Federal workers’ compensation claims are a growing area of business for many third party administration companies.  With this growth comes an opportunity for team members to learn a new line of work and enhance the services they provide.

Quick Background on Federal Work Comp

The federal workers’ compensation system was established in the early 1900s to deal with work-related injuries sustained by federal employees.  This program is administered under the Federal Employees Workers’ Compensation Act, and covers all federal government disability insurance in the United States.

Like state-based workers’ compensation programs, this law covers a variety of indemnity and medical benefits.  Federal workers with compensable injuries in the workplace are also entitled to various vocational rehabilitation benefits.

How the Federal Workers’ Compensation Operates

The federal workers’ compensation program is the responsibility of the Office of Workers’ Compensation Programs (OWCP) within the United States Department of Labor.  This office administers the benefits federal workers are entitled to if they claim to or have in fact sustained a compensable workplace injury.  Other groups of federal workers’ compensation programs include the following:

• Energy Employees Occupational Illness Compensation Program;
• Federal Employees’ Compensation Program;
• Longshore and Harbor Workers’ Compensation Program; and
• Black Lung Benefits Program.

Understanding Federal Workers’ Compensation Benefits

Injured workers under the above programs are entitled to various benefits that are often found in state workers’ compensation programs.  The difference lies in the determination and payment lengths of these benefits.

• Continuation of Pay or “COP” is defined under 20 C.F.R. §10.200 and serves as an injured workers wage loss benefits. For most federal work injuries, the injured party is entitled to 100% of their regular pay for a period no longer than 45 calendar days as long as the person is disabled.  This percentage is then reduced and the employee continues to receive either total or partial disability benefits until they are reassigned or fully return to work.  Unlike their state counterparts, COP is considered “compensation” and therefore taxable under the Internal Revenue Code.  It is also subject to retirement and other deductions.

• Medical Benefits. Under the federal workers’ compensation scheme, an injured work is entitled to choose the primary doctor of their choice without objection. The ability to change doctors is limited for subsequent changes.  The workers’ compensation plan pays for all reasonable and necessary medical treatment provided it is causally related to the work injury.

• Vocational Rehabilitation. Injured workers under the federal framework are also expected to make efforts to either return to their pre-injury work, or accept a comparable assignment within their work restrictions.  Issues regarding return to work can include assignments to a different work shift or other differentiating characteristics.

There are also various other factors to consider when dealing with federal workers’ compensation benefits.  These factors include the pay grade of an employee, length of service within the federal government and the nature of their work.

Other Factors to Consider

Dealing with federal workers’ compensation matters presents additional issues for parties involved in these cases.  This includes strict limitations on the ability of employees to have their benefits discounted or terminated.  The use of other traditional methods of cost containment such as utilization review and independent medical examinations is also limited based on statute and practice.  If one is not familiar with these practices, it is important to consult an expert or attorney.

Author Michael Stack, Principal, COMPClub, Amaxx LLC. He is an expert in workers compensation cost containment systems and helps employers reduce their work comp costs by 20% to 50%.  He works as a consultant to large and mid-market clients, is co-author of Your Ultimate Guide To Mastering Workers Comp Costs, a comprehensive step-by-step manual of cost containment strategies based on hands-on field experience, and is founder of COMPClub, an exclusive member training program on workers compensation cost containment best practices. Through these platforms he is in the trenches on a working together with clients to implement and define best practices, which allows him to continuously be at the forefront of innovation and thought leadership in workers’ compensation cost containment. Contact: mstack@reduceyourworkerscomp.com.

©2016 Amaxx LLC. All rights reserved under International Copyright Law.

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

This past Friday, June 6th marked the 70th anniversary of the D-Day landings. Justifiably, the focus of attention was on the hundreds of thousands of service personnel who participated. What is rarely discussed are the hundreds of thousands of civilian employees participating in or near the combat areas and sustaining many casualties resulting in death or injury.

 
Civilian Casualties Were Not Considered Compensable Prior to Defense Based Act

Prior to, and in the early days of, WWII, civilian casualties during war, or by terrorists were not considered compensable as workplace injuries because of the exclusion from insurance contracts for acts of the “common enemy”. That was, in the US, largely rectified by the Defense Base Act, enacted on 8/16/41, which gave broad federal workers comp coverage to workers, overseas and otherwise, who were working under a defense contract. That would also include Red Cross workers and USO entertainers (think Bob Hope and his troupe).

Higher Percentage of Civilian Merchant Marines Killed Than Marine Corps

The Merchant Marine, however, fell through the cracks. Although a greater percentage of mariners were killed than those in the Marine Corps (3.9% and 2.94%, respectively) the merchant mariners were not given veteran status until 1988. Since they were paid civilian wages, far higher than the military, and had the right to refuse a voyage that they considered too dangerous, they were considered “civilians”. But the Jones Act, under which they were covered, was only for negligence on the part of the ship owners and the Defense Base Act did not cover them.

Civilians could also be found serving in unlikely places. One of the aircraft carriers in the Battle of Midway had to be sent while its repairs were not yet completed from the Battle of the Coral Sea. As a result, civilian workers were kept aboard and were still completing repairs as the ship sailed into battle.

Red Cross workers do not appear to have been disembarked during D-Day but they were surely aboard the ships already at sea for the follow up landings.

Reading work comp court decisions during and after WWII, one is struck by the nearly complete silence on the war, almost as if it hadn’t happened. That can be due to the fact that injuries in the combat zone had few ways in which they could NOT be compensable and therefore didn’t make it into court decisions. In addition, there was a war-time culture that simply would not deny a trivial compensation claim in an environment of extreme sacrifice being the common experience.

Courts Should Not Be Blind To What Is Obvious To All

For this author, the Defense Base Act was his first comp appeal victory, while still a law student. The plaintiff was driven into extreme stress reactions, physical and mental, while serving as the construction foreman in the desert in the Horn of Africa in 1970. Every night, bandits raided his base, stealing the supplies. The work was supervised by the US Army Corps of Engineers but the contract was issued as a foreign aid agricultural assistance program. The base was a listening post for oil tankers entering and leaving the Red Sea.

The court agreed with the law student and quoted Justice Oliver Wendell Holmes that “Courts should not be blind to what is obvious to all.”

To all those in the landings of June 6, 1944…………THANKS!!

Author: Attorney Theodore Ronca is a practicing lawyer from Aquebogue, NY. He is a frequent writer and speaker, and has represented employers in the areas of workers’ compensation, Social Security disability, employee disability plans and subrogation for over 30 years. Attorney Ronca can be reached at 631-722-2100. medsearch7@optonline.net

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

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MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.

The various aspects of hiring, accommodating, providing modified duty in the case of workers’ compensation and firing an employee with a disability can be tricky. But being informed and communicating policies clearly takes the mystery out of managing disabled workers and those who may become disabled following a work-related injury.

Americans with Disabilities Act (ADA)

Title I of the Americans with Disabilities Act of 1990 prohibits private employers, state and local governments, employment agencies and labor unions from discriminating against qualified individuals with disabilities in job application procedures, hiring, firing, advancement, compensation, job training and other terms, conditions, and privileges of employment. The ADA covers employers with 15 or more employees. It also applies to employment agencies and labor organizations.

Disability discrimination occurs:

• when an employer treats a qualified individual with a disability who is an employee or applicant unfavorably because of the disability
• when an employer treats an applicant or employee less favorably because of a history of a disability
• or because the employee is believed to have a physical or mental impairment that is not transitory (lasting or expected to last six months or less) and minor (even if the employee does not have such an impairment)
• when an employer treats an employee differently because of the employee’s relationship with a person with a disability (even though the employee is not disabled)

The law requires an employer to provide reasonable accommodation to an employee or job applicant with a disability to perform the “essential functions of the job”, unless doing so would cause “undue hardship.” Undue hardship means a significant difficulty or expense for the employer when considered in light of factors such as the employer’s size, financial resources and the nature and structure of its operation.

Reasonable accommodations may include things like:

• making existing facilities used by employees readily accessible to and usable
• job restructuring
• modifying work schedules,
• reassignment to a vacant position
• acquiring or modifying equipment or devices,
• adjusting or modifying examinations, training materials, or policies,
• providing qualified readers or interpreters

Employee Retirement Income Security Act (ERISA)

ERISA is administered by the Employee Benefits Security Administration (EBSA). The provisions of Title I of ERISA cover most private sector employee benefit plans. ERISA grants employees several protections such as the right to receive information about their pension or health benefit plans, to participate in timely and fair processes for benefit claims, to elect to temporarily continue group health coverage after losing coverage, to receive certificates verifying health coverage under a plan and to recover benefits due under the plan.

Consolidated Omnibus Budget Reconciliation Act (COBRA)

The Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) includes provisions for continuing health care coverage. These provisions are in Part 6 of Title I of ERISA. They apply to group health plans of employers with 20 or more employees. COBRA gives certain former employees, retirees, spouses, former spouses and dependent children (“qualified beneficiaries”) the right to temporary continuation of health coverage at group rates. This coverage, however, is only available when coverage is lost due to certain specific events (“qualifying events”) such as termination of employment. Group health coverage for COBRA participants is usually more expensive than health coverage for active employees because usually the employer pays a part of the premium for active employees while COBRA participants generally pay the entire premium themselves. Plans must give covered individuals an initial general notice informing them of their rights under COBRA and describing the law.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) amended ERISA to provide for improved portability and continuity of health coverage connected with employment. These provisions include rules relating to exclusions of preexisting conditions, special enrollment rights and prohibition of discrimination against individuals based on health status-related factors.

Family and Medical Leave Act (FMLA)

The FMLA is administered by the Wage and Hour Division of the Department of Labor (DOL). The FMLA requires employers that have 50 or more employees to give up to 12 weeks of unpaid, job-protected leave to eligible employees for the birth or adoption of a child or for the serious illness of the employee or a spouse, child or parent. Employers need to be aware of a possible obligation to extend FMLA benefits if an injured worker does not want to participate in the company’s transitional duty (TD) program. On March 8, 2013 statutory amendments to the FMLA involving military families and airline crew became effective.

The DOL has an interactive FMLA Advisor tool to help employees and employers understand their rights and responsibilities under the FMLA. The FMLA Advisor can help identify which employers are covered by the law, which employees are eligible for FMLA leave, what entitlements and benefits are provided under the law, and in what situations FMLA leave may be used. http://www.dol.gov/elaws/fmla.htm.

It’s important to coordinate your transitional duty (TD), light duty and modified duty policies with ADA and FMLA requirements. Disability and employment laws vary from state to state. Make sure your legal counsel and insurer review all policies and procedures you use for workers’ compensation.

Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact:RShafer@ReduceYourWorkersComp.com.
Editor Michael B. Stack, CPA, Principal, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher. www.reduceyourworkerscomp.com. Contact: mstack@reduceyourworkerscomp.com.

©2014 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law.

WORK COMP CALCULATOR:   http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:   http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:  http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker, attorney, or qualified professional.