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Part 6. Human Resources Management

Chapter 800. Employee Benefits

Section 1. Workers’ Compensation Program

6.800.1  Workers’ Compensation Program

6.800.1.1  (01-01-2004)
Purpose and Content

  1. This Section explains all general aspects of the workers’ compensation program as it applies to the Internal Revenue Service.

  2. It provides the legal basis and administrative oversight of the program.

  3. The Section includes procedures and guidance for managers and other interested parties in processing and managing workers’ compensation claims.

  4. It includes several helpful exhibits, which can be used as sample guides and informational items.

  5. This Section is subject to revision as the Federal Employees Compensation Act (FECA) and regulations are amended periodically and as the Internal Revenue Service (IRS) and Workers’ Compensation Center (WCC) procedures are changed. The electronic filing option for Forms CA-1 and CA-2 was effective on October 1, 2001 and these procedures are included.

  6. Other procedures information and forms are available in the Guide to Workers’ Compensation Procedures on the ERC website at http://erc.web.irs.gov. Just insert "workers compensation" in the search option.

6.800.1.2  (01-01-2004)
Legal Basis and IRS Program Oversight

  1. The IRS is fully committed to providing administration of the FECA in a manner that will provide employees who are injured while on duty all benefits to which they are entitled. Administration of the injury compensation program will also reflect sound management and fiscal practices, with emphasis on minimizing costs of program benefits and maximizing the value to the function of each injured employee and his/her productivity consistent with applicable law and regulation. The FECA, under the authority of United States Code (5 U.S.C. 8101) and the Code of Federal Regulations (20 C.F.R. 10) provides compensation benefits to civilian employees of the United States for disability due to personal injury or disease sustained while in the performance of duty. The FECA also provides for the payment of benefits to dependents if a work-related injury or disease causes an employee’s death. The FECA is intended to be remedial in nature, and proceedings under it are non-adversarial.

  2. Benefits provided under the FECA constitute the sole remedy against the United States for 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 statute. The Assistant Secretary of Labor for Employment Standards of the Department of Labor (DOL) has delegated the responsibility for administration and implementation of Chapter 5 of the FECA to the Director, Office of Workers’ Compensation Programs (OWCP). Therefore, OWCP of the DOL alone determines whether the employee is entitled to benefits and compensation under the FECA.

  3. The FECA mandates that all initial claims, whether via electronic filing or on paper forms (CA-1 and CA-2), must be submitted to the DOL no later than 10 workdays from the agency’s receipt of the claim. The agency’s receipt date is the date the manager receives the signed claim summary sheet or form from the injured worker. Forms CA-7 for wage loss compensation and/or Form CA-2a, Notice of Recurrence, are to be submitted within 5 workdays of the agency’s receipt.

  4. The WCC provides all workers’ compensation services for the IRS through a variety of state-of-the-art, user-friendly modalities. The program uses automation and telecommunications systems to ensure information access and services for all employees and managers Servicewide. All personnel responsible for administering FECA ensure the protection of claimants’ rights and that management exercises appropriate options timely so that workers’ compensation program costs are effectively controlled.

  5. The WCC is designed to increase the effectiveness of the IRS’s workers’ compensation program through program integration and collaboration with the Service’s Special Accommodations Program for employees with disabilities. Their goal is to ensure equity between employees with disabilities and employees who sustain temporary or permanent disabilities from work related injuries. All employees, regardless of disabilities, are entitled to job accommodations and opportunities for full employment if work is available.

  6. Regulations in 20 C.F.R. 10.16 state that criminal penalties apply for wrongfully impeding a FECA claim. See IRM 6.800.1.11, Controlling the Claim, paragraph (6).

6.800.1.3  (01-01-2004)
Responsibilities of Employees

  1. The responsibilities of all employees are as follows:

    1. Report all job-related injuries immediately.

    2. Provide all required information, including medical documentation. Advise physician that light duty is available.

    3. Keep management informed of his or her medical status and promptly report any changes in medical or physical status.

    4. Return to work as soon as possible when medical documentation indicates no longer totally disabled.

    5. Cooperate with management to identify reasonable accommodations to return to gainful employment.

    6. Comply with agency regulations to report any criminal act or violation of the Code of Ethics.

    7. Ensure that federal health and life insurance premiums are deducted from compensation or paid to the carrier when filing claims.

  2. Additional information is available through the ERC web site at http://erc.web.irs.gov in the Guide to Workers’ Compensation Procedures.

6.800.1.4  (01-01-2004)
Responsibilities of Managers

  1. The responsibilities of all managers are as follows:

    1. Ensure that injured employees receive prompt and appropriate medical attention.

    2. Have up-to-date knowledge of workers’ compensation benefits.

    3. Properly complete and timely submit appropriate injury forms.

    4. Maintain a supply of all required forms. Forms can be ordered through the servicing CIDS site. Use the catalog numbers that appear in the "Other Government Agency Items" section of Document 7130, IRS Published Products Catalog. The CIDS toll-free telephone number is 1-800-829-2437. Most CA-forms are now available for printing on the ERC web site or the Intranet. The address is http://erc.web.irs.gov and is available in the Guide to Workers’ Compensation Procedures.

    5. Work with Safety officials and other personnel to determine the cause of accidents and maintain a supply of accident reporting forms.

    6. Understand the criteria and procedures for controverting, challenging or clarifying claims believed to be questionable or unjustified. FECA regulations provide that absent a full reply from the agency, DOL will accept the claimant’s statements/allegations as factual and assume that the agency fully concurs with these statements.

    7. Inform WCC of any proposed, pending or current adverse actions involving the claimant.

    8. Advise the employee of his or her obligation to return to work as soon as possible and to keep the manager informed of his or her medical status.

    9. Comply with agency regulations to report any criminal act or violations of the Code of Ethics.

    10. Monitor the employee’s medical progress and duty status by obtaining periodic medical reports from the employee’s physician. Provide the Duty Status Form to the employee for each doctor’s visit and instruct him/her to return it within 48 hours.

    11. Work with WCC in monitoring continuation of pay for 45 days.

    12. Provide or develop jobs commensurate with employee’s skills, medical limitations and earnings in order to provide reasonable accommodations.

    13. Ensure that injured seasonal employees who are unable to work are carried in LWOP-OWCP status.

    14. Carry the injured employee on the employment rolls, where feasible, with the goal of returning him or her to duty as soon as possible. This will facilitate tracking the employee’s recovery and will simplify the administrative process involved in fulfilling the agency’s obligation to restore the injured employees to gainful employment.

    15. Provide a copy of the SF-50, Notification of Personnel Action, to the WCC case manager when the employee is terminated for any reason from IRS.

  2. Additional information is available through the ERC at http://erc.web.irs.gov in the Guide to Workers’ Compensation Procedures.

6.800.1.5  (01-01-2004)
Responsibilities of WCC

  1. The responsibilities of the WCC are as follows:

    1. Advise managers and employees of their responsibilities.

    2. Properly process and submit initial claims via electronic transmission to DOL, when appropriate, and complete other applicable sections of injury forms within time limitations.

    3. Work with Safety officials and other personnel to determine the cause of an accident.

    4. Monitor claims and work with managers to controvert/challenge claims.

    5. Comply with agency regulations to report any criminal act or violations of the Code of Ethics.

    6. Track pending and approved claims, including COP related cases, to ensure compliance of FECA rules.

    7. Monitor approved claims and medical evidence to determine earliest practical return to duty date.

    8. Work with managers to provide light duty and reasonable accommodations for partially disabled employees.

    9. Receive, review, approve and monitor leave buy back requests.

    10. Train managers concerning the workers’ compensation program, adhering to budget restraints.

  2. Additional information is available through the ERC at http://erc.web.irs.gov in the Guide to Workers’ Compensation Procedures.

6.800.1.6  (01-01-2004)
Filing Claims

  1. Upon notification of an injury, the manager must take time to listen and discuss with the employee the nature of the injury. He or she will ascertain how, when and where it took place, along with the names of any witnesses, if appropriate. Once these facts are obtained and an investigation of the work areas and the "type" of injury is identified, the manager will suggest that the employee e-file the initial claim through the Safety and Health Information Management System (SHIMS), mandated August 2002 for Treasury-wide usage by the Treasury Secretary. If a computer is unavailable, the manager may provide the appropriate form(s) to the employee for submission.

    1. Form CA-1, Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation. This form is for traumatic injury cases only. A traumatic injury is a wound or other condition caused by external forces, including physical stress or strain caused by a specific event or incident, or series of events within a single work shift. The injury is identifiable as to time and place of occurrence and part or function of the body affected. This is the criterion that sets a traumatic injury apart from an occupational disease. See Forms/Pubs on IRWeb.

    2. Form CA-2, Notice of Occupational Disease and Claim for Compensation. An occupational disease is produced by systemic infections, continued or repeated stress or strain, exposure to poison fumes, noise, etc., in the work environment over a longer period of time. To qualify as a disease, the injury must be caused by exposure or activities on more than one workday or shift. See Forms/Pubs on IRWeb. OWCP has developed checklists (Forms CA-35) to assist employees and agency personnel in gathering and submitting material required for adjudication of occupational disease claims. See ERC website at http://erc.web.irs.gov in the Guide to Workers’ Compensation Procedures - Forms CA-35 (Checklists for Occupational Disease Claims).

    3. Form CA-2a, Federal Employee’s Notice of Recurrence of Disability and Claim for Continuation of Pay and Compensation. A recurrence of an injury (traumatic or occupational) is defined as a spontaneous return or increase of disability due to a previously accepted injury, without intervening cause. See Forms/Pubs on IRWeb.

    4. Form CA-7, Claim for Compensation on Account of Traumatic Injury or Occupational Disease. This form is used to claim compensation for wages lost due to a work-related traumatic injury after the expiration of COP or for occupational disease claims. The CA-1 or CA-2 must be an approved claim before the CA-7 can be processed. The CA-7 is submitted biweekly until the claimant is notified by OWCP that no additional Forms CA-7 are needed or until the claimant returns to duty. It is also used for leave buyback and schedule award requests. CA-20, Physician’s Report, is attached to the CA-7. See Forms/Pubs on IRWeb.

    5. Form CA-16, Authorization for Examination and/or Treatment . This form is used to authorize initial medical treatment in traumatic injury cases This form allows initial payment of medical bills to the provider of medical services by the DOL office, in accordance with their schedule. See the manager who can order this from the local CIDS site.

    6. Form CA-35, Evidence Required in Support of a Claim for Occupational Disease or Illness. This form is used in developing an occupational disease claim. See ERC website at http://erc.web.irs.gov in the Guide to Workers’ Compensation Procedures – Forms CA-35.

    7. Form CA-17 (or the WCC devised form), Duty Status Report . The agency can use this form for every doctor’s appointment to request information from a physician, particularly regarding the employee’s ability to return to work and when restrictions may be involved. See Exhibit 6.800.1-1, Duty Status Report. See also http://ciweb/sections/strategy/human_resources/human_resources.htm for a special Criminal Investigation form.

    8. OWCP-1500 or HCFA-1500, Health Insurance Claim Form. This form is used to request payment for most medical bills. All doctor bills not directly related to a hospital stay must be submitted on the OWCP-1500. Failure to do so will result in unpaid bills that will be returned to the doctor and will become the responsibility of the employee.

    9. UB-52 or UB-92. This form is used by hospitals to request payment for services rendered.

    10. Form CA-915, Claimant Medical Reimbursement Form. This form, which may be obtained from your DOL (OWCP) district office or via the DOL website at www.dol.gov/esa/regs/compliance/owcp/forms.htm is used for requesting reimbursement for medical payments on accepted claims when the employee has paid the charges.

    11. SF-91, Motor Vehicle Accident Report. This form is used to report employee motor vehicle accidents. Obtain it from the local Safety Officer.

    12. SF-1199A,Direct Deposit Sign-up. This form is used for payment of compensation and may be obtained from local financial institutions.

  2. Additional information is available through the ERC web site at http://erc.web.irs.gov in the Guide to Workers’ Compensation Procedures.

6.800.1.7  (01-01-2004)
Traumatic Injury Claim Procedures (Form CA-1) (Includes Paper Claim Methods)

  1. The manager should promptly authorize treatment by giving the employee a properly executed Form CA-16, Authorization for Examination and/or Treatment, within 7 days of the employee’s injury, shorter timeframe if possible. To be valid, a Form CA-16 must give the full name and address of the physician or medical facility, must be signed and dated by the authorizing official (usually the manager), and must show his or her title and local phone number. With emergencies, when there is no time to complete a Form CA-16, the manager may authorize treatment by telephone and then forward the completed CA-16 to the medical provider within 48 hours. If the employee has already been seen by the physician, the Form CA-16 is not issued retroactively. Managers are encouraged to use discretion in issuing this form if an employee has reported an injury several days after the fact, or did not request medical treatment within 24 hours of the injury. The CA-16 obligates the agency to pay for medical treatment for a period of 60 days. Therefore, in cases of a doubtful nature (for example, injury was not witnessed, injury may not be work related, late reporting of injury by employee), Item 6(B) (2) of the form should be completed authorizing an initial examination only, and indicating the doubt.

  2. Advise the employee that he or she may choose a physician within a 25-mile radius of the workplace or the employee’s home, or reimbursement may be terminated. Under FECA law, physicians can be extended to include clinical psychologists, optometrists and chiropractors (for treatment of manual manipulation of the spine to correct subluxation, shown by x-ray to exist). Inform the employee that a change of physician is only authorized with prior OWCP approval.

  3. In accordance with the IRS and NTEU national agreement, managers should provide Publication CA-550, FECA Questions and Answers about the Federal Employees' Compensation Act. The CA-550 is available through the ERC at http://erc.web.irs.gov and DOL at www.dol.gov/dol/esa/public/regs/compliance/owcp/feca550q.htm. You may also refer the employee to Document 9669, Employee Personnel Resource Guide (Catalog #22761G) or on the ERC website for guidance.

  4. Notify WCC by telephone immediately after the injury at 804-771-2900. State "I am calling to report an injury." Be prepared to report all the facts of the injury.

  5. Advise the employee to e-file the claim. See IRM 6.800.1.9.for procedures on E-Filing Methods for CA-1 and CA-2. If there is no computer availability for the employee, provide the employee with Form CA-1 for reporting the injury. See IRM 6.800.1.6 for information on Filing Claims.

  6. If electronic filing is not an option, the claim should be submitted as a paper claim. After the employee completes the front of the form it should be submitted to the manager who is responsible for completing the supervisor’s report located on the back of the form. The form should then be submitted via fax transmittal to WCC at 804-771-2270 for review.

  7. The manager should make additions/corrections to his/her portion of the original form at the advice of the WCC representative. During the contact call from the WCC, the manager will be advised to overnight mail Form CA-1 and all other pertinent information to the WCC within 2 workdays of written receipt of the signed Form CA-1. FECA law requires receipt by DOL of the Form CA-1 within 10 workdays of the manager’s written receipt of the notice of injury. The WCC address is: Internal Revenue Service, Workers’ Compensation Center, OS:A:PS:C:W, 11 South 12th Street, #110, Richmond, VA 23219-4035.

  8. The "Receipt of Notice of Injury" should be completed and signed by the supervisor and returned to the employee. A copy should be attached to the original CA-1 and sent to the WCC.

  9. The employee should be advised that it is his/her responsibility to provide medical evidence as to his/her duty status and it is his/her obligation to return to work as soon as possible. The manager should issue the Duty Status Report, See Exhibit 6.800.1-1, along with the Form CA-16, prior to the initial doctor’s appointment. The employee must return the Duty Status Report or other medical evidence immediately after examination or at the start of the employee’s next scheduled work shift if medically able to do so. (If the employee is unable to work, the form must be mailed immediately to the manager.) Upon receipt, the manager should forward it to WCC.

  10. Inform the employee that he/she is obligated according to FECA regulations to advise the physician of the fact that limited duty is available. If the employee cannot yet return to work, the manager should monitor the employee’s medical progress and duty status by obtaining periodic medical reports every 2 weeks. See Exhibit 6.800.1-2, Sample Letter to Physician Reporting Work Restrictions.

  11. If applicable, track continuation of pay for up to the 45 days allowed. See IRM 6.800.1.10,Continuation of Pay. Consult with WCC for advice and send them a leave analysis breakdown for the duration of the injury. Do not permit the employee to work overtime, compensatory time, credit hours or flexi-tour while on light/limited duty due to medical restrictions unless these specialized duty hours are specified in writing by the physician.

  12. Carefully review the dates of disability on the Duty Status Report. If the employee can return to work, the manager must furnish the employee with a written description of the specific duties, physical requirements and date of availability of the limited duty assignment. See Exhibit 6.800.1-3., Sample Job Offer Letter. Have the employee sign the letter as accepting or declining the light duty offer and send a copy to WCC.

  13. Additional information is available at the ERC web site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures.

6.800.1.8  (01-01-2004)
Occupational Illness Claim Procedures (Form CA-2) (Includes Paper Claim Methods)

  1. Occupational disease/illness claims are those which occur over a period of more than one day. The procedures for submitting the claim are the same as those for traumatic injuries with the same 10 workday time limitations as for traumatic injuries. See IRM 6.800.1.7, Traumatic Injury Claim Procedures (Form CA-1), paragraphs 5-13.

  2. In addition, the employee and the manager should complete an appropriate corresponding checklist, Form CA-35. See the ERC website at erc.web.irs.gov in the Guide to Workers’ Compensation Procedures. Forms CA-35 have been devised for various conditions in order to facilitate submission of evidence. The employee completes his/her portion of the checklist and submits it to the manager, who then completes the "employing agency" portion of the checklist. All should be sent to WCC, but do not delay submission of the CA-2 while awaiting supporting documentation for the checklist.

  3. Because CA-2 claims can be more complex cases, the DOL can take up to 6 months and occasionally longer to determine acceptance or denial.

  4. Form CA-16 is not issued for occupational disease claims. Obtain medical documentation as for CA-1 claims to return the employee to work.

  5. Continuation of pay is not available for occupational disease claims. If the claim is accepted, the employee can file a Form CA-7 for wage loss. See IRM 6.800.1.14, Claim for Wage Loss Compensation (Form CA-7).

  6. Additional information is available at the ERC web Site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures.

6.800.1.9  (01-01-2004)
E-Filing Method for Forms CA-1 and CA-2

  1. It is not necessary to file both electronically and via hard copy, since this merely creates a duplicate claim. At the beginning of filing a claim, select one method only.

  2. IRS employees may file Forms CA-1 and CA-2 electronically via the Safety and Health Information Management System (SHIMS). SHIMS is a web-based application owned by Treasury and is accessible through the Treasury Intranet via the ERC. SHIMS is also used for filing safety incident reports. The benefits in using the e-file method for filing claims include less chance of errors, faster claims processing, automatic safety incident completion while filing claims and computer access.

  3. SHIMS is designed in a user-friendly question and answer format. By answering the questions the system will determine whether the appropriate claim form is a CA-1 or CA-2.

  4. To file, access SHIMS. The employee clicks on the ERC web link at http://erc.web.irs.gov and accesses the SHIMS link on the left index.

  5. The employee selects from the menu "File a claim," after which he/she will be given his/her own secure unique claim number (called a tracking number) available only to the employee and his/her manager.

  6. The employee collects the summary of information needed for filing and continues to file, print and manually sign and certify the printed claim summary sheet, following the instructions.

  7. The employee hands the printed summary sheet to the manager who then electronically completes his/her portion of the claim and signs and certifies it immediately afterwards. The claim is electronically submitted to WCC.

  8. The manager prints a copy of the summary sheets for his/her records and ensures the employee maintains the original "Receipt of Notice of Injury."

  9. The manager must mail the signed copies of the employee and manager summary sheets to the WCC immediately. If any item needs correction, contact WCC immediately.

  10. Additional information is available at the ERC web site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures.

6.800.1.10  (01-01-2004)
Continuation of Pay

  1. Continuation of pay (COP), FECA leave, is the continuation of an employee’s regular pay by the employing agency when absence is directly related to the injury. The manager must advise the employee of the right to elect continuation of regular pay or to use annual and/or sick leave if the injury is disabling. The employee may not buy back leave during the 45 day entitlement period. See IRM 6.800.1.15, Leave Buy Back.

  2. COP is applicable in traumatic injury cases only for a maximum of 45 calendar days. The days do not have to be used consecutively, but must be used within 45 calendar days from the day of the injury or within 45 calendar days of the date the employee first returned to work following the initial disability, whichever is later.

  3. To qualify for COP, an employee must file a CA-1 within 30 days of the date of injury and must submit medical evidence within 10 calendar days of claimed COP or date disability begins, whichever is later. The COP selection must be selected on the CA-1 initial filing.

  4. Management must first notify the WCC before authorizing COP. If the claim is controverted/challenged for any of the reasons listed on the CA-1 instructions (#36), the agency may refuse to pay COP. See IRM 6.800.1.12, Controversion/Nonconcurrence. The medical must also support that the employee is not fit for duty due to his/her workplace injury.

  5. COP usually starts the first day of absence following the date of injury (the only exception being if the injury occurred before the actual work shift began). On the day of the accident, an injured employee’s absence from work in order to seek medical attention and take time because medical documentation indicated total disability is charged to administrative leave. COP is counted in one-day increments, even if the employee worked a portion of the day.

  6. Refer to the Time and Leave Handbook, Document 11103, Catalog #27297B, Federal Employees’ Compensation Act Section, for more details on how to report and count COP days. The website is http://erc.web.irs.gov/DOCS/2002/AWSS/PS/Timekeeping/Timekeepingindex.html

  7. A workers’ compensation case manager at the WCC will assist you in closely monitoring the duration of COP. Dates of eligibility for COP should be compared with medical reports regarding an employee’s inability to work. In cases where the employee has elected sick or annual leave, the employee will be placed in a leave status. However, medical documentation is required for all absences, regardless of leave type chosen. For every week when an employee has an injury related absence, the manager should send to WCC a copy of payroll Form 3081.

  8. COP is not authorized for occupational illnesses (Forms CA-2).

  9. Additional information is available at the ERC web site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures.

6.800.1.11  (01-01-2004)
Controlling the Claim

  1. The management of the claim from submission to adjudication by DOL is the responsibility of the WCC and IRS management. All claims and allied correspondence except medical bills must flow through the WCC before being forwarded to DOL. This includes claims filed with no lost time and no medical expense.

  2. Upon receipt of the SHIMS Claimant Report, or the CA-1, CA-2 or CA-2a, the manager will prepare a case folder to be maintained in his/her office. Also, the WCC will maintain a case file at its site.

  3. Investigation of the claim by the immediate manager should start immediately upon notification that an injury/illness has occurred. The Safety Officer should be a part of this investigation. The investigation should either substantiate the claim or raise doubt as to the validity of the claim. Some sources and expertise available for the investigation are:

    • Injured employee

    • Witnesses

    • Immediate manager and section chief

    • Treating physician

    • Safety Officer

    • Local law enforcement agency

    • On-site occupational health nurse

  4. A determination will be made whether or not to controvert or question the claim. If there is no basis for controversion, the claim and all supportive documentation will be immediately forwarded to the WCC. If the investigation reveals there are questionable circumstances, the manager will prepare a statement outlining the facts that will be forwarded with the claim, if possible, to the WCC. This may be forwarded later, so as not to jeopardize the two workday claim timeframe. This topic is also discussed in the following subsection. See IRM 6.800.1.12, Controversion/Nonconcurrence.

  5. Upon completion of the investigation, the claims package will be prepared and forwarded to the WCC within two workdays from the date the supervisor is notified of an injury or illness. The package must contain the following applicable items and should be sent by overnight service:

    1. Properly completed Claim Form CA-1, CA-2 or CA-2a, OR, if electronically filed, signed and dated summary sheets.

    2. Diagram of the accident site to identify its exact location and cause.

    3. Copy of Motor Vehicle Accident Report, Form SF-91, if applicable.

    4. Complete and up-to-date medical report, including dates of the examination and treatment, history of injury given by the employee to the physician, detailed description of findings, results of all x-ray and laboratory tests, diagnosis, clinical course of treatment followed, and the physician’s opinion supported by medical rationale as to the causal relationship between the employee’s condition or disability claimed and the injury reported; the physician’s discussion of the issue of causal relationship is crucial to the claim.

    5. Light duty job offer and duty status report.

    6. Leave audit (breakdown day by day of time worked and leave taken) for the previous 12 Months. Contact the WCC case manager for advice.

    7. If applicable, complete OWCP Claim Questionnaire, which is for use in cases of suspected fraud and/or abuse. See Exhibit 6.800.1-4, OWCP Claim Questionnaire (Key Indicators for Fraud and Abuse). See Exhibit 6.800.1-5, OWCP Claim Questionnaire. See Exhibit 6.800.1-6, Fraud Referral Letter.

    8. Routing slip to indicate any pending disciplinary action, and

    9. Position description.

  6. The submission of the claim should not be unduly delayed. If medical reports and supportive information are not readily available, a completed e-claim or paper claim form must be sent to the WCC in order for a claim number to be assigned and the processing of the claim to be initiated. The regulations in 20 C.F.R. 10.16 provide that any person charged with the responsibility of making reports in connection with an injury who willfully fails, neglects, or refuses to do so; induces, compels, or directs an injured employee to forego filing a claim; or willfully retains any notice, report, or paper required in connection with an injury; is subject to administrative proceedings (criminal penalties).

  7. Additional information is available at the ERC web site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures.

6.800.1.12  (01-01-2004)
Controversion/Nonconcurrence

  1. "Controvert" means to dispute COP. An employee can file a claim with OWCP and begin collecting COP even though the agency initiates the controversion of the COP. Also, If the preliminary review of the CA-1, CA-2, CA-2a, witness statement or medical report suggests that the claim is unjustified, the agency may controvert/challenge the entire claim or any portion of it.

  2. Controversion/challenge of a claim when it is filed is the agency’s only opportunity to notify OWCP that it disagrees with the claim being filed. If a claim seems unjustified, only the agency can clarify the circumstances effectively and immediately. FECA regulations provide that, absent a full reply from the agency, DOL can accept the claimant’s statements/allegations as factual and can assume that the agency fully concurs with them. The agency has no appeal rights in the claim’s adjudication process; therefore, it is essential that all pertinent information be provided to DOL prior to the adjudication of the claim.

  3. If it is determined that the claim or any portion of it should be controverted/challenged, a controversion or nonconcurrence package will be prepared. The package should contain, at a minimum, the following:

    1. A statement signed by the manager or authorized official summarizing specific factual reason(s) for controversion, and

    2. Exhibits, such as statements of witnesses, investigative reports, photographs, official documents, etc.

  4. The controversion package should be submitted to the WCC with the claim package, if possible. This will allow DOL to act upon the claim in a timely manner. However, even if elements of the controversion package are not readily available, the claim form and available documentation must be submitted to the WCC within two days of the injury. If you cannot meet the two-day deadline, contact WCC to request an extension. The controversion package should also include a statement that indicates whether evidence will be submitted upon receipt. This evidence should then be forwarded as soon as possible to expedite the adjudication of the claim.

  5. Additional information is available at the ERC web site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures.

6.800.1.13  (01-01-2004)
Appeal Rights

  1. The DOL makes formal decisions on whether injured employees are entitled to benefits and compensation under the FECA. Negative decisions give a reason for denial and include a description of employee appeal rights.

  2. If the employee disagrees with the DOL’s formal decision, he/she can appeal it by requesting either a:

    1. hearing,

    2. reconsideration, or

    3. review by the Employee’s Compensation Appeals Board.

  3. Employees may request only one form of appeal at a time and each appeal has time limits as prescribed by DOL.

  4. Employees or managers wishing information regarding the appeal process may contact WCC for more information.

6.800.1.14  (01-01-2004)
Claim for Wage Loss Compensation (Form CA-7)

  1. If an employee sustained a traumatic injury and the employee cannot return to work at the end of a 45-day period of COP, the employee should be placed in LWOP (OWCP) and file a claim for compensation from DOL. The following procedures apply to claims for compensation:

    1. At the end of the 45-day period of COP (applicable for Form CA-1) or upon acceptance of Form CA-2, forward a Standard Form (SF) 52, Personnel Processing Action, to the servicing personnel office, placing the employee in an LWOP-OWCP status. Forward a copy of the SF-52 to the WCC. Note that there is a three-day waiting period for which no compensation is paid unless the disability lasts more than 14 calendar days.

    2. The employee is to complete the front of the Form CA-7 and submit the form and supporting medical documentation to the manager. For intermittent absences, Form CA-7a, Time Analysis, is required. Both forms are available on the ERC web site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures. The manager is to complete the back of the form and then forward the completed CA-7 with all relevant medical evidence to the WCC. Because this is the form which sets the compensation payment, please ensure that all necessary blanks are completed fully and that the claim is filed immediately. Payments are unnecessarily delayed when items are incomplete on the form. DOL pays at the rate of 75% of the claimant’s salary, for those injured employees with children under 19 (or under qualified schooling) and/or a spouse. Those employees without qualifying dependents are paid at 66 2/3% of their salaries. Compensation paid by DOL is not subject to income tax.

    3. If the disability is expected to continue beyond the period claimed on the initial CA-7, have the employee complete subsequent Forms CA-7 every 2 weeks until he/she returns to work on limited/regular duty, or until otherwise directed by the WCC or the servicing DOL office.

    4. Contact the employee’s WCC case manager by telephone immediately after the claimant returns to work. Telephone notification is critical to prevent a possible overpayment by DOL. Prepare a written job offer denoting any changes in the job to fit the employee’s restrictions, using See Exhibit 6.800.1-3,Sample Job Offer Letter.

    5. Additional information is available at the ERC web site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures.

6.800.1.15  (01-01-2004)
Leave Buy Back

  1. A leave buy back or leave restoration is a process by which the sick or annual leave the employee used during his/her injury period, including any leave bank hours used, is re-purchased and restored to his/her personal leave account. Credit and/or compensatory hours may not be repurchased.

  2. These are some of the criteria for acceptance:

    1. A claim must be approved by DOL prior to requesting a leave buy back. Medical documentation must be submitted to support all dates claimed.

    2. The leave buy back must be initiated within one year of the date OWCP approved the claim or one year from the last date that leave was used for a job-related absence, whichever is later.

    3. Employees will have only one opportunity to repurchase leave used for each OWCP injury.

    4. The minimum amount of time accepted for a leave buy back is 10 hours.

    5. The employee must be on the active IRS rolls.

    6. Claims must be initiated before third party settlements in order to be approved for leave buy backs.

    7. Leave buy backs requesting that a check be sent directly to the claimant will not be approved.

    8. Consult WCC for any unusual circumstances.

  3. To apply, the employee must submit Forms CA-7 and CA-7a with supporting medical documentation (if not previously furnished) to the WCC. These should include specific dates and the amount of leave requested to be repurchased.

  4. In the leave buy back process, the claimant must pay the IRS the difference between the total cost of the leave buy back and the DOL contribution (based on 2/3 or 3/4 compensation rates). This compensation pay rate which is determined by DOL is the salary in effect on the date of injury, date of recurrence or date disability began. The WCC caseworkers will process the request and will be available for assistance.

  5. From the time the CA-7 and CA-7a are received at the WCC, it takes 6 or more months until the actual restoration occurs.

  6. Refer to the Time and Leave Handbook, Document 11103, Catalog #27297B, Federal Employees’ Compensation Act Section, for more details on the leave buy-back process. The website is http://erc.web.irs.gov/DOCS/2002/AWSS/PS/Timekeeping/Timekeepingindex.html

  7. It is imperative for managers to adhere to the guidance provided by WCC. The DOL will at times issue instructions which are generic to all governmental agencies, and are not tailored for the IRS. Because the National Finance Center (NFC) maintains IRS payroll accounts, NFC regulations must be followed. The employee will not receive the leave restoration until all payback amounts are submitted.

  8. Additional information is available at the ERC web site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures.

6.800.1.16  (01-01-2004)
Extended Claim Disabilities

  1. When it is apparent the injured employee will be disabled from work for an extended period of time, DOL may take any one or more of several steps of action to encourage return to work. Oftentimes, WCC contacts DOL to proactively suggest progressive steps. In all cases, DOL informs the employee, generally via letter (copy to WCC), of any activity they propose on the case. The following are some case management activities DOL may pursue:

    1. Review DOL decisions.

    2. Schedule conference calls with employees and/or managers/WCC case workers to discuss claim progress.

    3. Request more medical information from physicians.

    4. Initiate more medical development of the case.

    5. Assign DOL contract nurses to meet, either telephonically or in person, with employee and/or manager, physician, and WCC representatives to assist in return to work.

    6. Assign contract rehabilitation counselors to explore accommodating limited duty at the employee’s job site or to test and train for employment elsewhere.

    7. Schedule second and referee medical examinations

6.800.1.17  (01-01-2004)
Return to Work/Reasonable Accommodations

  1. Title 5 C.F.R. 353 and Subpart C obligates agencies to restore current and former employees who have fully or partially recovered from work-related injuries. This is based on medical reports provided by the physician. Please refer to this code for more detailed information.

  2. Fully recovered within one year – A current or former employee who fully recovers within 1 year from the date eligibility for compensation began is entitled to be restored immediately and unconditionally to his/her former position or an equivalent one in the local commuting area the employee left.

  3. Fully recovered after one year – A current or former employee whose full recovery takes longer than one year from the date eligibility for compensation began, is entitled to priority consideration for restoration to his/her former position or an equivalent one as long as his/her application is made within 30 days of DOL notification. Regulations on retention rights are in 5 C.F.R. 353, 302 and 330.

  4. Partially recovered:

    1. Managers must make every effort to restore, in the local commuting area, an individual who has partially recovered and is able to return to work in some capacity. This could mean re-engineering his/her former position, if feasible, or placing the employee in another position that is within the work capabilities.

    2. An employee who is physically disqualified for his/her former position or an equivalent position because of a work injury, is entitled to be placed in another position that will provide the employee with the same status and pay, or the nearest approximation thereof, consistent with the circumstances in each case. The DOL will determine if additional benefits will be paid for loss of wages.

    3. If the residuals of the injury will prohibit the employee from returning to full duty in the position he/she held at the time of injury, a formal written job offer must be issued for a different position . Contact the WCC case manager for assistance in this area.

  5. Seasonal employees – Managers should return seasonal employees to their positions of record or comparable positions as soon as possible. Do not wait until the normal furlough season is over. Contact WCC for advice.

  6. When the claimant returns to work, the manager should immediately notify the WCC case manager by telephone. Telephone notification is critical to prevent possible overpayment of compensation by DOL.

  7. Additional information is available at the ERC web site at http://erc.web.irs.gov through the Guide to Workers’ Compensation Procedures.

  8. See http://ciweb/sections/strategy/human_resources/human_resources.htm for special instructions on return to work for Criminal Investigation.

Exhibit 6.800.1-1  (01-01-2004)
Duty Status Report

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Exhibit 6.800.1-2  (01-01-2004)
Sample Letter to Physician Requesting Work Restrictions

Sample Letter to Physician Requesting Work Restrictions
Physician’s Name
Physician’s Address 		   
    Claimant:
Claim #:
SS#:
DOI:
Dear Dr. __________ :
This is regarding the workers’ compensation claim filed by our employee and your patient, (Employee Name).
We sincerely regret any discomfort or inconvenience suffered as a result of this occurrence/condition and we are willing to make reasonable accommodations in accordance with any work restrictions deemed medically necessary. Light duty assignments are available upon notification of work restrictions. We need to ensure that the employee can perform the duties assigned and determine if any changes need to be made to accommodate any existing medical condition.
For this reason, we would appreciate your completing the attached Duty Status Report outlining current work restrictions. To assist you in making your determination, we have enclosed a copy of the position description. Your response may be faxed to (employee’s manager) at (fax number).
We appreciate your cooperation in this matter and look forward to working with you. If you have any questions regarding the employee’s work requirements, please contact (employee’s manager) at (telephone #). Questions pertaining to Internal Revenue Service workers’ compensation issues may be directed to our Workers’ Compensation Center located in Richmond, Virginia, at 1-800-234-8323.
  Sincerely,




Manager
Manager’s Title 		 
Enclosures

cc: Workers’ Compensation Center

Exhibit 6.800.1-3  (01-01-2004)
Sample Job Offer Letter

Employee’s Name
Employee’s Address
Dear    
We have received medical information from your physician indicating you can return to work. In accordance with your medical restrictions, the following position is offered to you:
Title:
Permanent/Seasonal/Temporary (Job offer must agree with employee’s last appointment):
Series/Grade/Salary:
Organization/Location:
Tour of Duty/Hours of Work:
Date Job Available:
The following describes the duties and physical/environmental requirements of this position.

Caution:

The functional requirements of the offered position must be included in narrative format and must comply with the individual’s physical limitations.

Example:

While sitting in a chair, you input data into a remote computer terminal. The terminal is at eye level when the operator is in a sitting position and no reaching or working above shoulder level is required. You may occasionally be required to move and carry computer listings short distances. This activity may not exceed a total of 1 hour per day and weight may not surpass 10 pounds. No stair climbing is involved. You will be working indoors and will not be exposed to cold or dampness. You will be allowed to sit or stand at your convenience, for comfort, and you will be permitted to take frequent walks.] A copy of the official position description is attached.

If you decline this position and OWCP determines that this is a job that you can perform, your benefits under the Federal Employees’ Compensation Act may be terminated (except for medical benefits). If you accept this position, we will provide the necessary information to the OWCP claims examiner for determination of loss of wage earning capacity, if any. Your decision as to acceptance or declination of this offer should be made in writing within 15 days of the date of this letter. The enclosed Acceptance/Declination Statement is provided for this purpose. Failure to notify this office of your decision will constitute a rejection of a valid re-employment offer and may serve as a legal basis for OWCP to terminate benefits.