2010 FECA Circulars which have previously been issued by the DFEC but have since been superseded by another Circular or inclusion in the FECA Procedure Manual.
|
Circular |
Subject |
|---|---|
|
Guidance for claims filed as a result of the 2010 Decennial Census |
|
|
Current Interest Rates for Prompt Payment Bills and Debt Collection |
|
|
Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment |
|
|
Dual Benefits - FERS Cost of Living Adjustments |
|
|
Early disability management in 2010 Decennial Census claims |
|
|
Overpayments in cases where lesser impairment is established after a schedule award has been paid for greater impairment |
Attention: This circular has been superseded and is inactive.
|
FECA CIRCULAR NO. 10-01 |
January 15, 2010 |
SUBJECT: Guidance for claims filed as a result of the 2010 Decennial Census
This circular is intended to provide instructions for calculating pay rates, determining Continuation of Pay (COP) entitlement, and understanding third party subrogation for claims filed by employees of the Department of Commerce as a result of the 2010 Decennial Census. While this information is not new, it is being provided so that claims staff can consistently apply the rules and regulations in these cases.
Background:
The Department of Commerce is responsible for conducting the Decennial Census and employs enumerators and crew leaders to gather statistical data through interviews with property residents. The Bureau of the Census expects to hire approximately one million individuals with temporary appointments not to exceed 180 days. These employees will work an average of 84 hours during a four to five week period, one week of which will be training. The peak employment period is April through June 2010.
Pay Rates:
Information pertaining to the 2010 Decennial Census has been updated in FECA PM Chapter 2-0900-12 and Chapter 2-0901-9 to reflect current work patterns. The current work schedule has been determined to be 4.5 hours per day, 4 days per week.
All positions, including enumerators, crew leaders and clerks are paid on an hourly basis. Below are the hourly wage rates for enumerators, crew leaders and clerks:
|
Position |
Rates |
|---|---|
|
Enumerator: |
$10.93 to $22.10 |
|
Crew Leader: |
$12.43 to $23.60 |
|
Clerk: |
$ 8.20 to $15.82 |
Where disability does not exceed 90 days, compensation should be paid on a daily basis in accordance with section 5 U.S.C. 8114(c).
Where disability extends beyond 90 days and the claimant had similar employment during the year prior to the injury, compensation should be paid in accordance with section 5 U.S.C. 8114(d)(1) and (2). If this is not applicable, compensation should be paid on a weekly basis using the following formula: 150 x the actual daily wage divided by 52 (the actual daily wage should be determined by multiplying the hourly pay rate by 4.5 hours).
Any questions regarding pay rates may be referred to the Bureau of Census, Demographic and Decennial Staff, at (301) 763-9620.
COP:
Census workers are civil employees of the Federal government and are included under the COP provisions of 5 U.S.C. 8118; therefore, COP should be determined and calculated in the usual fashion in most instances. However, due to the shorter period of employment for most of these employees, there are a few regulatory provisions to keep in mind.
20 C.F.R. 10.220(d) provides that "an employer shall continue the regular pay of an eligible employee without a break in time for up to 45 calendar days, except when, and only when...the injury was not reported until after employment has been terminated." The employment termination date must be supported by official documentation in the file, such as an SF-50 (or equivalent).
20 C.F.R. 10.222(a)(5) provides that "where the employer has continued the pay of the employee, it may be stopped only when at least one of the following circumstances is present...(5) The employee's period of employment expires or employment is otherwise terminated (as established prior to the date of injury)." The Census Bureau can therefore terminate COP if an SF-50 (dated prior to the date of injury) reflects that the employment would end on a specific date. The key here though is that the SF-50 (or equivalent) must be dated prior to the date of injury.
Also, the Census Bureau sometimes enters into contracts with state, county and city governments to conduct various types of surveys. Most of the workers are hired for very short periods of time, and they are paid directly by the local entity conducting the study. It has been determined that they are not eligible for COP.
Third Party:
Because of statutory confidentiality requirements, Census workers (enumerators and field representatives) cannot file third party claims against home owners or the owners of business establishments unless there is a deliberate act by the resident or owner. Census workers are required by 13 U.S.C. 9(a)(2) to maintain the confidentiality of information provided by a resident or establishment, and are subject to criminal penalties including imprisonment under 13 U.S.C. 214 for the release of information protected by 13 U.S.C. 9. For this reason, it has been determined that OWCP will not require a Census enumerator or field representative who is injured on the private property of the resident or interviewee to pursue a third party claim against the resident or owner. The Bureau of Census has therefore been instructed to answer "no" on the Form CA-1 in response to the question regarding third party liability. The CE should therefore not release the CA-1045 in most instances.
There are only a few exceptions to this rule. If the CE confirms with the Bureau of the Census that the injury was the result of a deliberate act by a resident, or the injury was sustained in transit between interview sites in such a way that the Census worker can maintain confidentiality, the CE should proceed with the release of the CA-1045. For a more detailed discussion, see Federal FECA Procedure Manual at 2-1100-7(a)(3) and FECA Bulletin 99-30, issued August 30, 1999.
Pilot Programs:
Because of the intensive effort involved in the 2010 Census and the need to facilitate quick action on these cases, DFEC and the Bureau of Census are piloting expedited case file access and early nurse referral on a limited basis in order to assess the efficacy of such efforts in improving outcomes for injured employees.
DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Distribution: List No. 2—Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)
Back to Top of FECA Circular No. 10-01
Attention: This circular has been superseded and is inactive.
|
FECA CIRCULAR NO. 10-02 |
January 29, 2010 |
SUBJECT: Current Interest Rates for Prompt Payment Bills and Debt Collection
The interest rate to be assessed for the prompt payment bills is 3.25 percent for the period of January 1, 2010 through December 31, 2010. This new rate has been updated in the Central Bill Payment system tables.
The rate for assessing interest charges on debts due the government has also been changed. The interest rate for assessing interest charges on debts due the government is now 1.0 percent for the period of January 1, 2010 through December 31, 2010.
Ordinarily, the rate of interest charged on debts due the U.S. Government is only changed in January, and is effective for the entire year. However, the rate may be changed in July if there is a difference in the Current Value of Funds (CVF) interest rate of more than two percent. The rate will be reviewed on July 1, 2010 to determine if the Treasury has changed the rate.
Attached to this Circular is an updated listing of both the Prompt Payment and Debt Management interest rates from January 1, 1985 through the current date.
DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Attachments
Distribution: List No. 2--Folioviews Groups A, B, and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)
|
Dates |
Percentage |
Dates |
Perentage |
|---|---|---|---|
|
01/1/10 - 12/31/10 |
3¼% |
|
|
|
|
|
|
|
|
7/1/09 - 12/31/09 |
4 7/8% |
7/1/99 - 12/31/99 |
6½% |
|
1/1/09 - 12/31/09 |
5% |
1/1/99 - 6/30/99 |
5.0% |
|
7/1/08 - 12/31/08 |
5 |
7/1/98 - 12/31/98 |
6.0% |
|
1/1/08 - 6/30/08 |
4¾% |
1/1/98 - 6/30/98 |
6¼% |
|
7/1/07 - 12/31/07 |
5¾% |
7/1/97 - 12/31/97 |
6¾% |
|
1/1/07 - 6/30/07 |
5¼% |
1/1/97 - 6/30/97 |
6% |
|
7/1/06 - 12/31/06 |
5¾% |
7/1/96 - 12/31/96 |
7.0% |
|
1/1/06 - 6/30/06 |
5% |
1/1/96 - 6/30/96 |
5% |
|
7/1/05 - 12/31/05 |
4½% |
7/1/95 - 12/31/95 |
6% |
|
1/1/05 - 6/30/05 |
4¼% |
1/1/95 - 6/30/95 |
8% |
|
7/1/04 - 12/31/04 |
4½% |
7/1/94 - 12/31/94 |
7.0% |
|
1/1/04 - 6/30/04 |
4.0% |
1/1/94 - 6/30/94 |
5½% |
|
7/1/03 - 12/31/03 |
3% |
7/1/93 - 12/31/93 |
5% |
|
1/1/03 - 6/30/03 |
4¼% |
1/1/93 - 6/30/93 |
6½% |
|
7/1/02 - 12/31/02 |
5¼% |
7/1/92 - 12/31/92 |
7.0% |
|
1/1/02 - 6/30/02 |
5½% |
1/1/92 - 6/30/92 |
6% |
|
7/1/01 - 12/31/01 |
5% |
7/1/91 - 12/31/91 |
8½% |
|
1/1/01 - 6/30/01 |
6% |
1/1/91 - 6/30/91 |
8% |
|
7/1/00 - 12/31/00 |
7¼% |
7/1/90 - 12/31/90 |
9.0% |
|
1/1/00 - 6/30/00 |
6¾% |
1/1/90 - 6/30/90 |
8½% |
|
|
|
|
|
|
7/1/89 - 12/31/89 |
9% |
|
|
|
1/1/89 - 6/30/89 |
9¾% |
|
|
|
7/1/88 - 12/31/88 |
9¼% |
|
|
|
1/1/88 - 6/30/88 |
9% |
|
|
|
7/1/87 - 12/31/87 |
8% |
|
|
|
1/1/87 - 6/30/87 |
7% |
|
|
|
7/1/86 - 12/31/86 |
8½% |
|
|
|
1/1/86 - 6/30/86 |
9¾% |
|
|
|
7/1/85 - 12/31/85 |
10% |
|
|
|
1/1/85 - 6/30/85 |
12% |
|
|
ATTACHMENT TO FECA CIRCULAR NO. 10 – 02
Back to Top of FECA Circular No. 10-02
|
Dates |
Percentage |
|---|---|
|
1/1/10 – 12/31/10 |
1% |
|
|
|
|
1/1/09 - 12/31/09 |
3% |
|
7/1/08 - 12/31/08 |
3% |
|
1/1/08 - 6/30/08 |
5% |
|
1/1/07 - 12/31/07 |
4% |
|
7/1/06 - 12/31/06 |
4% |
|
1/1/06 - 12/31/06 |
2% |
|
1/1/05 - 12/31/05 |
1% |
|
1/1/04 - 12/31/04 |
1% |
|
1/1/03 - 12/31/03 |
2% |
|
7/1/02 - 12/31/02 |
3% |
|
1/1/02 - 06/30/02 |
5% |
|
1/1/01 - 12/31/01 |
6% |
|
1/1/00 - 12/31/00 |
5% |
|
|
|
|
1/1/99 - 12/31/99 |
5% |
|
1/1/98 - 12/31/98 |
5% |
|
1/1/97 - 12/31/97 |
5% |
|
1/1/96 - 12/31/96 |
5% |
|
7/1/95 - 12/31/95 |
5% |
|
1/1/95 - 06/30/95 |
3% |
|
|
|
|
1/1/94 - 12/31/94 |
3% |
|
1/1/93 - 12/31/93 |
4% |
|
1/1/92 - 12/31/92 |
6% |
|
1/1/91 - 12/31/91 |
8% |
|
1/1/90 - 12/31/90 |
9% |
|
1/1/89 - 12/31/89 |
7% |
|
1/1/88 - 12/31/88 |
6% |
|
1/1/87 - 12/31/87 |
7% |
|
1/1/86 - 12/31/86 |
8% |
|
1/1/85 - 12/31/85 |
9% |
|
|
|
|
Prior to 01/01/84 |
Not applicable |
ATTACHMENT TO FECA CIRCULAR NO. 10 – 02
Back to Top of FECA Circular No. 10-02
Attention: This circular has been superseded and is inactive.
|
FECA CIRCULAR NO. 10-03 |
Issue Date: January 29, 2010 |
Expiration Date: December 31, 2010
Subject: Bill Pay - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.
Background: Effective January 1, 2010, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile reduced to 50 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, determination has been made to apply the applicable rate to disabled FECA beneficiaries traveling to secure necessary medical examination and treatment.
Applicability: Appropriate National Office and District Office personnel.
Reference: Chapter 5-0204, Principles of Bill Adjudication, Part5, Benefit Payments, Federal (FECA) Procedure Manual and 5 USC 8103.
Action: The Central Bill Pay (CBP) facility has updated their system to reflect the new rates. Since there is no action required at the District Office level, the rates are being provided for informational purposes only.
The following is a list of the historical mileage rates used to reimburse claimant travel expense:
|
Dates |
Cents per mile |
|---|---|
|
01/01/1995 - 06/06/1996 01/14/2000 - 01/21/2001 01/01/2006 - 01/31/2007 |
30.0 cents per mile 32.5 cents per mile 44.5 cents per mile |
Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.
Douglas Fitzgerald
Director for
Federal Employees' Compensation
Distribution: List No. 2 -- Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal Personnel).
Back to Top of FECA Circular No. 10-03
Attention: This circular has been superseded and is inactive.
|
FECA CIRCULAR NO. 10-04 |
January 29, 2010 |
SUBJECT: Dual Benefits - FERS Cost of Living Adjustments
For the first time since the enactment of Cost-of-Living (COLA) increases in 1975, there will not be a raise in the benefits issued by the Social Security Administration (SSA) for 2010. This is due to the fact that there was no increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers (CPI-W) from the third quarter of 2008 to the third quarter of 2009, as reported by the Bureau of Labor Statistics. The CPI-W percentage of increase sets the amount of the SSA COLA, so the lack of increase results in no increase to SSA benefits.
Since there is no increase to account for, there will be no change to the amounts currently being offset for Federal Employees' Retirement System (FERS) Dual Benefits deductions.
The historical SSA cost of living adjustments are as follows:
|
Dates |
Percentage |
|---|---|
|
12/01/2009 - 11/30/2010 |
0.0% |
DOUGLAS C. FITZGERALD
Director for
Federal Employees' Compensation
Distribution: List No. 1 – FolioViews Groups A, B and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, Staff Nurses and Fiscal Personnel)
Back to Top of FECA Circular No. 10-04
Attention: This circular has been superseded and is inactive.
FECA CIRCULAR NO. 10-05
Issue Date: March 24, 2010
Expiration Date: March 24, 2011
Subject: Early disability management in 2010 Decennial Census claims.
Background: The Department of Commerce is responsible for conducting the Decennial Census and employs enumerators and crew leaders to gather statistical data through interviews with property residents. The Bureau of the Census expects to hire approximately one million individuals with temporary appointments not to exceed 180 days. These employees will work an average of 84 hours during a four to five week period, one week of which will be training. The peak employment period is April through June 2010. Because of the large number of temporary workers being hired, there will not necessarily be limited duty positions available for those who are injured on the job. OWCP is therefore piloting a new early disability management process that will attempt to return these temporary employees to suitable work quickly and appropriately.
Purpose: To provide guidance to claims staff, Staff Nurses and Rehabilitation Specialists on early disability management in Census claims under the pilot project.
Applicability: All National Office staff and District Office claims personnel, Staff Nurses and Rehabilitation Specialists.
Actions:
1. The assignment of nurses will be handled differently under this pilot project. COP nurses will be assigned earlier and have a more in-depth role in the management of the Census claims. 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. Beginning with the iFECS release on March 29, 2010, Census cases will be eligible for automatic assignment 7 days after the claimant stops work. The case will actually show up for assignment on day 8. The Staff Nurse (SN) should assign all COP cases on a daily basis.
Census will not be using the CA-3 to report a return to work (RTW); therefore, if a claimant returns to work after the CA-1 has already been submitted, Census will call the appropriate district office to report the RTW. The person taking the call should immediately update the RTW field in iFECS so that a COP nurse is not assigned. A telephone message (CA-110) should not be sent since the information needs to be entered on the day it is received; however, a closed CA-110 should be created documenting the call and return to work date. Entering a RTW date (prior to the data run on the night of day 7) will prevent the case from showing up as eligible for assignment on day 8.
Beginning with the March 29, 2010 iFECS release, agencies will be able to see that a COP nurse has been assigned to one of their cases by checking for a new flag in the Agency Query System (AQS).
It is possible that a claimant may stop work after the CA-1 has already been submitted, which makes that case ineligible for automatic COP nurse assignment. In these cases, Census can request that a nurse be assigned (after checking AQS to verify that a COP nurse has not already been assigned). The Field Nurse (FN) [or Telephonic Case Manager (TCM) if a FN cannot be assigned] is the available option at that point, if the case has been or can be accepted.
If the following criteria are met, Census may ask for a nurse assignment:
- The claimant is currently out of work and there is no projected RTW date, or the projected RTW date is at least 1 week into the future; or
- The claimant has been released to light duty but no light duty is available.
If these criteria have been met, Census will contact the applicable office via fax with a standardized request. The request submitted by the Census will contain the following information:
- Claimant information to include name, case number and date of injury (DOI);
- RTW information – date stopped work and anticipated RTW date, or an indication that no anticipated RTW date has been provided;
- Agency contact person and telephone number; and
- Whether light duty is available and if so how many hours and the type.
Each district office will determine the best way to channel these requests for the most effective use of resources in that particular office, but one contact person will be established for each office. That contact person will receive the faxed requests and track them to be sure that appropriate actions are taken.
The first step is to expedite adjudication.
2. COP Nurses will be expected to do more than just obtain RTW dates and close the case. In these cases, the COP nurse will be expected to take the following actions:
a) Make contact with the claimant, employing agency and physician's office.
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 agency, confirm work status, find out if light duty is available, and confirm the date the claimant's position was expected to end.
d) From the attending physician's office, obtain verbal history of treatment and expected treatment plan, and provide OWCP address for submission of reports and ACS contact information to be used should the claim be approved. The nurse should also advise whether job modifications can be made, and, if appropriate, fax a CA-20 requesting that it be completed and submitted to OWCP.
e) The COP nurse will also make recommendations about assignment of a FN.
Once a COP nurse has been assigned, he or she will have 7 days to submit a closure report. Two new Census COP reports will be used for this purpose (one for RTW cases and one for cases with no RTW). These reports contain fields for information that the COP nurse is expected to obtain.
After obtaining this information, the COP Nurse should close the case, complete the report, and submit it to OWCP within 7 days of assignment. Upon receipt of a COP nurse report indicating no RTW, only partial RTW, or some other pending issue, OWCP will take two primary actions: 1) Claims will expedite adjudication of the case, and 2) The SN will assign a FN earlier than usual.
Each district office must determine the most effective way of communicating the COP nurse report findings to the assigned Claims Examiner (CE) so that appropriate action can be taken.
3. Case adjudication will need to be expedited in these claims so that a FN can be assigned as early as possible (when appropriate). If the claim cannot be accepted upon first review, development should be undertaken immediately. The claimant will be afforded the normal 30 day period to submit evidence but the claim should be monitored during that 30 day period so that an acceptance can be issued as soon as the supporting documentation is received. The CE should not wait until the 30 days have elapsed to review any evidence that has been submitted. However, if the claimant fails to submit evidence sufficient to warrant acceptance of the claim, the full 30 day period must be provided.
4. Field Nurses will be assigned once the claim has been accepted and continued disability is indicated. During this pilot project, FN assignment will occur within 7 days of acceptance even if the COP period has not elapsed. The FN will have the usual instructions regarding facilitating medical management and return to work, but she will also be expected to make recommendations for the assignment of a Vocational Rehabilitation Counselor (RC). On occasion, the FN and RC may be working on a claim at the same time. See below for more details on this process.
If the FN is assigned after a COP nurse assignment, the DM record will already exist. Once 45 days from 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) in DM and changes the category to QCM Resolved Triage. Offices will either need to close the FN or open a new DM record if they follow Light Duty RTW with a nurse.
If the FN is assigned in a case with no prior COP nurse assignment (via a fax request from Census), the DM record should be created with a Track date equal to day 46 after the DOI for traumatic injuries (unless the case is accepted before day 46, then the Track date equals the current/start date). If the case is an occupational disease claim, the Track date should equal the date disability began.
5. Rehabilitation Counselors will be assigned earlier than usual and may, in some instances, be assigned prior to the FN concluding intervention, leading to a dual-track intervention. Dual intervention of FNs and RCs is not routinely utilized outside of catastrophic claims, but the unique circumstances and short term nature of Census employment will likely result in more disability due to limited availability of modified duty with the agency. Since private industry employment will be more common in these cases, dual tracking will lead to efficient disability management and an earlier return to work.
Dual assignment of FNs and RCs should be considered if both of the following criteria apply:
- The claimant has a condition that will likely lead to permanent work related restrictions, which would prohibit a return to the date of injury position. The medical evidence should reflect expectations for when the restrictions will likely be permanent and the kinds of restrictions that are expected.
- There will likely be no Census employment opportunities for an individual with the expected restrictions.
The FN will already be assigned to the case in most instances and he or she can make the recommendation to the CE when these circumstances are present. OWCP staff [the CE, SN or Rehabilitation Specialist (RS)] may also make this determination.
If these conditions exist, a rehabilitation referral should be considered. Part time referrals can be made in these cases even for placement with a new employer (since most Census workers are not full time), but the labor market survey has to support that any targeted jobs are reasonably available on a part-time basis.
- The FN's focus in this situation is on the claimant's medical condition (obtaining permanent work tolerance limitations).
- The RC's focus is on the early stages of plan development, to include an initial interview to gather the background information for a transferable skills analysis, a labor market survey, and perhaps vocational testing. A plan would typically not be finalized until the restrictions are considered stable and well defined.
- To avoid any confusion with the medical providers, the FN would continue to communicate with the physician – providing information as necessary to the CE and RC. Any needed RC communication with the physician, while the FN is still assigned to the case, would flow through or be coordinated with the FN.
The FN should communicate with the SN and CE, and the RC should communicate with the RS and the CE. However, the FN and RC should also communicate with each other during this process to facilitate the best possible outcome. For example, if the RC has questions about the medical restrictions being imposed by the physician, he or she may contact the FN. This communication should be documented in both the FN and RC reports.
Once a case has been identified for dual tracking purposes, the CE should complete a referral to rehabilitation with an indication that Medical Rehabilitation is needed concurrently with FN services. When this referral is completed in iFECS, the CE should notify the SN and RS of the dual tracking.
Upon receipt of the referral, the RS should assign the case to a RC and place an M status in NRTS. The OWCP-35 to the RC will authorize 3 months and $1500 in services. The initial OWCP-3 to the RC will explain that a FN is on the claim and provide the nurse's contact information. It will explain the types of services that should be offered concurrently with the nurse services and indicate when the case should move forward in Plan Development. After the referral has been made to the RC, the CE and SN will be provided with the referral date and the RC's name and contact information. Rehabilitation Screeners are not to be utilized in these claims.
When the CE receives confirmation of the RC assignment, a letter should be sent to the claimant explaining that both a FN and RC are assigned to the claim. The letter will define the roles that each of these individuals will take as well as the claimant's responsibility to cooperate. The letter "Dual Track-Census" (in Correspondence Library) should be used for this purpose.
Any cases assigned for dual tracking must be reported monthly to the National Office.
Once the FN has obtained stable, well defined work restrictions, the nurse portion of disability management will cease and the RC will continue with the rehabilitation process.
Once the claim is in posture for plan development (i.e. stable and well defined medical restrictions are established), the RS should change the case status to D and notify the RC of the status change and applicable time frames. If this has not occurred by the end of the 3 month period allowed on the initial OWCP-3, then the case should likely be closed. Extensions are not allowed unless there is a pending work hardening or functional capacity evaluation or stable well defined work restrictions are imminently expected.
6. Closure Codes for Dual Tracking Cases –
- If the claimant happens to RTW with Census while both the FN and RC are on the case, the successful closure code will be entered in the nurse record as a successful nurse RTW.
- If the claimant happens to RTW with a new employer while both the FN and RC are on the case, the successful closure code will be entered in the rehab record as a successful rehabilitation.
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 Circular No. 10-05
Attention: This circular has been superseded and is inactive.
FECA CIRCULAR NO. 10-06
Issue Date: May 14, 2010
Expiration Date: March 24, 2011
Subject: Overpayments in cases where lesser impairment is established after a schedule award has been paid for greater impairment.
Background: On May 1, 2009, the Office began using the Sixth Edition of the American Medical Association Guides to the Evaluation of Permanent Impairment (AMA Guides), instead of the Fifth Edition. When this change occurred, FECA Bulletin 09-03 was issued. That bulletin addressed situations of lesser impairment of a schedule member after a greater award has been paid if the ratings were based on different editions of the AMA Guides. Specifically, where a calculation under the Sixth Edition results in a lower impairment rating to a schedule member than the original award under the Fifth Edition, the Office (consistent with past practice) will make the finding that the claimant has no more than the percentage of impairment originally awarded; that the evidence does not establish an increased impairment; and that an overpayment will not be declared. That bulletin has since been incorporated into the Procedure Manual.
This circular is being issued to clarify what actions are appropriate when a lesser impairment is found after a greater award has been paid when the different impairment ratings are based on the same edition of the AMA Guides.
Purpose: To provide guidance on actions to be taken in cases where a schedule award has been paid based on a certain percentage of impairment, but a later determination based on the same edition of the AMA Guides substantiates a lesser degree of impairment of the schedule member.
Actions:
1. Before addressing the issue of whether an overpayment is appropriate in this circumstance, the schedule award issue must be resolved. In Richard Saldibar 51 ECAB 585 (2000), the ECAB found that an overpayment was not in posture for review because the Office had not properly resolved the schedule award issue. Therefore, before the amount of the overpayment can be determined, the evidence must clearly establish the degree of permanent impairment. The evidence should be carefully reviewed and the schedule award decision that establishes the lesser award should explain in detail the rationale for the lesser degree of impairment.
2. In the case of Michael Reed, Docket No. 04-734 (issued October 5, 2004), the ECAB stated:
"If a claimant receives a schedule award and the medical evidence does not support the degree of permanent impairment awarded, an overpayment may be created."
Therefore, if a schedule award decision is set aside (after a hearing or review by the ECAB, or as part of the reconsideration process) and additional development is undertaken to resolve the schedule award issue, a new schedule award decision should be issued that fully addresses the reasons for the change in rating. Declaring an overpayment thereafter is appropriate if the later decision substantiates a lesser degree of impairment than previously awarded.
Similarly, if a claimant requests an increased schedule award due to a belief that his or her medical condition has deteriorated since the original award has been issued, and additional development is undertaken to address this claim for an increased award, a new schedule award decision should be issued that addresses and substantiates the newly determined impairment rating. If a lesser degree of impairment than previously awarded is substantiated, an overpayment thereafter is appropriate.
3. Where a schedule award decision establishes a lesser impairment, after a greater award has been paid, the resulting overpayments will have a finding of without fault.
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 Circular No. 10-06