Division of Federal Employees' Compensation (DFEC)
FECA Part 0
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1. Purpose and Scope. This chapter provides a brief overview of the Federal Employees' Compensation Act (FECA) and the background and structure of the Office of Workers' Compensation Programs (OWCP) and the functions of the National Office, FECA Offices and Claims Units.
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2. FECA. In 1908, President Theodore Roosevelt signed legislation to provide workers' compensation for certain Federal employees in unusually hazardous jobs. The scope of the law was very restricted and its benefits were quite limited. However, it was the first workers' compensation law to pass the test of constitutionality applied by the U. S. Supreme Court.
The FECA, 5 U.S.C. 8101 et seq., which superseded the 1908 statute in 1916, is a workers' compensation law for all civilian Federal employees who have suffered work-related injuries or occupational diseases. It provides for wage-loss compensation, schedule award benefits, vocational rehabilitation, medical care, and survivors' benefits; however, the FECA is not a retirement program. Employees who fully or partially recover from their injuries are expected to return to work.
Federal civilian employees are covered by virtue of their employment status. Benefit costs are paid from the Employees' Compensation Fund, which OWCP administers. Federal employers reimburse the Fund for the amounts paid to its employees in workers' compensation benefits through the chargeback system. See 5 U.S.C. 8147
Benefits provided under the FECA constitute the sole remedy against the United States for a work-related injury or death. A Federal employee or surviving dependent is not entitled to sue the United States or recover damages for such injury or death under any other law for a work injury (5 U.S.C. 8116). The FECA is intended to be remedial in nature, and proceedings under it are non-adversarial. There are, however, penalties for filing a false claim. Federal law provides severe penalties, including forfeiture and termination of benefits, for knowingly and willfully falsifying, concealing or covering up a material fact. See 5 U.S.C. 8148; 5 U.S.C. 1920.
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3. Organization. OWCP includes four workers' compensation programs, of which the FECA program is one. The other three are the Longshore and Harbor Workers' Compensation Program, the Division of Coal Mine Workers' Compensation, and the Division of Energy Employees' Occupational Illness Compensation.
The OWCP Director, along with the OWCP Deputy Director, have authority for the administrative management of the four programs. The division directors work directly for OWCP; therefore, the Division of Federal Employees’ Compensation (DFEC) Director reports to OWCP.
The Employees' Compensation Appeals Board (ECAB) is a distinct body under the jurisdiction of the Secretary of Labor, entirely separate from OWCP. It is authorized to hear and determine appeals from claimants involving questions of law or fact after DFEC has issued a final decision on the issue in question. See 5 U.S.C. 8149.
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4. FECA Program Leadership and Branches. The Director for DFEC, along with the FECA Program's Deputy Director of Program and System Integrity and Deputy Director of Operations and Claims Management are tasked with the implementation and oversight of the entire FECA program. This includes setting program goals and oversight.
Final authority over FECA program matters remains with the Director for DFEC. Under the immediate supervision of the Director are two Deputy Directors. Under the Deputy Directors are six specific branches along with the National Administrator(s) of Field Operations that provide specialized oversight and guidance to FECA staff. Each branch has a Branch Chief.
a. Branch of Regulations, Policies, and Procedures. This Branch develops recommendations for new FECA operational policies, regulations and procedures consistent with the overall policies of OWCP. Changes in operational policies and procedures may be the result of new legislation, court decisions, ECAB decisions, program audits and studies, or precedent setting claims under the FECA. The Branch formulates procedures and maintains a FECA Procedure Manual to be used by the FECA offices in adjudicating FECA claims and paying benefits. This branch also conducts ongoing claims audits and develops training materials for claims personnel. The Branch also manages the field nurse and vocational rehabilitation programs.
b. Branch of Technical Assistance. This Branch is responsible for developing, preparing, and distributing FECA technical assistance materials and guides to Federal agencies, labor organizations, employees and their representatives. These materials are designed to educate and inform Federal employees of their responsibilities in reporting injuries and to inform Federal agencies of their responsibilities in processing claims under the FECA. This Branch reviews and analyzes Federal agencies' injury compensation programs, performance statistics, progress, and trends, and then makes recommendations for overall improvement. Employees of this branch conduct training sessions with various groups to advance understanding of the Program. This Branch also oversees and implements all communication strategies for the program.
c. Branch of Information Technology. This Branch is responsible for the coordination and control of all information technology (IT) requirements, systems relating thereto, and supporting documentation. The Branch operates, maintains and enhances the integrated Federal Employees' Compensation System (iFECS) and coordinates with OWCP to ensure it meets the data needs of the program and conforms to Federal and OWCP guidelines and operational procedures. In conjunction with OWCP, the Information Technology Branch directs and coordinates activities of IT support contractors in the development, operation and maintenance of DFEC IT systems and hardware. Toward that end, the Branch maintains liaison with the Offices in regard to the operation of iFECS and other information systems and provides technical oversight and assistance.
d. Branch of Fiscal Operations. This Branch is responsible for formulating and monitoring all financial operations for DFEC on a national level, handling items such as Chargeback and the monitoring of program debt performance. This Branch performs a variety of functions to ensure the financial integrity of the program. Specifically, the Branch directs the efforts of to train or otherwise advise all Offices and branches on billing, payment, and fiscal practices. Formulation and monitoring of all fiscal policy and procedures is conducted by this Branch, including national oversight of agency automated compensation and bill payment systems. This Branch houses Fiscal Officers who assists with fiscal-related matters and are responsible for the maintenance of financial management records, changes in health benefits coverage, etc. This Branch also houses Medical Coding Specialists who are responsible for providing technical coding expertise in reviewing, resolving, and auditing billing problems; assisting claims staff with correctly coding accepted condition(s) of injured workers; and monitoring payments for overutilization and abuse. They routinely audit medical bill processing transactions to ensure amounts paid through the medical billing contractor are accurate.
e. Branch of Hearings and Review (H&R). This Branch issues appellate-level decisions on claims involving hearings or requests for review of the written record, which affirm, reverse, modify, or remand cases to any of the Offices. Hearing representatives are responsible for conducting the hearings, which are primarily telephonic although other formats may be used.
f. Branch of Program Integrity, Fraud Prevention and Prescription Management. This branch is responsible for developing and adjudicating claims for benefits for injured workers under the FECA, as well as medical treatment requests to include pharmaceuticals such as opioids and compounded medications. Medical Benefit Claims Examiners (MBE) also work to eliminate barriers that could impede necessary medical treatment and manage ongoing claims to include the verification of continuing entitlement to benefits. This Branch also houses Investigative and Program Analysts who analyze data to look for anomalies and potential vulnerabilities with medical and compensation payments. The Branch works closely with the FECA Branch of Fiscal Operations, the OWCP Branch of Medical Standards and Rehabilitation, and the Offices of Inspectors General when potential vulnerabilities or fraud is suspected.
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5. FECA Program Offices.
a. Field Operations. FECA Program Offices are administered by an Office Director (OD), who reports to the FECA program's National Administrator(s) of Field Operations. The National Administrator(s) of Field Operations presides over Field Operations nationwide.
The OD is responsible for operations within that office and for seeing that that FECA claims functions are administered in a timely and efficient manner.
b. Office Staff. Employees in the Offices administer the FECA and work to achieve the goals set by the Director.
c. FECA Office Functions.
(1) Claims Functions. Each office will have Supervisory Claims Examiners, who are responsible for the operation of individual claims units. Each claims unit generally has a Quality Assurance and Mentoring Examiner (QAM) and Claims Examiners (CE). CEs have the primary responsibility for adjudicating claims, authorizing medical treatment, making compensation payments, and overseeing disability management. Individuals at each level of authority are delegated specific responsibilities for issuing decisions on claims.
(2) Disability Case Management Functions. CEs also have a vital role in the management of disability claims.
In addition to claims staff, the FECA program employs Staff Nurses who are responsible for helping ensure contract Field Nurses and Triage (COP) Nurses service the needs of the OWCP claimant. Both Triage (COP) Nurses and Field Nurses are professionals contracted by OWCP to provide disability case management services; however, they do not provide clinical treatment. The Triage (COP) Nurse is assigned early in the life of a traumatic injury case and works each case telephonically. The Field Nurse monitors the claimant's medical progress and assists with the return to work effort by coordinating efforts with the CE, treating physician, employing agency, and claimant.
The Rehabilitation Specialists (RS) is responsible for helping ensure that contract Vocational Rehabilitation Counselors service the needs of the FECA claimants. The RS manages the counselors, who work under contract with OWCP, to help claimants obtain employment.
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Back to Chapter 0-0200 Table of Contents
1. Purpose and Scope. This chapter describes the communications and directives system used by the Division of Federal Employees’ Compensation (DFEC). It focuses on the structure of the Procedure Manual governing claims under the Federal Employees' Compensation Act (FECA) and addresses its relationship to the program's other written directives.
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2. Directives. DFEC is charged with identifying areas where new directives should be developed or existing directives updated. The purpose of this paragraph is to describe the publications relating to the Federal employees' compensation program. There are multiple avenues by which program information is disseminated.
a. External Directives. These may consist of either legal or informational releases.
(1) Federal Register. This publication contains notices and rules pertaining to new or revised policy. Notices advise the public of proposed changes and invite comments on them, while rules state the final changes adopted by the program. The FECA regulations are periodically updated through the Federal Register.
(2) Informational Web Site Postings. Such postings are intended to give claimants and their representatives, agencies and medical providers new or updated information on a particular topic. The FECA program website also contains links to publications such as the Injury Compensation for Federal Employees (CA-810) which serves as a handbook for Federal agency personnel specialists and Questions and Answers about the Federal Employees' Compensation Act (CA-550) which describe the basic provisions of FECA.
b. Other Directives. DFEC uses these directives to provide staff with internal policy, procedures and other information. There are three primary types of issuances: Transmittals, Bulletins and Circulars.
(1) FECA Transmittals are permanent (unless superseded) directives. They convey updates to the FECA Procedure Manual (PM). FECA Program Memoranda (FECA ProMs) are historical and used to convey such changes.
(2) FECA Bulletins are usually time-limited directives that require action. They may involve changes to procedures, special reports, or pilot programs. Bulletins require or invite action from the Offices and usually include reference to procedure manual chapters affected.
(3) FECA Circulars are primarily used to call attention to standing instructions or procedures which may require compliance or improvement; to announce proposed plans or anticipated program changes; to clarify program policies; and to keep the FECA Offices informed of the activities and interests of the National Office.
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3. FECA Procedure Manual. The purpose of this paragraph is to describe the sections of the FECA Procedure Manual.
a. Part 0, Overview. Part 0 of the FECA PM is an introduction to the FECA, the program that administers it, and the directives issued to implement it. This section provides employees with a quick look at operations, and it also contains an index to all parts of the PM.
b. Part 1, Mail and Files. This section discusses how reports of injury and occupational disease are made into case files, and how case files are maintained and combined. It also contains guidelines for transferring files between DFEC FECA Offices and Branches. Procedures for transferring and disposing of inactive files and records, as well as how to retrieve retired and closed cases from the Federal Records Center (FRC), are also included.
c. Part 2, Claims. This section describes policies, responsibilities and procedures for adjudicating and managing claims filed under the FECA. Used mostly by claims personnel, Part 2 describes the handling of claims as they are screened, developed, accepted or denied, tracked, managed, appealed (if applicable), and administered in all respects.
d. Part 3, Medical. This section discusses the functions and responsibilities of the medical advisory staff and other medical related topics such as schedule awards, authorizing examination and treatment, medical services and supplies, requirements for medical reports and exclusion of medical providers. It also addresses the responsibilities of the Staff Nurse with regard to nurse contract certification. Part 3 is also used by claims staff.
e. Part 4, Special Case Procedures. This section addresses groups of claims covered under the FECA by virtue of special legislation, such as Non-Federal Law Enforcement Officers, War Hazards Compensation Act and Civil Air Patrol.
f. Part 5, Benefit Payments. This section sets forth the policies and procedures for administering the financial aspects of the FECA program. Used primarily by fiscal staff, this part includes procedures for handling health benefit and life insurance matters; maintaining fiscal registers, records, and reports; and charging back to employing agencies the amounts of their expenditures from the compensation fund.
g. Part 6, Debt Management. This section describes the responsibilities of the program regarding computation, waiver and recovery of overpayments under the FECA.
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4. OWCP Procedure Manual. The purpose of this paragraph is to describe the sections of the OWCP Procedure Manual that should be referenced when processing FECA claims.
a. Chapter 1-400 (Privacy Act). This chapter addresses the Freedom of Information Act (FOIA), which provides the public with a procedure for obtaining records from the Federal government, and the Privacy Act, which assures private citizens the right to confidentiality of certain personal information.
b. Part 3 of the OWCP Procedure Manual. This section describes the vocational rehabilitation services which are available to injured employees and discusses the procedures by which they may be obtained.
c. Part 4 of the OWCP Procedure Manual. This section contains procedures for evaluating the quantity and quality of work in the Federal employees' compensation program, including procedures to be used for accountability reviews.
NOTE: OWCP may also issue OWCP bulletins where more than one program's activities are implicated or where OWCP wishes to issue program guidance on a particular issue.
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5. Citations to the Procedure Manual (PM). Each part of the PM consists of several chapters, which in turn are divided into paragraphs, subparagraphs, and sometimes sub-subparagraphs. Chapters and subdivisions should be cited as follows:
Citation to a part of the FECA PM: FECA PM Part 0
Citation to a chapter: FECA PM 0-200
Citation to a paragraph: FECA PM 0-200.5
Citation to a subparagraph: FECA PM 0-0200.5b
Citation to a sub-subparagraph: FECA PM 0-200.5b(1)
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6. Maintenance and Revision. New material will usually be distributed electronically. The FECA PM is available on the Department of Labor's website.
Because transmittal of the FECA PM is primarily electronic, DFEC does not insert page numbers when updated Paragraph citations, as opposed to page numbers, are used thereafter when updates are made.