Managing Leave due to owcp

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VA BEST PRACTICES IN FEDERAL WORKERS
COMPENSATION SUPERVISOR LEVEL COURSE

• Managing Leave due to owcp
• February 25 27, 2014

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Course Description

• This session will discuss Continuation of Pay
  (COP) entitlement and eligibility for COP.  It
  will provide a basis for managing agency COP
  through an understanding of COP entitlement,
  methods of authorization and how to calculate or
  count COP days. 
• It will also address the use of Leave without
  Pay, Annual Leave and Sick Leave after the COP
  period in connection with a claim.
•  

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Course Objectives

• Determine eligibility and entitlement to COP.
• Identify reason(s) for controverting COP.
• Identify valid reason(s) for terminating COP.
• Discuss the appropriate use of leave for medical
  appointments and disability.
• Discuss the issues of coordination with
  timekeeping and fiscal.
• Discuss ensuring that timecards reflect the
  appropriate leave status
•  

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History

• The first Workers Compensation Regulations were
  enacted in 1910. It was an Insurance Program
  approved because of high risk jobs, and a
  Progressive Political Climate. They wanted to
  establish an insurance plan to protect the family
  of the injured worker.
• This opened the gate for Old Age Insurance and
  Unemployment Insurance.
• The 1974 amendments to the FECA Program
  introduced the concept of Continuation of Pay.

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COP Defined

• COP is the continuation of regular pay for up to
  45 calendar days of wage loss due to disability
  and/or medical treatment after a work related
  traumatic injury.
• The intent of COP is to avoid interruption of pay
  while the claim is adjudicated by the Claims
  Examiner.

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What does COP Include / Exclude?

• COP Includes
• All regular pay deductions including income tax,
  retirement, allotments, etc.
• Night differential
• Scheduled changes in pay Promotions, step
  increases, etc
• COP Excludes
• Overtime
• Holiday Pay
• Saturday and Sunday Premium pay unless the
  employee actually worked on that day

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Eligibility and Entitlement

• The injury must be a traumatic injury.
• The employee must file a CA-1 (or Notice of
  Injury) within 30 days of the date of injury.
• The employee must begin losing time for
  disability or medical appointments within 45 days
  of the injury.
• COP cannot be paid if employee is separated from
  agency.
• If the light duty job excludes extra pay (night
  differential) COP is tracked for payment of this
  benefit up to 45 days (lost element of pay).

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Do I Controvert or Dispute COP

• The Agency may terminate or not begin COP only if
  the controversion is clearly based on one of the
  following nine categories.
• OWCP makes the final determination and can
  overturn the Agency Controversion and require
  that COP be paid.

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9 Reasons to Convert COP

1. Disability results from an occupational disease.
   (example Carpal Tunnel Syndrome)
2. The employee is excluded by 5 USC 8101 (1) B or
   E. This section of the law deals mostly with
   volunteers (unpaid) to the Federal Government.
3. The employee is neither a citizen nor a resident
   of the United States or Canada.
4. The injury occurred off the employing premises
   and the employee was not involved in official
   off premises duties.

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9 Reasons to Convert COP (Continued)

1. The injury was caused by the employees willful
   misconduct, intent to bring about injury or death
   to self or another person, or was proximately
   caused by employee intoxication.
2. The injury was not reported within 30 days.
3. Work stoppage first occurred more than 45 days
   following the injury.

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9 Reasons to Convert COP (Continued)

1. The employee initially reports the injury after
   his or her employment has been terminated.
2. The employee is enrolled in the Civil Air Patrol,
   Peace Corp, Job Corp, Youth Conservation Corp,
   Work Study Programs or other similar groups.
   This means they are not entitled to COP. They
   are entitled to compensation.

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Other Reasons to Dispute

• Evidence provided in the accident investigation
  does not match the injury claimed.
• Medical evidence does not support a diagnosis
  (ICD9) that can be connected to the work related
  event claimed. (Pain)
• Evidence of pre-existing medical condition.

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When can I terminate COP?

• Employee has not filed a CA-1 or notice.
• Medical evidence is not receive within 10 days
• Medical evidence shows the employee is not
  disabled for regular work.
• Medical evidence shows employee is capable of
  performing light duty and the employee has
  refused a written job offer.
• OWCP directs the Agency to stop COP.
• 45 calendar days of COP has been paid.

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What is Appropriate Medical Documentation?

• Date of examination.
• History of injury. (Reported by employee)
• Medical evidence supporting total or partial
  disability resulting from the claimed injury.
• Medical evidence should provide details of
  restricted activity and date of return to work.
• Document must be signed by a physician.

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Insufficient Medical for COP

• An off work slip indicating an employee is
  totally disabled, with a to and from date is not
  sufficient to continue COP past the 10 calendar
  days.
• The physician has to provide medical evidence
  supporting disability is a result of the alleged
  injury.

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Light Duty Job Offers-Why and How To

• Refusal to provide light duty work in writing to
  a partially disabled employee that has been
  released to return to modified work during a COP
  period requires the agency to pay COP.
• Job Offer should include Start date Scheduled
  days and hours, location Salary (note same pay)
  Description of duties assigned Physical
  requirements needed to perform work Supervisors
  signature and the employees signature noting
  acceptance or refusal.

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My Employee Elected Sick Leave - Not COP?

• Just above the signature line on the CA-1 the
  employee must choose to be paid either sick leave
  or COP if their injury should incur lost time.
• An employee may elect to use accumulated sick or
  annual leave instead of COP. This will not
  extend the COP period.
• The employee can request to have their leave
  changed to COP within 1 year of acceptance of the
  claim. 20 CFR 10.206(a), 206(b)

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Calculating AA and COP

• Authorized Absence (AA) This is paid on the day
  of a traumatic injury if the employee is disabled
  for work for the remainder of their shift, or if
  they leave work for medical treatment on the day
  of injury.
• An employee can be paid AA if they complete a
  CA-1, and require absence from work on the day of
  injury and during the same shift.
• A claim is not considered lost time if only AA is
  used on the day of injury.

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Calculating COP

• If the traumatic injury occurs prior to the
  beginning of the tour of duty, COP is authorized
  for time away from work on the date of injury.
• The COP period of eligibility begins after the
  first return to duty date.
• If the employee becomes disabled again within the
  45 days of entitlement. The employer will pay
  any of the remaining 45 days of entitlement.
• COP is counted by calendar days not work days

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Calculating COP Continued

• There are 3 possibilities for a first return to
  duty date.
• Employee returns on date of injury.
• Employee received AA and returns to work on the
  next scheduled day following the date of injury.
• The employee is place off work on the day of
  injury, and returns to duty between the second
  and 44th calendar day following the initial date
  of injury.

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Calculating COP Continued

• Use of any part of a work day counts as 1
  calendar day COP ( 2 hours COP for doctor visit
  1 calendar day COP).
• If the employee is disabled for Friday and Monday
  and not schedule Saturday and Sunday, continue
  calendar for 4 days of COP but pay for is for 2
  days.
• Holiday Pay is paid as a holiday, but counted as
  a COP day.

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Calculating COP Continued

• If the employees regular pay includes night
  differential, and they are scheduled light duty
  during the day, they are entitled to 45 days of
  COP that pays what they would have earned for the
  loss of night differential pay only. Lost
  elements of pay for Saturday and Sunday schedules
  cannot be paid unless they work on Saturday or
  Sunday. (COP only)

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Managing Timecards, Payroll, and DFAS

• COP should not be approved unless authorized by
  the Control Point (Usually Human Resources).
  Authorization can be transmitted by email, scan
  document, or a letter signed by the official
  designated to authorize COP with identified dates
  and hours of eligibility.
• The employee can enter sick leave in VISTA and
  notate it is for an on-job-injury. The
  timekeeper can change the sick leave to COP which
  is backed up and approved by the employees
  supervisor.

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Managing Timecards, Payroll, and DFAS

• Night Differential is paid by recording the
  original schedule that includes night pay. The
  timekeeper will make a notation that the employee
  was detailed to the day shift and identify hours
  and schedule actually worked.
• The timekeeper will also notate the number of
  hours authorized for an absence during the day
  shift, and indicate if the absence was connected
  to a medical appointment, or disability connected
  to the injury.

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Managing Timecards, Payroll, and DFAS

• Physician Pay for leave used is for a full day.
  If the physician has a scheduled appointment for
  COP, place them on regular scheduled hours and
  notate the physician used 4 hours COP to attend a
  medical appointment.
• Remember Payroll deadlines for COP.
• Check an recheck COP timecards for accuracy.
• Make immediate adjustments when errors occur, and
  follow-up with payroll if a debt is incurred due
  to an overpayment or rescinded COP.
• The employee may change rescinded COP to sick or
  annual leave if a balance is available.

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Employer Responsibilities

• The supervisor is responsible for initiating the
  CA-1 and notifying the employee they have 10 days
  to submit appropriate medical documentation.
• The supervisor is responsible for advising the
  employee of light duty availability and COP
  eligibility.
• The supervisor and Human Resources Office are
  responsible to inform the employee of any
  decision to controvert or dispute a claim, and
  provide the basis for doing so. OWCP will not
  uphold the termination of pay if the agency fails
  to notify the employee of a pending
  controversion. The employee must be provided the
  opportunity to respond to the reasons addressed
  by the Agency, and time to provide additional
  documentation if requested. OWCP has 30 days to
  adjudicate a CA-1 claim.

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Employee Responsibilities

• The employee is responsible for completion of
  form CA-1 as soon as possible, but no later than
  30 days.
• The employee is responsible for providing medical
  evidence and to cooperate with OWCPs development
  of their claim. They are also responsible for
  providing an accurate history of their condition
  including prior or pre-existing diagnosed
  conditions that are similar.
• The employee is responsible for selecting a
  physician that will provide work limitations
  with a return to duty date.
• The employee must provide their physician with a
  copy of any modified light duty assignments
  offered, and request when they can return to
  modified work . Failure to notify the physician
  of a refused written light duty assignment that
  is considered suitable is a sufficient reason to
  terminate COP.

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OWCP Absence After COP

• If the employee is expected to be off work beyond
  45 days, Human Resources will notify the
  supervisor and employee how to file for
  Compensation.
• (Recommended) The employee elects Leave without
  Pay (LWOP) for time lost due to the injury and
  files Form CA-7 and CA-7a to OWCP to be paid lost
  wage compensation by OWCP.
• (Not recommended) The employee can use their sick
  leave and annual leave and file a CA-7 for a
  Leave Buy Back (LBB) through DFAS

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Leave Without Pay (LWOP)

• The employee should elect LWOP if the claim is
  accepted and the physician has provided
  documentation for the employee to be off work.
• After filing the CA-7 and CA-7a, OWCP will pay
  the employee most often within two weeks.
• The Human Resources Specialist or Fiscal Officer
  must certify that all time claimed on form CA-7
  is for LWOP before submitting the claim to OWCP.
• An overpayment will be declared by OWCP if the
  employee is paid by the Agency and OWCP.

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Leave Buy Back (LBB)

• The employee may use their sick leave and/or
  annual leave for lost time due to a work related
  injury. Often an employee will elect to use
  leave when their claim is pending approval and
  they are not eligible for compensation.
• For LBB, the employee must pay the Agency the
  difference between what they were paid by the
  Agency and what they would receive for
  compensation
• There must be medical documentation supporting
  the inability to work as a result of the accepted
  medical condition for any period where LBB is
  claimed.

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Leave Buy Back (LBB)

• When the claim is approved, the employee files
  the CA-7 and CA-7a for a LBB.
• Payroll calculates the amount the employee will
  need to pay in order to have their leave restored
  on a CA-7b.
• DFAS sets up an account for OWCP to pay their
  portion of the LBB, and bills the claimant for
  their portion.
• Leave is restored when both payments are received
  by DFAS.

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LWOP for Workers Compensation

• A Form 50 is placed in the OPF indicating the
  employee was paid by OWCP and that OWCP deducted
  health benefits and life insurance during the
  period of absence.
• An employee does not earn leave or receive
  holiday pay while they are on LWOP. They cannot
  file for benefits they did not earn.

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LWOP for Workers Compensation

• LWOP does not affect
• Service Computation Dates
• Within Grade Increases (WGI)
• Time in Service requirements for leave accrual
• Health Insurance
• Life Insurance
• Retirement Credit
• LWOP does affect
• Eligibility to participate in Thrift Savings Plan
  (TSP)
• AL/SL accruals

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Family Medical Leave Act (FMLA)

• An employee is not required to invoke FMLA for
  LWOP used with a work related claim. If the work
  related claim is denied and the employee remains
  off work in a LWOP status, they should be
  notified they may file the forms requesting FMLA.

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Reasonable Accommodation

• An employee can file a request for a reasonable
  accommodation, and a work related claim at the
  same time. They are separate requests and should
  remain separate in both processes.
• The OWCP Claims Examiner may rate a job offer
  suitable, and stop OWCP compensation when the
  employee refuses to return to work. For the same
  job offer, EEOC might find the offer not suitable
  based on legal requirements identified with
  reasonable accommodation guidelines.
• If the OWCP claim is denied and disability
  continues, the employee should be advised to file
  for a reasonable accommodation.

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Contact Information

• Nicole Kelsch
• VA Medical Center
• Lake City, FL 32025
• [phone] x2621
• Nicole.Kelsch_at_va.gov