Office of Workers' Compensation Programs (OWCP)

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Division of Longshore and Harbor Workers' Compensation (DLHWC)

CHAPTER 9-800 — GOVERNMENT PERFORMANCE AND RESULTS ACT (GPRA)

1. Purpose and Scope. This Chapter describes the performance measurement adopted by DLHWC under the Government Performance and Results Act of 1993 (GPRA) and provides guidance and instruction for tracking and measuring program performance with respect to that performance goal.
2. Intent of the Government Performance and Results Act of 1993 (GPRA). In 1993, Congress enacted GPRA which required federal agencies to develop long-term strategic plans defining goals and objectives for their programs in terms of “outcomes” rather than “outputs,” to develop specific measurable performance goals and methods of measurement, and to report on actual results compared to the annual performance goal. The intent of GPRA is not to inflict a new measure of processes on federal programs, but to improve performance in a measurable way. The measure, that is the data entry, is not the goal of GPRA. District Office staff members are expected to make a good faith effort to improve the level of services provided in our informal dispute resolution mechanism in a number of areas. These areas may include:
   • telephonic intervention,
   • technical assistance,
   • compliance assistance,
   • prompt scheduling and conducting of Informal Conferences,
   • individual meetings with the parties,
   • streamlining the processes (paper handling, data entry, mail service, distribution to OALJ, etc.), and
   • other means of improving service in the district office.
   The GPRA measure is simply the methodology of reporting the effort to shorten the length of time it takes the program to resolve disputed issues. Program staff must keep in mind that GPRA outcome measures are the criteria by which Congress will distribute limited resources to programs, and our success in meeting our goals and documenting the achievement in our GPRA reports is the key to our future funding and staffing levels.
3. DLHWC GPRA Objective, Goal and Strategies.
   1. Objective. It is the GPRA objective of DLHWC to foster the kind of cooperative spirit and open communication among the parties to a claim with disputed issues that results in a smoother, more efficient process and quicker resolution of those disputes.
   2. Goal. To quantify the objective so it is measurable, the GPRA goal is to reduce the average time it takes to resolve certain types of disputes which arise in cases under the LHWCA and its extensions. The time taken by the OALJ in connection with the formal hearing process is to be included in measuring the time it takes to reach resolution. Advance notification of the annual fiscal year goal (i.e., the average number of days for dispute resolution) will be provided to the district offices by the National Office.
   3. Strategies. Program strategies to achieve the objective include, but are not limited to:
      • Improve, streamline, and better manage district office dispute resolution processes and tracking.
      • Exercise prompt and effective case management.
      • Use outreach to encourage voluntary compliance with the provisions of the Act.
      • Use outreach and technical assistance to institutionalize accelerated submissions of injury reports, required filings from employers/carriers, and other evidence so as to reduce the time to decision.
4. GPRA Tracking Codes. GPRA disputes and their resolution are tracked in the Longshore Case Management System (LCMS) using specific diary action codes. These codes are discussed below.
5. Documentation. Documentation of GPRA disputes and resolutions, as well as district office actions directed at resolution, is a necessity and will usually be satisfied by routine case documents such as LS-207, written correspondence from the parties, request for a conference, LS-206, LS-208, written documentation of phone calls, compensation orders, etc. However, where there is no such evidence in file or where the actions or determinations of the district office need explanation or clarification, legible notes are to be placed in the case file. A GPRA Log (Exhibit 27, PM Chapter 10-300) should be placed on the top of every file upon case creation, and updated as each GPRA entry is made. The Log is used to document the date and basis of each GPRA code entered or changed in the LCMS. It will make review and tracking less time consuming. The Log is designed so that it can be folded in half and turned over when one side is completely filled. Additional sheets may be added if needed. The top part of the Log may be used as an optional call-up sheet.
6. Disputes. Disputes that are to be tracked through the GPRA process are those genuine disputes involving temporary disabilities, permanent disabilities, medical treatment and/or payment, average weekly wage, occurrence of injury, or jurisdiction. Disputes concerning other issues such as attorney fees, penalties and interest, entitlement to section 8(f) relief, etc., are not disputes subject to the GPRA process.
   1. Identifying Disputes. Disputes are generally identified based on the receipt of a LS-207, a letter or telephone call from the claimant or the employer/carrier (or their representative) describing the disagreement, or a request for an informal conference. However, the mere receipt of a LS-207 or a request for conference does not, in and of itself, establish the existence of a dispute. For example, issues contained in an employer/carrier’s protective controversion that serves only to preserve due process rights (and which are often followed by the submission of a LS-206 or LS-208) are excluded as legitimate disputes. Further, receipt of a LS-207 which contains a reason for controversion such as “Section 8(f) relief” or “Claimant seeking benefits under the applicable State Act” does not constitute evidence of a legitimate dispute or disagreement.
      
      On the other hand, if the E/C submits a LS-207 with what appears to be a legitimate controversion, but the claimant does not respond within a reasonable period of time, the circumstances would support the conclusion that no dispute truly exists and no dispute code should be entered. If previously entered, the code should be overridden (see below concerning overriding dispute codes).
      
      The submission of a request for an informal conference may not necessarily constitute evidence of a genuine dispute. For example, if the employee’s representative submits medical evidence in support of permanent impairment along with a request for an informal conference, and shortly thereafter without any action by the district office other than possibly scheduling the conference, the employer advises that appropriate payment will be made, there is insufficient evidence to support that a genuine dispute existed. If previously entered, the dispute code should be overridden.
   2. Entering Dispute Codes in LCMS. GPRA disputes should be entered into the LCMS at the time the dispute is identified or as soon as possible thereafter. It is not recommended that disputes be entered at the time of primary review unless there is a strong indication that a dispute exists at that time. Indications of a dispute very early in the case may be misleading and may not represent the existence of a genuine dispute. Therefore, if a LS-207 is received with the LS-202, but the existence of a genuine dispute is not clear, it is acceptable to wait a reasonable time (e.g., 30 days) for the E/C to complete its investigation and possibly submit other documentation such as a LS-206 or LS-208 showing that, in fact, there is no disagreement with the claim.
   3. Date of Dispute. The date of dispute to be entered in the LCMS is the date of receipt of the evidence showing the existence of a dispute and not the date the evidence is reviewed or the date it is being entered into the system. The start date for tracking a dispute is the date the evidence showing the dispute is received in the district office.
   4. Multiple Disputes in a Single Case. If there are multiple disputes in a case, each dispute is to be entered separately in LCMS using the appropriate code. For example, if the employer contests the claimant’s right to temporary total disability for a particular period (207t) as well as the need for further medical treatment (207m), both disputed issues are to be entered in LCMS.
   5. Threshold Issues. Where one of several disputes in a case involves a threshold issue such as occurrence of injury or jurisdiction, all disputed issues should be entered in LCMS at the time they arise and not just the threshold issue. It should not be assumed that all the other issues are simply subsumed by the threshold issue and that only one code (e.g., 207j) need be entered. If the threshold issue is resolved in the claimant’s favor, other concurrent disputes such as AWW and entitlement to TTD, for example, are to be in LCMS and tracked to resolution.
   6. LCMS GPRA Dispute Codes. The following diary action codes are to be entered in the LCMS to identify the occurrence of a GPRA dispute. Note that diary action code 207r (LS-207 Received) is not a GPRA dispute code, but it should be entered separately to document the receipt of the LS-207.
      1. 207a - There is a dispute with regard to the injured worker’s average weekly wage.
      2. 207i - There is a dispute as to whether the injury arose out of and during the course of employment. (This is a threshold issue; however, any concurrent disputes should also be entered and tracked in LCMS.)
      3. 207j - There is a dispute with regard to situs, status or other related jurisdictional issues. (This is a threshold issue; however, any concurrent disputes should also be entered and tracked in LCMS.)
      4. 207m - There is a dispute is related to the necessity, authorization, cost, or payment of medical treatment.
      5. 207p - There is a dispute concerning the entitlement to permanent total or permanent partial disability including causal relationship, nature and extent. This code should also be used to identify a dispute involving causal relationship in a death case.
      6. 207t - There is a dispute concerning the entitlement to temporary total or temporary partial disability including causal relationship, nature and extent.
   7. “Overriding” a Previously Entered Dispute Code. If it is necessary to negate a previously entered dispute code because, for example, the claimant never responded to the employer’s genuine controversion of a claim for employment-related hearing loss, enter the code 207d in the diary action function of LCMS. This will negate, but not delete, the corresponding dispute code. Although still visible in the diary history, the overridden dispute code will not be reflected in any of the GPRA tracking or performance reports available through LCMS. Overriding a dispute code using 207d is not a GPRA resolution. A separate 207d override code should be entered for each previously entered dispute code to be negated. To help ensure that each 207d override code is associated with the correct dispute code, the 207d code should be given an LCMS sequence number which is one number greater than the sequence number for the dispute code to be overridden.
7. Resolutions. A resolution occurs when the parties to the disputed issue in a claim agree to a common position that ends the adjudication on that issue, or when a decision is rendered which resolves the disputed issue. For the purposes of GPRA, a decision on the disputed issue by the OALJ represents a resolution, and any subsequent appeal of that decision to the BRB or beyond does not fall within the GPRA tracking process. See the discussion of the GPRA resolution codes below for additional information on what constitutes a resolution.
   1. Identifying Resolutions. Resolutions are most frequently identified by the filing of an order issued by the District Director or the OALJ, the receipt of a LS-206 or LS-208, or other communication from the parties documenting that the dispute has been resolved.
   2. Entering Resolution Codes in LCMS. Resolutions should be entered into the LCMS at the time the resolution is identified or as soon as possible thereafter.
   3. Date of Resolution. The date of resolution to be entered in the LCMS is the date of filing of the compensation order or the date of receipt of the evidence showing the parties have resolved the dispute. Where the resolution involves the payment of compensation for wage loss or permanent impairment without an order, the date of resolution should be the date of receipt of the LS-206 or LS-208. The date of resolution is not the date the documentation is reviewed or the date it is being entered in LCMS.
   4. LCMS GPRA Resolution Codes and Dates. The following diary action codes are to be entered in the LCMS to identify the occurrence of a GPRA resolution. Note that diary action code 207d is not a GPRA resolution code. It is to be used to negate or cancel out a dispute code that was previously entered in error. To help ensure that each resolution code is associated with the correct dispute code, the resolution code should be given an LCMS sequence number which is one number greater than the sequence number for the dispute code being resolved.
      1. adj1 - Resolution as a result of an informal conference. The scheduling or holding of an informal conference or the issuance of conference recommendations does not, by itself, constitute a GPRA resolution. If the parties agree with the office’s recommendation and take the action agreed to, then resolution occurs at that point and the adj1 code should be entered in LCMS. The date of the resolution depends on the actions taken. As examples, the date of resolution would be the date of the compensation order (if an order is specifically requested by the parties), the date of receipt of the LS-206 or 208 confirming payment (if no compensation order was issued), the date of the communication advising that a disputed medical bill will be paid, etc. If communication is by telephone, the call must be documented in the file. The date of the conference or the date of the release of the conference recommendations is not the date of resolution.
      2. adj2 - Resolution as a result of a section 8(i) settlement approved by the district director. This would include cases remanded by the OALJ for consideration of a settlement agreement by the district director. Even though a compensation order is issued, the code adj2 should be used rather than adj4. The date of the resolution to be entered in LCMS is the date the order approving the section 8(i) settlement is filed. If resolution is reached by a section 8(i) settlement approved by the OALJ, resolution code adj5 should be used.
      3. adj3 - Resolution as a result of correspondence and/or telephone calls. Resolution of disputes involving unpaid medical bills or the need for further medical treatment may be resolved through this process. Disputes concerning the percent of permanent impairment may also be resolved through the exchange of medical evidence and other correspondence rather than through the informal conference process. The date of resolution would be the date of receipt of the communication indicating that agreement has been reached or that appropriate payment has been made. If the dispute concerns an unpaid medical bill, a communication from the E/C that the bill will be paid is sufficient. If resolution involves the payment of compensation, the date of resolution should be the date of receipt of the LS-206 or LS-208 showing payment. If the efforts of the district office through correspondence and telephone calls produce agreement among the parties but they request the issuance of a compensation order, code adj4 should be used rather than adj3, and the date of resolution would be the date the order is filed.
      4. adj4 - Resolution as a result of a compensation order issued by the district director. If actions by the district office result in agreement by the parties and the issuance of a compensation order (other than an order approving an 8(i) settlement), code adj4 should be entered in LCMS. If the order approves a section 8(i) settlement, adj2 should be used. This code would also be applicable where the case was remanded by the ALJ to the district office for additional action that culminated in the issuance of an order by the district director. (Also see code adj5 below concerning remand orders.) The date of resolution would be the date the order is filed in the district office.
      5. adj5 - Resolution as a result of an order issued by an ALJ, including those orders approving a section 8(i) settlement. This code should also be used for those ALJ orders remanding the case to the district office because the parties resolved their differences prior to the formal hearing. For example, if a dispute on the nature and extent of disability is resolved through evidentiary discovery prior to hearing (resulting in remand) and the E/C pays appropriate compensation, code adj5 should be used. The date of resolution would be the date the ALJ’s order is filed in the district office. If following the remand, additional adjudicatory action is required of the district office before resolution is reached by the parties, a code other than adj5 should be used.
      6. adj6 - Resolution as a result of 8(i) settlement approved by the district director in which the parties had obtained pre-approval from Medicare. This code is used in lieu of the adj2 resolutions. It is similar to the adj2 resolution but with the added qualification that the parties had submitted pre-approvals to Medicare. The purpose of separately tracking these settlement resolutions from the adj2 settlement resolutions is to account for the extra time it takes to resolve a case with Medicare pre-approval. The date of the resolution to be entered in LCMS is the date the order approving the section 8(i) settlement is filed.
      7. adj7 - Resolution as a result of a settlement order issued by an ALJ in which the parties had obtained pre-approval from Medicare. This code is used in lieu of the adj5 settlement resolutions. It is similar to the adj5 settlement resolutions but with the added qualification that the parties had submitted pre-approvals to Medicare. The purpose of separately tracking these settlement resolutions from the adj5 settlement resolutions is to account for the extra time it takes to resolve a case with Medicare pre-approval. The date of resolution would be the date the ALJ's order is filed in the district office.
8. Non-GPRA Tracked Cases. Beginning in FY 2002 the measurement of overall program GPRA performance for the first time included certain cases which had not been previously coded for tracking since GPRA was implemented on May 22, 2000. These cases are those with ALJ decisions issued after May 22, 2000 but which do not have a GPRA dispute code in the system. Since there is no dispute code and start date the LCMS cannot calculate the number of days in such cases. Therefore, a construct was designed to account for these disputes. For each such OALJ case, an average of 1.61 disputes and an average resolution time of 663 days for each dispute is counted. This construct of average disputes and resolution time was based on historical data. This results in a resolution time of 1,067.43 days for each non-GPRA tracked case returned from the OALJ.
   1. Definition. "Non-GPRA tracked cases" are those cases in the LCMS/GPRA tracking system with an LCMS code of "adec," but without any GPRA dispute codes having been entered in the system. In other words, there is a diary action code of an ALJ adjudication ("adec" code) within the reporting period, but there is no applicable GPRA dispute or resolution code in the diary history. Not all non-GPRA tracked cases contain disputes that are to be tracked through the GPRA process, but only those with disputes involving temporary disabilities, permanent disabilities, medical treatment and/or payment, average weekly wage, occurrence of injury, or jurisdiction (i.e., those that can be identified by the GPRA codes 207t, 207p, 207m, 207a, 207j, or 207i).
   2. Coding Non-GPRA Tracked Cases. Cases identified by LCMS as Non-GPRA tracked must be reviewed first to determine whether there are disputes that should be included in the category of GPRA Resolution by the OALJ; i.e., a GPRA dispute arose after May 22, 2000 and was resolved by the OALJ. If so, the appropriate GPRA codes and dates should be entered into the system. This will remove these cases from the Non-GPRA tracked measurement. There will still be cases that cannot be GPRA-coded because the dispute(s) started before May 22, 2000. When GPRA tracking was first implemented on May 22, 2000 a decision was made not to backfill data for disputes which arose prior to that date. For this reason, the LCMS was designed not to accept a GPRA dispute code with a date of dispute earlier than May 22, 2000. These true "Non-GPRA Tracked" cases must be reviewed to eliminate those which do not contain one of the six GPRA tracked dispute issues. Instead of "adec", the following substitute ALJ adjudication codes should be used to eliminate them from GPRA tracking. These substitute codes are:
      • adea - Cases with attorney fees as the sole disputed issue.
      • adef - Cases with 8f relief as the sole disputed issue.
      • adeo - This code should be used when an ALJ order is received in the district office that does not result in substantive dispute resolution, such as a notice of hearing or a pretrial order, and procedural and discovery orders (continuance, order to compel, show cause, joinder or dismissal of party defendant, etc.) This code is also used for errata or amended orders, ALJ decisions on reconsideration, and decisions on remand in cases where the initial Decision and Order had been issued sometime in the past. It should also be used in cases in which only Non-GPRA tracked disputes were resolved by the ALJ decision. Examples of Non-GPRA tracked issues are last responsible employer, employer-employee relationship, dependency, penalties and interest, discrimination, garnishment, misrepresentation and third party credit and forfeiture.
      • The adec code should continue to be used in all other ALJ Decisions and Orders. Do not use adea, adef, or adeo if the ALJ decision includes resolution of any GPRA-tracked issues.
   3. Inactive or Closed Cases. If inactive or closed files are reopened in order to consolidated with an active case for the purpose of a section 8(i) settlement, or for referral to the OALJ, these "companion" cases should not be separately GPRA-coded or tracked. They should be coded as "adeo" when they return from the OALJ. However, if there are genuine GPRA disputed issues in each (or some) of these reactivated cases, the usual GPRA coding should be used.
   4. Note: If a "ctoa" code has been entered in LCMS when the case is referred to the OALJ, an ALJ adjudication code, i.e., adec, adeo, adea, adef or rmd, must be entered when the case is returned from the OALJ. LCMS will not allow closure of a case with an open "ctoa" code.
9. GPRA Tracking and Performance Reports. GPRA tracking and performance reports are available through LCMS. Reports can be obtained based on either disputes or resolutions.
   1. Disputes. By selecting “Dispute,” specifying the period to be covered, and selecting “Include all cases,” LCMS will provide GPRA information for disputes (both resolved and unresolved) which occurred during the period. To see information for all disputes which have been entered in LCMS, the beginning date of the period should be set to 05/01/2000. The last page of this report also shows (1) the total number of disputes occurring during the specified period and (2) the average number of days to resolution for those disputes that were resolved. Note that this average time does not indicate the office’s performance against the GPRA goal. Rather it represents only the average time to resolution where the dispute occurred within the specified period. Performance is computed based on the resolutions that occurred within the fiscal year, regardless of when the dispute actually occurred (see paragraph b below). For those resolved disputes where the case was referred to the OALJ (i.e., the diary history reflects the code ctoa), the report also shows the average number of days from referral to resolution. Similar information can be obtained through this report function for the following subcategories of disputes:
      • Only those disputes occurring within the specified period where the case was referred to the OALJ (based on diary code ctoa).
      • All disputes occurring within the specified period excluding those referred to the OALJ (in effect, those disputes being handled exclusively by the district office).
      • Those disputes occurring within the specified period which are still unresolved.
   2. Resolutions. By selecting “Resolutions,” specifying the period to be covered, and selecting “Include all cases,” LCMS will provide GPRA information for resolutions that occurred during the period. To see information for all resolutions which occurred during the fiscal year to date, be sure the beginning date is set to October 1. The last page of this report also shows (1) the total number of resolutions that occurred during the specified period and (2) the average number of days it took to reach those resolutions. Where the period covers the fiscal year to date, the average number of days shown on this report indicates the district office’s GPRA performance. For those resolutions where the case was referred to the OALJ (i.e., the diary history reflects the diary code ctoa), the report also shows the average number of days from referral to resolution. Similar information can be obtained through this report function for the following subcategories of resolutions:
      • Only those resolutions occurring within the specified period where the case was referred to the OALJ (based on diary code ctoa).
      • All resolutions occurring within the specified period excluding those referred to the OALJ (in effect, those resolutions handled by the district office).
      Listed at the top of the page of each report is a breakdown of the types of resolutions for the specified period. The breakdown shows the number and percentage of resolutions listed separately for each adj code.