What you need to know about Workers’ Compensation

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What you need
to know about
Workers’
Compensation
Northern Rockies Incident
Business Committee
2015
1
2
Overview
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Overview of the Federal Employee
Compensation Act Program
Define Roles and Responsibilities
What happens when an employee is injured
or fall ill on the job
Specifics of the Federal Workers’
Compensation Program for each agency
Forms Review
When and how to use Agency Provided
Medical Care
Wrap-up
3
Federal Employee
Compensation Act

The Federal Employees' Compensation Act (FECA)
(5 U.S.C. 8101 et seq.) is administered by the
OWCP of the U.S. Department of Labor

OWCP provides compensation benefits to civilian
employees of the United States for disability due to
personal injury sustained while in the performance
of duty or for an employment-related disease

Payment of benefits to dependents if the injury or
disease causes the employee's death is also
covered under OWCP
4
Why do we care?

Employee health is our top priority and
ensuring they receive timely medical care
when injured or fall ill on the job is of the
upmost importance.
5
Who is covered under FECA?
Covered
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Federal regular government employees
Federal casuals
Federal Volunteers under agreement
Not Covered
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Contractors
Inmate crews and their custodians
State personnel and other cooperators
National Guard
Active duty military personnel
6
When is someone covered
under FECA?
Covered
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
On government premises
In travel status
Not Covered

Intentional self-injury

Condition resulting from
willful misconduct

Condition resulting from intoxication
7
State Workers’ Compensation
Covered:
Individuals hired under state authorities
Note: Individual state workers’ Compensation
programs are entirely independent of federal
programs. See specific state guidelines in Chapter
50 Supplements when processing such claims.
8
Incident Agency
Responsibilities

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Ensures workers’ compensation procedures are
implemented and followed
Provides a local agency contact
Provides the incident with medical facility
information
Establishes agreements with medical providers
9
Finance/Administration Section Chief,
Compensation/Claims Unit Leader, Injury
Specialist Responsibilities

Coordinates with the medical unit, medical
providers, and incident agency

Provides information and forms for state and
federal employees

Authorizes medical treatment

Ensures necessary paperwork is completed

Advises individuals of their rights and
responsibilities
10
Finance/Administration Section Chief,
Compensation/Claims Unit Leader, Injury
Specialist Responsibilities continued…



Ensures follow-up with the local office, despite
affiliation (i.e. contractor, causal, etc.)
Identifies a hospital liaison upon arrive
Clarifies who will notify the appropriate agency
administrator if someone is injured or falls ill
Note: Being injured or falling ill on the job can be
frightening and confusing. As agency
representatives, we need to make every attempt
within our legal power to ensure such individuals are
provided proper care.
11
Supervisory Responsibilities
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Obtains treatment
Completes forms
Provides copy to
employee
Ensures time loss is appropriately
documented
12
Employee Responsibilities
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Notifies incident supervisor
Requests treatment
Completes forms
Obtains witness statement
Notifies home unit supervisor
13
Home Unit Responsibilities
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Initiates follow-up medical treatment
Submits reportable claims to the
appropriate workers’ compensation office
Reports accidents/injuries per agency
guidelines
Follows up with clinics, hospitals and
pharmacies to provide OWCP case
number.
14
DOI vs. Forest Service

Provide immediate medical
care, if necessary, by taking
the injured employee to an
emergency room/clinic
accompanied with a
properly issued CA-16.

Incident faxes paperwork to
home unit within 1 business
day after making contact.

Send all original paper work
back with employee to the
home unit to process in
SMIS.

Provide immediate medical care,
if necessary, by taking the injured
employee to an emergency
room/clinic accompanied with a
properly issued CA-16.

Employee or supervisor enters
information in eSafety and signs
printed documents. (If computer
access not available home unit
will enter).

Incident faxes CA-16 to ASC with
eSafety #.
15
State Workers

Follow the specific states guidance as they
can vary greatly.

See Northern Rockies and other
Geographical Area Chapter 50 supplements
for more state specific information.

Do not issue a CA-16 for State employees.
16
When Injured on the Job…
First Aid Injuries
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Examples:
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Blister requiring salve and moleskin
Head cold requiring over the
counter medication
Athlete’s foot requiring foot powder
What to do…
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Document in the medical unit
No workers’ compensation forms are needed
Not reportable
17
When Injured on the Job…
Traumatic Injuries-occurs during a calendar day or
one work shift.
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Examples:

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Sprained ankle
Lacerations requiring stitches
Back strain from constructing fireline in one operational period
What to do….
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If necessary issue a CA-16 (Authorization for Examination
and/or Treatment) per the specific agencies guidelines
Have the employee and supervisor complete a CA-1
(Federal Employees Notice of Traumatic Injury)
Follow the employing agencies guidelines for processing
paper work
(continued)
18
Illness on the Job…
Occupational Disease-develops over a period longer than
one work day or shift

Examples:


Smoke inhalation from working on the fireline over a period of
several days
Back strain from unloading supply trucks during the course of a
week
What to do…
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Have the employee and supervisor complete a CA-2 (Notice of
Occupational Disease and Claim for Compensation)
Follow the employing agencies guidelines for processing paper
work
Note: A CA-16 should not be issued with a CA-2. The employee
must also submit factual and medical evidence of a diagnosed
disease for the claim to be accepted
19
When and how to use Agency
Provider Medical Care

When to use…
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One (or rarely two visits, i.e. follow-up) to a medical facility
No time lost
Relieve pain and suffering
When authorized by home unit
What to do…
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Have the employee and supervisor complete the
appropriate paper work (CA-1 or CA-2)for documentation
Send employee to medical facility with a FS-6100-16
Follow the employing agencies guidelines for processing
paper work
Notes on medical order request the (M#) and “Paid by
APMC” on reporting form
20
Injury Compensation Matrix
FSCA-1 CA-2 CA-16 6100-16
Traumatic Injury
(No Medical; Report Only)
X
Traumatic Injury
(APMC Treatment)
X
Traumatic Injury
(Other Treatment)
X
X
X
Occupational Illness
(APMC Treatment)
X
Occupational Illness
(OWCP Coverage)
X
X
21
Filling Prescriptions

The preferred method of payment is for the pharmacy to
directly bill electronically through DFEC-ACS.

Employee: It is the employee’s responsibility to verify
that the pharmacy will accept Federal Workers’
Compensation and to inform their compensation
coordinator that a prescription will be filled.

The agency representative must call the pharmacy with
the employee’s claim number upon receipt; otherwise,
the employee is responsible for paying any prescription
costs.
22
Filling Prescriptions –
continued…
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If the employee pays for the prescription, they will
need to fill out the OWCP- 915, Claim for Medical
Reimbursement Form, and provide original prescription
receipts to OWCP. Reimbursement may take 8-12
weeks.

Incidents may pay for prescriptions under OWCP only if
a commissary deduction is made on the OF-288. The
employee will need the original receipt(s) for OWCP
reimbursement.
Note: Generally all nationally recognized pharmacies
accept Federal Workers’ Compensation.
23
Burn Protocols

The agency administrator or designee having
jurisdiction for the incident and/or firefighter
representative (e.g. Crew Boss, Medical Unit
Leader, Compensations for Injury Specialist, etc.)
should coordinate with the attending physician to
ensure that a firefighter whose injuries meet the
burn injury criteria is immediately referred to the
nearest regional burn center.
Per 2015 Red Book, Chapter 07-17
24
Burn Injury Criteria
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Partial thickness burns (second degree) involving
greater than 5% Total Body Surface Area (TBSA)
Burns (second degree) involving the face, hands,
feet, genitalia, perineum, or major joints
Third-degree burns of any size are present
Electrical burns, including lightning injury are
present
Inhalation injury is suspected
Burns are accompanied by traumatic injury (such
as fractures)
Individuals are unable to immediately return to full
duty
25
Further References

Interagency Incident Business Management
Handbook, Chapter 10 Injury/Illness

Red Book, Chapter 7 Safety & Risk Management

Chapter 810 of the Federal Personnel Manual and
29 CFR

Northern Rockies OWCP Guide –contains links to
additional material and agency specific
information.
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