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CHAPTER 2-300 - SCREENING

1. Purpose and Scope. This Chapter describes the procedures for screening cases on a daily basis and establishing priorities of case files in order to achieve maximum efficiency in the processing of claims under the LHWCA. It defines the categories of cases, and the supporting documentation that must be identified at the earliest date and timely acquired by the Claims Examiner (CE) or Claims Examiner Clerk (CEC) for effective primary and secondary reviews as prescribed in PM 2-200 and 3-300.

2. Policy. A CE or CEC should schedule duty time in such a manner as to be able to handle not only the routine type cases which require very little action or attention, but also cases of a more complicated nature.

3. Categories of Cases. The principal categories of cases are as follows:

a. No-Lost-Time (NLT) Reports. The 1984 Amendments removed the requirement for ECs to report injuries which did not result in loss of one or more shifts of work. It is DLHWC policy that these injuries are not to be jacketed into case files. (See PM 1-400.) However, Industry Notice No. 63, May 8, 1987, notified ECs that injuries compensable under the schedule contained in sections 8(c)(1)-(20) of the Act would be jacketed even though the injury did not result in loss of one or more shifts of work. Therefore, most of the no-lost-time injury reports received will be reviewed by the mail and records personnel and discarded before jacketing, obviating initial review by the CE. The remaining no-lost-time cases fall into the next category of cases.

b. Compensable NLT Cases. In this category are cases involving schedule awards, disfigurements, third party action, or Notices of Controversion (Form LS-207, Exhibit 20, PM 10-200). Such cases may require requests for additional documents or reports. Usually, they can be processed in a very few minutes and can be placed in either the first or second stack explained in subparagraph 4a, below.

c. Lost-Time (LT) Uncontested Cases. These cases involve an injury which results in loss of time from work beyond the day or shift of injury and extending for more than three days. The EC must make payments periodically, promptly, and directly to the injured employee or survivors entitled to such benefits under the LHWCA (20 C.F.R. section 702.231). These cases may be satisfied by payments with or without a formal award. In certain instances, awards are paid as agreed settlements, (20 C.F.R. sections 702.241-243). These cases could be placed in either the third or fourth stack of cases mentioned in subparagraph 4a, below.

d. LT Contested Cases. These are cases where either the EC or the claimant/representative contests any action on a claim deriving from the injury or death of the employee under the LHWCA. It may consist of an ECs controversion of the right to compensation (20 C.F.R. section 702.251) or the claimant's contest of actions taken by the EC with respect to the claim (20 C.F.R. section 702.261). Such cases would be placed in the fourth stack of cases mentioned in subparagraph 4a, below.

e. Death Cases. These cases involve death benefits payable to the employee's survivors, covered by the LHWCA. For more detailed information on benefits and case determinations, see PM 2-202 and 3-302. Such cases would be placed in the third or fourth stack of cases (depending upon the degree of controversy) mentioned in subparagraph 4a, below.

f. Other Cases. These could be generally categorized as indicated in subparagraphs 3c, 3d, or 3e, but involve special issues and more complex evaluation/adjudication procedures as covered in PM 2-600, 3-302, 3-400, 3-500, 3-700, 4-200, 4-300, 4-500, 6-201, 6-202. Such cases would be placed in the fourth stack of cases mentioned in subparagraph 4a, below.

4. Screening. This is the process of inspecting and sorting the case files delivered to the CE's desk each day.

a. Organization for Screening. Under normal conditions, the CE inspects the case files by arranging three or four stacks of cases as follows:

(1) Stack 1 (Not Critical or Complicated) -- Contains those cases involving no complications, which can be handled very quickly. Certain cases can be closed without further action and others may need only a call-up, awaiting receipt of additional documents prior to closing.

(2) Stack 2 (Information Required) -- Contains those cases in which the CE/CEC will need to take a specific action, but of such a nature that it will not require significant amounts of time. Example would be the preparation and dispatch of letters requesting a medical report, wage data, clarification of jurisdictional questions, etc.

(3) Stack 3 (Evaluation Required) -- Contains cases that require some study to determine the issues, action to resolve them, and possibly the preparation of correspondence to obtain data that is critical to resolution of the controversy. These cases can consume more time and may require the CE to consult with the DD.

(4) Stack 4 (Further Study) -- Contains those cases of a more complicated nature. They require intensive study, perhaps research, and in most instances, consultation with the DD. These may include cases being processed for adjudication by informal conferences or final disposition (e.g., issuance of compensation order, payment of legal fee, approval of section 8(i) settlements, section 8(f) applications etc.).

b. Workload Scheduling. After arranging the incoming cases as in subparagraph 4a, the CE needs to estimate the amount of time required for processing each stack. The determination of the sequence for working each stack may be made by the individual CE; however, sufficient time should be set aside to allow for completion of work on each stack.

(1) Routine Cases. Since the majority of cases usually fall in Stack 1, many examiners consider it more advantageous to work that stack initially to complete and remove from the desk the greatest number of cases in the shortest period of time.

(2) Other Cases. Usually, the greatest portion of the work day is devoted to processing of the more complicated and time-consuming cases, placed in stacks 3 and 4. (See PM 2-201.3 and 3-301.3 for in-depth review procedures.)

c. Priorities of Cases and Documentation. Each case file arranged for screening as described in subparagraph 4a, is inspected for the essential documents and/or information which has not yet been seen by any CE. The presence of such documents may elicit a variety of possible responses. By organizing the files and documents involved in this screening system, the CE/CEC is able to review and process those cases with the greatest urgency and establish a priority category for all cases each time they are reviewed. This system consists of the following categories, in order of priority:

(1) Documents pertaining to cases where payment of compensation has been stopped prematurely or contrary to regulations.

(2) Documents pertaining to a death case (e.g., Claim for Death Benefits, Form LS-262, Exhibit 32, PM 10-200 and claimant's SSN).

(3) Requests for issuance of a Compensation Order and Proof of Service.

(4) Documents pertaining to a claim, the validity of which is being controverted.

(5) Medical Reports (Forms LS-1, and LS-204, Exhibits 1 and 18, PM 10-200 or other applicable documents) where full or maximum medical recovery from the reported injury is indicated, i.e., final medical reports.

(6) Form LS-208, Notice of Final Payment or Suspension of Compensation Payments (Exhibit 21, PM 10-200).

(7) Applications for section 8(f) relief.

(8) Form LS-206, Payment of Compensation Without Award (Exhibit 19, PM 10-200).

(9) Form LS-203, Employee's Claim for Compensation (Exhibit 17, PM 10-200) or other formal claim for compensation.

(10) Form LS-202, Employer's First Report of Accident or Occupational Illness and/or Form LS-201, Notice of Employee's Injury or Death (Exhibits 16 and 15, PM 10-200), and/or other injury reports.

(11) Form LS-222, Carrier's or Self-Insurer's Report on Rehabilitation (Exhibit 26, PM 10-200). (See PM 3-301.3g and OWCP Rehabilitation Procedure Manual.)

(12) Other documents or information received, not included in any of the above categories, will be reviewed and assigned appropriate priority by the CE.