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 Compensation Benefits
Medical Benefits
$1,000

$500

$-
1995 1997 1999 2001 2003 2005
FY 1996 includes one-time accounting adjustment of +$85 million.
 Total Compensation
$2,501,000,000
Chargeback
$2,251,000,000 04
$2,001,000,000
Chargeback
05
$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

Total
Army
USPS

DHS

DOD
Navy

Education
Justice
Transportation
Air Force

Interior
VA
 Total Compensation
$250,000,000

$225,000,000

$200,000,000 Chargeback 04
$175,000,000 Chargeback 05

$150,000,000

$125,000,000

$100,000,000

$75,000,000

$50,000,000

$25,000,000

$0
Army

USDA

SSA
Air Force
Navy

Education
DHS

DOD
Justice
Transportation

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
Nurse Interventions
3,000
Returns to Work
1,500
0
1995 1997 1999 2001 2003 2005
 Lost Production Days in QCM
Cases
Measured w/i 1st Year from the Date Wage Loss Began

200
5

9
180
19

7
18

18
Calendar Days

3
17
160

4
16

2
16

16

16

7
15
140

15
120

100

4Q, '97 '98 '99 '00 '01 '02 '03 '04 '05
'96
Fiscal Year
 Goal 4 - Lost Production
Days
160 FY03
FY04
140 147.6 147.2 FY05
148.8 FY06 Goal
Rate per 100 Employees

120 134.4 FY06 Q1

No Goal
100

80

60
61.9 56.1 57.1
56.0 54.3
40

20

0
USPS (non-SHARE) All Other Gov't
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

z To reduce Total Case Rates by at least 3% per year

z To reduce Lost Time Case Rates by at least 3% per year

z To improve the timely filing of injury and illness notices by

at least 5% per year

z 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 FY03
FY04
140 147.6 147.2 FY05
148.8 FY06 Goal
Rate per 100 Employees

120 134.4 FY06 Q1

No Goal
100

80

60
61.9 56.1 57.1
56.0 54.3
40

20

0
USPS (non-SHARE) All Other Gov't
 0
25
50
75
100
125
150
175
200
225
250
275
Navy

Army

VA

Air Force
Days

DOT

Treasury

TVA
Major Agency

USDA

DOD

Justice

Interior

HHS

Labor

Commerce
Goal 4 - Lost Production

DHS

SSA

HUD
FY05
FY04
FY03

All - Less USPS

 Goal 4 - Lost Production
Days
Major Agency – FY06 Goal vs. Actual
225
FY06 Goal
200 FY06 Q1

175

150

125

100

75

50

25

0
Army

Air Force

All - Less USPS

VA

TVA

USDA

SSA
Labor
Interior
Navy

Treasury

Justice

Commerce
DOT

HHS

DHS
DOD

HUD
 Goal 3 - CA-1/CA-2 Timeliness
(filed in 14 calendar days)

100% FY03
FY04
90% FY05
88.7% 92.5% 93.1% FY06 Goal
80%
79.0% FY06 Q1
70%
70.9% 69.9%
60%
61.4%
57.4%
No Goal
50%
49.6%
40%
30%
20%
10%
0%
USPS (non-SHARE) All Other Gov't
FECA Reform

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

Equity and fixes

zRestore waiting period
zAllow for subrogation of COP for Third
Party claims
zUpdate disfigurement and burial
payments
zPay 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
zConsequential
zIntervening
|Death – CA-5 and CA-6
Controverting COP

| The agency may controvert COP ONLY if one of the

following applies:
z Disability is a result of occupational disease or illness
z Employee comes within the exclusions of 5 USC 8101 (1)
(B) or (E)
z Employee is neither a citizen nor resident of the US or
Canada
z Injury occurred off the agency’s premises and the employee
was not engaged in official “off premises” duties
Controverting COP –
continued
z Employee’s willful misconduct, intentional harm or
death, or proximate intoxication
z Injury not reported within 30 days of injury
z Work stoppage first occurred more than 45 days after
the injury
z Employee reported injury after employment was
terminated
z 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
z Timely Filing of Claim
z Federal Civilian Employee
z Fact of Injury
z Performance of Duty
z Causal Relationship
Conditions of Coverage

| Timely Filing
Employee Has Three Years From:
z Date of Injury
z Date of First Awareness
z Date of Last Exposure
| Civil Employee
z FECA covers all civilian employees except for non-
appropriated fund employees
z 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

z Advising the claimant and the agency of

procedures for establishing a claim,
including detailed instructions for developing
the evidence
z Requesting all evidence necessary to
adjudicate the case
z Identifying potential third party cases so that
attempts at recovery may begin
z Making prompt decisions
OWCP Responsibilities

| Once a claim is adjudicated, claims

examiners are responsible for the following
case management activities

z Focus on Return to Work

z Initiate Interventions and Services
z Request Medical Information
z Follow up with the assigned Field Nurse or
Rehabilitation Specialist
z 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
z CA-1 and CA-2 within ten workdays of receipt
z 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
z enables prompt adjudication and medical
management of claim
z ensures compliance with the SHARE
initiative and Federal regulations
Containing OWCP Costs

| Controvert/Challenge Questionable Claims

z OWCP accepts employee statement as
factual unless agency provides refuting
evidence
z 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.
z Include actual evidence rather than
conjecture or opinion
Containing OWCP Costs

| Track Injured Employees’ Medical Status

z Maintain constant contact with employee

z Request frequent medical updates – in

writing from physician

z Cooperate with OWCP nurses, Claims

Examiners, Vocational Rehabilitation
Specialists, and Workers’ Compensation
Specialists/Injury Compensation Specialists
Containing OWCP Costs

| Offer Light Duty

z Match employee’s physical limitations to your
particular needs

z Create temporary positions where none exist

z 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.