Division of Federal Employees' Compensation (DFEC)
Part 3
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1. Overview. Under the FECA, referrals are made for vocational rehabilitation services if the Injured Worker (IW) is eligible for, and can benefit from, such services. The referral initiates the DFEC vocational rehabilitation process through assignment of the case to a Rehabilitation Counselor (RC) and provides relevant information and authorization for rehabilitation services.
a. Eligibility. The IW may be found eligible for DFEC rehabilitation services if, due to an approved work-related injury, he/she is potentially permanently disabled for the job held at the time of injury, has not returned to work and/or is unable to perform his or her usual work and is eligible for compensation for wage loss. In addition, the injury or medical condition must be deemed by a physician to be sufficiently stabilized. Often, work tolerances and restrictions are defined at the time of referral although there are circumstances in which vocational rehabilitation services are needed to assist with clarifying these and/or assessing the general ability to return to work.
Most often, IWs referred for vocational rehabilitation services have been released to modified duty or are capable of working full-time at least at sedentary demand levels. There may be exceptions to this, however, in which IWs may be released to work part-time and/or at sub-sedentary demand levels.
b. Types of Referrals. The referral for vocational rehabilitation services may be either for a range of services to include such things as vocational testing, plan development and job placement or it may be for more limited, or task-based, services (See Paragraph 2 of this Part). The referral may also be targeted to pursue return to work with the previous employer or with a new one.
In any case, DFEC places a great emphasis on timely referrals followed by efficient and effective vocational rehabilitation services with the goal of returning the IW to work as quickly as possible to a job compatible with his/her work restrictions and wage-earning capacity, and which minimizes wage loss.
c. Referral Source. The responsibility for referring IWs for DFEC vocational 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. When appropriate, the CE will generate the referral for vocational rehabilitation services which is forwarded to, and reviewed by, the DFEC Rehabilitation Specialist (RS). The RS will usually refer eligible IWs to an OWCP-certified RC who will work directly with the IW and develop and implement a rehabilitation plan.
While potential referrals may be identified by other sources including contracted DFEC Field Nurses, physicians or other health care professionals, previous employers, attorneys, union representatives, RCs or by injured employees themselves, the formal referral must be generated by the DFEC RS and/or CE.
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2. Referral Process and Documentation. The assigned RC will be provided with referral documentation, instructions and all information necessary to initiate and proceed with vocational services. Most often, the documentation will consist of the following:
a. Form OWCP-35 - Referral and Award letter The Referral and Award letter (or equivalent) provides initial authorization to the RC to provide the specified vocational rehabilitation services for the time period and amount noted. The form also provides information related to the RC's responsibilities and instructions for progress reports and billing.
The RS may authorize services on the OWCP-35 for any amount up to $5,000 and any period up to two years.
A copy of this form is sent to the IW and also provides information specific to the IW's responsibilities in the rehabilitation process.
With a focus on efficiency, the RC may be directed to facilitate a service individually or several concurrently. Unless otherwise directed, all services must be authorized in writing in advance by the RS.
b. Form OWCP 3 – Injured Workers Rehabilitation Status Report (or equivalent). The IW Rehabilitation Status Report, OWCP- 3, is used throughout the course of vocational rehabilitation services to designate the current status of services, document the time and professional hours authorized in each status and provide specific instructions from the RS to the RC. Accompanying the referral data, the OWCP-3 specifies the initial status of the case and documents any additional directions.
Initial case statuses may include: Medical Rehabilitation, Placement - Previous Employer (PPE), and/or Plan Development. Additional case statuses that may be used as applicable throughout the rehabilitation process include: Training, Placement – New Employer (PNE), Employed, Post-Employment and Interrupt.
c. Form OWCP 5 –Work Capacity Evaluation. The Work Capacity Evaluation provides work tolerance limitations and other physical and/or psychological restrictions which may impact a return to work. This may be supplemented with a performance based physical capacity evaluation, functional capacity evaluation or similar reports.
d. Form OWCP 14 – Referral to OWCP Rehabilitation. This form is used by the CE to refer a case to the RS for consideration of rehabilitation services. It is sometimes forwarded on to the RC and contains information regarding the physician, wage loss compensation amount, accepted condition (s) and whether or not the RC may contact the attending physician.
e. Additional documentation. In addition, the referral may include documentation of other current and relevant medical and vocational information. This may include things such as copies of medical evaluations, DFEC Field Nurse reports, Functional Capacity Evaluation, treating physician notes and any rehabilitation reports or notes completed prior to the current referral (previous Transferrable Skills Analysis or Labor Market Survey, testing results, etc).
f. Obtaining additional background information. The referral will include the IW's recent employment and basic demographic information. During the initial interview or otherwise, the IW can provide a more detailed history including additional employment and educational background, relevant experience, special skills and abilities and any additional information not included in the referral documentation which may benefit the rehabilitation process.
If not included with the referral and/or if needed to supplement employment history, the RC may request from the previous employer copies of the IW's Federal application, position description(s) and, if permitted by the IW, performance evaluations. These are all valuable sources of information for work, skills and performance background which may be beneficial in effective planning and for tasks such as Transferrable Skills Analysis and Labor Market Surveys.
g. If in need of additional information, the RC should contact the RS.
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3. Time Frames for Initial Contact. The RC has 10 working days, upon receipt of the referral documentation, to make contact with the IW for introductions and to schedule the initial interview.
a. The initial interview should be held in-person in an accessible location and occur as soon as possible after the initial contact is made in order to ensure prompt provision of services. In rare cases, there may be extenuating circumstances which preclude an in-person interview. The RC should contact the RS for guidance in these circumstances.
b. In some cases, the RS may choose to schedule a conference with the IW, RC and/or CE to introduce the IW to the vocational rehabilitation process, to obtain any missing information and/or to establish rapport.
c. Whether during the initial meeting with the IW or during the initial group conference, the RC should provide information about the FECA Vocational Rehabilitation Program including the responsibilities of both the RC and IW, the benefits of the program and possible consequences for non-participation. The IW should also be informed of FECA policies which may dictate the adjustment of wage loss compensation at the closure of rehabilitation services, whether reemployment is achieved or not. It may be beneficial to include the RS in this discussion if the IW has more extensive programmatic questions and/or refer the IW directly to the CE for claims-specific questions. The RC should also be aware – and discuss - that he or she will likely be asked to provide information related to the IW's wage-earning capacity at the time of case closure. This information will assist the IW with making informed choices during the rehabilitation process and with understanding the expectations of the FECA program.
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4. Limited Service Referrals. In some circumstances, a referral may be initiated by the RS for a single vocational rehabilitation service or a short-term, limited course of services. The outcome of such services may determine subsequent actions in the rehabilitation process or provide what is needed and be followed by case closure.
The referral process for Limited Service Referrals will be the same as that discussed in Paragraph 2 of this Part. The RS will assign the case to an RC and the RC will be provided with referral documentation and information, including the nature of the limited referral and the desired action(s) from the RC. For any questions, as always, the RC should contact the RS for further clarification.
Limited Service Referrals may be made for the following:
a. Home and Vehicle Modifications. When vehicle and/or housing modifications are necessary to accommodate the IW's accepted work-related medical conditions, a limited referral to an RC may be made as rehabilitation services are often necessary in developing and carrying out such proposals.
The RC will receive specific instructions from the RS as to how to facilitate the modification process as there are regulations specific to different types of situations (vehicle, home, owner-status, rental status, etc). Most often, however, the RC will be instructed to work with the IW, contracted DFEC Field Nurse or treating physician to confirm the type of modification needed and/or to assist with the process of obtaining vendor estimates. Once the RC and CE have reviewed the estimates and approved a plan for modifications, the RC may be asked to assist with facilitation and monitoring through completion of the project.
Specific guidance related to Home and Vehicle Modifications may be found in the FECA Procedure Manual 2-1800, Housing and Vehicle Modifications.
b. Post-injury disabling conditions. When medical evidence establishes that the IW could work in some capacity due to the work injury, but is more severely restricted from work due to a non-employment related condition which post-dates the work injury, the RS may refer the case for limited vocational services solely for the purpose of determining the IW's capacity to earn wages in the open labor market based on the restrictions attributable to the work injury as well as any pre-existing medical conditions.
For these types of referrals, the RC should follow the RS's specific instructions but, most often, will be requested to perform a Transferrable Skills Analysis and Labor Market Survey to make a determination of the IW's wage-earning capacity with consideration of restrictions related to the work injury and pre-existing medical conditions only.
c. Task-Based Assignments. Referrals for single service or task-based assignments may be made in a variety of situations in which vocational information or other rehabilitation services are needed. These situations may include evaluations to assess the IW's general ability to return to work or employability in previous or new positions. These may also include services to determine or clarify work restrictions and need for accommodations or for other case-specific needs.
(1) PPE Task-Based Referral. A task-based referral may be made in conjunction with attempts to return the IW to work with the previous employer. This type of referral may be beneficial if, for example, a Functional Capacities Evaluation (FCE), vocational testing, ergonomic evaluation, job site analysis or assistive technology would enable the employing agency to offer a job to the IW or explore job opportunities for placement in another department or position.
In some situations, the referral may be for "dual tracking" in which the RC will work in conjunction with the DFEC Field Nurse to facilitate services. (See Part 6, Paragraph 12, of this handbook).
(2) Medical Rehabilitation. A task-based referral may be made for a medical rehabilitation service or Occupational Rehabilitation Program (ORP) when there is a need to obtain clarification of work tolerance limitations and/or when a short period of medical rehabilitation may result in specific restrictions which can be used for a return to work plan or which may result in improved employability. In these circumstances, the referral may be for a FCE, work hardening or any other therapy program aimed at exploring work capabilities, documenting work restrictions and improving employability. (See Part 4 of this handbook).
(3) Sub-sedentary and Part-time. For IWs who are limited to part-time or sub-sedentary exertion levels, the RS may initiate a referral to determine whether sufficient part-time or sub-sedentary work exists within the IW's commuting area in order to determine the feasibility of rehabilitation services or a rehabilitation plan.
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