Division of Federal Employees' Compensation (DFEC)
FECA Part 8
|
Chapter |
Subject |
|---|---|
|
Paragraph and Subject |
Date |
Trans. No. |
|---|---|---|
|
Table of Contents |
08/12 |
12-12 |
|
08/12 |
12-12 |
|
|
08/12 |
12-12 |
|
|
08/12 |
12-12 |
|
|
08/12 |
12-12 |
|
|
08/12 |
12-12 |
|
|
6. Compensation Entitlement during and after Vocational Rehabilitation |
08/12 |
12-12 |
|
08/12 |
12-12 |
|
|
08/12 |
12-12 |
Back to Chapter 8-0100 Table of Contents
1. OWCP Objectives. The Office of Workers' Compensation Programs (OWCP) is committed to seeing that benefits for compensation and medical services are appropriately and timely provided. OWCP is also committed to assisting injured workers in obtaining a successful medical recovery and minimizing the period of disability from work. Management of disability claims begins as soon as a new claim is received indicating that the employee has lost time from work as a result of the injury or is disabled from his or her date of injury position.
Back to Chapter 8-0100 Table of Contents
2. Purpose. The purpose of vocational rehabilitation within the Division of Federal Employees' Compensation (DFEC) is to assist disabled employees who are covered by the Federal Employees' Compensation Act (FECA). Vocational rehabilitation is part of DFEC's Disability Management process, and the goal is to minimize the injured worker's disability and assist with a return to gainful work. Rehabilitation helps injured workers to become self-supporting and productive, and saves money by eliminating or reducing workers' compensation payments.
DFEC Rehabilitation Specialists (RSs) and Claims Examiners (CEs) in the district offices carry out the program with the assistance of contracted Rehabilitation Counselors (RCs), private and public agency rehabilitation providers, physicians, and employers, so that eligible workers receive the rehabilitation services best designed to return them to suitable work, preferably with little or no loss of earnings. The emphasis of DFEC's program is on early referral and evaluation of all injured workers who need services; case management standards to ensure that plans are efficient and of good quality; flexibility to provide the widest range of services from private and public rehabilitation agencies; preference for reemployment with the previous employer; and placement of workers in jobs where disability does not prevent them from competing with non-disabled employees.
DFEC provides all benefits to the injured worker and makes all decisions on eligibility for benefits. Procedures have been designed to allow DFEC to accomplish early, beneficial intervention in disability cases while also making timely eligibility determinations. Two themes are basic to the rehabilitation portion of case management so that DFEC can meet these dual goals: (1) close coordination of CE and RS/RC actions, and (2) a clear, consistent message to the injured worker that return to some kind of work is expected as soon as the worker is medically ready.
When it appears that the claimant's work-related injury will prevent a return to the job held on the date of injury (DOI), vocational rehabilitation services may be provided to assist the claimant in returning to the workforce in suitable employment. These services may occur simultaneously with Nurse Intervention (see Part 7 of the FECA PM). OWCP will make every reasonable effort to arrange for employment of a partially disabled worker, taking into consideration not only the effects of the work-related condition and any condition(s) pre-existing the injury, but also any medical condition(s) arising after the compensable injury. Of critical programmatic importance is understanding that return to work placement efforts with the claimant's previous employer are an essential part of the vocational rehabilitation process, and that vocational rehabilitation does not consist only of testing, training and outside employment. Such rehabilitation efforts will be directed initially to the employing agency (EA), but if reemployment with the agency is not possible, OWCP will help the worker secure employment with a new employer. This may include DFEC-sponsored vocational training, if needed, to furnish the worker with the necessary skills to obtain other employment.
Back to Chapter 8-0100 Table of Contents
3. Scope. This chapter provides the legislative and regulatory authority under which vocational rehabilitation services are provided and governed, and discusses the claimant's entitlement to compensation benefits during vocational rehabilitation and the effects on services if the claimant elects benefits from the Office of Personnel Management (OPM) during the rehabilitation effort.
This chapter also addresses related topics such as restoration rights with the Federal government, and defines the different types of rehabilitative services available, as well as the roles of the rehabilitation professionals who participate in the vocational rehabilitation effort.
Further information about vocational rehabilitation can be found in the OWCP Procedure Manual (PM), Part 3, Rehabilitation; however, since Part 8 of the FECA PM contains the most current guidance and procedures specific to DFEC, Part 8 of the FECA PM should be consulted prior to the OWCP PM, and the FECA PM guidance followed if any difference exists.
While Part 8 of the FECA PM provides a programmatic view of vocational rehabilitation and discusses vocational rehabilitation from the RS's perspective, FECA PM 2-0600 discusses disability management from a CE's perspective, and FECA PM 2-0813 discusses the vocational rehabilitation process from a CE's perspective.
Back to Chapter 8-0100 Table of Contents
4. Statutory and Regulatory Requirements. The FECA 5 U.S.C. 8101 et seq. and Code of Federal Regulations (CFR) Title 20, parts 1-25, establish rehabilitation benefits and define a claimant's responsibility to undertake a program when so directed.
a. Statutory Requirements. The FECA allows the Office to direct a claimant to undergo vocational rehabilitation and to reduce, prospectively, the claimant's monetary compensation for refusal to do so.
1) Section 8103 (a) of the FECA provides for any medical care prescribed by a qualified physician which is considered likely by the Secretary to cure, give relief, reduce the degree or period of disability; or aid in lessening the amount of monthly compensation. The section permits DFEC to authorize medical treatment.
2) Section 8104 of the FECA provides that a permanently disabled individual may be directed to undergo vocational rehabilitation. The injured worker receives compensation while cooperating and participating in the rehabilitation process.
3) Section 8111 of the FECA allows the Office to pay an individual undergoing vocational rehabilitation additional compensation necessary for maintenance, not to exceed $200 per month.
4) Section 8113 (b) of the FECA allows the Office to prospectively reduce compensation in accordance with a claimant's wage-earning capacity if he or she refuses, without good cause, to undergo vocational rehabilitation.
5) Section 8115 (a) of the FECA provides for the reduction of compensation to reflect a worker's earning capacity.
6) Section 8151 of the FECA provides restoration rights for injured employees and is administered by OPM.
7) Appropriations language for the Department of Labor provides "That such sums as are necessary may be used for a demonstration project under Section 8104 of title 5, United States Code, in which the Secretary may reimburse an employer, who is not the employer at the time of injury, for portions of the salary of a reemployed, disabled beneficiary..." This language provides authority to use the FECA fund to pay a portion of the salary of a newly reemployed Federal worker (who is eligible for disability benefits under the FECA) via Assisted Re-employment.
b. Regulatory Requirements. The Code of Federal Regulations discusses the vocational rehabilitation services provided at 20 CFR §10.518, which may include vocational evaluation, testing, training and placement services. Additionally, the actions taken when the employee refuses to cooperate with vocational rehabilitation, which includes reducing the claimants compensation during the period of non-cooperation and a reduction to zero absent evidence to the contrary, are discussed at 20 CFR §10.519. Finally, the method used for determining compensation after services are provided, such as actual earnings if they fairly and reasonably represent the claimant's earning capacity, is discussed at 20 CFR §10.520.
Back to Chapter 8-0100 Table of Contents
5. Roles and Responsibilities. The Vocational Rehabilitation (VR) Program is comprised of a National Office Rehabilitation Consultant; Rehabilitation Specialists located in the district offices; and Rehabilitation Counselors, who are certified counselors in the field. The CE refers appropriate cases for rehabilitation services, and with recommendations from the RS, is responsible for the management and overall direction of the case, even during the rehabilitation period.
A brief outline of the various roles is provided here, but FECA PM 2-0813 can also be referenced for additional information regarding the roles of the RS, RC, and CE in the rehabilitation effort.
a. National Office Rehabilitation Consultant (NORC). The NORC serves as the National Coordinator for DFEC's Vocational Rehabilitation Program and is responsible for overseeing all aspects of the VR Program, which includes serving as a professional resource for the Rehabilitation Specialists located in the district offices. The NORC monitors and evaluates the quality and timeliness of rehabilitation services received by injured workers, and assures that services are provided in accordance with DFEC policies and procedures. The NORC also develops new initiatives and return-to-work options for the vocational rehabilitation of injured federal workers; fosters relationships with Federal agencies to promote selective placement job opportunities for FECA injured workers; develops training materials for RSs, RCs and claims staff as necessary; and certifies FECA claimants eligible for the Schedule A Appointing Authority.
b. Rehabilitation Specialist (RS). The RS's responsibilities include, but are not limited to, the following: coordinating the assignment of RCs for specific cases; monitoring the RC's performance in correlation to both the contract specifications and the quality of service provided; providing guidance to RCs regarding VR services and course of action; reviewing RC reports for completeness and timeliness prior to authorizing payment of bills; communicating with the CEs regarding the cases assigned for VR services; relaying important or time sensitive information to the CEs so that action can be taken if needed; providing guidance to CEs on how to recognize when vocational services are necessary to assist the claimant with returning to work; serving as a vocational resource to the CEs; and providing solutions for return-to-work barriers in cases.
c. Rehabilitation Counselor (RC). The RC's responsibilities include, but are not limited to, the following: coordinating any necessary medical rehabilitation services; evaluating the claimant's vocational abilities and transferable skills; recommending potential suitable and available occupational titles as the basis of potential earning capacity; facilitating employment placement including with the previous employer; arranging for vocational testing and training; developing and overseeing individual vocational re-employment plans; conducting labor market surveys; assisting the claimant with job-seeking skills such as resume building and interview techniques; identifying potential employers; arranging for specialized ergonomic job modification services; and making recommendations to the RS and CE if a particular barrier is hindering the return-to-work effort.
d. Claims Examiner (CE). The CE's responsibilities include, but are not limited to, the following: referring appropriate cases for rehabilitation services; evaluating medical determinations in cases; responding to requests from the RS or RC; reviewing rehabilitation plans for medical suitability; advising the RS and RC of any changes in the medical or factual evidence which might alter any current course of action; issuing warning letters if non-cooperation occurs; and issuing notices of proposed actions and formal decisions pertaining to a claimant's entitlement to compensation.
Back to Chapter 8-0100 Table of Contents
6. Compensation Entitlement during and after Vocational Rehabilitation.
a. Compensation for Wage Loss. Section 8104 (b) of the FECA provides that an individual undergoing an OWCP-approved rehabilitation program is entitled to receive compensation at the rate for total disability, less any earnings received from employment which is not undertaken as a specific part of the rehabilitation program.
b. Retirement Benefits. OWCP is a return-to-work program and not a retirement program; however, if eligible, the claimant may have a right under law to choose retirement benefits from OPM in lieu of OWCP benefits (see FECA PM 2-1000). An election offer should be issued if the claimant states this is his or her choice.
A claimant may not receive vocational rehabilitation services simultaneously with retirement benefits from OPM. See FECA Program Memorandum No. 27. However, a claimant may not use the retirement process to avoid the obligation to undergo vocational rehabilitation when directed by OWCP. Despite issuing an election letter, the CE and RS should pursue case management and rehabilitation to its logical conclusion. Sending the election letter does not guarantee OPM election. Until the claimant actually submits a signed election form choosing OPM benefits, he or she is required to participate fully in rehabilitation or be subject to the sanction process.
When reviewing instances of non-cooperation in conjunction with an OPM election during the vocational rehabilitation process, it is important to focus on the behavior and level of non-cooperation. Sanctions may apply to the non-cooperative behavior but not to the choice to elect OPM. If the claimant does not cooperate during the election process, any behavior which is deemed to be non-cooperation will be subject to sanctions pursuant to 5 U.S.C. 8113. A non-cooperation sanction under 5 U.S.C. 8113 may not be initiated once a claimant has officially elected OPM benefits. It may only be finalized following an OPM election if the warning letter was issued while the claimant was in receipt of FECA benefits.
If the claimant elects OPM benefits during Placement, vocational rehabilitation efforts should be terminated and the CE provided with the factual information necessary to determine the claimant's Loss of Wage-Earning Capacity (LWEC).
c. Schedule Awards. If a claimant requests a schedule award while participating in vocational rehabilitation, development of the award should proceed. Payment of the award, however, should usually be deferred until the completion of rehabilitation, since payment of a schedule award is most beneficial after a return to employment, as it may not be made concurrently with compensation for wage loss, and a claimant will often opt to receive OPM benefits concurrently with a schedule award, and concurrent receipt of OPM and OWCP benefits is prohibited during a period in which vocational rehabilitation services are being provided.
If a claimant is already receiving compensation for a schedule award while in rehabilitation, he or she should continue receiving those benefits unless the claimant is also receiving an annuity from OPM, in which case the claimant should be advised that he or she cannot be provided with vocational rehabilitation services while receiving an OPM annuity. The claimant should be offered an election, and if he or she elects OWCP benefits, the schedule award payments should be converted to payments for temporary total disability until completion of the rehabilitation effort. If the claimant elects OPM benefits, the schedule award benefits should continue, and medical and factual development should be undertaken to determine the claimant's LWEC entitlement at the end of the schedule award, but vocational rehabilitation efforts should be terminated.
d. Loss of Wage Earning Capacity (LWEC). The loss of wage-earning capacity determination performed pursuant to 5 U.S.C. 8115 provides that an injured worker will not be penalized for returning to a lower-paying job because of a disabling condition. It also permits the adjustment of compensation to reflect partial rather than total disability, if the requirements of the law are strictly met.
1) LWEC Based on Actual Earnings. The worker's salary, after placement in a lower-paying position, may be used as a basis for LWEC determination if it fairly reasonably represents the worker's earning capacity. The worker receives compensation based on the difference between the pre-injury and post-injury wages. 20 C.F.R. § 10.520.
2) LWEC Based on Potential Earnings (Constructed LWEC). If an injured worker does not return to work during the rehabilitation effort, OWCP may find that work suitable to the worker's physical condition, vocational abilities, and educational background was reasonably available in the worker's commuting area (or, in some cases, the area where the worker resided when injured). At the end of a rehabilitation program, if the claimant does not return to work, the RC is required, if possible, to provide relevant information for two available and appropriate jobs, including salary and an explanation of how any specific vocational preparation requirements are met. Based on this information, the CE determines whether these jobs are suitable to form the basis of an LWEC determination. The RC or RS should use available non-private sources, including the state employment services, to provide this information.
Compensation may also be reduced following successful completion of training, to reflect the worker's earning capacity as a result of training. If the worker drops out of or refuses training without a good reason, compensation may be reduced to reflect likely earnings had the training been completed. In both cases, the suitability and availability of the specific types of positions and the typical earnings must be documented.
Back to Chapter 8-0100 Table of Contents
7. Restoration Rights with the Federal Government. Section 8151 of the FECA provides civil service retention rights to Federal employees who have recovered either fully or partially from an employment-related injury or illness, and who can perform the duties of the original job or its equivalent. The EA must restore a permanent employee (i.e., one with career or career-conditional status) who recovers within one year after beginning compensation to that position or its equivalent. This provision does not apply to temporary or term employees. 20 CFR §10.505 explains that the employer should make all reasonable efforts to place the employee in his or her former or an equivalent position in accordance with 5 U.S.C. 8151 if the employee has fully recovered after one year.
a. OPM's regulations on retention rights are published at 5 CFR §§302, 330, and 353. They require agencies to grant leave without pay (LWOP) to disabled workers for at least the first year the injured worker is receiving compensation. 20 CFR §353.301 provides an overview of restoration rights for fully recovered and partially recovered employees. OPM has jurisdiction and is responsible for enforcing these regulations. See Charles J. McCuistion, 37 ECAB 193 (1985) (DOL has no jurisdiction over restoration under 5 U.S.C. 8151).
b. An injured worker who has been terminated and who wishes to reclaim his or her job should be advised to contact the EA. If this effort fails, OWCP will contact the EA, citing 5 U.S.C. 8151 as the basis for the worker's attempt to regain employment. In addition, 5 U.S.C. 8151 (b) (2) and its implementing regulations provide for priority placement under certain circumstances. If this course is also unsuccessful, the injured worker may be advised to exercise his or her appeal rights as provided by OPM.
c. Issues pertaining to retention rights should be referred to the EA or OPM, and OWCP should not offer claimants advice on these rights. It should also be noted that not all individuals covered by FECA are entitled to restoration rights.
Back to Chapter 8-0100 Table of Contents
8. Available Services.
a. Medical Rehabilitation Services. Medical Rehabilitation refers to those medical and related services necessary to correct, minimize or modify the impairment caused by a disease or injury so that the injured worker can return to an adequate level of function and employment. Thus, it is distinguished from actual medical treatment to cure or relieve the effects of the injury.
Various medical rehabilitation services can be provided during this phase. These include coordination of care in cases of catastrophic injury; Functional Capacity Evaluations (FCE), work hardening, or any other physical therapy program aimed at producing work tolerance limitations; clarification of a work release and/or imposed work tolerance limitations; speech therapy, orthotics, prosthetics, or other assistive devices that would make the claimant employable; and/or psychiatric pain management counseling. Substance abuse treatment may be considered if substance abuse prevents an injured worker from participating in a rehabilitation plan or returning to work.
Housing and vehicle modifications can also be provided under the rehabilitation program.
Medical rehabilitation services such as home and van modifications are considered medically necessary services to which the claimant is entitled as part of his/her medical benefit. The concurrent payment of these benefits, in conjunction with retirement benefits, is permitted based on the 1960 amendments to the Compensation Act (Public Law 86-767). See FECA Program Memorandum 27.
b. Vocational Rehabilitation Services. Active vocational rehabilitation services are based on stable and well-defined work tolerance limitations which may or may not have been established during a period of medical rehabilitation (FCE, work hardening, or other physical therapy program aimed at producing work restrictions). Vocational rehabilitation services include counseling and guidance, selective placement assistance (i.e. with the previous employer), transferable skills analyses, vocational assessment, labor market surveys, Schedule A certification, pre-vocational and short-term training, job placement assistance, assisted reemployment and assistance following initial re-employment. Long term training is considered only in exceptional circumstances, and self-employment assistance is provided only in very rare instances.
Medical rehabilitation may also be provided in conjunction with vocational rehabilitation, but, as indicated in paragraph 6.b. above, active vocational rehabilitation services aimed at identifying a suitable job cannot be provided to a claimant in receipt of OPM benefits.
c. Substantial Services. Injured workers are considered rehabilitated if they return to an appropriate occupation within their physical and vocational limits, after receiving substantial services which include professional counseling and guidance, placement assistance, training, medical rehabilitation, or any combination thereof. Injured workers returning to their pre-injury occupation are not considered rehabilitated unless medical rehabilitation, significant accommodation, or placement assistance was provided. Intermittent requests for return-to-work status updates either to the EA or the claimant are not considered substantial services.
The record, including RS and RC reports, must demonstrate and fully document the substantial services provided.
Back to Chapter 8-0100 Table of Contents
|
Paragraph and Subject |
Date |
Trans. No. |
|---|---|---|
|
Table of Contents |
11/13 |
14-03 |
|
11/13 |
14-03 |
|
|
11/13 |
14-03 |
|
|
11/13 |
14-03 |
|
|
11/13 |
14-03 |
|
|
11/13 |
14-03 |
|
|
11/13 |
14-03 |
|
|
11/13 |
14-03 |
|
|
11/13 |
14-03 |
Back to Chapter 8-0200 Table of Contents
1. Authority. Statutory and regulatory provisions pertaining to vocational rehabilitation under the Federal Employees' Compensation Act (FECA) can be found in FECA Procedure Manual 8-100. While this chapter focuses on referrals for vocational rehabilitation services, there is no requirement under the FECA to provide such services. Relevant case law from the Employees' Compensation Appeals Board (ECAB) pertaining to the provision of rehabilitation services is provided below.
a. 5 U.S.C. 8104 provides that an employee may be directed to undergo rehabilitation. However, when an employee is no longer disabled within the meaning of the FECA, there is no entitlement to vocational rehabilitation benefits under the Act. See Roniva Brown, 38 ECAB 338 (1986).
b. ECAB has stated "There is no requirement that vocational rehabilitation be afforded each and every claimant who is permanently disabled due to a compensable condition under the Act." See Billie Gentry, 38 ECAB 498,506 (1987).
c. ECAB has recognized that the vocational rehabilitation provisions of the FECA vest OWCP with discretionary powers and a decision granting or denying an application for training will not be set aside by ECAB unless it represents an abuse of discretion, that is, a manifestly unreasonable exercise of judgment. See Mabel R. Chapman, 30 ECAB 421 (1979); Raymond F. Porter 29 ECAB 15 (1977).
d. The fact that an employee sustains a physical impairment permanent in nature is not sufficient to warrant the provision of vocational rehabilitation, as there must be a showing of a loss of wage-earning capacity. The purpose of providing training under the Act is to upgrade the skills and education of beneficiaries who cannot return to their former federal employment in order that they may qualify for other suitable employment to restore lost earning capacity. See Gary L. Loser, 38 ECAB 673 (1987).
Back to Chapter 8-0200 Table of Contents
2. Purpose and Scope. Referral screening is the process through which the Rehabilitation Specialist (RS) determines whether vocational rehabilitation services are needed to return an injured worker to employment and productivity. Referral screening may also be undertaken for other limited purposes. Referral screening has two related steps: the review of the compensation case file and the outcome determination.
This chapter explains and describes the procedures for evaluation of injured workers for rehabilitation services. This chapter also explains the sources of referrals, includes referral requirements depending on level of service, discusses referral statuses, and provides procedures for the closure of rehabilitation referrals.
Back to Chapter 8-0200 Table of Contents
3. Referral Sources and Mechanics. The probability of effective rehabilitation, resulting in the best return-to-work arrangement, is greatly increased when such efforts begin as early as possible in the recovery process. Generally, it is the policy of the Office of Workers' Compensation Programs (OWCP) to offer rehabilitation services to any claimant who is potentially permanently disabled for the job held at the time of injury, if needed, provided that the condition has stabilized sufficiently, work tolerances are well defined, and a realistic goal can be identified.
Federal injured workers have a right to return to their original jobs if they recover fully within one year. (Civil service retention and restoration rights are not within OWCP jurisdiction or control; the Office of Personnel Management has jurisdiction over matters arising under 5 U.S.C. 8151.) It is generally easier for agencies to offer jobs to injured workers if they have not been separated from Federal service, which may happen routinely after one year of disability. 20 C.F.R. §10.505 explains that the employer should make all reasonable efforts to place the employee in his or her former or an equivalent position in accordance with 5 U.S.C. 8151 if the employee has fully recovered after one year. For this reason, the Department of Federal Employees Compensation (DFEC) has instituted intensive early case management procedures for its disability cases. See FECA PM 2-0600 for a detailed discussion of disability management.
a. The responsibility for referring injured workers for rehabilitation services rests primarily with the Claims Examiner (CE), who oversees the disability management process and is in the best position to act promptly when services are needed. A sufficient number of referrals is necessary to reach program goals related to return to work. If cases are not being referred by the CEs in sufficient numbers or are being referred long after the medical condition stabilizes, the RS should use the supplemental sources described below to look for potential vocational rehabilitation candidates.
b. Potential rehabilitation referrals can also be identified or brought to the attention of the RS by sources other than CEs, such as representatives/attorneys, doctors, employers or vocational Rehabilitation Counselors (RCs), or by injured employees themselves. The RS should normally obtain the concurrence of the CE for referrals obtained from any of these sources, since the CE is responsible for medical determinations in cases. Unless there is recent documentation from the CE regarding the weight of the medical evidence of record, e.g. a letter from the CE requesting a job offer from the employing agency (EA) based on indentified work tolerance limitations, the RS should request a completed OWCP-14 from the CE and follow up as necessary until once is received.
The CE should promptly refer the case for rehabilitation services except where the medical evidence establishes that the case is not in posture for such referral.
(1) Computer-Generated Reports. To identify cases for early intervention, the RS may use computer generated reports from various sources and notify the CE of cases which appear appropriate for rehabilitation services, including Functional Capacity Evaluations (FCEs) or Occupational Rehabilitation Programs (ORPs). See paragraph 7 below.
(2) Field Nurses (FN). FNs who are monitoring the injured worker's medical care are also referral sources, as they are able to offer pertinent and timely information regarding the condition of the injured worker from their contact with claimant and physician. The FN may recommend a vocational rehabilitation referral at any time, or specifically at the end of nurse services or if the claimant has not collaborated with or fully benefited from nursing services. The nurses' referrals will be transmitted by the CE.
(3) Previous Employer. If the agency indicates its interest in the reemployment of the injured worker, via phone for example, the RS should document the agency's request with a CA-110 (or equivalent) and request that the CE determine whether the medical evidence warrants such referral.
(4) Physician and Other Health Professionals. If a physician notes that vocational rehabilitation services are warranted in a medical report to the CE, the CE should initiate the referral process. Rarely, a physician may contact the RS directly requesting rehabilitation services for a particular injured worker. The RS should ask the physician to submit a report which clearly establishes that the claimant has stable and well-defined residuals. While the restrictions do not have to be on Form OWCP-5, work limitations from the accepted employment conditions that prevent the claimant from returning to the job held at the time of injury should be set forth in sufficient detail in terms of limitations and capabilities for an assessment of rehabilitation/work readiness to be made. The RS may also request that the physician include an accompanying statement that the injured worker is ready to undertake a vocational rehabilitation program.
(5) The Injured Worker. Injured workers may contact the RS or other district office staff to inquire about the availability of rehabilitation services.
(6) Other Sources. Referrals or inquiries may also be initiated by attorneys, union representatives, or RCs.
Back to Chapter 8-0200 Table of Contents
4. Referral Requirements. If the current medical evidence indicates that the claimant has objective residuals of the work-related condition and has stable, well-defined work limitations which allow him or her to work 8 hours per day, the case should be referred for vocational rehabilitation services. Cases must be referred promptly when the injured worker is receiving compensation and no light duty offer has been made by the agency. These cases are given immediate attention and ideally a plan should be in place within one year of the first day of compensable disability, though circumstances vary by case.
The CE refers cases for vocational rehabilitation services using Form OWCP-14 (or equivalent). The referral should include:
a. The accepted conditions in the case, as well any accepted conditions in other FECA files that are pertinent with regard to medical restrictions. Other significant non-work related conditions should also be noted.
b. The name of the attending physician.
c. The physician's name and date of medical report which represents the weight of medical evidence.
d. The date on which disability (or recurrent disability) began, to identify the one-year time frame for placement with the previous employer.
e. The gross amount of compensation the claimant is awarded each week and the pay rate on which this amount is based.
f. Any medical or adjudicatory action which is in process or imminent (e.g., second opinion examination or referral for investigation) should be identified.
g. An indication as to whether or not Field Nurse (FN) services are active and, if applicable, the reasons for continued FN service (e.g., a remaining medical issue is still being resolved).
h. The CE should indicate whether or not direct contact by the RS or RC with the attending physician is authorized. The CE may authorize such contact when it will not potentially disturb the weight of medical evidence concerning work limitations. However, the CE should not authorize such contact when work tolerance limitations have been established by a second opinion or referee examination.
i. If the agency has specifically indicated that placement services with the previous employer are unavailable or inappropriate, the CE should provide notification of such.
j. Any pertinent notes regarding a request for specific services; for example, the injured worker has returned to work part-time but medical reports indicate capacity for full-time work, and the CE wants an RC to work with the previous employer to obtain longer hours within the injured worker's work limitations.
k. When the case is being referred on a limited basis, the CE should include the nature of the limited referral, the CE's assessment of the situation, and the desired action from the RC. See paragraph 7 below.
Once the referral has been completed and made a part of the case record, the CE should send a Vocational Rehabilitation referral to the RS via the case management system, which will automatically populate the appropriate code in the Disability Management (DM) record.
Back to Chapter 8-0200 Table of Contents
5. Active Field Nurse Cases and Dual Tracking. Active FN cases may be referred for dual tracking. The referral in these cases will be for "Medical Rehabilitation" and the period will usually be limited to 3 months for concurrent services. Refer to FECA PM 2-0600-8(c) and 2-0600-9(e) for further information on the dual tracking of cases.
a. In some dual tracking cases, the restrictions may not be completely defined. As a result, full plan development cannot begin immediately with these claimants, but in the interest of expediting the return to work, the RC may assist with work hardening and functional capacity evaluation scheduling and begin the groundwork for the development of a return-to-work plan by obtaining the claimant's work history, performing preliminary labor market surveys and conducting a transferable skills analysis.
The FN will focus on the medical aspects of the case, and the RC will focus on the vocational aspects of the case. Once the claimant has stable and well- defined restrictions, nurse intervention will cease and the RS will direct the RC to begin actual plan development.
b. The FN or CE may also recommend a task based rehabilitation referral in conjunction with FN services. For instance, if vocational testing, an ergonomic evaluation, or assistive technology would enable the employing agency to offer a job to the claimant or explore job opportunities for placement in another departmental position, a dual assignment would be appropriate for this purpose. A dual tracking assignment may be solicited by the CE, FN, RC, RS, or Staff Nurse (SN).
Back to Chapter 8-0200 Table of Contents
6. Screening. Screening a case provides the RS with basic information regarding the injured worker's medical condition, work capabilities, reemployment potential and other data which will determine whether or not the case is in posture for referral to an RC. The goal of screening is to confirm that the injured worker needs vocational rehabilitation services to return to employment and achieve a productive level of functioning.
a. Timeframes. Rehabilitation referrals should be reviewed and recorded in the case management system within five work days of receipt by the RS. Accurate and prompt recording of cases is key to maintaining the efficiency of the rehabilitation work flow in the district office.
b. Medical Information. The major sources of medical information in the case file are OWCP standard forms and narrative medical reports submitted by the treating physician and other medical professionals involved in the case.
(1) The CE's OWCP-14 will point to the physician's report which is accepted as defining the injured worker's work tolerance limitations. It may be from an attending physician, second opinion physician, or referee specialist. Other reports may give supplementary information, but work limitations which differ from those the CE has designated should not be used as the basis for the rehabilitation effort. The OWCP-14 will also indicate whether the physician may be contacted for clarification which is normally granted only if the claimant's attending physician provided the work tolerance limitations.
(2) Narrative medical reports contain information about the nature, extent and duration of the injury or illness, course of treatment recommended, and expected outcome. Standard forms may also serve this purpose. Pertinent data may be on Form CA-1, Federal Employee's Notice of Injury and Claim for Continuation of Pay/Compensation, Form CA-2, Claim for Occupational Disease, and Form CA-20, Attending Physician's Report.
Form OWCP-5, Work Capacity Evaluation provides specific limitations recommended by the examining physician and an estimate of the number of hours per day the injured worker is able to perform certain activities.
c. Non-Medical Information. The RS also needs information about the employer or agency, education and history of employment. Forms which may contain this information are the CA-1 and CA-2, cited above. An application for employment, if available, provides the injured worker's work history and other pertinent data, while the position description gives the physical demands for the date of injury job.
d. Evaluation of Injured Worker Information. The RS assesses the information in the case file, with emphasis on the present accepted medical and vocational condition of the injured worker and the feasibility of rehabilitation and reemployment.
(1) The RS should defer to the CE on medical issues to avoid creating an appearance of conflicts concerning medical evidence.
(2) If the medical condition of the injured worker is not described or appears unstable, the RS uses Form OWCP-3 or equivalent to notify the CE of the issues that need to be clarified and asks that an updated report be obtained. The RS may also use a Rehabilitation Action Report (OWCP-44). At the same time, the RS proceeds to the next step in the referral.
(3) If non-medical evidence is incomplete, the RS should note this fact and advise the RC to obtain the missing information from the injured worker during the initial interview, if necessary.
e. The RS should continue with the referral process in cases with the exception of injured workers who have successfully returned to work. These cases should be closed and recorded appropriately in the case management system.
Back to Chapter 8-0200 Table of Contents
7. Referral Outcome. Once the RS has completed an initial assessment of the case, s/he should be able to determine whether or not the injured worker is a candidate for vocational rehabilitation services.
a. Closing a Case from Referral. A case can be closed from referral if the injured worker has successfully returned to work or will return to work shortly without benefit of rehabilitation intervention; or if the injured worker is not able to work four hours per day and there is no possibility of improvement. The RS should notify the CE of closure on Form OWCP-3 or equivalent, explaining why rehabilitation services were not offered. The RS may recommend additional medical development and subsequent referral at a later date. If the case is closed for medical infeasibility, the CE should concur that this is what the medical reports indicate. The case should then be coded in the case management system.
b. Opening a Case. If the injured worker has not returned to work, is unable to perform his or her usual work because of the compensable injury, and will benefit from rehabilitation services, the case can be opened using form OWCP-3 or equivalent. The OWCP-3 will identify the status in which the case is being opened and provide initial instructions to the RC based on the information provided by the CE on Form OWCP-14 or equivalent.
(1) If the CE has specifically indicated that placement services with the previous employer are unavailable based upon the employer's notification of such, the case should be opened in Plan Development status.
Note - If this information (the EA's declination) is not clear and evident in the file, the RC should be instructed to contact the EA to determine if a return to work with the EA is possible.
(2) All other cases, should be opened in Placement Previous Employer status so that employment possibilities within the claimant's former agency may be explored for at least thirty days. However, the RC should also proceed with the preliminary Plan Development components during this period so that an appropriate plan is not delayed if the former agency is unable to reemploy the claimant.
(3) When opening a case, the RS decides whether to refer a case to an outside rehabilitation counselor (RC) for services, or to retain direct control.
(a) Usually, the RS refers the injured worker to an OWCP- certified RC. The RC will work directly with the injured worker, and develop and implement a rehabilitation program. The RS authorizes services as required, approves or disapproves the recommended program, and evaluates the quality and timeliness of services.
(b) As a rule, RC services should be provided in person as necessary. However, where this is not possible (e.g. remoteness of the area in which the claimant resides or lack of available RCs), an RC may be assigned to provide all services telephonically with the approval of the RS.
(c) In some cases, the RS may choose to retain control of the planning and coordination of the rehabilitation effort. This should happen only when services are not otherwise available or if the RS is able to accommodate any limited services requested. See paragraph 7 of this chapter for more information regarding limited referrals.
(4) The RS may decide to conduct a conference with the claimant, CE, and/or RC to obtain any missing information, introduce the claimant to the vocational rehabilitation process and establish rapport.
(5) All services must be authorized in advance by the RS in writing. Form OWCP-35 or equivalent is used to refer a case to an RC, authorize initial services, and give instructions. The form authorizes counseling, guidance, testing by an outside vendor arranged by the RC, and placement services by the RC or by a placement professional supervised by the RC. The RS may authorize services for any amount up to $5,000 and any period up to two years on the OWCP-35.
(6) Forms OWCP-3 and OWCP-35 (or equivalent) must be documented for the file, signed by the RS and sent to the selected RC with copies distributed to the injured worker, employer, and authorized representative, if any. Form OWCP-35 may be sent to the treating physician for information purposes.
(7) The RC should additionally be provided with copies of the accepted work-tolerance limitation on Form OWCP-5 Work Capacity Evaluation or equivalent and any pertinent medical and Field Nurse reports.
The RC should defer to the CE on medical issues so to avoid creating conflicts of medical evidence.
Back to Chapter 8-0200 Table of Contents
8. Limited Referrals. If the claimant is only able to perform part-time or sub-sedentary work, or could otherwise engage in active vocational rehabilitation services but for a non-employment-related condition which post-dates the injury, limited vocational rehabilitation services may be appropriate.
a. An Occupational Rehabilitation Program (ORP) may be appropriate when the specific work limitations are unknown or sub-sedentary but there is an expectation that a short period of medical rehabilitation will result in restrictions which can be used for a return to work. The RS may refer the claimant for an ORP when the physician prescribes a functional capacity evaluation (FCE), work hardening, or any other therapy program aimed at exploring work capabilities and documenting work restrictions. Upon completion of the ORP, the case should then be reviewed for placement services if work tolerance limitations were obtained.
b. A task based rehabilitation referral may be appropriate if a functional capacity evaluation (FCE), vocational testing, ergonomic evaluation, job site analysis or assistive technology would enable the employing agency to offer a job to the claimant or explore job opportunities for placement in another departmental position.
c. For claimants who cannot work 8 hours per day, a referral to an RC may be made for placement services with the previous employer. Placement with a new employer may be considered in those labor markets with sufficient part-time work in the commuting area. If later medical evidence demonstrates an improvement in medical status, attempts to establish the claimant's ability to work a full day should be pursued.
d. For claimants who are limited to sub-sedentary exertion levels, the RS may initiate a referral if sufficient sub-sedentary work exists within the commuting area. The RS should instruct the RC to confirm that sufficient numbers of otherwise suitable sub-sedentary jobs are identified, in order for a rehabilitation plan to commence.
e. Where the weight of the medical evidence establishes that the claimant could work in at least a sedentary capacity due to the work injury, but is more severely restricted from work due to a non-employment-related condition which post-dates the injury, the CE may refer the case for limited vocational services solely for the purpose of determining the claimant's capacity to earn wages in the open labor market based on the restrictions attributable to the work injury and any pre-existing medical conditions. The completed OWCP-14 should identify the non-employment-related condition(s) which arose after the work injury. Upon referral the RS should advise the RC that any restrictions resulting from these post-existing condition(s) need not be taken into consideration when identifying positions which represent the claimant's wage-earning capacity.
f. When vehicle and/or housing modifications are necessary to accommodate the claimant's accepted medical conditions, a limited referral to an RC may be made as rehabilitation services are often necessary in developing such proposals. See FECA PM 2-1800.
Back to Chapter 8-0200 Table of Contents
|
Paragraph and Subject |
Date |
Trans. No. |
|---|---|---|
|
Table of Contents |
09/12 |
12-14 |
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
|
|
09/20 |
20-05 |
|
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
|
|
09/12 |
12-14 |
Back to Chapter 8-0800 Table of Contents
1. Purpose and Scope. The objective of Assisted Reemployment (AR) is to increase the number of job offers made by private employers, thereby increasing the number of permanently disabled workers who make a successful transition from the Federal Employees' Compensation Act (FECA) compensation rolls to regular, productive employment. AR is a temporary subsidy designed to encourage employers to hire and retain qualified rehabilitated workers.
The Office of Workers' Compensation Programs (OWCP) Procedure Manual discusses AR in chapter 3-0401. That chapter may be referenced for a historical perspective, but since it has not been recently updated, this chapter (FECA PM 8-0800) should be consulted, since it contains the most current policies and procedures pertaining to AR for the Division of Federal Employees' Compensation (DFEC).
Back to Chapter 8-0800 Table of Contents
2. Background. Assisted Reemployment began as a four-year demonstration project in FY 1992. As conveyed in FECA Bulletin 92-08 (Return to Work/Reemployment: Assisted Reemployment), issued on December 17, 1991, the goal was to increase the number of permanently disabled employees who could successfully return to the labor force even though they could not be placed with their former employer. OWCP then issued follow-up bulletins on the subject and incorporated it into the Procedure Manual.
AR is now a staple of the FECA program and one of several options that DFEC uses to assist injured workers with a return to gainful employment.
Back to Chapter 8-0800 Table of Contents
3. Funding Authority. Appropriations language for the Department of Labor provides "That such sums as are necessary may be used for a demonstration project under Section 8104 of title 5, United States Code, in which the Secretary may reimburse an employer, who is not the employer at the time of injury, for portions of the salary of a reemployed, disabled beneficiary...." This language provides authority to use the FECA fund to pay a portion of the salary of a newly reemployed Federal worker (who is eligible for disability benefits under the FECA) via AR.
Back to Chapter 8-0800 Table of Contents
4. Eligible Employers. AR salary reimbursement may be offered to employers in the private sector, or to State or local government agencies. It may not be offered to Federal agencies at this time.
A business owned or managed by the injured worker, the injured worker's relatives, an employee of OWCP (or his/her family), or an OWCP vocational rehabilitation counselor (or his/her family) is not eligible for an AR subsidy.
Back to Chapter 8-0800 Table of Contents
5. Reimbursement Parameters. The rate and duration of wage reimbursements offered should be negotiated separately with each employer, depending on the nature of the job market and the particular circumstances in the case. AR subsidies, however, are subject to these restrictions:
a. The period of the subsidy for any injured worker may not exceed 36 consecutive months.
b. The rate of reimbursement may not exceed 75% of gross wages paid to the injured worker.
c. If a subsidy of longer than 1 year is approved, it should be phased out over the entire period, usually in no more than three rate changes, e.g., 75% in the first year, 50% in the second year and 25% in the last year.
d. At no time may the wage subsidy paid to the employer, plus any compensation payment paid to the injured worker for his/her Loss of Wage-Earning Capacity (LWEC), exceed the amount of compensation for total disability which would be paid to the injured worker in the absence of employment.
e. The subsidy is not transferrable from one employer to another.
f. If the injured worker's entitlement to compensation is terminated for any reason, e.g. no continuing injury-related disability, the subsidy terminates at that time as well.
g. If the injured worker's entitlement to compensation is suspended (e.g. for failure to attend an OWCP-directed examination or return Form CA-1032), any subsidy payment is suspended as well. If previously approved, reimbursement may be made retroactively if compensation benefits are restored for failure to return Form CA-1032. If compensation benefits are not payable during a period of obstruction of a medical examination under 5 U.S.C. 8123, no subsidy payment may be made for a period in which the claimant is not in receipt of compensation benefits.
h. If the injured worker quits or is fired from the position for which the AR subsidy is being paid, the AR subsidy terminates as of that date.
i. If the new employer fails to respond in full to any inquiry made by OWCP pertaining to the injured worker or the subsidy arrangement, the AR subsidy can be terminated.
j. An Assisted Reemployment Memorandum of Agreement must be signed by the employer and included in the OWCP case file prior to any payment being made.
k. Wage reimbursements made to employers will be treated as taxable income, and a Form 1099 will be issued to each employer at the end of each calendar year.
Back to Chapter 8-0800 Table of Contents
6. Eligible Cases. A Claims Examiner (CE), a Rehabilitation Specialist (RS) or a Rehabilitation Counselor (RC) may propose AR for an injured worker during Plan Development, or at any time during Placement, especially if it seems that it may be difficult to place the injured worker.
For instance, AR may be appropriate if the injured worker has significant transferrable skills but placement will be difficult due to a tight job market in that specialty, or if an injured worker has completed training in a field which has become highly competitive due to area economic conditions.
Before proceeding with AR, the file should reflect that the Employing Agency (EA) has declined or failed to offer appropriate modified employment. Additionally, AR subsidies should not be considered in instances where the claimant is not putting forth a good-faith effort in the return-to-work process, or has demonstrated non-cooperative behavior or otherwise poor conduct.
AR should be considered for employees who currently qualify for the identified position, and the unsubsidized wages should fairly and reasonably represent the injured worker's earning capacity. AR should not to be substituted for necessary training or to employ the injured worker in an unsuitable position. If training is necessary, formal or on-the-job training should be implemented before AR is considered.
Back to Chapter 8-0800 Table of Contents
7. Assisted Reemployment Initiation. When the RS determines that AR would be beneficial in a particular case, the RS should document the file (via Form OWCP-3 or equivalent) and advise the RC. The RS and RC should discuss the particular case, and the RS should provide the RC with information pertaining to the amount of a possible AR wage subsidy based on the claimant's compensation. The CE should assist with obtaining this information for the RS by calculating the injured worker's projected wage-earning capacity (using form CA-816 or equivalent) based on the unsubsidized wages of the identified position.
The RC, in cooperation with the injured worker and under the guidance of the RS, should then incorporate AR into the vocational rehabilitation plan and placement efforts. Although the injured worker's concurrence (or co-signature) is not required to pursue AR, the injured worker should be copied on any revisions of the plan or placement information.
In general, the RC proceeds as with any other vocational rehabilitation case in plan development or placement. As with any placement with a new employer, a thorough vocational evaluation should be performed before jobs under AR are pursued, with the goal of identifying jobs which can be obtained by the injured worker which can significantly reduce the loss of wage-earning capacity.
Back to Chapter 8-0800 Table of Contents
8. Placement Phase. Once the RS has concurred that AR should be pursued, the RC should initiate employer contacts, verify that available positions are within the physical and vocational abilities of the worker, and arrange interviews for the injured worker.
a. If the injured worker is released to full-time work, the AR subsidy should only be considered for an employer who is offering the injured worker full-time work. A part-time AR subsidy should not be considered for an injured worker who has been released to full-time work.
b. The RC should inform a potentially interested private employer of all pertinent aspects of the AR subsidy, including: details of the Assisted Reemployment Memorandum of Agreement, information needed by OWCP to assure prompt processing of wage reimbursement submissions, and the fact that reimbursement payments must be reported as taxable income.
c. The RC should also advise any prospective employer of the assistance that can be provided by OWCP for any necessary job modifications in the workplace, and of available post-employment services.
d. The RC should provide a summary of each prospective AR encounter to the RS in the monthly report. The summary should contain the date of the contact, the employer's name and address, the type of contact (phone, personal, etc.), details of the wage subsidy offered, and the result of the contact.
e. If an employer expresses significant interest, the RS and RC may arrange for a conference call to discuss all relevant issues and answer any questions the employer may have. (The CE may also attend this conference.) If conducted, this call should be documented as an informal conference by the RS. See FECA PM 2-0500-3(b) and 2-0600-12(c) for a discussion of the level of documentation required for an informal conference.
f. If the injured worker fails to cooperate with the rehabilitation effort, the RC/RS should proceed to document the file for CE review to determine if non-cooperation sanctions or a constructed LWEC decision is appropriate. If the claimant is uncooperative and later decides to cooperate, an AR subsidy should usually not be considered based on this pattern of behavior.
Back to Chapter 8-0800 Table of Contents
9. Assisted Reemployment Approval. Once an employer has agreed to an AR subsidy, the RS will draft a written Assisted Reemployment Memorandum of Agreement to record the terms of the wage subsidy.
a. The Assisted Reemployment Memorandum of Agreement must include the following elements:
(1) Injured worker's full name and claim number;
(2) Employer's name, address and Employer Identification Number (EIN);
(3) The agreed upon amount of payments, with schedule for any decrease over time;
(4) All steps which an employer must take to ensure accurate and timely reimbursement;
(5) A job description and specification of the injured worker's starting wage rate;
(6) An agreement by the employer to comply with the procedures and all applicable Federal, State and local laws; and
(7) Pertinent items outlined in Paragraph 5 of this chapter.
b. OWCP's share of the cost is subject to a $15,000 limit for RS authorization. Any total subsidy greater than this amount must be approved by the Supervisory Rehabilitation Specialist.
c. Due to the length/amount of most wage subsidies, most AR placements will require authorization of the Supervisory Rehabilitation Specialist. Once arrangements have been finalized and the injured worker has accepted the job offer, the Assisted Reemployment Memorandum of Agreement should be provided to the Lead Vocational Rehabilitation Specialist for preliminary review. If no changes are needed, the Lead Vocational Rehabilitation Specialist will forward the Memorandum of Agreement to the Supervisory Rehabilitation Specialist for final review, approval and signature.
d. A copy of the signed agreement, with a cover letter, should be sent to the employer, the injured worker and the EA. A copy must also be placed in the case file.
e. When the injured worker accepts a position, the RS must notify the CE promptly so that compensation can be adjusted to reflect the injured worker's actual wages on return to work, and so that the CE can calculate the employee's wage-earning capacity. It is extremely important that the CE be notified promptly when reemployment begins so that compensation is paid at the correct rate.
Back to Chapter 8-0800 Table of Contents
10. Case Closure. A worker may be considered successfully rehabilitated when employed for more than 60 days without interruption (due to the disability). Normally, the RS will close a case at this time. The same basic principle applies to cases with AR subsidies, except that wage reimbursement payments will be made on the injured worker's behalf for up to three years after the return to work, and post-employment services may be provided throughout this entire period.
Back to Chapter 8-0800 Table of Contents
11. Post-Employment Services. For AR cases, the RS may authorize post-employment services throughout the period of wage reimbursement if the injured worker has adjustment difficulties and needs additional services to maintain the vocational goal. Services may include counseling, guidance, additional training, and medical rehabilitation, as well as contact with the new employer.
a. Initial post-employment services should extend for a period of 60 days, as with a usual return-to-work. Unless there is an indication that further services are needed at the end of 60 days, the case can be closed without any additional services at that time. The 60-day period of time is sufficient in most cases.
During the first two months of reemployment, the RC should counsel and guide the injured worker. At a minimum, the RC should contact the worker at the end of the first day, first week, first month, and second month of employment. The RC should also contact the employer at the end of the first week, first month, and second month of employment. These contacts should be detailed in the RC's monthly report.
b. If there are significant unresolved issues at the end of 60 days, and the RC believes that an additional period of post-employment services would be useful to achieve a successful rehabilitation, the RC should document these reasons and seek such authorization from the RS. The RS can then extend the post-employment service period until any pending issues are resolved. Extensions should usually be granted in only 30-60 intervals to address specific issues and not for indefinite periods of time or for undefined reasons.
c. When post-employment services would no longer be helpful, the case should be closed. However, post-employment services may extend for the life of wage subsidies to the employer (not to exceed three years), even if on an limited intermittent basis, if the file reflects a true need for such services.
Back to Chapter 8-0800 Table of Contents
12. Payment of Assisted Reemployment Subsidies. All steps which employers must take to obtain accurate and timely reimbursements should be specified in the Assisted Reemployment Memorandum of Agreement.
a. Employers should submit claims on a monthly or quarterly basis for reimbursement of wages paid to injured workers.
b. Requests for reimbursement should be submitted on Form CA-2231, Claim for Reimbursement Assisted Reemployment (available on the DFEC internet home page), and include the following:
(1) Employer's name, phone number and full mailing address for remittance;
(2) Employer's Federal tax identification number;
(3) Injured worker's full name, FECA claim number and signature;
(4) Hours worked, hourly rate, amount of gross wages paid, amount to be reimbursed, and the period covered; and
(5) Name and signature of the authorized official certifying that information submitted is correct.
c. Upon receipt, the RS should verify the information submitted against the Assisted Reemployment Memorandum of Agreement. The RS should also review the case file to determine if there is any evidence indicating that the claimant may no longer be working for that employer, i.e. the most recent Form CA-1032.
(1) If all is in order, the RS should approve the reimbursement request for payment.
(2) If there is evidence indicating that the injured worker is no longer employed with the employer submitting the claim for AR reimbursement, the RS should consult with the CE and Claims Supervisor to determine the next course of action, which may include communication with the injured worker, and possibly a referral to the Office of Inspector General if there is any indication of a fraudulent claim on behalf of the employer or claimant. See FECA PM 2-402.
d. If the claimant did not sign the CA-2231, the reason for the missing signature provided by the employer in the applicable block of the CA-2231 should be scrutinized, and the file should be reviewed carefully to ascertain whether the claimant is still working with that employer.
Like (c) above, if there is any doubt, the RS should consult with the CE and Claims Supervisor to determine the next course of action, which may include communication with the injured worker, and possibly a referral to the Office of Inspector General if there is any indication of a fraudulent claim on behalf of the employer.
A CA-2231 without the claimant's signature should usually not be used as the basis for a reimbursement payment absent unique and documented circumstances. If such payment is made one time, the employer and claimant should be advised to make sure the form is signed for the next submission.
e. AR reimbursement requests are processed as Prompt Pay bills.
(1) Claims must be paid (check dated or electronic payment issued) within 30 days of receipt unless the employer was notified of a defect within seven days.
(2) Claims not paid must be returned with appropriate advice within seven days of receipt.
Back to Chapter 8-0800 Table of Contents
Exhibit 1: Assisted Reemployment Memorandum of Agreement
Assisted Reemployment Memorandum of Agreement
This memorandum constitutes the agreement between <<EMPLOYER NAME>> and the US Department of Labor, Office of Workers' Compensation Programs (OWCP), and defines the terms and parameters whereby OWCP will reimburse <<EMPLOYER NAME>> for wages paid to <<CLAIMANT NAME>>, whose OWCP file number is <<CLAIM NUMBER>>.
By entering into this agreement, OWCP does not in any way formally associate itself with, or endorse the activities of, <<EMPLOYER NAME>>.
<<CLAIMANT NAME>> will work for <<EMPLOYER NAME>> as a <<JOB TITLE>>. The duties of this job include the following: <<DESCRIPTION>>.
<<EMPLOYER NAME>> agrees to notify OWCP in writing within 48 hours of any substantial change in these job duties, or if <<CLAIMANT NAME>> is no longer an employee.
<<CLAIMANT NAME>> will work the following schedule <<DETAILS>>, and <<EMPLOYER NAME>> agrees to pay the following wage: <<DETAILS>>.
OWCP will reimburse <<EMPLOYER NAME>> for part of the wages paid to <<CLAIMANT NAME>> according to the following schedule: <<DETAILS>>. This Assisted Reemployment subsidy arrangement cannot be transferred to another employer.
OWCP will make these reimbursement payments to <<EMPLOYER NAME>> on a quarterly basis upon receipt of a fully completed Form CA-2231, available on-line at http://www.dol.gov/owcp/dfec/index.htm. Completion of this form requires:
- Employee's full name
- Employee's OWCP file number (as listed in the first paragraph above)
- Hours worked and rate of pay
- Gross wages paid
- Amount to be reimbursed
- Time period covered
- Complete remittance address for <<EMPLOYER NAME>>
- Tax identification number (EIN) for <<EMPLOYER NAME>>
- Name and signature of the authorized official for <<EMPLOYER NAME>> certifying that information submitted is correct
- Signature of <<CLAIMANT NAME>>
Assisted Reemployment subsidy payments will be treated as taxable income.
If <<CLAIMANT NAME>> is no longer employed by <<EMPLOYER NAME>>, this Assisted Reemployment subsidy ends as of the last date worked.
If compensation for <<CLAIMANT NAME>> is terminated or suspended by OWCP for any reason, payments under this Assisted Reemployment Agreement terminate as of the date of termination or suspension.
If <<EMPLOYER NAME>> fails to respond in full to any inquiry made by OWCP pertaining to <<CLAIMANT NAME>> or the subsidy arrangement, OWCP can terminate the Assisted Reemployment subsidy.
By signing this agreement, all parties agree with the conditions set forth in this Assisted Reemployment Memorandum of Agreement.
PERIOD OF AGREEMENT: Unless otherwise specified, this agreement expires <<# of months/years>> from the date of the last signature below. This agreement may be terminated by either party on thirty (30) days notice.
The contents of this agreement (and any other information provided to the employer by OWCP regarding this claim) are protected under the Privacy Act of 1974, as amended. Do not disclose without the prior written approval of OWCP.
|
(EMPLOYER DESIGNEE SIGNATURE) |
Date: ___________ |
|
<<EMPLOYER DESIGNEE NAME>>
|
|
|
(REHABILITATION SPECIALIST SIGNATURE) |
Date: ___________ |
|
<<REHABILITATION SPECIALIST NAME>>
|
|
|
(DISTRICT DIRECTOR SIGNATURE) |
Date: ___________ |
|
<<OWCP DISTRICT DIRECTOR NAME>>
|
Back to Chapter 8-0800 Table of Contents