you too can handle feca claims: the basics
TRANSCRIPT
You Too Can Handle FECA Claims: The Basics
Daniel M. Goodkin – Steven E. Brown, PLC
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
What is the FECA?
Simply put, it’s the workers comp system for employees of the US Government (excludes active duty military). Unlike state workers’ compensation, there is no apportionment. It is supposed to be a non-adversarial system, but anyone who has filed a claim knows that is not true.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
Why get involved with FECA?
According to the Office of Personnel Management, there are 64,000 federal employees in the judicial branch and 2,776,000 employees in the executive branch
for a total of 2,840,000 federal employees. This does not include uniformed military personnel.
The US Department of Labor, which oversees the Federal Employees’
Compensation Act (FECA) reported that In FY 2010, 127,526 new cases were created. The program provided $2.86 billion in benefits to approximately 251,000
workers and survivors for work-related injuries or illnesses. Of these benefit payments, over $1.8 billion was for wage-loss compensation, $913 million for
medical and rehabilitation services, and $138 million for death benefit payments to surviving dependents.
Simply put, there are a lot of federal employees and they need help!
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
Who is covered by FECA?
• Employees of all federal agencies in all three branches of government, and the Postal Service, including temporary and probationary employees, but not employees of contractors or of entities covered by other federal workers’ compensation laws such as the Longshore & Harbor Workers Compensation Act, The Defense Base Act, the Outer Continental Shelf Lands Act, and the War Risk Hazards Act. There is also coverage for volunteers, certain non-federal law enforcement officers, etc.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
Monetary Benefits • Lost wages – Currently pays 75% to an injured worker with dependents (spouse, children under 18 or 23 if they are in college) who loses the capacity to work due to his or her work related medical condition. The rate is 66 2/3% without dependents. See 5 USC §8105 and §8110(a). • Schedule Award – This is as close to a settlement as there is in FECA claims. It is a onetime cash payment for permanent impairment. It is limited to specific body parts – primarily the extremities. Not on the list is the spine, brain or heart. See 20 CFR §10.404 for a complete list and 5 USC §8107(c)(22). Legs 288 weeks, arms 312 weeks, etc. • Survivor Benefits – Payment to the surviving spouse or dependent children whose spouse or parent has died sooner than they otherwise would have without the work related injury. The death does not need to be “caused” by the work injury, a claimant just has to show that the injury hastened death or made the event which caused death more likely. see 5 USC §8133.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
Non-Monetary Benefits
• Medical Treatment - All medical treatment for accepted medical conditions are paid 100% by OWCP. No co-pays.
• Vocational Rehabilitation Services – This is rarely a benefit to claimants. The way this system is used is to give the injured worker some nominal training, find that they can work in some capacity, and use that determination to reduce benefits. The training rarely lasts more than 90 days.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
How does one file a claim?
• Claims are filed using standard forms and are submitted directly through the injured worker’s employing agency. The forms are preferred - however, in a pinch, any words of claim stating that the injured worker believes he or she has developed a medical condition as the result of a work accident or conditions of employment is sufficient.
STEVEN E. BROWN
A PROFESSIONAL LAW CORPORATION Daniel M. Goodkin Esq.
Types of Claims
• Traumatic Injury – CA-1
• Occupational Disease – CA-2
• Recurrence – CA-2a
• Death benefit – CA-5
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
CA-1 Notice of Traumatic Injury
• This is a claim for a medical condition that the claimant believes resulted from exposure to work factors over one work shift. For example, a federal firefighter who gets burned fighting a forest fire.
• Should be filed immediately after the injury occurs. Eligible for 45 days of Continuation of Pay (COP) – 45 days of pay given by the agency without charging sick or annual leave if submitted within 30 days of the injury. Medical documentation must be provided within 10 days.
• Agency should provide medical care authorization (CA-16) until claim is adjudicated.
• Can be filed up to 3 years afterwards (no time limit if the employer was made aware of the injury and causal connection within 30 days).
• Consider third party responsibility.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
CA-2 – Notice of Occupational Disease
• This is a claim for a medical condition that the claimant believes resulted from exposure to work factors over more than one work shift. For example, an air traffic controller who develops a stress related emotional condition as a result of working under pressure for several years.
• Can be filed up to 3 years afterwards
• When it doubt if other work events contributed, or even if you suspect they might have, file a CA-2.
• Consider third party responsibility – example asbestosis
• No COP available. Employee uses own insurance until claim is adjudicated.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
CA-2a – Notice of Recurrence
• This is a rather complicated claim and one that we tend to avoid for a variety of reasons. It is a claim that additional medical treatment is necessary after release from treatment for the work-related injury or that a work stoppage was caused by a spontaneous return of the symptoms of a previous injury or occupational disease without intervening cause. It is very difficult to prove there is no intervening cause and typically, if the employee has gone back to work, there will be new work factors to implicate.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
CA -5 – Claim for Compensation by Widow, Widower and/or Children
• This includes not only when the employee died as a result of a work injury (such as a federal law enforcement officer killed in the line of duty) but also includes situations where an injury or occupational disease contributed in any way to the employee’s death. “To hasten death is to cause it, as far as the right to compensation is concerned.” Ann L. Oakes, 32 ECAB 39 (1980).
• Even suicide can be covered if the primary reason for the suicide was due to the physical or psychological condition.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
What are the elements that must be proven in every FECA claim?
• (1) status as a federal employee covered by the Act; (2) fact of injury (including toxic exposures, repetitive motion activities, etc.); (3) injury occurring in the performance of duty (AOE/COE); (4) fact of medical condition (diagnosis, etc.); (5) causal relationship between the injury and the medical condition, such that the injury caused or contributed to the condition or aggravated a pre-existing medical condition.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
What evidence is necessary to support a FECA claim?
• a factual statement identifying employment factors alleged to have caused or contributed to the presence or occurrence of the disease or condition
• medical evidence establishing the presence or existence of the disease or condition for which compensation is claimed
• medical evidence establishing that the diagnosed condition is causally related to the employment factors identified by the employee.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
Pitfalls!
• Forms are generally insufficient
• Must be an MD. No PAs, NPs, etc. Limited exception for chiropractors – spinal subluxation only.
• Equivocal language in reports
• Avoid the blame game
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
What happens next?
• Development letter – The most common response to a claim submission is for OWCP to ask for more information
• Referral for a second opinion
• Acceptance of the medical condition
• Denial
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
If the claim is accepted
• Make sure the right condition is accepted • Notify medical providers of the accepted
condition • Submit past medical bills for reimbursement • File a CA-7 for any wage loss • When the condition has reached maximum
medical improvement, file a CA-7 for a schedule award
• Regular medical reports must be submitted.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
Some negatives about FECA
• No right to judicial review, except in rare instances of constitutional rights violations. 5 U.S.C. §8128(b); Duncan v. Department of Labor, 49 Fed. Appx. 653 (8th Cir. 2002); Rodrigues v. Donovan, 769 F.2d 1344 (9th Cir. 1985); Czerkies v. USDOL, 73 F.3d 1435, 1439 (7th Cir. 1996).
• Inconsistent application of the law and interpretation of the facts by OWCP.
• Constant review by OWCP employees who try to terminate benefits.
• Excessive OWCP delays in taking actions and making decisions, with no penalty (such as interest added to benefits or payment of attorney fees) against the government for same.
• Difficulty communicating with and obtaining information from OWCP.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
Some positives about FECA claims
• No cap on benefits. No time limit on benefits.
• No fault
• No apportionment. Any contribution – no matter how slight – by the employment to the production of the injury or disease is sufficient to make the entire disability compensable, without apportionment. Beth P. Chaput, 37 ECAB 158 (1985). This means if you allege 30 things, and one is proven, and medical evidence shows it contributed, the whole condition is accepted as work-related.
• The injured worker is afforded nearly infinite “bites at the apple.” After each denial on the merits, a claimant can submit additional evidence and request that OWCP reconsider its decision, with no limit on the number of such requests that can be filed. See 20 C.F.R §10.600.
• Emotional conditions caused by the stress of the work duties themselves, including where the employee is trying to meet the regular or specially assigned duties of his/her position, are fully compensable. See, e.g., Robert J. Benetti and Department of Transportation, Federal Aviation Agency, 106 LRP 42673 (ECAB 2006).
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
Examples
• Postal worker calls and says his shoulder hurts after 20 years of delivering mail.
• Air traffic controller calls after being involved in a near miss.
• Former secret service agent calls because his back has gotten worse since he retired.
• TSA employee calls after hurting his back lifting luggage. • Widow of a federal law enforcement officer calls after her husband
dies after suffering a heart attack while chasing a suspect.
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
Daniel M. Goodkin
Steven E. Brown, A Professional Law Corporation
910 Hampshire Road, Suite G
Westlake Village, California 91361-2888
805-496-9777 voice; 805-496-6368 fax
Email - [email protected]
STEVEN E. BROWN A PROFESSIONAL LAW CORPORATION
Daniel M. Goodkin Esq.
FEDERAL LEGISLATIVE UPDATE - FECA REFORM
By: Steven E. Brown, Attorney at Law
October 21, 2011
This is a summary of recent activity in Congress and at the U. S. Department of Labor regarding
changes and proposed changes to the Federal Employees‟ Compensation Act (FECA).
1. Regulatory changes proposed in 2010
On August 13, 2010, the U. Department of Labor‟s Office of Workers‟ Compensation Programs
(OWCP) issued proposed regulations encompassing many changes to the regulations governing
FECA. These were found at http://edocket.access.gpo.gov/2010/pdf/2010-18965.pdf. See item 8
below for current status of these regulatory changes.
The main changes involved expanding the list of scheduled members to include the skin (a pro-
employee change), a new requirement that reconsideration requests must be received (not just
mailed) within one year of an adverse decision, and incorporation of the ECAB‟s decision in
K.R. (discussed in footnote below) regarding recurrences of disability. 1
Anti-employee proposed changes:
Layoffs, recurrences and Loss of Wage Earning Capacity (LWEC) determinations
OWCP clarified 20 C.F.R. §§10.509 and 10.510 to provide that losing one‟s job as a result of
downsizing of any sort (whether or not a formal Reduction in Force - RIF) does not constitute a
compensable recurrence of disability, AND that when an employee loses his/her job due to such
downsizing an LWEC should be established based on the last position the employee was
performing before the downsizing, subject to the requirements of §10.510. Since the Postal
Service steadfastly maintained that its massive National Reassessment Process (NRP) was not a
1 In early 2010, ECAB overturned its prior decision in K.R. and USPS, Docket No. 09-415 (Sept 30, 2009),
with its decision in K.R. and USPS, Docket No. 09-415 (February 4, 2010). The Board in the latter decision
ruled that a claimant‟s limited-duty position being withdrawn does not constitute a recurrence of disability
under FECA, and therefore the injured worker is not automatically entitled to wage loss compensation if
that injured worker already had a loss of wage earning capacity (LWEC) determination in place. This
reverses the earlier K.R. decision and is in opposition to other aspects of federal employment law, under
which an injured federal worker is entitled to “restoration to duty” within certain limitations after an
industrial injury, and the later withdrawal of a limited-duty position is included in the definition of “failure
to restore” the employee to duty - which is an appealable employment action. See 5 U.S.C. §8151; 5 C.F.R.
§353.301; Merit Systems Protection Board (MSPB) cases such as Brehmer v. USPS, 106 MSPR 463
(2007); Barachina v. USPS, 2009 MSPB 227, 113 MSPR 12 (issued 12/14/09); Chen v. USPS, 2010
MSPB 129 (issued 07/08/10); Marquez v. USPS, 2010 MSPB 144 (issued 07/16/10); Kinglee v. USPS, 110
LRP 43007 (issued 07/23/10). MSPB recently issued a public request for amicus curiae briefs to be filed
on this issue in Latham v. USPS,, Docket No. DA-0353-10-0408-I-1 and related cases (pending), and the
undersigned filed such a brief on 08/24/11. Joining in the brief were several other federal employee rights
attorneys and WILG; OPM later filed an amicus curiae brief agreeing with our position. The February
2010 K.R. decision also conflicts with 20 C.F.R. 10.5(x): “… A recurrence also means an inability to work
that takes place when a light duty assignment made specifically to accommodate an employee‟s physical
limitations is … withdrawn.” An employee with an LWEC in place can still obtain FECA wage-loss
benefits if he can show that his condition has deteriorated, or that the original LWEC was in error
(including that the position that served as the basis of the LWEC determination was “odd-lot” or makeshift).
RIF 2 (as that would be contrary to the CBAs it has agreed to with Postal unions), and many of
these job offers are seen as make-shift or odd-lot “positions”, these changes seemed directly
aimed at Postal employees and at defeating their wage-loss claims after being affected by NRP.
§10.510 sets forth the requirements for a position to serve as the basis of an LWEC
determination. It states that the position must be a classified position to which the employee has
formally been reassigned, must conform to the established physical limitations of the injured
employee, must have a written position description outlining the duties and physical
requirements, and must correlate to the type of appointment held by the injured employee at the
time of injury. The Board‟s decision in A.J.3 (see footnote below) elaborates on and expands
these pro-employee requirements for purposes of setting LWECs.
The proposed changes to §10.509 and §10.510 seemed designed to allow a federal employer,
such as the Postal Service, to hire back injured workers in some capacity for a short period of
time, then “„downsize” the “position” that the injured worker returned to, and thereafter simply
ask OWCP to set the injured worker‟s permanent future LWEC based on the eliminated
“position”. The Postal Service had already been doing this as a way of avoiding paying workers‟
compensation benefits before these changes were proposed.
Contingency fees:
§10.702 and §10.703(b) – these sections state that contingency fees for attorneys are not allowed,
even if the client agrees with the fee amount. This follows up on FECA Circular 09-03 issued
06/01/09 stating informally that such fees are not allowed but which was based entirely on legal
precedents interpreting the pre-1999 regulations. This was an unnecessary attempt to further
limit the right of injured workers to obtain competent legal counsel. When the fee rules were
changed in 1999 it was on the basis that, as stated in the Federal Register at the time, “Section
10.702 implements a new procedure by which OWCP will automatically approve all fees unless
the represented party objects to the amount billed.” OWCP backtracked on that change, for no
good reason and based on its apparent desire to discourage or exclude attorneys from
representing FECA claimants.
No mailbox rule for reconsideration requests:
§10.607 - changes the deadline for filing reconsideration requests from the mailbox rule (i.e.
2 According to a letter not disclosed publicly until July 2011, USPS discontinued NRP in January 2011.
3 It is not all bad news for workers affected by the NRP. In A.J. and USPS, 61 ECAB ___, Docket No. 10-
619, 110 LRP 39850 (June 29, 2010), the ECAB seems to have lowered the bar as to what kind of position
will be considered “odd-lot” and therefore would be inappropriate to use in determining an employee‟s
LWEC. In A.J. the Board ruled that a claimant‟s position was makeshift because:
1. It was created specifically for the employee and tailored to her medical work restrictions,
2. The position did not allow her to perform the general duties of a clerk, although it was described as a
clerk position, and
3. There was no evidence that she would have been able to secure a position in the community at large that
required such limited duties.
The Board also found the position was temporary, and therefore could not be the basis of an LWEC because
there was no indication that the job offered was permanent; in fact, the employer had eliminated the position
because it could no longer accommodate the appellant‟s restrictions. This decision should make it easier for
Postal workers affected by the NRP to petition OWCP to overturn LWEC ratings based on light duty or
modified duty positions (but see the regulatory changes discussed herein).
deemed filed when placed into the mail stream) to "when received". This of course raises the
question: how would one know exactly when OWCP receives anything – especially since they
lose so many documents?
Other anti-employee proposed changes:
§10.18 - affirmative duty for beneficiary to report to OWCP any incarceration based on a felony
conviction that would result in forfeiture of beneficiary's right to compensation.
§10.617 - changes hearings to being generally limited to one hour.
§10.511 - codifies ECAB law which delineates the only circumstances under which loss of wage-
earning capacity can be modified, i.e.: only where the party seeking modification establishes that
there is a material change in the nature and extent of the injury-related condition, the employee
has been retrained or otherwise vocationally rehabilitated, or the original determination was
erroneous.
§10.517 - when employee refuses to seek or accept suitable work, termination of compensation
applies to prior injuries in which comp is payable as well as to the current claim.
§10.525 - employees must now report all employment activities including all outside
employment in determining disability, even when the employment is dissimilar to their current
job. Regarding this, §10.526 includes volunteer activities as well.
§10.618 - when changing a hearing request to a request for review of the written record, all
evidence and argument must be submitted with that request.
§10.703 - OWCP can only approve OWCP fees and ECAB can only approve ECAB fees. When
the fee is disputed, OWCP considers customary local charges for a representative with similar
qualifications in considering what is a reasonable fee.
Pro-employee proposed changes:
Addition of skin as a body part on the schedule:
§10.404 - Includes the skin as an organ - 205 weeks compensation for total loss. Covers people
suffering such losses on or after September 11, 2001. [Note – how would this be coordinated
with the special fund set up for 911 first responders?]
Electronic submission of documents:
§§ 10.1,10.101,10.102, 10.103 and 10.105 revised to allow electronic submission of notices and
claim forms by December 31, 2012.
Travel distance
§10.315 increases reasonable distance of travel up to a roundtrip distance of 100 miles for
reimbursement.
Attendance at medical exams:
§10.32 - can allow another person at medical examination where someone needs assistance
because s/he is hearing impaired or possibly needs an interpreter.
Miscellaneous:
§10.417 - reduces reporting requirements re dependency for adult children who are incapable of
self-support to once a year. Also adds option to change dependency to permanent.
§10.501 allows OWCP to require less medical documentation for continuing benefits where
circumstances merit such reduced documentation. Specifically for employees over 65 and with
serious conditions not likely to improve (but still usually not less than once every 3 years).
§10.609 - OWCP won't wait to give Agency chance to comment on recon when comments from
agency are not germane to the issue.
//
Neutral proposed changes:
§10.103 - OWCP can create a separate form for schedule awards.
§10.104 - clears up what a recurrence is and what is the basis for modifying a loss of wage
earning capacity determination.
§10.606 – reconsideration requests must be signed and dated.
§10.712 - better clarification re third party claims and crediting.
§10.801 - clarifies how medical billing works.
New rules for non-citizen and non-resident employees of U.S., any territory, or Canada, re FECA
coverage.
Public comment on these regulatory changes was invited through October 12, 2010. The author,
on behalf of WILG, 4 filed detailed objections to some of the proposed changes on behalf of the
WILG FECA Section. Unlike in prior years when proposed regulations were issued, OWCP
received many hundreds of comments from the public and from law firms and employee
organizations about the proposed changes to its FECA regulations. OWCP later adopted nearly
all of its proposed changes, however (see item 8, below).
2. S.B. 4000
“U. S. Postal Service Improvements Act of 2010” – introduced by Senator Collins in December
2010 (in the previous Congress), this bill dealt primarily with easing the Postal Service‟s
financial woes; but it also contained a section 5 proposing that injured federal employees be
transitioned from OWCP (workers‟ compensation) benefits to CSRS or FERS (federal civilian
retirement) benefits at retirement age. Retirement age was defined as the age when the employee
reached eligibility for Social Security retirement benefits under 42 U.S.C. §416(l)(1). As written,
it would also have made retirement-age employees ineligible for any FECA benefits in the event
of an industrial injury, in effect forcing them to immediately retire unless they simply did not file
a FECA claim. This bill died in committee.
3. S.B. 261
After the new Congress was seated in January, in February Senator Collins re-introduced the
FECA-related provisions of S.B. 4000 as a stand-alone bill entitled “Federal Workers‟
Compensation Reform Act of 2011”. The provisions are identical to the earlier bill. Senator
Collins also requested that the Government Accountability Office (GAO) study what provisions
existed in state workers‟ compensation laws relating to continued receipt of workers‟ comp
benefits after retirement age. This bill has not been acted on.
4. S.B. 353
Also in February 2011 Senator Collins re-introduced the FECA-related provisions of S.B. 4000
as part of another Postal Service financing bill entitled “U. S. Postal Service Improvements Act
of 2011, Title III” The provisions related to FECA are identical to those in the other bills, S.B.
4000 and S.B. 261. This bill also has not been acted on.
4 Workers Injury Law & Advocacy Group, the nation‟s only organization of attorneys dedicated to
representing workers‟ compensation claimants/applicants, with over 850 members and members in all 50
states. The author is Chair of the FECA Section of WILG. 5 Title III – “Federal Workers Compensation Reforms for Retirement Eligible Employees”
5. FIERA
At about the same time as S.B. 261 was introduced, on February 9, 2011 OWCP invited various
federal employee union officials to the Department of Labor‟s offices in Washington and made a
presentation outlining OWCP‟s FECA reform ideas, which it called the “Federal Injured
Employees‟ Reemployment Act of 2010”. This is a comprehensive set of changes which would
result in an overall decrease in workers‟ compensation benefits. When asked by one of the union
officials whether there would be an opportunity to discuss these proposals before they were
enacted, the OWCP officials said that would “not be necessary”. Later, however, several of
OWCP‟s proposals met with opposition from federal unions and some members of Congress at
hearings (see below). While no bill on FIERA has been introduced in either House of Congress
as of this writing, it was outlined and discussed in the three hearings on the Hill mentioned
below, and it is still circulating as the basis for various reform proposals. Also on July 8, 2011
the Government Accountability Office [GAO] was asked to conduct, and is conducting, a study
on how several of FIERA‟s key proposals would affect federal employees; the results of the
study are not expected for several more months.
SUMMARY OF OWCP‟S FIERA PROPOSAL PACKAGE
Vocational rehabilitation – can start six months after an injury, even if the employee is not yet
considered permanently disabled. Increases maintenance allowance paid to workers in rehab by
50%. Allows OWCP to reimburse employers who hire a previously injured federal worker for
up to three years, and allows OWCP to reimburse federal agencies that reemploy injured workers
after they suffer a recurrence of disability.
Total disability rates for new injuries payable at 70% of wages for all employees instead of at the
current 66-2/3% or 75% of wages (for employees with dependents).
Total disability rates, for new injuries or periods of disability, reduced from 75% or 66-2/3% of
wages to 50% of wages after the employee reaches Social Security retirement age and has been
receiving benefits for at least a year.
Schedule award benefits payable at 70% of wages for all employees instead of at 66-2/3% or
75% of wages. All awards to be calculated on the pay rate of a GS-11 step 3 employee
regardless of the injured employee‟s actual wages. Awards to be paid in a lump sum, and also
may be paid while employee is receiving wage-loss benefits.
Schedule awards for disfigurement increased from maximum of $3,500.00 to maximum of
$50,000.00, for new injuries, with this maximum adjusted yearly for cost-of-living increases.
Earnings reporting - Requires all disabled claimants receiving benefits for total or partial
disability to report earnings, but eliminates this requirement, and the requirement to participate in
vocational rehabilitation, after the employee‟s benefits are reduced due to reaching Social
Security retirement age.
Death benefits payable at a maximum of 70% of deceased employee‟s wages for all dependents,
reduced from current 75% maximum. Adds domestic partners as eligible survivors.
Continuation of Pay [COP] to be recouped by OWCP from third party settlements and credited to
federal employing agency that paid it – currently COP cannot be recouped. 45-day period of
COP increased to 135 days for employees injured in a zone of armed conflict, and COP for those
employees is available for both traumatic and occupational disease claims.
Burial expense reimbursement maximum increased from $800.00 to $6,000.00 for new death
claims.
Physicians‟ assistants and nurse practitioners are added to the list of recognized medical
providers.
Election between workers‟ comp and retirement - Requires employees who have retired to
permanently elect to receive either OWCP benefits or retirement (CSRS or FERS) benefits
within a reasonable time after retiring.
Sanctions - Imposes a new sanction (suspension of benefits) against employees who fail to
cooperate with OWCP field nurses. Cooperation with such nurses has been voluntary.
Matching of benefits and earnings - Allows new automatic matching of FECA recipients to those
receiving earnings per Social Security records to eliminate improper payments.
Chargeback - Allows reimbursement of claims administration expenses to be paid from the
Employees‟ Compensation Fund, and requires federal agencies for the first time to pay their fair
share of these costs back to OWCP.
MAIN CRITICISMS THAT HAVE BEEN VOICED ABOUT OWCP‟S FIERA PROPOSALS
Total disability benefits should not be reduced from 75% to 70% for employees with dependents,
as those employees have higher living expenses.
Schedule award benefits should not be calculated on the pay rate of a GS-11 step 3 employee
(currently $53,639.00 per year), as that would drastically reduce awards for higher-paid
employees, many of whom are law enforcement and other public safety officers.
Death benefits should not be reduced from current maximum of 75% of deceased employee‟s
wages for all dependents to a maximum of 70%, since some deceased employees have several
dependents and the number of such claims is relatively small.
Employees who have retired should not be required to permanently elect to receive either OWCP
benefits or retirement (CSRS or FERS) benefits, since some of them retired early on disability
retirement while their OWCP claim was not yet even decided, and they should not lose the much
higher OWCP benefit if and when it is granted.
6. Congressional hearings
On April 13, 2011 a hearing entitled “FECA: A Fair Approach” was held in the House
Committee on Oversight and Government Reform [“OGR”], Subcommittee on the Federal
Workforce, chaired by Darrell Issa (R-CA). Witnesses were:
Gary Steinberg, Acting Director, Office of Workers‟ Compensation Programs, USDOL
Bill Siemer, Assistant Inspector General for Investigations, U. S. Postal Service
Lisa McManus, President, CCS Holdings, L.P.
Milagro Rodriguez, Occupational Health and Safety Specialist, American Federation of
Government Employees AFL-CIO
At this hearing Mr. Steinberg outlined FIERA in detail. Mr. Siemer complained about fraud in
the FECA system allegedly being perpetrated by Postal workers. Ms. McManus, whose firm is a
private workers‟ comp claims administration service, argued for privatization of the FECA
system. Ms. Rodriguez argued against any reduction in employee benefits under FECA.
On May 12, 2011 a hearing entitled “Reviewing Workers’ Compensation for Federal Employees”
was held in the House Education and Workforce Committee, Subcommittee on Workforce
Protections, chaired by Tim Walberg (R-MI). Witnesses were:
Daniel Bertoni, U. S. Government Accountability Office
Susan Carney, Human Resources Director, American Postal Workers Union AFL-CIO
Elliot P. Lewis, Assistant Inspector General, U. S. Department of Labor
Gary Steinberg, Acting Director, Office of Workers‟ Compensation Programs, USDOL
Scott Szymendera, Congressional Research Service.
At this hearing, Mr. Bertoni testified about a 1996 GAO report on FECA and how he felt it was
still relevant, based on secondary sources such as the Congressional Research Service, but not
based on any legal analysis; he concluded that any proposal to replace FECA benefits with
retirement benefits for older workers should be very carefully studied before being implemented.
Ms. Carney voiced objections to the provisions that reduced employee benefits and certain other
procedural changes, citing numerous reasons. Mr. Lewis made recommendations for changing
the 3-day waiting period, cautioned against forcing FECA claimants onto the retirement rolls,
favored allowing OWCP to gain SSA earnings information more easily, and favored bolstering
OWCP efforts in the area of vocational rehab and return to work. Mr. Steinberg again outlined
FIERA in detail, but curiously stopped short of advocating its adoption in legislation. Mr.
Szymendera reviewed the history of federal employee workers‟ compensation laws and the
various amendments to FECA since 1916.
Following these hearings in April and May, staffers for the Subcommittee on Workforce
Protections began working on a piece of legislation to be proposed after the July 4th holiday that
would reform FECA (see H.R. 2465, below).
On July 26, 2011 a hearing entitled “Examining the Federal Workers’ Compensation Program
for Injured Employees” was held in the Senate Subcommittee on Oversight of Government
Management, the Federal Workforce, and the District of Columbia. Witnesses were:
Christine Griffin, Deputy Director, U. S. Office of Personnel Management
Gary Steinberg, Acting Director, Office of Workers‟ Compensation Programs, USDOL
Andrew Sherrill, Director, Education, Workforce, and Income Security, USGAO
Joseph Beaudoin, President, National Active and Retired Federal Employees Association
Ronald Watson, Consultant, National Association of Letter Carriers, AFL-CIO
Gregory Krohm, Executive Director, International Association of Industrial Accident
Boards and Commissions.
At this hearing, Ms. Griffin argued against transferring retirement-age FECA recipients to federal
employee pension benefits, and said she preferred OWCP‟s FIERA proposal to reduce FECA
benefits at retirement age instead. Mr. Steinberg again outlined FIERA in detail. Mr. Sherrill
discussed a previous related GAO report and reiterated its continued relevance. Mr. Beaudoin
generally opposed all benefit reductions to active and retired employees. Mr. Watson opposed
the reduction of benefits to 70% for all claimants and the mandatory switch to retirement for
injured FECA claimants as unfair to employees, Mr. Krohm provided rather murky personal
comments, not on behalf of IAIABC, comparing and commenting on some differences between
FECA and state workers‟ compensation laws.
7. H.R. 2465
The result of the bipartisan efforts of the House staffers involved with the May 12 hearing was
this bill, entitled “Federal Workers‟ Compensation Modernization and Improvement Act”, which
was introduced on July 8, 20111and was quickly reported out of committee on July 13, 2011.
HR 2465 FECA Amendments
District of
Columbia
employees
Amends §8101 to exclude employees of the District of Columbia, who have their
own WC law effective 03/03/79.
Physicians‟
Assistants and
Nurse Practitioners
Amends §§8101(3), 8103(b), and 8121(6) to provide that the services of
Physicians‟ Assistants or Nurse Practitioners are covered medical services and
allow them to certify disability for periods of COP in traumatic injury cases only.
Injuries outside of
U. S.
Amends §8102(b) to strike outdated language, and to include injuries from terrorist
attacks.
Schedule Award
Disfigurement
Amends §8107(c)(21) - maximum of $3,500 increased to $50,000 for disfigurement
of the head, face or neck, effective for injuries starting 3 years prior to date of
enactment. Adds language adjusting this amount yearly using the existing FECA
cost of living adjustment in 5 U.S.C. §8146a.
Social Security
Provisions
Amends §8116 by adding section (e) to allow USDOL to require claimants to
consent to release of SSA earnings records to OWCP as a condition of receiving
FECA benefits.
Continuation of
Pay / Zone of
Armed Conflict
Amends §8118 to expand continuation of pay from 45 days to up to 135 days to
ease benefit delivery for employees injured in a zone of armed conflict - applies to
both traumatic and occupational injuries. Also increases time to claim COP from
30 to 45 days for these employees.
Subrogation-
Continuation of
Pay (COP)
Amends §§8131 and 8132 to allow COP cost to be recouped from Claimant‟s
recovery from liable third party by DOL, credited to employing agency that paid it.
Eliminates double recovery of wares.
Burial Expenses Amends §8134 - Increases maximum benefit from $800 to $6,000 for burial
expenses (applies to death claims after enactment) and adds language adjusting this
amount yearly using the existing FECA cost of living adjustment in 5 U.S.C.
§8146a.
Employees‟
Compensation
Fund – claim
admin. expenses
Amends §8147 to allow for payment of administrative expenses from the fund and
to require agencies to pay their share of costs associated in administering the
statute.
The WILG FECA Section has supported this bill, as have several federal employee unions. As
this bill contains only non-controversial revisions to FECA, it is widely viewed as not addressing
the financial concerns driving FECA reform.
8. Regulatory changes adopted
On June 28, 2011, while noting the many voices opposing several of the changes, OWCP
adopted its regulatory change proposals nearly intact. The changes were effective August 29,
2011, and can be found at http://frwebgate2.access.gpo.gov/cgi-
bin/PDFgate.cgi?WAISdocID=bvP8VL/32/2/0&WAISaction=retrieve. Notable was a change in
the first sentence of 20 CFR §10.510 from ““A light duty position may form the basis of a loss of
wage-earning capacity determination …” to “A light duty position that fairly and reasonably
represents an employee‟s ability to earn wages may form the basis of a loss of wage-earning
capacity determination …” [emphasis added[; this change makes that Section a bit more
palatable to claimants and is more in line with the Board‟s A.J. ruling.
9. H.R. 2309
This bill was introduced on June 23, 2011, sponsored by Darrell Issa (R-CA) and co-sponsored
by Dennis Ross (R-FL); it affects employees covered by FECA as part of a larger plan to
reorganize the Postal Service. Some effects of this bill would be:
A. creates a Commission on Postal Reorganization to oversee Postal operations,
with powers such as voiding existing Postal employee union contracts, recommending
closure of Postal facilities, etc.;
B. increases employee costs for health care coverage and life insurance at
expiration of the current union contracts, and eliminate the right to collectively bargain
over these benefits;
C. eliminates Saturday delivery.
On June 23, 2011 this bill was referred to the House Committee on Oversight and Government
Reform [“OGR”].
10. Ross Amendment to H.R. 2309
“Postal Service Workers‟ Compensation Reform” - This amendment to Cong. Issa‟s bill,
sponsored by Cong. Ross (R-FL) [“Issa-Ross Postal Reform Act”] and introduced on September
21, 2011, would create special workers‟ compensation rules and procedures, within FECA just
for Postal Service employees, including:
A. giving the Postal Service the right to determine which doctors can treat injured
workers (except for emergency treatment);
B. limiting payment of disability benefits to “a total of not to exceed 104 weeks per
incident” unless the [Postal Service approved] physician “finds that one or more
temporary extensions are necessary or that the disability is permanent”;
C. reducing disability benefits to 50% of wages for employees who have reached Social
Security retirement age [as in FIERA], after the employee receives current-level
benefits for 12 months;
D. would apply to current benefits for all injuries to Postal workers, past and present.
On September 21, 2011 the Federal Workforce, U. S. Postal Service, and Labor Policy
Subcommittee of OGR reported out this bill to the full committee. An October 5, 2011 hearing
before OGR on this bill was canceled due to an inter-committee jurisdictional dispute.
11. Final Amendment to H.R. 2309
News reports on October 13, 2011 stated that the Ross-Issa bill was reported out of committee in
a different form – namely the FECA reform provisions were changed to provide that all U. S.
Postal employees would be removed from FECA coverage to be placed into an as-yet-unnamed
new workers‟ compensation system. Exact language of this amendment is not yet available. It is
felt that this change would be extremely harmful to the rights of injured Postal employees.
12. S. 1625
On September 23, 2011 this bill was introduced by Senator McCain (R-AZ) as the “Postal
Reform Act of 2011”, co-sponsored by Senator Tom Coburn (R-OK); it mostly deals with Postal
reform issues, but it contains a section (Section 311) which provides as follows:
SEC. 311. SENSE OF CONGRESS.
“It is the sense of Congress that--
(1) the Postal Service should develop and manage a program to pay
compensation for the disability or death of an officer or employee of the
Postal Service which results from an injury sustained while in the
performance of duty;
(2) such program should include an automatic transition to retirement and
provide a retirement pension based on the average salary of the officer or
employee, determined as if such officer or employee had continued to receive
basic pay from the date of injury to the date of retirement; and
(3) officers or employees of the Postal Service receiving compensation for a
disability from an injury sustained while in the performance of duty should be
transitioned to the program described in paragraph (1).”
Thus this Senate bill appears to be a moderated version of Senator Collins‟s various bills that
would require “transition” from FECA benefits to retirement benefits for injured workers once
they reach retirement age, and would require the worker be credited with time-in-service for the
period between disability onset and retirement. This bill was read twice and on September 23,
2011 was referred to the Senate Committee on Homeland Security and Governmental Affairs.
Steven E. Brown, PLC
910 Hampshire Road, Suite G
Westlake Village, CA 91361-2888
Voice: 805-496-9777
Fax: 805-496-6368
Email: [email protected]
Web: www.federal-law.com