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Division of Federal Employees' Compensation (DFEC)

FECA Bulletins (2006-2010)

FECA Bulletins have been divided into five-year groups to make it easier for you to search and find the information you are looking for.

Table of Contents

 


Fiscal Year 2010

FECA Bulletin No. 10-01

Compensation Pay: Compensation Rate Changes Effective January 2010

FECA Bulletin No. 10-02

Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2010

FECA Bulletin No. 10-03

Processing claims for Death Gratuity benefits for deaths covered under section 8102(a) of the Federal Employees' Compensation Act (FECA)

FECA Bulletin No. 10-04

COP (Continuation of Pay) Nurse Intervention Process Updates

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Fiscal Year 2009

FECA Bulletin No. 09-01

Compensation Pay: Compensation Rate Changes Effective January 2009

FECA Bulletin No. 09-02

Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2009

FECA Bulletin No. 09-03

Permanent Impairment/Schedule Awards: Sixth Edition of the AMA Guides to the Evaluation of Permanent Impairment

FECA Bulletin No. 09-04

Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment

FECA Bulletin No. 09-05

United States Postal Service National Reassessment Program Guidance

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Fiscal Year 2008

FECA Bulletin No. 08-01

Compensation Pay - Compensation Rate Changes Effective January 2008

FECA Bulletin No. 08-02

Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2008

FECA Bulletin No. 08-03

Compensation Payment – Segregation of Duties for Change of Address in the Integrated Federal Employees' Compensation System (iFECS)

FECA Bulletin No. 08-04

Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment

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Fiscal Year 2007

FECA Bulletin No. 07-01

Periodic Entitlement Review Management (PER) – Use of iFECS Application

FECA Bulletin No. 07-02

Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment

FECA Bulletin No. 07-03

Compensation Pay - Compensation Rate Changes Effective January 2007

FECA Bulletin No. 07-04

Comp Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2007

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Fiscal Year 2006

FECA Bulletin No. 06-01

Compensation Pay - Compensation Rate Changes Effective January 2006

FECA Bulletin No. 06-02

Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Vehicles Necessary to Secure Medical Examination and treatment

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FECA BULLETIN NO. 10-01

Issue Date: January 29, 2010

 


Expiration Date: January 1, 2011


Subject: Compensation Pay: Compensation Rate Changes Effective January 2010.

Background: On December 23, 2009, the President signed Executive Order 13525 implementing a salary increase of 1.50 percent in the General Schedule basic pay. The applicability under 5 U.S.C. 8112 only includes the 1.50 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment became effective at the start of the first full pay period after January 1, 2010.

Purpose: To inform the appropriate personnel of the increased minimum/maximum rates of compensation and the adjustment procedures for affected cases on the periodic disability and death payrolls.

The new rates were effective with the first compensation payroll period beginning on or after January 1, 2010. Thus, for daily roll supplemental payments January 3, 2010 is the specific effective date of the increase. The effective date for the increase of periodic and death roll payments will be January 17, 2010. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, step 10, which is now $129,517 per annum. The basis for the minimum compensation rate is the salary of a GS-2, Step 1 which is $20,017 per annum.

The minimum increase specified in this Bulletin is applicable to employees of the U.S. Postal Service.

The effect on 5 U.S.C. 8112 is to increase the payment of compensation for disability claims to:

Effective January 3, 2010

Minimum

Maximum

 

Weekly
Daily (5-day week)

$288.71
57.74

$1,868.03
373.61

 
       

Effective January 3, 2010

Minimum

Maximum

 

28-Day Cycle

$1,154.83

$7,472.13

 

The effect on 5 U.S.C. 8133(e) is to increase the monthly pay on which compensation for death is computed to:

Effective January 3, 2010

Minimum

Maximum

 

Monthly

$1,668.08

$8,094.81

 

Applicability: Appropriate National and District Office personnel

Reference: Memorandum for Executive Heads of Departments and Agencies dated December 23, 2009, and the attachment for the 2010 General Schedule.

Action: The Integrated Federal Employees' Compensation System (iFECS) will update the periodic disability and death payrolls. It should be noted that this adjustment process re-calculates EVERY compensation record from its very beginning to current date. Thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect.

Any cases keyed as "Gross Overrides without CPI" in iFECS will not have a supplemental record or make a separate calculation of additional entitlement. Thus, these gross override cases must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required and the case record documented. A notice should be sent to the payee by the District Office, detailing the change in the rate of compensation. All cases keyed as "Gross Overrides with CPI" will be adjusted in the usual manner.

1. Adjustments Dates.

a. As the effective date of the adjustment was January 17, 2010 for the periodic disability and death rolls, there was no supplemental payroll needed. The February 13, 2010 death and disability payments will include any necessary minimum/maximum compensation adjustments.

b. The new minimum/maximum compensation rates were available in iFECS on January 25, 2010.

2. Adjustment of Daily Roll Payments. The salary adjustments are not retroactive, so it is assumed that all Federal agencies have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2010. Therefore, it is not necessary to review any of these payments.

However, if an inquiry is received then verification of the pay rate must be secured from the employing agency, and the necessary adjustment applied.

Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2 – Folioviews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA BULLETIN NO. 10-02

Issue Date: January 29, 2010

 


Expiration Date: February 28, 2011


Subject: Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2010.

Purpose: To furnish information on the CPI adjustment process for March 1, 2010.

The cost of living adjustments granted to a compensation recipient under the FECA are based on the "Consumer Price Index for Urban Wage Earners and Clerical Workers" (CPI-W) figures published by the Bureau of Labor Statistics (BLS). The annual cost of living increase is calculated by comparing the base month from the prior year to the base month of the current year, with the percentage of increase adjusted to the nearest one-tenth of 1 percent, determining the amount of the CPI increase granted to claimants. 5 U.S.C. 8146(a) establishes the base month for the FECA CPI as December.

December 2008 had a CPI-W level of 204.813 and the December 2009 level was reported by BLS as 211.703. This means that the new CPI increase, adjusted to the nearest one-tenth of one percent, is 3.4 percent. The increase is effective March 1, 2010, and is applicable where disability or death occurred before March 1, 2009. In addition, the new base month for calculating the future CPI is December 2009.

The maximum compensation rates, which must not be exceeded, are as follows:

$8,094.81
7,472.13
1,868.03
373.61

per month
each four weeks
per week
per day (for a 5 day week)

Applicability: Appropriate National Office and District Office personnel.

Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981; Bureau of Labor Statistics Consumer Price Index Publication for December 2009 (USDL-10-0011)

Action: National Office Production staff will update the iFECS CPI tables and have all payment records re-calculated when the iFECS system is not in use by District Office personnel. This will occur on or about March 1, 2010. The March 13, 2010 check will include the supplemental CPI payment for the period of March 1st to March 13th. The following periodic roll check will reflect the updated 28-day amount. Please note that if there are any cases with fixed gross overrides, there will be no supplemental record created. These cases must be reviewed to determine if CPI adjustments are necessary, and if so a manual calculation will be required. If the gross override payment is in fact eligible for annual CPI increases, the payment plate should be adjusted in the iFECS system to pay as a "Gross Override with CPI."

1. CPI Minimum and Maximum Adjustments Listings. Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated to indicate the increase for 2010. Attached to this directive is a complete list of all the CPI increases and effective dates since October 1, 1966 through March 1, 2010, for reference.

2. Forms.

a. All claimants will be provided a notice with their Benefit Statements, indicating the amount of this year's increase. The Treasury will include this notice as a "stuffer card" with every Benefit Statement issued for the March 13, 2010 rolls.

b. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc.), please continue to provide this data in letter form from the district office. Many times a Benefit Statement may not reach the addressee and regeneration of the form is not possible. A letter indicating the amount of compensation paid every four weeks will be an adequate substitute for this purpose.

Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

 

Attachment

Distribution: List No. 2 --Folioviews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, and Rehabilitation Specialists)

COST-OF-LIVING ADJUSTMENTS
Under 5 USC 8146(a)

EFFECTIVE DATE

RATE

EFFECTIVE DATE

RATE

10/01/66
01/01/68
12/01/68
09/01/69
06/01/70
03/01/71
05/01/72
06/01/73
01/01/74
07/01/74
11/01/74
06/01/75
01/01/76
11/01/76
07/01/77
05/01/78
11/01/78
05/01/79
10/01/79
04/01/80
09/01/80
03/01/81
03/01/82
03/01/83
03/01/84
03/01/85
03/01/86

12.5%
3.7%
4.0%
4.4%
4.4%
4.0%
3.9%
4.8%
5.2%
5.3%
6.3%
4.1%
4.4%
4.2%
4.9%
5.3%
4.9%
5.5%
5.6%
7.2%
4.0%
3.6%
8.7%
3.9%
3.3%
3.5%
N/A

03/01/87
03/01/88
03/01/89
03/01/90
03/01/91
03/01/92
03/01/93
03/01/94
03/01/94
03/01/95
03/01/96
03/01/97
03/01/98
03/01/99
03/01/00
03/01/01
03/01/02
03/01/03
03/01/04
03/01/05
03/01/06
03/01/07
03/01/08
03/01/09
03/01/10

0.7%
4.5%
4.4%
4.5%
6.1%
2.8%
2.9%
2.5%
2.5%
2.7%
2.5%
3.3%
1.5%
1.6%
2.8%
3.3%
1.3%
2.4%
1.6%
3.4%
3.5%
2.4%
4.3%
0.0%
3.4%

Prior to September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).

Prior to 09/07/74

.08-.34 = .23
.35-.57 = .46
.58-.80 = .69
.81-.07 = .92

Eff. 11/01/74

.13-.37 = .25
.38-.62 = .50
.63-.87 = .75
.88-.12 = 1.00

ATTACHMENT TO FECA BULLETIN NO. 10 - 02

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FECA BULLETIN NO. 10-03

Issue Date: February 26, 2010

 


Expiration Date: February 26, 2011


Subject: Processing claims for Death Gratuity benefits for deaths covered under section 8102(a) of the Federal Employees' Compensation Act (FECA).

Background: The National Defense Authorization Act for Fiscal Year 2008, Public Law 110-181, was enacted on January 28, 2008. Section 1105 of P.L. 110-181 amended the FECA, creating a new section 8102(a). The section establishes a new FECA benefit for eligible survivors of federal employees and Non-Appropriated Fund Instrumentality (NAFI) employees who die of injuries incurred in connection with service with an Armed Force in a contingency operation. The new section 8102(a) states that the United States will pay a death gratuity of up to $100,000 to those survivors upon receiving official notification of the employee's death.

Section 8102(a) states that the United States will pay the death gratuity to the eligible survivors "immediately upon receiving official notification" of an employee's death. The section also contains a retroactive payment provision, stating that the death gratuity will be paid for employees of certain agencies who died on or after October 7, 2001, due to injuries incurred in connection with service with an Armed Force in the theater of operations of Operation Enduring Freedom and Operation Iraqi Freedom.

Purpose: To provide guidance on processing claims filed under section 8102(a) of the Act.

References: Title 5 U.S.C. 8102(a); 20 C.F.R. Part 10.900 - 10.916 (Interim Final Rule and Final Rule); CA-40, (Beneficiary Designation); CA-41, (Claim for Benefits); and CA-42, (Agency's Official Notice of Employee's Death).

Applicability: All National Office staff and District Office claims personnel.

Actions:

1. All claims for benefits under 8102(a) will be processed by the Special Claims Unit in the Cleveland District Office. As a result, all claims for a death gratuity are to be transferred to Cleveland immediately upon receipt. Once received in Cleveland, these cases will be assigned a specific claim number series beginning with DG. A DG claim number will be assigned to each person making the claim. That means that more than one DG claim could be created as the result of one death. This also means that if a claim for a death gratuity is made in an existing FECA case, a new DG claim will be assigned to the death gratuity - distinct from the existing FECA case. If more than one DG claim is filed as the result of one death, the associated DG cases will be cross referenced in the case file; however, the reference will only be to the other DG case numbers (without names or any other personally identifiable information) and to the decedent. The statute states that the United States will make payment to eligible survivors "immediately upon receiving official notification" of an employee's death.

2. Three new forms were created for processing these claims: the CA-40, Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a); the CA-41, Claim for Survivor Benefits Under the Federal Employees' Compensation Act Section 8102a Death Gratuity; and the CA-42, Official Notice of Employees' Death for Purposes of FECA Section 8102a Death Gratuity.

3. There are two ways to initiate a death gratuity claim. The employing agency may initiate the process by filing form CA-42 (Official Notice of Employee's Death), or a claimant may initiate the process by filing a claim with the OWCP using form CA-41 (Claim for Survivor Benefits). Each claimant who wishes to claim survivor benefits must file form CA-41. Regardless of which party filed a form initiating the process, forms from the agency and all claimants must be filed with the OWCP. Additionally, the employing agency must submit form CA-40, the designation form completed by the employee prior to death, if such form exists. See section 10.911 of the regulations for further details.

4. In addition to the claim forms needed to initiate the death gratuity payment process, the OWCP must ensure that the employing agency provides as much information as possible about any living survivors or alternate beneficiaries. When this information is received from the agency, the OWCP will attempt to contact any living survivors or alternate beneficiaries and provide them with the CA-41 with instructions on how to file a claim, as provided in section 10.911 of the regulations. Additional documentation (such as marriage certificates and death certificates) will be required and should be requested from the claimant if not submitted with the CA-41 or CA-42.

5. Once the claim forms and supplemental documentation are received, the OWCP will review the claim and make a determination on whether the criteria for payment are established. The claimant bears the ultimate burden in the submission of proof of eligibility, but the employing agency and the OWCP will assist in gathering documentation. The claim and accompanying documentation must be evaluated for timeliness, employee status of the decedent, fact of injury, performance of duty [including death due to a war risk hazard under 8102(b)], and causal relationship just as in other FECA claims. In addition, the evidence must be reviewed in order to determine whether the fatal injury or illness occurred "in connection with the employee's service with an Armed Force in a contingency operation." Examples are provided in section 10.912 of the regulations.

6. Section 8102(a) contains a provision for retroactive payment which allowed the employing agency the option of applying this gratuity to deaths that occurred on or after October 7, 2001 if the death resulted from injuries incurred in connection with an employee's service with an Armed Force in the theater of operations of Operation Enduring Freedom or Operation Iraqi Freedom. As no employing agency chose to opt out of this retroactivity provision during the regulatory process, claims that meet all other eligibility criteria may be paid. When reviewing these claims for a determination on timely filing, note that time cannot begin to run until the Interim Final Rules for filing were published on August 18, 2009, as noted in section 10.912 of the regulations.

7. If the evidence establishes that the employee's death falls within the scope of coverage, taking into account all of the factors listed above, then the OWCP will calculate and distribute the death gratuity. By regulation, the OWCP has determined, for equitable reasons, that every death gratuity will be paid in the amount of $100,000, minus the amount of any death gratuity payments that have been paid under any other law of the United States based on that same death.

8. Please note that the FECA death benefits payable under section 8133 of the Act do not constitute a dual benefit and are not, therefore, deducted from the $100,000 payment made under section 8102(a).

a. All federally paid death gratuities paid at the time that the OWCP dispenses the FECA death gratuity must be deducted to offset the amount available for payment. The employing agency is required to provide information about other death gratuities. For example, if the $10,000 death gratuity benefit payable under Public Law 104-208 (which authorizes payment of up to $10,000 to survivors of employees who died in the line of duty on or after August 2, 1990) has been paid, it constitutes a dual benefit that must be offset and only $90,000 of the FECA death gratuity may be paid. As certain agencies have death gratuities that pay a full year's salary, there will be instances where no FECA death gratuity is payable. See section 10.916 of the regulations for further information.

b. If the information of record indicates that there may be a death gratuity benefit which has been paid for the same death, that death gratuity benefit amount will need to be deducted from the $100,000 payable under 8102(a) of the FECA. The OWCP should request information from the agency in writing about any such payment and request a response within 20 days. (The employing agency is also required to provide information about any other death gratuity benefits on the DG forms.) When all other development has been completed, the OWCP will notify the agency in writing that payment will be made 14 days from the date of the OWCP's letter based on the evidence of record and payments made on that date. As the statute and regulations anticipate expeditious processing of all FECA death gratuity claims, offset can only be applied for other death gratuity payments that have been made. If no further information is received, the OWCP will proceed with payment of the $100,000. If an agency pays a death gratuity subsequent to the OWCP's issuance of payment of the FECA death gratuity, such a payment does not create an overpayment of FECA compensation.

9. The order of precedence is set forth in section 10.907 of the regulations as follows:

(a) Employee's surviving spouse;
(b) Employee's children, in equal shares;
(c) Employee's parents and siblings or any combination of them if designated by the employee pursuant to designation procedures; OR
(d) Employee's parents, in equal shares; and THEN
(e) Employee's brothers and sisters, in equal shares

10. In addition to the survivors defined above, an employee can designate an alternate beneficiary or beneficiaries to receive up to 50 percent of the death gratuity, as described in section 10.908 of the regulations. The alternate beneficiary can be any person and is separate from the order of precedence set forth above. In order for the alternate beneficiary provision to be effective, the employee must have completed Form CA-40 with the alternate beneficiary designation fully and completely prior to death and the employing agency must have completed their portion of the form. (See regulations for changes in the order of precedence.)

11. Once the apportionment has been established and payments made to the eligible survivors, a letter should be sent to each beneficiary with an explanation of the benefits they are receiving. Where benefits are denied or the beneficiary disagrees with an OWCP determination, a formal decision with appeal rights should make findings of fact and explain the reason for the denial. Consult the National Office as questions arise.

12. Definitions (refer to sections 10.900, 10.901 and 10.906 of the regulations for more detailed definitions):

Armed Forces - We have adopted the same definition of "Armed Forces" as found in 10 U.S.C. 101(a)(4): Army, Navy, Air Force, Marine Corps and Coast Guard. Contingency Operation - The first part of this definition is a "military operation that is designated by the Secretary of Defense as an operation in which members of the Armed Forces are or may become involved in military actions, operations, or hostilities against an enemy of the United States or against an opposing military force." The second part of this definition includes any "military operation that results in the call or order to active duty members of the uniformed services during a war or national emergency declared by the President or Congress." Note that this includes humanitarian and peacekeeping operations. Employee - In addition to the definition found in section 8101 of the FECA, NAFI employees are covered under the new death gratuity. Beneficiaries - The statutory definitions of survivors in the new section 8102(a) differ from the existing definitions of the same terms in FECA at 5 U.S.C. 8101. A surviving spouse is defined as "the person who was legally married to the deceased employee at the time of his or her death." The definition of children includes all of the employee's natural children, adopted children, and some stepchildren without regard to age, marital status, or dependency on the employee. Parent includes parents through adoption and persons who stood in loco parentis in accordance with regulatory requirements. The employee's brothers and sisters as well as half-siblings and siblings through adoption are survivors. Step-siblings are not included.

Disposition: Retain until incorporated into the FECA Procedure Manual.

 

DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation

Distribution: List No. 1--Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA BULLETIN NO. 10-04

Issue Date: September 10, 2010

 


Subject: COP (Continuation of Pay) Nurse Intervention Process Updates.

Background: OWCP has been using COP Nurses (CNs) during the 45-day COP period for many years, but the CN process is being updated to allow quicker assignment and more efficient follow up to aid in more effective disability management. The revised CN processing guidelines have new components for the Staff Nurse (SN), Claims Examiner (CE) and CN. Several updates have been made in iFECS to facilitate these changes, effective with the iFECS release in September, 2010.

Purpose: To provide guidance to claims staff, Employing Agencies (EA) and SNs on the revised COP Nurse Intervention Process.

Applicability: All National Office staff and District Office claims personnel, Staff Nurses and Rehabilitation Specialists.

Actions:

1. Assignment of a CN. CNs will be assigned earlier and have a more proactive, in-depth role during the COP period. Beginning with the iFECS release in September, 2010, all cases will be eligible for automatic assignment 7 days after the claimant stops work. This information is taken from the data contained on the CA-1. (Currently, a case does not automatically become eligible for a COP nurse assignment unless the claimant has stopped work for at least 15 days and has not returned to work.) The case will actually show up for assignment by the SN on day 8. Once assigned, the EA will be able to see in the Agency Query System (AQS) that a CN has been assigned. Once the CN's case is closed, the EA will be able to see that closure status and date.

Note: If a return to work date has been entered into iFECS prior to the data run on the night of day 7, the case will not be eligible for assignment of a CN.

2. Reporting a Return to Work (RTW). If the claimant returns to work, the EA can report this to OWCP in one of two ways, via electronic CA-3 or phone call. The electronic CA-3 is the preferred method.

Electronic CA-3 – A CA-3 reporting a claimant's RTW can be submitted electronically to OWCP. Upon receipt of a CA-3 reporting a RTW, the case will be flagged until the CA-3 is reviewed and the RTW date is approved or rejected as being accurate.

Phone Call - If a claimant returns to work after the CA-1 has already been submitted, but prior to assignment of a CN, the EA can call the appropriate district office to report the RTW if the EA is unable to transmit an electronic CA-3. The person taking the call at the district office should immediately update the RTW field on the Work Status tab in the Case Maintenance application in iFECS so that a COP nurse is not assigned. A report of the telephone call (CA-110) should be created and placed into the imaged case file; however, a telephone message should not be sent to the CE for action at a later date since the information needs to be entered on the day it is received.

3. Recording a RTW date in iFECS. The Case Maintenance application in iFECS has a RTW field on the Work Status tab as noted above. A new RTW section has also been added to this tab, titled CA3/COP RTW. This new section will record a RTW date taken from the submission of an electronic CA-3 during the COP period. The CA-3 status though will be blank, and the CA-3 RTW date is considered pending until reviewed by the CE (or any claims personnel) or the SN. Once the CA-3 has been reviewed, and the date has been approved as accurate or rejected, the user ID of the person who made the decision will appear, along with the updated status (Approve or Reject).

a) A user can make this decision directly in the Case Maintenance application by clicking the box for either Approve or Reject, or while indexing the CA-3 as described below.

b) If an electronic CA-3 is submitted from an EA, it will show up in the CE's unreviewed mail. If the CA-3 is submitted during the COP period, a new workflow will be triggered during the indexing process. While indexing this document, the CE will be presented with a new dialog box. The dialog box will present the CE with three options: Approve, Reject or Postpone. The CE has to make a selection between these three options before moving on. If while indexing that CA-3, the CA-3 RTW date has already been approved or rejected by someone else, the CE gets no prompt and will index the document in the usual manner.

Approve – The CE will click this option if everything on the CA-3 looks accurate and there are no obvious problems with the RTW date provided. If the RTW date is approved, it will be recorded in Case Maintenance, without the actual application opening.

Reject – The CE will click this option if the information on the form seems to be incorrect, e.g. there is a RTW date listed, but the EA indicates in the comment field that the claimant was scheduled to return on that date but did not do so. If the CA-3 RTW date is rejected, it will be recorded in Case Maintenance, without the actual application opening.

Postpone – The CE will click this option if the choice is not clear and the CA-3 needs to be reviewed more carefully to make a determination. The CE may need to review the case documents and/or make a call to the EA before approving or rejecting the date. If the CE chooses Postpone, no change will take place in Case Maintenance and the case will remain flagged in the system awaiting a decision on the CA-3 RTW date. The CA-3 RTW date will remain pending in Case Maintenance. When the CE does make a decision on the CA-3 RTW date at a later time, the CE will have to choose the Approve or Reject option in Case Maintenance.

c) While a decision on the CA-3 is pending, the case is flagged as ineligible for CN assignment. The SN will see a flag next to the case in the COP Nurse Assignment screen in iFECS. The SN may at that time review the CA-3 and approve or reject the RTW date, or the SN may wait for the CE or other claims personnel to make that decision. (This process may vary by district office or staff availability.) If the RTW date is approved, the case will no longer be eligible for assignment to a CN. If the RTW date is rejected, the flag in the COP Nurse Assignment screen will disappear, making the case eligible for assignment to a CN.

4. COP Nurse Actions. The CN will be using a new application in iFECS called COP Case Processing. He or she will also have "view only" access to the Imaging and Case Maintenance applications but will be able to enter information into the new COP Case Processing application.

Once assigned, the CN will see the new case requiring action, along with other open cases and cases requiring follow up action. He or she will update the record with all contact information, RTW dates, etc. in the COP Case Processing application. CNs will be expected to take the following actions and record the information in the activity log portion of COP Case Processing in iFECS:

a) Make contact with the claimant, EA, and attending physician's office or other medical providers as appropriate.

b) From the claimant, obtain a brief history of injury, history of treatment and current work status, as well as attending physician contact information.

c) From the EA, confirm work status and find out if light duty is available.

d) From the attending physician's office, obtain verbal history of treatment and expected treatment plan, and provide OWCP's mailing address for submission of reports and ACS contact information to be used should the claim be approved. The CN should also advise whether job accommodations can be made based on the contact with the EA, and, if appropriate, provide a form CA-20, Attending Physician's Report, requesting that it be completed and submitted to OWCP.

e) The CN should also make recommendations about assignment of a Field Nurse (FN).

Both the CE and the SN will be able to see the actions taken by the CN at any time during the period of assignment by clicking on a new COP Activity Log icon in Case Maintenance.

Once the CN has obtained the required information, the case will be submitted for approval to the SN. It will then be considered a "pending closure" and will be placed into a queue for review by the SN. After the SN reviews the Activity Log, the SN will approve or reject the closure. If the closure is rejected, e.g. information is missing, the case is returned for review by the CN. If the SN approves the closure, the CN's bill is automatically sent for processing and the COP Nurse Closure report is automatically generated. The SN will then electronically image the COP Nurse Closure report into the case file.

If a CA-3 with a RTW is received during this period, the COP Nurse case will be locked and the CN can not make further entries into the COP Activity Log. If the CA-3 RTW date is approved as accurate, the case will be closed (whether the CN has taken any actions or not). If the CA-3 RTW date is rejected, the case will be unlocked and the CN can proceed.

5. COP Nurse Timeframes. The CN should obtain the necessary information, as outlined above, and submit a closure report within 7 days. There is a limited amount of flexibility with this 7-day timeframe. If the CN has determined that the claimant will be returning to work within the following week, and the specific contact information supporting a definitive return to work date has been added to the Activity Log, the COP Nurse case can be held open beyond the 7-day window to verify and report that RTW date and status. CN closure, even with this kind of limited extension, should occur though no later than 14 days after assignment.

6. COP Nurse Reports. The COP Nurse Closure reports have been updated. The information will be pulled directly from the information entered by the CN in the iFECS COP Nurse Activity Log. These reports will look different depending on the closure code. The COP closure code and date, as well as RTW information, will be clearly visible. Other pertinent information, depending on the closure type, will also be viewable.

7. COP Nurse Closure Codes. The closure codes have been expanded to allow for closures based on the CN, actions taken by the CE, or information approved from a CA-3. The complete list of closure codes is below:

9A

COP Case Closed – Case Accepted

9B

COP Case Closed by CE with FT/LD RTW (Full Time Light Duty)

9C

COP Case Closed by CE with FT/RD RTW (Full Time Regular Duty)

9D

COP Case Closed – Case Denied

9E

COP Case Closed by CE with PT RTW (Part Time)

9F

COP Case Closed Using CA-3 with FT/RD RTW

9G

COP Case Closed Using CA-3 with FT/LD RTW

9H

COP Case Closed – Emergency Hospitalization

9K

COP Case Closed Using CA-3 with PT RTW

9L

COP Case Closed by Nurse with FT/LD RTW

9N

COP Case Closed - No RTW

9O

COP Case Closed - Claimant Not Cooperating

9P

COP Case Closed by Nurse with Part-time RTW

9R

COP Case Closed by Nurse with FT/RD RTW

9S

COP Case Closed – Surgery Imminent

9T

COP Case Closed – Catastrophic Case

9U

COP Case Closed - RTW Unknown

9X

COP Case Closed – Stopped Work > 45 days

9Y

COP Case Closed Using CA-3 – RTW without status

8. CE Actions Upon CN Closure. Upon receipt of a COP Nurse Report indicating no RTW, only partial RTW or some other pending issue, the CE should take two primary actions: adjudication (or development) should be expedited if possible and assignment of a FN should be considered.

9. Case Adjudication. Any closure code that denotes less than a full-time RTW will flip an administratively closed case to UN so that it can be adjudicated. Since FNs are not assigned to unadjudicated cases, the CE should attempt to expedite the adjudication process in these claims where the claimant has not RTW in a full-time capacity. If the claim cannot be accepted upon first review, development should be undertaken. The claimant will be afforded 30 days to submit necessary evidence but the claim should be monitored during that 30-day period so that it can be accepted as soon as the proper supporting documentation is received. The OQS2 reports for unadjudicated traumatic injury and reopened c-closure cases have been updated with new fields to enable the CEs to monitor these cases more easily, as outlined in #11.

10. Field Nurses. Each case is unique, but in most instances, if the case is accepted and the claimant has not RTW in a full-time capacity, the case should be referred for FN assignment promptly after acceptance, even if the COP period has not elapsed. A FN may also be assigned if the claimant has returned to work full time, light duty.

If the FN is assigned after a CN assignment, the DM (Disability Management) record will already exist for QCM (Quality Case Management) actions. Once 45 days from the date of injury (DOI) have elapsed, if no RTW full-time code has been entered in DM, the status code TCQ (QCM-Triage to QCM-Open) is auto populated via a nightly run and the category changes to QCM Open. The Start date and Track date are populated with the date the record is changed to QCM Open. If the claimant returns to work before the 45 days from DOI have elapsed, entry of the RTW information in DM tracking inputs the TRC status code (Closed -Triage with RTW during COP) and changes the category to QCM Resolved Triage. Offices will either need to close the FN or open a new DM record in order to follow a light duty RTW with a FN.

11. Online Query System (OQS2) Reports. New report capabilities have been created and some existing reports have been updated to better manage cases during this process.

CE3/CE4 and M23 – Traumatic Injury Cases UN/UD
These reports still list UN/UD (undecided) Traumatic Injury cases along with the age of the case as they do currently; however, a new data column has been added to show the COP Closure Description, if there is one. The report will also be broken into 2 sections. Cases with a COP Closure Code indicating less than a full-time RTW will be listed in the top section, by age, and the bottom portion of the report will list all other UN/UD Traumatic Injury cases by age that do not have a COP Closure Code or have a COP Closure Code indicating that the claimant has returned to work full time. The age data on the report has not changed; the report structure has only been modified to allow the CEs to more easily focus attention on the cases where the claimant is losing time from work.

CE19 and M17 – Reopened LT/NLT Closures Unadjudicated
These reports still list UN/UD c-closure cases, by age, that have been reopened and are awaiting adjudication. CN cases closed with a closure code indicating no RTW or a RTW of less than full time will flip open and appear on this report for adjudication. The report will show the "Reopen Reason" as COP Nurse Closed – No Full-Time RTW.

CE20 – Pending CA-3 During COP Period
This is a new report. This report lists all cases with a pending CA-3 reporting a RTW date during the COP period. The cases will show on this list as soon as they are received and will remain on the report until the RTW date has been approved or rejected. Once the RTW date has been approved or rejected, the case will drop from this list. CEs will likely approve or reject the date while indexing mail; however, this report will enable CEs to find the cases in which they decided to "postpone" the decision while indexing mail.

CE21 – Closed COP Cases
This is a new report. This report will list cases during an identified period for a specific CE, a unit or the office. The user can enter a particular closure code, a set of specific codes, or retrieve all closure codes during a period. This report can be used to follow up on cases by the closure type. The report may also be used to find cases in which the closure code entered indicates only a light duty RTW.

12. NRTS Reports – Two new NRTS reports have also been created for use by the SN to better manage the cases during this process.

Closed COP Cases – This is a new report, similar to the CE21 report in OQS2. This report will allow the user to obtain CN cases that were closed within a given time period by a particular closure code or a set of specific codes, or obtain all closures within the given period.

Overdue COP Cases – This is a new report. This will show all CN cases that are overdue (beyond 7 days old) and have not yet been closed. Cases that the CN has closed that have not yet been reviewed by the SN (pending closures) will not appear on this report. There is a column in the report that will show how many days the CN case is overdue.

13. Tasks. New tasks, viewable in the users Workload Organization Window (WOW), have also been created to assist the CEs and SNs with case management.

CA-3 form should be reviewed - This task will appear for any case with a pending CA-3 reporting a RTW date during the COP period and it will appear on the WOW of the Responsible Claims Examiner (RCE). The task will appear in the WOW as soon as a CA-3 is received and will remain until the RTW date has been approved or rejected. The age column in the WOW shows the task age, and the due date for the task is 3 days later. If the user double-clicks on the task, the Imaging application will open and display the case. Once the RTW date has been approved or rejected (either when indexing the CA-3 or in Case Maintenance), the task will be automatically deleted. CEs will likely approve or reject the RTW date while indexing; however, this task will remind the CE to make a decision on any case where the CE decided to "postpone" the decision while indexing mail.

No COP activity for at least 4 days - This task will appear on the SN's WOW for any case where the CN has not made any entries to the activity log for 4 days. For instance, if the CN takes an action on the case on the day the case is assigned, but then takes no action after that for 4 days (as evidenced by no new entries in the activity log), this task will be created. The age column in the WOW shows the task age (not the COP Nurse case age), and the due date for the task is 3 days later. If the user double-clicks on the Task, NRTS will open and display the case data. The task is deleted when the CN takes any action on the COP case or when the COP case is closed. Note – this task will also appear on the WOW of the CE, but no action is required by the CE.

 

Disposition: Retain until the procedures noted here are incorporated into the FECA Procedure Manual.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Attachments

Distribution: List No. 1--Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA BULLETIN NO. 09-01

Issue Date: February 15, 2009

 


Expiration Date: January 1, 2010


Subject: Compensation Pay: Compensation Rate Changes Effective January 2009.

Background: On December 18, 2008, the President signed Executive Order 13483 implementing a salary increase of 2.90 percent in the General Schedule basic pay. The applicability under 5 U.S.C. 8112 only includes the 2.90 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment became effective at the start of the first full pay period after January 1, 2009.

Purpose: To inform the appropriate personnel of the increased minimum/maximum rates of compensation and the adjustment procedures for affected cases on the periodic disability and death payrolls.

The new rates were effective with the first compensation payroll period beginning on or after January 1, 2009. Thus, for daily roll supplemental payments January 10, 2009 is the specific effective date of the increase. The effective date for the increase of periodic and death roll payments will be January 18, 2009. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, step 10, which is now $127,604 per annum. The basis for the minimum compensation rate is the salary of a GS-2, Step 1 which is $19,721 per annum.

The minimum increase specified in this Bulletin is applicable to employees of the U.S. Postal Service.

The effect on 5 U.S.C. 8112 is to increase the payment of compensation for disability claims to:

Effective January 10, 2009

Minimum

Maximum

 

Weekly
Daily (5-day week)

$284.44
56.89

$1,840.44
360.09

 
       

Effective January 18, 2009

Minimum

Maximum

 

28-Day Cycle

$1,137.75

$7,361.77

 

The effect on 5 U.S.C. 8133(e) is to increase the monthly pay on which compensation for death is computed to:

Effective January 18, 2009

Minimum

Maximum

 

Monthly

$1,643.42

$7,975.25

 

Applicability: Appropriate National and District Office personnel

Reference: Memorandum for Executive Heads of Departments and Agencies dated December 18, 2008; and the attachment for the 2009 General Schedule.

Action: The Integrated Federal Employees' Compensation System (iFECS) will update the periodic disability and death payrolls. It should be noted that this adjustment process re-calculates EVERY compensation record from its very beginning to current date. Thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect.

Any cases keyed as "Gross Overrides without CPI" in iFECS will not have a supplemental record or make a separate calculation of additional entitlement. Thus, these gross override cases must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required and the case record documented. A notice should be sent to the payee by the District Office, detailing the change in the rate of compensation. All cases keyed as "Gross Overrides with CPI" will be adjusted in the usual manner.

1. Adjustments Dates.

a. As the effective date of the adjustment was January 18, 2009 for the periodic disability and death rolls, there was no supplemental payroll needed. The February 14, 2009 death and disability payments will include any necessary minimum/maximum compensation adjustments.

b. The new minimum/maximum compensation rates were available in iFECS on February 2, 2009.

2. Adjustment of Daily Roll Payments. The salary adjustments are not retroactive, so it is assumed that all Federal agencies have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2009. Therefore, it is not necessary to review any of these payments.

However, if an inquiry is received then verification of the pay rate must be secured from the employing agency, and the necessary adjustment applied.

Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2 – Folioviews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA BULLETIN NO. 09-02

Issue Date: March 1, 2009

 


Expiration Date: February 28, 2010


Subject: Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2009.

Purpose: To furnish information on the CPI adjustment process for March 1, 2009.

The cost of living adjustments granted to a compensation recipient under the FECA are based on the "Consumer Price Index for Urban Wage Earners and Clerical Workers" (CPI-W) figures published by the Bureau of Labor Statistics (BLS). The annual cost of living increase is calculated by comparing the base month from the prior year to the base month of the current year, with the percentage of increase adjusted to the nearest one-tenth of 1 percent, determining the amount of the CPI increase granted to claimants. 5 U.S.C. § 8146a establishes the base month as December.

December 2007 had a CPI-W level of 205.777 per BLS. The CPI-W level for December 2008 was reported as 204.813 by BLS, which is in fact a decrease of 0.5% from the December 2007 level. As a result of this decline in the CPI-W level, there will not be a cost of living increase for FECA recipients in 2009.

1. Despite the lack of an increase, the new base month is December 2008.

2. The maximum compensation rates, which must not be exceeded, are at the following rates:

$ 7,975.25
7,361.77
1,840.44
360.09

per month
each four weeks
per week
per day (for a 5 day week)

Applicability: Appropriate National Office and District Office personnel.

Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981; Bureau of Labor Statistics Consumer Price Index Publication for December 2008 (USDL-09-0035)

Action: Since there is no change this year there is no action required by the National Office Production staff to re-calculate or adjust compensation.

1. CPI Minimum and Maximum Adjustments Listings. Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated to indicate that there will not be an increase in 2009. Attached to this directive is a complete list of all the CPI increases and effective dates since October 1, 1966, through March 1, 2009, for reference.

2. Forms.

a. All claimants will be provided a notice with their Benefit Statement, indicating that there will not be a CPI increase this year. The Treasury will include this notice as a "stuffer card" with every Benefit Statement issued for the March 14, 2009 rolls.

b. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc.), please continue to provide this data in letter form from the district office. Many times a Benefit Statement may not reach the addressee, and regeneration of the form is not possible. A letter indicating the amount of compensation paid every four weeks will be an adequate substitute for this purpose.

Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

 

Attachment

Distribution: List No. 2 --Folioviews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, and Rehabilitation Specialists)

COST-OF-LIVING ADJUSTMENTS
Under 5 USC 8146(a)

EFFECTIVE DATE

RATE

EFFECTIVE DATE

RATE

10/01/66
01/01/68
12/01/68
09/01/69
06/01/70
03/01/71
05/01/72
06/01/73
01/01/74
07/01/74
11/01/74
06/01/75
01/01/76
11/01/76
07/01/77
05/01/78
11/01/78
05/01/79
10/01/79
04/01/80
09/01/80
03/01/81
03/01/82
03/01/83
03/01/84
03/01/85
03/01/86

12.5%
3.7%
4.0%
4.4%
4.4%
4.0%
3.9%
4.8%
5.2%
5.3%
6.3%
4.1%
4.4%
4.2%
4.9%
5.3%
4.9%
5.5%
5.6%
7.2%
4.0%
3.6%
8.7%
3.9%
3.3%
3.5%
N/A

03/01/87
03/01/88
03/01/89
03/01/90
03/01/91
03/01/92
03/01/93
03/01/94
03/01/94
03/01/95
03/01/96
03/01/97
03/01/98
03/01/99
03/01/00
03/01/01
03/01/02
03/01/03
03/01/04
03/01/05
03/01/06
03/01/07
03/01/08
03/01/09

0.7%
4.5%
4.4%
4.5%
6.1%
2.8%
2.9%
2.5%
2.5%
2.7%
2.5%
3.3%
1.5%
1.6%
2.8%
3.3%
1.3%
2.4%
1.6%
3.4%
3.5%
2.4%
4.3%
0.0%

Prior to September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).

Prior to 09/07/74

.08-.34 = .23
.35-.57 = .46
.58-.80 = .69
.81-.07 = .92

Eff. 11/01/74

.13-.37 = .25
.38-.62 = .50
.63-.87 = .75
.88-.12 = 1.00

ATTACHMENT TO FECA CIRCULAR NO. 09-02

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FECA BULLETIN NO. 09-03

Issue Date: March 15, 2009

 


Expiration Date: May 1, 2010


Subject: Permanent Impairment/Schedule Awards: Sixth Edition of the AMA Guides to the Evaluation of Permanent Impairment

Background: The schedule award provisions of the Federal Employees' Compensation Act (FECA) at 5 U.S.C. 8107 and its implementing regulations at 20 C.F.R. 10.404 establish the compensation payable to employees sustaining permanent impairment. For consistent results and to ensure equal justice under the law to all claimants, good administrative practice necessitates the use of a single set of tables with uniform standards applicable to all claimants. The American Medical Association's (AMA) Guides to the Evaluation of Permanent Impairment has been adopted by the Office of Workers' Compensation Programs Division of Federal Employees' Compensation (DFEC) as the appropriate standard for evaluating schedule losses. In January 2008, the AMA published the Sixth Edition of the Guides, noting that the Guides are revised periodically to incorporate current scientific clinical knowledge and judgment. This Edition implements substantial reforms to the methodology of calculating permanent impairment. In accordance with its long established practice, the DFEC is moving forward to the most recent version of the Guides and generally utilizes the Sixth Edition in evaluating permanent impairment under the Guides.

The Sixth Edition substantially revises the evaluation methods used in previous Editions, characterizing the new methodology's objectives as: to be consistent, to enhance relevancy, to promote precision and to standardize the rating process. The AMA describes the Sixth Edition of the Guides as implementing a major paradigm shift in the way impairment evaluations are conducted based on five axioms: (1) Adopting terminology and the conceptual framework of disablement outlined by the World Health Organization's (WHO's) International Classification of Functioning, Disability, and Health (ICF); (2) Becoming more diagnosis-based and basing the diagnoses in evidence; (3) Optimizing rater reliability through simplicity, ease of application and following precedent; (4) Rating percentages are functionally based to the fullest extent possible; (5) Stressing conceptual methodological congruity within and between organ rating systems.

The attachment describes the major changes in the Guides applicable to FECA as well as those areas where other criteria apply.

Purpose: To provide information about the use of the Sixth Edition of the AMA Guides and changes found in the new version.

Applicability: Claims Examiners, Senior Claims Examiners, Hearing Representatives, All Supervisors, District Medical Directors and Advisers, Technical Assistants, Rehabilitation Specialists and Staff Nurses.

Action:

1. EFFECTIVE DATE OF MAY 1, 2009. All Claims Examiners should begin using the Sixth Edition of the AMA Guides effective May 1, 2009. Correspondence with treating physicians, consultants and second opinion specialists should reflect the use of the new Edition for decisions issued after May 1, 2009, and form letters that refer to the AMA Guides are revised to reflect this change. All schedule award decisions issued on or after May 1, 2009, should be based on the Sixth Edition of the A.M.A. Guides with the exceptions (such as statutory criteria) as noted.

2. RECALCULATIONS RESULTING FROM HEARINGS, REVIEW OF THE WRITTEN RECORD OR RECONSIDERATIONS. Any recalculations of previous awards which result from hearings or reconsideration decisions issued on or after May 1, 2009, should be based on the Sixth Edition of the Guides. However, if the percentage of the award is affirmed but the case is remanded for further development of some other issue, i.e. pay rate, recalculation of the percentage of the award under the Sixth Edition is not required.

3. REQUESTS FOR INCREASED SCHEDULE AWARD WHERE PRIOR AWARD WAS MADE UNDER AN EARLIER EDITION OF AMA GUIDES In accordance with DFEC's established practice when moving to an updated version of the AMA Guides, awards made prior to May 1, 2009, are not and should not be recalculated merely because a new Edition of the Guides is in use. A claimant who has received a schedule award calculated under a previous Edition and who claims an increased award, will receive a calculation according to the Sixth Edition for any decision issued on or after May 1, 2009. Should the later calculation result in a percentage impairment lower than the original award (as sometimes occurs), the Claims Examiner or Hearing Representative should make the finding that the claimant has no more than the percentage of impairment originally awarded, that the evidence does not establish an increased impairment and that therefore the Office has no basis for declaring an overpayment.

Disposition: Retain until the indicated expiration date.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 1
(Claims Examiners, All Supervisors, District Medical Advisers, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

ATTACHMENT 09-03

AMA Guides to the Evaluation of Permanent Impairment,
Sixth Edition

The Sixth Edition of the American Medical Association (AMA) Guides to the Evaluation of Permanent Impairment differs significantly from previous Editions. There are extensive changes affecting the calculations of schedule awards for FECA claimants. The latest Edition represents both a paradigm shift as well as the continued evolution in creating a uniform and consistent method for measuring impairment. The Sixth Edition of the AMA Guides consists of seventeen chapters, one less than the Fifth Edition. (Two cardiovascular chapters in the Fifth Edition have been consolidated into one chapter in the Sixth.)

The biggest alteration from previous Editions involves the rating of permanent impairment based on a specific diagnosis rather than the extremity or organ system. In previous Editions, an impairment rating may have included multiple diagnoses within an organ or extremity. Under the Sixth Edition most ratings will consider only the diagnosis with the most impact on the rated body region, i.e. digits/hand, wrist, elbow and shoulder are the regions defined for the upper extremity. However, once a rating is established for a specific region, the ratings for various regions within an extremity will be combined, just as in the Fifth Edition. For instance, a rating may be established separately for an entrapment neuropathy at the wrist, another at the elbow and a third rating for a shoulder impingement. Those three ratings would then be combined using the Combined Values Chart to establish the impairment rating for the upper extremity. In the Fifth Edition of the Guides, impairment ratings relied heavily on loss of range of motion and strength in comparison to a paired extremity. The Sixth Edition primarily incorporates these findings only insofar as they relate to the specific diagnosis evaluated.

Key changes affecting the calculation of schedule awards for FECA claimants are highlighted below. Also summarized are circumstances where calculations are done under criteria that vary from the Sixth Edition:

1. DIAGNOSIS BASED GRID: The foundation of the new methodology is the diagnosis-based grid used for each organ system and chapter. Evaluators will rate impairment according to the diagnosis representing the source of the most impairment in the given body region. If there is more than one ratable diagnosis in an affected extremity, the rater should combine all regional impairments for a final impairment at the extremity level. This combining of impairment ratings does not represent a change from prior Editions.

Each diagnosis grid is divided into five classes of impairment severity, ranked from '0' (no impairment) to '4' (very severe). Within each class are five severity grades categorized 'A' through 'E' (default 'C') with corresponding impairment percentages.

Raters distinguish the level of severity using criteria separated into key factors and non-key factors. These criteria consist of: (1) history of clinical presentation; (2) physical findings; (3) clinical studies or objective test results; (4) functional history. In most organ systems or disease processes, clinical history is the key factor which will determine the impairment class. However, physical findings or objective test results may serve as the key factor in select organ system evaluations. The evaluator will adjust the severity grade based on the results of the remaining criteria. For instance, if the claimant has an accepted condition of right shoulder impingement syndrome, the evaluator would use Table 15-5 to locate that diagnosis. The history of clinical presentation (key factor) would be used to determine whether the severity of the condition would be a Class 0 (no impairment) or a Class 1. Tables 15-7, 15-8 and 15-9 would then be consulted to determine where, within Class 1, the impairment would fall based on functional history, physical examination and clinical studies (non-key factors). These adjustments cannot exceed the percentage of impairment within the range specified by the designated class.

2. MUSCULOSKELETAL: Musculoskeletal regions in the Sixth Edition of the Guides consist of the upper extremities (Chapter 15), lower extremities (Chapter 16) and the spine and pelvis (Chapter 17). The upper extremity is divided into four separate zones, including digits/hand, wrist, elbow and shoulder. The lower extremity is divided into three zones consisting of foot/ankle, knee and hip. The spine and pelvis is divided into four zones, including cervical, thoracic, lumbar, and the pelvis (consisting of the ilium, ischium, pubis, sacrum and coccyx). Diagnosis classes for the upper and lower extremities are broken into the following categories: Soft tissue, muscle and tendon, ligament, and bone and joint. If impairment percentages are calculated in whole person ratings, they must be adjusted to individual extremity or organ system percentages using conversion charts or rates.

3. PAIN: The chapter on impairments due to pain (Chapter 3) has been updated. As with the Fifth Edition, the Sixth Edition allows for a maximum 3% impairment rating for non-specific pain that cannot be attributed to a condition addressed elsewhere in the Guides. However, in no circumstances should the pain-related impairment developed under Chapter 3 be considered as an add-on to impairment determinations based on the criteria listed in Chapters 4 – 17. While the Guides permit a presumptive percentage for pain when it is not accompanied by objective findings, if the pain accompanies objective findings, the rating is made using the applicable chapter.

4. CARPAL TUNNEL: Entrapment neuropathy of the upper extremities (e.g. carpal tunnel, cubital tunnel, etc.) (Section 15.4f) must be documented with nerve conduction velocity (NCV) testing in order to consider ratable impairment under the section on entrapment neuropathy. If testing was not conducted or does not meet the criteria outlined by the Guides, no ratable entrapment neuropathy impairment may be considered and any impairment must be calculated using a different section. Table 15-23 is used to determine entrapment/compression neuropathy impairments. Additionally, the preoperative electrodiagnostic test should be used in the impairment rating unless postoperative studies were done for a clinical indication of failure to improve with surgery and the postoperative study is clearly worse than the preoperative electrodiagnostic study. When evaluating multiple simultaneous neuropathies, the first (or most impairing) is rated at 100%, the second is rated at 50%, and the third is rated at 0% of the impairment listed in Table 15-23. The impairments are then combined. Multiple simultaneous neuropathies of the same region should occur very rarely.

5. MAXIMUM MEDICAL IMPROVEMENT: The Guides stipulate only permanent impairment may be rated, and only after the claimant has reached a point of "maximum medical improvement" (MMI). The Guides do not afford a rating for possible future impairment. Impairment should not be rated permanent until sufficient time has passed for healing and recovery, which may vary substantially depending on the condition and the claimant's profile. The clinical findings must indicate the medical condition has stabilized for the claimant to have reached MMI. This approach is consistent with program history, case law and long established practice. See Franklin L. Armfield, 28 ECAB 445 (1977).

In cases where a claimant declines surgical intervention or other therapeutic treatment, an MMI determination may still be reached as long as the physician indicates that the individual is at MMI in lieu of additional treatment. MMI is determined to be a point where no further improvement is anticipated and symptoms are expected to remain stable or managed with palliative care.

6. BACK CONDITION: As FECA does not allow a schedule award for impairment of the back (see 5 U.S.C. 8101 (19), a diagnosed injury or medical condition originating in the back or spine may only be considered to the extent that it results in permanent impairment of the extremities. There is no separate impairment for radiculopathy unless specified in the regional grid in Chapter 17. Even then, radiculopathy is used as a grade modified rather than defining an impairment class. However, the peripheral nerve impairment charts in the upper and lower extremity chapters may be used. Rating impairment to peripheral nerves in the lower extremities is explained in Section 16.4c and Table 16-12. Likewise, upper extremity peripheral nerve impairment is explained in Section 15.4 and Tables 15-20 and 15-21.

7. Under the Sixth Edition of the Guides, an impairment rating may not be allowed simply because there was a surgical intervention. For instance, Table 16-3 under cruciate or collateral ligament injury specifically states that surgery is not a rating factor. However, impairment based on a total knee replacement is provided in Table 16-3.

8. SPECIAL DETERMINATIONS AFFECTING USE OF SIXTH EDITION See FECA PM 3-700.4)

a. Loss of digits/statutory criteria. While the percentage of impairment is generally computed in accordance with the AMA Guides, special computations may be required. Loss of more than one digit of a hand or foot should be computed in terms of impairment to the whole hand or foot unless the impairment computed for loss of two or more digits exceeds the percentage for the hand or foot. In such instances, the award should reflect the computation most favorable to the claimant. The FECA itself addresses compensation for loss of more than one phalanx as being the same as loss for the entire digit and loss of the first phalanx is one-half the compensation for loss of the entire digit. See 5 U.S.C. 8107 (15). Calculations of amputation at the wrist or ankle are considered the same as a total loss of that member. See 5 U.S.C. 8107 (16).

b. Loss of hearing. There continue to be special requirements for hearing loss testing. Special calculation requirements are contained in Program Memoranda 162. 181 and 217. In accordance with 5 U.S.C. 8107 (19), loss is determined without regard to correction.

c. Loss of vision. The percentage of impairment continues to be based on best uncorrected vision. See 5 U.S.C. 8107 (19). Loss of binocular vision or for loss of 80 percent or more is the same as for loss of the eye. See 8107 (14).

d. Loss/loss of function of organs.

1) Where there is total loss of a single paired organ such as one kidney, lung, breast, testicle, or ovary) the schedule award rating is generally based on loss of one organ rather than loss of function of the pair. Under FECA, it is immaterial for purposes of a schedule award evaluation whether the remaining organ of the pair compensates for the loss.

2) Awards for respiratory impairment are based on the loss of use of both lungs and the impairment percentage is multiplied by twice the award for a single lung. However, for anatomical loss by injury or surgery of an entire lung, the award will be for 100% of one lung. Similarly, for loss of less than an entire lung, the impairment percentage will be based on loss of lung tissue by weight or volume and calculated based on the schedule for a single lung. The claimant is entitled to the higher of the impairment based on anatomical loss vs. loss of use calculation.

4) While the AMA Guides express the impairment of certain organs in terms of the whole person, schedule awards under the FECA are based on the percentage of impairment of the particular organ/schedule member. See FECA PM 3-700-4 (c).

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FECA BULLETIN NO. 09-04

Issue Date: April 10, 2008

 


Expiration Date: December 31, 2009


Subject: Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.

Background: Effective January 1, 2009, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile (POV) was reduced to 55 cents per mile by the General Services Administration (GSA). No restriction is made as to the number of miles that can be traveled. As in the past, this rate will also apply to disabled Federal Employees' Compensation Act (FECA) beneficiaries traveling to secure necessary medical examination and treatment.

Applicability: Appropriate National Office and District Office personnel.

Reference: Federal (FECA) Procedure Manual Part 5, Benefit Payments, Chapter 204, Principles of Bill Adjudication and 5 U.S.C. § 8103.

Action: The Central Bill Processing (CBP) facility has updated their system to reflect the new rates. Since there is no action required at the District Office level, the rates are being provided for informational purposes only.

The following is a list of the historical mileage rates used to reimburse claimant travel expense:

01/01/1995 – 06/06/1996
06/07/1996 – 09/07/1998
09/08/1998 – 03/31/1999
04/01/1999 – 01/13/2000

30.0 cents per mile
31.0 cents per mile
32.5 cents per mile
31.0 cents per mile

   

01/14/2000 – 01/21/2001
01/22/2001 – 01/20/2002
01/21/2002 – 12/31/2002
01/01/2003 – 12/31/2003
01/01/2004 – 02/03/2005
02/04/2005 – 08/31/2005
09/01/2005 – 12/31/2005

32.5 cents per mile
34.5 cents per mile
36.5 cents per mile
36.0 cents per mile
37.5 cents per mile
40.5 cents per mile
48.5 cents per mile

   

01/01/2006 – 01/31/2007
02/01/2007 – 03/18/2008
03/19/2008 – 07/31/2008
08/01/2008 – 12/31/2008
01/01/2009 – Current

44.5 cents per mile
48.5 cents per mile
50.5 cents per mile
58.5 cents per mile
55.0 cents per mile

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2 -- Folioviews Groups A, B and D
(Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Staff Nurses, Rehabilitation Specialists and Fiscal Personnel).

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FECA BULLETIN NO. 09-05

Issue Date: August 18, 2009

 


Expiration Date: August 18, 2010


Subject: United States Postal Service National Reassessment Program Guidance

Background: The United States Postal Service (USPS/Postal Service) has undertaken a National Reassessment Process (NRP) affecting a large number of Federal Employees' Compensation Act (FECA) claimants who are currently working for the Postal Service but not at their date of injury position. Some of these claimants are working at a position for which they have received a loss of wage-earning capacity determination (LWEC), while other claimants working light duty positions have not received an LWEC rating. These employees are being advised that no light duty or little light duty (a few hours a day) is available. While the NRP process was piloted in certain areas serviced by a number of Division of Federal Employees' Compensation (DFEC) district offices including San Francisco and Boston, the USPS NRP is now going beyond the piloting stage to nationwide implementation.

Purpose: This bulletin offers guidance to DFEC offices in an effort to provide consistency in claims handling to address these situations:

1. Where Postal employees who have been working light duty positions are being sent home because they have been advised by the Postal Service that there are No Operationally Necessary Tasks (NONT) for them to perform or there is No Work Available (NWA).

2. Where Postal employees who have been working light duty are being required to report to work and being informed that at that point in time there are only a certain number of hours of Operationally Necessary Tasks available for them to perform.

Postal employees encountering some permutation of these scenarios are completing CA-7 forms and seeking wage loss compensation. While some of the impacted Postal Service employees completing CA-7s have formal LWEC ratings in place, other Postal employees have not received a formal LWEC determination for the light duty they are performing. In some instances where an LWEC rating was issued, the Postal employee, his or her representative, or the Postal Service may contend that the job in question was not a real job and was in fact a "make work," "sheltered" or "odd lot" position for which an LWEC rating should not have been made. Other employees may demonstrate a worsening of their accepted medical condition or submit a claim for a recurrence.

Follow the action items and consult the reference sections for additional guidance.
NOTE: A CE should forward any general inquiries concerning the NRP to DFEC management for referral to the Postal Service and should not provide advice or commentary on the NRP to claimants, particularly concerning any USPS personnel requirement that a USPS employee report to work for a given amount of time.

Action items:

When a CA-7 referencing NRP, NONT or NWA is received, each case must be assessed individually with regard to the following three criteria:

A. whether the medical evidence continues to support ongoing injury related disability;
B. whether the claimant is losing intermittent time or making a claim for total wage loss; and
C. whether a formal LWEC rating is in place.

The course of action varies depending on these three criteria.

In all scenarios:

Review the CA-7 carefully to determine exactly what is being claimed (sick or annual leave, administrative leave, LWOP, etc.), and if it is unclear, request clarification from the agency. Note that no changes have been made to the usual leave buy back procedures, and payment cannot be made for any time in which the claimant was on administrative leave.

Once it has been determined that payment should be made, cases should be reviewed individually to determine whether the claimant is entitled to a recurrent pay rate.

  • If the recurrence begins more than six months after the injured employee resumed regular full-time employment, payment may then be made at a recurrent pay rate based on a CA-7. As long as the claimant was working a regular full time job when the light duty was withdrawn, the claimant would be entitled to a recurrent pay rate. A full duty return to work is not required; however, if the claimant did not return to regular full-time employment (for example, an individual who is receiving an LWEC based on working four hours a day, 20 hours per week), a recurrent pay rate would not be appropriate. See Reference on recurrent pay rates.
  • Note that if a formal LWEC is modified because the original position was determined to be "make work," "sheltered" or "odd lot," the claimant would not be entitled to a recurrent pay rate since the work was by virtue of this finding not "regular" work.

If a claimant is in receipt of a Schedule Award, and a determination has been made to pay the claim, the award should be interrupted so that the claimant can be placed on the periodic roll for temporary total disability or intermittent payments can be made, whichever is applicable.


I. Claims for TOTAL DISABILITY

A. LWEC decision HAS been issued -

If a formal LWEC decision has been issued, the CE must develop the evidence to determine whether a modification of that LWEC is appropriate.

1. All Postal Service cases where CA-7s are received that involve LWEC ratings based on actual positions should be reviewed to confirm that the file contains evidence that the LWEC rating was based on an actual bona fide position. This evidence may include a job offer, an SF 50, a classified position, a formal Position Description or other documentary evidence of file. If it is determined that the LWEC rating was without any factual or legal basis at the time it was issued, the file should be properly documented and the LWEC rating should be formally modified. The CE should then proceed to the action items for cases without LWEC decisions in the file.

2. The CE should review the file to determine whether any medical benefits have been paid in the case and whether a current medical report is on file that supports work-related disability and establishes that the current need for limited duty or medical treatment is a result of injury related residuals. If the case lacks current medical evidence (within the last 6 months), the claimant should be requested, as part of the standard LWEC modification development process, to provide a narrative medical report within 30 days that addresses the nature and extent of any employment-related residuals of the original injury. The Postal Service should also be requested to provide any medical evidence in its possession that would assist OWCP in determining whether there is a medical basis to modify the LWEC. This will provide information on the claimant's current medical condition, and it is essential where employees may not have been requested to provide recent medical evidence because they have a zero LWEC rating or have not recently sought medical care for the employment-related condition.

3. In an effort to proactively manage these types of cases, OWCP may also undertake further non-medical development. OWCP may request the Postal Service to address in writing whether the position on which the LWEC rating was based was a bona fide position at the time of the LWEC rating. The Postal Service should be directed to review its files for contemporaneous evidence concerning the position. The Postal Service should be granted 30 days to submit evidence and advised that failure to submit evidence may result in OWCP issuing a decision based on the evidence of file, including the evidence submitted by the claimant. No payment should be made during this period of development.

4. If after development and review, the evidence establishes that the LWEC rating was proper and none of the criteria were met to modify the LWEC, then the claimant is not entitled to compensation, and a formal decision denying modification of the LWEC and the claimed compensation should be issued.

5. If the medical evidence establishes that the employment-related residuals of the injury have ceased, a proposed decision to both modify the LWEC and terminate benefits should be issued because (a) the claimant's medical condition has changed and that is one of the reasons to modify an LWEC and, (b) the medical evidence of file now supports no ongoing residuals related to the work injury. The two issues are linked and both must be addressed in a situation like this.

6. If the evidence establishes the LWEC decision was correct, but the medical evidence establishes that the original accepted condition has worsened, then the LWEC rating meets a Strong criterion for modification (see Reference on modification), and the CE should issue a decision modifying the LWEC and authorize payment based on the CA-7 (after determining the appropriate pay rate).

7. If the CE evaluates the available evidence and finds that the employee or the employer has presented persuasive evidence that the position was odd lot or sheltered, then the LWEC rating meets another Strong criterion for modification (that the original rating was in error). If that is the case, the CE should issue a decision modifying the LWEC determination and authorize payment based on the CA-7 (after determining the appropriate pay rate).

8. If the LWEC is modified, payment can be made for total wage loss and the claimant can be placed on the periodic roll. The case will then fall into the Disability Management universe. Since these cases stem from the NRP process, placement with the previous employer is not a reasonable option, so other disability management efforts must be pursued with actions leading to a vocational rehabilitation referral. While not required, in some cases nurse referrals may be useful to arrange functional capacity evaluations, or to clarify work tolerance limitations or some other medical aspect of the case. In many instances though, CE medical management will likely be the first disability management action. These actions may include development to the treating physician or referrals for second opinion and, if needed, referee examinations. Once work tolerance limitations are received that represent the weight of medical evidence in the case, a referral for vocational rehabilitation should be made. All vocational rehabilitation options should be considered, including work hardening and Assisted Reemployment.

B. LWEC decision HAS NOT been issued –

1. If the claimant has been on light duty due to an injury related condition without an LWEC rating (or the CE has set aside the LWEC rating as discussed above), payment for total wage loss should be made based on the CA-7 as long as the following criteria are met:

  • the current medical evidence in the file (within the last 6 months) establishes that the injury related residuals continue;
  • the evidence of file supports that light duty is no longer available; and
  • there is no indication that a retroactive LWEC determination should be made. (Note - Retroactive LWEC determinations should not be made in these NRP cases without approval from the District Director.)

2. If the medical evidence is not sufficient, the CE should request current medical evidence from both the Postal Service and the claimant. As with the previous scenario, the claimant should be requested to provide a narrative medical report within 30 days that addresses the nature and extent of any employment-related residuals of the original injury.

3. If payment is made and the claimant is placed on the periodic roll, the case must then be entered into Disability Management with appropriate action as outlined in the above section.


II. Claims for INTERMITTENT PARTIAL DISABILITY

A. LWEC decision HAS been issued –

If a formal LWEC decision has been issued, the CE must develop the evidence to determine whether a modification of that LWEC is appropriate. Since the initial actions are identical to those found in Section I. Claims for TOTAL DISABILITY / LWEC decision HAS been issued, the CE should follow steps 1 though 5 in that section and then proceed with the following for claims for intermittent partial disability:

1. If the evidence establishes the LWEC decision was correct, but the medical evidence establishes that the original accepted condition has worsened, then the LWEC rating meets a Strong criterion for modification (see Reference on modification), and the CE should issue a decision modifying the LWEC and authorize payment for the intermittent hours on the CA-7 in conformity with #3 below.

2. If the CE evaluates the available evidence and finds that the employee or the employer has presented persuasive evidence that the position was odd lot or sheltered, then the LWEC rating meets another Strong criterion for modification (that the original rating was in error). If that is the case, the CE should issue a decision modifying the LWEC determination and authorize payment for the intermittent hours on the CA-7 in conformity with #3 below.

3. If the LWEC has been modified and it has been determined that payment can be made for intermittent hours based on the CA-7, the CE must be careful to pay only for the hours when light duty was not available. The evidence must establish that a certain number of hours of light duty have been withdrawn, thereby establishing a recurrence of disability for those hours for which light duty is not available.

Note - The penalty provision of termination for refusal or abandonment of suitable work can not be utilized in any case where USPS is making ongoing and/or daily determinations of how many hours of work are available. OWCP will not consider such offers as potential offers of suitable employment within the meaning of FECA, as they do not meet the regulatory and procedural criteria for that provision.

4. Like claims for total disability, a payment in these cases will also result in a Disability Management record (DM code PLP) requiring action. While not required, in some cases nurse referrals may be useful to arrange functional capacity evaluations, or to clarify work tolerance limitations or some other medical aspect of the case. In many instances though, CE medical management will likely be the first disability management action. These actions may include development to the treating physician or referrals for second opinion and, if needed, referee examinations.

  • If after some period of time all light duty is withdrawn, the CE must be sure to close this Disability Management record (CRN) and create a new record based on the total disability status.

B. LWEC Decision HAS NOT been issued –

1. If the claimant has been on light duty due to an injury related condition without an LWEC rating (or the CE has set aside the LWEC rating as discussed above), payment for intermittent wage loss should be made based on the CA-7, as long as the following criteria are met:

  • the current medical evidence in the file (within the last 6 months) establishes that the injury related residuals continue;
  • the evidence of file supports that a certain number of hours of light duty are no longer available; and
  • there is no indication that a retroactive LWEC determination should be made. (Note - Retroactive LWEC determinations should not be made in these NRP cases without approval from the District Director.)

2. If the medical evidence is not sufficient, the CE should request current medical evidence from both the Postal Service and the claimant. As with the previous circumstances, the claimant should be requested to provide a narrative medical report that addresses the nature and extent of any employment-related residuals of the original injury.

3. As outlined above, the CE must be careful to pay only for the hours when light duty was not available. The evidence must establish that a certain number of hours of light duty have been withdrawn, thereby establishing a recurrence of disability for those hours for which light duty is no longer available.

Note - The penalty provision of termination for refusal or abandonment of suitable work can not be utilized in any case where USPS is making ongoing and/or daily determinations of how many hours of work are available. OWCP will not consider such offers as potential offers of suitable employment within the meaning of FECA, as they do not meet the regulatory and procedural criteria for that provision.

4. If payment is made for intermittent hours, the case must then be entered into the Disability Management universe with appropriate action as outlined above in this section.

References:

1. Wage-Earning Capacity. Determinations of wage-earning capacity are made in accordance with the criteria of 5 U.S.C. 8115(a), the applicable regulations and the precedent of the Employees' Compensation Appeals Board (ECAB) in this area. In cases such as Bettye F. Wade, 37 ECAB 556 (1986), Leonard L. Rowe, Docket No. 88-1179 (issued September 27, 1988) and Alfred A. Moss, Docket No. 89-846 (issued July 26, 1989), the ECAB pointed out that "wage-earning capacity" is a measure of the employee's ability to earn wages in the open labor market under normal employment conditions given the nature of the employee's injuries and the degree of physical impairment, his usual employment, his age and vocational qualifications, and the availability of suitable employment. Once the claims examiner determines that the selected position is appropriate, the principles set forth in Albert C. Shadrick, 5 ECAB 376 (1953), are applied so as to result in the percentage of the claimant's loss of wage-earning capacity.

2. Actual Earnings LWEC. In Lee R. Sires, 23 ECAB 12 (1971), which is the leading case on this issue, the ECAB expressed the following principles on the proper interpretation of § 8115(a): "Generally, wages actually earned are the best measure of a wage-earning capacity [pursuant to § 8115(a)], and in the absence of evidence showing they do not fairly and reasonably represent the injured employee's wage-earning capacity, must be accepted as such measure." [emphasis supplied] The ECAB has found that actual earnings are not the "best measure" of a claimant's wage-earning capacity when there is "evidence showing they do not fairly and reasonably represent" his or her wage-earning capacity. For example, in the case of Elizabeth E. Campbell, 37 ECAB 224 (1985), the ECAB held that the claimant's actual earnings as a "cover sorter" did not fairly and reasonably represent her wage-earning capacity because the evidence suggested that the work was both seasonal in nature and constituted make-shift work designed for her particular needs. In Mary Jo Colvert, 45 ECAB 575 (1994), the ECAB set aside a determination that the claimant's actual earnings as a part-time clerk fairly and reasonably represented her wage-earning capacity because her hours varied widely and the medical evidence of record established that she was, in fact, totally disabled.

However, in the event that a proper formal LWEC determination is in place, the fact that the employing agency has withdrawn a light duty position does not automatically entitle the claimant to continuing ongoing compensation; in order for compensation to be payable, the evidence must establish a basis for modification of the LWEC. See FECA Procedure Manual, Chapter 2-1500-7 (a) (5).

3. Modification of LWEC. The ECAB established the following criteria for modifying a formal LWEC decision in Elmer Strong, 17 ECAB 226 (1965): (1) The original LWEC rating was in error; (2) The claimant's medical condition has changed; or (3) The claimant has been vocationally rehabilitated. The party seeking modification of the LWEC decision has the burden to prove that one of these criteria has been met. If the claimant is seeking modification on the basis of an increase in wage loss, he or she must establish that the original rating was in error or that the injury-related condition has worsened.

4. Intermittent Claims for Wage Loss Where an LWEC Rating is in Place. See J.J., Docket No. 2008-1286, issued March 10, 2009; Tamara Lum, Docket No. 2005-0111, issued December 6, 2005. In both of these cases, the Board specifically held that the OWCP is not precluded from adjudicating a limited period of disability following the issuance of a loss of wage-earning capacity decision; indeed, in the Lum case, the Board found that the claimant had established disability for work on particular dates. If the CE deems it appropriate under the facts and circumstances of an individual case based on the cases noted above, limited compensation for a particular period may be paid based on CA-7 submissions even where an LWEC rating is in place. For example, intermittent wage loss may be paid where a claimant has a demonstrated need for surgery. Claimants may not be placed on the periodic roll in such circumstances.

5. Recurrence of Disability - Burden of Proof Standard When a Claimant Has Been Working on Light Duty. To the extent that an employee is claiming a recurrence of disability on the ground that light duty is no longer available, the principles of Terry R. Hedman, 38 ECAB 222 (1986) apply. The ECAB stated in Hedman: "When an employee, who is disabled from the job he held when injured on account of employment-related residuals, returns to a light-duty position or the medical evidence of record establishes that he can perform the light-duty position, the employee has the burden of establishing by the weight of the reliable, probative and substantial evidence a recurrence of total disability and show that he cannot perform such light duty. As part of his burden, the employee must show a change in the nature and extent of the injury-related condition or a change in the nature and extent of the light-duty job requirements." See 20 C.F.R. 10.5(x), which provides a definition of recurrence of disability that includes the situation where the employing agency has withdrawn light duty.

6. Where An Employee's Light-Duty Job Is Eliminated Due To Downsizing Or A Reduction In Force. As noted in 20 C.F.R. 10.509, an employee generally will not be considered to have experienced a compensable recurrence of disability as defined in § 10.5(x) merely because his or her employer has eliminated the employee's light-duty position in a reduction-in-force or some other form of downsizing. When this occurs, OWCP will determine the employee's wage-earning capacity based on his or her actual earnings in such light-duty position if this determination is appropriate on the basis that such earnings fairly and reasonably represent the employee's wage-earning capacity and such a determination has not already been made. For the purposes of 10.509, a light-duty position means a classified position to which the injured employee has been formally reassigned that conforms to the established physical limitations of the injured employee and for which the employer has already prepared a written position description such that the position constitutes federal employment. In the absence of a "light-duty position" as described in this paragraph, OWCP will assume that the employee was instead engaged in non-competitive employment which does not represent the employee's wage-earning capacity, i.e., work of the type provided to injured employees who cannot otherwise be employed by the Federal Government or in any well-known branch of the general labor market. (In order for 10.509 to be potentially applicable, the USPS must confirm that the position is being eliminated in a "reduction-in-force or some other form of downsizing.")

7. Application of 5 U.S.C. 8106 (c) (2) Penalty Provision for Refusal, Abandonment or Neglect of Suitable Employment. Under the FECA, its implementing regulations, procedures and case law, OWCP alone can make a determination that a particular position is suitable within the meaning of 5 U.S.C. 8106. The ECAB has described 5 U.S.C. 8106 (c) (2) as a penalty provision that must be narrowly construed, noting OWCP must consider preexisting and subsequently developed conditions (including non-employment related conditions) in considering whether a position is suitable employment within the meaning of this section. See Richard P. Cortes, 56 ECAB 200 (2004). The ECAB has long rejected the contention that employment may be considered suitable based on a general representation by the agency that work is available within medical restrictions. See Clara M. Jackson, 33 ECAB 1782 (1982); Harry B. Topping, 33 ECAB 341 (1981). Moreover, longstanding FECA procedures do not permit any position of less than 4 hours to be considered suitable for this penalty provision. For these reasons, where claimants are working less than 4 hours a day, OWCP has determined as a threshold matter that it will not consider any application of this penalty provision to this situation. Nor will this provision be applied to circumstances where light duty employment is being sporadically offered for 4 hours or more. This is true even where the USPS contends that it "has provided suitable work," or the claimant contends that the work that is being offered or provided is "not suitable." Suitability determinations implicating the penalty provision in claims affected by the NRP will only be performed in cases that meet all of OWCP's established criteria for such cases; suitability determinations will be performed with strict adherence to all the requirements of the statute, regulations, procedures and case law.

8. Recurrent Pay Rates. Pay rate formulations for compensation are based on the pay rate as determined under section 8101(4) which defines "monthly pay" as: "[T]he monthly pay at the time of injury or the monthly pay at the time disability begins or the monthly pay at the time compensable disability recurs, if the recurrence begins more than six months after the injured employee resumes regular full-time employment with the United States, whichever is greater...." 5 U.S.C. 8101(4). To be eligible for a recurrent pay rate, there need not be a "continuous" six months of full-time employment prior to the recurrence of disability. See Johnny Muro, 19 ECAB 104 (1967); Carolyn E. Sellers, 50 ECAB 393 (1999) [citing Muro for the proposition that the return to regular full-time employment need not be continuous; a claimant need only work cumulatively for the required six months in regular full-time employment]. However, to be eligible for a recurrent pay rate, the claimant must have returned to "regular" full-time employment. The ECAB has defined "regular" employment, as "established and not fictitious, odd-lot or sheltered," contrasting it with a job created especially for a claimant. The ECAB has also noted that the duties of "regular" employment are covered by a specific job classification, pointing out that the legislative history of the 1960 amendments to FECA, which added the alternative provisions to section 8101(4), demonstrating that " Congress was concerned with the cases in which the injured employee had 'recovered' or had 'apparently recovered' from the injury." See Jeffrey T. Hunter, Docket No. 99-2385 (issued September 5, 2001) [Finding a claimant was not entitled to a recurrent pay rate–he did not return to "regular" employment as he worked only limited duty, as opposed to the full duties of a mail handler after his return to work following his employment injury]. The test is not whether the tasks that appellant performed during his limited duty would have been done by someone else, but instead whether he occupied a regular position that would have been performed by another employee. See also Eltore D. Chinchillo, 18 ECAB 647 (1967) [ECAB noted in remanding the case for further development that if the employee only returned to work in a temporary position designed to keep him on the payroll until his future ability to perform shipfitter duties was ascertained, the employee did not resume "regular" full-time employment within the meaning of the statute.]

Disposition: This Bulletin is to be retained in Part 2, Claims, Federal (FECA) Procedure Manual, until further notice or until incorporated into Part 2 of the Procedure Manual.


DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


Distribution: List No. 1
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA BULLETIN NO. 08-01

Issue Date: February 29, 2008

 


Expiration Date: January 1, 2009


Subject: Compensation Pay - Compensation Rate Changes Effective January 2008.

Background: On January 4, 2008, the President signed Executive Order 13454 implementing a salary increase of 2.50 percent in the General Schedule basic pay. The applicability under 5 U.S.C. 8112 only includes the 2.50 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment becomes effective at the start of the first full pay period after January 1, 2008.

Purpose: To inform the appropriate personnel of the increased minimum/maximum rates of compensation, and the adjustment procedures for affected cases on the periodic disability and death payrolls.

The new rates were effective with the first compensation payroll period beginning on or after January 1, 2008. Thus, for daily roll supplemental payments, January 6, 2008, is the specific effective date of the increase. The effective date for the increase of periodic and death roll payments will be January 20, 2008. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, step 10, which is now $124,010 per annum. The basis for the minimum compensation rate is the salary of a GS-2, Step 1 which is $19,165 per annum.

The minimum increase specified in this Bulletin is applicable to employees of the U.S. Postal Service.

The effect on 5 U.S.C. 8112 is to increase the payment of compensation for disability claims to:

Effective January 6, 2008

Minimum

Maximum

 

28-Day Cycle
Weekly
Daily (5-day week)

$1,105.67
276.42
55.28

$7,154.42
1,788.61
357.72

 

The effect on 5 U.S.C. 8133(e) is to increase the monthly pay on which compensation for death is computed to:

Effective January 6, 2008

Minimum

Maximum

 

Monthly

$1,597.08

$7,750.62

 

Applicability: Appropriate National and District Office personnel

Reference: Memorandum for Executive Heads of Departments and Agencies dated January 4, 2008; and the attachment for the 2008 General Schedule.

Action: The Integrated Federal Employees' Compensation System (iFECS) will update the periodic disability and death payrolls. It should be noted that this adjustment process re-calculates EVERY compensation record from its very beginning to the current date. Thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect.

Any cases keyed as "Gross Overrides without CPI" in iFECS will not have a supplemental record or make a separate calculation of additional entitlement. Thus, these gross override cases must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required and the case record documented. A notice should be sent to the payee by the District Office, detailing the change in the rate of compensation. All cases keyed as "Gross Overrides with CPI" will be adjusted in the usual manner.

1. Adjustments Dates.

a. As the effective date of the adjustment was January 20, 2008, for the periodic disability and death rolls, there was no supplemental payroll needed. The February 16, 2007 death and disability payments will include any necessary minimum/maximum compensation adjustments.

b. The new minimum/maximum compensation rates were available in iFECS on February 4, 2008.

2. Adjustment of Daily Roll Payments. The salary adjustments are not retroactive, so it is assumed that all Federal agencies have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2008. Therefore, it is not necessary to review any of these payments.

However, if an inquiry is received, then verification of the pay rate must be secured from the employing agency and the necessary adjustment applied.

Disposition: This bulletin should be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2 – Folioviews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

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FECA BULLETIN NO. 08-02

Issue Date: March 1, 2008

 


Expiration Date: February 28, 2009


Subject: Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2008.

Purpose: To furnish instructions on CPI adjustment implementation of March 1, 2008.

1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 4.3 percent.

2. The increase is effective March 1, 2008, and is applicable where disability or death occurred before March 1, 2007.

3. The new base month is December 2007.

4. The maximum compensation rates, which must not be exceeded, are the following:

$ 7,750.62
7,154.42
1,788.61
357.72

per month
each four weeks
per week
per day (for a 5 day week)

Applicability: Appropriate National Office and District Office personnel.

Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981.

Action: National Office Production staff will update the Integrated Federal Employees' Compensation System (iFECS) CPI tables, and have all payment records re-calculated, on or about April 3, 2008, when the iFECS system is not in use by District Office personnel. If there are any cases with fixed gross overrides there will be no supplemental record created. These cases must be reviewed to determine if CPI adjustments are necessary and, if so, a manual calculation will be required. If the gross override payment is, in fact, eligible for annual CPI increases, the payment plate should be adjusted in the iFECS system to pay as a "Gross Override with CPI".

1. Adjustment Dates.

a. The effective date of the CPI is March 1, 2008, and the period of the first adjusted periodic and death payroll cycles is February 17, 2008 to March 15, 2008. As a result, there will be a supplemental record created for the period of March 1 through March 15, 2008 to account for the increases due after March 1. Payment of this supplemental record will be combined with the April 12, 2008 periodic and death payrolls. A separate payment will not be issued for the March 1 through March 15, 2008 increase amount. Effective May 10, 2008, the periodic and death payrolls will reflect the increased amount of the regular death and periodic payrolls.

b. All tables in the iFECS system will be updated with the new CPI percentage. This update will be performed for all district offices by the iFECS Production staff in the National Office.

2. CPI, Minimum and Maximum Adjustments Listings. Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated with the new information. Attached to this directive is a complete list of all the CPI increases and effective dates from October 1, 1966 through March 1, 2008.

3. Forms.

a. All claimants will be provided a notice with the Benefit Statement dated April 14, 2007, indicating that a CPI of 4.3% will be applied to all eligible cases. The notice will also advise the claimant of upcoming increases in their compensation pay, including the supplemental CPI payment and the new periodic payment beginning on May 10, 2008. The Treasury will include this notice as a "stuffer card" with every Benefit Statement issued for the April 12, 2008 rolls.

b. Beginning with the compensation payment cycle that covers April 13, 2008 to May 10, 2008, the Office will issue an updated monthly Benefit Statement to each individual receiving benefits on the 28-day periodic roll cycle. This Benefit Statement will indicate the gross amount of compensation, period of compensation covered by the statement and the pertinent deductions made from the gross compensation. For compensation payments made via paper checks, the Benefit Statement will accompany the check. For compensation payments made through Electronic Fund Transfer (EFT), the Benefit Statement will be mailed separately.

c. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc.), please provide this data in letter form from the district office. Sometimes a Benefit Statement may not reach the addressee and regeneration of the form is not possible. A letter indicating the amount of compensation paid every four weeks will be an adequate substitute for this purpose.

Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.


DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


Attachment


Distribution: List No. 2 - Folioviews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)

COST-OF-LIVING ADJUSTMENTS
Under 5 USC 8146(a)

EFFECTIVE DATE

RATE

EFFECTIVE DATE

RATE

10/01/66
01/01/68
12/01/68
09/01/69
06/01/70
03/01/71
05/01/72
06/01/73
01/01/74
07/01/74
11/01/74
06/01/75
01/01/76
11/01/76
07/01/77
05/01/78
11/01/78
05/01/79
10/01/79
04/01/80
09/01/80
03/01/81
03/01/82
03/01/83
03/01/84
03/01/85
03/01/86

12.5%
3.7%
4.0%
4.4%
4.4%
4.0%
3.9%
4.8%
5.2%
5.3%
6.3%
4.1%
4.4%
4.2%
4.9%
5.3%
4.9%
5.5%
5.6%
7.2%
4.0%
3.6%
8.7%
3.9%
3.3%
3.5%
N/A

03/01/87
03/01/88
03/01/89
03/01/90
03/01/91
03/01/92
03/01/93
03/01/94
03/01/94
03/01/95
03/01/96
03/01/97
03/01/98
03/01/99
03/01/00
03/01/01
03/01/02
03/01/03
03/01/04
03/01/05
03/01/06
03/01/07
03/01/08

0.7%
4.5%
4.4%
4.5%
6.1%
2.8%
2.9%
2.5%
2.5%
2.7%
2.5%
3.3%
1.5%
1.6%
2.8%
3.3%
1.3%
2.4%
1.6%
3.4%
3.5%
2.4%
4.3%

Prior to September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).

Prior to 09/07/74

.08-.34 = .23
.35-.57 = .46
.58-.80 = .69
.81-.07 = .92

Eff. 09/07/74

.13-.37 = .25
.38-.62 = .50
.63-.87 = .75
.88-.12 = 1.00

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FECA BULLETIN NO. 08-03

Issue Date: April 30, 2008

 


Expiration Date: April 29, 2009


Subject: Compensation Payment – Segregation of Duties for Change of Address in the Integrated Federal Employees' Compensation System (iFECS)

Background: From its inception, security and access control have been an integral part of iFECS. A critical component of iFECS is its ability to ensure the proper segregation of staff duties, including the processing of claimant/payee changes of address. Such segregation of duties is necessary to ensure the integrity of system data and the security of all monies disbursed under the Federal Employees' Compensation Act (FECA). FECA Bulletin No. 00-14, issued on April 12, 2000, discussed the segregation of duties in the Automated Compensation Payment System (ACPS) and the Case Management File (CMF) subsystems of the Federal Employees' Compensation System (FECS). However, while iFECS implements the proper segregation of duties functions, the necessary documentation detailing these processes has been missing. This bulletin updates the process for segregation of duties in the iFECS Case Management and Compensation Management subsystems.

Purpose: To provide procedural guidance for all Federal Employees' Compensation (FEC) offices concerning segregation of duties for processing a change of address request.

Applicability: Regional Directors, District Directors, Fiscal Officers, Bill Payment Supervisors, Claims personnel, and appropriate National Office personnel.

Reference: FECA Bulletin No. 00-14 issued April 12, 2000.

Action: Satisfactory procedures for handling changes of address in the iFECS Case Management and Compensation Management subsystems include several elements described as follows:

1. Documentation. The action to change an address must be initiated by the claimant/payee or authorized representative in written form. A telephone contact is not sufficient for the Office of Workers' Compensation Programs (OWCP) to change an address. The source document for the address change must be signed and dated by the claimant/payee or the authorized representative. A typical example of a source document would be a letter from the claimant/payee or representative. Another acceptable document for an address change is the SF-1199a used to elect receipt of compensation payments by electronic funds transfer (EFT). An existing EFT address (bank account number and routing number) should be changed in iFECS with a signed SF-1199a form or a similar form generated by the financial institution. While use of the SF-1199a is strongly encouraged, any bank documentation is acceptable so long as it is accompanied by the original signature of the claimant. Documentation should be retained electronically in the case record (Imaging).

2. Personnel. No person with access to the iFECS Compensation Management subsystem will be involved in the certification process of changing addresses for directing compensation payments. This includes address changes for checks and EFT account information. The person certifying the change of address will be non-claims personnel. That is, they are not to have access to any other claims payment options in the iFECS Compensation Management menu. This access level control is achieved through the use of secure logins, secure application programming interfaces, managed client applications and user role definitions—which ultimately restrict each iFECS user's access level to only those functions authorized by his or her supervisor.

Each district office will designate appropriate staff person(s) who will be responsible for certifying changes of address, and the list of such persons will be maintained in the District Director's office. The District Director's list will be updated immediately as changes in this responsibility occur.

3. Process. The staff initiating the change of address will record the new information in the "Update Payee" screen of the Case Admin Tool within the iFECS Case Management subsystem. Once the address information is saved, iFECS will prompt the keyer to send a referral to an authorized certifier via the Case Referral screen. The new address will remain in a pending status until the referral is certified. In Case Referral, the keyer should select "Certify Data Changes" under the "Make Referral" tab, and then select the appropriate option under the "Referral Reason" drop-down box. The keyer should also reference the specific source document in the Referral Instructions text field so the certifier can quickly verify the information. When a certifier receives an address change referral, s/he should review the case file materials referenced and approve or deny the referral based on the accuracy of the updates keyed by the referrer. If the referral is denied, the referring staff should make the necessary corrections and re-refer the changes for certification. Once the new address is certified, the claims staff may continue processing compensation through normal channels.

For cases involving physical address changes only (as opposed to EFT updates) the responsible claims staff will also need to update the iFECS record for directing correspondence. These changes are made separately in the Case Maintenance screen within Case Management. Changes are completed by selecting the "Edit Case Information" option then completing the appropriate text fields in the Employee Data tab. Changes in correspondence address only do not require certification. However, if a claimant/payee is receiving compensation at the time of the address change request, changes to both the correspondence and compensation records should be made at the same time. If the correspondence and compensation addresses do not match when a compensation payment is processed, iFECS will display a pop-up notice advising the keyer of the mismatch. The keyer will need to review the file and decide if additional changes are necessary before proceeding with the payment.

4. Accountability. District office managers must ensure that all affected personnel are aware of this process and recognize its importance. Adherence to these procedures will be monitored biannually in the accountability review process and annually during the Office of Inspector General's (OIG) Consolidated Financial Statement Audit.

Disposition: Retain until incorporated in the FECA Procedure Manual or until further notice.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation


Distribution: List No. 2 - Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Systems Managers, Rehabilitation Specialists and Staff Nurses)

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FECA BULLETIN NO. 08-04

Issue Date: April 30, 2008

 


Expiration Date: December 31, 2008


Subject: Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.

Background: Effective March 19, 2008, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile (POV) was increased to 50.5 cents per mile by the General Services Administration (GSA). No restriction is made as to the number of miles that can be traveled. As in the past, this rate will also apply to disabled Federal Employees' Compensation Act (FECA) beneficiaries traveling to secure necessary medical examination and treatment.

Applicability: Appropriate National Office and District Office personnel.

Reference: Federal (FECA) Procedure Manual Part 5, Benefit Payments, Chapter 204, Principles of Bill Adjudication and 5 U.S.C. § 8103.

Action: The Central Bill Processing (CBP) facility has updated their system to reflect the new rates. Since there is no action required at the District Office level, the rates are being provided for informational purposes only.

The following is a list of the historical mileage rates used to reimburse claimant travel expense:

01/01/1995 – 06/06/1996
06/07/1996 – 09/07/1998
09/08/1998 – 03/31/1999
04/01/1999 – 01/13/2000

30.0 cents per mile
31.0 cents per mile
32.5 cents per mile
31.0 cents per mile

   

01/14/2000 – 01/21/2001
01/22/2001 – 01/20/2002
01/21/2002 – 12/31/2002
01/01/2003 – 12/31/2003
01/01/2004 – 02/03/2005
02/04/2005 – 08/31/2005
09/01/2005 – 12/31/2005

32.5 cents per mile
34.5 cents per mile
36.5 cents per mile
36.0 cents per mile
37.5 cents per mile
40.5 cents per mile
48.5 cents per mile

   

01/01/2006 – 01/31/2007
02/01/2007 – 03/18/2008
03/19/2008 – Current

44.5 cents per mile
48.5 cents per mile
50.5 cents per mile

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.


DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2 -- Folioviews Groups A, B and D
(Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Staff Nurses, Rehabilitation Specialists and Fiscal Personnel).

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FECA BULLETIN NO. 07-01

Issue Date: January 31, 2007

 


Expiration Date: January 31, 2008


Subject: Periodic Entitlement Review Management (PER) – Use of iFECS Application.

Background: Payment on the periodic roll is an efficient method of ensuring regular payments of compensation to those with long-term compensable disabilities. After payment has begun, the claims examiner (CE) is responsible for periodic review of active cases to ensure that payments are correct and to document continuing entitlement. Historically, CEs have annually recorded information from incoming completed CA-1032 forms on the Checklist for Disability Roll Cases, form CA-674. The CA-674 was placed in the file and the CE took any necessary case management action based upon the claimant's responses. With the deployment of the Integrated Federal Employees' Compensation System (iFECS), the CE should document the annual review within Disability Management using the Periodic Entitlement Review Management (PER) application.

Purpose: To implement uniform procedures in the use of the PER application in iFECS to track and record Form CA-1032 data. The PER effectively replaces Form CA-674 in recording claimants' earnings, dependency and continuing disability status.

Applicability: Appropriate National and District Office personnel.

Reference: Chapter 2-0812, Periodic Review of Disability Cases, Federal (FECA) Procedure Manual.

Action:

1. Each month the District Office (DO) generates and mails Form CA-1032 to a set of claimants on the office's periodic compensation rolls. Tasks are automatically generated in iFECS to remind the claims examiner (CE) when the CA-1032 review is due and a PER record is automatically generated in the Periodic Entitlement Review Management application in iFECS.

2. The PER record reflects the current benefit level and compensation rate, the CA-1032 issue date and any dependents. The CE should input the date of any follow-up requests for completion of the CA-1032 and the date of receipt of the CA-1032. The CE should review the updated information from the CA-1032 and match it against the current entitlement records in file.

3. The CE should enter into the PER record the date of the medical report(s) used to establish continuing disability and causal relationship.

3. If additional development is needed to follow-up or verify responses to determine entitlement, the CE should set a reminder in iFECS and follow-up timely according to existing procedures. The PER contains a drop-down menu in the "PER action to be taken" section and the CE should select the appropriate action as follows:

NC – No Payment/Entitlement Change
NI – PN Memo in Development
SI – Payment/Entitlement Suspension in Development
TI – Payment/Entitlement Termination in Development
UD – Under Development

4. Once all development is complete, the CE should so indicate in the PER application and input the date all development was completed.

Disposition: Retain until the indicated expiration date or until incorporated in the FECA Procedure Manual.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2 – Folio Views Groups A, B, and D
(Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA BULLETIN NO. 07-02

Issue Date: August 1, 2007

 


Expiration Date: December 31, 2007


Subject: Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.

Background: Effective February 1, 2007, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile (POV) increased to 48.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, this rate will also apply to disabled FECA beneficiaries who travel by POV to secure necessary medical examination and treatment.

Applicability: Appropriate National Office and District Office personnel.

Reference: Chapter 5-0204, Principles of Bill Adjudication, Part5, Benefit Payments, Federal (FECA) Procedure Manual and 5 USC § 8103.

Action: The Central Bill Processing (CBP) facility has updated their system to reflect the new rates. Since there is no action required at the District Office level, the rates are being provided for informational purposes only.

The following is a list of the historical mileage rates used to reimburse claimant travel expense:

01/01/1995 – 06/06/1996
06/07/1996 – 09/07/1998
09/08/1998 – 03/31/1999
04/01/1999 – 01/13/2000

30.0 cents per mile
31.0 cents per mile
32.5 cents per mile
31.0 cents per mile

   

01/14/2000 – 01/21/2001
01/22/2001 – 01/20/2002
01/21/2002 – 12/31/2002
01/01/2003 – 12/31/2003

32.5 cents per mile
34.5 cents per mile
36.5 cents per mile
36.0 cents per mile

   

01/01/2004 – 02/03/2005
02/04/2005 – 08/31/2005
09/01/2005 – 12/31/2005

37.5 cents per mile
40.5 cents per mile
48.5 cents per mile

   

01/01/2006 – 01/31/2007
02/01/2007 – Current

44.5 cents per mile
48.5 cents per mile

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.

 

Douglas C. Fitzgerald
Director for
Federal Employees' Compensation

Distribution: List No. 2 -- Folioviews Groups A, B and D
(Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Staff Nurses, Rehabilitation Specialists and Fiscal Personnel).

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FECA BULLETIN NO. 07-03

Issue Date: August 1, 2007

 


Expiration Date: January 1, 2007


Subject: Compensation Pay - Compensation Rate Changes Effective January 2007.

Background: On December 21, 2006, the President signed Executive Order 13420 implementing a salary increase of 1.70 percent in the General Schedule basic pay. The applicability under 5 U.S.C. 8112 only includes the 1.70 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment became effective at the start of the first full pay period after January 1, 2007.

Purpose: To inform the appropriate personnel of the increased minimum/maximum rates of compensation, and the adjustment procedures for affected cases on the periodic disability and death payrolls.

The new rates were effective with the first compensation payroll period beginning on or after January 1, 2007. Thus, for daily roll supplemental payments January 7, 2007, is the specific effective date of the increase. The effective date for the increase of periodic and death roll payments will be January 21, 2007. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, step 10, which is now $120,981 per annum. The basis for the minimum compensation rate is the salary of a GS-2, Step 1 which is $18,698 per annum.

The minimum increase specified in this Bulletin is applicable to employees of the U.S. Postal Service.

The effect on 5 U.S.C. 8112 is to increase the payment of compensation for disability claims to:

Effective January 7, 2007

Minimum

Maximum

 

28-Day Cycle
Weekly
Daily (5-day week)

$1,078.72
269.69
53.94

$6,979.68
1,744.92
348.98

 

The effect on 5 U.S.C. 8133(e) is to increase the monthly pay on which compensation for death is computed to:

Effective January 7, 2007

Minimum

Maximum

 

Monthly

$1,558.16

$7,561.31

 

Applicability: Appropriate National and District Office personnel

Reference: Memorandum for Executive Heads of Departments and Agencies dated December 21, 2006; and the attachment for the 2007 General Schedule.

Action: The iFECS will update the periodic disability and death payrolls. It should be noted that this adjustment process re-calculates EVERY compensation record from its very beginning to the current date. Thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect.

Any cases with gross overrides will not have a supplemental record or make a separate calculation of additional entitlement. Consequently, the cases with gross overrides must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required and the case record documented. A notice should be sent to the payee by the District Office, detailing the change in the rate of compensation.

1. Adjustments Dates.

a. As the effective date of the adjustment was January 21, 2007 for the periodic disability and death rolls, there was no supplemental payroll needed. The February 17, 2007 death and disability payments will include any necessary minimum/maximum compensation adjustments.

b. The new minimum/maximum compensation rates were available in iFECS on January 20, 2007.

2. Adjustment of Daily Roll Payments. The salary adjustments are not retroactive, so it is assumed that all Federal agencies have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2007. Therefore, it is not necessary to review any of these payments.

However, if an inquiry is received then verification of the pay rate must be secured from the employing agency, and the necessary adjustment applied.

3. Minimum and Maximum Adjustment Listings. Form CA-842, Minimum Compensation Pay Rates, and Form CA-843, Maximum Compensation Rates, should be annotated with the new rate information as follows:

CA-842 - 01/07/2007

 

 

53.94-80.91

269.68-404.52

53.94

269.68 (1,078.72) 1,558.16

53.94-71.92

269.68-359.58

   

CA-843 - 01/07/2007

   

348.98

1,744.92(6,979.68)

7,561.31

Disposition: This Bulletin should be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.

 

DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation

 

Distribution: List No. 2 – Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitations Specialists and Staff Nurses)

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FECA BULLETIN NO. 07-04

Issue Date: March 1, 2007

 


Expiration Date: February 28, 2008


Subject: Comp Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2007.

Purpose: To furnish instructions on CPI adjustment implementation of March 1, 2007.

1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 2.4 percent.

2. The increase is effective March 1, 2007, and is applicable where disability or death occurred before March 1, 2006.

3. The new base month is December 2006.

4. The maximum compensation rates, which must not be exceeded, are the following:

$ 7,561.31
1,744.92
6,979.68
348.98

per month
per week
each four weeks
per day (for a 5 day week)

Applicability: Appropriate National Office and District Office personnel.

Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981.

Action: National Office Production staff will update the iFECS CPI tables and have all payment records re-calculated, on or about April 4, 2007, when the iFECS system is not in use by District Office personnel. If there are any cases with fixed gross overrides there will be no supplemental record created. These cases must be reviewed to determine if CPI adjustments are necessary, and if so, a manual calculation will be required. If the gross override payment is in fact eligible for annual CPI increases, the payment plate should be adjusted in the iFECS system to pay as a "Gross Override with CPI".

1. Adjustment Dates.

a. As the effective date of the CPI is March 1, 2007, and the start date of the periodic and death payroll cycles is February 18, 2007, there will be a supplemental record created for the period March 1 through March 17, 2007. Payment of this supplemental record will be combined with the April 14, 2007 periodic and death payrolls. A separate payment will not be issued for the March 1 through March 17, 2007 increase amount, as in previous years. Effective May 13, 2007, the periodic and death payrolls will reflect the increased amount of the regular death and periodic payrolls.

b. All tables in the iFECS system will be updated with the new CPI percentage. This update will be performed for all district offices by the iFECS Production staff in the National Office.

2. CPI, Minimum and Maximum Adjustments Listings. Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated with the new information. Attached to this directive is a complete list of all the CPI increases and effective dates since October 1, 1966 through March 1, 2007.

3. Forms.

a. All claimants will be provided a notice with the Benefit Statement dated April 14, 2007, indicating that a CPI of 2.4% will be applied to all eligible cases. The notice will also advise the claimant of upcoming increases in their compensation pay, including the supplemental CPI payment and the new periodic payment beginning on May 13, 2007. The Treasury will include this notice as a "stuffer card" with every Benefit Statement issued for the April 14, 2007 rolls.

b. Beginning with the compensation payment cycle that covers April 15, 2007, to May 12, 2007, the Office will issue an updated monthly Benefit Statement to each individual receiving benefits on the 28-day periodic roll cycle. This Benefit Statement will indicate the gross amount of compensation, period of compensation covered by the statement and the pertinent deductions made from the gross compensation. For compensation payments made via paper checks, the Benefit Statement will accompany the check. For compensation payments made through Electronic Fund Transfer (EFT), the Benefit Statement will be mailed separately.

c. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc.), please provide this data in letter form from the district office. Sometimes a Benefit Statement may not reach the addressee and regeneration of the form is not possible. A letter indicating the amount of compensation paid every four weeks will be an adequate substitute for this purpose.

Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.

 

Douglas C. Fitzgerald
Director for
Federal Employees' Compensation

 

Attachment

Distribution: List No. 2 --Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants and Rehabilitation Specialists)

 

COST-OF-LIVING ADJUSTMENTS

Under 5 USC 8146(a)

EFFECTIVE DATE

RATE

EFFECTIVE DATE

RATE

10/01/66
01/01/68
12/01/68
09/01/69
06/01/70
03/01/71
05/01/72
06/01/73
01/01/74
07/01/74
11/01/74
06/01/75
01/01/76
11/01/76
07/01/77
05/01/78
11/01/78
05/01/79
10/01/79
04/01/80
09/01/80
03/01/81
03/01/82
03/01/83
03/01/84
03/01/85
03/01/86

12.5%
3.7%
4.0%
4.4%
4.4%
4.0%
3.9%
4.8%
5.2%
5.3%
6.3%
4.1%
4.4%
4.2%
4.9%
5.3%
4.9%
5.5%
5.6%
7.2%
4.0%
3.6%
8.7%
3.9%
3.3%
3.5%
N/A

03/01/87
03/01/88
03/01/89
03/01/90
03/01/91
03/01/92
03/01/93
03/01/94
03/01/94
03/01/95
03/01/96
03/01/97
03/01/98
03/01/99
03/01/00
03/01/01
03/01/02
03/01/03
03/01/04
03/01/05
03/01/06
03/01/07

0.7%
4.5%
4.4%
4.5%
6.1%
2.8%
2.9%
2.5%
2.5%
2.7%
2.5%
3.3%
1.5%
1.6%
2.8%
3.3%
1.3%
2.4%
1.6%
3.4%
3.5%
2.4%

Prior to 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).

Prior to 11/01/74

.08-.34 = .23
.35-.57 = .46
.58-.80 = .69
.81-.07 = .92

Eff. 11/01/74

.13-.37 = .25
.38-.62 = .50
.63-.87 = .75
.88-.12 = 1.00

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FECA BULLETIN NO. 06-01

Issue Date: March 1, 2006

 


Expiration Date: January 1, 2007


Subject: Compensation Pay - Compensation Rate Changes Effective January 2006.

Background: On December 22, 2005, the President signed Executive Order 13393 implementing a salary increase of 2.10 percent in the General Schedule basic pay. The applicability under 5 U.S.C. § 8112 only includes the 2.10 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment becomes effective at the start of the first full pay period after January 1, 2006.

Purpose: To inform the appropriate Office personnel of the increased minimum/maximum rates of compensation and the adjustment procedures for affected cases on the periodic disability and death payrolls.

The new rates were effective with the first compensation payroll period beginning on or after January 1, 2006. Thus, for daily roll supplemental payments January 8, 2006 is the specific effective date of the increase. The effective date for the increase of periodic and death roll payments will be January 22, 2006. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $118,957 per annum. The basis for the minimum compensation rate is the salary of a GS-2, Step 1 employee which is now $18,385 per annum.

The minimum increase specified in this Bulletin is applicable to employees of the U.S. Postal Service.

The effect on 5 U.S.C. § 8112 is to increase the payment of compensation for disability claims to:

Effective January 8, 2006

Minimum

Maximum

 

28-Day Cycle
Weekly
Daily (5-day week)

$1,060.68
265.17
53.03

$6,862.88
1,715.72
343.14

 

The effect on 5 U.S.C. § 8133(e) is to increase the monthly pay on which compensation for death is computed to:

Effective January 8, 2006

Minimum

Maximum

 

Monthly

$1,532.08

$7,434.81

 

Applicability: Appropriate National and District Office personnel

Reference: Memorandum for Executive Heads of Departments and Agencies dated December 22, 2006; and the attachment for the 2006 General Schedule.

Action: The iFECS will update periodic disability and death payrolls automatically. It should be noted that this adjustment process re-calculates EVERY compensation record from its very beginning to current date. Thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect.

Any cases with gross overrides will not have a supplemental record or make a separate calculation of additional entitlement. Thus, the cases with gross overrides must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required and the case record documented. A notice should be sent to the payee by the District Office, detailing the change in the rate of compensation.

1. Adjustments Dates.

a. As the effective date of the adjustment was January 22, 2006, for the periodic disability and death rolls, there was no supplemental payroll needed. The February 18, 2006 death and disability payments will include any necessary minimum/maximum compensation adjustments.

b. The new minimum/maximum compensation rates were available in iFECS on February 6, 2006.

2. Adjustment of Daily Roll Payments. The salary adjustments are not retroactive, so it is assumed that all Federal agencies have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2006. Therefore, it is not necessary to review any of these payments.

However, if an inquiry is received then verification of the pay rate must be secured from the employing agency, and the necessary adjustment applied.

3. Minimum and Maximum Adjustment Listings. Form CA-842, Minimum Compensation Pay Rates, and Form CA-843, Maximum Compensation Rates, should be annotated with the new rate information as follows:

 

CA-842 - 01/08/2006

 

 

53.03-79.55

265.17-397.76

53.03 265.17(1,060.68)

1,532.08

53.03-70.71

265.17-353.56

   

CA-843 - 01/08/2006

   

343.14

 

1,715.72(6,862.88)

7,434.81

Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims
Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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FECA BULLETIN NO. 06-02

Issue Date: March 1, 2006

 


Expiration Date: December 31, 2006


Subject: Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Vehicles Necessary to Secure Medical Examination and Treatment.

Background: Effective January 1, 2006, the mileage rate for reimbursement to Federal employees traveling by privately-owned vehicle (POV) was decreased to 44.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, this rate will also apply to individuals covered by the FECA who travel by POV in order to obtain necessary medical examination and treatment.

Applicability: Appropriate National Office and District Office personnel.

Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 5, Benefit Payments, Federal (FECA) Procedure Manual and 5 U.S.C. § 8103.

Action: The Central Bill Processing (CBP) facility has updated their system to reflect the new rates. Since there is no action required at the District Office level, the rates are being provided for informational purposes only.

The following is a list of the historical mileage rates used to reimburse claimant travel expense:

01/01/1995 – 06/06/1996
06/07/1996 – 09/07/1998
09/08/1998 – 03/31/1999
04/01/1999 – 01/13/2000

30.0 cents per mile
31.0 cents per mile
32.5 cents per mile
31.0 cents per mile

   

01/14/2000 – 01/21/2001
01/22/2001 – 01/20/2002
01/21/2002 – 12/31/2002
01/01/2003 – 12/31/2003

32.5 cents per mile
34.5 cents per mile
36.5 cents per mile
36.0 cents per mile

   

01/01/2004 – 02/03/2005
02/04/2005 – 08/31/2005
09/01/2005 – 12/31/2005
01/01/2006 – Current

37.5 cents per mile
40.5 cents per mile
48.5 cents per mile
44.5 cents per mile

Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.

 

DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation

Distribution: List No. 2 - Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)

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