the importance of supervisors’ roles and responsibilities

Bryan J RichardsonVHA National Workers’ Compensation Program Manager

&Kristin Coyle

VISN 1 Lead WC Specialist

The Importance of Supervisors’ Roles and Responsibilities

510,423

323,728

$510,423 per dayVHA workers’ compensation chargeback in CBY 2013

$323,728 per dayPortion of VHA chargeback that relates to disability wage loss

LOST PRODUCTIVITY!

Objectives

At the end of this session, you will better understand: Impact your role has on injured employees, mission, and cost to

your organizationHow you as a supervisor can prevent employee injuries Importance of thorough investigations of all incidents How to communicate with workers’ compensation staffYour role in return-to-work managementTimekeeping practices for injured employeesHow to protect information related to on-the-job injuries

Impact of Workers’ Compensation


Employee

Biological and Physiological NeedsBasic Necessity– Air, Food, Drink, Shelter, Warmth & Sleep

Safety NeedsPersonal, Financial, Health, & Well Being

Belongingness & LoveFriendship, Intimacy, & Family

Esteem NeedsSelf Esteem, Self Respect, & Self

Confidence

Self ActualizationPersonal Growth & Fulfillment

Maslow’s Hierarchy of Needs


Agency Mission• Staff reductions when employee is disabled from work• Over-hiring when employee is out for 365 days• Additional HR activity to ensure entitlements to injured

workers• Overtime requirements for healthy employees• LOSS OF PATIENT CARE RESOURCES• INABILITY TO SERVE OUR VETERANS THE BEST WE CAN


Agency Budget

• Chargeback Costs

• Continuation of Pay

• Indirect Cost


Chargeback Costs• Employees Compensation Fund (Congressional Appropriation)

• DOL-OWCP pays medical bills and compensation on accepted claims

• DOL-OWCP charges back the cost to the Agency every year, including an administrative fee

• Agency has two fiscal years to pay the bill• Repayment is returned to the Employees Compensation Fund• Funds future year payments from Employees Compensation Fund

• Each Administration pays its share of the cost


Continuation of Pay• FECA provides that the employer must continue the

employee's regular pay during any periods of resulting disability, up to a maximum of 45 calendar days.

• Entitlement to 45 days must start within 45 days from DOI

• Employer paid at 100% of the employees salary which is subject to taxes and all other payroll deductions that are made from regular income.

• The employer, not OWCP, pays COP.


Continuation of Pay (COP)Employer has the right to ‘controvert’ COP entitlement If a claim is denied by OWCP, COP is rescinded, Employee

must elect AL, SL or LWOP in lieu of COP Employees are not automatically entitled to COPEligibility requirements apply

• Must file a CA-1 for a traumatic injury• Claim must be filed within 30 days from the date of injury• Must have lost time within 45 days from injury


Indirect Cost• Overtime – Results in 2.5 times salary for same service

• Replacement receives overtime• Injured employee receives COP or disability compensation

• Over-hiring – Recruitment, on-boarding, & Training

Approximately 27% of employee salary

WC Program Importance


Did you know that long-term disability recipients…• Receive up to 75% of their salary – TAX FREE when on

compensation?• Receive Cost of Living Adjustment(COLA), or raises

while Federal wages are frozen?• Based on CPI - inflationary indicator that measures the

change in the cost of a fixed basket of products and services.• For 2013, the CPI increase was 1.7%

• May be exempt from paying mortgages or car loans• If employee pays for disability insurance on their own.


Your roles and responsibilities to the WC Program• Pre-Injury responsibilities• Investigation of incidents• Communication with workers’ compensation staff• Timely completion and forwarding of claim forms• Proactive participation in return-to-work efforts• Appropriately document injury-related timekeeping• Protecting workers’ compensation data

Pre-Injury Responsibilities


Eliminating Hazards in the workplace is your BEST method of preventing injuries and illnesses

Enforce VA OSH rules, regulations, and standards within your area of responsibility.

Identify unsafe and unhealthy conditions and practices in the workplace and take prompt corrective action.

Encourage employee suggestions on how to improve Occupant Safety and Health.


Observation of employee work practices and constructive guidance is just as important

Ensure employees under your supervision are:• Trained to perform their work safely and such training is

properly documented• Aware of the hazards, if any, involved in their normal work

functions, and that such training is properly documented.

Initiate progressive disciplinary action, as appropriate, against employees who repeatedly violate safe work practices and procedures.


Near Miss incidents serve as a ‘dress rehearsal’ for injuries and illnesses in the workplace

600 – Near Misses

30 – Property Damage

10 – Minor Injuries

1“There is one Serious Injury for every 600 near miss incidents”

Frank Bird – US Safety Researcher

Investigation of Incidents


Supervisor• Gather facts related to the incident• Obtain witness statements if necessary• Communicate findings to Safety and WCP staff• Complete VA Form 2162, Incident Report within 3 working days.

Safety Officer• Designated point of contact for secondary incident investigation• Serves as consultant in work-related accident investigations.

The WCP staff • Collaborates with employee, supervisor, and Safety• Determines relevant facts of the case • Transmits the case to DOL, if appropriate


Office of Workers’ Compensation Program (OWCP)• Exclusive authority to administer, interpret and enforce FECA

• Sole adjudication authority for FECA processes

• When an employee disagrees with a decision made by OWCP, they may appeal to OWCP

• Liability under FECA is exclusive and instead of all other direct judicial proceedings, civil actions, or under a Federal tort liability statute.


Step 1: Determine if emergency treatment is required!

Ensure that employees under your supervision receive prompt and appropriate medical attention in the event of

an injury or illness.

Such medical services are offered—not mandatory.


Step 2: Gather facts related to the incidentDetermine causal and contributing factors

• Causal Factor - Any behavior, omission, or deficiency that if corrected, eliminated or avoided probably would have prevented the incident or injury.

• Contributing Factor - Any behavior, omission, or deficiency that sets the stage for an incident or increases the severity of injuries or extent of property damages.

Identify necessary corrective actions


Investigating for Causal and Contributing FactorsWho – Was involved or witnessed?What – Occurred or was seen?Where – Did it occur, and where were witnesses?When – Did this occur or when was it reported?Why, Why, Why, Why, Why?Any other factors relative to the incident?


Step 3: Document investigation on VA Form 2162

Step 4: Determine OSHA Recordability

Step 5: Collaborate with WC staff on findings

Step 6: Implement corrective actions


Implement Corrective Actions

Correcting hazards prevents future injuries and illnesses!

Communication with WC Staff


Your facility WC staff has no authority to accept or deny workers’ compensation claims

However, they are able to provide objective evidence of dispute for consideration by the OWCP

Findings from your incident investigation may either support or refute an employee’s statement on CA-1 or CA-2.


Disputing an employee’s claimWC staff submits a letter of dispute to OWCP

• Describe the factual allegation or argument to support disagreement

• Provide evidence or argument to support the agency’s position• Include supporting documents such as witness statements,

medical reports or records, or any other relevant information.Timeliness is key! Dispute must be submitted to OWCP:

• CA-1: With the notice of traumatic injury or death• CA-2: Within 30 calendar days from the date notice of

occupational disease or death is received from the claimant.


Disputing an employees claim (continued)

If a letter of dispute is not submitted appropriately, OWCP may accept the claimant's report of injury as established.

A disagreement with an aspect of the claimant's report is not cause to:• Delay forwarding the claim to OWCP • Compel or induce the claimant to change or withdraw the

claim.


Discussion Points with WC StaffHas employee established burden of proof – 5 Elements?

1. Timely Filed (3 year statue of limitations)2. Employee of the United States3. Fact of Injury4. Performance of Duty5. Causal Relationship

Fact of Injury may be questioned if:• Employee statements and investigation findings are

inconsistent • Evidence of a previous injury to the same part of the body• There is a delay in reporting the injury• You have knowledge of other employment or reserve duty• There are documented past violations of safe work practices • Notification of misconduct or pending termination was given • Leave requests during injury period have been denied


Performance of Duty may be questioned if:• The injury occurred outside of working hours• The employee was not performing assigned duties

at the time of injury• The injury occurred off premises?• The injury occurred during a recreational activity• Horseplay, willful misconduct were involved• Injury was a result of a vehicular accident• Injury was the result of an assault


Employees are considered to be in the Performance of Duty on premises including steps, sidewalks and parking lots owned, controlled or managed agency:• During work hours and/or on breaks • Outside working hours

• Usually considered 30 minutes before or after working hours• Not extended to employees who are visiting the premises for non-

work-related reasons.• Performing representational functions entitling them to

official time are covered. • Injuries to employees engaged in the internal business of a labor

organization are not covered.


Causal Relationship is a medical determination usually addressed by the OWCP Claims Examiner.

Communicate with the WC staff if you have concerns that the medical condition identified by the employee is not causally related to the claimed injury.

The following Statutory Exclusion should also be addressed with the WC staff

• Willful misconduct• Alcohol or drug impairment involved• Intent to injure self or others


In cases of work-related employee deathNotify the Facility Workers’ Compensation Office

immediately to report a death due to a work-related traumatic or occupational disease-facility workers’ compensation office will notify OWCP immediately via telephone or fax

Complete form CA-6, Official Superior’s Report of Employee’s Death, immediately so facility workers’ compensation office can submit to OWCP within 10 workdays from notification


Claim Initiation Process


Supervisor WC Staff

Provide Guidance and Counsel to Injured Employees

Communicate Employee Rights and Responsibilities

Provide Notice of Choice of Physician

Respond to Development Letters & Requests from OWCP timely

Provide Release of Information Document

Investigate Incident Dispute Questionable ClaimsEmergency Treatment (if

needed) Authorize use of CA-16

Ensure Leave Requests are Made

Authorize use of COP if applicable

Track OWCP Pending ActionsPeriodically Check on Employee

Injury-Related Timekeeping

Supervisor WC Staff

Ensure Entitlement to COP

Controvert COP when applicable

Request Election of Other Leave

Rescind COP when Case Denied

Ensure Leave Requests are Made

Notify Employee of Controversion

Ensure Appropriate Leave is Used Authorize Requests for COP

Track COP Day Count

Notify Employee when Controversion Upheld

Review COP Cost for Facility

Forward Medical to WC Staff

For Traumatic Injuries:Advise the injured employee of his or her right to file for

workers’ compensation benefits using Form CA-1.Complete the required fields of the VA 2162, the Incident Report

within 5 days.Complete the required fields of the supervisory portion of the

Form CA-1 within 3 days of signing by the employee. Do not delay injury claim completion while waiting for other

documents or disputes to be completed.


A claims is not complete until:Employee has electronically signedSupervisor has electronically signedThe claim form has been printed and both the employee’s and

supervisor’s wet ink signature has been obtainedA claim will not be transmitted/submitted to OWCP without wet

ink signature


Here’s the fine print: No employer or other person may require an employee or other claimant to

enter into any agreement, either before or after an injury or death, to waive his or her right to claim compensation under the FECA. No waiver of compensation rights shall be valid. 20 CFR 10.15

A number of statutory provisions make it a crime to file a false or fraudulent claim or statement with the government in connection with a claim under the FECA, or to wrongfully impede a FECA claim. See 20 CFR 10.16, Title 18 U.S. C. section 287, 1001. 1920, and 1922.

Administrative proceedings may be initiated under the Program Fraud Civil Remedies Act of 1986 (PFCRA), 31 U.S.C. 3801-12, to impose civil penalties and assessments against persons who make, submit, or present, or cause to be made, submitted or presented, false, fictitious or fraudulent claims or written statements to OWCP in connection with a claim under FECA. 29 CFR Part 22


18 U.S.C. 1922 - False or withheld report concerning FECA

Whoever, being an officer or employee of the United States charged with the responsibility for making the reports of the immediate superior specified by section 8120 of title 5, willfully fails, neglects, or refuses to make any of the reports, or knowingly files a false report, or induces, compels, or directs an injured employee to forego filing of any claim for compensation or other benefits provided under subchapter I of chapter 81 of title 5 or any extension or application thereof, or willfully retains any notice, report claim, or paper which is required to be filed under that subchapter or any extension or application thereof, or regulations prescribed thereunder, shall be fined under this title or imprisoned not more than one year, or both.


Return to Work Management


Supervisor WC Staff

Monitor Transitional Duty to Ensure Restrictions are not Exceeded

Provide Release of Information Document

Identify Transitional Job Duties

Update Written Job OfferNotify WC of Updated Restrictions

Request Medical to Support Leave

Notify WC Staff-IOD Leave Used

Provide Written Job Offer

Monitor any Leave upon RTW Monitor Medical for RTW Changes

Transitional duty must be made available to injured employees

The transitional assignment must be provided in writing to the injured employee with the option of accepting or declining the offer. (initial in verbal is okay- f/u with written.)

Transitional duties should align with medical restrictions. Transitional job offer should not exceed 90-120 days without modification—This depends on severity of the injury.


When medical restrictions are received from the physician, you will be asked by the WC staff for the following information:

1. Description of duties to be performed

2. Physical requirements for those duties

3. Location where job will be performed

4. Salary information for transitional job

5. Date that the job is available

6. Work schedule for the job

7. Date response to job offer is due

8. If moving expenses will be paid


Notify your Facility Workers’ Compensation Office immediately if you believe an injured employee is off work as a result of a work injury, don’t take it for granted they are


If a claim is denied by OWCP

Notify employee of their right to request reasonable accommodation within 30 days of denial of claim

Engage the Reasonable Accommodation specialist at your facility for assistance


Supervisors SHOULD NOT:

Send an employee home because transitional duties are not available

Allow an injured employee to perform transitional duty without a written job offer

Treat injured employees differently than you treat other employees. An injury is not a “get out of jail free” card.


Supervisors SHOULD NOT: (continued)

Allow an employee to dictate what duties he or she feels he/she can or cannot do

Withhold taking appropriate administrative or disciplinary actions against an injured employee

Impede employee’s election to take annual, sick leave or leave without pay for time lost because of a job-related injury


Retention Rights – Separation from Agency RollsUnder 5 U.S.C. 8151, an employee who recovers within 1 year of

starting compensation has mandatory rights to his or her old position or its equivalent, regardless of whether he or she is still on the Agency rolls

If full recovery occurs after 1 year, or the employee is considered partially recovered, he or she is entitled to priority consideration as long as application is made within 30 days of the date compensation ceases

Employees incur no loss of benefits which they would have received but for the injury or disease.

5 CFR Section 353, 301, 302, and 303


Protecting Employee Data


VA Systems of RecordCreated or amended as needed to meet the legislative requirements

of the Privacy Act of 1974SORNs (System of Record Notices) are in place to protect employee

data. VA Systems of Record DO NOT cover employee workers’

compensation records

DOL/GOVT-1 System of RecordsProtects records relating to claims for benefits filed under the FECA,

including any copies maintained by an employing agencyThis system of records is maintained by and under the control of

OWCP, and, as such, all records covered by DOL/GOVT-1 are official records of OWCP.


Confidentiality of WC RecordsAll records relating to claims for benefits, including copies

of such records maintained by an employer, are considered confidential and may not be released, inspected, copied or otherwise disclosed except as provided below:

• Freedom of Information Act • Privacy Act of 1974 • DOL/GOVT-1 if such release is consistent with the purpose for which

the record was created.


Storage and Use of WC DocumentsWorkers’ Compensation related documents must be stored in

locked cabinets inside of a locked roomThe use of the information collected must be connected in some

way with the compensation claimAgencies may not use copies of information from claim files for

these purposes without written consent of the injured employee:

a) In connection with EEO complaintsb) Disciplinary actionsc) Other administrative actions


Employee Right to RepresentationMay appoint one individual to represent his or her interest

in the claim process• Appointment must be in writing• There can be only one representative at any one time

May authorize any individual to represent him or her in regard to a claim under the FECA• A Federal employee may act as a representative only:

• On behalf of immediate family members provided no fee is charged• While acting as an officially sanctioned union official provided no fee or

gratuity is charged.

ANY QUESTIONS????

the importance of supervisors’ roles and responsibilities

Documents

cop employees

employees regular pay

employees salary

calendar days

cop entitlement

injured employeeshow

dayportion of vha chargeback

self respect