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The Federal Employees' Compensation Act provides workers' compensation coverage to
three million Federal and Postal workers around the world for employment-related
injuries and occupational diseases. Benefits include wage replacement, payment
for medical care, and where necessary, medical and vocational rehabilitation
assistance in returning to work. The program has 12 district offices nationwide.
The Division of Federal Employees' Compensation adjudicates new claims for benefits and manages
ongoing cases; pays medical expenses and compensation benefits to injured
workers and survivors; and helps injured employees return to work when they are
medically able to do so.
In FY 2006, 139,874 new cases were created. The program provided 264,000 workers and
survivors approximately $2.4 billion in benefits for work-related injuries or illnesses. Of
these benefit payments, over $1.6 billion was for wage-loss compensation, $668 million for medical
and rehabilitation services, and $129 million for death benefit payments to surviving dependents.
Prompt Adjudication. If you are an injured worker, you can expect timely
adjudication of your compensation claim:
- For traumatic injuries, this means a decision within 45 days of receipt in all but
the most complex cases.
- For simple occupational illness cases, a decision will be issued within 90 days of
receipt.
- For most occupational illness cases, which require more extensive evidentiary
development, a decision should be forthcoming within six months of receipt.
- For very complex occupational illness cases, a decision should be rendered within 10
months of receipt.
Prompt Payment of Medical Bills. Medical bills, whether submitted directly by the
providers or as reimbursement requests by injured workers, are usually processed
within 28 days of receipt. For any bill which is not payable, an Explanation of
Benefits describing the reason for non-payment is issued to the party who
submitted the bill.
Prompt Payment of Compensation. Injured workers can also expect prompt payment of
claims for wage loss in accepted cases. Where medical evidence supports
disability for work, compensation payments are usually made within 14 days of
submittal to the district office by the employing agency.
Assistance in Returning to Work. The Federal Employees' Compensation Act gives injured
workers the right to reclaim their Federal jobs within one year of the onset of
wage loss. We will do everything we can to help employees return to work during
that time period, and, if necessary, beyond. Injured workers and employing
agencies can expect timely case management services, which include the
following:
- Assignment of a registered nurse if the injured employee cannot return to work soon after
the injury. The nurse ensures that appropriate medical care is provided and
assists the worker in returning to employment.
- Referral to a medical specialist for a second opinion examination where required by the
worker's medical condition or the program's need for additional medical
information.
- Referral for vocational rehabilitation services if the employee is unable to return to
work at the employing agency or in his or her previous job category.
Employing agencies are responsible for reimbursing the Division of Federal Employees'
Compensation for their workers' compensation expenses. This reimbursement occurs
once each year through the chargeback process.
The administrative cost of the services provided by the Division of Federal
Employees' Compensation is very low. Overhead is just 4% of benefits, and
Federal workers' compensation costs are only 1.8% of total Federal and Postal
payrolls, compared to 2.3% for private insurance and state funds.
Also, because disputes in claims under the Federal Employees' Compensation Act are
resolved administratively, the Federal government avoids time-consuming and
expensive litigation, which in some non-Federal workers' compensation systems
can account for as much as 46% of payout.
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