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Division of Federal Employees' Compensation (DFEC)

Procedure Manual

FECA Part 0

LIST of CHAPTERS

0-0100

Introduction to FECA and DFEC

0-0200

Program Directives

 


Chapter 0-0100, Introduction to FECA and DFEC

Paragraph and Subject

Date

Trans. No.

Table of Contents

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11-01

1. Purpose and Scope

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2. The FECA

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3. Organization

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4. National Office

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5. District Offices

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1. Purpose and Scope. This chapter provides a brief overview of the Federal Employees' Compensation Act (FECA) and the background and structure of the Division of Federal Employees' Compensation (DFEC). It also addresses the relationship between DFEC and the Office of Workers' Compensation Programs (OWCP) and the functions of the National Office and the Field Offices.

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2. The FECA. In 1908, President Theodore Roosevelt signed legislation to provide workers' compensation for certain Federal employees in unusually hazardous jobs. The scope of the law was very restricted and its benefits were quite limited. However, it was the first workers' compensation law to pass the test of constitutionality applied by the U. S. Supreme Court.

The FECA, 5 U.S.C. 8101 et seq., which superseded the 1908 statute in 1916, is a workers' compensation law for all civilian Federal employees who have suffered work-related injuries or occupational diseases. It provides for wage-loss compensation, schedule award benefits, vocational rehabilitation, medical care, and survivors' benefits; however, the FECA does not provide retirement benefits. Employees who fully or partially recover from their injuries are expected to return to work.

Federal civilian employees are covered by virtue of their employment status. The costs are paid from the Employees' Compensation Fund, which OWCP administers. Federal employers reimburse the Fund for the amounts paid to its employees in workers' compensation benefits through the chargeback system.

Benefits provided under the FECA constitute the sole remedy against the United States for a work-related injury or death. A Federal employee or surviving dependent is not entitled to sue the United States or recover damages for such injury or death under any other law for a work injury (5 U.S.C. 8116). The FECA is intended to be remedial in nature, and proceedings under it are non-adversarial. There are, however, penalties for filing a false claim. Federal law provides severe penalties, including forfeiture and termination of benefits, for knowingly and willfully falsifying, concealing or covering up a material fact. See 5 U.S.C. 8148; 5 U.S.C. 1920.

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3. Organization. OWCP includes four separate programs, of which DFEC is one. The other three are the Division of Longshore and Harbor Workers' Compensation, the Division of Coal Mine Workers' Compensation, and the Division of Energy Employees' Occupational Illness Compensation.

The OWCP Director, along with the OWCP Deputy Director, has authority for the administrative management of the four programs. The individual program directors work directly for OWCP; therefore, the DFEC Director reports to OWCP. Likewise, the Regional Directors, who are considered the chief executives for the OWCP programs within the regions, report directly to OWCP.

The Employees' Compensation Appeals Board (ECAB) is a distinct body under the jurisdiction of the Secretary of Labor, entirely separate from OWCP. It is authorized to hear and determine appeals from claimants involving questions of law or fact after DFEC has issued a final decision on the issue in question.

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4. National Office. The Director for Federal Employees' Compensation, along with the DFEC Deputy Director, is tasked with the implementation and oversight of the entire FECA program. This includes setting program goals.

Final authority over program matters remains with the DFEC Director. Under the immediate supervision of the Director and Deputy Director are five specific branches that provide specialized oversight and guidance to the district offices. Each branch has a Branch Chief who reports to the Deputy Director.

a. Branch of Regulations, Policies, and Procedures. This Branch develops recommendations for new operational policies, regulations and procedures consistent with the overall policies of OWCP. Changes in operational policies and procedures may be the result of new legislation, court decisions, ECAB decisions, program audits and studies, or precedent setting claims under the FECA. The Branch formulates procedures and maintains a procedure manual to be used by the district offices in adjudicating FECA claims and paying benefits. This branch also conducts accountability reviews of district offices with help from district office personnel and develops training materials for claims personnel.

b. Branch of Technical Assistance. This Branch is responsible for developing, preparing, and distributing technical assistance materials and guides to Federal agencies, labor organizations, employees and their representatives. These materials are designed to educate and inform Federal employees of their responsibilities in reporting injuries and to inform Federal agencies of their responsibilities in processing claims under the FECA. This Branch reviews and analyzes Federal agencies' injury compensation programs, performance statistics, progress, and trends, and then makes recommendations for overall improvement. Employees of this branch conduct training sessions with various groups to advance understanding of the Program. This Branch also oversees and implements all communication strategies for the program.

c. Branch of Automated Data Processing (ADP) Coordination and Control. This Branch is responsible for the coordination and control of all information technology (IT) requirements, systems relating thereto, and supporting documentation. The Branch operates, maintains and enhances the integrated Federal Employees' Compensation System (iFECS) and coordinates with OWCP to ensure it meets the data needs of the program and conforms to Federal and OWCP guidelines and operational procedures. In conjunction with OWCP, the ADP Branch directs and coordinates activities of IT support contractors in the development, operation and maintenance of DFEC IT systems and hardware. Toward that end, the Branch maintains liaison with the district offices in regard to the operation of iFECS and other information systems and provides technical oversight and assistance.

d. Branch of Fiscal Operations. This Branch is responsible for formulating and monitoring all financial operations for DFEC on a national level, handling items such as Chargeback and the monitoring of program debt performance. This Branch performs a variety of functions to ensure the financial integrity of the program. Specifically, the Branch directs the efforts of the National Office to train or otherwise advise all district offices on billing, payment, and fiscal practices. Formulation and monitoring of all fiscal policy and procedures is conducted by this Branch, including national oversight of agency automated compensation and bill payment systems.

e. Branch of Hearings and Review (H&R). This Branch issues appellate-level decisions on claims involving hearings or requests for review of the written record, which affirm, reverse, modify, or remand cases to any of the district offices. A staff of hearing representatives (based in both Washington, DC and the field offices) is responsible for conducting the hearings, which can be held in a variety of formats, including video hearings, face-to-face hearings, and telephonic hearings.

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5. District Offices. DFEC has a total of 12 district offices (DOs), which include two in the Northeast Region (New York and Boston), the Southwest Region (Dallas and Denver), and the Pacific Region (San Francisco and Seattle); three in the Midwest Region (Chicago, Cleveland, and Kansas City); and one each in Jacksonville, Philadelphia and Washington, DC. See Part 1 of the Procedure Manual for more specific information on jurisdiction.

a. The National Operations Office (Washington, DC). This office is one of DFEC's twelve district offices, and the District Director of this office reports directly to the DFEC Deputy Director. This district office administers FECA benefits on claims submitted by Federal employees located in the District of Columbia, Northern and Eastern Maryland, and Virginia, as well as for some special categories of cases. These special categories include claims involving national security considerations and other special category cases as assigned.

b. DFEC Field Operations. OWCP programs in each of the regions are administered by a Regional Director (RD), who reports to the OWCP Deputy Director. The RD serves as the chief executive for OWCP programs within the region and presides over one or more OWCP district offices within the region.

Each DFEC district office is headed by a District Director, who is responsible for operations in the district and for ensuring that FECA claims functions are administered in a timely and efficient manner.

c. District Office Staff. Employees in the twelve districts administer the FECA within their respective geographic boundaries and work to achieve the goals set by the DFEC Director. Cases are created based on the employee's duty station at the time of injury in most instances, with the exception of Department of Labor cases (which are handled by the Kansas City office) and special claims involving radiation, injury to overseas personnel, special category legislation, and claims pertaining to the War Hazards Compensation Act (which are handled by the Cleveland office).

d. District Office Functions.

(1) Claims Functions. In each DO there are two or more Supervisory Claims Examiners, who are responsible for the operation of individual claims units and the Senior Claims Examiners and Claims Examiners within those units. Claims Examiners and Senior Claims Examiners have the primary responsibility for adjudicating claims, authorizing medical treatment, making compensation payments, and overseeing disability management. Individuals at each level of authority are delegated specific responsibilities for issuing decisions on claims.

(2) Fiscal Functions. Each DO has a Fiscal Officer and at least one other employee who assists with fiscal-related matters. These personnel are responsible for the maintenance of financial management records, changes in health benefits coverage, etc.

(3) Medical Functions. Each DO has at least one District Medical Adviser (DMA) who works under contract to review individual cases, and some DOs may have a District Medical Director (DMD) as well. Each DO also has personnel assigned to schedule medical examinations as needed.

(4) Disability Case Management Functions. Claims Examiners and Senior Claims Examiners have a vital role in the management of disability claims.

In addition to claims staff, each DO has at least one Staff Nurse who is responsible for ensuring there is a sufficient number of COP (Continuation of Pay) Nurses and Field Nurses to service the needs of the district office. Both COP Nurses and Field Nurses are professionals who are contracted by OWCP to provide disability case management services, but they do not provide clinical treatment. The COP Nurse is assigned early in the life of a traumatic injury case and works each case telephonically. The Field Nurse monitors the claimant's medical progress and assists with the return to work effort by coordinating efforts with the Claims Examiner, treating physician, employing agency and claimant.

Each DO also has at least one Rehabilitation Specialist (RS). The RS is responsible for ensuring that there is a sufficient number of vocational Rehabilitation Counselors to service the needs of the district office. The RS manages the counselors, who work under contract with OWCP, to help claimants obtain employment.

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Chapter 0-0200, Program Directives

Paragraph and Subject

Date

Trans. No.

Table of Contents

10/10

11-01

1. Purpose and Scope

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11-01

2. Directives

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3. FECA Procedure Manual

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4. OWCP Procedure Manual

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5. Citations to the Procedure Manual

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6. Maintenance and Revision

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11-01

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1. Purpose and Scope. This chapter describes the communications and directives system used by the Division of Federal Employees' Compensation (DFEC). It focuses on the structure of the Procedure Manual governing claims under the Federal Employees' Compensation Act (FECA) and addresses its relationship to the program's other written directives.

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2. Directives. DFEC is charged with identifying areas where new directives should be developed or existing directives updated. The purpose of this paragraph is to describe the publications relating to the Federal employees' compensation program. There are multiple avenues by which program information is disseminated.

a. External Directives. These may consist of either legal or informational releases.

(1) Federal Register. This publication contains notices and rules pertaining to new or revised policy. Notices advise the public of proposed changes and invite comments on them, while rules state the final changes adopted by the program. The FECA regulations are periodically updated through the Federal Register.

(2) Injury Compensation for Federal Employees (CA-810). This publication is meant to serve as a handbook for Federal agency personnel specialists, compensation specialists, and supervisors. It provides information pertaining to the adjudication and management of claims under the FECA. This publication can be found via the Department of Labor's website.

(3) Questions and Answers about the Federal Employees' Compensation Act (CA-550). This booklet contains answers to questions often asked about the FECA. It describes the basic provisions of the FECA in simple language and discusses the issues most commonly raised about entitlement to benefits. This publication can be found via the Department of Labor's website.

(4) Informational Web Site Postings. Such postings are intended to give claimants and their representatives, agencies and medical providers new or updated information on a particular topic.

b. Other Directives. DFEC uses these directives to provide staff with internal policy guidance, procedures and other information. There are three primary types of issuances: Transmittals, Bulletins and Circulars.

(1) FECA Transmittals are permanent (unless superseded) directives. They convey updates to the FECA Procedure Manual (PM). FECA Program Memoranda (FECA ProMs) have also been used to convey such changes.

(2) FECA Bulletins are usually time-limited directives that require action. They may involve changes to procedures, special reports, or pilot programs. Bulletins require or invite action from district offices and usually bear an expiration date and a reference to any procedure manual chapters affected.

(3) FECA Circulars are primarily used to call attention to standing instructions or procedures which may require compliance or improvement; to announce proposed plans or anticipated program changes; to clarify program policies; and to keep district offices informed of the activities and interests of the National Office.

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3. FECA Procedure Manual. The purpose of this paragraph is to describe the sections of the FECA Procedure Manual.

a. Part 0, Overview. Part 0 of the FECA PM is an introduction to the FECA, the program which administers it, and the directives issued to implement it. This section provides employees with a quick look at operations, and it also contains an index to all parts of the PM.

b. Part 1, Mail and Files. This section discusses the jurisdiction of cases, as well as how reports of injury and occupational disease are made into case files, and how case files are maintained and combined. It also contains guidelines for transferring files between District Offices and to and from the National Office. Procedures for transferring and disposing of inactive files and records, as well as how to retrieve retired and closed cases from the Federal Records Center (FRC), are also included.

c. Part 2, Claims. This section describes policies, responsibilities and procedures for adjudicating and managing claims filed under the FECA. Used mostly by claims personnel, Part 2 describes the sequential handling of claims as they are screened, developed, accepted or denied, tracked, managed, appealed (if applicable), and administered in all respects.

d. Part 3, Medical. This section discusses the functions and responsibilities of the medical advisory staff in each district office and other medical related topics such as schedule awards, authorizing examination and treatment, medical services and supplies, requirements for medical reports and exclusion of medical providers. It also addresses the responsibilities of the Staff Nurse with regard to nurse contract certification. Part 3 is also used by claims staff.

e. Part 4, Special Case Procedures. This section addresses groups of claims covered under the FECA by virtue of special legislation, such as Non-Federal Law Enforcement Officers, War Hazards Compensation Act and Civil Air Patrol.

f. Part 5, Benefit Payments. This section sets forth the policies and procedures for administering the financial aspects of the Federal employees' compensation program. Used primarily by fiscal staff, this part includes procedures for handling health benefit and life insurance matters; maintaining fiscal registers, records, and reports; and charging back to employing agencies the amounts of their expenditures from the compensation fund.

g. Part 6, Debt Management. This section describes the responsibilities of the program regarding computation, waiver and recovery of overpayments under the FECA.

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4. OWCP Procedure Manual. The purpose of this paragraph is to describe the sections of the OWCP Procedure Manual that should be referenced when processing FECA claims.

a. Chapter 1-400 (Privacy Act). This chapter addresses the Freedom of Information Act (FOIA), which provides the public with a procedure for obtaining records from the Federal government, and the Privacy Act, which assures private citizens the right to confidentiality of certain personal information.

b. Part 3 of the OWCP Procedure Manual. This section describes the vocational rehabilitation services which are available to injured employees and discusses the procedures by which they may be obtained.

c. Part 4 of the OWCP Procedure Manual. This section contains procedures for evaluating the quantity and quality of work in the Federal employees' compensation program, including procedures to be used for accountability reviews.

NOTE: OWCP may also issue OWCP bulletins where more than one program's activities are implicated or where OWCP wishes to issue program guidance on a particular issue.

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5. Citations to the Procedure Manual (PM). Each part of the PM consists of several chapters, which in turn are divided into paragraphs, subparagraphs, and sometimes sub-subparagraphs. Chapters and subdivisions should be cited as follows:

Citation to a part of the FECA PM: FECA PM Part 0

Citation to a chapter: FECA PM 0-200

Citation to a paragraph: FECA PM 0-200.5

Citation to a subparagraph: FECA PM 0-0200.5b

Citation to a sub-subparagraph: FECA PM 0-200.5b(1)

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6. Maintenance and Revision. New material will usually be distributed electronically. The FECA PM is available in Folioviews and can be found via the Department of Labor's website.

Because transmittal of the FECA PM is primarily electronic, DFEC does not insert page numbers when an entire chapter is reissued. Paragraph citations, as opposed to page numbers, are used thereafter when updates are made.

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