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On October 1, 2012, the Office of Workers’ Compensation Programs (OWCP) introduced two new requirements for all cases within the Federal Employees’ Compensation Program (FECP). The first requirement is that within 28 days of the start of a worker’s participation in FECP disability management, OWCP must assign a field nurse to the case. The second requirement is that, for workers determined to be “totally disabled,” a second opinion evaluation is necessary if the case remains unresolved after 12 months.

To understand the effectiveness of this policy change, the U.S. Department of Labor (DOL) examined FECP administrative data on all cases that received disability management services between January 2006 and June 2017.

The report explains the descriptive statistics used to address the research questions posed by DOL's Chief Evaluation Office (CEO) and OWCP and summarizes the findings of the analyses. Because this study is descriptive in nature, the study results should NOT be interpreted as having a causal relationship with the policy change, and particularly with the rate of successful resolutions.

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Research Questions

• How prevalent was a successful resolution over time? Did the rate of successful resolution increase after the policy change?
• How prevalent are field nurse assignments and a second opinion evaluation in the disability management cases? How does the timing of these disability management interventions compare before and after the policy change?
• What intervention patterns were most associated with successful resolutions, and at what frequency were specific interventions implemented?

Key Takeaways

• Successful resolution rates were stable over the entire study timeframe. The mean successful resolution rate for this period was 89.3%. The rate decreased from 90.0% before the policy change to 88.3% after the policy change.
• The median disability management case duration increased from 7.0 months before the policy change to 7.4 months after the policy change.
• After the policy change, there was a 5 percentage-point increase in the proportion of all cases that received a field nurse assignment, from 72.6% to 77.6%.
• Overall, cases that received a field nurse assignment had a higher successful resolution rate compared to cases that did not (92.1% vs. 86.0%). The difference was less pronounced after the policy change (88.7% vs. 87.3%). Researchers hypothesize that the policy change may have indirectly lowered the successful resolution rate of field nurse assignment by assigning a field nurse to cases that were unlikely to benefit from the intervention.
• After the policy change, there was a 33.3 percentage-point increase in the proportion of eligible cases that had a second opinion evaluation, from 37.3% to 70.6%.
• Three sequences of disability management interventions (intervention patterns) were observed in over half (52.8%) of cases. They were: (1) Field nurse assignment followed by successful resolution, (2) no disability management interventions, and (3) surgery followed by a field nurse assignment and successful resolution. There were very few differences in the distribution of the 10 most prevalent intervention patterns before and after the policy change.
• Successful resolution rates were relatively stable for the 10 most prevalent sequences over the study timeframe (98.0% before policy change, 98.4% after). These sequences were also associated with the highest successful resolution rates (98.1% successful resolution rate for common sequences as opposed to an overall 89.3% successful resolution rate).

Research Gaps

• The findings in this report suggest potential avenues for further investigation: Why did successful resolution rates not increase after the field nurse assignment policy change? What were the characteristics of these claimants? These claimants affected by the policy who had lower successful resolution rates may be very different (types of injuries, demographics) from the rest of the population. What were their outcomes? Propensity score analysis can help identify these types of claimants moved from one category to the other and what were the outcomes of comparable claimants. Could factors other than the policy change account for changes in successful resolution rates? Who benefited the most and who benefited the least? Why did claimants who did not receive a second opinion evaluation after 12 months experience a higher rate of successful resolution than those who did receive a second opinion evaluation? What happened after the first successful resolution? (page 41)

Citation

Urdapilleta, O., McAllister, J., Easterly, M., Fink, S., Perttunen, N., Peto, B. (2021). Summit Consulting. Analysis of FY2013 Policy Change on Disability Management under the Federal Employees Compensation Program. Chief Evaluation Office, U.S. Department of Labor.

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The Department of Labor’s (DOL) Chief Evaluation Office (CEO) sponsors independent evaluations and research, primarily conducted by external, third-party contractors in accordance with the Department of Labor Evaluation Policy and CEO’s research development process.