CW2 TRACY JOLLY

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CW2 TRACY JOLLY
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PERFORMANCE APPRAISAL SYSTEM
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CHANGES TO PERFORMANCE APPRAISAL SYSTEM

• NEW FORM - AGO FORM 216
• THREE TIER SYSTEM
• EXCEEDS STANDARDS/MEETS STANDARDS/BELOW STANDARDS
• BULLET/NARRATIVE STATEMENTS

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INCENTIVE AWARDS
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CHANGES TO INCENTIVE AWARDS PROGRAM

• NO INCENTIVE AWARDS COMMITTEE
• SSPAS - SET AMOUNT - 750.00
• TWO YEARS BETWEEN AWARDS
• BASED ON LAST APPRAISAL OR NARRATIVE
  JUSTIFICATION ON PLAIN BOND PAPER.
• TIME OFF AWARD - BASED ON PERFORMANCE/ONE TIME
  ACHIEVEMENT

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INJURY COMPENSATION
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HRO Comp Key Personnel

• Workers Comp Program POCs
• TSG Pam Guthrie 334-213-7587 DSN 363-7587
• email guthriep_at_al-arng.ngb.army.mil
• SGT Hilda Cepeda 334-213-7715 DSN 363-7715
• email cepedah_at_al-arng.ngb.army.mil
• Fax [phone] DSN 363-7267
• Address TAG-AL-HRO, P.O. Box 3711, Montgomery,
  AL 36109-0711
• Located at State Mil Dept Annex

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OBJECTIVES

• Provide supervisors with a general overview of
  the Federal Employees Compensation Act (FECA
  law)
• Types of benefits
• Requirements for entitlement
• Continuation of pay (COP)

• Familiarize supervisors with their
  responsibilities in effectively administering the
  FECA program
• Forms completion
• Returning employees to work

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THE FEDERAL EMPLOYEES COMPENSATION ACT--FECA
.

• Provides monetary compensation, medical care and
  assistance, vocational rehabilitation, and OPM
  retention rights to Federal employees who sustain
  traumatic injuries or occupational diseases as a
  result of their employment with the Federal
  Government.

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The FECA also provides

• for the payment of burial expenses and monetary
  compensation to qualified survivors of a Federal
  employee in cases of employment-related death.
• Exclusive remedy for on-the-job injuries.
• FECA is not a disability retirement program.

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5 BASIC REQUIREMENTS FOR ENTITLEMENT

• Time
• Civil employee
• Fact of injury
• Performance of duty
• Causal relationship
• ALL 5 MUST BE MET BEFORE BENEFITS CAN BE
  AWARDED.

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TIME

• Employee has three (3) years to file a claim.
• If Traumatic Injury, time runs from date of
  injury.
• If Occupational Disease, time runs from date of
  last exposure or date employee becomes aware of
  medical condition, whichever is later.
• NOTE To receive COP, claim must be filed within
  30 days of traumatic injury.

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CIVIL EMPLOYEE

• Any civilian employee in any branch of Federal
  government.
• Volunteers performing personal services similar
  to Federal employees are usually covered.
• Independent contractors or employees of
  independent contractors are usually not covered.

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FACT OF INJURY -- two parts

• FACTUAL Actual occurrence of an
  accident/incident/exposure at the time, place,
  and in the manner alleged.
• MEDICAL Is there a medical condition diagnosed
  in connection with that accident/incident/exposure
  ?

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FACT OF INJURY -- two parts

• FACTUAL Actual occurrence of an
  accident/incident/exposure at the time, place,
  and in the manner alleged.
• MEDICAL Is there a medical condition diagnosed
  in connection with that accident/incident/exposure
  ?

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PERFORMANCE OF DUTY (POD) -- two parts

• COE -- course of employment -- Did the
  injury/exposure occur while at work?
• AOE -- arises out of employment -- Did the injury
  occur because of the employment or because of a
  personal situation or condition?

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POD usually met if

• On industrial premises performing assigned duties
  or engaging in activities which are reasonable
  incidents of employment
• personal acts for employees comfort, health,
  convenience, and relaxation
• eating meals, lunches, snacks
• reasonable time before/after shift OK (usually
  1/2 hr)

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POD also usually met if

• Off premises while performing official duties
• Travel between the two duty locations
• TDY -- 24 hour protection if performing
  activities incidental to employment
• Informal recreational activities on premises
  during lunch and breaks
• Horseplay
• Unexplained falls

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POD may or may not be met if

• Assault
• Formal and/or off premises recreational injuries
  -- must look at degree of agency support and
  benefit derived
• The intangible value of improvement in employee
  health and morale that is common to all kinds of
  recreation and social life is not sufficient

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No POD if

• Traveling to and from work (commute)
• Significant deviations
• Idiopathic fall (personal condition) to
  supporting surface (e.g. floor)
• Statutory exclusions
• Willful misconduct
• Intoxication
• Intent to injure oneself or another
• HARD TO PROVE

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CAUSAL RELATIONSHIP

• Link between the work-related incident/exposure
  and the diagnosed condition.
• Types -- Direct cause, Aggravation (worsening of
  a pre-existing condition), Acceleration
  (hastening of a pre-existing condition),
  Precipitation (bringing a latent condition into
  the open).

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TRAUMATIC INJURY (TI)

• A wound or other condition of the body
  caused by external force, including stress or
  strain. The injury must be identifiable as to
  time and place of occurrence and member or
  function of the body affected. It must be caused
  by a specific event or incident or series of
  events or incidents occurring within a single day
  or work shift.

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OCCUPATIONAL DISEASE (OD)

• A condition which is produced by continued
  or repeated exposure to elements of the work
  environment such as noxious substances, damaging
  noise levels, or repetitive work
  activities/movements occurring over a period of
  more than one work day or shift.

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TI vs. OD -- the differences

• Traumatic Injury (TI)
• COP may be paid.
• Form CA-16 may be issued.
• Form CA-1 is completed.
• Quicker adjudication by OWCP -- usually requires
  less factual and medical info.

• Occupational Disease
• No COP paid.
• No CA-16 may be issued.
• Form CA-2 is completed.
• Lengthy adjudication by OWCP-- requires more
  detailed factual and medical info.

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RESPONSIBILITIES OWCP

• Make a timely and fair decision on the claim.
• Upon acceptance of a claim, manage the claim and
  pay benefits as allowed by law.
• Assist the employee to return to employment.
• Exclusive authority to award or deny all
  benefits, including COP.

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EMPLOYEE

• Has the burden of proof to establish a claim.
• Has to submit factual evidence as required by
  OWCP.
• Has to provide medical evidence to support the
  level of benefits claimed.

• Must keep both the agency and OWCP advised of his
  or her status and submit reports as required.
• Must seek and accept suitable work when such work
  is available.

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SUPERVISOR

• Enforce safety regulations.
• Advise employees of his/her responsibilities in
  filing a claim, rights, and benefits.
• Complete claim forms in a timely manner and
  verify accuracy of same, providing all required
  information.
• Report all injuries promptly to the ICPA/FECA
  Program Manager.

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SUPERVISOR contd

• Continue pay in traumatic injury claims as
  appropriate and promptly authorize medical care
  within regulatory guidelines.
• Assist employees in returning to work by
  providing work within the employees work
  tolerance limitations.
• Represent agency interests in monitoring claims.

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IMPORTANT for Supervisors to

• Identify and challenge questionable claims with
  the Advice of HRO.
• Keep in contact with employees during the
  recovery period.
• Help to manage compensation costs by assisting
  claimants in obtaining prompt medical care,
  filing their claims promptly, and accommodating
  work limitations with appropriate light duty.

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IMPORTANT NOTE

• A MONETARY PENALTY FROM 500 TO 2000 AND
  IMPRISONMENT OF UP TO ONE YEAR IS PROVIDED FOR IN
  THE LAW IF ONE PREVENTS OR DISCOURAGES AN
  EMPLOYEE FROM FILING A CLAIM , OR RETAINS AND
  REFUSES TO COMPLETE A CLAIM FILED BY AN EMPLOYEE.

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MEDICAL BENEFITS

• Examinations
• Diagnostic Tests
• Treatment -- physical therapy, surgery,
  medications
• Appliances other medical supplies
• Housing/Vehicle modifications

• Transportation costs to obtain medical care
• UNLIMITED amount in accordance with fee schedule
• Can continue INDEFINITELY so long as required for
  injury-related residuals

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Medical Benefits continued....

• Employee has initial choice of treating physician
  -- but may be changed only with OWCPs approval
• Preventative treatment may be authorized in
  limited circumstances
• Limitations on chiropractic treatment to manual
  manipulations of the spine for correction of
  subluxations

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CONTINUATION OF PAY (COP)

• 45 calendar days of regular pay without charge to
  sick or annual leave for disability and/or
  medical appointments due to a traumatic injury.
• Administered by EA.
• Disability must begin within 45 days.

• Payable from first day of disability following
  date of injury unless injury occurs before the
  start of the work shift. (Time off on the date
  of injury is usually covered by administrative
  leave.)

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Addl Requirements for COP

• Employee must submit medical evidence of
  disability due to the work injury within 10
  workdays after COP is requested or disability
  begins, whichever is later.

• Agency should controvert/challenge payment of COP
  if one of the 9 exceptions on Form CA-1 are met.
• Agency should terminate COP if employee refuses
  suitable work within 5 workdays.

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OTHER TYPES OF EARNINGS REPLACEMENT

• Temporary total disability payments -- 66 2/3 or
  75 of salary with dependent(s) includes night
  differential, Sunday premium, COLA locality
  pay does not usually include overtime.
• Loss of Wage-Earning Capacity (LWEC) payments if
  partially disabled.
• TAX FREE

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OTHER MONETARY COMPENSATION BENEFITS

• Attendant allowances, if unable to care for
  personal needs (feeding, clothing, bathing) due
  to work-related injury.
• Schedule Awards for loss of or loss of use of a
  scheduled member, function, or organ (e.g. leg,
  arm, lung).
• NOT payable for brain, heart, or back
• CAN be paid for permanent, serious disfigurement
  of face, neck, or head.

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DEATH BENEFITS

• OWCP has allowances for certain death benefits
  that occur because of an On-The -Job Injury.

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REHABILITATION SERVICES

• Nurse Intervention/Quality Case Management
  Programs -- first effort return to work with
  employing agency. Nurses now can be assigned
  during COP period
• Training
• Job placement assistance
• Assisted Reemployment Program -- subsidy paid to
  new employers to encourage hiring of injured
  employees.

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FORM CA-1, NOTICE OF TRAUMATIC INJURY

• Explain COP vs. leave and requirements for
  obtaining COP.
• Advise if COP is being controverted.
• Emphasize responsibility to return to work and to
  keep you advised.

• Scan form for accuracy and completeness.
• Give employee receipt.
• Give form to ICPA immediately to be forwarded to
  OWCP within 10 workdays if lost time/medical
  costs incurred.

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FORM CA-16, AUTH. FOR EXAM AND/OR TREATMENT

• To be used for traumatic injuries only.
• May NOT be issued for past medical care, except
  within 48 hrs of emergency treatment for which
  pre-authorization was verbally given.

• Explain employees right to choose initial
  treating physician.
• Note definition of physician restriction on
  chiropractors.
• Traumatic injured employees have up to one week
  to request a Form CA-16.

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FORM CA-17 DUTY STATUS REPORT

• Used to monitor extent of disability and COP
  entitlement.
• Used to determine work tolerance limitations for
  providing suitable light duty.
• INDICATE ON FORM THAT LIGHT DUTY WILL BE
  PROVIDED.
• Have employee provide updated CA-17 from
  physician about every 2 weeks.

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FORM CA-7, CLAIM FOR COMP ON ACCT OF TI/OD

• Claim form should be sent to employee at 30th
  day of COP if it appears disability will exceed
  45 calendar days, or as soon as pay stops if no
  COP.
• Accuracy of pay information is critical.
• Medical evidence of disability required.
• Give form to HRO Workers Comp Spec/ICPA
  immediately must be forwarded to OWCP within 5
  work days of receipt from employee.

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FORM CA-2, NOTICE OF OCCUPATIONAL DISEASE

• Employee must submit a detailed statement and
  medical report per the appropriate CA-35
  checklist. (Found in the CA-810)
• Supervisor must review and provide written
  comments upon the employees statement.
• Give form to HRO Workers Comp Spec/ICPA
  immediately to be forwarded to OWCP within 10
  workdays. Do not hold CA-2 awaiting the required
  statements and reports.

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RECURRENCES

• A recurrence is a spontaneous return of symptoms
  and/or disability without new or intervening
  causes.
• Form CA-2a, Notice of Recurrence of Disability,
  must be completed.

• Form CA-16 is not to be issued without
  pre-approval from OWCP.
• COP may be paid for recurrences within 45 days of
  the first return-to-work date, if a portion of
  the original 45 days remains unused.

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APPEAL RIGHTS

• Hearing (HR)
• Must request within 30 calendar days.
• Oral hearing or written review of record may be
  requested.
• New evidence is optional.
• Must be requested before a reconsideration.

• Reconsideration
• Must request within 1 year.
• Must submit new evidence or new legal argument.
• Appeal (ECAB)
• Must request within 90 days.
• No new evidence is considered.

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BASIC FORMS

• Basic Forms are available at the HRO Web Page
  http//alguard.state.al.us/hro/. Reference
  Employee Relations.
• Note Form CA-16, Authorization For Examination
  And/Or Treatment is not available at the website.
  
• Additionally, Form CA-10, What A Federal Employee
  Should Do When Injured At Work must be posted on
  Employees Bulletin Board.