2010 FECA Bulletins which have previously been issued by the DFEC but have since expired or been superseded by another Bulletin, Circular or inclusion in the FECA Procedure Manual.
|
FECA Bulletin No. |
Subject |
|---|---|
|
Compensation Pay: Compensation Rate Changes Effective January 2010 |
|
|
Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2010 |
|
|
Processing claims for Death Gratuity benefits for deaths covered under section 8102(a) of the Federal Employees' Compensation Act (FECA) |
|
|
COP (Continuation of Pay) Nurse Intervention Process Updates |
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 10-01
Issue Date: January 29, 2010
Expiration Date: January 1, 2011
Subject: Compensation Pay: Compensation Rate Changes Effective January 2010.
Background: On December 23, 2009, the President signed Executive Order 13525 implementing a salary increase of 1.50 percent in the General Schedule basic pay. The applicability under 5 U.S.C. 8112 only includes the 1.50 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment became effective at the start of the first full pay period after January 1, 2010.
Purpose: To inform the appropriate personnel of the increased minimum/maximum rates of compensation and the adjustment procedures for affected cases on the periodic disability and death payrolls.
The new rates were effective with the first compensation payroll period beginning on or after January 1, 2010. Thus, for daily roll supplemental payments January 3, 2010 is the specific effective date of the increase. The effective date for the increase of periodic and death roll payments will be January 17, 2010. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, step 10, which is now $129,517 per annum. The basis for the minimum compensation rate is the salary of a GS-2, Step 1 which is $20,017 per annum.
The minimum increase specified in this Bulletin is applicable to employees of the U.S. Postal Service.
The effect on 5 U.S.C. 8112 is to increase the payment of compensation for disability claims to:
|
Effective January 3, 2010 |
Minimum |
Maximum |
|---|---|---|
|
Weekly |
$288.71 |
$1,868.03 |
|
Daily (5-day week) |
57.74 |
373.61 |
|
Effective January 3, 2010 |
Minimum |
Maximum |
|---|---|---|
|
28-Day Cycle |
$1,154.83 |
$7,472.13 |
The effect on 5 U.S.C. 8133(e) is to increase the monthly pay on which compensation for death is computed to:
|
Effective January 3, 2010 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,668.08 |
$8,094.81 |
Applicability: Appropriate National and District Office personnel
Reference: Memorandum for Executive Heads of Departments and Agencies dated December 23, 2009, and the attachment for the 2010 General Schedule.
Action: The Integrated Federal Employees' Compensation System (iFECS) will update the periodic disability and death payrolls. It should be noted that this adjustment process re-calculates EVERY compensation record from its very beginning to current date. Thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect.
Any cases keyed as "Gross Overrides without CPI" in iFECS will not have a supplemental record or make a separate calculation of additional entitlement. Thus, these gross override cases must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required and the case record documented. A notice should be sent to the payee by the District Office, detailing the change in the rate of compensation. All cases keyed as "Gross Overrides with CPI" will be adjusted in the usual manner.
1. Adjustments Dates.
a. As the effective date of the adjustment was January 17, 2010 for the periodic disability and death rolls, there was no supplemental payroll needed. The February 13, 2010 death and disability payments will include any necessary minimum/maximum compensation adjustments.
b. The new minimum/maximum compensation rates were available in iFECS on January 25, 2010.
2. Adjustment of Daily Roll Payments. The salary adjustments are not retroactive, so it is assumed that all Federal agencies have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2010. Therefore, it is not necessary to review any of these payments.
However, if an inquiry is received then verification of the pay rate must be secured from the employing agency, and the necessary adjustment applied.
Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Distribution: List No. 2 – Folioviews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
Back to Top of FECA Bulletin No. 10-01
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 10-02
Issue Date: January 29, 2010
Expiration Date: February 28, 2011
Subject: Compensation Pay - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2010.
Purpose: To furnish information on the CPI adjustment process for March 1, 2010.
The cost of living adjustments granted to a compensation recipient under the FECA are based on the "Consumer Price Index for Urban Wage Earners and Clerical Workers" (CPI-W) figures published by the Bureau of Labor Statistics (BLS). The annual cost of living increase is calculated by comparing the base month from the prior year to the base month of the current year, with the percentage of increase adjusted to the nearest one-tenth of 1 percent, determining the amount of the CPI increase granted to claimants. 5 U.S.C. 8146(a) establishes the base month for the FECA CPI as December.
December 2008 had a CPI-W level of 204.813 and the December 2009 level was reported by BLS as 211.703. This means that the new CPI increase, adjusted to the nearest one-tenth of one percent, is 3.4 percent. The increase is effective March 1, 2010, and is applicable where disability or death occurred before March 1, 2009. In addition, the new base month for calculating the future CPI is December 2009.
The maximum compensation rates, which must not be exceeded, are as follows:
| Rate | Time |
|---|---|
|
$8,094.81 |
per month |
Applicability: Appropriate National Office and District Office personnel.
Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981; Bureau of Labor Statistics Consumer Price Index Publication for December 2009 (USDL-10-0011)
Action: National Office Production staff will update the iFECS CPI tables and have all payment records re-calculated when the iFECS system is not in use by District Office personnel. This will occur on or about March 1, 2010. The March 13, 2010 check will include the supplemental CPI payment for the period of March 1st to March 13th. The following periodic roll check will reflect the updated 28-day amount. Please note that if there are any cases with fixed gross overrides, there will be no supplemental record created. These cases must be reviewed to determine if CPI adjustments are necessary, and if so a manual calculation will be required. If the gross override payment is in fact eligible for annual CPI increases, the payment plate should be adjusted in the iFECS system to pay as a "Gross Override with CPI."
1. CPI Minimum and Maximum Adjustments Listings. Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated to indicate the increase for 2010. Attached to this directive is a complete list of all the CPI increases and effective dates since October 1, 1966 through March 1, 2010, for reference.
2. Forms.
a. All claimants will be provided a notice with their Benefit Statements, indicating the amount of this year's increase. The Treasury will include this notice as a "stuffer card" with every Benefit Statement issued for the March 13, 2010 rolls.
b. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc.), please continue to provide this data in letter form from the district office. Many times a Benefit Statement may not reach the addressee and regeneration of the form is not possible. A letter indicating the amount of compensation paid every four weeks will be an adequate substitute for this purpose.
Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.
DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Attachment
Distribution: List No. 2 --Folioviews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, and Rehabilitation Specialists)
|
EFFECTIVE DATE |
RATE |
EFFECTIVE DATE |
RATE |
|---|---|---|---|
|
10/01/66 |
12.5% |
03/01/87 |
0.7% |
Prior to September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After September 7, 1974, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).
| Date | Compensation | Date | Compensation |
|---|---|---|---|
|
Prior to 09/07/74 |
.08-.34 = .23 |
Eff. 11/01/74 |
.13-.37 = .25 |
ATTACHMENT TO FECA BULLETIN NO. 10 - 02
Back to Top of FECA Bulletin No. 10-02
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 10-03
Issue Date: February 26, 2010
Expiration Date: February 26, 2011
Subject: Processing claims for Death Gratuity benefits for deaths covered under section 8102(a) of the Federal Employees' Compensation Act (FECA).
Background: The National Defense Authorization Act for Fiscal Year 2008, Public Law 110-181, was enacted on January 28, 2008. Section 1105 of P.L. 110-181 amended the FECA, creating a new section 8102(a). The section establishes a new FECA benefit for eligible survivors of federal employees and Non-Appropriated Fund Instrumentality (NAFI) employees who die of injuries incurred in connection with service with an Armed Force in a contingency operation. The new section 8102(a) states that the United States will pay a death gratuity of up to $100,000 to those survivors upon receiving official notification of the employee's death.
Section 8102(a) states that the United States will pay the death gratuity to the eligible survivors "immediately upon receiving official notification" of an employee's death. The section also contains a retroactive payment provision, stating that the death gratuity will be paid for employees of certain agencies who died on or after October 7, 2001, due to injuries incurred in connection with service with an Armed Force in the theater of operations of Operation Enduring Freedom and Operation Iraqi Freedom.
Purpose: To provide guidance on processing claims filed under section 8102(a) of the Act.
References: Title 5 U.S.C. 8102(a); 20 C.F.R. Part 10.900 - 10.916 (Interim Final Rule and Final Rule); CA-40, (Beneficiary Designation); CA-41, (Claim for Benefits); and CA-42, (Agency's Official Notice of Employee's Death).
Applicability: All National Office staff and District Office claims personnel.
Actions:
1. All claims for benefits under 8102(a) will be processed by the Special Claims Unit in the Cleveland District Office. As a result, all claims for a death gratuity are to be transferred to Cleveland immediately upon receipt. Once received in Cleveland, these cases will be assigned a specific claim number series beginning with DG. A DG claim number will be assigned to each person making the claim. That means that more than one DG claim could be created as the result of one death. This also means that if a claim for a death gratuity is made in an existing FECA case, a new DG claim will be assigned to the death gratuity - distinct from the existing FECA case. If more than one DG claim is filed as the result of one death, the associated DG cases will be cross referenced in the case file; however, the reference will only be to the other DG case numbers (without names or any other personally identifiable information) and to the decedent. The statute states that the United States will make payment to eligible survivors "immediately upon receiving official notification" of an employee's death.
2. Three new forms were created for processing these claims: the CA-40, Designation of a Recipient of the Federal Employees' Compensation Act Death Gratuity Payment under Section 1105 of Public Law 110-181 (Section 8102a); the CA-41, Claim for Survivor Benefits Under the Federal Employees' Compensation Act Section 8102a Death Gratuity; and the CA-42, Official Notice of Employees' Death for Purposes of FECA Section 8102a Death Gratuity.
3. There are two ways to initiate a death gratuity claim. The employing agency may initiate the process by filing form CA-42 (Official Notice of Employee's Death), or a claimant may initiate the process by filing a claim with the OWCP using form CA-41 (Claim for Survivor Benefits). Each claimant who wishes to claim survivor benefits must file form CA-41. Regardless of which party filed a form initiating the process, forms from the agency and all claimants must be filed with the OWCP. Additionally, the employing agency must submit form CA-40, the designation form completed by the employee prior to death, if such form exists. See section 10.911 of the regulations for further details.
4. In addition to the claim forms needed to initiate the death gratuity payment process, the OWCP must ensure that the employing agency provides as much information as possible about any living survivors or alternate beneficiaries. When this information is received from the agency, the OWCP will attempt to contact any living survivors or alternate beneficiaries and provide them with the CA-41 with instructions on how to file a claim, as provided in section 10.911 of the regulations. Additional documentation (such as marriage certificates and death certificates) will be required and should be requested from the claimant if not submitted with the CA-41 or CA-42.
5. Once the claim forms and supplemental documentation are received, the OWCP will review the claim and make a determination on whether the criteria for payment are established. The claimant bears the ultimate burden in the submission of proof of eligibility, but the employing agency and the OWCP will assist in gathering documentation. The claim and accompanying documentation must be evaluated for timeliness, employee status of the decedent, fact of injury, performance of duty [including death due to a war risk hazard under 8102(b)], and causal relationship just as in other FECA claims. In addition, the evidence must be reviewed in order to determine whether the fatal injury or illness occurred "in connection with the employee's service with an Armed Force in a contingency operation." Examples are provided in section 10.912 of the regulations.
6. Section 8102(a) contains a provision for retroactive payment which allowed the employing agency the option of applying this gratuity to deaths that occurred on or after October 7, 2001 if the death resulted from injuries incurred in connection with an employee's service with an Armed Force in the theater of operations of Operation Enduring Freedom or Operation Iraqi Freedom. As no employing agency chose to opt out of this retroactivity provision during the regulatory process, claims that meet all other eligibility criteria may be paid. When reviewing these claims for a determination on timely filing, note that time cannot begin to run until the Interim Final Rules for filing were published on August 18, 2009, as noted in section 10.912 of the regulations.
7. If the evidence establishes that the employee's death falls within the scope of coverage, taking into account all of the factors listed above, then the OWCP will calculate and distribute the death gratuity. By regulation, the OWCP has determined, for equitable reasons, that every death gratuity will be paid in the amount of $100,000, minus the amount of any death gratuity payments that have been paid under any other law of the United States based on that same death.
8. Please note that the FECA death benefits payable under section 8133 of the Act do not constitute a dual benefit and are not, therefore, deducted from the $100,000 payment made under section 8102(a).
a. All federally paid death gratuities paid at the time that the OWCP dispenses the FECA death gratuity must be deducted to offset the amount available for payment. The employing agency is required to provide information about other death gratuities. For example, if the $10,000 death gratuity benefit payable under Public Law 104-208 (which authorizes payment of up to $10,000 to survivors of employees who died in the line of duty on or after August 2, 1990) has been paid, it constitutes a dual benefit that must be offset and only $90,000 of the FECA death gratuity may be paid. As certain agencies have death gratuities that pay a full year's salary, there will be instances where no FECA death gratuity is payable. See section 10.916 of the regulations for further information.
b. If the information of record indicates that there may be a death gratuity benefit which has been paid for the same death, that death gratuity benefit amount will need to be deducted from the $100,000 payable under 8102(a) of the FECA. The OWCP should request information from the agency in writing about any such payment and request a response within 20 days. (The employing agency is also required to provide information about any other death gratuity benefits on the DG forms.) When all other development has been completed, the OWCP will notify the agency in writing that payment will be made 14 days from the date of the OWCP's letter based on the evidence of record and payments made on that date. As the statute and regulations anticipate expeditious processing of all FECA death gratuity claims, offset can only be applied for other death gratuity payments that have been made. If no further information is received, the OWCP will proceed with payment of the $100,000. If an agency pays a death gratuity subsequent to the OWCP's issuance of payment of the FECA death gratuity, such a payment does not create an overpayment of FECA compensation.
9. The order of precedence is set forth in section 10.907 of the regulations as follows:
(a) Employee's surviving spouse;
(b) Employee's children, in equal shares;
(c) Employee's parents and siblings or any combination of them if designated by the employee pursuant to designation procedures; OR
(d) Employee's parents, in equal shares; and THEN
(e) Employee's brothers and sisters, in equal shares
10. In addition to the survivors defined above, an employee can designate an alternate beneficiary or beneficiaries to receive up to 50 percent of the death gratuity, as described in section 10.908 of the regulations. The alternate beneficiary can be any person and is separate from the order of precedence set forth above. In order for the alternate beneficiary provision to be effective, the employee must have completed Form CA-40 with the alternate beneficiary designation fully and completely prior to death and the employing agency must have completed their portion of the form. (See regulations for changes in the order of precedence.)
11. Once the apportionment has been established and payments made to the eligible survivors, a letter should be sent to each beneficiary with an explanation of the benefits they are receiving. Where benefits are denied or the beneficiary disagrees with an OWCP determination, a formal decision with appeal rights should make findings of fact and explain the reason for the denial. Consult the National Office as questions arise.
12. Definitions (refer to sections 10.900, 10.901 and 10.906 of the regulations for more detailed definitions):
Armed Forces - We have adopted the same definition of "Armed Forces" as found in 10 U.S.C. 101(a)(4): Army, Navy, Air Force, Marine Corps and Coast Guard. Contingency Operation - The first part of this definition is a "military operation that is designated by the Secretary of Defense as an operation in which members of the Armed Forces are or may become involved in military actions, operations, or hostilities against an enemy of the United States or against an opposing military force." The second part of this definition includes any "military operation that results in the call or order to active duty members of the uniformed services during a war or national emergency declared by the President or Congress." Note that this includes humanitarian and peacekeeping operations. Employee - In addition to the definition found in section 8101 of the FECA, NAFI employees are covered under the new death gratuity. Beneficiaries - The statutory definitions of survivors in the new section 8102(a) differ from the existing definitions of the same terms in FECA at 5 U.S.C. 8101. A surviving spouse is defined as "the person who was legally married to the deceased employee at the time of his or her death." The definition of children includes all of the employee's natural children, adopted children, and some stepchildren without regard to age, marital status, or dependency on the employee. Parent includes parents through adoption and persons who stood in loco parentis in accordance with regulatory requirements. The employee's brothers and sisters as well as half-siblings and siblings through adoption are survivors. Step-siblings are not included.
Disposition: Retain until incorporated into the FECA Procedure Manual.
DOUGLAS C. FITZGERALD
Director for Federal Employees' Compensation
Distribution: List No. 1--Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
Back to Top of FECA Bulletin No. 10-03
Attention: This bulletin has been superseded and is inactive.
FECA BULLETIN NO. 10-04
Issue Date: September 10, 2010
Subject: COP (Continuation of Pay) Nurse Intervention Process Updates.
Background: OWCP has been using COP Nurses (CNs) during the 45-day COP period for many years, but the CN process is being updated to allow quicker assignment and more efficient follow up to aid in more effective disability management. The revised CN processing guidelines have new components for the Staff Nurse (SN), Claims Examiner (CE) and CN. Several updates have been made in iFECS to facilitate these changes, effective with the iFECS release in September, 2010.
Purpose: To provide guidance to claims staff, Employing Agencies (EA) and SNs on the revised COP Nurse Intervention Process.
Applicability: All National Office staff and District Office claims personnel, Staff Nurses and Rehabilitation Specialists.
Actions:
1. Assignment of a CN. CNs will be assigned earlier and have a more proactive, in-depth role during the COP period. Beginning with the iFECS release in September, 2010, all cases will be eligible for automatic assignment 7 days after the claimant stops work. This information is taken from the data contained on the CA-1. (Currently, a case does not automatically become eligible for a COP nurse assignment unless the claimant has stopped work for at least 15 days and has not returned to work.) The case will actually show up for assignment by the SN on day 8. Once assigned, the EA will be able to see in the Agency Query System (AQS) that a CN has been assigned. Once the CN's case is closed, the EA will be able to see that closure status and date.
Note: If a return to work date has been entered into iFECS prior to the data run on the night of day 7, the case will not be eligible for assignment of a CN.
2. Reporting a Return to Work (RTW). If the claimant returns to work, the EA can report this to OWCP in one of two ways, via electronic CA-3 or phone call. The electronic CA-3 is the preferred method.
Electronic CA-3 – A CA-3 reporting a claimant's RTW can be submitted electronically to OWCP. Upon receipt of a CA-3 reporting a RTW, the case will be flagged until the CA-3 is reviewed and the RTW date is approved or rejected as being accurate.
Phone Call - If a claimant returns to work after the CA-1 has already been submitted, but prior to assignment of a CN, the EA can call the appropriate district office to report the RTW if the EA is unable to transmit an electronic CA-3. The person taking the call at the district office should immediately update the RTW field on the Work Status tab in the Case Maintenance application in iFECS so that a COP nurse is not assigned. A report of the telephone call (CA-110) should be created and placed into the imaged case file; however, a telephone message should not be sent to the CE for action at a later date since the information needs to be entered on the day it is received.
3. Recording a RTW date in iFECS. The Case Maintenance application in iFECS has a RTW field on the Work Status tab as noted above. A new RTW section has also been added to this tab, titled CA3/COP RTW. This new section will record a RTW date taken from the submission of an electronic CA-3 during the COP period. The CA-3 status though will be blank, and the CA-3 RTW date is considered pending until reviewed by the CE (or any claims personnel) or the SN. Once the CA-3 has been reviewed, and the date has been approved as accurate or rejected, the user ID of the person who made the decision will appear, along with the updated status (Approve or Reject).
a) A user can make this decision directly in the Case Maintenance application by clicking the box for either Approve or Reject, or while indexing the CA-3 as described below.
b) If an electronic CA-3 is submitted from an EA, it will show up in the CE's unreviewed mail. If the CA-3 is submitted during the COP period, a new workflow will be triggered during the indexing process. While indexing this document, the CE will be presented with a new dialog box. The dialog box will present the CE with three options: Approve, Reject or Postpone. The CE has to make a selection between these three options before moving on. If while indexing that CA-3, the CA-3 RTW date has already been approved or rejected by someone else, the CE gets no prompt and will index the document in the usual manner.
Approve – The CE will click this option if everything on the CA-3 looks accurate and there are no obvious problems with the RTW date provided. If the RTW date is approved, it will be recorded in Case Maintenance, without the actual application opening.
Reject – The CE will click this option if the information on the form seems to be incorrect, e.g. there is a RTW date listed, but the EA indicates in the comment field that the claimant was scheduled to return on that date but did not do so. If the CA-3 RTW date is rejected, it will be recorded in Case Maintenance, without the actual application opening.
Postpone – The CE will click this option if the choice is not clear and the CA-3 needs to be reviewed more carefully to make a determination. The CE may need to review the case documents and/or make a call to the EA before approving or rejecting the date. If the CE chooses Postpone, no change will take place in Case Maintenance and the case will remain flagged in the system awaiting a decision on the CA-3 RTW date. The CA-3 RTW date will remain pending in Case Maintenance. When the CE does make a decision on the CA-3 RTW date at a later time, the CE will have to choose the Approve or Reject option in Case Maintenance.
c) While a decision on the CA-3 is pending, the case is flagged as ineligible for CN assignment. The SN will see a flag next to the case in the COP Nurse Assignment screen in iFECS. The SN may at that time review the CA-3 and approve or reject the RTW date, or the SN may wait for the CE or other claims personnel to make that decision. (This process may vary by district office or staff availability.) If the RTW date is approved, the case will no longer be eligible for assignment to a CN. If the RTW date is rejected, the flag in the COP Nurse Assignment screen will disappear, making the case eligible for assignment to a CN.
4. COP Nurse Actions. The CN will be using a new application in iFECS called COP Case Processing. He or she will also have "view only" access to the Imaging and Case Maintenance applications but will be able to enter information into the new COP Case Processing application.
Once assigned, the CN will see the new case requiring action, along with other open cases and cases requiring follow up action. He or she will update the record with all contact information, RTW dates, etc. in the COP Case Processing application. CNs will be expected to take the following actions and record the information in the activity log portion of COP Case Processing in iFECS:
a) Make contact with the claimant, EA, and attending physician's office or other medical providers as appropriate.
b) From the claimant, obtain a brief history of injury, history of treatment and current work status, as well as attending physician contact information.
c) From the EA, confirm work status and find out if light duty is available.
d) From the attending physician's office, obtain verbal history of treatment and expected treatment plan, and provide OWCP's mailing address for submission of reports and ACS contact information to be used should the claim be approved. The CN should also advise whether job accommodations can be made based on the contact with the EA, and, if appropriate, provide a form CA-20, Attending Physician's Report, requesting that it be completed and submitted to OWCP.
e) The CN should also make recommendations about assignment of a Field Nurse (FN).
Both the CE and the SN will be able to see the actions taken by the CN at any time during the period of assignment by clicking on a new COP Activity Log icon in Case Maintenance.
Once the CN has obtained the required information, the case will be submitted for approval to the SN. It will then be considered a "pending closure" and will be placed into a queue for review by the SN. After the SN reviews the Activity Log, the SN will approve or reject the closure. If the closure is rejected, e.g. information is missing, the case is returned for review by the CN. If the SN approves the closure, the CN's bill is automatically sent for processing and the COP Nurse Closure report is automatically generated. The SN will then electronically image the COP Nurse Closure report into the case file.
If a CA-3 with a RTW is received during this period, the COP Nurse case will be locked and the CN can not make further entries into the COP Activity Log. If the CA-3 RTW date is approved as accurate, the case will be closed (whether the CN has taken any actions or not). If the CA-3 RTW date is rejected, the case will be unlocked and the CN can proceed.
5. COP Nurse Timeframes. The CN should obtain the necessary information, as outlined above, and submit a closure report within 7 days. There is a limited amount of flexibility with this 7-day timeframe. If the CN has determined that the claimant will be returning to work within the following week, and the specific contact information supporting a definitive return to work date has been added to the Activity Log, the COP Nurse case can be held open beyond the 7-day window to verify and report that RTW date and status. CN closure, even with this kind of limited extension, should occur though no later than 14 days after assignment.
6. COP Nurse Reports. The COP Nurse Closure reports have been updated. The information will be pulled directly from the information entered by the CN in the iFECS COP Nurse Activity Log. These reports will look different depending on the closure code. The COP closure code and date, as well as RTW information, will be clearly visible. Other pertinent information, depending on the closure type, will also be viewable.
7. COP Nurse Closure Codes. The closure codes have been expanded to allow for closures based on the CN, actions taken by the CE, or information approved from a CA-3. The complete list of closure codes is below:
| Code | Description |
|---|---|
|
9A |
COP Case Closed – Case Accepted |
|
9B |
COP Case Closed by CE with FT/LD RTW (Full Time Light Duty) |
|
9C |
COP Case Closed by CE with FT/RD RTW (Full Time Regular Duty) |
|
9D |
COP Case Closed – Case Denied |
|
9E |
COP Case Closed by CE with PT RTW (Part Time) |
|
9F |
COP Case Closed Using CA-3 with FT/RD RTW |
|
9G |
COP Case Closed Using CA-3 with FT/LD RTW |
|
9H |
COP Case Closed – Emergency Hospitalization |
|
9K |
COP Case Closed Using CA-3 with PT RTW |
|
9L |
COP Case Closed by Nurse with FT/LD RTW |
|
9N |
COP Case Closed - No RTW |
|
9O |
COP Case Closed - Claimant Not Cooperating |
|
9P |
COP Case Closed by Nurse with Part-time RTW |
|
9R |
COP Case Closed by Nurse with FT/RD RTW |
|
9S |
COP Case Closed – Surgery Imminent |
|
9T |
COP Case Closed – Catastrophic Case |
|
9U |
COP Case Closed - RTW Unknown |
|
9X |
COP Case Closed – Stopped Work > 45 days |
|
9Y |
COP Case Closed Using CA-3 – RTW without status |
8. CE Actions Upon CN Closure. Upon receipt of a COP Nurse Report indicating no RTW, only partial RTW or some other pending issue, the CE should take two primary actions: adjudication (or development) should be expedited if possible and assignment of a FN should be considered.
9. Case Adjudication. Any closure code that denotes less than a full-time RTW will flip an administratively closed case to UN so that it can be adjudicated. Since FNs are not assigned to unadjudicated cases, the CE should attempt to expedite the adjudication process in these claims where the claimant has not RTW in a full-time capacity. If the claim cannot be accepted upon first review, development should be undertaken. The claimant will be afforded 30 days to submit necessary evidence but the claim should be monitored during that 30-day period so that it can be accepted as soon as the proper supporting documentation is received. The OQS2 reports for unadjudicated traumatic injury and reopened c-closure cases have been updated with new fields to enable the CEs to monitor these cases more easily, as outlined in #11.
10. Field Nurses. Each case is unique, but in most instances, if the case is accepted and the claimant has not RTW in a full-time capacity, the case should be referred for FN assignment promptly after acceptance, even if the COP period has not elapsed. A FN may also be assigned if the claimant has returned to work full time, light duty.
If the FN is assigned after a CN assignment, the DM (Disability Management) record will already exist for QCM (Quality Case Management) actions. Once 45 days from the date of injury (DOI) have elapsed, if no RTW full-time code has been entered in DM, the status code TCQ (QCM-Triage to QCM-Open) is auto populated via a nightly run and the category changes to QCM Open. The Start date and Track date are populated with the date the record is changed to QCM Open. If the claimant returns to work before the 45 days from DOI have elapsed, entry of the RTW information in DM tracking inputs the TRC status code (Closed -Triage with RTW during COP) and changes the category to QCM Resolved Triage. Offices will either need to close the FN or open a new DM record in order to follow a light duty RTW with a FN.
11. Online Query System (OQS2) Reports. New report capabilities have been created and some existing reports have been updated to better manage cases during this process.
CE3/CE4 and M23 – Traumatic Injury Cases UN/UD
These reports still list UN/UD (undecided) Traumatic Injury cases along with the age of the case as they do currently; however, a new data column has been added to show the COP Closure Description, if there is one. The report will also be broken into 2 sections. Cases with a COP Closure Code indicating less than a full-time RTW will be listed in the top section, by age, and the bottom portion of the report will list all other UN/UD Traumatic Injury cases by age that do not have a COP Closure Code or have a COP Closure Code indicating that the claimant has returned to work full time. The age data on the report has not changed; the report structure has only been modified to allow the CEs to more easily focus attention on the cases where the claimant is losing time from work.
CE19 and M17 – Reopened LT/NLT Closures Unadjudicated
These reports still list UN/UD c-closure cases, by age, that have been reopened and are awaiting adjudication. CN cases closed with a closure code indicating no RTW or a RTW of less than full time will flip open and appear on this report for adjudication. The report will show the "Reopen Reason" as COP Nurse Closed – No Full-Time RTW.
CE20 – Pending CA-3 During COP Period
This is a new report. This report lists all cases with a pending CA-3 reporting a RTW date during the COP period. The cases will show on this list as soon as they are received and will remain on the report until the RTW date has been approved or rejected. Once the RTW date has been approved or rejected, the case will drop from this list. CEs will likely approve or reject the date while indexing mail; however, this report will enable CEs to find the cases in which they decided to "postpone" the decision while indexing mail.
CE21 – Closed COP Cases
This is a new report. This report will list cases during an identified period for a specific CE, a unit or the office. The user can enter a particular closure code, a set of specific codes, or retrieve all closure codes during a period. This report can be used to follow up on cases by the closure type. The report may also be used to find cases in which the closure code entered indicates only a light duty RTW.
12. NRTS Reports – Two new NRTS reports have also been created for use by the SN to better manage the cases during this process.
Closed COP Cases – This is a new report, similar to the CE21 report in OQS2. This report will allow the user to obtain CN cases that were closed within a given time period by a particular closure code or a set of specific codes, or obtain all closures within the given period.
Overdue COP Cases – This is a new report. This will show all CN cases that are overdue (beyond 7 days old) and have not yet been closed. Cases that the CN has closed that have not yet been reviewed by the SN (pending closures) will not appear on this report. There is a column in the report that will show how many days the CN case is overdue.
13. Tasks. New tasks, viewable in the users Workload Organization Window (WOW), have also been created to assist the CEs and SNs with case management.
CA-3 form should be reviewed - This task will appear for any case with a pending CA-3 reporting a RTW date during the COP period and it will appear on the WOW of the Responsible Claims Examiner (RCE). The task will appear in the WOW as soon as a CA-3 is received and will remain until the RTW date has been approved or rejected. The age column in the WOW shows the task age, and the due date for the task is 3 days later. If the user double-clicks on the task, the Imaging application will open and display the case. Once the RTW date has been approved or rejected (either when indexing the CA-3 or in Case Maintenance), the task will be automatically deleted. CEs will likely approve or reject the RTW date while indexing; however, this task will remind the CE to make a decision on any case where the CE decided to "postpone" the decision while indexing mail.
No COP activity for at least 4 days - This task will appear on the SN's WOW for any case where the CN has not made any entries to the activity log for 4 days. For instance, if the CN takes an action on the case on the day the case is assigned, but then takes no action after that for 4 days (as evidenced by no new entries in the activity log), this task will be created. The age column in the WOW shows the task age (not the COP Nurse case age), and the due date for the task is 3 days later. If the user double-clicks on the Task, NRTS will open and display the case data. The task is deleted when the CN takes any action on the COP case or when the COP case is closed. Note – this task will also appear on the WOW of the CE, but no action is required by the CE.
Disposition: Retain until the procedures noted here are incorporated into the FECA Procedure Manual.
DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Attachments
Distribution: List No. 1--Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
Back to Top of FECA Bulletin No. 10-04