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OWCP
WHEN
INJURED AT WORK
Information Guide for Federal Employees
Introduction
The
Federal Employees' Compensation Act (FECA) (5 U.S.C. 8101 et
seq.) is administered by the Office of Workers' Compensation
Programs (OWCP) of the U.S. Department of Labor. It provides
compensation benefits to civilian employees of the United States for
disability due to personal injury sustained while in the performance
of duty or to employment-related disease. The FECA also provides for
the payment of benefits to dependents if the injury or disease
causes the employee's death. Benefits cannot be paid if the injury
or death is caused by the willful misconduct of the employee or by
the employee's intention to bring about his or her injury or death
or that of another, or if intoxication (by alcohol or drugs) is the
proximate cause of the injury or death.
Medical Benefits
An employee is entitled to medical, surgical and
hospital services and supplies needed for treatment of an injury as
well as transportation for obtaining care. The injured employee has
initial choice of physician and may select any qualified local
physician or hospital to provide necessary treatment or may use
agency medical facilities if available. Except for referral by the
attending physician, any change in treating physician after the
initial choice must be authorized by OWCP. Otherwise, OWCP will not
be liable for the expenses of treatment.
The term "physician" includes surgeons,
osteopathic practitioners, podiatrists, dentists, clinical
psychologists, optometrists and chiropractors within the scope of
their practice as defined by State law. Payment for chiropractic
services is limited to treatment consisting of manual manipulation
of the spine to correct a subluxation as demonstrated by x-ray to
exist. If the physician selected has been excluded from
participating in the Compensation Program the OWCP District Office
will advise the employee of the exclusion and the need to select
another physician.
Compensation for
Temporary Total Disability
An employee who sustains a disabling, job-related
traumatic injury may request continuation of regular pay for the
period of disability not to exceed 45 calendar days or sick or
annual leave. If disability continues beyond 45 days or the employee
is not entitled to continuation of pay, the employee may use sick or
annual leave or enter a leave without pay status and claim
compensation from OWCP.
When disability results from an occupational
disease, the employing agency is not authorized to continue the
employee's pay. The employee may use sick or annual leave or enter a
leave without pay status and claim compensation.
Compensation for loss of wages may not be paid
until after a three-day waiting period, except when permanent
effects result from the injury or where the disability causing wage
loss exceeds 14 calendar days. Compensation is generally paid at the
rate of 2/3 of the salary if the employee has no dependents and 3/4
of the salary if one or more dependents are claimed.
The term "dependent" includes a
husband, wife, unmarried child under 18 years of age, and a wholly
dependent parent. An unmarried child may qualify as a dependent
after reaching the age of 18 if incapable of self-support by reason
of mental or physical disability, or as long as the child continues
to be a full-time student at an accredited institution, until he or
she reaches the age of 23 or has completed four years of education
beyond the high school level.
Compensation for
Permanent Effects of Injury
The Act provides a schedule of benefits for
permanent impairment of certain members, functions and organs of the
body such as the eye, arm, or kidney and for serious disfigurement
of the head, face or neck. For example, an award of 160 weeks of
compensation is payable for total loss of vision in one eye.
In addition, compensation for loss of earning
capacity may be paid if the employee is unable to resume regular
work because of injury-related disability. This compensation is paid
on the basis of the difference between the employee's capacity to
earn wages after an injury and the wages of the job he or she held
when injured.
OWCP may arrange for vocational rehabilitation
and provide a maintenance allowance not to exceed $200 per month. A
disabled employee participating in an OWCP-approved training or
vocational rehabilitation program is paid at the compensation rate
for total disability.
If the employee's condition requires a constant
attendant, an additional amount not to exceed $1500 per month may be
allowed.
Compensation for
Death
If no child is eligible for benefits, the widow
or widower's compensation is 50 percent of the employee's pay at the
time of death, if death was due to the employment-related injury or
disease. If a child or children are eligible for benefits, the widow
or widower is entitled to 45 percent of the pay and each child is
entitled to 15 percent. If children are the sole survivors, 40
percent is paid for the first child and 15 percent for each
additional child, to be shared equally. Other persons such as
dependent parents, brothers, sisters, grandparents, and
grandchildren may also be entitled to benefits. The total
compensation may not exceed 75 percent of the employee's pay or the
pay of the highest step for GS-15 of the General Schedule, except
when such excess is created by authorized cost-of-living increases.
Compensation to an employee's surviving spouse
terminates upon his or her death or remarriage. A widow or widower's
benefits continue, however, if the remarriage takes place after the
age of 55. Awards to children, brothers, sisters and grandchildren
terminate at the age of 18, unless the dependent is incapable of
self-support, or continues to be a full-time student at an
accredited institution, until he or she reaches the age of 23, or
has completed four years of education beyond the high school level.
Burial expenses not to exceed $800 are payable.
Transportation of the body to the employee's former residence in the
United States is provided where death occurs away from the
employee's home station. In addition to any burial expenses or
transportation costs, a $200 allowance is paid for the
administrative costs of terminating an employee's status with the
Federal Government.
Cost-of-Living
Increases
Compensation payments on account of a disability
or death which occurred more than one year before March 1 of each
year, are increased on that date by any percentage change in the
Consumer Price Index published for December of the preceding year.
Settlements With
Third Parties
Where an employee's injury or death in the
performance of duty occurs under circumstances placing a legal
liability on a party other than the United States, a portion of the
cost of compensation and other benefits paid by OWCP must be
refunded from any settlement obtained. OWCP will assist in obtaining
the settlement and the Act guarantees that the employee may retain a
certain proportion of the settlement (after any attorney fees and
costs are deducted) even when the cost of compensation and other
benefits exceeds the amount of the settlement.
Appeal Rights
An employee or survivor who disagrees with a
final determination of OWCP may request an oral hearing or a review
of the written record from the Branch of Hearings and Review. Oral
and/or written evidence in further support of the claim may be
presented. The employee may also request a reconsideration of a
decision by submitting a written request to the District
Office which issued the decision. The request must be
accompanied by evidence not previously submitted. If reconsideration
has been requested, a hearing on the same issue may not be granted.
The employee or survivor may also request review by the Employees'
Compensation Appeals Board (ECAB). Because the ECAB rules solely on
the evidence of record at the time the decision was issued, no
additional evidence may be presented.
More Detailed
Information
More detailed information about the requirements
for coverage and benefits under the Federal Employees' Compensation
Act may be obtained from Federal Personnel Manual Chapter 810,
Injury Compensation [now OWCP
Publication CA-810], and booklet CA-550,
Questions and Answers About the Federal Employees' Compensation Act,
which answers questions commonly asked about compensation benefits.
What To Do...
1. Keep This Pamphlet. It is important
that you know what you are entitled to, since benefits are not paid
automatically. You or your survivors must claim them.
2. In Case of Injury, obtain first aid or
medical treatment even if the injury is minor. While many minor
injuries heal without treatment, a few result in serious prolonged
disability that could have been prevented had the employee received
treatment when the injury occurred.
For traumatic injuries, ask your employer to
authorize medical treatment on Form CA-16 BEFORE you go to the
doctor. Take Form CA-16 when you go to the doctor, along with Form
OWCP-1500, which the doctor must use to submit bills to OWCP. Your
employer may authorize medical treatment for occupational disease
ONLY if OWCP gives prior approval.
Submit bills promptly, as bills for medical
treatment may not be paid if submitted to OWCP more than one year
after the calendar year in which you received the treatment or in
which the condition was accepted as compensable.
3. Report Every Injury to your supervisor.
Submit written notice of your injury on Form CA-1 if you sustained a
traumatic injury, or Form CA-2 if the injury was an occupational
disease or illness. (Forms CA-1 and CA-2 may be obtained from your
employing agency or OWCP.)
Form CA-1 must be filed within 30 days of the
date of injury to receive continuation of pay (COP) for a disabling
traumatic injury. COP may be terminated if medical evidence of the
injury- related disability is not submitted to your employer within
10 workdays. YOU ARE RESPONSIBLE FOR ENSURING THAT SUCH MEDICAL
EVIDENCE IS SUBMITTED TO YOUR EMPLOYING AGENCY. Form CA-2 should
also be filed within 30 days. Any claim which is not submitted
within 3 years will be barred by statutory time limitations unless
the immediate superior had actual knowledge of the injury or death
within 30 days of occurrence.
4. Establish the Essential Elements of Your
Claim. You must provide the evidence needed to show that you
filed for benefits in a timely manner; that you are a civil
employee; that the injury occurred as reported and in the
performance of duty; and that your condition or disability is
related to the injury or factors of your Federal employment. OWCP
will assist you in meeting this responsibility, which is called
burden of proof, by requesting evidence needed to fulfill the
requirements of your claim.
5. File a Claim for Compensation. File
Form CA-7, Claim for Compensation on Account of Traumatic Injury or
Occupational Disease, if you cannot return to work because of your
injury and you are losing (or expect to lose) pay for more than
three days. Give the form to your supervisor seven to ten days
before the end of the COP period, if you received COP. If you are
not entitled to COP, submit Form CA-7 when you enter or expect to
enter a leave without pay status. All wage loss claims must be
supported by medical evidence of injury-related disability for the
period of the claim.
If you continue to lose pay after the dates
claimed on Form CA-7, submit Forms CA-8 Claim for Continuing
Compensation on Account of Disability, through your employer to
claim additional compensation until you return to work or until OWCP
advises they are no longer needed. You are not required to use your
sick or annual leave before you claim compensation.
If you choose to use your leave, you may, with
your agency's concurrence, request leave buy-back by submitting Form
CA-7 to OWCP through your employing agency. Any compensation payment
is to be used to partially reimburse your agency for the leave pay.
You must also arrange to pay your agency the difference between the
leave pay based on your full salary and the compensation payment
that was paid at 2/3 or 3/4 of your salary. Your agency will then
recredit the leave to your leave record.
6. Return To Work As Soon As your Doctor
Allows You To Do So. If your employing agency gives you a
written description of a light duty job, you must provide a copy to
your doctor and ask if and when you can perform the duties
described. If your agency is willing to provide light work, you must
ask your doctor to specify your work restrictions. In either case,
you must advise your agency immediately of your doctor's
instructions concerning return to work, and arrange for your agency
to receive written verification of this information. COP or
compensation may be terminated if you refuse work which is within
your medical restrictions without good cause, or if you do not
respond within specified time limits to a job offer from your
agency.
In appropriate cases, OWCP provides assistance in
arranging for reassignment to lighter duties in cooperation with the
employing agency. In addition, injured employees have certain other
specified rights under the jurisdiction of the Office of Personnel
Management, such as reemployment rights if the disability has been
overcome within one year.
7. Tell Your Family about the benefits
they are entitled to in the event of your death. For assistance in
filing a claim they may contact your employing agency's personnel
office or OWCP.
For Additional Information or When in Doubt About
Your Compensation Benefits Write to the Office
of Workers' Compensation Programs - CLICK HERE.
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Charlotte Area Local 375, APWU
3521 Mulberry Church Rd.
Charlotte , NC 28208
Phone: (704) 394-5104
Toll Free:1-800-798-9895
Fax:
(704) 394-5404 |
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