WORKERS` COMPENSATION

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Federal Workers’ Compensation
First Line Supervisor Course
Gold Nuggets
Of
Medical Issues
February 25-27, 2014 Phoenix, AZ
David L. Hull, MBA
Program Manager
Federal Workers’ Compensation Program
U.S. Department of Veterans Affairs
Federal Workers’ Compensation - Supervisory Course
Course Title: Federal
Workers’ Compensation First Line Supervisor Course
Target Audience: VA First Line Supervisors
Understand the various laws and regulations
involved in medical issues concerning Federal
employees
Differentiate between the issues in various cases to
select the appropriate rules to follow
Understand the Agency Medical Exam process to
obtain objective medical information upon which an
informed employment decision may be based
Federal Workers’ Compensation - Supervisory Course
Identify the right rules
1. Is the medical condition work-related or non-workrelated?
2. Does the medical condition define the employee as a
'qualified handicapped employee under the
Americans With Disabilities Act as Amended
(ADAA)?
3. Does the employee's position have properly
established medical qualifications or physical
requirements?
Federal Workers’ Compensation - Supervisory Course
Identify the right rules
1. Is the medical condition work-related or non-workrelated?
Work-related injuries are covered by the Federal Employees
Compensation Act (FECA) and the rules to follow are found
in 20 CFR Part 10. It does not matter if the HR Specialist,
supervisor or manager feels like the condition is NOT workrelated, these rules must be followed if the employee CLAIMS
the condition is work-related. The Office of Workers
Compensation Programs, U.S. Department of Labor, will
make all decisions regarding claims of work-related medical
conditions.
Federal Workers’ Compensation - Supervisory Course
Identify the right rules
2. Does the medical condition define the employee as a
'qualified handicapped employee under the Americans
With Disabilities Act as Amended (ADAAA)?
Non-work-related medical conditions, where the
employee requires modification of their job to
accommodate a significant disability is covered by the
Americans With Disabilities Act as Amended (ADAAA)
and 29 CFR 1614.203. In order to be entitled to coverage
under this statute, the employee must suffer from a
medical condition that 'substantially impairs a major life
function'.
Federal Workers’ Compensation - Supervisory Course
Identify the right rules
3. Does the employee's position have properly established
medical qualifications or physical requirements?
For those Federal employees who hold positions that
require medical qualifications or physical requirements,
maintenance of certain heath criteria is mandatory to hold
their position. These medical qualification requirements
may be found in the Office of Personnel Management's
Operating Manual, Section VI or in the Human Resources
section of the employing agency for those standards that
were developed locally.
Federal Workers’ Compensation - Supervisory Course
Results
Remember, granting benefits or accommodations to
employees who do not qualify, results in reduced staffing
efficiency; reduced morale in employees who must
perform the work of the employee receiving unearned
benefits; and may well cause discrimination complaints
of disparate treatment by other employees who were not
afforded similar benefits for similar reasons.
Federal Workers’ Compensation - Supervisory Course
Work-Related
5 USC 8145 - The Secretary, U.S. Department of
Labor, through the Director, Office of Workers’
Compensation Programs (OWCP), has the
exclusive authority to administer, interpret and
enforce the provisions of the Federal Employee
Compensation Act (FECA).
Federal Workers’ Compensation - Supervisory Course
Important Aspects
 FECA is not subject to interpretation by EEOC, FLRA,
MSPB, Negotiated Bargaining Agreements or Federal
judicial courts.
 Federal Workers’ Compensation prohibits civil
litigation, Unfair Labor Practice complaints, union
grievances, appeals to the Merit Systems Protection
Board or review by the Equal Employment Opportunity
Commission.
 In all cases, OWCP has sole authority for any matter
pertaining to administering, adjudicating or enforcing
the provisions of FECA.
Federal Workers’ Compensation - Supervisory Course
Purpose of Workers’ Compensation
To provide compensation and medical benefits to
civilian employees of the federal government for
personal injury or illness sustained while in the
performance of duty.
Federal Workers’ Compensation - Supervisory Course
NOT
the purpose of Workers’ Compensation
FECA ≠ Retirement
Federal Workers’ Compensation - Supervisory Course
Office of Workers’ Compensation Programs
Chargeback Year 2013
(JULY 1, 2012 - JUNE 30, 2013)
U.S. POSTAL SERVICE
DEPARTMENT OF THE NAVY
DEPARTMENT OF VETERANS AFFAIRS
DEPARTMENT OF THE ARMY
HOMELAND SECURITY
DEPARTMENT OF THE AIR FORCE
DEPARTMENT OF JUSTICE
DEPARTMENT OF TRANSPORTATION
DEPARTMENT OF AGRICULTURE
DEPARTMENT OF DEFENSE
Federal Workers’ Compensation - Supervisory Course
$1,305,072,082
$ 222,803,441
$ 199,368,470
$ 166,731,441
$ 183,968,314
$ 126,470,302
$ 115,768,099
$ 93,651,731
$ 72,364,968
$ 66,517,347
Office of Workers’ Compensation Programs
Chargeback Year 2013
(JULY 1, 2012 - JUNE 30, 2013)
DEPARTMENT OF THE INTERIOR
DEPARTMENT OF TREASURY
TENNESSEE VALLEY AUTHORITY
SOCIAL SECURITY ADMINISTRATION
HEALTH AND HUMAN SERVICES
DEPARTMENT OF LABOR
DEPARTMENT OF COMMERCE
GENERAL SERVICES ADMINISTRATION
PEACE CORPS
Federal Workers’ Compensation - Supervisory Course
$58,871,646
$55,002,740
$46,824,653
$25,601,751
$27,225,954
$18,154,430
$17,032,174
$13,169,364
$14,591,288
Office of Workers’ Compensation Programs
Chargeback Year 2013
(JULY 1, 2012 - JUNE 30, 2013)
U.S. DEPARTMENT OF ENERGY
HOUSING AND URBAN DEVELOPMENT
DEPARTMENT OF STATE
FEDERAL JUDICIARY
GOVERNMENT PRINTING OFFICE
NASA
SMITHSONIAN INSTITUTION
ENVIRONMENTAL PROTECTION AGENCY
DEPARTMENT OF EDUCATION
CORP. FOR NATIONAL & COMMUNITY SVC
EXECUTIVE OFFICE OF THE PRESIDENT
Federal Workers’ Compensation - Supervisory Course
$9,219,999
$7,285,615
$9,435,510
$7,061,743
$5,367,160
$4,861,652
$4,460,990
$4,509,635
$1,677,212
$1,033,106
$1,001,204
Other Costs
Continuation of Pay
Overtime
Lost Productivity
Increased potential for injury
Federal Workers’ Compensation - Supervisory Course
Cost to Taxpayer
Total compensation and medical bills paid for all
injured Federal employees in chargeback year
2011:
$2,927,295,955
An increase of $78,561,259 over 2012
Federal Workers’ Compensation - Supervisory Course
Basic Elements of a Claim
In seeking benefits under FECA, there are five essential elements of an
acceptable claim and the employee/claimant has the burden of
providing the facts that establish these elements. They are:
Timely filed - The claim was timely filed within the applicable time
limitation period of the Act;
Civil Employee - The individual is an "employee of the United States"
within the meaning of FECA;
Fact of Injury – Occurrence of event and resulting medical condition
Performance of Duty - An injury was sustained in the performance of
duty as alleged;
Causal Relationship - Disability and/or a specific condition for which
compensation is claimed is causally related to Federal employment.
Federal Workers’ Compensation - Supervisory Course
Questionable Issues
Was the injury caused by:
Willful misconduct
Intoxication by drugs or alcohol
Intent to injure self or others
These are Statutory Bars to Coverage
Federal Workers’ Compensation - Supervisory Course
Other Considerations
“An employee who is separated for misconduct and
whose removal is wholly unconnected to the workrelated injury is not entitled to further compensation
benefits.”
OWCP Publication CA-810, Chapter 8, paragraph 8-9
Federal Workers’ Compensation - Supervisory Course
Medical Evidence
Objective medical evidence is required to make
an informed employment decision (which
includes separation from employment)
If an employing agency does not have suitable
medical facilities or access to appropriate
medical specialists, Agency Medical Exams may
be contracted with appropriate private sector
companies, who specialize in providing such
examinations.
Federal Workers’ Compensation - Supervisory Course
Medical Report Requirements
(for work-related conditions)
In all cases, a medical report from the
attending physician should include:
(a) Dates of examination and treatment;
(b) History given by the employee;
(c) Physical findings;
(d) Results of diagnostic tests;
(e) Diagnosis;
(f) Course of treatment;
Federal Workers’ Compensation - Supervisory Course
Medical Report Requirements
(continued)
(g) A description of any other conditions found
but not due to the claimed injury;
(h) The treatment given or recommended for the
claimed injury;
(i) The physician's opinion, with medical reasons,
as to causal relationship between the diagnosed
condition(s) and the factors or conditions of the
employment;
Federal Workers’ Compensation - Supervisory Course
Medical Report Requirements
(continued)
(j) The extent of disability affecting the employee's
ability to work due to the injury;
(k) The prognosis for recovery; and
(l) All other material findings.
20 CFR 10.330
Federal Workers’ Compensation - Supervisory Course
Medical Report Requirements
(for non-work-related conditions)
An acceptable diagnosis must include the
following information:
(a) The history of the medical condition,
including references to findings from previous
examinations, treatment, and responses to
treatment;
Federal Workers’ Compensation - Supervisory Course
Medical Report Requirements
(for non-work-related conditions)
(b) Clinical findings from the most recent medical evaluation,
including any of the following, which have been obtained:
findings of physical examination; results of laboratory tests; Xrays; EKGs and other special evaluations or diagnostic
procedures.
(c) Diagnosis, including the current clinical status;
(d) Prognosis, including plans for future treatment and an
estimate of the expected date of full or partial recovery;
Federal Workers’ Compensation - Supervisory Course
Medical Report Requirements
(for non-work-related conditions)
(e) An explanation of the impact of the medical
condition on overall health and activities,
including the basis for any conclusion that
restrictions or accommodations are or are not
warranted, and where they are warranted, an
explanation of their therapeutic of risk
avoiding value;
Federal Workers’ Compensation - Supervisory Course
Medical Report Requirements
(for non-work-related conditions)
(f) An explanation of the medical basis for any
conclusion that indicates the likelihood that
the individual is or is not expected to suffer
sudden or subtle incapacitation by carrying
out, with or without, accommodation, the
tasks or duties of a specific position.
Federal Workers’ Compensation - Supervisory Course
Medical Report Requirements
(for non-work-related conditions)
(g) Narrative explanation of the medical basis
for any conclusion that the medical condition
has or has not become static or well stabilized
and the likelihood that the individual may
experience sudden or subtle incapacitation as
a result of the medical condition.
Federal Workers’ Compensation - Supervisory Course
Medical Report Requirements
(for non-work-related conditions)
(g) continued - Subtle incapacitation means
gradual, initially imperceptible impairment of
physical or mental function, whether
reversible or not, which is likely to result in
performance or conduct deficiencies. Sudden
incapacitation means abrupt onset of loss of
control of physical or mental function.
5 CFR 339.104
Federal Workers’ Compensation - Supervisory Course
Agency Medical Exams
Oftentimes, medical information provided by an employee,
does not provide sufficient detail with which the employer
might construct light duty offers, alternate duty assignments,
or modifications to existing positions, that would meet the
employee’s physical limitations.
Federal Workers’ Compensation - Supervisory Course
Key Regulatory Points to Remember
Agency Medical Exams must be offered or
ordered, in writing, usually by the Employing
Agency’s Appointing Authority (commonly the
Chief of Human Resources).
5 CFR Part 339
Federal Workers’ Compensation - Supervisory Course
Key Regulatory Points to Remember
Employing agencies may require an employee
who has applied for, or is receiving, benefits, as a
result of an on-the-job injury, to undergo a medical
examination that may affect placement decisions.
5 CFR 339.301 (c)
Federal Workers’ Compensation - Supervisory Course
Key Regulatory Points to Remember
The Agency must inform the employee in
writing of the reason for the exam and
consequences of failure to cooperate.
5 CFR 339.303 (a)
Federal Workers’ Compensation - Supervisory Course
Key Regulatory Points to Remember
The Agency designates the physician, but
must offer the employee the opportunity to
submit medical documentation from their
own physician.
5 CFR 339.303 (b)
Federal Workers’ Compensation - Supervisory Course
Key Regulatory Points to Remember
Agency must review and consider all medical
documentation submitted by employee’s physician.
Notice must give the physician’s name, location,
date and time of examination in order to be
enforceable.
5 CFR 339.303 (b)
Agency must pay for exam, ordered or offered.
5 CFR 339.304
Federal Workers’ Compensation - Supervisory Course
Key Regulatory Points to Remember
The Agency must forward all reports and
medical documentation, resulting from exams
relating to on-the-job injury claims, to the Office
of Workers Compensation Programs (OWCP).
The Agency must also report the failure of any
workers’ compensation claimant to report for a
properly ordered examination.
5 CFR 339.305 (c)
Federal Workers’ Compensation - Supervisory Course
Key Regulatory Points to Remember
Agency Medical Examinations are not
sufficient, in and of themselves, to cause OWCP
to render decisions on the level of medical
impairment of a workers compensation
claimant. OWCP must, however, consider any
other medical reports in the file.
20 CFR 10.502
Federal Workers’ Compensation - Supervisory Course
Important Considerations
“A person who claims benefits has the burden of
establishing the essential elements of his claim,
including the fact that he sustained an injury
while in the performance of duty, and that he had
disability as a result. As part of this burden the
employee must present rationalized medical
opinion evidence, based on a complete factual and
medical background, showing a causal
relationship between the injury and the
disability.”
Daniel R. Hickman, 34 ECAB 1220 (1983)
Federal Workers’ Compensation - Supervisory Course
Important Considerations
“Agency Medical Exams must be processed
correctly and in accordance with applicable
statutes and regulations. There must be a logical,
work-related basis for all requests for Agency
Medical Exams and other medical information,
lest the employing agency be found guilty of
discrimination.”
Bell v. Henderson (Postmaster General) EEOC Appeal
#01974429 3/6/00
Federal Workers’ Compensation - Supervisory Course
Important Considerations (continued)
“Where a person has a pre-existing condition which
is not disabling, but which becomes disabling
because of aggravation causally related to the
employment, then regardless of the degree of such
aggravation, the resulting disability is compensable.
If the medical evidence reveals that an employment
factor contributes in any way to the employee's
condition, the condition is considered to be
employment related.”
Arnold Gustafson, 41 ECAB 131 (1989)
Federal Workers’ Compensation - Supervisory Course
Critical EEO Decisions
“A claimant may not use the EEO process to
launch a collateral attack on the workers
compensation process.”
Story v USPS, EEOC 05960314 (10/18/96)
Federal Workers’ Compensation - Supervisory Course
Critical EEO Decisions
“The Commission has recognized that an agency
has the right to represent its position and interest
in the OWCP Forum, and will not review decisions,
which would require it to judge the merits of a
workers compensation claim.”
Hogan EEOC 05940407
Federal Workers’ Compensation - Supervisory Course
Critical EEO Decisions
The Commission stated: “…it is well established that
an Agency has an obligation to controvert an
employee’s workers compensation claim where there
is a dispute as to the employee’s entitlement.”
Andel v. USPS EEOC 01975337
Federal Workers’ Compensation - Supervisory Course
Reasonable Accommodation
Non-work-related medical
conditions
29 CFR 1614.203
Federal Workers’ Compensation - Supervisory Course
Reasonable Accommodation
(for non-work-related injuries)
To be useful, employment decisions must be based
upon objective medical evidence
The employing Agency must identify and
document the ‘essential functions’ of the position
in question
Federal Workers’ Compensation - Supervisory Course
Important Considerations
“Employing Agencies should ensure that a documented
review of the provisions relating to Reasonable
Accommodation is prepared, particularly with regard to
work-related aggravations of pre-existing medical
conditions. Such a review may aid in the determination as
to whether the employee is eligible for permanent
accommodation under disability laws, should the medical
condition prove to be severe enough to warrant such a
review.” 29 CFR 1614.203
Federal Workers’ Compensation - Supervisory Course
Reasonable Accommodation
Checklist
Use sample checklist provided to ensure that all
steps are taken with regard to Reasonable
Accommodation requests.
Federal Workers’ Compensation - Supervisory Course
Sample Letters
Letter Number 1 – used for non-work-related
medical conditions and to offer AME
Letter Number 2 – used to request medical
evidence to support work-related claims
Letter Number 3 – used to request medical
information for non-work-related conditions
Letter Number 4 – used to order an employee to
undergo an AME for work-related conditions
Federal Workers’ Compensation - Supervisory Course
References
FECA – 20 CFR Part 10
Reasonable Accommodation – 29 CFR 1614.203
Leave Administration – 5 CFR 630
Agency Medical Exams – 5 CFR 339
Federal Workers’ Compensation - Supervisory Course
Pop Quiz
In support of a claim for compensation, the employee is
responsible for submitting, or arranging for the submittal
of:
a. a disability to work statement
b. medical evidence to OWCP which establishes both that
disability continues and that the disability is due to the work
related injury
c. medical evidence that establishes disability
d. none of the above
Federal Workers’ Compensation - Supervisory Course
Pop Quiz
The need for __________ medical information is paramount.
a.
b.
c.
d.
comprehensive
objective
summary
targeted
Federal Workers’ Compensation - Supervisory Course
Pop Quiz
The causal relationship between a medical condition and
factors of employment:
a. are based upon the subjective assertions of the patient
b. are established if the relationship is 'likely' or 'probably'
caused by work factors
c. must be established by reasoned medical opinion based upon
a complete, actual and factual medical background.
d. all of the above
Federal Workers’ Compensation - Supervisory Course
Pop Quiz
Brief medical notes, such as 'Off work six weeks', written
on prescription note pads, are acceptable forms of evidence
for employees seeking workers' compensation benefits.
a. Because most bargaining unit agreements only require
employees to provide medical notes that state the employee is
incapacitated for the job.
b. Employees only have to provide the employer with ‘prima
facie’ medical evidence to support their claim
c. Employees have a difficult time getting their physician to
write a more detailed narrative
d. The statement is false. Short notes without a reasoned
medical opinion do not meet FECA criteria for supporting
medical documentation.
Federal Workers’ Compensation - Supervisory Course
Pop Quiz
A benefit for Federal employees is that they must be given a
different job when he or she can simply no longer perform
the job for which hired, if they become medically disabled.
a. This is true in all cases
b. This only applies in Reasonable Accommodation cases under
the Americans with Disabilities Act
c. This only applies in Federal Workers' Compensation cases
d. None of the above
Federal Workers’ Compensation - Supervisory Course
Pop Quiz
Who is responsible for establishing the essential elements of
the claim?
a.
b.
c.
d.
The employing agency
The employee’s supervisor
The employee’s physician
The employee filing the claim
Federal Workers’ Compensation - Supervisory Course
Contact Information
David L. Hull, MBA
Program Manager
Federal Workers' Compensation
U.S. Department of Veterans Affairs
Mailing Address:
Department of Veterans Affairs (00S1)
810 Vermont Avenue
Washington, DC 20241
E-mail: [email protected]
Federal Workers’ Compensation - Supervisory Course
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