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Division of Federal Employees' Compensation (DFEC)

OWCP Bulletins

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Fiscal Year 2012

OWCP Bulletin No. 12-01

War Hazards Compensation Act (WHCA) and Defense Base Act (DBA) Cases

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Fiscal Year 2010

OWCP Bulletin No. 10-01

Converting DFEC Paper Cases into Fully Imaged Official Case Records

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Fiscal Year 2008

OWCP Bulletin No. 08-01

Privacy Act - Personally Identifiable Information (PII)

OWCP Bulletin No. 08-02

Case-specific email transactions

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Fiscal Year 2005

OWCP Bulletin No. 05-01

War Hazard Compensation Act-Claims for Reimbursement and Detention Benefit Procedures

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Fiscal Year 2004

OWCP Bulletin No. 04-01

Case-specific email transactions

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Fiscal Year 2001

OWCP Bulletin No. 01-01

OASIS - Retention Schedule for Paper Documents

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Fiscal Year 1999

OWCP Bulletin No. 99-01

Resolving FECA Rehabilitation Cases Earlier by Streamlining the Rehabilitation Referral and Planning Process (04/99B)

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Fiscal Year 1998

OWCP Bulletin No. 98-01

Coding of Vocational Rehabilitation Bills

OWCP Bulletin No. 98-02

Prior Authorization of Field Nurse Services

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Fiscal Year 1997

OWCP Bulletin No. 97-01

Measuring Rehabilitation Resolutions for the Program Plan

OWCP Bulletin No. 97-02

Selection of Rehabilitation Counselors (RCs) during Option Years

OWCP Bulletin No. 97-03

Additional Codes for Nurse Rehabilitation Tracking System (N/RTS)

OWCP Bulletin No. 97-04

Selection of Contract Field Nurses during Option Years

OWCP Bulletin No. 97-05

Management Review of Vocational Rehabilitation

OWCP Bulletin No. 97-06

Vocational Rehabilitation Counselor (RC) Notification of Performance during Option Years

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OWCP BULLETIN NO. 12-01

Issue Date: October 6, 2011


Subject: War Hazards Compensation Act (WHCA) and Defense Base Act (DBA) - Ongoing handling of DBA cases accepted for reimbursement under 42 U.S.C. § 1704(a)(1) in which the Division of Federal Employees' Compensation (DFEC) has chosen to pay benefits directly to the entitled beneficiary in lieu of reimbursing the DBA carrier ("direct payment") as authorized by 42 U.S.C. § 1704(a)(3) and described in 20 CFR 61.105.

References: This bulletin supplements the information contained in the Federal Employees' Compensation Act (FECA) Procedure Manual (PM) 4-0300 and OWCP Bulletin 05-01.

Background: After accepting a claim for reimbursement under 42 U.S.C. § 1704(a) of the WHCA, DFEC may pay benefits directly to an entitled beneficiary, in lieu of reimbursement to a carrier in accordance with 42 U.S.C. 1704(a)(3) and 20 CFR § 61.105. The regulations at 20 C.F.R. § 61.105(c) provide that DFEC will not assume direct payment unless the rate of compensation and the period of payment have become relatively fixed and known. OWCP has further determined in OWCP Bulletin 05-01, that only a formal compensation order by the Division of Longshore and Harbor Workers' Compensation (DLHWC) will meet the regulation's requirement of being relatively fixed and known (absent extraordinary circumstances). Even if DFEC assumes direct payment, under the regulations DFEC maintains the right to transfer any case back to the carrier for it to pay benefits. 20 C.F.R. §61.105(f). Nevertheless, as a practical matter, if a compensation order under the DBA awards continuing compensation benefits (either due to disability or death), and DFEC accepts the case for reimbursement under the WHCA, DFEC usually assumes direct payment of compensation.

20 CFR 61.105(d) outlines that in such direct payment cases, "medical care for the effects of a war risk may be furnished in a manner consistent with the regulations governing the furnishing of medical care under the Federal Employees' Compensation Act." Part (e), however, clearly specifies that, "the transfer of a case to the Office [DFEC] for direct payment does not affect the hearing or adjudicatory rights of a beneficiary or carrier as established under the Defense Base Act or other applicable workers' compensation law." The regulations reflect that direct payment cases continue to be DBA cases subject to all the provisions of the Longshore and Harbor Workers' Compensation Act (LHWCA).

Due to the increased number of cases where benefits are being paid directly by DFEC to an injured worker or a survivor under 42 U.S.C. § 1704(a)(3) of the WHCA, generally pursuant to a compensation order issued under the DBA, it is necessary to outline a protocol for handling directly paid WHCA reimbursement cases.

Purpose: To provide specific guidance on the interplay between DFEC and DLHWC, and the responsibilities of each program in the administration of DBA/WHCA reimbursement cases with ongoing entitlement.

Applicability: All National Office staff and District Office claims personnel for the Division of Federal Employees' Compensation (DFEC) and the Division of Longshore and Harbor Workers' Compensation (DLHWC).

Actions:

I. Notification and Interaction between DFEC and DLHWC

1. The notification and interaction described in this bulletin will occur at the District Office level for both DFEC and DLHWC, but the District Offices may seek additional guidance from the respective Branches of Regulations and Procedures and appropriate Office of the Solicitor divisions as needed.

2. Any written clarification between the two divisions should be included in the applicable case files maintained by each office.

II. Clarification of DBA Decisions

On occasion, prior to DFEC accepting the claim for direct payment, clarification of the DLHWC Informal Conference Memorandum or Compensation Order may be required.

1. If clarification regarding the award amount is needed prior to assuming direct payment, the District Director for the DFEC Special Claims District Office will seek guidance concerning the terms of the order directly from the DLHWC District Director who filed the order. Such a request will be made in writing with copies provided to the claimant, the insured, and their legal representatives, if any. If a new order is issued, it will be made part of the case file maintained by DFEC, as well as DLHWC's case file.

2. If a compensation order awards benefits for more than one injury, and some, but not all of the injuries for which benefits are awarded qualify for reimbursement under the WHCA, DFEC will request clarification from the carrier submitting the reimbursement request to determine how much of the compensation due is attributable to each injury. The carrier will be asked to substantiate which portions of the compensation due are attributable to each injury. It is the carrier's responsibility to submit proof of how much of what was paid is directly attributable to the WHCA injury or injuries; this must be established to DFEC's satisfaction.

III. Disagreement with or Modification of a DBA Decision

As a general matter the findings in a compensation order are accepted and no additional review is done by DFEC. (20 C.F.R. § 61.102(c), OWCP Bulletin 05-01) However, if after a case has been assumed for direct payment DFEC has reason to believe that there was a mistake in determination of fact in the DBA compensation order or the circumstances existing at the time the DBA compensation order issued have changed, e.g. payment of total disability for a period in which earnings were present, DFEC, after appropriate development, should notify the DLHWC District Director that modification of the compensation order may be warranted [See Parts V and VI below for further discussion on changes in compensation after the case has been assumed for direct payment].

1. DFEC will notify DLHWC in writing and provide supportive documentation, if applicable.

2. If DLHWC agrees that modification is warranted, it will initiate modification proceedings under Section 22 of the LHWCA, as incorporated. If DLHWC disagrees with DFEC that modification is warranted, it will so notify DFEC.

3. Reimbursement for the stated period and/or assumption of direct payment may be delayed pending receipt of a response from DLHWC. If a modification proceeding is commenced, DFEC may consider terminating direct payment and transfer the case back to the carrier for it to pay subject to reimbursement.

IV. Medical Treatment

As outlined in 20 CFR 61.105(d), in reimbursement cases where DFEC takes over direct payment of DBA benefits, the furnishing of medical treatment may be provided in a manner consistent with the regulations governing the furnishing of medical treatment under the FECA. The DFEC Procedure Manual provides that it will utilize these regulations, and therefore, medical treatment in reimbursement cases where DFEC has taken over direct payment will be authorized and paid for by DFEC in accordance with its regulations and procedures in administering the FECA.

DFEC contracts it medical billing services and this system is premised on the conditions specifically accepted by DFEC in adjudicating a FECA claim. It is recognized that compensation orders and decisions issued under the DBA do not necessarily identify the specific medical conditions associated with the DBA claim. To the extent that stipulations can be reached to identify these conditions when carriers and claimants are seeking compensation orders from DLHWC District Directors or litigating cases before the Office of Administrative Law Judge, it is recommended that they do so. In addition, when an application for reimbursement is submitted which is likely to result in direct payment by DFEC, the applicant should include a list of conditions that it believes are related to the DBA claim. At the time of acceptance for direct payment, DFEC will list these conditions as those accepted for medical treatment which will be entered into its electronic claims processing system (iFECS) for the purpose of medical bill payments.

It is recognized that medical treatment and conditions are not static and that changes in treatment and conditions do occur. Because of this dynamic process, additional guidance is necessary. OWCP has identified the following circumstances and steps it will follow in these cases:

1. If the claimant requests treatment for a consequential condition (a condition that flows as a natural consequence from the covered injury), DFEC should develop the medical evidence to determine whether it is a consequential condition stemming from the compensable injury.

a. If such development substantiates that the new condition is related, DFEC may authorize necessary treatment without input from DLHWC, but DLHWC and the carrier will be notified of that determination along with the claimant.

b. If such development does not substantiate that the new condition is related to the already covered conditions, DFEC will outline the rationale for its determination in a letter to the claimant, attach any applicable medical documentation, and advise the claimant to seek an adjudicatory decision from DLHWC. DLHWC and the carrier will be notified of this determination as well.

Note - A condition that DFEC accepts as consequential for purposes of authorizing medical treatment may also give rise to a change in the level or duration of disability benefits. In such instance, DFEC should direct the claimant to DLHWC for initiation of modification proceedings. See Part V. 1.

2. If the claimant requests treatment for or acceptance of a completely new condition not readily identifiable in the DLHWC compensation order (e.g. DLHWC issued a decision finding an injury to the arm and the claimant seeks treatment for the ankle), DFEC will direct the claimant to file a claim for medical benefits or, if appropriate, seek a modification of the compensation order from DLHWC; DLHWC and the carrier will receive copies of this correspondence as well. DFEC will not take any development action in such a case and will await the outcome of claimant's request for modification. DLHWC will initiate modification proceedings under Section 22 of the LHWCA, as incorporated. The employer and/or the carrier, as well as the claimant, will be the parties to such proceedings. The carrier is reminded that a failure to present any and all viable defenses to such claim may result in a subsequent denial of its reimbursement claim under the WHCA. The carrier should also be put on notice that the new claim, if accepted, will not be covered under the WHCA absent a subsequent request by the carrier and determination by DFEC.

3. If the claimant requests a change in treating physician, DFEC will consider such factors as the reason for the request, the appropriateness of current care, and other circumstances (e.g. whether the current treating physician has retired, the claimant has moved, etc.).

a. If a change in the treating physician is clearly warranted (such as a change due to a geographical move or to an appropriate medical specialist), DFEC will authorize the change without input from DLHWC, and DLHWC and the carrier will be notified of such approval along with the claimant.

b. If it appears such change may not be warranted, DFEC will outline the rationale for its determination in a letter to the claimant, attach any applicable medical documentation, and advise the claimant to seek an adjudicatory decision from DLHWC. DLHWC and the carrier will be notified of this determination as well. DLHWC will take necessary action to resolve the medical dispute, including an informal conference and an independent medical examination as necessary. The DLHWC District Director may issue an Order for Medical Treatment under certain circumstances. If a factual dispute exists that cannot be resolved at the district office, the case will be referred to the Office of Administrative Law Judges for formal adjudication. The employer and/or the carrier, as well as the claimant, will be the parties to such proceedings.

V. Compensation for Disability and Permanent Impairment

In cases where DFEC has taken over direct payment and for which regular periodic payments are being made for disability, DFEC pays compensation as specified by the DBA compensation order. A change in benefit level or amount of the award cannot be made by DFEC without modification of the order.

1. If a claimant requests a change in benefit level, e.g. an increased schedule award or total disability benefits in lieu of partial disability benefits, DFEC will advise the claimant to seek such modification from DLHWC. DLHWC and the carrier will be copied on this notification. If DFEC disagrees with the claimant's request for change in the benefit level at that time, DFEC will outline the rationale for its disagreement and attach any applicable documentation.

Note -- If a claimant initially seeks modification directly from DLHWC, DLHWC should provide notice of the request to DFEC.

2. If DFEC obtains evidence that it believes warrants a change in benefit level (i.e. partial disability benefits in lieu of total disability benefits), DFEC will, after appropriate development of the case, notify DLHWC in writing that modification of the order may be warranted. DFEC will include any supporting documentation and request a review of the benefit level. If DLHWC agrees that modification is warranted, it will initiate modification proceedings. If DLHWC disagrees with DFEC that modification is warranted, it will so notify DFEC.

3. If an overpayment of compensation exists, DFEC will take no action without direction from DLHWC. As a general rule, payment at the rate prescribed by the compensation order must continue until a new or modified order is issued. FECA overpayment procedures do not apply in these cases. If DLHWC determines that an overpayment exists, DLHWC will determine whether and how a credit will be taken for DFEC to recoup the amount overpaid. [Under certain circumstances, such as where a surviving spouse receiving death benefits remarries or a child turns 18, DFEC can unilaterally stop or change the amount of compensation being paid. See Part VI below.]

4. DFEC can request periodic medical updates to substantiate continued disability. Generally, this will occur once every three years, unless more frequent reports are needed to monitor medical care and support the payment of medical bills. A yearly inquiry will also be sent to the claimant to verify the current address, continuing receipt of benefits, and employment.

If the claimant does not submit the requested medical evidence, DFEC may arrange for an examination under Sections 7 and 19(h) of the LHWCA, as incorporated. If the claimant fails to submit the required medical evidence, fails to attend the examination, or fails to return the yearly benefit verification statement, DFEC will provide written notice to DLHWC, with any supporting documentation, and request appropriate modification of the order, which may include suspension, reduction, or termination of benefits. The claimant and the carrier will also be advised of this request for modification of the benefit level.

5. DFEC will on a yearly basis send Form LS-200 to claimants receiving compensation for total or partial disability, requesting a report of their earnings from employment or self-employment. However, because disability compensation is payable under the DBA at a rate of two-thirds of average weekly wage (for total disability) and is not subject to augmentation of the compensation rate similar to that allowed under the FECA, information about a disabled employee's marital status or dependents need not be requested as the presence or absence of a spouse or dependent children has no effect on compensation rates for disability under the DBA. However, that information is germane and should be obtained in death benefit cases - see Part VI below.

VI. Compensation in Death Cases

In cases where DFEC has taken over direct payment and for which regular periodic payments are being made for the death of an employee, DFEC pays death benefits as specified by the DBA compensation order. DFEC cannot terminate such benefits without a modified award by DLHWC, except in certain specific circumstances.

1. In DBA reimbursement cases for which benefits are being paid to the spouse of a deceased employee, a yearly inquiry will be made to verify that there has been no change in the marital status of the widow or widower. DFEC will use Form LS-267 for this purpose. If the widow/widower fails to return the yearly benefit verification statement, DFEC will provide written notice to DLHWC, with any supporting documentation, and request a review of the ongoing benefit payments and/or consideration of suspension of benefits. The widow/widower and the carrier will also be advised of this request for a review of ongoing benefit payments.

Note - DFEC cannot stop benefit payments in this instance, but must await a determination by DLHWC. If benefits are ultimately suspended and the widow then submits the required information, DFEC will reinstate benefits and notify DLHWC.

2. If a widow/widower notifies DFEC that he/she has remarried, or if DFEC obtains evidence that a widow/widower has remarried, DFEC will immediately stop ongoing payments and compute a two-year, lump-sum payment representing two years of compensation. DFEC will pay the lump sum, taking credit for any amount paid since the remarriage in order to avoid an overpayment, and notify the beneficiary of the payment amount. DLHWC and the carrier will also be advised, but this action can be taken without input from DLHWC as the remarriage itself extinguishes any order issued by DLHWC. This procedure is currently set forth in the FECA Procedure Manual. See FECA PM 4-300-15(b).

Note - If the beneficiary has already received compensation in excess of the two-year, lump-sum amount at the time of notification/verification, DLHWC and the carrier should be advised along with the beneficiary, but no action can be taken with regard to any overpayment, as an overpayment under the FECA cannot be declared.

3. If benefits are being paid to a minor child, DFEC must monitor the age/status of that child and adjust beneficiary benefit levels in a timely manner to avoid any excess compensation payments. Compensation may continue after a child's 18th birthday if he/she meets the definition of a student. The requirements for student status are the same as those under the FECA, and DFEC should request the necessary documentation needed for verification of student status prior to the child's 18th birthday, and on a periodic basis thereafter. DFEC will use Form LS-266 for this purpose. DFEC should promptly terminate compensation payments for a child when he/she turns 18 years of age if full-time student status is not established or if the evidence on file no longer supports student status after initially established.

Note - If the beneficiary has already received excess compensation at the time of the cessation of compensation, DLHWC and the carrier should be advised along with the beneficiary, but no action can be taken with regard to any overpayment, as an overpayment cannot be declared. Credit can be taken, however, if the child subsequently becomes eligible again, based on the same injury or death, e.g. a student.

4. In DBA reimbursement cases where benefits are being paid to an employee who subsequently dies, DFEC will direct any potential survivor to file a death benefits claim with DLHWC; DLHWC and the carrier will receive copies of this correspondence as well. DFEC will not take any development action in such a case and will await a determination on the death benefits claim. The carrier's failure to present any and all viable defenses to such claim may result in a subsequent denial of its reimbursement claim under the WHCA. Upon approval of the death benefits claim, DLHWC should instruct the carrier of its responsibility to initiate timely payment on the DBA order. The carrier may subsequently seek reimbursement from DFEC under the WHCA.

VII. DLHWC Determinations and DFEC's Role

Once DLHWC receives a request for modification, either from the claimant or from DFEC, DLHWC will take appropriate action required under the DBA. Given that DFEC has assumed responsibility for direct payments, however, DFEC should maintain active oversight of that claim and will provide any information or assistance requested by DLHWC to determine claimant entitlement or resolve claim disputes.

1. DLHWC will seek input from DFEC, as it would from the claimant and the carrier, and DFEC will provide written or verbal input as requested.

2. The DFEC Special Claims District Director, or his/her designee, will usually be the point of contact for DFEC in proceedings before the DLHWC District Director. He/she may request assistance as needed from the Branch of Regulations and Procedures and/or the Office of the Solicitor. In some instances a representative from the Branch of Regulations and Procedures and/or the Office of the Solicitor will act as DFEC's point of contact in a DLHWC District Director proceeding, in lieu of or along with the Special Claims District Director, or his/her designee.

VIII. DBA Decisions

1. Generally, DLHWC may only issue an order resolving an issue based on the agreement of the claimant and the employer/carrier.

2. If no agreement is reached, any party may seek adjudication of the issue through formal hearing and the various levels of review established under the LHWCA/DBA -- Office of the Administrative Law Judge (OALJ), the Benefits Review Board (BRB) and federal courts. FECA appeal rights are not applicable in these cases.

3. Any of those adjudicatory bodies may issue a decision and order that is effective upon filing or issuance and which will become final once the time to appeal to a higher body has passed.

4. Once an order on an issue outlined in this bulletin is filed, it is binding and DFEC must proceed accordingly, e.g. increasing the benefit level, paying an additional award, accepting a new medical condition, etc.

5. If payment of compensation is due, it must be paid within 10 calendar days of the DLHWC District Director's filing of the order or additional compensation is also owed in the amount of twenty percent (20%) of the accrued amount of compensation due.

6. Any request for payment of additional compensation due to a late payment should be made to DLHWC. If DLHWC determines that additional compensation is payable, DFEC will be so notified along with the claimant and carrier, and DFEC will process any necessary payment.

IX. Attorney Fees

The LHWCA/DBA requires approval of any claimant's attorney fee by the body before whom the work was performed, e.g. the DLHWC District Director, the OALJ, the BRB, or the federal courts. Therefore, if a fee petition is received by DFEC due to an issue outlined in this bulletin (or any other reason), DFEC will direct the representative to seek approval from the appropriate body. DFEC can object to the requested fee, and will submit its response to the fee request to the appropriate body when necessary. DFEC will not review such fee petitions in accordance with FECA standards.

X. Notice to the Employer/Carrier

Once DFEC takes over direct payment of reimbursement cases, any notice to the employer/carrier provided for in this bulletin should be given as follows:

  • DFEC will send a letter to the employer/carrier, and to their attorney, containing all relevant information and/or proposed actions to be implemented.
  • The letter should also contain the caveat that the employer/carrier will be deemed to have consented to the action proposed unless it files an objection to such action with the DLHWC within 15 days.
  • If the employer/carrier does object, it is incumbent upon it to take the appropriate action in furtherance of its objection.

XI. Miscellaneous

1. DFEC requires, before acceptance of any WHCA reimbursement claim, that the employer/carrier has made only reasonable and prudent efforts in presenting all meritorious defenses against a DBA claim without regard to whether the case is eligible for WHCA reimbursement. An employer/carrier's inadequate or overly zealous representation in defending against a DBA claim may be grounds for denying all or some portion of a request for WHCA reimbursement.

2. DFEC'S development of any aspect of a claim may include communication with the claimant and his legal counsel, as the situation dictates.

Disposition: This bulletin is to be retained until the FECA and LHWCA Procedure Manuals have been updated.

CECILY A. RAYBURN
Director, Division of Planning, Policy and Standards

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OWCP BULLETIN NO. 10-01

Issue Date: May 5, 2010


Expiration Date: May 5, 2011


Subject: Converting DFEC Paper Cases into Fully Imaged Official Case Records

Background: In FY 2000, the DFEC deployed a new imaging system in its district offices. The OWCP Automated System for Imaging Services (OASIS) changed the process by which case files were handled by DFEC staff. This system was developed to provide DFEC staff with an electronic case file to use in place of a paper file. Once OASIS was activated in a district office, every new claim created and all documentation received for all cases was processed using this system. All case file documents were captured and stored electronically. In FY 2005, the DFEC deployed a new database system, iFECS (Integrated Federal Employees' Compensation System), which incorporated the OASIS Imaging system into its own imaging application.

While all new cases created after the deployment of the imaging system in FY 2000 were completely electronic, the DFEC maintained all paper files and documents received prior to that date. Since that time, the district offices have converted some of these paper case file components into imaged documents, thereby creating a fully imaged record. Cases have been fully imaged for various reasons, including but not limited to the following: ease of management, prior to transferring a case to the Employees' Compensation Appeals Board (ECAB), and prior to referring a case for a referee examination (see FECA Bulletin 05-01, Medical Exams/IME: Security of Case Records During the Referral Process).

When these paper case files have been converted to fully imaged electronic records, the district offices have made every effort to preserve distinct documents in the electronic case record; e.g. if a 3-page paper letter was in the paper case file, it was imaged as a 3-page document in the imaging system. The received date for these documents has been input in one of two ways: 1) the true received date from the document (taken from date stamp on the paper document) was entered as the received date, or 2) the paper documents were imaged with a received date equivalent to the date that the district office "went live" with the original OASIS imaging system.

Regardless of the reason for converting the case or which received date option was chosen, once the case file was completely converted to electronic images, the Fully Imaged indicator in iFECS was changed to "Y". However, the DFEC has stored these paper records and not disposed of them through the retention schedule that is used for all documents received since FY2000 (reference OWCP Bulletin 01-01, OASIS - Retention Schedule for Paper Documents). Once the paper portion of the case file has been captured and stored electronically, the paper documents are no longer necessary for the development and management of the case; however, each district office has stored the paper portions of these cases pending a disposal schedule for these materials.

Since ten years have now passed since the deployment of the imaging system, and some DFEC cases have been converted to fully electronic records, a process is needed whereby the fully electronic record can now be classified as the official case record, and the paper documents can be disposed of through a retention system.

Reference: OWCP Procedure Manual Chapter 1-0300

Purpose: To notify District Offices of the retention schedule and audit requirements for paper case files that are converted to electronic cases records.

Applicability: Claims Examiners, Senior Claims Examiners, All Claims Supervisors, Medical Schedulers, District Medical Directors, Technical Assistants, System Managers, Staff Nurses, and Vocational Rehabilitation Specialists

Action:

Converting Paper Cases into Fully Imaged Official Case Records

1. Every document in the paper case file must be imaged into a distinct electronic document viewable in the imaged case file.

2. Once distinct documents are identified, each document should be classified with the appropriate iFECS category and subject classifications, or the default category/subject option of MISC/Converted Paper Documents. Note – Prior to release of this Bulletin, these documents may have been classified as MISC/Other.

3. The received date can be entered in one of two ways: 1) the true received date from the document (taken from date stamp on the paper document), or 2) the date equivalent to the date that the district office "went live" with the original OASIS imaging system.

4. If the case file has documents that cannot be scanned for some reason (e.g. very old documents on transparent types of paper, badly damaged documents, etc.), the documents must be maintained in a physical file folder, just like a piece of physical evidence. If the case file has documents like this, or has actual physical evidence (e.g. photos), the Physical Evidence indicator in iFECS must be activated. When activating this indicator, a description of the evidence should be added to the Physical Evidence Note field. In addition, a short memorandum to the file which briefly describes the nature of the physical evidence must be prepared and placed into the record.

5. If the case is a "Master" case and has "subsidiary" cases associated with it, all subsidiary cases must be fully imaged prior to classifying the master case as the official case record.

6. An audit of documents within the paper case file is required to ensure that all documents have been properly associated with the electronic case record, that the documents have been properly categorized, and that the imaged documents are of an acceptable quality. Twenty-five (25) documents must be sampled from the paper case file; if the case record contains more than 500 documents, five (5) percent of the documents must be sampled. In addition to the random sample of 25 documents or five percent, all of the following documents must also be verified as appropriately imaged and categorized: Forms CA-1, CA-2, CA-5, CA-6, CA-2a and CA-7; acceptance letters; and all formal decisions.

7. The person(s) assigned to perform the audit must be claims personnel or the iFECS Site Manager. Each district office will designate the appropriate staff person(s), and the list of such persons will be maintained in the District Director's office. The list must be updated immediately as changes in this responsibility occur.

8. Once the case file has been completely imaged and audited for accuracy, the District Director or designee must take the following steps:

a) Change the Fully Imaged indicator in iFECS to "Y"
b) Image a copy of the Fully Imaged Case Memo (See Attachment 1)
c) Index this memo as MISC/Fully Imaged Memo

9. After these actions have been taken, the electronic record will then be classified as the official case record for that case.

10. The paper case file must be retained for sixty (60) days from the date the case file was fully converted to electronic images. If no problems arise during this period, the paper case documents may be destroyed at the end of the sixty (60) day period.

Backlog of Fully Imaged Cases

1) Since the paper portions of the current Fully Imaged cases have not been destroyed as of this date, there is a backlog of stored paper case files in several district offices. An audit of these paper case files must be performed prior to their destruction.

2) Like the process for newly converted cases, the person(s) assigned to perform the audit must be claims personnel or the iFECS Site Manager as designated by the District Director.

3) This person must ensure that the case file has been fully imaged in conformity with steps 1 through 5 above, and then an audit of the documents within the paper case file is required to ensure that all documents have been properly associated with the electronic case record, appropriately categorized in the electronic case record, and that the imaged documents are of an acceptable quality. Twenty-five (25) documents (or five percent of the documents if the case record contains more than 500 documents in total) must be sampled from the paper case file. In addition to the random sample of 25 documents or five percent, the following documents must also be verified as appropriately imaged and categorized: Forms CA-1, CA-2, CA-5, CA-6, CA-2a and CA-7; acceptance letters; and all formal decisions.

4) Once the case file has been audited for accuracy, the District Director or designee must take the following steps:

a) Change the Fully Imaged indicator in iFECS to "Y" if it has not already been changed
b) Image a copy of the Fully Imaged Case Memo (See Attachment 1)
c) Index this memo as MISC/Fully Imaged Memo

5) After these actions have been taken, the electronic record will then be classified as the official case record for that case. If sixty (60) days have passed since the conversion to electronic images, the paper case documents may be destroyed. If sixty (60) days have not yet passed, the District Office should retain the paper portion of the case in conformity with step 10 above.


Disposition: This Bulletin is to be retained in Part 1, Office of Workers' Compensation Programs (OWCP) Procedure Manual, until further notice or until incorporated into Part 1 of the Procedure Manual.

 

CECILY A. RAYBURN
Director, Division of
Planning, Policy and Standards


ATTACHMENT TO OWCP BULLETIN NO. 10 – 01

Fully Imaged Case Memo

Case File: ________________________


Claimant: ________________________

Reference: In FY 2000, the DFEC deployed an imaging system that created an electronic case file to use in place of a paper file. Every new claim created was processed using this system, and all incoming case file documents received for all cases were imaged into the electronic case file. While all new cases created and all documentation received after the deployment of the imaging system in FY 2000 were completely electronic, the DFEC maintained all paper files and documents that were received prior to that date.

Action: In conjunction with OWCP Bulletin 10-01, the paper portion of this case has now been fully imaged into the electronic case record. Therefore, the electronic case file has now been classified as the official case record for this case.

Checklist:

The case is ___ is not ___a "Master" case.

___

The case is a Master case with "subsidiary" cases attached to it, and all subsidiary cases have been fully imaged prior to classifying the master case as the official case record.

___

An audit of all CA-1, CA-2, CA-5, CA-6, CA-2a and CA-7 forms, acceptance letters, and all formal decisions has been performed, and no problems were found.

___

An audit of 25 additional random documents has been performed, and no problems were found.

OR

___

If the case record contains more than 500 documents, five percent of the total documents have been audited and no problems were found.

___

Physical Evidence indictor has been activated for documents that were unable to be imaged, or because the case file contained other kinds of physical evidence, and a memorandum to the file briefly detailing the physical evidence has been prepared and placed in the case file.

___

The Fully Imaged indicator has been activated.

Audit Performed By: __________________________

Date Audit Performed: ________________________

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OWCP BULLETIN NO. 08-01

Issue Date: January 23, 2008


Expiration Date: Until Further Notice


Subject: Privacy Act - Personally Identifiable Information (PII)

Background: The Office of Workers' Compensation Programs (OWCP) is responsible for the maintenance of workers' compensation claim files and related reports and documents. These files constitute a system of records under the Privacy Act and must be treated accordingly.

These records contain personally identifiable information (PII). This refers to information that can be used to distinguish or trace an individual's identity such as a person's name, social security number or biometric records. These identifiers can either stand alone or, when combined with other PII data, identify a specific individual. An example would be a document that does not contain a name or social security number but does contain a place of birth and mother's maiden name which, when taken together, may identify a specific individual.

The amount of paperwork collected, maintained and shared in the management of workers' compensation files creates certain vulnerabilities in the integrity of the privacy of the records maintained by OWCP. As a result, procedures must be put in place to mitigate the risk of improper disclosure.

Purpose: To implement uniform procedures designed to minimize the risk of improper release of personally identifiable information and to set forth the steps to be taken when a breach of release protocol occurs.

Applicability: All National Office and District Office personnel.

Action:

1. OWCP is creating a customized on-line PII protection awareness training program and all OWCP employees and contractors with protection responsibilities will be required to complete this training.

2. A new iFECS feature is being developed which will make it easier for Claims Examiners in the Division of Federal Employees' Compensation to identify claim numbers and claimant names during document indexing and file review. This will help minimize errant filings of electronic documents which increase the likelihood of an improper disclosure.

3. The Division of Energy Employees Occupational Illness Compensation will issue detailed procedures addressing how potentially sensitive PII received from the Department of Energy or NIOSH, especially on CD-ROM files, should be handled in managing EEOICPA case files.

4. When the improper release of PII information occurs as a result of the inadvertent mailing of a case record copy to an incorrect individual, or the release pursuant to a Privacy Act request of a case record that contains incorrectly filed documents or documents with other individuals' PII that has not been redacted, the OWCP employee will:

a. Begin the document recapture process by asking the individual to return the document in question (either via telephone or registered mail) and offering a self-addressed, stamped envelope for return of the material directly to the district office for re-filing or destruction.

b. Notify the District Director who will in turn notify the Regional Director, who will comply with established Departmental reporting requirements documenting the type of PII disclosure, the circumstances surrounding the disclosure and how it was discovered, the appropriate actions taken to recover the PII documents in question and the disposition of that recovery effort.

c. Each PII recapture request must be tracked within the regional office. If the recapture of the PII document(s) is successful, the incident will be closed with the incident record filed and maintained in OWCP.

d. If the third party in possession of errant PII document(s) refuses to return the document(s), this situation must be reported to the National Office, through the Regional Director, who will provide guidance on determining what actions should be taken.

Disposition: The bulletin is to be retained until further notice.

 

CECILY RAYBURN
Director, Division of
Planning, Policy, and Standards

Distribution: List No. 1 (All OWCP Employees)

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OWCP BULLETIN NO. 08-02

Issue Date: May 9, 2008


Expiration Date: Until Further notice (Replace previous OWCP Bulletin04-01)


Subject: Case-specific email transactions

Background: With the increased emphasis on securing Privacy Act information, it is critical that the office maintain policies that guard against any possible privacy violations in E-Mail communication, while still being responsive to inquiries.

The Department defines Protected PII (Personally Identifiable Information) as information:

"whose disclosure could result in harm to the individual whose name or identity is linked to that information. Examples include, but are not limited to, social security number; credit card number; bank account number; residential address; residential or personal telephone; biometric identifier (image, fingerprint, iris, etc.); date of birth; place of birth; mother's maiden name; criminal records; medical records; and financial records. The conjunction of one data element with one or more additional elements, increases the level of sensitivity and/or propensity to cause harm in the event of compromise."

Purpose: To establish clear guidance on when and how email is to be used for communication regarding a specific case file.

Applicability: All OWCP staff, contractor staff, District Medical Advisers, Telephonic and Field Nurses, Rehabilitation Counselors, Second Opinion Examination Contractors.

Action: Employees and contractors will comply with the following guidance when communicating claimant and case information via email:

Email within the DOL network:

1. Email sent from one OWCP employee to another DOL employee through the ESA wide-area network (WAN) is considered secure. Email to and from contractors who use the ESA network (ESA owned and properly configured equipment, including remote laptops that access the ESA WAN) is also considered secure. As such, reference to the employee's name and case number may be used in the message. However, no reference to the employee's name or Protected-PII (see definition above) should be made in the subject portion of the email.

Central Bill Process (CBP) "threads", provided through ACS's secured website conform to this policy, as they are secured within an accredited network.

2. Any internal email that is forwarded to outside parties becomes non-secure, and PII must be deleted as explained below in Email outside the DOL Network.

Email outside the DOL network:

3. Email between OWCP employees and outside parties is outside the ESA network, and therefore does not guarantee security. As such, no reference to the claimant's complete SSN, name or other Protected PII should be made in any part of the email message.

• A person's claim number may be referenced if that claim number is not the claimant's SSN.

• The last four digits of a person's SSN may be referenced along with the last name only, as long as the remainder of the SSN, full name, or other PII is not used anywhere in the E-Mail message or in attachments that are not password protected or encrypted.

• Attachments that are encrypted with Point Sec may contain the full SSN and name. (See instructions for sending encrypted documents to non-Point Sec users: http://esa/omap/Pointsec%20Encryption/Quick_Reference_Guide.pdf)

FOR DFEC EMPLOYEES AND CONTRACTORS ONLY: DFEC has been granted approval by the Department to transmit Protected-PII via MS Office password-protected files sent as attachments to email messages. Protected-PII is only to be included in the password-protected file (not the email message itself), and the password must be sent to the recipient in a separate email message.

NOTE: OWCP staff is reminded that substantive email responses to outside parties who are not OWCP contractors and not a party to the case are strictly prohibited. An acknowledgement email may be sent, but reference to any personal identifiers must be removed, and we never confirm existence of cases for specific claimants to members of the public who are not a party to the case.

4. When Black Lung and Energy employees exchange email messages with ACS concerning claimants, the communications should reference the claimant's CBP Member ID (from the CBP claimant eligibility file). FECA employees may use case number as FECA case numbers are not the same as SSN. Claimant names should not be included in the same email message as these Member IDs or case numbers, unless they are provided in an encrypted attachment.

5. Attachments and email message chains must be reviewed, and if necessary altered to remove reference to the claimant's name, SSN or other protected PII if that email trail is being forwarded outside of DOL. If it is not possible to alter or redact the document or email, or if it is important that the attachment or email include both the claimant's name and case number or SSN, it must be sent as an encrypted attachment, faxed, or be sent via USPS or courier to the appropriate party. Packages containing extracts of multiple Protected PII records sent via mail or courier must be tracked (E.g. Registered Mail, Return Receipt, Fed Ex, etc.). Please refer to Working with Personally Identifiable Information (PII) POL-O-007 http://esa/owcp/ITPolicies/OWCP/PII.doc).

6. If a case-specific email message is received from an outside party containing Protected PII, the message should be printed or bronzed for inclusion in the case file.

If an OWCP response containing Protected PII is required, the response should be made in accordance with the above guidance. If an OWCP response does not require Protected PII, the response may be made via a reply email message, but the Protected PII from the originating email request must be deleted or redacted. The response should also include a statement encouraging the party to write or call with future requests that include Protected PII.

7. OWCP does not handle claims communications with our claimants over email. OWCP staff should always encourage claimants to communicate with us via telephone or letter if they have specific questions regarding their individual claims, as email cannot be considered secure.

8. Staff may respond to inquiries and communications regarding deceased claimants without protecting the decedent's information, as the right to privacy ends upon death. Staff members are cautioned, however, that living beneficiaries' information must continue to be protected.

This email policy addresses claimant- and case-specific email containing Protected PII. Any information sent via email continues to be subject to the provisions of the Privacy Act and should be released only if appropriate to do so.

Disposition: The bulletin is to be retained until further notice.

 

CECILY RAYBURN
Director, Division of
Planning, Policy and Standards

Distribution: List No. 1 – (All OWCP Employees, Contractors)

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OWCP BULLETIN NO. 05-01

Issue Date: October 18, 2004


Expiration Date: October 18, 2005


Subject: War Hazard Compensation Act-Claims for Reimbursement and Detention Benefit Procedures

Background: The War Hazards Compensation Act (WHCA) 42 U.S.C. § 1701 et seq. establishes a compensation system that provides reimbursement to contractors covered by the Defense Base Act (DBA) 42 U.S.C. § 1651, et seq. for both benefit and administrative costs resulting from an injury or death caused by a "war risk hazard." It also provides direct payments to DBA and certain employees as a result of their detention by a "hostile force or person" and payments to certain employees (and their dependents) when injury or death occurs due to a "war risk hazard."

Reimbursement--Section 104(a) of the WHCA provides for reimbursement to an employer or carrier by the United States, from the Employees' Compensation Fund, for compensation and medical benefits paid pursuant to a valid compensation claim under the DBA where the injury for which such compensation is payable "arose from a war risk hazard" as defined in section 201(b) of the WHCA.42 U.S.C. § 1711(b). Reimbursement is available for both the amount of benefits paid and reasonable and necessary claims expenses. Section 104(a)(3) also provides the Secretary with the authority once the reimbursement claim is accepted to pay the benefits directly to the employee 42 U.S.C. § 1704(a)(3) See also20 C.F.R. § 61.105.

Detention--Section 101(b) of the WHCA, 42 U.S.C. § 1701(b) provides benefits for "detention." It applies to:

• employees identified in section 101(a) of the WHCA;
• employees covered by the DBA;
• employees covered by the Non-Appropriated Funds Instrumentalities Act (NFIA) (civilian employees working outside the continental U.S. for non-appropriated funds instrumentalities such as military PX's); and
• employees under contract by the United States for personal services outside of the U.S.

Detention benefits, payable from the Employees' Compensation Fund, are provided for a covered employee missing because of a belligerent action of a "hostile force or person" or when the employee has been taken by a "hostile force or person" as a prisoner, hostage, or otherwise. While being detained the employee is entitled to be credited with compensation benefits, as for total disability, at a rate of 100 percent of his or her average weekly wage at the time detention begins; seventy percent of such benefits can be disbursed to his or her U.S. resident dependents.

Direct Claims--Section 101(a) of the WHCA provides for a direct claim for compensation for disability or death. In view of the infrequency of these claims, they will not be addressed in this bulletin. Claimants should look to relevant sections of the regulations and Federal (FECA) Procedure Manual for guidance in filing direct claims and should be aware that the regulations require a determination by DLHWC that DBA benefits are not available before a direct claim may be filed. See 20 C.F.R. § 61.201.

Issues--Because of the large number of contractor employees serving the military in Afghanistan and Iraq and their exposure to "war-risk hazards" and detention by a "hostile force," employers and insurance carriers for these employees are anticipating an increase in claims under the DBA for injuries and deaths caused by military or terrorist actions.

DBA claims are administered by OWCP's Division of Longshore and Harbor Workers Compensation (DLHWC); DBA claims arising in Iraq and Afghanistan are initially reported to its New York District Office (201 Varick Street, Room 750 Post Office Box 249 New York, NY 10014-0249). Employers and insurers anticipate seeking reimbursement under the WHCA in cases meeting WHCA criteria as well as assisting employees and their dependents in seeking detention benefits. Consequently, it is anticipated that there will also be a corresponding increase in reimbursement and detention benefits claims filed with the Division of Federal Employees' Compensation (DFEC), which is responsible for administering WHCA claims and does so through its Cleveland District Office, U.S. Department of Labor, OWCP, 1240 East Ninth Street, Room 851, Cleveland, OH 44199, under the direction of the DFEC National Office. Initial claims for reimbursement should be submitted directly to the Cleveland office; follow-up correspondence should contain the claim number and be submitted to the U.S. Department of Labor, DFEC Central Mailroom, PO Box 8300, London, KY 40742-8300.

In recognition of the anticipated increase in WHCA claims and the relationship between the DBA and the WHCA, it is necessary to address certain aspects of the claims process to ensure prompt and orderly adjudication of the WHCA claims. One of the critical issues that need to be addressed is whether an insurer or employer must first obtain a compensation order under the DBA from DLHWC finding that its employee is entitled to DBA benefits, before filing a claim for reimbursement under the WHCA. Similarly, guidance is needed concerning whether a claimant must obtain a compensation order issued by DLHWC finding that an employee is not entitled to benefits under the DBA before submitting a claim for detention benefits on behalf of the employee. A question has also been raised regarding the extent that DFEC will rely on the findings in a compensation order including the findings made in a section 8(i) settlement.

Reference: Statutes; WHCA 42 U.S. C § 1701 et seq., DBA 42 U.S.C. § 1651 et seq., Federal Employees' Compensation Act (FECA), 5 U.S.C. § 8101 et seq., Regulations; WHCA 20 C.F.R. Part 61, Longshore 20 C.F.R. Part 702, Procedure Manuals; Federal (FECA) Procedure Manual Chapter 4-300; Longshore PM Chapter 0-200, Forms; CA-278.

Purpose: To establish clear guidance on the procedures for processing reimbursement claims and detention benefit claims under the WHCA.

Applicability: Regional Directors, District Directors, Assistant District Directors, and National Office Staff.

Action:

The following policies are hereby put into effect--

1. Compensation Orders Under the DBA are Strongly Encouraged but Not Required for Reimbursement and Detention Benefit Claims.

The WHCA or its regulations do not require that a compensation order under the DBA be issued before either a DBA-benefits reimbursement claim or a detention-benefits claim can be filed and adjudicated. However, to ensure efficient adjudication of reimbursement claims and detention benefit claims under the WHCA, OWCP suggests that employees, employers and insurers obtain a compensation order under the DBA from the appropriate DLHWC district office since that will expedite payment of claims.

2. Reimbursement Claims Should Not Be Filed Until Benefits Have Been Paid, Should Contain Appropriate Documentation and It is Strongly Encouraged that a Compensation Order under the DBA be Obtained.

The fundamental requirement for filing a reimbursement claim is that the employer or insurer has actually paid benefits to the employee or the employee's dependents. Notice of an intention to pay or report of injury such as a LS-202 is not sufficient grounds to justify filing a claim under the WHCA. A claim requesting reimbursement should not be filed until an employer or insurer has made payments for which it is seeking reimbursement. Such a request should be made by means of a Form CA-278 with supporting documentation. The WHCA regulations require the following documents if available; statements of the employee or employer, medical reports, proof of liability (e.g. insurance policy) and compensation orders. See 20 C.F.R. § 61.101(c). It is recommended that the employer or insurer also provide a statement concerning why its claim should be reimbursed as a war hazard.

In addition, the regulations and procedures contemplate that entitlement to benefits should be established, and the rate of compensation and period of payment should be relatively fixed and known before a claim for reimbursement is submitted. See 29 C.F.R. § 61.105; Federal (FECA) Procedure Manual Chapter 4-300.12. Thus, it is recommended that the employer or insurer first seek to obtain a compensation order from the appropriate DLHWC district office.

If a compensation order has been issued on the DBA claim, the employer or insurer must submit this order with its claim for reimbursement under the WHCA when filing the claim with the Defect's special claims unit in the Cleveland District Office. See 20 C.F.R. § 61.101(c). Absent extraordinary circumstances, the DFEC will generally accept the findings regarding DBA compensability including DBA coverage, injury, causal relationship, dependents and benefit rates made in the compensation order without further independent review. In addition, a compensation order can be the basis for DFEC to assume direct payments of DBA benefits.

If a compensation order has not been issued on the DBA claim, either because the claimant declines to participate in the proceeding or because one or more parties do not agree to the issuance of such an order, the insurer or employer may obtain an OWCP recommendation on the compensability of the DBA claim by requesting an informal conference at the office of the DLHWC District Director.1 20 CFR § 702.311 et seq. Such a request should only be made after the employer or insurer has engaged in documented good faith efforts to contact the employee or the eligible survivors, to reach agreement on all issues in the claim, and to obtain a signed stipulation for issuance of a compensation order. The informal conference may be held in person or by telephone, and the District Director or the Claims Examiner must make every effort to ensure the participation of the claimants and/or their legal representatives and will document their efforts. Following the informal conference, if the parties still cannot agree to submit stipulations for entry of a compensation order, the District Director or the Claims Examiner will prepare a Memorandum of Informal Conference, setting forth all pertinent issues in the DBA claim, a summary of all relevant facts and evidence, and his or her recommendations and rationale for resolution of such issues. In the case of a permanent (or potential permanent) disability claim, such recommendations should not made until the employee has reached maximum medical improvement. The Memorandum of Informal Conference will address all issues of DBA compensability and will contain the same elements of a compensation order; however it will not have the binding effect of a compensation order.

If a Memorandum of Informal Conference as described above has been issued by the DLHWC, the Memorandum should be filed with the claim for WHCA reimbursement. Absent extraordinary circumstances, the DFEC will accept the recommendations made by the DLHWC District Director or Claims Examiner with regard to DBA compensability, including DBA coverage, injury, causal relationship, dependents and benefit rates without further independent review.

Note: Development of Reimbursement Claims filed without either a compensation order or an informal conference memorandum is likely to result in greater processing time than those reimbursement claims that were filed with compensation orders or informal conference memorandums, as the DFEC will be required to develop all aspects of the claim including DBA compensability. This includes DBA coverage, injury, causal relationship, dependents and benefit rates. DFEC may consult DLWHC on this additional development.

3. DFEC Will Not Accept a WHCA case for Direct Payment without a Formal Compensation Order, Absent Extraordinary Circumstances.

While the acceptance of a reimbursement claim can be based on an informal conference memorandum issued by a DLHWC District Director or Claims Examiner, DFEC will not utilize the informal conference memorandum as the basis to assume direct payment of DBA benefits. It has determined that, absent extraordinary circumstances, only a compensation order will meet the requirement of the regulations that "the rate of compensation or benefit and the period of payment have become relatively fixed and known." See 20 C.F.R. § 61.105(c). Thus an employer or insurer seeking to have DFEC assume direct payment of a claim should obtain a compensation order fixing liability for the claim.1

4. Settlements Pursuant to section 8(i) of the LHWCA Should Be Carefully Reviewed by Insurers Who Believe They May Seek Reimbursement from OWCP under the WHCA To Assure the Settlement is Not Excessive.

DBA claims with potential for WHCA reimbursement may be settled pursuant to § 8(i) of the Longshore and Harbor Workers' Compensation Act (LHWCA), 33 U.S.C. § 908(i). Settlement applications are reviewed and approved by the District Director within thirty days of receipt unless the settlement sum is inadequate or procured by duress. The settlement application must comply with the regulatory criteria in 20 CFR § 702.241 – 243, and the order approving settlement must include an explanation of why the proposed settlement is adequate.

If the DBA claim has been settled under § 8(i) of the LHWCA, a copy of the settlement application and the compensation order approving settlement must be submitted to the DFEC when the employer or insurer is seeking reimbursement under the WHCA. The reimbursement claim should also include an explanation from the employer or insurer as to why the settlement was not excessive. Absent extraordinary circumstances, the DFEC will generally accept without further independent review the findings with regard to DBA compensability, including DBA coverage, injury, causal relationship, dependents and benefit rates, made in the compensation order approving the § 8(i) settlement by the District Director. Settlement amounts that appear to be excessive will constitute extraordinary circumstances and DFEC will conduct its own independent review of the settlement, engage in any development it deems appropriate and if necessary determine the appropriate amount of benefits that should be reimbursed.

5. Claims for Detention Benefits Should Contain Appropriate Documentation; It is Recommended that a Compensation Order under the DBA be Obtained.

A claim for detention benefits should contain the information identified in the regulations at 20 C.F.R. § 61.301, which includes the name, address, and occupation of the missing employee; name, address and relation to the employee of any dependent making the claim; name and address of the employer; contract number under which employed; and date, place and circumstances of capture and detention. The employer must provide information about the circumstances of the detention, which should include available evidence on whether the employee is being detained by a hostile force or individual within the meaning of the WHCA, and the employee's pay rate at the time of capture. Dependents making claims for detention benefits may be required to submit all evidence available to them concerning the employment status of the missing person and the circumstances surrounding his or her absence.

In addition to filing the above information, it is highly recommended that the person filing the claim for detention benefits (such as an employer, insurer, employee or the employee's dependents) should first obtain a compensation order from the appropriate DLHWC district office. Upon receipt of the DBA claim and after conducting the necessary investigation, the DLHWC will immediately issue a compensation order which will include a finding on whether the employee is covered under the DBA and whether DBA benefits are payable. If there is no evidence that the employee is either injured or has died, the compensation order will be in the form of a denial of DBA benefits. If the DLHWC is unable to issue a compensation order, the DLHWC will issue an informal conference memorandum in accordance with the procedures described in Section 2 of this Bulletin. At the same time that the compensation order or informal conference memorandum is issued, the District Director will advise the claimants of the opportunity to file for detention benefits under the WHCA with DFEC.

Either the compensation order or the informal conference memorandum can be a basis for the acceptance of the detention benefit claim. The DFEC, absent extraordinary circumstances, will accept the findings of either the compensation order or the informal conference memorandum as they pertain to the DBA claim such as whether the employee is injured or has died and whether the employee would be entitled to DBA benefits. The DFEC will engage in development as to whether the employee has been detained and the appropriate amount of compensation benefits.

Note: Development of detention benefit claims filed without either a compensation order or an informal conference memorandum may result in greater processing time than those detention benefit claims filed with compensation orders or informal conference memorandums as the DFEC may be required to develop all aspects of the claim, including DBA compensability. The DFEC may consult DLHWC on this additional development.

6. WHCA Reimbursement Claims May Be Denied Due to "Premium Loading."

A claim for reimbursement filed by an insurance carrier or self-insured employer will be denied if it is found that the benefits paid or payable were on account of injury, detention or death which arose from a war-risk hazard for which a premium (which included an additional charge or loading for such hazard) was charged. By submission of a Form CA 278, the party seeking reimbursement is certifying that that premium loading has not occurred. If deemed necessary in a particular case, the DFEC will scrutinize DBA insurance policies and any other relevant information to ensure that such premium loading has not occurred and insurers may be required to certify that such loading has not occurred beyond the statement on the Form CA-278 that the claim does not contain, nor will the insurance carrier or self-insured demand, an additional charge or loading for war-risk hazard, as defined in 42 USC 1711(b).

Disposition: Retain until the indicated expiration date.

 

CECILY A. RAYBURN
Director, Division of
Planning, Policy and Standards

Distribution: Regional Directors, District Directors, FECA Director, and Longshore Director

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OWCP BULLETIN NO. 04-01

Issue Date: May 17, 2004


Expiration Date: May 17, 2005


Subject: Case-specific email transactions

Background: With the increase in the use of email as a means of communication from our customers, it is critical that the office maintain policies that guard against any possible privacy violation and that ensure response to inquiries.

Purpose: To establish clear guidance on when and how email is to be used for communication regarding a specific case file.

Applicability: All OWCP staff, District Medical Advisers, Telephonic and Field Nurses, Rehabilitation Counselors, contractor staff, Second Opinion Examination Contractors.

Action:

Email within the DOL network

1. Email sent from one OWCP employee to another OWCP employee through the ESA wide-area network (WAN) is considered secure. Email to and from on-site contractors who use the ESA network is also considered secure. (ESA owned and properly configured equipment, including dial-up laptops, that accesses the ESA WAN.) As such, reference to the employee's name and case number may be used in the message. No reference to the employee's name and case number should be made in the subject portion of the email.

2. Email sent from an OWCP employee to another DOL employee through the DOL network is also considered secure. As such, reference to the employee's name and case number may be used in the message. No reference to the employee's name and case number should be made in the subject portion of the email.

3. It is important to note that once an email is forwarded to anyone outside the DOL network, the message is no longer secure. The person forwarding the message is responsible for ensuring that all parts of the forwarded message including the subject line meet the guidelines stated below under the heading Email with non-DOL government agencies and OWCP contractors.

Email with non-DOL government agencies an/or OWCP contractors

1. Email between OWCP and non-DOL government agencies and/or most OWCP contractors, occurs outside the ESA network and therefore security is not guaranteed. As such, any reference to a specific case file must include the case number only. No reference to the claimant's name or SSN should be made in any part of the email message. (This policy does not apply to ACS "threads" which are maintained by ACS through a secured website maintained by ACS).

2. Attachments and email message chains must also be altered to remove reference to the claimant's name or SSN if that email trail is being forwarded outside of DOL. If it is not possible to alter or redact the document or email or it is important that the attachment or email include both the claimant's name and case number or SSN, the information must be password protected (see item 3 below) before it is forwarded outside DOL. Alternatively, it may be mailed or faxed to the appropriate party.

Email with outside parties who are not OWCP contractors

1. Email between OWCP employees and outside parties is outside the ESA network, and therefore does not guarantee security. As such, substantive email responses to outside parties who are not OWCP contractors are prohibited. An acknowledgement email may be sent but reference to any personal identifiers must be removed.

2. If a case-specific email message is received from an outside party, the message should be printed or bronzed for inclusion in the case file. OWCP's response should be made via letter or telephone call. The response should include a statement encouraging the party to write or call with future requests. This will allow the office to better track receipt and response and will ensure the security of the claimant.

3. If an email response is required using claimant's name and case number or SSN, the response must made in an attached document, not in the body of the transmitting email, and must be password protected before it is sent outside DOL. If this attachment is returned with the original email, the email must be altered to delete all references to all personal identifiers.

This email policy addresses case specific email only. Email may be used to answer general questions without restriction as long as the claimant's personal identifiers are not referenced.

Any information sent via email continues to be subject to the provisions of the Privacy Act and should be released only if appropriate to do so.

Disposition: Retain until the indicated expiration date.

 

Cecily A. Rayburn
CECILY A. RAYBURN
Director, Division of Planning,
Policy and Standards

Distribution: List No. 1 – All Employees

 

Creating Password Protected documents in WORD and EXCEL

Once your document has been completed/saved, select Tools on the toolbar.
Select Options.
Click on the Security Tab.
You will see the following:
"File encryption options for this document"
"Password to open: _____________"
Type the password you have created.
Click OK.
A dialogue box will appear as follows:
"Reenter password to open: _______________"
Retype your password.
Click OK.

Your document is now password protected.

If you are sending this document as an attachment, contact the receiving party and provide the password.

Caution – Once you've password protected the document, it is password protected for everyone, including you! It is recommended that you do one of the following: keep a separate list of the passwords you have chosen; keep a second document with the same information and a different file name; or remove the password on your copy once the document has been sent.

To remove a password, open the document, using the password.
Select Tools on the toolbar.
Select Options.
Click on Security Tab.
You will see the following:
"File encryption options for this document"
"Password to open: *******"
Block and delete the password. (The asterisks are the password.)
When you hit delete, the asterisks should disappear.
Click OK.

The password has been removed.

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OWCP BULLETIN NO. 01-01

Issue Date: February 21, 2001


Expiration Date: February 21, 2002


Subject: OASIS - Retention Schedule for Paper Documents

Background: In FY 2000 DFEC began deploying a new imaging system in its district offices. OWCP Automated System for Imaging Services (OASIS), changes the process by which case files are handled by DFEC staff. This system was developed to provide DFEC staff with an electronic case file to use in place of a paper file. Once OASIS is activated in a district office, every new claim created is processed using this system. All case file documents for these claims are captured and stored electronically and the claims examiner adjudicates and manages them exclusively in the electronic environment.

However, at this time most case file related documents are still received in the district offices in paper form. Once the document has been captured and stored electronically, the paper document is no longer necessary for the development and management of the case as the electronic image becomes the official record. Since the deployment of OASIS, each district office has stored the paper documents pending quality review and disposal schedules for these materials.

Reference: OWCP Procedure Manual Chapter 1-0300

Purpose: To notify district offices of the retention schedule and audit requirements for paper documents after input has been made into OASIS.

Applicability: Regional Directors, District Directors, Assistant District Directors, Chiefs of Operations, Systems Managers, Technical Assistants, and National Office Staff.

Action:

On-going Imaged Material

1. The paper copy of all OASIS imaged material must be retained for ninety (90) days from the date of receipt.

2. An audit of documents is required to ensure that documents belonging to OASIS-processed cases are being properly imaged and associated with the appropriate case file and that the imaged documents are of an acceptable quality.

3. The person(s) assigned to perform the audit must be claims personnel. Each district office will designate the appropriate staff person(s), and the list of such persons will be maintained in the District Director=s office. The list must be updated immediately as changes in this responsibility occur.

4. The audit must be performed on a weekly basis and the documents to be sampled must be identified prior to the document preparation stage.

5. Ten (10) documents must be sampled from the incoming mail batches (including medical mail batches). The documents to be sampled should not include CA-1, CA-2, CA-2a, CA-7 forms or medical bills.

6. In addition, one (1) to two (2) documents from incoming faxes must be sampled.

7. If the mail flow of the district office is such that certain types of documents are received/opened/reviewed first by someone other than the mail room staff and the mail is then returned to the mail room for routine OASIS handling, one (1) to two (2) documents from each of these other sources must be sampled.

8. Additionally, two (2) to three (3) documents must be sampled from internally created documents. (Transfer batches should be excluded from this sampling.)

9. When a document is selected to be sampled, the auditor must annotate the OASIS Document Audit Worksheet. (See Attachment 1.) The auditor enters the date of receipt, the file number, and a brief description of the document.

10. One (1) week to two (2) weeks later, the auditor will attempt to locate the sampled document in OASIS. The results must be entered on the OASIS Document Audit Worksheet. The auditor will note whether the electronic version of the sampled document was found in OASIS, if the imaged document was readable, and if the file number was correct, and will then initial and date the entry.

11. All OASIS Document Audit Worksheets must be maintained by the District Director in a central location.

12. If the sampling reveals problems with either the document control or image quality, the Director for FEC should be notified and immediate corrective action must be taken by the district office.

13. If no problems result from the sampling, all imaged documents for the week sampled may be destroyed after ninety (90) days have elapsed from the date of receipt.

Backlog of Imaged Material

1. Since no imaged documents have been destroyed as of this date, there is a backlog of stored documents for several district offices. An audit of these stored documents must be performed prior to their destruction.

2. A one-time audit of all stored documents more than one (1) week old at the time of the implementation of this bulletin must be performed prior to their destruction.

3. The person(s) assigned to perform the audit must be claims personnel. The District Director must maintain a list of all claims staff authorized to perform this audit of backlogged material.

4. For each month, four (4) C-closures must be sampled. In the case of C-closures only, the auditor must locate in OASIS and inspect all documents contained in the paper file.

5. Additionally, six other documents must be sampled for each month. The auditor should pull six batches that were processed during the month being sampled. The batches should have been processed on different days of the week. From the pulled batches, the auditor must choose one (1) document each from the beginning of two (2) batches, from the middle of two (2) batches and from the end of two (2) batches.

6. When a document is selected to be sampled, the auditor must annotate the OASIS Backlogged Document Audit Worksheet. (See Attachment 2.) The auditor enters the time period being audited and, the date of receipt, the file number, the position in the batch (i.e. beginning, middle or end) or C-closure, and a brief description of the document.

7. The auditor will then attempt to locate the sampled document in OASIS. The results must be entered on the OASIS Backlogged Document Audit Worksheet. The auditor will note whether the electronic version of the sampled document was found in OASIS, if the imaged document was readable, and if the file number was correct, and will then initial and date the entry.

8. Each sampled period must be documented by completion of the OASIS Backlogged Material Audit Worksheet. The worksheets must be retained by the District Director in a central location.

9. If the sampling reveals problems with either the document control or image quality, the Director for FEC should be notified and immediate corrective action must be taken by the district office.

10. If no problems result from the sampling, all imaged documents for the month sampled may be destroyed after ninety (90) days have elapsed from the date of receipt.

The destruction of all paper file material should be accomplished in accordance with district office policy on the destruction of case files.

Disposition: Retain until the indicated expiration date.

 

CECILY A. RAYBURN
Acting Director, Division of
Planning, Policy and Standards

Distribution: List No. 3-Folioviews Group D
Regional Directors, District Directors, and National Office Staff

Attachment 1 - OASIS DOCUMENT AUDIT WORSHEET

Attachment 2 - OASIS BACKLOGGED DOCUMENT AUDIT WORKSHEET

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OWCP BULLETIN NO. 99-01

Issue Date: April 9, 1999


Expiration Date: April 8, 2000


Subject: Resolving FECA Rehabilitation Cases Earlier by Streamlining the Rehabilitation Referral and Planning Process.

Background: To achieve the OWCP Strategic Plan goal of returning injured employees to work, the FY 1999 Federal Employees' Compensation program plan established a new goal of resolving Quality Case Management (QCM) cases within 30-months of the date disability began.

A resolution includes such outcomes as: reemployment, approval of a suitable training program for the injured worker, and formal determination of wage-earning capacity following vocational services. The OWCP rehabilitation program thus plays a central role in achieving this Federal Employees' Compensation program goal.

When Quality Case Management (QCM) procedures were established, the OWCP Rehabilitation Procedure Manual and "Red Book" (Counselor Resource Book) were revised to include stricter time requirements for referral of QCM cases to a Rehabilitation Counselor (RC), contacts by the counselor with the injured employee and employer, and receipt of an acceptable rehabilitation plan, if the employee did not return to work with the previous employer. Since active medical treatment, nurse efforts to obtain light duty, and second opinion evaluations can consume many months before a QCM case reaches the Rehabilitation Specialist (RS), these rehabilitation time requirements will take on added importance in meeting the new goal.

Much time is consumed in OWCP rehabilitation cases by paperwork, waiting periods, and administrative processes. By streamlining preliminary steps, reducing paperwork, and insisting on prompt service delivery, time is gained for high quality vocational services.

Purpose: To streamline rehabilitation referral and planning procedures to meet program goals for reducing days lost due to disability.

Reference: VR Counselor Resource Book, p. 30; OWCP Procedure Manual 3-300.6b; 3-401 passim.

Applicability: OWCP Rehabilitation Specialists; FEC Supervisors.

Action:

A. Improve Referral Development

1. Rehabilitation Specialists should use the Rehabilitation Tracking System (N/RTS) "K/O Closure Reports" to identify cases which have been closed from nurse intervention services and which the CE may find are in posture for referral for vocational services. Reports closed code "K" by the Staff Nurse have work limitations on file. The RS should bring cases to the CE's attention which appear to be able to work full-time.

2. Cases should be opened for services promptly when referred and the directions and information given to the RC should be focused and complete. If a case comes from the CE with incomplete or contradictory work restrictions, the RS should make an effort to get resolution at the time of referral by discussing it with the CE face-to-face, so as to give the RC specific guidance, rather than leave it to the RC to interpret the medical information. If the discrepancy is not major, the CE may stipulate that the more restrictive work limitations be used as a basis for rehabilitation.

3. The RS should use judgement in sending medical reports to the RC. The RC must have the work tolerance limitations which were identified by the CE as the basis for a vocational rehabilitation effort, any reports explaining those limitations, and other medical information relevant to the vocational effort (such as a report describing a needed accommodation, or a fuller description of the accepted or concurrent medical conditions). Earlier reports in file which created a conflict of opinion, or which raise issues that were subsequently resolved by the CE may not be useful and should be omitted.

Nurse reports should be included when they contain relevant information- about the injured worker's level of motivation, or approaches made to the employing agency, or the injured worker's background. The RS should be judicious in selecting medical and nurse reports which will focus the RC effort, not raise side issues.

If the RC is expected to pick up where the nurse left off with the employer, or to skip those contacts and move on, those instructions should be included in an OWCP-3 with the referral or inserted in the OWCP-35. The RS should give concrete direction to the RC and convey the expectation that the case will be handled timely, giving specific timeframes which you expect to be observed.

4. Enclose the injured employee's position description or SF-171, Optional Form 612 and/or resume' with the referral, if on file.

5. Each RS should review recent referral time frames to determine whether the quick turnaround required for QCM cases (five working days) is being met, and if not, make appropriate changes in the process so as to meet the time frames. The Accountability Review teams in FY 1999 will collect and share data on whether each office is meeting time frames.

6. The screening activity has been minimized in QCM cases. QCM cases must be referred for services or opened for functional capacity evaluation/work hardening unless there is some strong bar to referral in the judgement of the RS. To save time, the initial interview is optional in QCM cases if nurse reports are in file. Moreover, the guidelines in this bulletin require less copying of reports to further streamline referral.

This reduces the need for the professional services of contract screeners in recommending whether to open a case and conducting the initial interview. Screeners may be used in QCM cases only if there is an unusual volume of referrals which would otherwise not meet the five-working-day requirement. When used, screeners are required to meet that time frame.

B. Enforce Time Requirements on Counselors. The RS should take the following actions:

1. Review initial counselor reports to see if QCM time requirements for contacting the injured employee and employer are being observed. Reiterate the time frames in the outgoing Form OWCP-3, and issue a warning immediately if they are not observed. After a second warning, caseloads may be reduced. To accomplish this reduction, stop sending QCM cases to RCs who are not timely in initiating services.

2. Treat Placement, Previous Employer and Plan Development as a single period with a high level of services. In QCM cases, where work has already been done with the previous employer, two ninety-day periods should not be needed for these services. The RS should advise the RC in the OWCP-3 or OWCP-35 how much time is allotted for PPE/PD and state the date on which a plan is required if the injured employee is not back at work with the previous employer. Enforce these time requirements with a warning if the plan is not on time (unless something exceptional has occurred to justify the delay).

Vocational evaluation should begin simultaneously with employer contacts, as soon as the case is opened. If testing is anticipated, it should be done in the first 30 days after referral. A transferable skills analysis should also be requested immediately. These tools can be helpful in thinking about reemployment opportunities with the Federal employer, getting the injured employee ready for the next step, and assessing the need for training.

3. Notify counselors in the region that, in keeping with national policy and Privacy Act considerations, you are using e-mail and fax to improve the quality and timeliness of service acquisition, and encourage (do not require) them to participate. Use e-mail or fax to alert RCs that a referral is coming and confirm their availability. Be sure that RCs are aware of the privacy rule that the injured employee is identified only by case number in the message. All e-mail communications with the RC should be printed and placed in the FECA case file.

C. Streamline the preliminary stages of the process.

1. The RS may authorize RCs to do their own vocational testing on QCM cases if they are able to provide good quality testing reports. Testing should be completed and evaluations submitted promptly.

2. The RS may waive testing if, based on reliable and documented information, the injured worker appears qualified for, e.g., training. The information could include past education and work experience, the results of the transferable skills analysis, a previous rehabilitation referral, or other documentation.

3. If the previous employer never provides light duty or the nurse has exhausted all potential, the RS should direct the counselor to move straight to planning and provide a plan within 90 days.

4. Be aware of the "lost production days" of each QCM referral and, within reason, modify planning time requirements to meet the goal. Give the RC a date on which the plan is due, and enforce timeliness.

Disposition: Retain until superseded or incorporated in the OWCP Procedure Manual.

 

Diane B. Svenonius
Director, Division of
Planning, Policy and Standards

Distribution: List No. 5
(All FECA and LHWCA Claims Examiners, Supervisors, Rehabilitation Specialists, Staff Nurses, Systems Managers and Technical Assistants).

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OWCP BULLETIN NO. 98-01

Issue Date: July 1, 1998


Expiration Date: June 30, 1999


Subject: Coding of Vocational Rehabilitation Bills

Background: At present, no service code is necessary for processing vocational rehabilitation bills. As a consequence, all FECA vocational rehabilitation bills suspend for verification that the services have indeed been authorized, and that the authorization amount has not been exceeded. Because of the requirement for the separation of functions, the Rehabilitation Specialist in charge of the case cannot directly approve a particular bill for payment.

To streamline the processing of Rehabilitation Counselor (RC) bills, increase the RS's ability to monitor and control authorization amounts, and maximize the data recoverable from the automated system, a prior authorization mechanism is being incorporated into the Division of Federal Employees' Compensation's (DFEC) bill processing system.

This prior authorization mechanism allows the RS to authorize RC services for each case for a specific range of dates and for a specific dollar amount. Incoming bills are keyed into the system using a set of service codes described below. Bills that conform to the authorization parameters are paid and services outside the authorized date range or dollar amount are suspended for resolution. The system will determine whether the incoming bills exceed the authorized amount by totaling the RC services previously paid according to the on-line BPS history and the bill being processed, and comparing this figure with the authorized amount. This calculation will be subject to the following constraints: (1) only services paid to a provider classified under Provider Type U will be considered, and, (2) the program will sum the paid services found in the district office's bill pay history, which contains records of the bills paid during approximately the previous year. Other rehabilitation bills will be edited for dates of service against the authorized dates.

Because of these restrictions and because of the need to consider cases in progress, blanket authorizations for $5000 will not provide adequate control, and cannot now be introduced into the system. To maximize the efficiency and accuracy of the prior authorization mechanism, district offices must follow the procedures detailed below.

Purpose: To transmit procedures for the prior authorization of vocational services and the processing of bills in the FECA bill system.

Applicability: Regional Directors, District Directors, Supervisory Claims Examiners, OWCP Rehabilitation Specialists, and bill processing personnel in FECA District Offices.

Action:

1. The rehabilitation counselor service authorization procedures will be implemented on or about July 15th. To prepare for the orderly transition, the RS should:

a) Ensure that all RCs and only RCs appear in the Provider File only under provider type U. To assist in this task, a report of all the providers under provider types C, U, V, and W was forwarded to all district offices on April 9th. Once the RS determines the specific changes, additions and deletions to be made to the file, the staff person responsible for the Provider File maintenance can input all changes. As of July 15th, field rehabilitation counselors must appear only under provider type U. All training facilities should be provider type V. Any other active rehabilitation service provider should be assigned provider type W. Provider type C will be obsolete.

b) Forward the DPPS Notice No. 8 to all active rehabilitation counselors (RCs) in the district, advising them of the new coding and billing requirements and allowing 15 days for an answer. A counselor who refuses to sign and return the statement acknowledging receipt and agreement to submit bills in accordance with the new procedure within the specified time period can be removed from the rotation. After implementation, RCs who continue to submit incomplete or erroneous bills after being instructed once are subject to a warning letter.

2. The rehabilitation authorization program is available as Option 39 under FECS001, Case Management Menu. It requires the input of a FECA case number, the authorized date range and the dollar amount authorized. (Instructions on how to use the program will be transmitted separately). The RS may enter authorization on new cases. Each district office may select other staff member(s) not associates with bill pay process to perform the data input on prior cases, and they should become familiar with the format of the screen.

3. For rehabilitation cases that are opened on or after 7/15/98, the RS should enter the following in the prior authorization table when the case is opened for RC services:

Claim file number

The date of the OWCP-35 opening the case is input as the "from" date of authorization. The "through" date is input as two years after the "from" date. The RS should authorize a shorter period of time whenever there is a high probability that the case will be closed in less than two years. The system will suspend bills where dates of services fall outside the range.

c. The dollar amount approved for RC services for one year. This figure may be estimated as the total amount authorized divided by the number of years. For example, if the total amount authorized in the OWCP Form 35 is $5000, the RS should enter $2500 in the dollar amount field.

4. It is not required that "backfill" of authorizations for open cases be done prior to implementation. Bills for these case will suspend for manual review because there is no match in the prior authorization table (Error code 610). The case data can be entered into the prior authorization screen at this point and the bills recycled. To determine the date range and the dollar amount that should be authorized for cases in progress, the RS examines the data in the RH-7 SUMMARY report.

The "from" date assigned to all cases in progress should equal the date the case is opened for services, according to the RH-7 Summary report. The RS should assign a "through" date based on the present status of the case, and the authorization period for all services. While tuition and other bills do not require service codes, they will be edited for dates of service against the authorization.

To determine the dollar amount to be introduced in the authorization program, the RS should estimate an average annual expenditure. An estimated average year's expenditure can be obtained by adding the amounts under Plan Development (U) and Placement (W) in a recent RH-7 report and dividing this figure by the number of years of services. (If the estimated amount needed for the coming year plus the amount already spend exceeds the original written authorization to the counselor, the RS must use Forms OWCP-24 and OWCP-16 to formally authorize the additional money.)

5. Offices should continue to receive, screen, route, number and batch rehabilitation bills according to established practices.

6. However, as of July 15, all RC bills MUST contain the alphanumeric service codes detailed in Attachment 1 to describe the services rendered. In addition, the bills must contain the dates of service, individual service charges, the provider's EIN, name and address, and the claimant's claim file number, name and address. Suggested billing formats are depicted in Attachments 2 and 3.

Instructions on how to input bill data onto the screen will be transmitted separately.

During the initial "backfill" period and later, bills may suspend or be denied for a variety of reasons including: lack of essential data such as rehabilitation procedure codes, claimant or provider information; eligibility issues; or duplicate edits. Bills suspended for these and other reasons unrelated to rehabilitation should continue to be resolved in the usual manner.

8. Once each case has been given an initial on-line authorization, bill resolvers will notify the RS through a designated supervisor (to preserve separation of function) when bills fail Edits 609, 610 and/or 620 because the dollar amount has been exceeded or the date of service fall outside of the authorized time period. The RS uses the process described under 4a-b of this bulletin to arrive at the dollar amount and/or time period to be authorized and enters these data in the rehabilitation authorization table. The RS can modify the existing dollar amount and "from" date or add a new date range. Once this is completed, the bill resolver is notified and the bill can be recycled for final processing.

9. It is suggested that when approving a new or revised plan, the RS review the authorization and make any needed changes.

10. When a case is closed for rehabilitation services, the RS changes the "through" date in the rehabilitation authorization table to the closure date. This will prevent the payment of services rendered after the case is formally closed.

11. If an office is using a counselor as a screener, the RC's provider type code should be changed to W, and bills should be processed as they are now, without service codes. When the counselor resumes work as a field counselor and accepts cases, the code is changed to U and service codes must be entered.

Disposition: This bulletin is to be retained until the expiration date, until canceled or superseded, or until incorporated into the OWCP Procedure Manual, Part 3.

 

DIANE B. SVENONIUS
Director, Division Of
Planning, Policy and Standards

Distribution: List No. 5
(All FECA and LHWCA Claims Examiners, Supervisors, Rehabilitation Specialists, Systems Managers, and Technical Advisors)

Attachments (3)

 

Attachment 1

Code

Description

VR001

Professional time of RC - counseling, placement, monitoring, testing, transferable skills analysis, job seeking skills training - prior authorization required

VR002

Non-professional time, by RC, or clerk/typist under the RC's supervision, travel, waiting - prior authorization required

VR003

Testing or transferable skills analysis performed by other than RC (when RC has paid the vendor and submits to OWCP original receipt and bills for reimbursement) - prior authorization required;

Testing or transferable skills analysis performed by other than RC (when RC does not pay vendor); vendor submits original and duplicate bill and report directly to OWCP for payment - prior authorization required

VR004

Mileage associated with all travel - prior authorization required

VR018

Long distance telephone calls, Parking, Tolls, and other Itemized Expenses

 

Attachment 2 (Link to Image)

 

Attachment 3 (Link to Image)

 

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OWCP BULLETIN NO. 98-02

Issue Date: September 15, 1998


Expiration Date: August 14, 1999


Subject: Prior Authorization of Field Nurse Services

Background: The DOL field nurse procedure codes (NIPOO, NIPO1, NIAOO, NIAO1, NITRA and NIPTC) allow the processing of field nurse (FN) services through the automated Bill Processing System (BPS). However, the BPS does not contain edits or checks to verify that the nurse services have been authorized or that particular services fall within the time period and/or the dollar amount of the authorization. At present, the staff nurse (SN) must manually review bills to ensure that the charges have been authorized and to verify that the costs of the case do not exceed the established case maximum.

To streamline the processing of FN bills, increase the SNs ability to monitor and control authorization time periods and amounts, and maximize the data recoverable from the automated system, a prior authorization mechanism is being incorporated into the Division of Federal Employees' Compensation's (DFEC) automated system.

As designed, the prior authorization mechanism allows the SN to authorize FN services in a case for a specific range of dates and dollar amount. Incoming bills are keyed into the system and those that conform to the authorization parameters are paid, while bills that do not conform are suspended for review.

This Bulletin details the procedures for the prior authorization of FN services, including the resolution of suspended bills.

Purpose: To transmit procedures for the prior authorization of FN services and the processing of bills through the BPS.

Applicability: Regional Directors, District Directors, Supervisory Claims Examiners, FEC Staff Nurses and bill processing personnel in FECA District Offices.

Action:

1. The prior authorization mechanism is to be used for FN services exclusively. This enhancement is not applicable to services rendered by the "telephonic case manager" (TCM) which are coded with NC procedures. A new long distance phone call reimbursement code for the TCM has been developed to maintain a separation of FN codes (NI) and TCM codes (NC). This new telephone reimbursement code for the TCM is NCPTC.

2. The FN authorization program is available as Option 40 on the Case Management Menu. It requires the input of a FECA case number, the authorized date range and dollar amount. (Instructions on how to actually use the program will be transmitted separately). The SN may enter the authorizations on all cases. However, to assist in the process, each district office may select other staff members not associated with the bill pay process to perform the data input, and they too, should become familiar with the format of the screen.

3. For FN cases that are opened on or after 8/15/98, the SN should enter the following in the prior authorization table:

a. Claim file number

b. The "from" date is the date the FN is assigned the case or the date the "B" is coded into the N/RTS. The "to" date should reflect the usual 180 days that an FN is assigned to a case (120 days on intervention and 60 days follow up on the RTW). The SN may authorize a shorter period of time whenever there is a high probability that the case will be closed in less than 180 days. Conversely, when the FN time needs to be extended past the initial "to" period, it may be overwritten or "blanked out" and the new date may then be entered. Since there is no historical backup on this data, a screen printout should be made and kept in the file prior to overwriting the end date.

c. The dollar amount approved for FN services should reflect the maximum dollar amount per case which is $4,000. This is based on a FN hourly rate of $65.00. As with the date range, if FN hourly reimbursement rate is lower than the $65.00, the SN may enter a lesser dollar amount. If on the other hand, at the time of authorization, the SN enters an amount greater than $4,000 because it is recognized that the $4,000 maximum will not cover the duration and complexity of the case (catastrophic case), an error message will appear "$4,000 Maximum Exceeded - Amount Justified? Continue? [ Y/N]." The SN then needs to respond [Y].

4. Once each case has been given an initial on-line authorization, bill resolvers will notify the SN through a designated supervisor (to preserve the separation of function) when bills fail Edits 609, 610 and/or 620 because the dollar amount has been exceeded or the date of service falls outside the authorized time period. The SN uses the process described in 3. a-b of this bulletin to arrive at the dollar amount and/or time period to be authorized and enters these data in the nurse authorization table. The SN may modify the existing dollar amount and "from" date or add a new date range. Once this is completed, the bill resolver is notified and the bill can be recycled for final processing.

5. Bills for cases will suspend for manual review when there is no match in the prior authorization table (ERROR code 610). The case data can then be entered into the prior authorization screen at this point and the bills recycled. To determine the date range and the dollar amount that should be authorized for cases in progress, the SN should evaluate the data in the NI reports and the Case Status Query report from the N/RTS.

a. The "from" date assigned to all cases in progress should equal the date the case is opened for services, according to the NI Summary report. The SN should assign a "through" date based on the present status of the case, and the time frame left on the case. For example if the case is currently in "B" status, the through date should reflect at least 120 days from the date the case is entered in the prior authorization table. If however the case is already in the "H" status, a 60 day period between the from and through dates is all that is needed. Since you can always overwrite the ending date, it is safer to err on the conservative side.

b. To determine the dollar amount to be introduced in the authorization, the SN should estimate the monthly charges of the FN and enter that amount based on the period of time left on the case.

6. Offices should continue to receive, screen, route, number and batch FN bills according to established practices.

7. Bills may suspend or be denied for a variety of reasons including: lack of essential data such as procedure codes, claimant or provider information, eligibility issues, or duplicate edits. Bills suspended for these and other reasons unrelated to nursing service issues, should continue to be resolved in the usual manner.

8. When a case is closed for FN services, the SN changes the "to" date to the closure date. This will prevent the payment of services rendered after the case is formally closed.

Disposition: This bulletin is to be retained until the expiration date, until canceled or superseded, or until incorporated into the OWCP Procedure Manual, Part 3.

 

Diane B. Svenonius
Director, Division of
Planning, Policy and Standards

Distribution: List No. 5
(All FECA Claims Examiners, Supervisors, Staff Nurses, Rehabilitation Specialists, Systems Managers and Technical Advisors)

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OWCP BULLETIN NO. 97-01

Issue Date: February 14, 1997


Expiration Date: February 13, 1998


Subject: Measuring Rehabilitation Resolutions for the Program Plan.

Background: For the Fiscal Year 1997, OWCP has adopted "percent of cases successfully resolved" as a measure of the success of the vocational rehabilitation program. According to the Operational Planning memorandum issued on September 30, 1996, resolution is defined as:

a. reemployment with a new or the previous employer (status codes 2, 4,v,3).

b. demonstration of a wage-earning capacity or presumed earning capacity following completion of a rehabilitation program. This may occur in one of the following ways:

- On closing the case, the rehabilitation counselor completes a sound OWCP-66 certifying that two jobs are reasonably available and medically and vocationally suitable, in accordance with OWCP procedures. For FECA, if the jobs are other than those originally considered by the CE in reviewing the vocational plan, the CE must initial the OWCP-66 signifying agreement (status code 5, reason code j).

- A Longshore case is settled based on representations of OWCP-sponsored vocational rehabilitation and after significant services over and above a labor market survey were provided (status code 5, reason code s).

- A medically and vocationally appropriate job is formally offered to the injured worker but the worker does not return to work (retires or refuses employment)(status code 5, reason code r).

Refusal to cooperate with the vocational program before its completion is not considered to demonstrate an earning capacity. Partial or total completion of a training program is also not considered a positive outcome in and of itself. Two jobs must be suitable and available and at least 30 days of placement services must have been offered to the injured worker.

The provisional goal for FY 1997 is that 70% of closures during the Fiscal Year shall have one of these outcomes.

Purpose: To give instructions for recording cases which satisfy the definition of "resolution" for program plan purposes.

Applicability: FECA and LHWCA Rehabilitation Specialists and Supervisors; FECA and LHWCA Claims Staff.

Action:

1. New closure reason codes have been added to the
Nurse/Rehabilitation Tracking System to reflect
resolutions which meet the standards as follows:

r - Refused suitable job.
s - Settled case based on OWCP rehabilitation.

The provisional "resolution" standard will be measured as follows:

The sum of closures during the period which were Closed, Reemployed (codes 2, 4, and either V or 3 with reemployment occurring within the reporting period) plus the closures without reemployment listed above, taken as a percent of total closures within that period.

A percentage "score" for each office and each program will be computed quarterly and reported on the Vocational Rehabilitation Performance Report, which accompanies the RH reports. At the end of the Fiscal Year, an annual score will be tabulated.

3. To make sure that resolutions are coded accurately and consistently, you should use the reason codes in a way that indicates whether suitable and available jobs leading to a wage-earning capacity determination were identified at closure. For example, you should use reason code j if two jobs were identified (and, in FECA cases, approved by the CE) and the injured worker elected to retire rather than return to work. Use reason code r if a job offer was refused and the injured worker's compensation was terminated as a result.

The accuracy of resolution coding will be examined on accountability reviews. The selection of two jobs should be documented in the file with Form OWCP-66, and for FECA Quality Case Management cases there should be indication that the CE had an opportunity to review the job or job goals for suitability either when a plan was approved or at closure.

Disposition: This Bulletin should be retained until incorporated in the OWCP Procedure Manual.

 

DIANE B. SVENONIUS
Director, Division of
Planning, Policy and Standards

Distribution: List No. 5
(All FECA and LHWCA Claims Examiner, Supervisors, Rehabilitation Specialists, Systems Manager, and Technical Advisors)

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OWCP BULLETIN NO. 97-02

Issue Date: March 10, 1997


Expiration Date: March 9, 1998


Subject: Selection of Rehabilitation Counselors (RCs) during Option Years.

Background: The current certification procedures call for a one-year certification period of Rehabilitation Counselors (RCs) followed by four one-year option periods. For the purpose of these procedures, the certification year is defined as a twelve month period beginning on the date of the local workshop. For this reason, the certification year will expire on difference dates across district offices. Each district office should use the procedures described in this bulletin to implement the first and succeeding option years.

References: OWCP Bulletin No. 96-2

Purpose: To provide directions for the selection of RCs during the option years.

Action:

1. Review of the office's needs.

a. Geographic clusters. The RS examines the distribution of injured workers (IWs) and the location of RCs in the geographic clusters under his or her jurisdiction. To do so, the RS studies the rotation of RCs within each cluster, posing questions such as: Are the number and/or size of the clusters commensurate with the number and location of the IWs in the region? Do the number and size of the clusters expedite or, conversely, impede the rotation and the management or RCs? Are the travel costs submitted by the RCs in the cluster reasonable in terms of duration and frequency?

If, as a result of this review, the RS identifies areas where the number or the geographic makeup of the clusters is not appropriate, he or she may consider actions such as the merging of clusters, or altering the size and borders of clusters to arrive at an adequate configuration. After this stage is completed, the RS continues the review, taking into account the results of any changes in the configuration of the region's clusters.

b. Number of Counselors per cluster.

(1) The RS examines the number of RCs per cluster, and based on the available reports determines whether the number is adequate or whether there are a significant number of counselors in a cluster that have more or less than an optimal number of active cases/year. In a large urban cluster, we believe that the optimal number of active cases/RC/year ranges from a minimum of four (one per quarter) to a maximum of 10. A case load of less than four cases is not generally sufficient to successfully acquaint the RC with the OWCP programs and procedures. In contrast, too many cases may lead to delays, inefficiency, or uneven quality. These limits do not apply to clusters composed of rural areas and/or small cities or towns. In these instances, the program needs to maintain the presence of some RCs per cluster even though some of these RCs may receive one or no cases per year. In such clusters, the RS studies additional factors to arrive at a determination of the appropriateness of the number of RCs per cluster. The factors include the results of the RC evaluation process, historical rates of attrition, availability of RCs in neighboring clusters, etc.

(2) The RS establishes the appropriate number of RCs per cluster as well as the number to be subtracted, if any. He or she documents the results of this review and continues the process.

c. RC evaluation.

(1) The RS should conduct the evaluation of the RCs under his or her jurisdiction in accordance with the OWCP Bulletin 96-2. If the cluster distribution and the number of RCs per cluster are deemed appropriate, the RS can go to the next step and determine whether there are any RCs who have at least two cases and who rank significantly below others in the cluster in the RC Detail Evaluation Report and/or the RC Ranking Report. (The counselor's ranking on the planning score and the overall case quality score should be considered individually. The combined ranking tends to disfavor RCs who close cases in the previous employer period.) These RCs should not be selected for the option year unless there are clear and major attenuating circumstances including precipitating a shortage of counselor by subtracting their number from the current complement of RCs in the cluster.

(2) The RS lists the names of the RCs who will not be asked to come back during the option year and documents all findings and decisions.

2. Communications.

a. District office management. The RS should share the option year procedures, the results of the review, and the time frames for completion of the process with the office management. This should be done prior to the release of the RC letters.

b. Other staff. The RS consults with other RSs in the district office and/or in adjacent jurisdictions and makes them aware of any potential effects on their case load. In addition, the RS informs CEs that they will no longer work with the RCs who are discontinued and that their cases will be reassigned.

c. Counselors. The RS should release appropriate option year letters to all RCs under his or her jurisdiction. The letter to counselors who are not continued should state that the initial agreement year has expired, and that "in the best interest of the government, OWCP has reviewed its use of counselor services, and has decided not to exercise its option to continue using this counselor's services." There are no appeal rights from this determination.

Disposition: Retain until superseded.

 

DIANE SVENONIUS
Director, Division of Planning,
Policy and Standards

Distribution: List No. 5
(All FECA and LHWCA Claims Examiners, Supervisors, Rehabilitation Specialists, Systems Managers, and Technical Advisers)

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OWCP BULLETIN NO. 97-03

Issue Date: February 24,1997


Expiration Date: February 23,1998


Subject: Additional Codes for Nurse Rehabilitation Tracking System (N/RTS)

Background: OWCP Bulletin No.94-3 clarified the coding and reporting of nurse accomplishments under Quality Case Management in the Federal Employees' Compensation Program. This directive addressed basic coding sequences (B,H,7 etc.) initiated by the staff nurse (SN) during the intervention and return to work (RTW) follow-up activities of the field nurse(FN). As the nurse intervention program expanded, additional actions by claims examiners (CEs) and staff nurses to facilitate case resolution were identified. For example, when the complexity of a case warrants it (surgery, second opinion), FN services are either extended or interrupted for a finite time period. District offices also relate that by assigning FNs to claimants who are already in a light duty capacity, progression to full duty status is often expedited.

Since the coding and reporting of these case actions impacts on evaluating intervention time frames and outcomes, a standardized approach to code and track these actions on the Nurse Rehabilitation Tracking System (N/RTS) needs to be made available.

Purpose: This bulletin defines the new "interrupt" (Y) and "light duty" status" (L) codes and clarifies their use in the N/RTS. Code U is replaced by code O.

Applicability: FECA supervisors and claims examiners; staff nurses; rehabilitation specialists; systems managers.

Reference: OWCP Procedure Manual Chapter 3-400.15; OWCP Bulletins : 92-7, 94-3, and FECA Bulletin 96-6.

Action:

1. To capture the new codes and track case progression, a STATUS HISTORY screen for nurse cases has been added to the N/RTS. The screen is accessed by selecting "Status" from the update case screen or selecting "maintain status" from the CASE drop down menu. Once the code has been entered on the status history screen, the current status block on the case screen will automatically reflect this entry.

2. Use of the "Y" or "interrupt" code will now permit the SN to track extensions of FN services for specific medical reasons (surgery, second opinions) and for a finite time period. When FN services need to be interrupted (a decision that is coordinated with the claims examiner), the SN enters a "Y" code on the status history screen. While the case is in "Y" status, Progress Flags will not be updated. The tickler code and date will be used instead. The tickler code for "report due" (RD)is already available for use. When the case is removed from the "Y" status, the nurse may enter an "L" code on the status screen, update the H status date on the case screen or enter a closure on the case screen. Once the case moves out of the "Y" status, the next progress report flag update will be calculated systematically (e.g. if the report was due 15 days after it entered the "Y" status, it will now be due 15 days after it leaves the "Y" status). Note: if the worker has not returned to work when leaving the "Y" status, you may reflect this on the status screen by entering "L" with 0 hours.

3. Code "L" has now been added to track cases where the claimant is: (1) already working light duty when the FN is assigned and/or (2) the FN successfully gets the injured worker (IW) back to light duty. If the SN wants to record return to work status at the time the IW returns to light duty, the "H" status code should be entered with a status date one day after the "L" code. At the time the "L" is entered on the status screen, the system will prompt for entry of the number of hours (Exhibit #1).

4. Coding reflecting such events as light duty ("L") or interrupt ("Y") status will be reflected in this manner:

Case Action

Code

Screen

a. case open in lt. dty (4 hr.)
status or no work

B
L 4

Case screen
Status history

b. surgery required
history

Y

Status

c. out of interrupt but no RTW
history

L 0

Status

d. RTW lt. dty (6 hrs)
history

L 6

Status

60 day FN follow up begins

H

Case Screen

e. remains at work for 60 days
may/may not have increased lt. dty hours

7

Case Screen

5. The "O" code now replaces the former closure code of "U" and signifies "Closed, no work limitations on file". Cases previously closed in "U" status have been converted to "O". Additional codes reflecting FN activity resulting in non-RTW (medically unfeasible, refer to ORP, etc. will be added to the system at a later date.

6. The addition of the above three new codes will be reflected on your monthly NI reports.

7. An "H" Code tracking report is now available to all SNs at their local level and provides at a glance, FN caseload and length of time FN is following claimant's RTW.

Disposition: This bulletin should be retained until superseded or until incorporated into OWCP Procedure Manual.

 

DIANE SVENONIUS
Director, Division of
Planning, Policy and Standards

Distribution: List No.5
(All FECA Claims Examiners, Supervisors, Staff Nurses, Rehabilitation Specialists, Systems Managers and Technical Advisers)

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OWCP BULLETIN NO. 97-04

Issue Date: February 24, 1997


Expiration Date: February 23, 1998


Subject: Selection of Contract Field Nurses during Option Years.

Background: The current certification procedures outlined in FECA PM Chapter 3-200 detail the soliciting, recruiting, selecting and contracting with registered nurses to work with FECA injured workers. The certification occurs at five year intervals. Nurses sign a Memorandum of Agreement (MOA) that is valid for two (2) years. After the initial two year agreement, the FN services may be renewed yearly for three (3) option years. Guidance and direction for the renewal of contracts during the option years are detailed below:

Reference: FECA Procedure Manual Chapter 3-200

Purpose: To provide direction for the selection of contract nurses during the option years.

Action:

1. Review Office's Needs.

a. Geographic Clusters. The SN examines the distribution of injured workers (IW) and the location of field nurses in these geographic clusters. The SN also needs to take into account the number of cases which the telephonic nurse can handle. In performing this needs assessment, the SN studies the rotation of the FNs within each cluster, posing such questions as: Are the number and/or size of the clusters commensurate with the number and location of the IWs in the region? Do the number and size of the clusters expedite or conversely impede the rotation and management of the FNs? Are travel costs submitted by the FNs in the cluster reasonable in terms of duration and frequency?

If as a result of the review, the SN identifies areas where the number or the geographic make-up of the clusters is not appropriate, she may consider actionssuch as merging clusters or altering the size and borders of clusters to arrive at an adequate configuration. After this stage is completed, the SN continues the review taking into account the results of any changes in the configuration of the region's clusters.

b. Number of FNs per cluster. The SN examines the number of FNs per cluster and based on the available data determines whether the number of FNs per cluster is adequate or whether the nurses in the cluster have too few or too many cases per year. In a large urban cluster, we believe that the optimal number of active cases/FN/year ranges from a minimum of 5 to a maximum of 10. A case load of less than 4 cases is generally not sufficient to successfully acquaint the FN with OWCP policies and procedures. In contrast, too many cases may lead to delays, inefficiency or uneven quality. These limits do not apply to clusters in rural areas and/or small cities or towns. In these instances, the SN needs to maintain the presence of some FNs per cluster even though some of these FNs may receive one or even no cases per year. In such clusters, the SN needs to study additional factors to arrive at a determination of the appropriateness of the number of FNs per cluster. These factors include: evaluating FN performance, historical rates of attrition and availability of FNs in neighboring clusters.

c. The SN establishes the appropriate number of FNs per cluster as well as the number to be subtracted if applicable. SN documents the results of this review and continues the process.

2. Field Nurse Evaluation:

a. The SN reviews the FN performance in terms of timeliness, quality, billing characteristics, intervention successes, complaints or compliments received from employing agencies, claimants, FEC staff and whether there was a need for verbal or written warnings. The suggested evaluation factors to be used when considering option year renewal are detailed in Exhibit # 1. A notification letter advising the FN of the option year assessment is detailed in Exhibit #2. This evaluation is a cumulative review of the FNs performance. The SN must support a "no" response on the evaluation factors by documentation (case number, delayed report, no CE contact etc.) If the answer is "no" in 50% or more of the factors, the option year should not be renewed.

b. If the cluster distribution and the number of FNs per cluster are deemed appropriate, the SN can go to the next step and determine whether there are any FNs who have at least two (2) cases and rank significantly below the others in the cluster. These FNs should not be selected for option year renewal unless there are clear and major extenuating circumstances including precipitating a shortage of FNs when subtracting their number from the current complement of FNs in the cluster.

c. The SN lists the names of the FNs who will not be renewed for the option year and documents all findings and decisions. The FN is made aware via letter that the option year was not renewed. A sample of this non renewal letter is attached (Exhibit #3)

3. Communication:

a. District Office Management. The SN should share the option year procedures, results of the review and the time frames for completion of the process with the office management.

b. Other staff. The SN advises CEs and other SNs in the adjacent region of those FNS who have not been renewed by the program.

c. Inform FNs. The SN releases letters to those FNs who have been renewed for the option year. (Exhibit #4)

Disposition: This Bulletin is to be retained until the expiration date.

 

DIANE SVENONIUS
Director, Division of
Planning, Policy and Standards

Distribution: List No. 5
(All FECA Claims Examiners, Supervisors, Staff Nurses, Rehabilitation Specialists, Systems Managers and Technical Assistants)

Attachment 1

OPTION YEAR ASSESSMENT NOTIFICATION LETTER

Dear M    :

At present the Office of Workers' Compensation Programs (OWCP) is reviewing the status of contract nurses who provide services to injured workers under our program. This review will determine whether you are approved to continue working for OWCP for the next year.

Your assessment will be based on how you have fulfilled the terms of your contract with OWCP, your overall comprehension of the OWCP nurse intervention process and how you compare with other contract nurses serving this office in terms of quality and outcomes.

You will be notified by------------- of our decision.

Sincerely,

 

Staff Nurse
Region ________

cc: contract nurse file

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Attachment 2

OPTION YEAR DENIAL LETTER

Dear M    :

Your two-year agreement with the Office of Workers' Compensation Programs(OWCP) to provide direct services to injured workers has expired. We have determined that in the government's interest, OWCP will not exercise its option to refer additional cases to you.

To be selected during an option year, OWCP requires adherence to our standards as presented in the contract, compliance with our reporting requirements, and importantly, excellence in the quality of services provided. A review assessed your performance on work you have completed during the past year as well as cases that are now in progress. As a result of the review, OWCP will not renew your option for another year. Specifically, the decision is based on
-----------------------
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
You should now close all your open cases. To this end, you may contact each injured worker and active party (for instance the employing agency) once, by telephone for a brief call, notifying them that you will no longer be providing intervention services for OWCP. All materials pertinent to your cases should be forwarded to my attention as soon as possible.

Please acknowledge receipt of this notice.

Sincerely,


Staff Nurse

Region _______

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Attachment 3

OPTION YEAR RENEWAL LETTER

Dear M    :

The Office of Workers' Compensation Programs(OWCP) has reviewed your performance as a contract nurse providing services to injured workers who receive benefits under our program.

Your performance was assessed on work you have completed during the past twelve months, as well as on cases that are now in progress. Based on the overall quality of your performance, OWCP has determined to exercise its option to extend your agreement for another year, pending continuing good performance.

We appreciate your efforts on behalf of injured workers and your interest in our program.

Sincerely,


Staff Nurse
Region ____


cc: Contract Nurse File

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Attachment 4

CONTRACT FIELD NURSE EVALUATION FORM

Instructions: This evaluation form should be completed when the FN option year renewal is being considered. These factors should be graded equally and are based on a cumulative review of the FNs case outcomes and performance.

Did the FN:

Yes  No

1. Respond timely to the request for case Referral?

2. Communicate timely & effectively with IW, AP EA,
SN,CE and other parties?

3. Identify problems which could affect the RTW
promptly and accurately?

4. Offer good problem solving techniques and/or viable
recommendations to OWCP?

5. Only make commitments based on the written approval
and authorization of FEC staff (CE,SN)?

6. Provide and coordinate necessary services (e.g. 2
option examinations) without delay?

7. Follow the directions of the SN and CE?

8. Submit reports and bills timely and accurately?

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OWCP BULLETIN NO. 97-05

Issue Date: March 19, 1997


Expiration Date: March 18, 1998


Subject: Management Review of Vocational Rehabilitation

Background: Each OWCP Regional Director is required to supplement the OWCP accountability review process with an internal management review of vocational rehabilitation quality in any year in which there is no national review. The rehabilitation review is modeled on the national office accountability review, and uses the same standards and sampling techniques to examine Longshore and FECA cases. The results in summary form must be submitted to the National Office, Division of Planning, Policy and Standards.

Purpose: To revise and reissue procedural requirements for conducting management review of the vocational rehabilitation program in OWCP district offices.

Applicability: Regional Directors, District Directors for FECA and LHWCA Rehabilitation Specialists, and their supervisors in each FECA and Longshore district office.

Action:

1. A management review of the district office rehabilitation program will be conducted, usually bi-annually by randomly sampling vocational rehabilitation cases. A review should be done one year after the National Office review in each program, and at annual intervals until the next National Office review.

2. The timeliness and quality of rehabilitation services, equitable use of available counselors, and quality of management of counselors by the RS will be measured using standards 4a-e of the FECA accountability review manual. (the same standards are used for both FECA and Longshore reviews by the National Office, except that reference to Quality Case Management and loss of earning capacity are deleted from the Longshore standards).

3. Worksheets for each management review item are attached and should be copied in sufficient numbers for the sample to be reviewed.

4. The size of the universe of cases for a particular item and the sample size which is adequate for a statistically valid sample should be determined from the attachments. The most recent month's automated reports, RH-1, RH-7, LS-1 and RTS reports should be used according to the instructions in the attachment. If the office has more than one RS, each RS's work is sampled in proportion to his or her share of the workload (however it is not necessary to pull a statistically valid sample for each RS). A counselor Referral Log must be run from the RTS to review standard 8c.

5. The reviewer should prepare a summary report for the District Director and Regional Director which includes, for each standard, the size of the universe of cases, the statistically valid sample size, the number of cases reviewed, the error rate, and a discussion of the types of errors and other significant findings noted. A copy of the report should be submitted to the Director, Division of Planning, Policy and Standards, Room S3522, Frances Perkins Building.

6. The designated reviewer should prepare by reading the OWCP Procedure Manual Part 3, particularly Chapters 3-201, 3-300, 3-400 and 3-700. Counselor certification guidelines (Red Book, revised December 1996) are an important supplement to this material. The Procedure Manual can be found in Folioviews; the current Red Book may be obtained by calling the Branch of Medical Standards and Rehabilitation, (202) 329-6808. Questions about the application of the standards can also be directed to the Branch.

7. Office management should address problems identified through appropriate corrective actions.

Disposition: Retain until expiration date.

 

DIANE B. SVENONIUS
Director, Division of
Planning, Policy and Standards

Distribution: List No. 6
(All Supervisors, Rehabilitation Specialists, Systems Managers and Technical Advisers).

Attachments: (1) Accountability Review Standards for FECA and Longshore, FY 1997; definitions of universe and sample with special instructions; (2)sample size chart; (3) worksheets.


OWCP BULLETIN NO. 97 - 5, Attachment 1.

Standard 4 a.

Is the RS following procedures for selecting and monitoring Rehabilitation Counselors (RCs)?

Standard: The RS follows procedures for selection, use, evaluation and termination of private RCs. The RS documents exceptions to geographic counselor rotation. The RS follows up with RCs when reports are not timely, RCs do not follow instructions or do not submit required documentation or when other violations of the contract occur. (Reference: OWCP Procedure Manual Chapters 3-600 and 3-700; OWCP Bulletin 92-3).

Special instructions:

Rotation is not reviewed by sampling, but from a list of case openings since the last review. A Counselor Referral Log should be printed for each RS to show for each zip code cluster the number of cases assigned to each counselor in that cluster. Each RC in the cluster should have received a roughly equal number of referrals. If referrals appear skewed, the RS should have documented exceptions to geographic referral in the "notes" section of the RTS or in the counselor files maintained in the office. Acceptable deviations for cases needing special skills or for counselors assigned by agency are covered in Rehabilitation PM Ch. 3-400.4 (b)(1) and 3-700.6.

Warnings and terminations can be reviewed in conjunction with item 4c, using the same sample. Warnings should be issued when there is a violation of one of the standards in the RC's agreement (Form OWCP-36, Exhibit 21, OWCP Rehabilitation PM 3-800, page 37). Reviewers should particularly note occasions when the RC did not comply with the RS's instructions; knowingly submitted incorrect bills; provided services beyond the authorization on OWCP-35, OWCP-16, or OWCP-24 without requesting and receiving additional authorization; failed to submit reports, tests, etc. on time; failed to notify the RS when the injured worker was uncooperative, and so on.

Standard 4 b

Does the RS direct the provision of services, including rehabilitation planning, and intervene to ensure that timely cost-effective services are provided to reemploy the injured worker? Does the RS or RC-S conduct the initial interview, explaining the responsibilities and essential points of the vocational rehabilitation program? Are vocational plans well-developed and reasonable? Does the RS keep parties informed of rehabilitation progress?

Standard: The RS gives appropriate guidance to the RC, responds to requests and recommendations, and intervenes when problems and delays occur. [FECA only: FECA Quality Case Management (QCM) referrals are opened promptly and managed in accordance with QCM procedures.] Planning is initiated immediately if the previous employer does not respond promptly to the RC. Testing by a qualified examiner, other than the RC or an associate of the RC's unless otherwise documented by the RS, is conducted immediately with specific recommendations from the examiner.

Approved plans are based on adequate evaluation of worker characteristics and job availability, have clear achievable goals, and are supported by required documentation. Training plans are requested when likely to significantly improve earning capacity or employability; (FECA only: Assisted Reemployment Plans are requested when they could reasonably be expected to improve the likelihood or quality of placements).

Time limits for Planning/Placement Previous Employer, Placement New Employer, Medical Rehabilitation and Interrupted Status are observed or reasonable extensions are granted in writing where justified. Individual Placement Plans are prepared for Placement, New Employer. OWCP-3s are used to keep parties informed of major events, and the CE is promptly advised when intervention is needed. (Reference: OWCP PM Chapters 3-201, and 3-400).

Source: Sample files opened for rehabilitation or active in rehabilitation during the preceding 12 months or since the last accountability review, whichever is less.

Special Instructions:

Universe and sample:

The universe is the total number of open cases for the RSs at the time of the most recently monthly RH-1 or LSRH-1. Add the number of cases on each RS's section of the report for which the status is N (Placement Previous Employer, No Other Services); W (Placement Previous Employer with Other Services; D (Plan Development); T (Training): P (Placement, New Employer); E (Employed); S (Self-Employment Program); and G (Assisted Reemployment Placement Program).

The sample size should be selected from the chart (Attachment 2) and halved. The resulting number should be divided into the universe number (N) to yield N. Every nth item should be selected from the RH-1 listing for the RSs of open cases to form half of the sample. (This will automatically yield a proportionate sample for each RS if their workloads are approximately equal. If not, the review should draw a proportionate share of the total sample from each listing. It is not necessary to draw a valid sample for each RS separately). An equal number, the other half of the sample, should be drawn from a "code I" report generated from RTS for the cohort which was last scored for QR&A.

Standard 4c

Does the case file contain a properly executed authorization covering time and cost for all services provided? Does the file contain executed authorizations for services not covered by the OWCP-35, including authorization above the RS level where required?

Standard: All services being provided are covered by the appropriate authorization (RS or above). Plans have appropriate justifications.

Source: Sample cases active in the last 12 months. Review OWCP-16s and 24s for appropriate signatures.

Special instructions:

Universe and Sample:

For FECA cases the universe consists of the number of cases with costs exceeding $8,000 on the most recent RH-7s for all of the RSs in the office. Although DD approval is only required when services are authorized which will bring total costs over $20,000 (not including the OWCP-35 authorization), the lower figure is used to identify cases in which expenses of this magnitude have been or should have been authorized, even thought they may not have been spent. Since the universe is generally small, it is often necessary to review a 100% sample; otherwise use the nth item technique described above.

For Longshore cases, examine the disbursement sheets maintained by the bill examiner who authorizes Longshore rehabilitation bills to identify cases in which authorizations reach or exceed $8,000. Consult the Branch of Medical Services and rehabilitation if assistance is needed.

Guidance:

All expenses in a rehabilitation case require prior authorization by the RS. Initially, this is in the form of OWCP-35, which authorizes RC services, including sub-contracted testing, up to $5,000 and two years. RC services beyond that, and any additional services such as tuition, vocational evaluation, and so on, must be authorized on OWCP-15 with OWCP-24 issued to the service vendor if the vendor is not the RC. If an authorization will bring the total dollar amount of authorized services to more than $20,000, that authorization and each additional $5,000 worth of authorizations require DD or designated approval.

A case would contain an error if for example:

DD approval is lacking on the OWCP-16 which brings total authorization $20,000 not including the original OWCP-35;

Services by the RC had exceeded the original $5,000 or two years and no OWCP-16 covering counselor services had been approved by the RS;

A school provided services and no OWCP-16 and OWCP-24 had been approved by the RS.

The RC may subcontract for testing under the initial OWCP-35 authority without preparing and submitting an OWCP-16.

If the case was previously opened and closed, only those costs occurring in the same or prior Fiscal year are counted in determining whether a higher level of authorization is needed.

Standard 4d

Are reemployment closures and closures without reemployment made in accordance with procedures? Are they documented in the case file and RTS?

Standard: Reemployment case closures meet the criteria for each type. Cases are properly documented in each case file and on the Rehabilitation Tracking System. Injured workers are followed in employment for sixty days before closure. (FECA ONLY: If an injured FEC worker was not placed the CE received appropriate documentation concerning refusal to participate or to accept employment or documentation of suitable jobs. Medical issues impeding rehabilitation are reviewed with the FECA CE). (Reference: OWCP Procedure Manual Chapter 3-400).

Source: Cases closed within the preceding 12 months (status 2, 4, 5, 7, V) are sampled for conformance with requirements.

Universe and sample:

The universe consists of the number of cases in status 2, 4, 7, V and 5 in the last year or since the last review. It may be necessary to use the two RH or LS reports to determine this, since the closures accumulate during the fiscal year and drop off the report at the end of September. The RTS Case Query Capability can be sued to produce a listing of closed cases within a six month period from each RS's PC. Combine the listing and sample consecutively from each.

Determine the sample size from Attachment 2, divide into the universe (N) to determine n and choose each nth item from the list(s). Use each RH-1 in turn so that the sample is drawn from each RS.

Code 7s (nurse service requirements) may be incorporated into the claims management review, depending on district office structure.

This portion of the review may identify cases for which wage-earning capacity determinations should have been performed but were not. If so, better procedures should be instituted for tracking and following up on Code 5 closures with two jobs identified.

See PM 3-400.16.

Note on Standard 4 e

Does the RS maintain current and complete records in the rehabilitation Tracking System?

Review of this standard is optional but recommended. The worksheets are designed to collect coding information without drawing a separate sample. The usefulness of the extensive RH and N/RTS management reports is wholly reliant on the accuracy of coding.

Standard: Case record information and plan status changes are entered into RTS within five working days of the event being recorded. Code I is entered when a plan for training, placement or medical rehabilitation is approved by the RS, as documented by referral to the FECA CE or notification to the counselor. Codes and dates are present and accurate for 90 percent of the sample.

Source: Sample N/RTS case status history, and compare with RH reports or with documents in case file.

Inaccurately coded "rehabilitations" could count as errors when selected under standard 4e as well as 4f.

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OWCP BULLETIN NO. 97-05, ATTACHMENT 2

ACCOUNTABILITY REVIEW SAMPLE SIZES:

If Universe <33 then Sample Size = Universe

If Universe >33 then Sample Size = 34

If Universe >199 then Sample Size = 35

If Universe >224 then Sample Size = 36

If Universe >249 then Sample Size = 37

If Universe >324 then Sample Size = 38

If Universe >399 then Sample Size = 39

If Universe >599 then Sample Size = 40

If Universe >799 then Sample Size = 41

If Universe >1499 then Sample Size = 42

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OWCP BULLETIN NO. 97-06

Pending

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