What you need to know about Workers’ Compensation Northern Rockies Incident Business Committee1 Overview Overview of the Federal Employee Compensation Act Program Define Roles and Responsibilities What happens when.
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What you need to know about Workers’ Compensation Northern Rockies Incident Business Committee 2015 1 2 Overview Overview of the Federal Employee Compensation Act Program Define Roles and Responsibilities What happens when an employee is injured or fall ill on the job Specifics of the Federal Workers’ Compensation Program for each agency Forms Review When and how to use Agency Provided Medical Care Wrap-up 3 Federal Employee Compensation Act The Federal Employees' Compensation Act (FECA) (5 U.S.C. 8101 et seq.) is administered by the OWCP of the U.S. Department of Labor OWCP provides compensation benefits to civilian employees of the United States for disability due to personal injury sustained while in the performance of duty or for an employment-related disease Payment of benefits to dependents if the injury or disease causes the employee's death is also covered under OWCP 4 Why do we care? Employee health is our top priority and ensuring they receive timely medical care when injured or fall ill on the job is of the upmost importance. 5 Who is covered under FECA? Covered Federal regular government employees Federal casuals Federal Volunteers under agreement Not Covered Contractors Inmate crews and their custodians State personnel and other cooperators National Guard Active duty military personnel 6 When is someone covered under FECA? Covered On government premises In travel status Not Covered Intentional self-injury Condition resulting from willful misconduct Condition resulting from intoxication 7 State Workers’ Compensation Covered: Individuals hired under state authorities Note: Individual state workers’ Compensation programs are entirely independent of federal programs. See specific state guidelines in Chapter 50 Supplements when processing such claims. 8 Incident Agency Responsibilities Ensures workers’ compensation procedures are implemented and followed Provides a local agency contact Provides the incident with medical facility information Establishes agreements with medical providers 9 Finance/Administration Section Chief, Compensation/Claims Unit Leader, Injury Specialist Responsibilities Coordinates with the medical unit, medical providers, and incident agency Provides information and forms for state and federal employees Authorizes medical treatment Ensures necessary paperwork is completed Advises individuals of their rights and responsibilities 10 Finance/Administration Section Chief, Compensation/Claims Unit Leader, Injury Specialist Responsibilities continued… Ensures follow-up with the local office, despite affiliation (i.e. contractor, causal, etc.) Identifies a hospital liaison upon arrive Clarifies who will notify the appropriate agency administrator if someone is injured or falls ill Note: Being injured or falling ill on the job can be frightening and confusing. As agency representatives, we need to make every attempt within our legal power to ensure such individuals are provided proper care. 11 Supervisory Responsibilities Obtains treatment Completes forms Provides copy to employee Ensures time loss is appropriately documented 12 Employee Responsibilities Notifies incident supervisor Requests treatment Completes forms Obtains witness statement Notifies home unit supervisor 13 Home Unit Responsibilities Initiates follow-up medical treatment Submits reportable claims to the appropriate workers’ compensation office Reports accidents/injuries per agency guidelines Follows up with clinics, hospitals and pharmacies to provide OWCP case number. 14 DOI vs. Forest Service Provide immediate medical care, if necessary, by taking the injured employee to an emergency room/clinic accompanied with a properly issued CA-16. Incident faxes paperwork to home unit within 1 business day after making contact. Send all original paper work back with employee to the home unit to process in SMIS. Provide immediate medical care, if necessary, by taking the injured employee to an emergency room/clinic accompanied with a properly issued CA-16. Employee or supervisor enters information in eSafety and signs printed documents. (If computer access not available home unit will enter). Incident faxes CA-16 to ASC with eSafety #. 15 State Workers Follow the specific states guidance as they can vary greatly. See Northern Rockies and other Geographical Area Chapter 50 supplements for more state specific information. Do not issue a CA-16 for State employees. 16 When Injured on the Job… First Aid Injuries Examples: Blister requiring salve and moleskin Head cold requiring over the counter medication Athlete’s foot requiring foot powder What to do… Document in the medical unit No workers’ compensation forms are needed Not reportable 17 When Injured on the Job… Traumatic Injuries-occurs during a calendar day or one work shift. Examples: Sprained ankle Lacerations requiring stitches Back strain from constructing fireline in one operational period What to do…. If necessary issue a CA-16 (Authorization for Examination and/or Treatment) per the specific agencies guidelines Have the employee and supervisor complete a CA-1 (Federal Employees Notice of Traumatic Injury) Follow the employing agencies guidelines for processing paper work (continued) 18 Illness on the Job… Occupational Disease-develops over a period longer than one work day or shift Examples: Smoke inhalation from working on the fireline over a period of several days Back strain from unloading supply trucks during the course of a week What to do… Have the employee and supervisor complete a CA-2 (Notice of Occupational Disease and Claim for Compensation) Follow the employing agencies guidelines for processing paper work Note: A CA-16 should not be issued with a CA-2. The employee must also submit factual and medical evidence of a diagnosed disease for the claim to be accepted 19 When and how to use Agency Provider Medical Care When to use… One (or rarely two visits, i.e. follow-up) to a medical facility No time lost Relieve pain and suffering When authorized by home unit What to do… Have the employee and supervisor complete the appropriate paper work (CA-1 or CA-2)for documentation Send employee to medical facility with a FS-6100-16 Follow the employing agencies guidelines for processing paper work Notes on medical order request the (M#) and “Paid by APMC” on reporting form 20 Injury Compensation Matrix FSCA-1 CA-2 CA-16 6100-16 Traumatic Injury (No Medical; Report Only) X Traumatic Injury (APMC Treatment) X Traumatic Injury (Other Treatment) X X X Occupational Illness (APMC Treatment) X Occupational Illness (OWCP Coverage) X X 21 Filling Prescriptions The preferred method of payment is for the pharmacy to directly bill electronically through DFEC-ACS. Employee: It is the employee’s responsibility to verify that the pharmacy will accept Federal Workers’ Compensation and to inform their compensation coordinator that a prescription will be filled. The agency representative must call the pharmacy with the employee’s claim number upon receipt; otherwise, the employee is responsible for paying any prescription costs. 22 Filling Prescriptions – continued… If the employee pays for the prescription, they will need to fill out the OWCP- 915, Claim for Medical Reimbursement Form, and provide original prescription receipts to OWCP. Reimbursement may take 8-12 weeks. Incidents may pay for prescriptions under OWCP only if a commissary deduction is made on the OF-288. The employee will need the original receipt(s) for OWCP reimbursement. Note: Generally all nationally recognized pharmacies accept Federal Workers’ Compensation. 23 Burn Protocols The agency administrator or designee having jurisdiction for the incident and/or firefighter representative (e.g. Crew Boss, Medical Unit Leader, Compensations for Injury Specialist, etc.) should coordinate with the attending physician to ensure that a firefighter whose injuries meet the burn injury criteria is immediately referred to the nearest regional burn center. Per 2015 Red Book, Chapter 07-17 24 Burn Injury Criteria Partial thickness burns (second degree) involving greater than 5% Total Body Surface Area (TBSA) Burns (second degree) involving the face, hands, feet, genitalia, perineum, or major joints Third-degree burns of any size are present Electrical burns, including lightning injury are present Inhalation injury is suspected Burns are accompanied by traumatic injury (such as fractures) Individuals are unable to immediately return to full duty 25 Further References Interagency Incident Business Management Handbook, Chapter 10 Injury/Illness Red Book, Chapter 7 Safety & Risk Management Chapter 810 of the Federal Personnel Manual and 29 CFR Northern Rockies OWCP Guide –contains links to additional material and agency specific information.