U.S.
DEPARTMENT OF AGRICULTURE
WASHINGTON,
D.C. 20250
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DEPARTMENTAL REGULATION |
Number: 4430‑003 |
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SUBJECT: Workers'
Compensation Program |
DATE: January 8, 2001 |
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OPI: |
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1 PURPOSE
This regulation states the authority and policy for providing
compensation and benefits to employees who sustain a traumatic injury or
occupational condition while in the performance of duty
2 POLICY
The Department of
Agriculture's (USDA) policy is to manage Workers' Compensation and Return‑to‑Work
Programs in an effective manner to provide rightful benefits to eligible
employees, their dependents or survivors, and to control program costs This
regulation prohibits discrimination in the administration of the Workers'
Compensation and Return‑to‑Work Programs according to race, sex,
national origin, and disability7 in addition to religion, political beliefs,
martial/familial status, equal pay, reprisal and sexual orientation
3 DEFINITIONS
a Injury. A wound or other condition of the body
caused by external force, including stress or strain The injury must be
identified by the time and place of occurrence and member of the body affected,
it must be caused by specific events or incidents within a single day or work
shift. Injuries also include damage to
or destruction of prosthetic devices or appliances, including eyeglasses and
hearing aids if they were damaged incidental to a personal injury requiring
medical services
b Illness. A condition which is the result of systemic
infection, continued/repeated stress or strain, exposure to toxins, fumes. or
other continued/repeated exposure to conditions of the work environment over a
period of time longer than a single work day or shifl
c Continuation of Pay (COP). The process by which an agency may continue
paying salary to an employee who is disabled and unable to work due to a
traumatic injury, for a period of 45 calendar days COP is not paid in cases of
occupational illnesses
d Controversion. The process by
which a supervisor or an agency recommends to the Department of Labor (DOL),
Office of Workers' Compensation Program (OWCP), that COP be denied
e Limited Dutv. Those specific
duties and responsibilities of an employee's regular position that meet the
employee's current work capabilities as identified by a physician. These duties
may constitute all or part of the employee's regular job assignment. They may
be performed for a full work shift or for shorter time periods.
f Light Duty. Those duties and
responsibilities that are outside an employee's regular position, but that meet
the employee's current work capabilities as identified by a physician. They may
be performed for a full work shift or for shorter time periods.
4 AUTHORITIES
The authorities for
providing compensation for injuries and illnesses sustained in the performance
of duty are contained in the Federal Employee's Compensation Act (FECA), Title
5 of the United States Code, Sections 8101‑8193 and Title 20 Code of
Federal Regulations, Part 1‑25.
5 RESPONSIBILITES
a The Assistant Secretary for
Administration will:
(1) Advise the Secretary of Agriculture,
Mission Area Agency Heads, and staff officials in planning, developing and
implementing policies, programs, and systems to manage workers' compensation
programs,
(2) Establish goals for the reduction of the
workers' compensation program costs.
b The Director of the Office of
Human Resources Management will:
(1) Advise the Assistant Secretary for
Administration and USDA agency and staff officials in planning, developing and
implementing policies, programs and systems to manage workers' compensation
programs,
(2) Develop and interpret Departmental
policies and standards for the USDA workers' compensation program; and
(3) Represent USDA in rule making
presentations before advisory or legislative groups affecting the workers'
compensation program.
c The Director, Safety, Health and
Employee Welfare Division (SHEWD) will:
(1 ) Provide Department wide policy, guidance
and oversight of the workers' compensation program,
(2) Provide Mission Area and Agency Heads
with access to the cost and claim information necessary to manage their
programs This includes quarterly COP reports, OWCP's Agency Query System and
other online resources, and the USDA Case Management Tracking System.
(3) Provide agency
officials with technical assistance and consultative services for complex
workers' compensation issues such as:
(a) Medical determinations for fitness for
duty, and physical standards for job tasks;
(b) Investigation of potentially fraudulent
claims:
(c) Reemployment and rehabilitation of
claimants
(4) Conduct periodic reviews of agency
programs to ensure compliance with applicable Federal and Departmental
Regulations and Guidelines. See Appendix for review criteria.
d Mission Area Agency Heads will:
(1) Furnish employees with a place of employment
free from recognized hazards that are causing or are likely to cause death or
serious physical harm;
(2) Designate a workers' compensation
program manager. This position may be
either full‑time or collateral‑duty as appropriate for the size of
the program;
(3) Administer a
workers compensation program in accordance with law and applicable regulations
to assist employees who have been injured on the job in obtaining the benefits
to which they are entitled. This program will be designed to reduce workers'
compensation costs and minimize time lost due to work-related injuries and
illnesses by:
(a) Establishing a
Mission Area-wide rehire program to offer injured workers suitable jobs and
return them to work as soon as possible,
(b) Establishing accountability
by charging program costs down to the lowest possible organizational level,
(c) Integrating
workers' compensation program management into the performance reviews of
managers and supervisors, and
(d) Providing workers'
compensation education and training to all employees (with special emphasis on
supervisory personnel)
e Managers
and Supervisors will:
(1) Assist injured
employees in completing workers' compensation claim forms in order to reduce
errors and omissions that may delay payment of valid claims;
(2) Advise employees
of their responsibilities, rights, and benefits. These include the obligation to submit medical evidence, to
obtain a description of work restrictions if light or limited duty is
available, and the right to elect COP, sick or annual leave for injuries;
(3) Assist in workers'
compensation cost reduction efforts by:
(a) Investigating and
reporting all injuries and illnesses and any instances of possible abuse or
false claims;
(b) Correcting, to the extent of their authority,
recognized hazards that are causing or are likely to cause death or serious
physical harm,
(c) Contacting the medical provider to
obtain the that the employee will be able to return to
work, even if only in a limited capacity;
(d) Devising ways to bring employees back to
work as soon as possible after injury; and
(e) Advising agency officials of the
availability of light or limited duty assignments, or other reemployment
opportunities.
f Employees will:
(1) Comply with all applicable safety and
health rules and regulations in order
to prevent injuries and illnesses,
(2) Report unsafe or unhealthful working
conditions to their immediate supervisor for corrective action,
(3) Report work‑related injuries and
illnesses to their immediate supervisor as soon as possible;
(4) Arrange for submission of medical
evidence to substantiate claims within 10 calendar days of the date of the
injury;
(5) Advise the physician of the availability
of light or limited duty when notified of such by the supervisor,
(6) Keep the immediate supervisor informed
of his/her medical status and recovery, and
(7) Respond positively to suitable job
offers consistent with his/her physical limitations, or risk termination of
compensation benefits
6 PROGRAM
ADMINISTRATION
a Case Management.
Claim forms must be
submitted to OWCP in a timely manner. The Employee's Notice of Traumatic injury
(CA‑I) or Occupational Condition (CA‑2) must be submitted within 10
working days or (14 calendar days) of receipt from the employee if lost time
from work or medical expenses are claimed or anticipated Claims for compensation (CA‑7) must be submitted no later than 5 working days or (7
calendar days) after receipt from the employee. Proper case management requires agencies to: establish a tracking system to review the OWCP time lag reports, on at least a quarterly basis, to
ensure timely filing and processing of
claims; contest claims where solid evidence supports that injury or illness did not occur in the performance
of duty, or if claims appear potentially fraudulent or otherwise invalid,
controvert payment of COP when the evidence does not establish that the
disability resulted from a job‑related injury illness, or the employee is not eligible for COP as
specified in the FECA.
b Return‑to‑Work Program
Agencies must review
all injured workers files (especially long‑term cases) to identify those
employees available to return to work in either their regular positions or in
limited or light‑duty positions. This can be on a full or a part‑time
basis. For new claims, intervene early to identify the point at which the
injured worker is medically capable to return to their regular or modified
position Coordinate with the servicing workers' compensation office regarding
the cost and extent of vocational rehabilitation necessary to retrain and re‑employ
injured workers. Monitor rehabilitation efforts and progress Coordinate re‑training
and reemployment with available resources, OWCP, USDA agencies, other Federal
and non‑federal organizations, and private employers to offer suitable
jobs to those able to return to work. Establish job information networks
(possibly using internet web sites) to share information regarding the
reemployment of work‑capable employees. Ensure that outreach efforts for
position vacancies consider disabled claimants as a potential source of
candidates
c Program Analyses and Reporting
Program costs can be
reduced by actively monitoring claims and quarterly reports for possible
overpayments resulting from third‑party recoveries, unreported
employment, dual benefits, death of employee, remarriage or death of widow(er),
and termination of student status. Mission Areas/Agencies are to coordinate
proper account crediting with OWCP and SHEWD.
Mission Areas/Agencies
also:
(1) Report the following to SHEWD on a quarterly
basis within 30 days of receipt of the appropriate data:
(a) Results of time lag report review;
(b) Results of quarterly charge back costs review;
(c) Possible overpayments to include third‑party
recoveries
(2) Report the following to SHEWD on an
annual basis (July I through June 30) within 30 days after receipt of the
appropriate data.
(a) Rehire and return‑to‑work
program activities and results,
(b) Long‑term disability case
management activities and results, and
(c) Program cost analysis, cost reductions
actions and results
7 INQUIRIES
Direct all inquiries
to the Office of Human Resources Management; Safety, Health and Employee
Welfare Division; Washington, D C. 20250, telephone number (202) 720‑8248
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END ‑
January 8, 2001
APPENDIX
Program
Management Reviews
As part of its overall program responsibility, SHEWD will conduct periodic reviews
of Mission Area agency workers'
compensation programs. These reviews will be
conducted as part of OHRM's Personnel Management Evaluations, or as deemed
necessary by SHEWD, or at the request of an agency
These program reviews will examine agency compliance
with DOL and USDA requirements. This includes but is not limited to the
agencies actions to:
Track claim forms
submissions, claimants' files, and OWCP time lag reports to ensure timely processing, controversion of
claims and return of employees to duty.
Manage
new and long‑term claims.
Monitor employees'
status during periods of disability, and ensure that employees are returned to
duty as soon as medically capable.
Implement agency
and/or Mission Area wide rehire and return‑to‑work programs.
Coordinate suitable
job accommodations for disabled employees with OWCP.
Utilize available job
information networks in the reemployment process and to consider disabled
claimants for position vacancies.
Review quarterly charge
back reports to monitor cases and identify any discrepancies involving
overpayments and third party recoveries.
Coordinate with OWCP
offices regarding the cost and extent of vocational rehabilitation necessary to
retrain and re‑employ injured workers.
Charge back workers
compensation costs to the unit incurring those costs.