Changes to FECA Reflected at this Year’s Federal Workers’ Compensation Conference

 


 
Senate & House Pass Legislation For First Changes in Almost 40 Years
 
Unlike the laws for state workers’ compensation programs, which have changed, often significantly, over the past several years, the law governing workers’ compensation for civilian Federal employees – including the U.S. Postal Service – has not seen substantial change in almost 40 years. Amid signs that this status quo may be changing – both the Senate and the House have passed separate legislation in this Congress that would amend the Federal Employees’ Compensation Act (FECA).
 
Tighter Budgets Require Changes
 
In 2012, FECA benefits paid to injured employees, their surviving dependents, and their medical providers topped $3 billion for the first time. Those costs are billed to Federal agencies by the U.S. Department of Labor, and Federal agencies must include these bills in their annual appropriation. In an era of tighter budgets, personnel looking for ways to manage those costs will be attending Conference sessions at the 14th Annual Federal Workers’ Compensation Conference that address topics such as: challenging questionable claims, managing complex cases, and offering suitable light or limited duty positions. Speakers at this Conference, who include officials from the Department of Labor and various Federal agencies, as well as physicians and managed care specialists, are subject matter experts on different aspects of case management. In all, 47 separate courses on Federal workers’ compensation management, plus another 19 on Federal occupational safety and health, will be held at this Conference. 
 
Underlying the Conference is speculation that FECA may be amended. The House passed legislation (H.R. 2465) in November of 2011 that would make minor changes in FECA, but the Senate passed legislation in April of 2012 (S. 1789) that would, as part of Postal Service reform, make some significant changes in the benefit rates paid under FECA, including lower rates for retirement-age workers and government-wide application of a 3-day waiting period that currently only applies to Postal Service employees. The fact that the 2012 elections are less than 4 months away leads some to believe that the chances for passage are slim, yet it is remembered that the last major changes in FECA were enacted in September of 1974 – two months before Congressional elections. It is also clear, given such evidence as a Presidential memorandum on Federal injury compensation in July of 2010, the Congressional legislation noted above, and increased attention by the Government Accountability Office which has issued two reports on FECA in the past year, that renewed attention is being focused on this program. Even if no legislation is enacted, however, the FECA program is rapidly evolving; within the past year alone, new regulations became effective, automated document submission began for both employees and employers, and additional fee schedules for medical services were put in place.   The Atlanta Conference will include sessions on several of these recent changes.
 
Atlanta Conference to Include Sessions on Changes
 
The 14th Annual Federal Workers’ Compensation Conference will take place from July 24 – July 27 in Atlanta, GA. For more information please visit http://www.wcconf.org/
 
 
Author Ralph G. Slighter is the Deputy Division Chief of the Injury Compensation and Unemployment Compensation Division (ICUC) for the Department of Defense. He will present at a variety of sessions at the Federal Workers’ Compensation Conference including, “Trends in Society and the Future of Federal Employees Compensation.” For more information on the sessions that Ralph Slighter will be teaching please refer to the conference schedule http://www.wcconf.org/sites/default/files/pdf/program.pdf .

Chemical Safety Board Develops New Employee Participation Investigation Policy

 

The U.S. Chemical Safety Board (CSB) reported that it has developed a new policy on employee participation in investigations that the Board hopes will enhance the vital role played by plant workers in determining root causes of incidents and promoting facility safety.
 
 
The policy, which was approved by a unanimous 3-0 vote of the Board earlier this year, follows a roundtable involving accident victims, family members, and worker representatives convened by the CSB. [WCx]
 
 
The new policy implements a key provision of the CSB enabling statute at 42 U.S.C. § 7412(r)(6)(L), which provides that employees and their representatives have similar rights in CSB accident investigations as they do during OSHA inspections under the Occupational Safety and Health Act of 1970.
 
 
The 10 key elements of the new policy include
 
 
  • If the CSB initiates an investigation at a union-represented site, the CSB will promptly identify and notify facility unions of its plans to investigate. At non-union sites, the CSB will seek to identify other employee representatives, such as employee members of any established Health and Safety Committee, or other employee representatives, if possible
  • The CSB will seek participation by contract employees and their representatives, similar to facility employees.
  • The CSB will establish direct, face-to-face communications with employee representatives from the outset of its investigations.
  • The CSB will take measures to avoid interference by any party with the proper exercise of employee participation.
  • CSB investigators will allow and encourage employee representatives to accompany the CSB team during site inspections and tours. Such participation is often critical for understanding complex processes and learning of important safety concerns and hazards.
  • Where necessary to obtain information, CSB investigators will conduct separate meetings with employee representatives.
  • During CSB interviews, any non-supervisory employee may be accompanied by another non-supervisory employee, a personal attorney, or a family member as described in 40 CFR 1610.
  • The CSB will provide employee representatives with the opportunity to review and comment upon evidence and equipment testing protocols and to observe testing, similar to the opportunities for companies and other parties. Employee representatives will also have access to any test results, to an extent equivalent to other parties.
  • The CSB will provide employee representatives with the opportunity to review and comment on the factual accuracy of CSB reports, recommendations, and interim statements of findings prior to public release, to a degree equivalent to any opportunities provided to company representatives.
  • The CSB will monitor the implementation of the policy to ensure that participation by facility employees and representatives in CSB investigations does not result in prohibited whistleblower retaliation under 42 USC § 7622. Documented instances of retaliation will be referred to appropriate federal enforcement agencies.
The CSB is an independent federal agency charged with investigating serious chemical accidents. The agency’s board members are appointed by the president and confirmed by the Senate. CSB investigations look into all aspects of chemical accidents, including physical causes such as equipment failure as well as inadequacies in regulations, industry standards, and safety management systems. [WCx]
 
 
The Board does not issue citations or fines but does make safety recommendations to plants, industry organizations, labor groups, and regulatory agencies such as OSHA and EPA.
 

Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.

 


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©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

California Postal Window Clerk Delivered Some Bad News

United States Attorney Benjamin Wagner announced that Chief United States District Judge Anthony Ishii sentenced 44 year-old Karina S. Beard of Turlock, California to one year in prison, to be followed by three years of supervised release, for four counts of mail fraud and two counts of federal workers compensation fraud. Beard was also ordered to pay $81,694 in restitution.

 
According to court documents, Beard worked as a distribution and window clerk for the Postal Service in Groveland. For two plus years, Beard received federal workers comp benefits for an on-the-job injury. Because of her claimed injuries, restrictions were placed on Beard's physical activities: no reaching, no pushing, no pulling, no driving for more than 20 minutes, etc.
 
 
Yet, Beard performed various physical tasks, such as horseback riding, caring for horses, yard work, and driving all using the purportedly injured part of her body. Because of claims Beard made in routine Department of Labor questionnaires, she continued to receive workers comp benefits, all while not entitled to such benefits. (WCxKit)
 
At least once a year the U.S. Department of Labor’s Office of Workers Compensation Programs is required to ask every total disability benefit claimant whether the claimant has had any employment, earnings, or changes in their medical condition over the previous 15 months. In compliance with regulations, OWCP sends out a questionnaire to each claimant. Claimants reporting changes in employment, earnings, or their medical conditions on the questionnaire may experience a reduction or termination of benefits.

 

Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.
 
 
 
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

NEWS on the Federal Employees Compensation Act and Prescription Drug Abuse

The Federal Employees Compensation Act (FECA) covers 2.7 million federal employees and postal workers and paid out $1.9 billion in wage-loss compensation, impairment and death benefits and $898 million in medical and rehabilitation services and supplies during the 2010 charge back year, which ended June 30, 2010.

 
There have been no major revisions to the law since 1974. Currently there are two bills pending. Both would put in place a few significant changes. “The Federal Workers Compensation Modernization and Improvement Act” (HR 2465), was passed in the House and has been sent to the Senate Committee on Homeland Security and Government Affairs. Another proposal that originated in the Senate, “The 21st Century Postal Service Act of 2011” (S1789) has made it out of committee. Both include significant provisions related to FECA reform.(WCxKit)

THE 21ST CENTURY POSTAL SERVICE ACT OF 2011 (S 1789)

There are several provisions
in the current version of the bill that would have a material impact on the claimants and the manner in which claims are managed. Section 302, Federal Workers Compensation Reforms for Retirement Age Employees, will reduce total available compensation rates and re-define coverage at and beyond retirement age. This particular provision would have a positive effect on cost as well as remove any notion that FECA is a retirement plan.

 
This legislation also includes provisions that are directly related to case management; one in particular supports increased involvement by the employing agency in managing its’ workers compensation claims. This provision requires an independent medical assessment of disability and potential for return to work for beneficiaries after six months of disability and on a regular basis thereafter.


Currently, federal agencies do not have the authority to schedule or direct the scheduling of independent medical evaluations. They can request that the Department of Labor set up an exam, but the final decision on whether and when to refer for an IME (independent medical evaluation) is in the hands of the claims examiner (DOL). In addition to requiring periodic scheduling of independent medical evaluations by the DOL, the current draft of the proposed legislation provides a mechanism for the employing agency to direct the scheduling of an IME, subject to review of the request by the Secretary of Labor.

 
The complementary piece of legislation that has passed the House is THE FEDERAL WORKERS COMPENSATION MODERNIZATION AND IMPROVEMENT ACT (HR 2465), which among other things would streamline the claims process for those workers who sustain a traumatic injury in a designated armed conflict zone, would permit physician assistants and nurse practitioners to certify disability for traumatic injuries and ensure that they are reimbursed for their services, and would allow the Department of Labor to verify federal employees salaries against social security administration data, all of which will modernize and streamline administration of FECA benefits.(WCxKit)

PRESCRIPTION OPIOID ABUSE

One significant industry-wide
issue that is not explicit to either piece of proposed legislation is prescription opioid abuse. Prescription opioid abuse is being addressed in most workers compensation systems by establishing controls on prescribing with the help of Pharmacy Benefit Management (PBM) programs. In the federal workers compensation system, only the Department of Labor has the authority to adjudicate claims, including those for ancillary services, which limits the employing agency’s ability to control the inappropriate use of pharmaceuticals.


Although federal agencies can, and a few do, hire PBMs to help address the efficacy and cost of prescription drugs, neither the agency nor the PBM have the authority to place any limits on prescribers or fulfillment beyond those established by OWCP, which are extremely limited. It is hard to imagine how the federal workers compensation system, which provides workers compensation coverage for almost 3 million workers, is going to be able to handle the opioid epidemic without a significant change in policy related to the use of formularies and other preventive controls applied at both the benefit level and the point-of-sale.

Authors Lisa M. Firestone, MHSA and Marianne Cloeren, MD, MPH, FACOEM provide services at Managed Care Advisors, Inc. (MCA) an innovative, woman-owned business specializing in workers' compensation, employee health benefits, disability management consulting, and full service workers compensation case management. Based in Bethesda, Maryland, MCA services customers throughout the United States and U.S. Territories. Visit the MCA’s website www.MCACares.com.
 
Lisa M. Firestone, MHSA is the company’s president and owner and brings her 30 years plus experience to the healthcare industry. She is a recognized expert in the areas of employee benefit program development, evaluation, and strategic planning. She has been actively involved in the evolution of workers’ compensation case management and disability management programs, most recently focusing on the federal workers’ compensation and disability systems. She can be reached at lfirestone@managedcareadvisors.com.
 
Marianne Cloeren, MD, MPH, FACOEM Medical Director of MCA where she supports the company’s federal workers’ compensation case management services, oversees quality assurance, and develops educational offerings related to disability management and evaluation. Dr. Cloeren’s experience includes managing employee health in the Veterans Administration system, serving as medical director for several companies, and as an occupational medicine physician for the Army’s Center for Health Promotion and Preventive Medicine, where her focus was federal workers’ compensation case management. She can be reached at mcloeren@managedcareadvisors.com.


 
WORKERS COMP MANAGEMENT BOOK:  www.WCManual.com
 
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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact  Info@ReduceYourWorkersComp.com.

It’s Dog Bite Prevention Week – Don’t Miss Three Hot Tips

Don't scream. Avoid eye contact. Don't run.
 
 
According to an Associated Press report, those are just a few tips offered by the U.S. Postal Service to avoid dog bites after more than 5,600 mail carriers were victims last year of dog attacks. The widespread problem cost the U.S. Postal Service nearly $1.2 million in medical expenses, the government reported recently. (WCxKit)
 
 
Houston and other warmer cities proved the most often locale of dog attacks, although letter carriers were bitten in more than 1,400 cities around the country.  From an insurance standpoint, State Farm noted it paid $11 million in claims for dog bites in California in 2010, the most of any state.
 
 
The Postal Service released the numbers in advance of annual dog bite prevention week, which begins the week of May 16. Its goal is to try and reduce the number of dog attacks, both on mail carriers and in the general population. Last year, more than 4.7 million Americans were bitten, most of them children.
 
 
According to the Postal Service, the top cities for dog attacks after Houston are Columbus, Ohio; San Diego, Calif.; Los Angeles; Louisville, Ky.; San Antonio, Texas; St. Louis, Mo.; Cleveland; Phoenix; Minneapolis; Portland, Ore.; Denver; Philadelphia; Sacramento, Calif.; and Seattle.
 
 
My advise: carry pepper spray, dog biscuits and a big jug of water…
 
Note: IF a post employee is bitten, it's a FECA Claim, and Managed Care Advisors a firm which specializes in helped federal employes control their claims costs can be found in our directory if you need help with these claims
 
 
Author Robert Elliott, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact:Info@ReduceYourWorkersComp.com or 860-553-6604.

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Federal Employee Illness and Injury Record Keeping Costs Staggering


Do you have any idea
how much time and money U.S. employers spend when it comes to federal employee illness and injury record-keeping? The answer is 2,967,237 hours and a staggering $136,753,120.
On the bright side, the hour mark is down 105,741 hours less than the task used to take, according to the U.S. Occupational Safety and Health Administration, which developed the estimates. (WCxKit)
The estimates are included in OSHA’s request for public comment and recommendations on the paperwork requirements of 29 CFR part 1904, Recording and Reporting Occupational Injuries and Illnesses (1218–0176). The notice (Docket No. OSHA–2010–0055) was published in the Federal Register on Jan. 13.
The Occupational Safety and Health Act and 29 CFR part 1,904 require employers to maintain records of job-related injuries and illnesses. OSHA uses the records to carry out enforcement and intervention activities, and the Bureau of Labor Statistics uses them to report on occupational illness and injury rates.
OSHA currently has approval from the Office of Management and Budget (OMB) to collect the required information until Feb. 28. The OSHA Notice requests OMB to extend its approval of the measure past that date and that it accept OSHA’s new, reduced “burden hour estimate” associated with the standard.
The current paperwork estimate is 3,072,978 hours, which assumes that each employer takes two hours annually to complete the required information. (WCxKit)
OSHA is also soliciting comment on its existing paperwork burden and seeking public responses to several questions related to the development of OSHA’s estimates. Comments must be submitted (postmarked, sent, or received) by March 14.


Author Robert Elliott
, executive vice president, Amaxx Risks Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information.  Contact:  Info@ReduceYourWorkersComp.com or 860-553-6604.

  

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Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

Congresswoman Giffords Rehabilitation Likely Workers Compensation: Learn About Physical Rehab

Most people would not think of workers compensation when hearing about the Tucson, Arizona tragedy where Congresswoman Gabrielle Giffords and 18 other people were shot. As Congresswoman Giffords and the members of her staff are federal employees, and as they were at an official function for Congresswoman Giffords, she and her staff would be covered for workers compensation by the U.S. Department of Labors Office of Workers Compensation Programs, which administers the Division of Federal Employees Compensation. This type of workers compensation is called FECA – Federal Employees Compensation Act.
 
 
Congresswoman Giffords, like other employees with a brain injury, will be going through physical rehabilitation. Most everyone understands that rehabilitation “rehab” is medical care to improve a medical condition, but most people do not know what rehab consist of. (WCxKit)
 
 
Rehab is specialized medical care for the treatment of a disability from injury or illness. The goal of rehab is to stabilize the injured employees medical condition and to assist the employee to recover from the injury or illness. The rehab process is administered by a team of specialists as the injured employee will normally need the medical expertise of a variety of doctors.
 
 
Rehabilitation hospitals are not all the same. One rehab hospital may specialize in burn cases while another rehab hospital may specialize in traumatic amputations. The initial medical provider treating the employee for his/her injuries needs to identify a rehabilitation hospital that is appropriate for the employee's medical condition. The rehabilitation hospital must have the proper mixture of specialty services needed by the employee. 
 
 
Rehab strives to return the employee to their pre-injury condition, but not everyone will have a 100% recovery. Most injured employees admitted to a rehabilitation hospital start with a program designed to provide the employee a path to full recovery.   However, often is unknown how much recovery an employee will have until the employee has been in rehab for a period of time.   Rehab will assist the employees who do not recovery 100% to learn to live with their disabilities. 
 
 
When an employee is sent to a rehabilitation hospital, it is because they need specialized services to recover their ability to function. Rehab incorporates numerous medical specialties that work together as a team. For an employee with a brain injury, the medical teams that will assist them include:
 
1.      Neurophysiologist
2.      Neurosurgeons
3.      Neuro-ophthalmologist
4.      Audiologist
5.      Speech Therapists
6.      Rehabilitation Case Manager
 
 
With a brain injury, other parts of the body may be affected. Some of the additional medical specialists that can be brought in to assist with the rehab include:
 
1.      Physical Therapist
2.      Occupational Therapist
3.      Vocational Rehabilitation Specialist
4.      Rehabilitation Nurse
5.      Clinical Psychologist
6.      In addition to all these specialties, the rehabilitation hospital will either provide or be able to refer an injured employee to dieticians, chaplains and social workers.
 
 
When the injured employee is transferred from the post-accident hospital to the rehabilitation hospital, the medical team at the rehab hospital will thoroughly review the employee's medical records to establish the types of specialized medical care that will be needed. In addition to reviewing the medical history, the employee will be put through a series of test to establish the medical and physical restrictions that prevent the employee from functioning better. 
 
 
Once admitted to the rehabilitation hospital, the employee's disability level will be measured using two scales. The Functional Independence Measure is used to asses the physical and cognitive abilities of the injured employee, and the Functional Assessment Measure is used to gauge emotional status, orientation, attention, community integration, reading and writing skills and employability. 
 
 
The physical and cognitive test will include testing to see if the employee can stand on his/her own, walk without assistance or not, chew and swallow without assistance, talk and communicate freely, and the testing will show if the employee can understand and comprehend instructions. Each of the specialists will also administer their own evaluations to see what the employee can and can not do. Based on the assessment of the medical team, a customized program is designed to diminish or eliminate the disability.
 
 
There is no standard time frame for a person to be in a rehab hospital. One employee may be fully recovered in a month or less, while another employer with extreme injuries could be in the rehab hospital six months or more. However, during the time the employee is in the rehabilitation program, much of the physical and cognitive testing will be repeated to measure the employees progress. Also, prior to the discharge from the rehab hospital, the Functional Independence Measure and the Functional Assessment Measure test will be repeated to measure the employee's overall level of improvement while in the rehab program. (WCxKit)
 
 
Physical rehabilitation is usually reserved for the employees who have the most severe disabilities, but it can often be effective in reducing the disability level (and the amount of the permanent partial disability award) in mid-level workers compensation claims. When your workers compensation adjuster and nurse case manager are working with an employee that has been admitted to a physical rehabilitation program as the result of an injury, support your employee throughout the process. Many employees who are admitted to a rehab program return to work to be productive again.
 
 

Author Rebecca Shafer, JD, President of Amaxx Risks Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker and website 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.  See www.LowerWC.com for more information. Contact:  RShafer@ReduceYourWorkersComp.com or 860-553-6604.

 
WORK COMP CALCULATOR:   http://www.LowerWC.com/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 or agent about workers comp issues.

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact
Info@ReduceYourWorkersComp.com.

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