1997 FECA Bulletins Archive

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-02

Issue Date: October 15, 1996

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Expiration Date: October 14, 1997

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Subject: ADP - "Reengineered" Coding Scheme and Data Entry for the Quality Case Management (QCM) System.

Background: Commencing in January 1995 the QCM/Time Management Team began developing a plan to streamline the QCM tracking system. During the months since then the team proposed various changes focusing primarily on making QCM data entry more "user-friendly." With considerable group effort, including input from district office management and QCM users, and through discussions with National Office staff, the team put forth its final recommendations this past May. With only a few minor exceptions, the proposed changes have now been incorporated into the QCM system. Associated changes in the QCM reports and in the Disability Tracking system have also been implemented.

Reference: FECA Bulletin 93-10, issued July 28, 1993, FECA Bulletin 94-11, issued November 29, 1993, FECA Bulletin 94-14, issued January 20, 1994, FECA Bulletin 94-24, issued August 5, 1994 and FECA Bulletin 95-13, issued February 28, 1995.

Purpose: To notify all QCM users and DFEC managers of the revised coding scheme and system enhancements for the Quality Case Management and Disability Tracking functions on the Sequent system.

Applicability: Claims Examiners, Senior Claims Examiners, Supervisors, Rehabilitation Specialists, Staff Nurses, Fiscal Personnel, Technical Assistants and Systems Managers.

Action:

1. Under the new scheme there are now 27 mandatory and 46 optional QCM status codes available to users (see Attachment 1). The mandatory codes must be used in all cases, as appropriate, in order to properly track QCM actions and to accurately measure performance. Optional codes will have no significance in the measurement of performance. Also, individual optional codes may be designated "active" or "inactive" within each district office. Optional codes that are designated "inactive" will not be accessible to the users of the system.

2. In the QCM data entry screen (option 35 in the Case Management menu), the mandatory status codes will be listed in the pop-up window (ADD STATUS) under four activity headings. The "active" optional codes, if any, will appear under a fifth heading. The Page Up/Page Down keys may be used to move quickly between the code groups while the Up/Down arrow keys may be used to scroll through the entire list of codes.

3. A new date field (d18_track_date) has been added to the QCM header record. This date will be displayed as the "TRACK DT:" in place of the "DWLB:" in the QCM screens. In most cases this date will reflect the "Disab Date" for the Disability Tracking record associated with the QCM case. However, for cases where the claimant had returned to light duty work prior to the creation of the QCM record the "TRACK DT" will be the same as the QCM Start Date.

QCM performance will now be based on the Track Date rather than the Disab Date (DWLB). Accordingly, where the claimant is already working in a light duty capacity when the case comes under QCM the one-year and two-year tiers for resolving the case will run from the date the case drops into QCM rather than from the date the claimant stopped work.

4. The "QCM CE:" code displayed in the header will now reflect the responsible examiner (RCE) code value associated with each QCM record. The initial value for this field will automatically be copied from the CMF when a QCM record is created. Unless changed manually by the user, this code will remain on the QCM record even if the RCE code is subsequently changed in the CMF. No changes to this field will be permitted on closed QCM cases.

The QCM header has also been modified to allow for the entry of two lines (160 characters) of text.

5. In addition to the many optional QCM status codes which will not be discussed in detail (see Attachment 1), several mandatory status codes have been added. The current list of mandatory codes, including any changes in their descriptions and defined uses, are detailed below. The nine listed with an asterisk (*) are the "intervention" codes under the new scheme.

 

CLAIMS EXAMINER ACTIVITY STATUS CODES

Code	Description
OIC*	(Other Intervention by CE) This code is significantly re-defined as CE or SrCE contact with the claimant, agency or physician to discuss a return to work date and the availability of limited duty. The following qualifies for use of this code:
	a. Telephone contact with the claimant which includes at a minimum, a discussion about the anticipated return to work date (or return to regular work); what the present limitations are and why these limitations preclude any work whatsoever (or preclude return to the regular job), and; whether the employer has been contacted concerning the availability of limited duty. The conversation should be substantive and should serve as a reminder to the claimant of his/her responsibility to return to work.
	b. Telephone or written contact with the employer to discuss the availability of limited duty for the injured employee; to discuss the limitations, and; to solicit a job offer. The work restrictions should actually be available on the date of the conversation/letter.
	c. Telephone contact with the physician to discuss the reasons for the continuing disability; to request a work release, and; to request the anticipated date of release to regular duty.
	A conversation concerning bill payment, compensation payments or other case issues will not qualify for the use of this. Also, if OIC is used based upon a telephone call, the conversation must be fully documented. "OIC" should be pencilled on the corner of the qualifying CA-110, letter or other document for easy identification. This code may be used more than once on a given QCM record.
QAP*	(Questions to Attending Physician) This new code applies to the situation where the claims examiner releases a letter to the attending physician posing pointed questions regarding the extent and duration of disability. Simply requesting a current report from the attending physician will not be considered sufficient for use of this code.
CON*	(Conference Held) No change.
MSI*	(Secop Initiated) The status effective date is now defined as the date of the exam (a future date will be allowed).
MRI*	(Referee Exam Initiated) The status effective date is now defined as the date of the exam (a future date will be allowed).

 

NURSE/REHAB ACTIVITY STATUS CODES

Code	Description
NFN*	(Referred to Field Nurse) No change.
NIN	(Nurse Interrupt) This code, which was added last January, will be used in situations where the services of the nurse are interrupted but are expected to resume at a later date. An example of the use of this code is where the claimant undergoes surgery that will require a period of recovery during which nurse services are inappropriate.
RRC*	(Referred to Rehab Counselor) This new code will be used to indicate referral of the case to a rehabilitation counselor.
RCL	(Rehab Case Closed - No RTW) This new code applies to all cases closed by the rehabilitation specialist without a return to work.
RLT*	(Eventual Reduction via Rehab (Ltr Sent by CE)) No change.
RTR*	(In Approved OWCP Vocational Training) No change.

 

WORK STATUS CODES

Code	Description
PLP	(Pre-QCM RTW Light Duty/Part Time) This code will apply to all situations where the claimant returns to part-time work prior to the case coming under QCM.
PLF	(Pre-QCM RTW Light Duty/Full Time) No change.
NLP	(RTW via Nurse; Light Duty/Part Time) This new code applies to all situations where the claimant returns to part-time work via the nurse. (This code may also be entered in cases that already have a PLP code. However, such an entry is proper only if the claimant's work hours are actually increased through the intervention of the nurse.)
NLF	(RTW via Nurse; Light Duty/Full Time) No change.
RLP	(RTW via Rehab; Light Duty/Part Time) This new code applies to all situations where the claimant returns to part-time work via rehab. (This code may also be entered in cases that already have a PLP code. However, such an entry is proper only if the claimant's work hours are actually increased through the intervention of the rehabilitation counselor.)
RLF	(RTW via Rehab; Light Duty/Full Time) No change.
MLP	(RTW via CE; Light Duty/Part Time) This new code applies to all situations where the claimant returns to part-time work other than through nurse intervention or rehabilitation services. However, there must be some identifiable intervention by the claims examiner, such as referral of the claimant for a second opinion evaluation, posing pointed questions to the attending physician regarding extent and duration of disability, or other intervention described under OIC above, in order to attribute the return to work to QCM and justify the use of this code. (This code may also be entered in cases that already have a PLP code. However, such an entry is proper only if the claimant's work hours are actually increased through the intervention of the claims examiner.)
MLF	(RTW via CE; Light Duty/Full Time) This new code applies to all situations where the claimant returns to light duty work on a full-time basis other than through nurse intervention or rehabilitation services. However, there must be some identifiable intervention by the claims examiner, such as referral of the claimant for a second opinion evaluation, posing pointed questions to the attending physician regarding extent and duration of disability, or other intervention described under OIC above, in order to attribute the return to work to QCM and justify the use of this code.

 

CLOSURE STATUS CODES

Code	Description
CFF	(Closed - RTW (DOI or Pre-established LWEC Job) Used in all cases where the claimant returns to full duty under QCM.
CNL	(Closed - RTW (Not DOI Job; 0% LWEC Decision)) No change.
CCO	(Closed - Comp Order No Disability) No change.
CSA	(Closed - Sanctions Imposed (or Comp Not Claimed)) In addition to designating a sanction decision, this code will now also be used in situations where the claimant elects OPM benefits or otherwise stops claiming compensation benefits. As with cases involving the imposition of sanctions, such cases are subject to reopening at the claimant's choosing. CSA is the only "successfully resolved" closure code where the case may be reopened by simply entering a later status code into the QCM record. With this "reopen" mechanism in place, QCM activity may continue to be tracked in cases where the sanctions are lifted or the claimant chooses to again receive compensation benefits.
CAE	(Closed - LWEC on Actual Earnings) No change.
CLW	(Closed - Constructed LWEC) No change.
CRN	(Recurrence/New Injury Following RTW Light Duty) This new code will be used in all cases where the claimant sustains a recurrence or a new injury while under QCM. Cases closed with this code will be scored as "resolved successfully" only where there exists an earlier status for a return to work attributable to QCM intervention (i.e., NLP, NLF, RLP, RLF, MLP, MLF). Where no such code exists the user will be prompted "OK to zero out this QCM record? Y/N:". If the user presses "Y" the CRN code will be added and case will automatically be set to category "0". Otherwise, the code entry will be aborted.
CPN	(Closed - Unable to Work (PN memo)) No change.

6. As part of the implementation of the new coding scheme some existing QCM status records have been deleted and others have been converted using new status codes, with revised descriptions, to replace the old code values. For example, existing QCM status records with old code NFC (1st FN Contact w/CE date) or OIC (Initial Call to Claimant) have been deleted from the database. Existing records with status code NCR (Ret'd to CE - Rehab Recommended) or NCS (Ret'd to CE - Second Opinion Recommended), have been converted to the new optional code NCO (Nurse Case Closed - Claimant Cooperative).

Further conversion of existing records has occurred as follows:

PL4 or PL6 (Pre-QCM RTW Light Duty/...) Earliest record updated to new code PLP and any subsequent record deleted.

NL4 or NL6 (RTW via Nurse; Light Duty/...) Earliest record updated to new code NLP and any subsequent record deleted.

RL4 or RL6 (RTW via Rehab; Light Duty/...) Earliest record updated to new code RLP and any subsequent record deleted.

NFF (RTW via Nurse; Full Duty/Full Time) Updated to code CFF.

CRE (Closed - Pre-QCM RTW Light Duty; Recur/New Injury) Updated to new code CRN.

NCW (Recurrence/New Injury Following RTW Light Duty) Updated to new code CRN.

RRS (Referred to Rehab) Updated to new code RRC.

RS1 (RS Closed on Referral) Updated to new code RCL.

RS5 (Closed Other) Updated to new code RCL.

In addition to the deletion and/or conversion of records, four of the old status codes have been made optional: NSN - Referred to Staff Nurse; NCN - Nurse Case Closed - Claimant Not Cooperative; MSC - Secop Exam Completed; MRC - Referee Exam Completed. Existing records with these status codes have not been disturbed.

7. Users of the QCM system will note a number of changes in the data entry edits and screen messages displayed in particular circumstances. For example, the system will prevent the entry of a "resolved" status code (NLP, MLP, RLP, NLF, RLF, MLF, CFF, CNL, CCO, CSA, CAE, CLW, CPN) in a case where no prior "intervention" code exists. The message "Status Not Valid Without Prior Intervention Code" will be displayed in that situation. A similar edit will prevent the deletion of the only remaining "intervention" code if a "resolved" code exists.

8. The data entry edits in the Disability Tracking system (option 36 in the Case Management menu) have also been revised slightly. The edit that prevented users from entering a "D" (Denied) status on a record with an associated RTW code has been removed. Also, for any record that is associated with a QCM record that has been "zero-ed out", the user may not change the status from "A" to another value without deleting the associated QCM record. A prompt "Status change will cause deletion of associated QCM record. Proceed? Y/N" will be displayed and the user may abort the change by pressing "N".

9. Changes have been made to several reports to accommodate the new QCM coding scheme. The changes are as follows:

CASE630 - QCM TRACKING: This report has been dropped from the FECS menu.

CASE633 - QCM NO INTERVENTION: This report has been modified to list QCM cases that do not have one of the nine qualifying "intervention" codes.

CASE611 - QCM QUARTERLY REVIEW AND ANALYSIS: This report has been revised significantly.

- QCM cohorts will now be based upon the "TRACK DT" rather than the "DWLB" (see paragraph 3 above).

- The report will list counts only for the mandatory status codes. Accordingly, several rows have been deleted and others have been added to the report. Cases with only optional status codes will be counted as having "no status."

- For cohorts over one-year old, the upper part of the report will show "0" counts for codes that qualify as a successful resolution only during the first year (RLT, NLP, NLF, MLP, MLF, RLP, RLF). The lower part of the report has been expanded to list the counts for these codes in the over one-year old cohorts. With this change, the "RESOLVED TOTALS" will actually represent the sum of the individual code counts in the upper part of the report.

10. A new option (UPDATV36 - RE-SET OPTIONAL QCM CODES) has been added to the FECS004 menu under "CASE MANAGEMENT". Accessible by System Managers, this option will enable each office to "activate" or "deactivate" any or all of the optional QCM status codes, as desired. With the initial installation of these revised QCM programs and code tables, certain optional codes were "activated" as requested by the individual district offices.

Disposition: This Bulletin should be retained until the indicated expiration date.

 

THOMAS M. MARKEY
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)

Attachment 1 to FECA Bulletin 97-02

QCM STATUS CODES

STATUS	DESCRIPTION
CLAIMS EXAMINER ACTIVITY STATUS CODES
OIC	Other Intervention by CE
QAP	Questions to Attending Physician
CON	Conference Held
MSI	Secop Initiated
MRI	Referee Exam Initiated
NURSE/REHAB ACTIVITY STATUS CODES
NFN	Referred to Field Nurse
NIN	Nurse Interrupt
RR	Referred to Rehab Counselor
RCL	Rehab Case Closed - No RTW
RLT	Eventual Reduction via Rehab (Ltr Sent by CE)
RTR	In Approved OWCP Vocational Training
WORK STATUS CODES
PLP	Pre-QCM RTW Light Duty/Part Time
PLF	Pre-QCM RTW Light Duty/Full Time
NLP	RTW via Nurse; Light Duty/Part Time
NLF	RTW via Nurse; Light Duty/Full Time
MLP	RTW via CE; Light Duty/Part Time
MLF	RTW via CE; Light Duty/Full Time
RLP	RTW via Rehab; Light Duty/Part Time
RLF	RTW via Rehab; Light Duty/Full Time
CLOSURE STATUS CODES
CFF	Closed - RTW (DOI or Pre-established LWEC Job)
CNL	Closed - RTW (Not DOI Job; 0% LWEC Decision)
CCO	Closed - Comp Order No Disability
CSA	Closed - Sanctions Imposed (or Comp Not Claimed)
CAE	Closed - LWEC on Actual Earnings
CLW	Closed - Constructed LWEC
CRN	Recurrence/New Injury Following RTW Light Duty
CPN	Closed - Unable to Work (PN memo)
PROCESS STATUS CODES (OPTIONAL)
DEL	Delayed Development
IAE	Interim Actual Earnings (No Formal LWEC)
NFE	Field Nurse Extension Granted
JOL	Suitable Job Offer Letter Issued
MIN	Medical Interruption of QCM Activity
MRC	Referee Exam Completed
MRF	Referee Exam Follow-up
MSC	Secop Exam Completed
MSF	Secop Exam Follow-up
NCE	Discussion of Case between CE and Nurse
NCN	Nurse Case Closed - Claimant Not Cooperative
NCO	Nurse Case Closed - Claimant Cooperative
NRC	Referred to CAP Nurse
NSN	Referred to Staff Nurse
OPM	OPM Elected (Use CSA Code to Close Case)
Attachment 1 to FECA Bulletin 97-02 (continued)
QCM STATUS CODES
STATUS	DESCRIPTION
PROCESS STATUS CODES (OPTIONAL) (continued)
PL4	Pre-QCM RTW Light Duty/4 hrs
PL6	Pre-QCM RTW Light Duty/6 hrs
NL4	RTW via Nurse; Light Duty/4 hrs
NL6	RTW via Nurse; Light Duty/6 hrs
ML4	RTW via CE; Light Duty/4 hrs
ML6	RTW via CE; Light Duty/6 hrs
PRL	Pre-reduction Notice Letter Issued
PTL	Pre-termination Notice Letter Issued
RHA	Initial Interview Held
RHC	Returned to Claims Examiner
RHD	Plan Development
RHE	Employed
RHG	Assisted Re-employment Program
RHI	Rehab Plan in Place
RHM	Medical Rehabilitation
RHN	Placement Previous Employer - Without Other Srvcs
RHP	Placement New Employer
RHQ	Screened
RHR	Referred to RS
RHS	Self Employment
RHT	Training
RHV	Employed, Assisted Reemployment Prog; RC Follow Up
RHW	Placement Previous Employer - With Other Services
RHX	Services Interrupted
RHZ	Post Employment Services
RDP	Rehab Development Plan in Progress
RWL	Rehab Non-cooperation 30-day Warning Ltr
SRE	Referred to SrCE for Conference
SUR	Surgery Authorized
TTD	Continuing Total Disability per Secop/Referee
TML	10-month Letter Issued

 

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-03

Issue Date: October 15, 1996

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Expiration Date: October 14, 1997

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Subject: ADP - New Case Management File (CMF) Data Elements and New "Case Create" and "Case Change" Coding Requirements.

Background: When employing agencies do not to promptly submit injury notices and claim forms to OWCP, it often results in the initial rejection of medical bills and other claims that could otherwise be paid. To better serve claimants and to avoid unnecessary delays in issuing payments, we have been emphasizing to employing agencies the importance of submitting claims involving lost time and/or medical expenses to OWCP in a timely fashion. In order to monitor performance in this area, a new date field has been added to the CMF database. This field will be used during the "case create" process to record the date the employing agency receives the CA-1 or CA-2 claim form.

Other data elements have been added to the CMF to facilitate the identification of potential "dual benefits" cases, especially with respect to claimants employed under the Federal Employees' Retirement System (FERS). In addition, the CMF now includes data elements that will be used to record changes in the adjudication status of a case.

Reference: FECA Bulletin 95-23, issued August 28, 1995.

Purpose: To notify district offices of the new data entry requirements and screen display changes relating to the data elements that have been added to the CMF.

Applicability: Appropriate District Office and National Office personnel.

Action:

1. In the CASE CREATE screen (option 1 of the CASE MANAGEMENT menu) users will note a new data entry field labeled "Agency Received Date". The entry of a valid date in this field is required for any case being created based upon the receipt of form CA-1 or CA-2. A date in this field is optional for other form types.

Form CA-1: For cases being created from form CA-1 the date to be entered as the "Agency Received Date" should be the date listed in item 22 (Date notice received) of the form. If no date is listed in item 22 then, as a last resort, the date listed in item 11 (Date of this notice) should be used. The CA-1 form should be returned to the employing agency for completion if no date is entered in either of these items.

After entering the "Agency Received Date" the screen will display the prompt "ITEM 38 OF CA-1 INDICATES 'NO LOST TIME AND NO MEDICAL EXPENSE:'? Y/N". Depending upon whether this box is checked in item 38 the user should press "Y" or "N", as appropriate. If the user presses "Y" a special code will be entered in the CMF record so that these cases may be excluded from analyses of agency time-lag in submitting CA-1s.

Form CA-2: For cases being created from form CA-2 the date to be entered as the "Agency Received Date" should be the later of the date of the employee's signature (item 18) or the date listed in item 26 (Date employee first reported condition to supervisor). The CA-2 form should be returned to the employing agency for completion if no date is entered for either of these items.

2. In addition to the "Agency Received Date", users will note three new data fields in the CASE CHANGE screen (option 2 of the CASE MANAGEMENT menu).

SERVICE COMP DATE: If known, the claimant's Federal "service computation date" should be entered in this field.

OPM RETIREMENT NUMBER and OPM RETIREMENT DATE: For a claimant who is retired or is continuing in Federal service as a "reemployed annuitant", the retirement claim number and effective date, if known, should be entered in these fields.

These new data fields display also in the CASE SEARCH screen (option 2 of the QUERY menu.)

3. The STATUS/ACCEPTED COND screen (option 9 of the CASE MANAGEMENT menu) and the CASE STATUS INFORMATION screen (option 15 of the QUERY menu) will now display the "Short Form Reopen Date" for cases where this is applicable. These screens will also display up to three previous adjudication status codes and dates under the heading "Adjudication History". The "Initial", "Prior" and "Post Short Form" adjudication codes and dates will be displayed, as applicable.

The "Initial" adjudication data will be permanently recorded in the CMF only when an adjudication code is entered where none previously existed. This includes cases that are closed "short form" at the time of "case create".

The "Prior" adjudication data will be captured in the CMF record whenever a new adjudication status is entered in place of an existing code. This includes "short form" closure cases that are reopened. The "Prior" adjudication data will be overwritten in the CMF record whenever a new adjudication status is entered.

The "Post Short Form" adjudication data applies only to "short form" closure cases that have been reopened and are adjudicated after the implementation of these system changes. The adjudication code and date entered in such cases will be permanently recorded in the CMF record.

An automatic backfill of the "Initial" adjudication data has been performed for cases that are currently closed "short form" and for reopened "short form" closure cases that are still in "UD" status. Further automated backfill of this data will be accomplished at a later date using information contained in the central database (NCMF).

4. Two new data elements have also been added to the CMF to record the responsible examiner ID associated with the "initial" and "current" adjudication of cases. The "Initial Adj Resp Exam" data will be permanently recorded in the CMF when an adjudication code is entered on a case where none previously existed. This data field will remain blank for cases that are closed "short form". However, if a "short form" closure case is reopened, the "Initial Adj Resp Exam" data will be captured the first time that an adjudication code is entered on the case.

The "Current Adj Resp Exam" data will be recorded automatically in the CMF whenever an adjudication code is entered in a case. This data field will also remain blank for cases that are closed "short form".

Both the STATUS/ACCEPTED COND screen (option 9 of the CASE MANAGEMENT menu) and the CASE STATUS INFORMATION screen (option 15 of the QUERY menu) will display the "Initial Adj Resp Exam" and "Current Adj Resp Exam" codes.

5. The DEPARTMENT CHANGE option has been removed from the CASE MANAGEMENT menu. Changes to the table of valid agency chargeback codes (v12, Department Master) will be made only by the National Office.

6. In one final system change, the threshold for payment of medical bills in "short form" closure cases has been raised from $1,000 to $1,500. Users will note this new dollar figure in the REOPEN LT/NLT CLOSURE screen (option 10 of the CASE MANAGEMENT menu).

Disposition: This Bulletin should be retained until the indicated expiration date.

 

THOMAS M. MARKEY
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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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-04

Issue Date: October 23, 1996

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Expiration Date: October 22, 1997

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Subject: Comp Pay--Elimination of Short-Term Roll and Code PI Rehabilitation--Elimination of Code PV

Background: In 1991, the Federal employees' compensation program began using the short-term roll as part of its case management procedures. It was designed for cases where disability was not expected to exceed one year, to fill the perceived gap between the functions of the daily and periodic rolls.

At that time, the program had not developed the capacity to assign expiration dates in periodic roll cases, and it still required certification of routine daily roll payments, which were processed at several different work stations within the district office.

It was anticipated that use of the short-term roll would make clear to claimants that their disabilities were not expected to continue indefinitely, and that it would reduce the need to move the case among various work stations, thus allowing more rapid referrals for second opinion and referee evaluations. However, neither of these effects was fully realized, and when short-term payments expired, it was sometimes necessary to authorize further payments on an expedited basis.

The changes in daily and periodic roll processing and the problems which have arisen with the short-term roll have essentially rendered the short-term roll unnecessary. It is therefore being eliminated effective October 23. As of that date, cases currently coded PI will be recoded PR, but the expiration dates will remain the same.

This change will affect several letters in the Forms Correspondence System. Forms CA-1650 and CA-1651 are being removed from the system, and Form CA-1655 is being combined with Form CA-1049, which is being completely revised. Minor revisions are being made to Form CA-1656.

Also effective October 23, cases coded PV will be recoded PR. This change is being made mainly because the Rehabilitation Tracking System provides many other ways to monitor cases where the OWCP is providing vocational rehabilitation services.

The National Office will forward lists of recoded cases to each district office.

Purpose: To advise district office staff of the changes which will accompany elimination of the short-term roll

Applicability: Claims Examiners, Senior Claims Examiners, Hearing Representatives, Supervisors, Technical Assistants, Rehabilitation Specialists, and Staff Nurses

Action:

1. Given the choice between placement on the periodic roll and continued daily roll payments, placement on the periodic roll should almost always be considered preferable.

2. Claims staff should use the periodic roll in place of the short-term roll by entering an expiration date which is carefully selected to reflect the circumstances of the case. It is assumed that expiration dates of at least six months to a year from the date of placement on the periodic roll will be needed in most cases given that it is OWCP's burden to terminate or reduce benefits absent a return to work when injury-related disability has ceased.

3. Claims staff should send Form CA-1049 to all claimants who will receive payments on the periodic roll, regardless of how long those payments are expected to continue.

Disposition: Retain until the indicated expiration date.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

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

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-05

Issue Date: January 9, 1997

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Expiration Date: January 8, 1998

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SUBJECT: ADP - Automated Compensation Payment System (ACPS) and Debt Management System (DMS) Report Schedule - 1997.

PURPOSE: To provide the 1997 schedule for processing the periodic disability and death payrolls under the ACPS and the DMS weekly and monthly reports for calendar year 1997.

APPLICABILITY: All appropriate personnel are to be made aware of the periods and "cut-off" dates for the ACPS periodic disability, death, and daily payrolls.

The production schedule for the DMS periodic reports is made available for the appropriate personnel. IT IS IMPERATIVE that this schedule be closely followed.

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

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Attachments

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

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-06

Issue Date: January 30, 1997

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Expiration Date: January 29, 1998

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Subject: Fiscal--Updates of Cash Deposits and Cancelled Check Items into the BPS and ACPS History Files

Background: Audits conducted by the Office of the Inspector General show large year-end differences between the chargeback and SF-224, Statement of Transactions, net disbursements. The differences are caused mainly by untimely updates of cash deposits and cancelled check items into the BPS and ACPS History Files. This includes third party transactions.

The National Office is working with the Department of Treasury to develop an automated method for transmitting deposit transactions directly from the Lockbox Depository. The transactions would then be conveyed to each district office for update to the appropriate BPS or ACPS record. Until the automated method is available, however, these transactions will be controlled via the Cash Receipts Register or the Mailroom Cash Receipts Log, Form DL 1-301.

The chargeback year runs from July 1 through June 30, and the target date for all cash receipt transactions is June 15.

Purpose: To describe the steps needed to ensure that cash deposits and cancelled check items are updated in a timely manner

Applicability: Fiscal Staff, All Supervisors, and Technical Assistants

Action:

1. Each district office must develop a plan to ensure that all cash receipts and cancelled checks received through June 15 are entered into the BPS and ACPS History Files by that date, which is the cutoff date for running the chargeback report.

2. Third party refund transactions MUST be included in this process. Entering third party data into the Debt Management System (DMS) is not the same as updating the chargeback file. The DMS transaction simply records the refund amount for the purposes of completing Schedule 9 (report from the Department of Labor to the Department of Treasury).

3. The Cash Receipts Register must be annotated as each transaction is updated in the BPS or ACPS history file. Since cancelled check items are not recorded on Form DL 1-301, the district office must maintain records to verify that history files have been updated. The manner in which the district office maintains these records is discretionary. However, each district office must be able to produce evidence that the history files have been updated, to include the date of the entries.

4. Each office must submit a brief report describing its plan for implementation, including the projected date of implementation, which should be no later than April 1. The report should be sent to Ken Siglin via e-mail (kls@fenix2) no later than April 15.

Disposition: Retain until the indicated expiration date.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 4--Folioviews Groups B and D
(Fiscal Officers, Benefit Payroll Clerks and Assistants, All Supervisors, Systems Managers, Technical Assistants)

Back to Top of FECA Bulletin No. 97-06

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-07

Issue Date: January 6, 1997

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Expiration Date: January 5, 1998

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Subject: Compensation Pay: Compensation Rate Changes Effective January 1997

Background: In November 1996, the President signed an Executive Order implementing a salary increase of 2.30 percent in the basic pay for the General Schedule. The applicability under 5 U.S.C. 8112 only applies to the 2.30 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment is effective the first pay period after January 1, 1997.

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

The new rates will be effective with the first compensation payroll period beginning on or after January 1, 1997. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $92,161 per annum.

The minimum increase specified in this Bulletin is applicable to Postal employees.

The effect on 5 U.S.C. 8112 is as follows:

Minimum/maximum compensation rates

Effective January 5, 1997	Minimum	Maximum
Monthly	$1,186.92	$5,760.06
Weekly	205.43	1,329.25
Daily(5-day week)	41.09	265.85

 

The basis for the minimum compensation rates is the salary of $14,243 per annum (GS-2, Step 1) and the basis for the maximum compensation rates is $92,161 per annum (GS-15, Step 10).

The effect on 5 U.S.C. 8133(e) is to increase the minimum monthly pay on which compensation for death is computed to $1,186.92, effective January 5, 1997. The maximum monthly compensation as provided by 5 U.S.C. 8133(e)(2) is increased to $5,760.06 per month.

Applicability: Appropriate National and District Office personnel.

Reference: Memorandum For Directors of Personnel (CPM 96-14), dated November 22, 1996; and the attachment for the 1997 General Schedule.

Action: ACPS will update the periodic disability and death payrolls. Any cases with gross overrides will not have a supplemental record created. 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.

1. Adjustments Dates.

a. As the effective date of the adjustment is January 5, 1997, there will be no supplemental payroll necessary for the periodic disability and death payrolls.

b. The new minimum/maximum compensation rates will be available in ACPS on or about January 24, 1997.

2. Adjustment of Daily Roll Payments. Since the salary adjustments are not retroactive, it is assumed that all Federal agencies will have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 1997. Therefore, it will not be necessary to review any daily roll payments unless an inquiry is received. If an inquiry is received, verification of the pay rate must be secured from the employing establishment.

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 (these forms will be reproduced after March 1, 1997):

CA-842
1/05/97	41.09-61.64 41.09-54.78	205.43-308.14 205.43-273.90	41.09	205.43	1,186.92
CA-843
1/05/97	265.85	1,329.25	(5,317.00)	5,760.06

 

4. Forms. CP-150, Minimum/Maximum Compensation, will be generated for each case adjusted. Notices to payees receiving an adjustment in their compensation will be sent from the National Office. Form CA-839, Notice of Increase in Compensation Award, will be utilized for this purpose Manual adjustments necessary because of gross overrides should be made on Forms CA-24 or CA-25 with a notice sent to the payee by the District Office.

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

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

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

Back to Top of FECA Bulletin No. 97-07

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-08

Issue Date: March 1, 1997

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Expiration Date: February 28, 1998

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Subject: Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 1997

Purpose: To furnish instructions for implementing the CPI adjustments of March 1, 1997.

1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 3.3 percent.

2. The increase is effective March 1, 1997, and is applicable where disability or death occurred before March 1, 1996.

3. The new base month is December 1996.

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

Maximum compensation rates

Rate	Time
$ 5,760.06	per month
1,329.25	per week
5,317.00	each four weeks
265.85	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: On or about February 21, 1997, both the periodic disability and death payrolls will be updated in ACPS. If there are any cases with gross overrides, there will be no supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if CPI adjustments are necessary. If adjustment is necessary, a manual calculation will be required.

1. Adjustment Dates.

a. The periodic disability and death supplemental payrolls for CPI adjustments will cover the period March 1, 1997 only, with the new cycle effective March 2, 1997.

b. The supplemental check date for the periodic disability and death payrolls will be March 18, 1997. Please note: payments of less than $1.00 will not be issued.

2. Adjustments of Daily Roll Payments. Since the CPI will not be in ACPS until February 21, 1997, daily roll payment cases requiring the new CPI should be held for data entry until that date.

3. 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. (These forms will be reproduced within the next month or so.)

4. Forms.

a. Form CA-837, Notice to Payee, will be sent to the payees on the periodic disability and death payrolls. The notice will be sent to the payees from the National Office. The CA-837 will be addressed using the ACPS Correspondence Address File. PLEASE be sure to maintain the address file as you do with the Payee Address File and the CMF. PLEASE remember that an address change to the CMF DOES NOT automatically change the ACPS check address or correspondence address. ACPS must be accessed and the enter key must be depressed through the address areas. Be watchful for those payments being sent via Direct Deposit.

b. Any manual adjustments necessary because of gross overrides in cases should be made on Form CA-24 or CA-25. A notice to the payee should be sent from the district office.

c. CP-140 will be printed for each case adjusted. These should be drop filed in the case file.

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

 

THOMAS M. MARKEY
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, and Rehabilitation Specialists)

Back to Top of FECA Bulletin No. 97-08

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-09

Issue Date: February 3, 1997

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Expiration Date: February 2, 1998

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Subject: Dual Benefits - Deduction from FECA benefits of Social Security Benefits "Attributable to Federal Service" in FERS cases.

Background: Retirement benefits under the Federal Employees' Retirement System (FERS) are considered dual benefits just like the Civil Service Retirement System (CSRS) benefits. Because FERS benefits include SSA death and old age benefits, however, they are treated differently. While there have been very few Federal employees eligible for retirement under FERS until recently, the number is beginning to grow. This bulletin explains how FERS retirement benefits affect FECA payments and what the CE must do to prevent payment of dual benefits.

WHAT IS THE FERS DUAL BENEFIT?

FERS, which took effect on January 1, 1987, is a mandatory replacement for CSRS and all employees first hired on or after January 1, 1982 are covered under FERS. CSRS employees were offered the opportunity to switch to FERS during an open season in 1987.

The FERS benefit package consists of three basic components, FERS basic benefits paid by OPM, the Thrift Savings Plan, and Social Security. Claimants elect between FECA benefits and the FERS basic benefit from OPM in the same manner as they elect between FECA benefits and CSRS benefits. There is no bar to concurrent receipt of the proceeds of the Thrift Savings Plan and FECA benefits. It is the SSA program which requires the most significant changes by OWCP in how it deals with retirement benefits.

FECA benefits have to be adjusted for the FERS portion of SSA benefits. The portion of the SSA benefit earned as a Federal employee is part of the FERS retirement package, and the receipt of FECA benefits and Federal retirement benefits concurrently is a prohibited dual benefit. 5 USC 8116(d)(2) requires that disability and death benefits paid under the FECA be reduced by the amount of any Social Security (Title II) old age or death benefits paid that are attributable to the Federal service of the employee. Unlike CSRS or FERS OPM benefits, however, this is not an election, but a deduction from FECA benefits payable. The beneficiary continues to receive their full SSA benefit.

There are general exceptions to the dual benefits deduction. The two major ones are: 1) schedule awards, as with CSRS retirement benefits, FERS retirement benefits paid by OPM or SSA can be paid concurrently with a schedule award, without any deduction from FECA benefits; 2) The deduction from FECA benefits does not apply to SSA disability benefits (SSA, not OWCP, makes a deduction from SSA disability benefits for FECA benefits paid).

HOW TO RECOGNIZE POTENTIAL FERS SSA DUAL BENEFIT CASES

In Disability Cases: The possibility of FERS SSA dual benefits exists where:

1. The claimant is at least 62 years old, and

2. The claimant had FERS retirement coverage during any of his or her Federal employment, and

3. The claimant is paid benefits based on age by SSA.

Claimants between 62 and 65 may be eligible for both SSA disability and SSA death benefits. If so, they may elect the more advantageous. If they elect disability, there is no FECA offset. At age 65, SSA disability benefits automatically convert to SSA old age retirement benefits. Therefore, all SSA retirees age 65 or older, who are covered by FERS, are subject to the FERS offset.

In Death Cases: The potential for FERS SSA dual benefits exists where:

1. The deceased employee had FERS retirement coverage during any of his or her Federal employment, and

2. There are dependent children, or

3. There is a spouse who either, 1) has in their care a child under the age of 16, 2) is 50 years old and disabled, or 3) is 60 years old.

Recognizing a FERS dual benefits situation may be difficult. Unlike CSRS retirement, OPM may not be aware of an individual receiving SSA benefits based on Federal employment, since applications for and entitlement to SSA benefits and OPM benefits are not dependent upon one another. OPM is not advised that a FERS employee has or has not applied for SSA benefits. Where a CSA number has been assigned, however, the CSA or CSF number is the easiest way to recognize FERS cases. The CSA number for all FERS retirement cases begins with 8 million. All FERS death cases have a 7 million CSF number.

Forms CA-1, CA-2, CA-5 and CA-5b are currently being revised to ask for the employee's retirement plan and whether a claim has been filed for SSA benefits.

HOW TO CALCULATE THE OFFSET OF SSA BENEFITS "ATTRIBUTABLE TO FEDERAL SERVICE":

Only that portion of SSA benefit "based on Federal Service" is deducted from the FECA benefits. This section explains how OWCP calculates what that portion is.

SSA benefits are computed based on the number of years of employment and the amount of earnings. To be eligible for SSA benefits, an employee must have a minimum number of quarters of employment (usually 40 quarters or 10 years) during which contributions were made to the Social Security System. OWCP has defined the portion of SSA benefits "ATTRIBUTABLE TO FEDERAL SERVICE", which must therefore be deducted from FECA benefits, as the difference between the beneficiary's actual SSA benefit and a hypothetical SSA benefit computed without the Federal earnings, assuming that the employee had the required number of quarters for SSA benefits.

Where a claimant has received SSA benefits, OWCP will obtain information from SSA on the amount of the claimant's SSA benefits beginning with the date of eligibility to FECA benefits. SSA will provide the actual amount of SSA benefits received by the claimant/beneficiaries. SSA will also provide a hypothetical SSA benefit computed without the FERS covered earnings. OWCP will then deduct the hypothetical benefit from the actual benefit to determine the amount of benefits which are "attributable to Federal Service". That amount is deducted from the FECA benefit to obtain the amount of compensation payable.

EXAMPLE: The claimant is entitled to $900.00 per month in FECA benefits. The actual Social Security benefit is $500 per month. The "hypothetical" SSA benefit is $300 per month.

$500 - $300 = $200 (the amount deducted from FECA benefits)

$900 - $200 = $700 (FECA benefits payable)

The claimant would be entitled to keep the entire $500 per month from SSA but would have to elect between the $700 per month FECA benefits and the full OPM retirement benefit. (Any Thrift Savings benefit is not considered a dual benefit.)

OTHER ISSUES RELATING TO CALCULATION OF BENEFITS

COLAs: All Social Security beneficiaries receive COLAs effective the 1st of December each year, regardless of when they were put on the rolls. A beneficiary who is first eligible for SSA benefits in November, receives the full COLA in December. Effective December 1 each year, all deductions for FERS SSA dual benefits will be increased by the percentage of the SSA COLA. The FECA CPI, effective March 1, will be added to the total amount of FECA benefits, before the FERS SSA deduction.

There are several issues related to the deduction of the FERS SSA benefit from FECA benefits which apply primarily to death and LWEC cases. In rare instances, they could apply to any claim. Guidelines for handling those issues are outlined in the addendum to this bulletin. The addendum should be kept with the bulletin and used as a reference for all death and LWEC cases.

Purpose: To provide procedures for making proper FERS SSA deductions from FECA benefits in cases which are covered under FERS and are eligible for SSA old age or death benefits.

Applicability: All claims and fiscal staff.

Reference: 5 USC 8116(d); title II of the Social Security Act

Action:

1. When it is determined that FECA benefits are payable, determine if there is a potential for FERS SSA dual benefits, using the criteria outlined in the background.

2. Where the claimant in a disability case is under 62 years old, place a call up on the case for the 62nd birthday.

In a death case, where the spouse is under 60 years old and has no children under 16, place a call-up for the 60th birthday.

Advise these claimants that they must notify OWCP at once upon applying for SSA old age or spousal death benefits.

3. Where there is a possibility of FERS SSA dual benefits, complete the FERS SSA Dual Benefits Form attached to this bulletin. This form should be photocopied in each district office. It will also be emailed to all District Directors for distribution to their staff.

FECA claims examiners complete the header information in all claims. Print your name, phone number and FAX number clearly in the "FROM" section. At the present time, Bill Hilton at SSA is performing the necessary computations for OWCP. FAX the form "TO" him at (410)966-9214. His phone number is (410)965-2468. The National Office will provide updates of the SSA contact. Check whether you are requesting an initial computation or a recomputation.

OWCP then completes the left side of the form. In Part I, provide the name, SSN, Date of Birth, and Date of Death (if applicable) of the employee. Provide the dates of FERS covered employment. It can be stated in years (e.g. 1981 - 1992). If the date FERS coverage began (either the date FERS covered employment began, or the date of the FERS election) is not available, use 1981. The computation date is the date that FECA benefits are payable.

Complete the name, DOB, SSN (if available) and relationship in item II for all survivors claiming benefits in death cases.

Provide any relevant remarks not covered by this form in item III.

FAX the completed form to SSA at (410) 966-9214, attention: Bill Hilton.

4. When a completed form is returned by SSA indicating that the claimant is not receiving SSA benefits, no further action is necessary at that time. If it is a long term disability case, however, the periodic review should include checking to make sure that SSA benefits have not been initiated since the last review.

When the form indicates that the claimant is in receipt of SSA benefits, subtract the "SSA rate W/O FERS" from the "SSA rate W/FERS" (as indicated on the form). The result is the FERS SSA dual benefit. Subtract the FERS SSA dual benefit from the FECA benefits payable. Perform this computation for each date the benefit amount was revised by either OWCP or SSA, for each beneficiary in the case.

Place a memorandum in the file explaining the claimant's entitlement, and the computation of benefits. A sample memorandum is attached.

5. Where the claimant is entitled to both OPM benefits, including any OPM lump sum death benefit, and FECA benefits, provide the claimant with an election between OPM benefits and FECA benefits, which identifies the full FECA amount, the FERS SSA dual benefit deduction and the amount of FECA benefits payable after the deduction.

With the election, provide the claimant with an explanation of how the FECA benefits were computed. Direct the claimant to address any questions related to Social Security's computations to the local Social Security office. A sample letter is attached for your reference. You may modify this to the circumstances in the case. You could also send the CA-1102 or CA-1103, and include a separate letter of explanation. Make sure that each claimant receives an independent election in a death case.

6. When a claimant elects FECA benefits, coordinate the transfer from OPM benefits and release appropriate correspondence such as Form CA-1049 or CA-180 according to current procedures. These form letters have been revised to advise claimants of the FERS SSA dual benefit deduction.

7. When initiating an ACPS payment in ANY FERS case, answer "Y" to the new system prompt, "FERS SSA Offset? [Y/N], even if there is no current FERS SSA dual benefit. (This will be available in ACPS in late January 1997.)

The following prompt will then appear, "FERS OFFSET AMOUNT". If there is a FERS SSA dual benefit deduction, enter the amount to be deducted from the full FECA benefit. The system will then make the deduction. If there is no current FERS SSA deduction, press "ENTER". This will fill the field with zero.

This will provide a unique identifier for FERS cases and aid in COLA adjustments, tracking and matching.

ACPS will adjust the FERS SSA deduction effective every December 1 with the SSA COLA. In the example provided in the background, the COLA would be added to the $200 deduction.

The FECA CPI will be added to the full FECA benefit, before any deductions, as with current procedures.

8. Some district offices have existing records with an established AR for the FERS off-set. It is necessary for these records to be entered in the new ACPS screen, when available. After entry in the new FERS screen, please be sure the AR is deleted.

9. If there is any adjustment to SSA benefits because of earnings (See addendum. SSA should indicate this in Part III, Remarks, on the form), call up for May 1 to ask SSA to update the computations. Complete and FAX another form. When it is received, adjust ongoing benefits according to the information provided. Provide a letter of explanation to the claimant. A sample is attached.

In addition, follow current procedures for actions appropriate to the receipt of earnings information.

Disposition: This Bulletin is to be retained in Chapter 2-1000, Dual Benefits, of the FECA Procedure Manual, until revised or incorporated into the existing procedures.

Training should be conducted in each District Office on these procedures. Please report to me that the training has been conducted within 60 days of receipt of this bulletin. Any questions regarding these procedures should be addressed to Cecile Moran (202) 219-8461.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

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

ADDENDUM: FERS SSA DUAL BENEFITS FOR DEATH AND LWEC CASES

WITHHOLDING OF SSA BENEFITS FOR EARNINGS: SSA computes an individual's entitlement as a yearly amount. When an individual under the age of 70 earns more than an amount established by SSA, while otherwise entitled to SSA benefits, SSA will withhold benefits for a period of time. There is no SSA earnings withholding after age 70. Before the start of a calendar year, beneficiaries are required to estimate their earnings for the coming year. Based on that estimate, the entire SSA benefit check is withheld, beginning January 1, until the excess earnings withholding is met. If part of a check is required to complete the withholding, the entire check is withheld.

In the middle of the year, SSA beneficiaries are asked to update the earnings estimate. They are also asked to advise SSA at such time as their earnings exceed their estimate. The SSA withholding period may be adjusted based on the earnings updates. After the year has ended, the beneficiary must report to SSA the actual amount of earnings for the year.

Any balance due the beneficiary by SSA at the end of the year is paid at the end of the year. If, at the end of the year, insufficient funds have been withheld to fully cover the earnings, the balance owed becomes an overpayment, subject to due process overpayment procedures. If, after due process has been followed, entitlement to SSA continues, the overpayment will likely be withheld from continuing benefits.

For example, a beneficiary estimates earnings for 1995, and SSA computes the amount of benefits that must be withheld based on that estimate to be $2,500. The individual is entitled to $500.00 per month in SSA benefits. Monthly payments, beginning January, 1995 are withheld until the amount of excess earnings is withheld. In this case, the total withholding will be met with the May check. The beneficiary will receive nothing from SSA through May. They will receive their full check for June and July. Based on information provided by the beneficiary on the mid-year mailer, SSA, during July, then recomputes the earnings withholding to be $2,900. The entire August check is then withheld to cover the additional $400.00.

By April 15, 1996, the beneficiary must report actual earnings during 1995. If, based on this report, SSA recomputes earnings withholding for 1995 to be $3,300, the beneficiary has an overpayment of $300 (remember the entire $500 was withheld for Aug). If, instead, the final computation of earnings withholding remains $2,900, the extra $100.00 will be paid to the beneficiary.

During months that the claimant is not receiving any SSA benefits due to earnings withholdings, they are entitled to their full FECA benefit. During months that they receive their full SSA check, the full FERS deduction of FECA benefits applies. Where SSA benefits are withheld fully or in part to collect an overpayment, the claimant will have to notify OWCP and request any resulting adjustment to the FERS deduction from FECA benefits.

Where the beneficiary's actual earnings are greater than the estimate, the result would be a decrease in the SSA benefits. A lower amount of SSA benefits results in a smaller deduction from FECA. In these cases, there would be no excess FECA benefits paid. There may by additional retroactive FECA benefits due based on the recomputation of SSA benefits.

SSA will provide pertinent information regarding any withholding for earnings in the comments section when they complete a benefit computation form for FECA. It is important that FECA claims examiners be aware of these SSA procedures so that they can follow up on earnings withholdings and correctly compute the FERS deduction in these cases.

Keep in mind that earnings reported by SSA could also be relevant to the cliamant's earning capacity in a disability case.

OVERPAYMENTS: Where timely notification of a benefit adjustment is received from SSA or the claimant, an immediate adjustment can be made to FECA benefits. Where OWCP does not learn until after the fact that a claimant's SSA benefits have commenced or increased, an overpayment of FECA benefits will be declared. Usually, prior notification to the claimant to advise OWCP of changes in SSA benefits, and the claimant's failure to provide such advice, will be sufficient to find the claimant "not without fault" in the occurrence of the overpayment.

THE DEDUCTION FROM FECA BENEFITS ONLY APPLIES TO SSA BENEFITS ACTUALLY RECEIVED: OWCP has interpreted the phrase "in the case of benefits received", in 5 USC 8116(d)(2), to mean that only benefits actually received by the claimant from SSA are subject to deduction from FECA benefits. If a claimant is potentially eligible for SSA benefits, but has not received anything, there is no deduction. If SSA benefits are reduced because of earnings or other adjustments, the deduction from FECA benefits is based on the actual SSA benefit received. If benefits are received by one individual on behalf of another, the benefit is considered to be received by the beneficiary, not the individual who receives the check.

MONTHLY MAXIMUM OF SSA BENEFITS IN DEATH CASES: Total SSA survivor benefits are limited by a monthly maximum. In some cases, where there is more than one eligible survivor, each survivor's benefit is reduced so that the total benefit paid does not exceed the monthly maximum. Where there are fewer beneficiaries, each beneficiary receives a larger portion.

WITHDRAWAL OR REFUSAL OF SSA BENEFITS: An individual may either withdraw their application for SSA benefits or decline to apply for benefits. Withdrawal nullifies entitlement. The beneficiary has to repay any benefits paid. If a beneficiary in a death case withdraws their application or declines to apply for benefits, the other eligible survivors will be paid as if that beneficiary does not exist. If a person declines benefits and then applies, the benefits are computed prospectively considering all of the entitled beneficiaries.

A widow with children, for example, could decline to apply for SSA benefits on her own behalf and still collect the same monthly maximum of SSA benefits for her children as if she accepted benefits for herself. Since the widow is not receiving any SSA benefits, OWCP will not make any SSA FERS deduction from her FECA benefits. OWCP will make the FERS SSA deduction for the children's FECA benefits only. The result may be that the widow can collect more from the combined programs than if she accepted SSA benefits on her own behalf. The law does not prohibit this.

 

Back to Top of FECA Bulletin No. 97-09

 

ATTACHMENT 1

FERS SSA DUAL BENEFITS CALCULATIONS FAX TRANSMITTAL NO. OF PAGES

FROM:		TO:
OFFICE OF WORKERS' COMPENSATION PROGRAMS		SOCIAL SECURITY ADMINISTRATION
PHONE NUMBER:		PHONE NUMBER:
FAX NUMBER:		FAX NUMBER:
INITIAL		RECOMPUTATION
THIS SIDE TO BE COMPLETED BY OWCP		THIS SIDE TO BE COMPLETED BY SSA
I. EMPLOYEE/ANNUITANT
NAME	SSN	EFF DATE SSA RATE W/FERS	SSA RATE W/O FERS
DATE OF BIRTH	DATE OF DEATH
FERS $$ PERIOD (FROM - TO)	COMPUTATION DATE (DATE ELIGIBLE FOR FECA)
II. SURVIVORS
1. NAME	DOB	ENTITLED EFF DATE TO SSA?	SSA RATE SSA RATE W/FERS W/O FERS
		YES NO
SSN	RELATIONSHIP
2. NAME	DOB	ENTITLED EFF DATE TO SSA? W/O FERS	SSA RATE SSA RATE W/FERS
YES NO SSN	RELATIONSHIP
3. NAME W/FERS	DOB W/O FERS	ENTITLED EFF DATE TO SSA?	SSA RATE SSA RATE
		YES NO
SSN	RELATIONSHIP

II. REMARKS:

 

NAME OF PERSON COMPLETING THE FORM FOR SSA

DATE FORM COMPLETED BY SSA

 

Back to Top of FECA Bulletin No. 97-09

 

ATTACHMENT 2

Memorandum to File
JOHN DOE, A00-********

This is a FERS SSA dual benefits case. The Office is required to deduct from FECA benefits that portion of Social Security benefits attributable to Federal Service. The widow has withdrawn her application for SSA benefits. Therefore, she is entitled to the full FECA benefit on her own behalf, with no deduction.

For the children, their SSA benefit is $588.00 per month each effective 9/25/94. Effective 12/1/94, their SSA benefit was increased to $603.00 each per month. In determining that portion of the SSA benefit attributable to Federal Service, SSA computed the amount of SSA benefit to which the children would be entitled, if the deceased never had FERS covered service, assuming that he died fully insured under the SSA system. (They deleted FERS covered earnings from the computation. There was some part time Federal service which was covered by SSA and not covered under any Federal retirement system. Earnings from this service were not deducted.)

The result was that the children would have been entitled to $327.00 each as of 9/25/94, and $336.00 each as of 12/1/94.

$588.00 327.00 $261.00

$603.00 - 336.00 $267.00

Therefore, effective 9/25/94, the FERS SSA dual benefit deduction for each child from their FECA benefit is $261.00. Effective 12/1/94, the deduction is $267.00.

The FECA benefit for each child at 15% of $2547.25 per month is $382.09.

$382.09 -261.00 $121.09 FECA as of 9/25/94

$382.09 -267.00 $115.09 as of 12/1/94

Effective December 1 of each year, the National Office will increase the FERS SSA dual benefits deduction by the percentage of the SSA COLA. In March, 1996, when the CPI is applied to the FECA benefit, it should be applied to the total FECA benefit ($382.09).

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CLAIMS EXAMINER
DATE:

 

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ATTACHMENT 3

Mrs. John Doe ******************** ********************

File Number: A00-000000

Dear **************,

I deeply regret your loss, and hope that I can be of some assistance in providing you with benefits to which you and your children are entitled on behalf of your husband's death.

Enclosed please find election forms for yourself and your two children, for you to elect between the compensation benefits payable to you as survivors under the Federal Employees' Compensation Act (FECA), and benefits payable to you by the Office of Personnel Management (OPM). Each of you is entitled to an independent election of the benefits you consider most advantageous, and you should complete and submit both originals for each of you to me at:

US Department of Labor, OWCP
District Office Address
***********************
***********************

FECA benefits and OPM benefits (including any lump sum death benefit provided under the FERS) are not payable for the same period of time. You are entitled to FECA benefits effective 9/25/93. If you elect FECA benefits, you may receive concurrently benefits from the Thrift Savings Fund and survivor benefits provided by the Social Security Act with the following exception.

5 USC 8116(d)(2) requires that compensation benefits be reduced by the portion of Social Security (SSA) benefits based on age or death that are attributable to Federal Service. Because you are receiving SSA benefits based on the Federal Service of an employee, your compensation benefits are reduced by the amount of Social Security benefits attributable to your husband's Federal service. Any questions related to SSA's computation of benefits should be addressed to your local SSA office.

If you elect compensation benefits, we will calculate the amount of compensation due from 9/25/93 to the present. Any benefits paid to you by OPM will be reimbursed to them from the compensation due, and any remaining balance will be paid to you. If you receive a lump sum death benefit from OPM under FERS, compensation due will be paid to OPM and no benefits will be paid to you until OPM has been fully reimbursed.

Your entitlement to FECA benefits is outlined below. FECA benefits are paid every 4 weeks, but the monthly amount is also shown for ease of comparison. Effective with the first periodic roll period following December 1 of each year, your compensation payment will be adjusted because of the cost of living increase granted to SSA beneficiaries.

EFFECTIVE 9/25/93:

Person	FECA	SSA DEDUCTION	MONTHLY	4 WEEKLY
Debra:	$1146.26	00	$1146.26	$1058.08
Shannon:	382.09	$261.00	121.09	111.78
Cathy:	382.09	261.00	121.09	111.78
Total:	$1910.44	522.00	$1388.44	$1281.64

 

EFFECTIVE 12/1/93:

Person	FECA	SSA DEDUCTION	MONTHLY	4 WEEKLY
Debra:	$1146.26	00	$1146.26	$1058.08
Shannon:	382.09	267	115.09	106.24
Cathy:	382.09	267	115.09	106.24
Total:	$1910.44	534	1376.44	1270.56

 

**** Use the following paragraph in situations where the spouse is not receiving benefits on his or her own behalf, or where the claimant has not yet met the requirements for SSA benefits. ****

(At such time as you apply for Social Security benefits, the appropriate deduction would apply to your FECA benefit. It is your responsibility to advise this office immediately if you should apply for SSA benefits.)

If you have any questions about this election, or if I can be of any assistance, please contact me on (your phone number).

 

Sincerely,

******************
Claims Examiner

cc: Agency

 

Claimant
***************
***************

Dear Claimant,

You were advised by letter of 00/00/00 that your FECA benefits had to be reduced by the portion of SSA old age or death benefits attributable to the FERS covered Federal Service of the employee.

Effective 01/01/96 your SSA benefits were adjusted to $550 per month. Your SSA benefits without the FERS covered Federal service would be $325 per month effective 01/01/96. As of 01/01/96, therefore, the amount of FERS SSA dual benefits which must be deducted from your FECA benefits is $225 per month, or $207.69 per 4 weeks. Your FECA benefits will be adjusted accordingly effective with your check dated 03/01/96.

Since OWCP only deducted $200 per month, or $184.62 per 4 weeks for the period January 1, 1996 through March 1, 1996, you have been overpaid in the amount of $50.00. Please remit a check in this amount at your earliest convenience.

If you have any questions about your SSA dual benefits deduction, please do not hesitate to contact me.

Sincerely,

 

NAME
Claims Examiner
Phone Number

 

***Please note: you must also release the standard overpayment letters***

 

Back to Top of FECA Bulletin No. 97-09

 

ATTTACHMENT 4

	File No. A14-000000 Date of Death: 9/25/93 Employee: ************
Employee SSN: ***-**-**** Mrs. ********** ***************** *****************	Employee DOB: 00/00/54 Monthly Pay: $2,547.25

Under the provisions of 5 U.S.C. 8101 et seq. (Federal Employees' Compensation Act), the OWCP makes the following

AWARD OF COMPENSATION

FOR WHOM PAID DEDUCTION	RELATION	FOUR WEEKLY PAY	FOUR % OF WEEKLY PAY	HEALTH BENEFITS COMP.
Debra	wife	$2351.31	45	1058.08	184.42
Shannon	daughter	2351.31	15	352.70
Cathy	daughter	2351.31	15	352.70
				$1763.48
				492.92
				1270.56

 

When an employee is covered under the Federal Employees' Retirement System (FERS), Social Security benefits payable to their beneficiaries, which are attributable to the employees' Federal Service, are deducted from FECA benefits (FERS SSA deduction). Each of your daughters are in receipt of Social Security benefits, a portion of which is attributable to the employees' Federal Service. Effective September 25, 1993, the amount of the FERS SSA deduction is $261.00 per month, or $240.92 per 4 weeks, per child. As of December 1, 1993, the FERS SSA deduction is $267.00 per month, or $246.46 per 4 weeks per child. As of December 1, 1993, the FECA benefits payable are $1270.56, minus health benefits of $184.42, for a net of $1086.14.

Your first check and the period covered: $15,361.31 9/25/93 to 10/15/94.

Your continuing four-weekly checks will be: $1,086.14. Effective with the first periodic roll period following December 1 of each year, your compensation payment will be adjusted because of the cost of living increase granted to SSA beneficiaries.

If, at some future time, you apply for Social Security benefits on your own behalf, you must advise this office immediately, so that we may coordinate the appropriate adjustment to your benefits with SSA.

By Order of the Director
Office of Workers' Compensation Programs

 

Claims Examiner

Enclosures: EN0180-0388, EN0180-0992, ENAPPA-0489/CA0180

cc: Attorney , OPM, Agency, file

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-10

Issue Date: February 15, 1997

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Expiration Date: February 14, 1998

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Subject: Case Doubling

Background: The existing procedures for case doubling, found in the Federal (FECA) Procedure Manual at Chapter 2-400.8, state, "Doubling of case files should be avoided if possible." This reluctance to double cases has led to some very difficult situations with respect to cases before the Employees' Compensation Appeals Board, payment of medical bills, correct adjudication of claims, and providing excellent customer service to claimants. In addition, differences in doubling practices among and within the district offices have led to disagreements.

Case doubling is now encouraged where certain criteria are met. In general, the oldest case will be the master case. As of July 5, 1996, the CASE632 report, "Claimant New and Prior Injuries Report," is produced automatically whenever CASE615 (Case Create) is run. All CASE632 reports must be reviewed and appropriate cases doubled.

Reference: Federal (FECA) Procedure Manual, Chapters 1-300.6 and 2-400.8.

Purpose: To describe new guidelines and procedures for case doubling.

Applicability: District Directors, Systems Managers, All Supervisors, Claims, Fiscal, Bill Resolution, Mail Room and ADP staff.

Action:

1. When an employee has sustained more than one injury, it is often necessary to incorporate all of the records in one case folder. The case records are kept separately but travel under one claim number, which is known as the "master file". The subsidiary and master files are cross-referenced in the FECS data base. Each case file is assigned a status code, as follows:

Status Codes

Code	Description
I	independent (neither a master or subsidiary file)
M	master file
S	subsidiary file

 

2. Cases should be doubled where correct adjudication of the issues depends on cross-reference between files. Cases meeting one of the following tests must be doubled:

a. A new injury case is reported for an employee who has filed a previous injury claim for a similar condition or the same part of the body. An example would be where a claimant has an existing case for a back strain and submits a new claim for a herniated lumbar disc.

b. Two or more separate injuries (not recurrences) have been sustained on the same date.

c. Adjudication or other processing of a case will require frequent reference to another case which is not for a similar condition or the same part of the body. An example would be where an individual who has an existing claim for carpal tunnel syndrome files a new claim for a mental condition which has overlapping disability periods. If only a few such references will be needed, the cases should not be doubled. Cases of this nature include:

1. cases in which problems arise keeping the cases straight for bill pay and/or mail purposes, such as when the same physician is treating the claimant for more than one injury;

2. cases with overlapping periods of disability; and

3. cases which should be handled by a single individual to ensure consistency and fairness.

3. The responsible claims examiner (CE) will be responsible for reviewing newly created cases for potential doubling and making doubling recommendations. The District Director or one or more designees will be responsible for approving case doublings and settling any disputes about whether cases should be doubled and which case file number should be the master file number. Unit claims managers may be designated reviewers.

4. Each day in which cases are created and CASE615 is run, a CASE632, "Claimant New and Prior Injuries Report" will be produced as well. This report shows all cases already existing for a claimant. Each page of the report should be placed in the corresponding newly created case file. If a case contains such a report, it must be forwarded to the responsible CE, even if it is a short-form closure case. The responsible CE will examine the list for each case in which a list appears and determine whether doubling is indicated. If needed, the other cases listed on the report may be pulled for the CE. The CASE632 report should be filed just above the CA-1 or CA-2. If the cases are to be doubled, the responsible CE should forward a request for case doubling to the designated reviewer, along with the cases. If the reviewer approves the case doubling, the cases should then be forwarded to the mail room.

5. If the CE notes, while examining a case file, that there are other injuries that may have bearing on the case at hand, the CE should request the other case file or files by completing Form CA-33. If the cases meet one of the criteria noted above, the CE should request that they be doubled. Such a request, which may be made by informal (handwritten) memo, should show the case file numbers, the master case file number, the reason for doubling, the CE's initials, and the date. The designated reviewer should approve the request before it is sent to the mail room.

6. When cases are forwarded to the mail room for doubling, the mail room should physically combine the cases into the master file jacket. The subsidiary case file numbers should be written on the front top center of the master file jacket. The subsidiary file jackets should be filed in the file room, with an annotation of the master file number. The spindles for the cases should remain separate, even though they are contained within the same jacket. The master file number should be written on the CA-800(s) of the subsidiary case(s). If any subsidiary case is inactive, as defined in item 10(a) below, the CA-800 will be spindled down. If the doubled file is too thick for the folder, it should be divided in accordance with FECA Procedure Manual Chapter 1-500.8. All of the inactive subsidiary cases should be placed in the A part of the file.

7. Once the cases have been physically doubled, the file should be forwarded to the ADP section for doubling on the FEC System. This is accomplished by using the Double/Undouble option under the FECS001 Case Management menu. After the cases have been doubled on the system, the memo which authorized the doubling should be initialed and filed down in the master file.

8. If cases are not doubled, but some cross-reference may be needed, and there is no CASE632 report in the file, related cases should be noted on Form CA-18. Medical and other evidence from other injuries may be copied, annotated to show the source, and added to the file. This would primarily be applicable to cases closed for more than 2 years which were accepted for minor conditions, and "automatic" closures more than 2 years old.

9. Cases should be doubled at the first indication that doubling is needed.

10. The master case file number should generally be the oldest (by file number) case in the office. The claims examiner who is responsible for the master case file will also be responsible for all of the subsidiary files. Changing claims examiners when a new claim is filed should be avoided. Subsequent related cases will be doubled into the existing master case file.

(a) Whether a case is open or closed will have little bearing on the doubling decision. However, a case that has been closed for at least two years and has not involved medical payments for two years is considered to be inactive, and will generally not be the master case file.

(b) Cases that have to be retrieved from the records center will generally not be the master case file.

(c) Cases that already have a master number will not be undoubled and redoubled under another master case file number. This is true even if compensation payments are being made under a subsidiary case file number, but not under the master case file number.

11. A subsidiary case is not necessarily an inactive case. Subsidiary cases may be in an open status. The status of the case should reflect the situation at hand. If a subsidiary case is open, it should also have appropriate call-ups in place.

12. When case files are doubled, a letter should be sent to the claimant, the employer, the treating physicians, authorized representatives, and other interested parties, informing them of the doubling, and instructing them as to which case file number to use for inquiries, medical bills, and compensation claims.

13. If the accepted conditions in doubled cases are the same, the employing agency is the same, and there is no third party involvement, bills should be paid using the master file number (if that is an open case). However, where accepted conditions among doubled cases are dissimilar, or employers have changed, or third party liability is involved, care should be taken to make bill payments under the appropriate case file number.

14. When doubled cases are retired, both the master and all of the subsidiary case files must be retired.

Training for all personnel affected by these changes should be conducted no later than March 31, 1997. Compliance with these new procedures will be evaluated as part of the accountability review process.

Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 3--Folioviews Groups A, B, C, and D
(All FECA Employees)

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-11

Issue Date: February 24, 1997

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Expiration Date: February 23, 1998

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Subject: District Office Use of Nurses Providing Telephonic Services

Background: To enhance the opportunities for the medical recovery and successful return to work of injured Federal workers, OWCP implemented two nurse intervention pilots from 1989 to 1991.

The first pilot, the Early Nurse Intervention Project, was implemented in three district offices and involved face-to-face contact of nurses in the local area (field) under contract to OWCP with claimants, health care providers, and employing agencies. These nurses were managed by designated office staff, usually a senior claims examiner, who served as a liaison between CEs in the office and the nurses. In contrast, the second pilot, Claimant Advocate Project (CAP) was strictly a telephone intervention. Nurses under contract to OWCP came into the district office and contacted claimants, treating physicians, and agency personnel. As in the first pilot, there was a staff member who coordinated the services of these nurses in each district office. Both pilots were effective in reducing compensation costs and enhancing the return to work. In addition, both demonstrated a high degree of satisfaction among participating claimants, agencies, district office staff and medical providers.

The face-to-face nurse intervention served as the model for the nurse intervention process included in the QCM procedures and was implemented nationally in 1993. However, the nurse providing telephonic case management offers several features that expand the district offices' ability to handle workloads. Some of these are: (1) it reduces the need for nurses in rural or geographically isolated areas, (2) it enables each nurse to handle a larger number of cases efficiently, (3) it is a relatively low-cost form of intervention. In implementing this program, district offices must be aware of the guidelines set forth below.

Purpose: This bulletin will provide guidelines and procedures for the use of nurses (telephonic) in the district offices.

Reference: OWCP Bulletin No. 91-2; Federal (FECA) Procedure Manual Chapter 3-200; OWCP Bulletin No. 93-6.

Applicability: Regional Directors, OWCP; District Directors, FEC; Staff Nurses and Claims Examiners

Action:
District offices implementing this type of intervention need to establish the number of nurses necessary to handle those cases subject to telephone intervention. In addition, district offices need to develop referral and reporting procedures which meet QCM time limits, privacy requirements and a process for the tracking and monitoring of cases by the Staff Nurse (SN). This includes the accurate coding of telephone intervention milestones in the QCM screen for tracking purposes.

Nurses performing telephonic intervention must be certified by OWCP and their recruitment, selection and certification must be in keeping with the process described in FECA PM, Chapter 3-202. Nurses selected for telephonic intervention must sign a Memorandum of Agreement (MOA) unique to telephone intervention. Should one of these nurses, elect to perform face-to-face work as a field nurse (or vice versa) he/she has to sign an appropriate MOA. Further, a nurse cannot perform both types of intervention at the same time. Any cases in an open status have to be transferred to other nurses before the nurse in question can change his/her duties and designation. Irrespective of where the telephonic intervention is conducted, contract nurses must hold valid licenses in the states where their assigned claimants reside.

All nurses providing telephonic services must establish their own work site (e.g. home, office) and cannot work out of the district office. They may come into the office as necessary to obtain or drop off documents and for other administrative purposes. While in the office, the nurse may interact with claims staff. They may also have access to the telephone, computers and copying machines in the office for administrative convenience, but are otherwise responsible for furnishing their own supplies and materials

The duties of the nurses providing telephone services should be identical to those of the field nurse. Both assist the CE in the medical management of compensation cases to bring about the return to work on a full-time, part-time or light duty basis. Nurses may also be asked to review the medical management of long term disability cases for the purpose of coordinating proper medical treatment and reducing residuals. Although nurses may offer medical guidance and input in a case, they cannot perform functions principally performed by a claims examiner such as: preparing statements of accepted facts (SOAF) or questions for a second opinion or referee physician. Further, the nurses' functions are limited to the individual cases assigned to them for medical management, and they may not perform certain duties such as scheduling second opinion examinations and handling medical authorization requests on an office-wide scale.

5. The SN provides general instructions and guidelines to accomplish the return to work goal. However, once a case is assigned, the nurse (telephonic) does not receive direct and continuing supervision. Performance is evaluated on the outcome of cases and on the timeliness and quality of services. Telephone intervention can have successful outcomes in cases with widely different diagnoses, length of disability, and/or demographic characteristics. However, because of its total dependence on oral communication at a distance, it may not be as efficacious as the face-to-face approach in some instances. To maximize results and to observe QCM time frames, a limit of 60 days should be applied to this intervention. However, in cases where there is a return to work (or return to work is imminent) within the 60 day period the nurse (telephonic) can provide the necessary follow-up. The CE may also allow extensions in special circumstances, such as when there are no available field nurses in the claimant's vicinity or when the nurse(telephonic) possesses language or professional skills that are necessary for the successful management of the case. Absent these circumstances, after 60 days the case should be transferred to a field nurse who will perform face-to-face intervention. An earlier transfer to a field nurse can occur if the nurse identifies factors which may render telephone intervention unsuitable. Some of these are: (a) claimants with problems in oral communication, (b) treating physicians who traditionally support total and prolonged disability for relatively benign conditions, (c) claimants with multiple, severe disabilities or with multiple recurrences of the accepted condition. In non-QCM cases, time limits for telephone intervention are the same as for face-to-face intervention: a total of 120-180 days.

Reimbursement to a nurse providing telephonic services cannot exceed $50,000. Any nurse who reaches this amount must not be assigned further work for the balance of the contract year. This reimbursement excludes all long distance telephone and FAX charges. These services are billed under the NIPTC code. Reimbursement for the services of the nurse (telephone) will follow the same requirements as for the field nurse namely the services provided must be case specific, a brief summary of the contacts made must be included, bills must submitted on the HCFA-1500 form and only the following unique telephonic codes must be used.

NCA00 - Telephonic nurse intervention, administrative - increments of time less than 1 hr.

NCA01 - Telephonic nurse intervention, administrative - 1 hr. increments of time.

NCP00 - Telephonic nurse intervention, professional services increments of time less than 1 hr.

NCP01 - Telephonic nurse intervention, professional services 1 hr.increments of time.

Do not use the field nurse (NIP) codes with the exception of the long distance telephone call code NIPTC for telephonic (CAP) nurse services.

Disposition: Retain until the expiration date or until superseded.

 

THOMAS M. MARKEY
Director for Federal Employees'
Compensation

 

Attachments

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

 

MEMORANDUM OF AGREEMENT

 

I. Introduction

The functional rehabilitation and return to work of injured workers are primary goals of the Federal Employees' Compensation Program. This agreement provides for early intervention by nurses to affect the extent and duration of disability or to improve medical management in cases where the length of disability is prolonged or uncertain. Examples include: back sprain/strain, neck or shoulder sprain/strain, knee injuries and carpal tunnel syndrome.

II. Services to be Provided

The following services will be performed by the contract nurse: (1) communicate directly with injured workers and their families to explain and monitor medical treatment and progress; (2) identify and pursue as needed more active treatment or more active participation by the injured worker; (3) as requested by the claims examiner, obtain concrete work limitations; (4) when applicable, arrange for on-site visits to the work place; (5) communicate directly with physicians about light duty opportunities and other issues; and (6) initiate return to work programs with the employee, agency and treating physician. All these interventions are conducted telephonically.

III. Reports

For any case referred to the nurse, a written management plan based on the nurse's initial telephone interview with the claimant must be submitted. Additional data elements will also be required in this management plan and will be discussed with the nurse during the training. Brief updates of the claimants medical condition, the goals reached or missed must also be submitted. Each district office will determine the desired frequency of these reports.

IV. Method of Billing and Payment

Reimbursement for the contract nurse's services will be made by charging individual case files worked. These services are considered to be prompt pay bills which will require the use of a separate HCFA-1500 form on each claimant's case.

V. Reimbursement Rate

There is a maximum time limit per case which may be authorized for these services. Duration of nurse services should not exceed sixty (60) days. Any plan for more than this time, must receive authorization by a claims examiner. There is a yearly reimbursement maximum of no more than $50,000 in a given fiscal year.

In those cases when a company will be billing for the nurse's services, the special disclaimer below needs to be signed by the individual nurse.

I hereby authorize (name of company) to act as my agent to bill and receive payment for any services I render under this contract, and I hereby release the U.S. Department of Labor, and the Employees'Compensation Program from any and all losses which I may suffer as a result of my using (name of company) as my billing and payment agent.

 

Nurse's signature................................................

Date ..................

 

VI. Security of Case Files

The contract nurse agrees to maintain the confidentiality of all records, reports, documents and case files developed or generated as part of this intervention effort in accordance with the Privacy Act of 1974 (5 U.S.C. 552a), and regulations promulgated by the Department of Labor to implement that statute (29 CFR Part 70a).

VII. Principles of Ethical Conduct

I understand that, the ethics rules (29 CFR Part O) and laws which apply to government employment may also apply to me. This includes the general prohibition against benefiting, through decision, approval, the recommendation, rendering of advice, or otherwise, in any particular matter in which a spouse, minor child, partner, organization in which you are serving as an officer, director, trustee, partner or employee or any person or organization with whom he is negotiating or has any arrangement concerning prospective employment or has a financial interest.

VIII. Termination

This agreement may be cancelled by either party upon thirty (30) days' written notice.

 

--------------------------------- (FEC district Office Staff	---------------------------------- (Contract Nurse)
Date ---------------------	Date ---------------------
Expiration Date of Contract
----------------------------	Address

Employment Identification Number (EIN) or the number under which payments should be reported to the Internal Revenue Service

 

State(s) in which licensed:

State Board
License Number:

Expiration Date :

 

Back to Top of FECA Bulletin No. 97-11

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-12

Issue Date: April 10, 1997

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Expiration Date: April 9, 1998

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Subject: February 1997 DFEC/OPM Computer Match

Background: Another DFEC/OPM computer match, designed to identify possible occurrences of prohibited concurrent dual benefit payment, was completed last month using the data for the February 1, 1997 periodic roll cycle. The data shared with OPM again included the death roll, and excluded schedule award cases. 110 cases survived the manual and automated screening processes employed by OPM. The last DFEC/OPM Computer Match was conducted in September 1995.

With its advance copy of this bulletin, each District Office will receive a computer printout of the cases under its jurisdiction which should be screened, followed and reported on in accordance with the procedures described in FECA Bulletin 96-4 and again specified below. The presence of a case on the list should indicate that benefits were being paid by both DFEC and OPM on February 1, 1997, in apparent violation of the dual benefit prohibitions.

For this, and future matches, we will continue to follow the procedures used in the past; that is, OPM and the responsible District Offices will directly converse and correspond in order to resolve the hits. The District Offices will continue to have National Office reporting requirements, as detailed below. However, any problems that arise with OPM, or with any other aspect of processing the match hits, should be raised with Alex Senecal (202) 219-8461 for resolution. Telephone inquiries to OPM should be directed to Eugene Wooldridge at (202) 606-0228 (or 606-0232). Written inquiries or other correspondence should be directed to the Office of Personnel Management, Retirement Inspection Branch, P.O. Box 7174, Room 2309, Washington, D.C. 20044-7174, Attention: Eugene Wooldridge.

Purpose: To inform District Offices of the procedures for follow-up review and reporting requirements concerning the "hits" identified in the February 1997 DFEC/OPM match, and to reiterate continuing reporting requirements for the previous OPM matches.

Applicability: District Directors, Assistant District Directors.

Action: Each District Office with one or more cases appearing as hits from this match will receive a copy of a computer printout detailing the information on those cases, in a combined listing of disability and death cases. (On this printout the OPM Claim Number begins with "A" for disability cases and begins with "F" for death cases. Also, if the first digit of the OPM Claim Number is 7 or 8 then benefits are being paid under FERS rather than CSRS.) In addition, individual "hit sheets" completed by OPM are in the process of being mailed directly to the District Offices by OPM. Please note that the field identified on the printouts as "OWCP Gross" is actually the FECA 28 day payment amount converted to a 30 day equivalent for easy comparison purposes. The "OWCP Net" field is the actual 28-day gross compensation amount paid.

1. Immediately pull and review each disability (OPM "A" prefix) case listed in which the OPM gross payment amount exceeds the FECA gross payment amount. (For these cases the OPM amount is underlined on the printout.) If a review of the case confirms that the claimant is, in fact, in receipt of prohibited dual benefits, then action should be taken immediately to obtain an election from the claimant. If the receipt of dual benefits was discovered as a result of this computer match, the claimant should be advised of this. The claimant should be advised that the benefit not elected will be terminated and that he or she may dispute the dual benefit finding and proposed action. The claimant will be given 30 days to complete and return an election of benefits form. Upon receipt of the completed election form, the benefit not elected is to be terminated as soon as possible. A copy of the election form is to be returned to OPM along with a copy of the supplemental "hit sheet." If the claimant fails to make an election or to dispute the dual benefit finding within the 30 day period, the claimant should be removed from the compensation rolls as soon as possible.

2. Review the remaining disability cases (those where FECA benefits exceed OPM benefits), and the death (OPM "F" prefix) cases (as detailed below). In the disability cases where FECA benefits are greater, OPM will seek the election and return a copy of the election along with a completed OPM "hit sheet" to DFEC.

3. In death/survivor cases (OPM "F" prefix), an informed election must be made before either benefit is terminated. Please remember that split elections can be made. In fact, several de facto split elections were discovered during previous matches; that is, there appeared to be dual benefits situations when in fact different beneficiaries were receiving OPM and FECA benefits. In other cases split elections have been made as a result of the matches. It is important that truly informed elections are made in these cases. During the 3rd match you were advised of our revised policy regarding the revocability of elections in death cases. That change was formalized by revision to the regulations. However, OPM maintains that survivor elections are irrevocable; that is, that once an election of FECA benefits is made, the beneficiary may not subsequently elect OPM benefits, unless the FECA entitlement is later determined to have been mistaken, or there is a third-party credit absorption.

Therefore, included in the information provided to a beneficiary in order for him/her to make an informed election should be a statement that an election of OPM benefits can later be changed to elect FECA benefits, but that the reverse is not possible. In addition, an informed election should be based on a comparison of each beneficiary's benefits. Where the total converted gross FECA benefit is greater than the total OPM benefit, OPM will obtain the election of benefits and return a copy of the election along with a copy of the OPM "hit sheet" to DFEC.

Where the total OPM benefit exceeds the total converted gross FECA benefit and the review of the file confirms that the claimant is, in fact, in receipt of prohibited dual benefits, then action should be taken immediately to obtain an election from the claimant. If the receipt of dual benefits was discovered as a result of this computer match, the claimant should be advised of this. The claimant should be advised that the benefit not elected will be terminated and that he or she may dispute the dual benefit finding and proposed action. The claimant will be given 30 days to complete and return an election of benefits form. Upon receipt of the completed election form, the benefit not elected is to be terminated as soon as possible. A copy of the election form is to be returned to OPM along with a copy of the supplemental "hit sheet." If the claimant fails to make an election or to dispute the dual benefit finding within the 30 day period, the claimant should be removed from the compensation rolls as soon as possible.

4. In any case which results in a DFEC overpayment, the District Office should take immediate action in accordance with the overpayment procedures specified in Part 6 of the Procedure Manual.

5. Each DFEC overpayment case should be reviewed in order to determine whether the usual notifications concerning the prohibition against receiving concurrent retirement and compensation payments have been made. If so, the assumption must be made that the claimant is not without fault when such an overpayment occurs. Thus, except where this assumption is overcome by the evidence in the case file, a CA-2201 should be released immediately. Examiners are reminded that the supporting memorandum should explicitly detail the notification made.

6. When the appropriate overpayment letter is released, a 30-day call-up should be placed in the file. As soon as possible after a final decision has been released, administrative offset should be requested from OPM.

7. Initial review of all the listed cases should be completed and a report submitted by May 9, 1997, and quarterly thereafter until each "hit" is resolved. This review should confirm or refute the information supplied, the receipt of dual benefits and, where receipt of dual benefits is confirmed, determine whether or not there is an election of benefits on file. Each report must include, as appropriate:

a. The FECA case number and beneficiary name for each listing.

b. For death cases, the name, date of birth and relationship to the decedent should be listed for each eligible beneficiary.

c. Periods for which FECA benefits have been paid (specify schedule award periods).

d. Was the payment of dual benefits discovered through this match? (yes/no)

e. Is there an election on file? (yes/no) If yes, a copy of the election letter should be attached.

f. Have compensation payments been terminated? If so, effective on what date?

g. Is there an overpayment of compensation? (yes/no)

h. Is DFEC responsible for recovery?

i. What is the amount of the OPM overpayment?

j. What is the amount of the FECA overpayment transferred to the Accounts Receivable ledger?

k. Dates of subsequent due process and collection actions, including issuance of overpayment letters, final decision, release of SF-2805 to OPM requesting offset, etc. (Note: The current version of the SF-2805, Revised October 1988, should be used.)

Follow-up reporting for this match and for unresolved cases from prior matches should continue quarterly (by the 15th day of the first month of each quarter, i.e., 7/15, 10/15, 1/15, 4/15) until final resolution of the matter, until, for example, either the debt has been collected in full, a repayment schedule has been established and met at least once, or the account is otherwise closed. The final report should describe the repayment plan and/or date of payment. For example, the final report should show that a CA-2201 was issued on July 7, 1997; a final decision was issued on August 11, 1997 finding an overpayment of $2000; an SF-2805 was issued on September 22, 1997; the first payment of $200 was received from OPM on December 1, 1997; the debt will be recovered by October 1998. (Note: For OPM debts, reporting may cease once the OPM overpayment amount has been reported. You no longer need to report any actions on OPM debts beyond this point.)

Disposition: This Bulletin should be retained until all actions have been completed.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 6
(Regional Directors, District Directors, Assistant District Directors, Chiefs of Operations, Systems Managers, Technical Assistants and National Office Staff)

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-13

Issue Date: June 5, 1997

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Expiration Date: June 4, 1998

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Subject: Contract Observers on Vessels

Background: Public Law 104-297, enacted on October 11, 1996, provides that observers on vessels who are under contract to carry out responsibilities under the Magnuson-Stevens Fishery Conservation and Management Act or the Marine Mammal Protection Act of 1972 shall be deemed to be Federal employees for the purpose of compensation under the Federal Employees' Compensation Act.

Contract observers are employed in private industry to carry out the requirements of these Acts, which are under the jurisdiction of the Department of Commerce. Since these individuals are not Federal employees, the Department of Commerce will not be charged back for these cases, and will not be directly involved in the claims process.

Because we anticipate that these cases will present unusual issues, they must be handled in one location.

Reference: P.L. 104-297, Section 204; Federal (FECA) Procedure Manual, Chapters 1-0100.5 and 2-0802.

Purpose: To alert district offices to the possibility of receiving claims from a new group of individuals.

Applicability: District Directors, Systems Managers, All Supervisors, Claims, Mail Room, and Case Create staff.

Action: All claims from contract observers and their survivors will be forwarded to the National Operations Office (District 25) without jacketing. They will be assigned case file numbers with an OB- prefix, and will be retained in the National Operations Office.

Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Distribution: List No. 3--Folioviews Groups A, B, C, and D

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-14

Issue Date: July 14, 1997

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Expiration Date: July 13, 1998

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Subject: Bill Pay--Travel Expenses

Background: Recent changes in travel regulations for federal employees have prompted National Office staff to reevaluate how FECA claimants should be reimbursed in connection with travel to obtain medical examination, treatment, appliances and supplies.

Consistent with the new regulations, claimants will no longer be reimbursed for meals obtained during periods of travel lasting 12 hours or less. Where the period of travel lasts between 12 and 24 hours, the claimant will be authorized actual expenses up to 3/4 of the per diem rate for the locality of travel based on reasonable charges. Where the period of travel is a full 24 hour day, the claimant will be authorized actual expenses up to the entire per diem rate for the locality of travel.

National Office staff will advise employing agencies of these changes through a notice on the Internet and at the next Interagency Meeting.

Reference: FECA Procedure Manual Chapters 3-500.10 and 5-204.8

Purpose: To provide guidance in evaluating claims for reimbursement of travel expenses

Applicability: Claims Examiners, Bill Resolution Staff, Technical Assistants, Staff Nurses, Rehabilitation Specialists, and Supervisors

Action:

1. When authorizing travel, claims staff should advise the claimant of the applicable rule, based on the likely period of travel, as stated above in the second paragraph under "Background".

2. Bill resolution staff should deny payment for meals and incidental expenses for travel lasting less than 12 hours. Ineligible amount code H (disallowed travel expenses) may be used to disallow a portion of a travel claim.

3. Claimants are still required to submit receipts for hotels. Bill resolution staff should reimburse claimants for meals in the same fashion as federal employees are while on official government travel. That is, 3/4 of the per diem rate on the first and last day of travel and full per diem rate for travel on any other days of the trip. With this there is no requirement for meal receipts.

4. To obtain per diem rates, claims and bill resolution staff may consult "Temporary Duty Guide for Department of Labor Employees", Publication No. 7. This booklet, which is revised each year, is available from OASAM.

5. Claimants must also continue to submit receipts for taxicabs, regardless of the amount, because the use of a taxicab is based on medical need.

6. These provisions are effective for all travel undertaken on or after the date of this bulletin.

7. Form CA-77 has been revised, and a copy is attached.

Disposition: Retain until the indicated expiration date.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

Attachment

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

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Attention: This bulletin has been superseded and is inactive.

FECA BULLETIN NO. 97-15

Issue Date: September 5, 1997

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Expiration Date: September 4, 1998

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Subject: Felony Imprisonment Cases—-Reporting Requirements

Background: Public Law 103-333, enacted on September 30, 1994, amended the FECA by adding a new section 5 U.S.C. 8148, which provides for (a) the termination of benefits payable to beneficiaries who have been convicted of defrauding the program, and (b) the suspension of benefits payable to beneficiaries imprisoned as a result of felony conviction.

FECA Bulletin 95-5 originally reported this amendment; it has since been incorporated into the Federal (FECA) Procedure Manual at 2-1400.12. Also provided were instructions for reporting suspensions to Don Frederick of the National Office so that savings from the enactment of this amendment could be monitored. A requirement was not created, however, for reporting when a claimant whose compensation had been suspended under this provision was released from prison and again entitled to compensation. This has resulted in the potential for overstatement of savings.

Purpose: To alert district offices of the requirement that resumption of benefits previously suspended due to felony imprisonment must be immediately reported to the National Office, and to alert district office staff of the new contact person, Sheila Baker.

Applicability: District Directors, Assistant District Directors, Claims staff.

Action: Any claim where compensation has been suspended due to felony imprisonment should continue to be immediately reported to Sheila Baker at the National Office. Ms. Baker should also be promptly notified when the imprisonment ends and compensation resumes.

Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.

 

THOMAS M. MARKEY
Director for
Federal Employees' Compensation

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

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