarding the:  workers’ compensation claims process; requirement to submit appropriate documentation of current medical condition and any restrictions within ten (10) working days of sustaining the work-related injury/illness, and that failure to do so may result in a challenge by the employing agency or denial of benefits by DOL/OWCP; and privacy protections that apply to information provided by employees, and the process by which these records are safeguarded.

o.         Report to the OOSH Workers’ Compensation Program and to the OIG any fraud, waste, and abuse in the workers’ compensation activities of his/her operating unit.

p.         Complete the DOL/OWCP ECOMP online training modules, including:  How to File a Claim Form; Reviewing Forms as a Supervisor; Electronic Document Submission FAQ; and Uploading Documents to FECA Case Files.
.08       Human Resources Offices.  The human resources office may be requested to provide:

a.         Personnel information required to establish eligibility for workers' compensation benefits.

b.         Copies of health benefit enrollment forms to establish entitlement to Federal employees’ health benefits.

c.         Retirement election forms.

d.         Position descriptions or copies of personnel actions.     
e.         Information concerning the availability of light- and/or limited-duty jobs.

f.          Assistance in reemploying an injured employee.

g.         Serve on a Workers’ Compensation Program-related return-to-work team when requested to do so by the OOSH Director.

h.         Report to the OOSH Workers’ Compensation Program and to the OIG any fraud, waste, and abuse in the operating units’ Workers’ Compensation Programs.

.09       Employees.  Employees are responsible for:

a.         Notifying the supervisor promptly of any work-related injury or occupational illness that has caused, aggravated, or adversely affected a medical condition; and participating collaboratively in the associated incident investigation.

b.         Obtaining and submitting (or arranging for submittal of) appropriate medical documentation within ten (10) calendar days of sustaining the work-related injury/illness from the affected health care provider (e.g., the attending physician) that specifies the employee’s current medical condition and any restrictions or limitations.  For wage loss benefits, the claimant must also submit medical evidence showing that the condition claimed is disabling and resulted in medical treatment on the dates claimed.

Note:  Examples of such medical limitations include: “may lift no more than fifteen pounds (15 lbs.)”; and “may stand no more than two (2) hours in a workday.”  General statements such as “off work” or “light duty” without additional specific information are not acceptable as medical documentation for workers’ compensation claims acceptable to DOL/OWCP.

c.         Utilizing ECOMP to complete and submit CA-1, CA-2, CA-7, and CA-7a forms in a timely manner (as soon as possible, no later than thirty (30) calendar days from the date of injury) and in accordance with applicable procedures.  The claimant must establish the burden of proof for his/her claim including evidence establishing the five basic requirements of a claim.  The five basic requirements of a claim consist of:

1.         Time.  An original claim for compensation for disability must be filed within three (3) years after:  date of injury (DOI); date when the injured employee becomes aware (or reasonably should have been aware) of a possible work-related disease or condition; or date of last exposure.

Note:  See section 7.10 (Other Claimants) for a discussion of filing for death-related benefits.

2.         Civil Employee.  It is presumed that the injured person filing the compensation claim was, at the time of injury, an employee of the United States Federal Government.

3.         Fact of Injury.  Establishing the fact that an injury or disease occurred.

4.         Performance of Duty.  Establishing the fact that the injury or disease occurred while the employee was in the performance of duty.

5.         Causal Relationship.  Establishing the fact that the medical condition for which compensation or medical benefits is claimed is causally related to the claimed injury or disease.

Note:  Neither the fact that the condition manifests itself during a period of Federal employment, nor the belief of the claimant that factors of employment caused or aggravated the condition, is sufficient in itself to establish causal relationship.      

d.         Signing a copy of the claim form.  The claimant’s supervisor must print a copy of the form and retain the claimant’s signature.

e.         Providing any additional or missing claims-related information in a timely manner, upon request from the supervisor, workers’ compensation specialist, OOSH, the workers’ compensation contractor, or DOL/OWCP.

f.          Initiating a prescription request, if a work-related traumatic injury or illness results in a doctor’s prescription, and the claimant elects to use the Department’s Workers’ Compensation Pharmacy Benefits Program.  Following completion of a CA-1 or CA-2 claim, the claimant should obtain a temporary First Fill card with instructions for filling out the card from his/her supervisor or workers’ compensation specialist.  The supervisor or workers’ compensation claims specialist can assist claimants in completing First Fill cards.

g.         Advising the supervisor promptly when the treating physician makes any medical changes in his/her work status (e.g., specifying or extending injury/illness-related medical leave, adding or removing work restrictions) or has released him/her to light, limited, or full duty.

h.         During the COP period, accepting any offer of work from the employing agency that is consistent with medically documented restrictions.

i.          Returning to work promptly when the treating physician has medically released him/her to light, limited, or full duty.

j.          Pursuing third-party litigation as required by DOL/OWCP when a third party caused or contributed to the injury or illness (U.S. Census Bureau employees may be exempt from this requirement in cases where the third party’s identity is protected under Title 13 confidentiality restrictions).

k.         Reporting any fraud, waste, and abuse in the Workers’ Compensation Program to the OOSH Workers’ Compensation Program and to the OIG.  This includes receiving overpayments of benefits, not reporting outside earnings when receiving compensation, failing to respond to DOL/OWCP requests for wage earnings, or receiving benefits when capable of returning to work.

l.          Maintaining regular communication with his/her supervisor on case-related matters, including reporting changes in status such as changes in marital status and number of dependents. Also, report such status changes to the bureau’s workers’ compensation specialist and the workers’ compensation contractor.

m.        Completing the appropriate DOL/OWCP ECOMP online training modules, including:  File a Claim Form; Electronic Document Submission FAQ; Access Existing Form; and Uploading Documents to FECA Case Files.

.10       Other Claimants.  Claimants for survivor benefits or for burial benefits are responsible for:

a.         Submitting the appropriate claim form to the employee’s supervisor within required time limits.

b.         Establishing that the death was causally related to factors of employment through the submission of factual and medical evidence that supports the claim filed.  Further, unless the relationship between the death and the employment is obvious, the claimant must present medical evidence relating the death to the injury.

c.         Submitting the official death certificate.

d.         Submitting additional documentation necessary to establish claimant’s survivor status.

.11       Health Units.  Health units are responsible for:

a.         Providing first aid for all injured employees upon request.

b.         Referring injured workers for further medical treatment beyond the scope of the medical facility/health unit, at the request of the employee.

c.         Issuing to an employee, or person designated to act on behalf of the employee, the appropriate instructions for notifying his/her supervisor of the incident; for completing the DOL/OWCP ECOMP forms; and for completing the Department’s online Form CD-137 to report work-related injury or illness.

 

SECTION 8.  PROCEDURES.

.01       Federal Employee New Claims Activities.

a.         When a Department employee sustains an injury or illness as a result of a work-related accident/incident, the employee must obtain appropriate first aid and/or medical treatment by visiting the health unit or other designated emergency medical treatment facility.

b.         The injured/ill employee (or someone acting on the employee’s behalf) must notify his/her supervisor as soon as practicable regarding the incident and should make reasonable efforts to do so before the end of the shift during which the incident occurred or within twenty-four (24) hours.

c.         The injured or ill employee (or someone acting on the employee’s behalf) must file an injury/illness report using CD-137, Report of Incident, Injury, Illness, Motor Vehicle Accident, Property Damage, or Fatality.

d.         The injured or ill employee (or someone acting on the employee’s behalf) must follow the injury, illness reporting procedures for the Department (as stated by DAO 209-3) and his or her bureau or operating unit.  The affected employee must complete questions 1–24 of the CD-137 accident report as completely as possible.  The CD-137 form must be completed in close collaboration with the employee’s supervisor and submitted within twenty-four (24) hours of the incident to the employee’s supervisor.  The supervisor needs to complete his/her review of the completed CD-137 form and submit a signed copy to the Bureau’s Safety Manager/Coordinator within five (5) working days.

e.         The injured or ill employee should initiate a prescription request if the employee’s medical condition results in a doctor’s prescription, and the claimant elects to use the Department’s Workers’ Compensation Pharmacy Benefits Program.  Following completion of a CA-1 or CA-2 claim, the claimant should obtain a temporary First Fill card along with instructions for filling out the card from his/her supervisor or workers’ compensation specialist.  The supervisor or workers’ compensation claims specialist will be able to assist claimants in completing the First Fill cards.

f.          If the injured/ill employee elects to file a workers’ compensation claim, he/she (or someone acting on the employee’s behalf) must use the DOL/OWCP ECOMP system (https://www.ecomp.dol.gov/#) to file the appropriate Workers’ Compensation forms (generally completing items 1–15 of CA-1, CA-2, etc.):

1.         CA-1 claim forms are used when a work-related traumatic injury occurs (i.e., single incident injury, or repetitive injury, which occurs during one work shift).

2.         CA-2 claim forms are used when a work-related occupational illness occurs (i.e., exposure to work factors for more than one work shift that causes an injury/illness).

g.         To use the DOL/OWCP ECOMP system  for form filing, the injured/ill employee (claimant) will need to establish an account by using the “Sign In/Register” function on the ECOMP home page.

h.         To establish an ECOMP account, the claimant will need to provide his/her:  email address; government organization; supervisor’s email address; for new injury/illness claims, details for the event (place, time, extent of injury, etc.); if available, supporting documentation, such as medical reports (have these ready in electronic format); and if filing a CA-7 form, the case number.

i.          To obtain his/her agency information, the claimant should consult his/her supervisor, or Bureau Safety Manager, coordinator, representative or specialist, or workers’ compensation specialist.

j.          Once the claimant establishes his/her ECOMP account, he/she will be able to sign-in to the account and manage the entire process from the Employee Dashboard.  To get to the Employee Dashboard, the claimant should click “Sign In/Register” on the home page.  To get to forms to be filed, the claimant should click on “File a Form” on the home page and enter his/her agency information.

k.         Once the claimant submits his/her claim to the OWCP, through ECOMP, he/she will:

1.         Be assigned a case number and receive an informational letter from the OWCP with that case number.

2.         Be able to use the information in the letter to view his/her case status, billing updates, coverage limitations, and other information via the Claimant Query System “ACS Web Bill Processing Portal.”

3.         Be able to submit information pertaining to his/her case file through ECOMP's Document Upload feature (available from the ECOMP home page), and also, use the upload feature for any existing case, not just those initiated through ECOMP.

Note:  In order to use the Document Upload feature, the claimant will need his/her last name, case number, date of birth, and date of injury.

4.         Be able to file a Form CA-7 (Claim for Compensation).  A CA-7 can be filed for any existing claim, not just those initiated through ECOMP, as long as the claimant has a case number and other identifying information.

5.         Be able to file a CA-7a (Time Analysis Form) for intermittent periods of wage loss and/or CA-7b (Leave Buy-Back Worksheet Certification).

l.          Once the claimant submits his/her claim to the OWCP, through ECOMP, he/she has the legal burden to prove that the claim-related medical condition is work-related.

Note:  The workers’ compensation contractor can advise the claimant on the type of evidence needed to support a successful claim.

m.        Once the claimant submits his/her claim to the OWCP, through ECOMP, he/she is responsible for:

1.         Keeping his/her supervisor and the Department’s workers’ compensation contractor informed of the status of his/her condition.

2.         Providing his/her supervisor and the Department’s workers’ compensation contractor with the relevant medical reports to support his/her disability claim.

3.         Requesting leave (COP, annual, sick leave, and/or LWOP) from his/her supervisor.

4.         Returning to work when the physician releases him/her to return to light, limited, or full duty.  The DOL will not authorize compensation for employees who refuse suitable work.

02.       Supervisors’ New Workers’ Compensation Claims Activities

When a supervisor has an employee who has been injured or sustained a work-related illness or has an employee who wishes to file a claim for traumatic injury or work-related illness, the supervisor is responsible for:

  1.       Assisting the employee in receiving first aid and/or advising the employee to seek other

appropriate medical attention.

b.         Assisting injured or ill employee to complete questions 1–24 of the CD-137, Report of Incident, Injury, Illness, Motor Vehicle Accident, Property Damage, or Fatality: as thoroughly as possible.  The employee must complete the CD-137 report (or equivalent) within twenty-four (24) hours of the incident.  Then, follow the distribution of copies requirements of Section 8 of DAO 209-3.

c.         Reviewing the employee’s portion of CD-137 for completeness and accuracy, completing questions 25–31 of the CD-137, signing the report, and submitting a signed copy of the report to the Bureau Safety Manager/Coordinator within five (5) working days, and distributing it in accordance with instructions provided on the form.

d.         Providing an employee who has initiated a CA-1 or CA-2 claim, and needs a prescription filled, with a temporary First Fill card along with instructions for filling out the card.  Assist the employee in completing the First Fill card.

e.         Assisting injured/ill employee to establish an ECOMP account and use ECOMP to complete questions 1–16 of the DOL/OWCP CA-1 form, the Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, or questions 1–18 of the DOL/OWCP CA-2 form, Notice of Occupational Disease and Claim for Compensation.

f.          Reviewing for completeness and accuracy the ECOMP CA-1, CA-2, CA-7, or CA-7a form completed by the employee who sustained a work-related traumatic injury or occupational illness.

g.         Completing questions 17–38 of the DOL/OWCP CA-1 or questions 19–35 of the CA-2.

h.         Contacting the workers’ compensation contractor when one of his/her employees suffers a traumatic injury (single episode injury or repetitive injury that occurs during one work shift).

i.          When contacted, the workers’ compensation contractor will provide specific instructions for claim-related procedures to follow and if appropriate, will issue a CA-16, Authorization for Examination and/or Treatment.

Note:  Generally, this form should not be issued more than seven (7) days after a traumatic injury.  This form should not be issued for occupational illness claims.

j.         Using ECOMP to submit the completed report forms (e.g., CA-1, CA-2, CA-7, or CA-7a) to the workers’ compensation contractor for further processing, review, and submittal to DOL/OWCP.

03.      Workers’ Compensation Specialists’ New Claims Activities.

a.         Within 5 working days of receiving a completed ECOMP workers’ compensation claim form, the workers’ compensation specialist will:

1.         Review claims for completeness and accuracy of required information and forward them to the workers’ compensation contractor for further processing and review.

2.         Review the claim to determine suitability for possible controversion or challenge.

b.         Assist injured or ill employees in pursuing their options under the Department’s leave buy-back program.

c.        Provide an employee who has initiated a CA-1 or CA-2 claim, and needs a prescription filled, with a temporary First Fill card along with instructions for filling out the card.  Assist the employee in completing the First Fill card.

d.         Provide case management assistance.  Examples of case management activities include, but are not limited to:  reviewing and verifying claims; identifying and requesting the claimant or affected supervisor provide any additional or missing claims-related information; rejecting claims for incomplete information or if requested additional or missing claims-related information is not provided; controverting COP; processing leave buy-back requests; conducting periodic roll claims reviews through monitoring medical evidence and work status; etc.

e.        Provide return-to-work assistance through implementation of the Return-to-Work Program by developing the annual return-to-work plan and quarterly status reports.

f.         Provide compensation cost monitoring by reviewing, analyzing, and tracking DOL/OWCP quarterly chargeback reports for compensation benefits paid for work-related injuries and deaths, and when appropriate, compensation savings.

g.        Provide assistance in detecting, investigating, and reporting fraud, waste, and abuse in the Workers’ Compensation Program.

h.        Reporting any fraud, waste, and abuse in the workers’ compensation activities of his/her bureau or operating unit to the OOSH Workers’ Compensation Program and to the OIG.

04.      New Workers’ Compensation Claims Activities.

a.        The workers’ compensation contractor within two (2) working days of receiving a completed ECOMP workers’ compensation claim form, will:

1.         Review claims for completeness of required information; identify and request claimant or affected supervisor provide any additional or missing claims-related information; reject claims for incomplete information or if requested additional or missing claims-related information is not provided; and forward adequately completed claims forms to DOL/OWCP for adjudication.

2.         Coordinate with the affected bureau, operating unit, or Department workers’ compensation specialist to review the claim for accuracy and suitability for possible controversion or challenge.

3.         Provide an employee who has initiated a CA-1 or CA-2 claim, and needs a prescription filled, with a temporary First Fill card (upon request) along with instructions for filling out the card.  Assist the employee in completing the First Fill card.

4.         Develop and submit controversions of COP when a claimant is not entitled to such, or prepare memoranda approving COP and duration of pay when claimant is entitled.

5.         Notify claimants of receipt of claims and provide them information regarding their claims.

6.         Work with the Department, supervisors, claimants, DOL/OWCP, and medical providers to ensure that claims’ cases are effectively managed and that claimants are receiving all benefits to which they are entitled.

05.       DOL/OWCP New Workers’ Compensation Claims Activities.

a.         When receiving a completed workers’ compensation claim form through ECOMP, DOL/OWCP will:

1.         Review the claims form and identify and request that the claimant or affected supervisor provide any additional or missing claims-related information needed to adjudicate the claim or reject claims for incomplete information.  Conversely, if OWCP has additional claims-related information obtained independently, provide such information to the claimant and/or affected supervisor.

2.        Accept or deny the claim based on the information provided.

3.        Send all claims and documentation related to an employee’s death in the performance of his/her job duties to OOSH, OHRM.

4.        Submit quarterly chargeback reports to OOSH, OHRM detailing the medical and compensation costs paid per claim.

06.      OOSH New Workers’ Compensation Claims Activities.

a.        When receiving a completed workers’ compensation claim form through ECOMP, OOSH will:

1.        Receive, review, and electronically file all new claims (CA-1s and CA-2s) received following the workers’ compensation contractor’s processing.

2.        Identify any third-party involvement in the claims case.

3.        Send a letter to DOL/OWCP for all cases identified as third-party involvement, and request assistance in seeking reimbursement.

.07      The Department’s Return-to-Work Program.

a.        The Department will make all feasible efforts to return an injured employee to work as soon as he/she is medically cleared to do so. 

b.        In absence of medical documentation that indicates an injured worker is unable to return to the workplace in a full-time, light duty, or limited duty assignment, the OOSH Director will implement the return-to-work procedures outlined in the current HR Bulletin 182 (FY14), dated April 7, 2014, describing the Department’s Workers’ Compensation Return-to-Work Program.

 

SECTION 9.  FORMS.

.01       The following forms, available from OOSH or ECOMP (DOL/OWCP) are required to establish a workers’ compensation claim:

a.         DOL Form CA-1, Federal Employee’s Notice of Traumatic Injury and Claim for
Continuation of Pay/Compensation.

b.         DOL Form CA-2, Notice of Occupational Disease and Claim for Compensation.

c.         DOL Form CA-5, Claim for Compensation by Widow, Widower and/or Children.

d.         DOL Form CA-5b, Claim for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren.

e.         DOL Form CA-6, Official Supervisor’s Report of Employee’s Death.

f.          DOL Form CA-7, Claim for Compensation.

g.         DOL Form CA-7a, Time Analysis Form.

h.        DOL Form CA-16, Authorization for Examination and/or Treatment.

i.          DOL Form CA-20, Attending Physician’s Report.

 

SECTION 10.  EFFECTS ON OTHER ORDERS. 

This Order supersedes Department Administrative Order 202‑810, dated September 18, 2007, and the provisions of all bureau or operating unit directives that prescribe authorities, responsibilities, or policies related to workers’ compensation.

 

Signed by: Director for Human Resources Management

Approved by: Chief Financial Officer and Assistant Secretary for Administration

Office of Primary Interest: Office of Human Resources Management

Questions and Comments

Send Questions or Comments on the Commerce Directives Management program to Directives@doc.gov.

Office of Privacy and Open Government
Office of the Chief Financial Officer and Assistant Secretary for Administration
U.S. Department of Commerce

 

Page last updated:April 25, 2017