Your employee has come to you and reported an injury on the job. What are you supposed to do? What type of a condition is it, and what is the process for filing a claim? This handbook will walk you through the basic steps of getting your employee the needed medical care, and then guide you through the sometimes complicated and confusing steps of reporting and documenting your employee's compensation case. We will touch on how you can assist your employee in returning to the workforce, which will help you get the workload accomplished and reduce compensation expenses.
While reading through this handbook, remember, you are not alone. Anytime you have questions or need assistance in dealing with a workers' compensation issue, you can call your Workers' Compensation Specialist for assistance and advice. Points of contact for the program and a list of frequently used forms are included in the appendices of this booklet to assist you with your responsibilities.
This handbook does not cover all the details of the Federal Employee's Compensation Act (FECA) or all the benefits employees may be due. Rather it is intended to provide quick and simple guidance that will help you through the majority of the situations you will encounter if one of your employees suffers a job related injury or disease.
What Type Of Condition Does My Employee Have?
Most work-related medical conditions fall into two categories (1) traumatic injury (Form CA-1), and (2) occupational disease (Form CA-2). You will need to be familiar with these categories so you can help your employee complete the correct paperwork. The easiest way to identify the difference between the categories is to identify how long it took the medical condition to occur.
Traumatic Injury (Form CA-1): If the condition happened in the course of one work shift, the condition is an injury. Examples: cut finger; tripped and fell; hit by forklift, etc. Sometimes the reported condition may not seem like an injury, such as mental stress or back strain. However, if the employee identifies the condition as occurring in the course of one work shift, the condition is still considered to be a traumatic injury.
Occupational Disease (Form CA-2): If the condition happened because of events in more than one work shift, the condition is an occupational disease. Examples: back strain from unloading trucks for the past two weeks; carpal tunnel from daily use of computer keyboard, etc.
Note: Your employee may complain of suffering a recurrence of a prior injury or disease and state the desire to file for benefits under the prior claim. A recurrence is defined as a return of symptoms related to the original injury or disease for no explainable reason other than there was a prior medical condition. If a new event or series of events (e.g., bent over to tie shoes, moved boxes, etc.) causes a return in symptoms, the condition must be treated as a new injury or disease as described above even if the exact same part of the body is affected. If symptoms do begin for no explainable reason other than the prior injury or disease, the employee can file for a recurrence under the prior claim. Recurrence claims are not detailed in this handbook (contact your Workers' Compensation Specialist for details).
How Do I Get My Employee Medical Attention?
Regardless of the category of the medical condition, your first concern will be to determine if your employee needs immediate medical care. If immediate care is required, assist in making arrangements for your employee to go to the nearest health care facility or to their private health care provider. Make sure your employee can safely drive. If the employee cannot drive, ensure that transportation is available, or call an ambulance. You can authorize the medical treatment by telephone to the private provider or hospital, and follow-up with the CA-16 to the medical facility within 48 hours.
If the situation is not an emergency, you will want to take time to discuss the situation with your employee. The Public Health Service (PHS) health care facilities can provide medical attention, and forms to report the work-related condition. Remember that you cannot authorize medical treatment in occupational disease claims without prior Office of Workers' Compensation Program (OWCP) approval. Forms required to obtain medical care are:
Traumatic injuries within the last 48 hours. Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider.
Occupational Diseases or traumatic injuries that occurred more than 48 hours ago. Form CA-20 - Attending Physician's Report. Because it is harder to prove that occupational diseases or injuries that are not recent were caused at work, a form that guarantee's payment for something that may not be the government's responsibility would not be appropriate. If the employee's claim is accepted, the medical bill will be paid even though a CA-16 was not issued.
It is recommended that you provide your employee with Form CA-17 - Duty Status Report to give to the physician. This form informs the doctor of the type of physical requirements your employee regularly performs; informs the physician that you can accommodate light and/or part-time duty; and provides the doctor a means to communicate to you what the employee can safely do; when the employee can return to light duty work; and when the employee can resume regular duty.
Your employee may decline to report for medical care; however, it will be important to the claim to have early medical reports. If you offer the employee an opportunity to seek medical care and the employee refuses, document the refusal with the claim.
I Don't Agree With My Employee's Report Of Injury
The circumstances surrounding the reported injury or disease may arouse your suspicions that the condition is not work-related. If this occurs, remember that a a supervisor, you are obligated to assist your employees in processing their paperwork in a timely manner, and your failure to do so can be punishable under the law. Neither you nor the agency can determine if an employee should file a claim or receive benefits. The DOL has the sole authority to approve or disapprove claims and to determine if benefits will be paid.
Rather than impeding the employee’s rights to file a claim, gather witness statements and facts to challenge the claim. The sooner you accomplish this the better, because once the DOL approves a case or pays benefits, it is difficult, if not impossible to have them change their decision. In you plan to challenge a claim but need additional time to gather your information, have your Workers’ Compensation Specialist attach a note to the claim and formally request an extension (normally 30 days) from the DOL so that they can consider your additional factors before adjudicating the claim.
We Got Medical Care, Now How Do We File The Claim?
You should encourage your employees to report all work-related conditions to you and to file the CA-1 or CA-2, even if there is no lost time or medical expense. All work related injuries/illnesses are to be reported using the Employees' Compensation Operations and Management Portal (ECOMP). The Department of Labor (DOL) considers claims to be 'allowable' if they are reported within three years; however, it will be easier for the employee to prove his or her case if paperwork is submitted as soon as possible after the injury or disease occurs. You are encouraged to familiarize yourself with the ECOMP process so that you can assist your employee with initiating a claim. Then you may challenge the claim. (For more information on challenging the claim, see the section below - "I Don't Agree With My Employee's Report Of Injury")
Effective October 1, 2012, claims for workers' compensation must be filed electronically using ECOMP. ECOMP allows Federal employees to file claims for benefits under the FECA online. You will be begin by registering with at the ECOMP website: https://ecomp.dol.gov/. Employees are required to register and create an ECOMP account before filing a claim. Completion of your claim requires close coordination between you, the employee, Occupational Safety and Health Specialist and your Workers' Compensation Specialist.
NOTE: In many instances, some of the sections on Forms CA-1 and CA-2 will not apply to your situation. Rather than leave them blank (which will result in them being returned to you and delaying the employee's claim), indicate "N/A".
Injury/illness claim paperwork must be processed through you, the immediate supervisor, your Workers' Compensation Specialist, and DOL within 10 work days from the day the employee submits the paperwork to you. Upon receiving the documents, fill out and return the receipt portion to your employee. It is then your responsibility to promptly forward the original claim forms to your Workers' Compensation Specialist within the allotted time frame. Your Workers' Compensation Specialist will complete agency coding, process the case file, and forward claims to the DOL. Submit any additional paperwork (CA-16, CA-17, CA-20, witness statements, challenges, etc.) with the claim or as soon as they become available.
You may receive medical updates, bills, etc., on your injured worker after the original claim has been filed. Submit all original documents to your Workers' Compensation Specialist to be included in the agency case files and for processing through DOL.
The circumstances surrounding the reported injury or disease may arouse your suspicions that the condition is not work-related. If this occurs, remember that as a supervisor, you are obligated to assist your employees in processing their paperwork in a timely manner, and your failure to do so can be punishable under the law. Neither you nor the agency can determine if an employee should file a claim or receive benefits. The DOL has the sole authority to approve or disapprove claims and to determine if benefits will be paid.
Rather than impeding the employee's rights to file a claim, gather witness statements (e.g., if anyone heard the employee state that he hurt himself over the weekend, the employee works another job, etc.) and facts to challenge the claim. The sooner you accomplish this the better, because once the DOL approves a case or pays benefits, it is difficult, if not impossible to have them change their decision. If you plan to challenge a case, but do not have time to gather your information before you initiate and process the claim, attach a note to be submitted with the claim and your Workers' Compensation Specialist can formally request an extension (normally 30 days) from the DOL. This process is necessary so that DOL does not adjudicate the claim without the additional facts.
You can anticipate that the DOL will contact you and the employee in a conference call to settle any conflict in the presented facts, or write to you and ask for more details on the case. Respond fully to such requests, and within the time frames given by the DOL. Without your answers, they will consider only the information on hand, and your employee may have sent in enough information to get the case approved despite your initial efforts.
Although it is a slow and sometimes frustrating process, you should always take the effort to challenge suspicious claims. The pay-off in money saved from one successfully challenged claim will more than offset the time you invest in doing a conscientious and thorough job of presenting the facts.
Now That It's Over. Congratulations!! In addition to your demanding job as a supervisor, you have successfully managed your injured workers' situation. Hopefully, he/she made it back to work and you are receiving some type of productivity for your efforts.
At this time you will want to remember that the successful management of the case took teamwork. You probably had subordinates that pitched in and did more than their fair share to get the job done and keep your mission going while you were shorthanded. Remember those employees when giving performance ratings, with awards, and words of appreciation, as appropriate. Your actions will enhance a positive work environment and foster the teamwork spirit that gets you through these tough times.
How Do I Cover My Employee's Absence?
Benefits to cover absences differ based on whether the employee suffered a traumatic injury or an occupational disease. We will cover each separately.
Continuation Of Pay (COP) For Traumatic Injury: Your employee may be eligible for uninterrupted pay beyond the date of injury without charge to leave. This benefit is called continuation of pay and is granted if all the following conditions are met:
The employee suffered a traumatic injury and filed form CA-1 within 30 days from the date of the injury.
The employee has provided you with valid medical documentation to show that the inability to work in any capacity is due to the injury.
The absences due to the injury began within 90 days from the date of injury.
The employee's absences do not exceed a total of 45 calendar days of COP. COP counts in whole day increments. If the employee works partial days, but is entitled to COP for the remainder of the work day, the few hours of COP count as a whole day of the 45 day entitlement.
If the employee returns to work, but has a recurrence of disability within the 90 days, the employee may receive COP for any of the remaining 45 day period he/she has not yet expended, even if the disability extends beyond the 90 day period.
NOTE: Medical verification of the employee's disability along with a copy of the worksheet should be annotated and submitted to your Workers' Compensation Specialist at the end of each pay period during which your employee used COP. This action should be coordinated with the timekeeper prior to coding the time sheets to ensure that the employee's pay is not adversely impacted. This enables your Workers' Compensation Specialist to assist in tracking the entitlement.
Denial Of COP: You may believe that your employee is not eligible for COP. Be aware that you can only deny COP based on the following reasons (if COP already began, terminate it) :
The disability is caused from an occupational disease rather than a traumatic injury.
The employee is not a U.S. citizen or a resident of the U.S. or Canada.
The injury occurred off government premises and the employee was not involved in official "off premise" activities.
The injury was caused by the employee's willful misconduct.
The injury was not reported on CA-1 within 30 days following the injury.
Work stoppage first occurred 45 days or more after the injury.
The employee initially reported the injury after his/her employment was terminated.
The employee is enrolled in the Civil Air Patrol, Peace Corps, Job Corps, Youth Conservation Corps, Work Study Program, or other similar groups covered by special legislation.
The employee is a volunteer working without pay or for nominal pay or persons appointed to the staff of a former president.
Note: If your employee is eligible for COP, but the claim is later denied, DOL will direct the Department of Justice to recoup the COP by changing the COP absences to leave or leave without pay. Also, COP can be terminated if the employee refuses a job offer within his/her restrictions and limitations, or fails to respond to your job offer.
Absences After COP: In many cases, an employee will return to work without using all 45 days of entitlement of COP. Should such an employee suffer a recurrence of disability, he or she may use COP is no more than 45 days have elapsed since the date of first return to work, including part-time work and or light or limited duty.
The employee can use sick or annual leave to continue uninterrupted pay, or:
Elect Leave Without Pay (LWOP) and submit Form CA-7 - Claim for Compensation. Form CA-7 alerts the DOL that the employee is not receiving any income and initiates wage loss pay. Form CA-7 is also used to claim absences at two week intervals if the absences continue beyond the period claimed on the initial form CA-7. The employee has the responsibility to submit medical documentation to support that the ongoing absences are related to the work-injury and should anticipate at least a 3-4 week delay before they receive pay from DOL. The delay can be longer if a claim is incomplete or controversial. Employees who elect to use their own leave can later repurchase the leave with their compensation benefits using Form CA-7. Information on this option (Leave Buy Back) is explained at Appendix C. Form CA-20 "Attending Physician's Report" should be filed at the same time as the CA-7. If the employee is losing time from work, these forms should be filed with OWCP five working days prior to the end of the 45 day COP period. CA-7 Forms are to be processed using ECOMP.
Absences Due To Occupational Disease: COP is not a benefit for occupational disease. If the employee cannot work due to the claimed condition, two options are available:
Use sick or annual leave to continue uninterrupted pay or:
Elect Leave Without Pay and submit Form CA-7, to request wage loss benefits from the DOL via ECOMP. Form CA-7 initiates wage loss pay, and continues wage loss at bi-weekly intervals if the absences continue beyond the initial period claimed on the form CA-7. The employee has the responsibility to submit medical documentation to demonstrate that the absences are related to the claimed work-condition. Because occupational disease claims take longer to adjudicate, it can take several weeks or even several months before the employee can expect to receive pay from the DOL. As a result, most employees elect to use their own leave and then later repurchase the leave with their compensation benefits.
Note: If disability continues beyond the date shown on the initial CA-7, subsequent Form CA-7s should be submitted 5 to 7 days before the end of the period claimed on the last claim form submitted. Form CA-20 (Attending Physician's Supplemental Report) should be filed with the subsequent CA-7.
Keep Up Communication
Make regular contact with your employee to let him/her know that he/she is missed at work and offer your assistance with any job or claim concerns. Your employee is anxious and nervous about what is happening with his/her job and future and your regular communication can work more magic in expediting your employee's recovery and return to work than any medical science.
Send Form CA-20, as well as Form CA-17, to the doctor every two weeks or as often as needed to keep updated on your employee's work status.
Keep your managers and the injured employee's co-workers informed of what is happening. By doing so, you will receive their support and cooperation in keeping up the extra workload and, when the time comes, in bringing the injured worker back to duty. Bringing the worker back to a positive environment will help your employee continue down the road to recuperation and/or help in the adjustment to job rehabilitation.
Keep your Workers' Compensation Specialist, and the DOL informed by forwarding all documentation regarding your injured worker for inclusion in the case files.
How Do I Document The Time And Attendance Report?
Date of Injury: For traumatic injuries only, if the employee cannot return to work following the injury and the injury occurred after the beginning of the work shift, the employee is carried as “administrative leave” on the time and attendance report for the number of hours not worked as a result of the injury.
COP:COP is coded TC67 which is leave for a duty-related traumatic injury. This code may only be used if: the employee suffered a traumatic injury; filed a CA-1 within 30 days from the date of injury; has provided you with medical documentation to support total disability due to the injury within 10 days, and does not exceed 45 calendar days of COP; and the disability begins within 45 days from the date of injury.
COP may be used in increments. Example: Your part-time (6 hours per day) employee has a release to return to work, but must go to physical therapy two hours per day. The time and attendance record would show four hours regular duty and two hours Code TC67, COP. Remember that even though only two hours of COP were used on this day, it still counts as whole day of the 45 days entitlement of COP.
Leave Without Pay: LWOP due to an injury or occupational disease is coded 71 which is approved leave with no pay. This puts the employee in an approved, LWOP status and flags it as being a work-related medical condition. Unlike other LWOP absences, the time missed from work will not count against the employee's tenure benefits, such as within grade increases and leave accrual.
This is the key to effectively managing your injured worker's case. It is DOJ policy to have injured workers return to work as soon as possible. The reasoning behind this policy is that all the benefits your employee receives from the DOL are charged back to the agency. Since you are "paying" your employee, you may as well arrange to get some productivity for your money, and at the same time help your employee's recuperation and rehabilitation by helping him/her feel needed and a part of the organization. Therefore, you will want to do everything possible to help your employee return to work by looking at the following options:
Can my employee return to his/her former job without modification?
Can my employee return to his/her former job with modification?
Can my employee return to another job in the organization?
Can a job be created to accommodate my employee's restrictions?
Since you are most familiar with your work area, you are the first line of making accommodation for your employee to return to work. Any such accommodation must be documented in writing to ensure that you, the employee, and the DOL know that accommodation has been made and that it is reasonable and within the employee's capabilities. If accommodation is not documented, and you have to later separate your employee, or if your employee just doesn't report for duty, he/she will likely be eligible to resume compensation.
All light and limited duty assignments must be documented in writing for the file. The employee and supervisor should sign the document, keep a copy for the file and forward to the appropriate WCS.
The Condition Is Permanent And My Employee Is Not Able To Return To The Former Job
Chances are you cannot afford to let your worker be indefinitely assigned to his/her regular position, drawing full wages when he/she can only perform limited duties. Steps can be taken to reassign the injured worker to another position so you can better manage your manpower allocations. If the reassignment results in lower wages or less hours of work for the employee, a claim can be filed for the difference in wages with DOL. Contact your Workers' Compensation Specialist and/or Human Resources for guidance.
If you cannot easily identify another position, you will want to work with your servicing Workers' Compensation Specialist and Human Resources to determine if another job can be developed.
In extreme cases, you may not be able to accommodate your injured worker and you may have no choice but separation. However, this could potentially be a million dollar decision and should only be considered as a last resort. Once your employee is separated, he/she will likely be eligible to resume compensation benefits (even if separated through retirement) and may receive these compensation benefits for the rest of his/her life. As mentioned before, these benefits will be charged back to the agency, with you receiving no productivity in return.
Employees' Compensation Operations and Management Portal Brochure (available only on the Department's intranet)
The following compensation forms information has been provided on only those forms you are likely to use.
CA-1 - Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation. Use for traumatic injury - employee was hurt because of a single event or within one workday.
CA-2 - Notice of Occupational Disease and Claim for Compensation. Use for occupational disease or illness claims - medical condition developed over more than one workday (i.e. carpal tunnel, skin disease).
CA-2a - Federal Employee's Notice of Recurrence of Disability and Claim for Pay/Compensation. Use for recurrence of injury or occupational disease - medical condition has flared up for no other explainable reason other than a previous work-related condition.
CA-7 - Claim for Compensation on Account of Traumatic Injury or Occupational Disease. Used for the following purposes:
- To claim loss wages when continuation of pay expires on a traumatic injury, and to claim wage loss on occupational disease claims.
- Use to initiate leave buy backs.
- Use to claim a scheduled award (employee has reached maximum medical improvement but has suffered a permanent loss or impairment to a part of their body).
- Use to keep compensation for wage loss coming in on a regular basis for employees on leave without pay.
CA-16 - Authorization for Examination and/or Treatment. This form guarantees the physician payment for care provided to the injured employee.
CA-17 - Duty Status Report. This form allows the physician to keep you updated on your employees work restrictions and/or duty status.
Send original forms/documents to your Workers' Compensation Specialist as soon as possible.
Failure to submit claim forms in a timely manner by employee (30 days) jeopardizes the employee's benefits. Failure to submit claim forms in a timely manner by supervisor (10 days) can result in a fine and/or imprisonment (20 CFR 10.16). Submit information to challenge claims rather than avoid or delay the process.
Incomplete forms cause unnecessary delays to the employee and cause complications with processing the claim. Look at and address every section for all forms. Indicate not applicable (N/A) if information is not pertinent. Call your Workers' Compensation Specialist if you need assistance.