USPS Unveils Prescription Drug Card
for Workplace Injuries
- The USPS has announced a voluntary
prescription drug card program for
employees who suffer workplace
injuries or illnesses. According to
the Postal Service, employees who
choose to participate in the program
will submit their drug card and
prescriptions to the pharmacy of
their choice, and the prescriptions
will be filled at no cost to the
employee. source: APWU (5/16/06)
U.S.
Postal Service ‘Outsourcing' Program
of Injured on Duty Employees
Program’ Goes Nationwide -
The Postal Service
aggressively monitors limited-duty and rehabilitation
assignments, and in May 2005
notified the
APWU that the USPS would begin a reassessment of rehabilitation
jobs and limited duty assignments. The “reassessments” will be
implemented nationwide, by District. San Diego has become the
initial site, and is set to begin late this summer. A pilot
program was initiated in April 2004 in the Long Island (NY)
District. The Postal Service
contends that the program is necessary because there are a
declining number of jobs available for injured employees who
have substantial medical limitations. If there is no
medically-suitable job available for such an employee, the
Postal Service will refer the employee to OWCP for placement in
OWCP’s vocational rehabilitation program and eventual
re-employment in the private sector.
ELM Revision: Return to Duty After
Occupational Illness or Injury
(Postal Bulletin - 6/8/06)
Return-to-work clearance may be
required for absences due to an
illness, injury, outpatient
medical procedure (surgical), or
hospitalization when management
has a reasonable belief, based
upon reliable and objective
information, that:
a. The employee may not be able
to perform the essential
functions of his or her
position, or
b. The employee may pose a
direct threat to the health or
safety of him/herself or others
due to that medical condition.
In making this determination,
management must consider the
essential functions of the
employee's job, the nature of the
medical condition or procedure
involved, guidance from the
occupational health nurse
administrator, occupational health
nurse, and/or the Postal Service's
physician regarding the condition
or procedure involved, and any
other reliable and objective
information to make an
individualized assessment whether
there is a reason to require the
return- to-work documentation.
In cases of occupational illness
or injury, the employee will be
returned to work upon
certification from the treating
physician, and the medical report
will be reviewed by a medical
officer or contract physician as
soon as possible thereafter
Privacy Rules, Violations
- Last year, the responsibility
for investigating certain types of
employee misconduct — including
workers’ compensation fraud — was
transferred from the Postal
Inspection Service to the Office
of Inspector General (OIG). OIG
workers’-comp investigations
routinely involve an OIG agent
visiting an injured employee’s
treating physician. The agent’s
tactics can be intimidating —
intrusive to physicians and
harassing to employees. This is
especially startling when you
consider that less than one-half
of one percent of all Office of
Workers’ Compensation (OWCP)
claimants have ever been found
guilty of fraud. Claimants and
their doctors should be well
prepared when confronted with an
OIG investigation. In addition to
the valuable information
Industrial Relations Director Greg
Bell provided in a recent article.
March/April 2006 issue of The
American Postal Worker magazine
OWCP Form CA-16 (source: APWU
Human Relations Dept. - 7/30/05)
The OWCP “Authorization for
Examination and/or Treatment ”
Form (CA-16), is issued by the
USPS to employees who sustain a
traumatic workplace injury and
report their injury within seven
days of the incident.
The Code of Federal Regulations
requires that the USPS issue the
form within four hours of
receiving notice; this is to
ensure that injured workers
receive immediate medical care.
Postal Service officials must
issue the form even when they
doubt that an injury is
work-related.
In emergency situations, the USPS
may provide verbal authorization
for medical treatment, but
officials must issue the form to
the employee within 48 hours.
Failure to comply is a violation
of Section 545.21 of the Employee
and Labor Relations Manual (ELM),
and should be grieved.
The CA-16 form guarantees payment
to the treating physician (or any
physician to whom the original
treating physician referred the
employee) for 60 days from the
date the form is issued, unless
OWCP terminates this authority at
an earlier date. When a CA-16 is
issued, no additional
authorization is needed.
Avoiding CA-16 Pitfalls:
The
following information may be
helpful.
Section A (Items 1 to 13) is
completed by the Postal Service;
Section B (Items 14 to 38) is
completed by the doctor.
The
employee’s choice of treating
physician should appear on the
form, not the USPS contract
physician or the medical
facility.
In emergency situations, if the
form is issued naming the
employee’s choice of hospital,
it shouldn’t be a matter of
great concern: OWCP advises that
it will recognize an employee’s
physician following the
emergency treatment.
Be sure that the complete
mailing address of the OWCP
District Office is provided in
Item 12 (including the street
address, city, state, and zip
code). This helps ensure that
your doctor sends the CA-16 to
OWCP, which permits ACS to pay
medical bills, without waiting
for claim adjudication and
medical authorization. (OWCP
contracted with a single
company, ACS, to handle its
medical authorization and bill
payment processes.)
Employees are strongly
encouraged to keep a copy of the
CA-16 form. The USPS is not
permitted to issue a second form
to the employee to provide to
other physicians they are
referred to. If the CA-16 is
improperly issued, most often by
fax directly to the hospital or
medical facility, the employee
should not leave without
retaining a copy for their
records.
Being
armed with this information and
knowing your rights keeps your
doctor happy, gets out-of-pocket
expenses reimbursed, prevents bad
credit ratings, and avoids a lot
of potential frustration. Members
with questions are encouraged to
contact their local or state APWU
representative.
Your Injury: Your Choice
-If you are injured at work, you
have the right to choose the
physician or facility that you
want to treat your injury. You may
select any qualified physician or
hospital within 25 miles of your
home or workplace.
In an
emergency situation you also have
the right to select the hospital
or physician of your choice.
Following emergency treatment, you
retain the right to select a
physician for subsequent medical
care.
A
supervisor is permitted to
accompany you to the doctor’s
office or hospital only in an
emergency, and only to ensure that
you receive prompt medical care.
Supervisors should not interfere
with medical care, breech your
privacy, or be present to advise
the doctor about limited-duty
accommodations. Ambulances should
be used to transport you in
emergencies, not USPS or personal
vehicles.
(APWU
March/April 2005)
USPS to Implement Pilot Program
to 'Outsource' Injured On Duty
Employees -The
Postal Service has informed NPMHU
of its intentions to implement an
Outplacement Pilot Program
in conjunction with the OWCP. The
program is intended to develop
work opportunities outside USPS
for employees who have sustained
job-related illness or injury (IOD).
The program will be initiated in
the Long Island (NY)
District and later will include
the other districts in the New
York Metro Area and eventually
nationwide.(4/4/04)
ELM 17 432.72 Medical Release Time When an employee is released from work and directed
by management to an on- or off-site health services unit due to illness
or injury, all time spent waiting for and/or receiving medical attention
on the service day on which the
illness or injury occurs and that would have been worked but for the medical
attention, including all time that the employee otherwise would have been
directed to work that day beyond his or her regularly scheduled tour,
is
included and credited as work time.
The Postal Service is undertaking an internal audit to re-code job functions
into productive labor codes. This internal audit affects all letter carriers
working in limited duty and permanent modified positions.
According to the Postal Service, the objective of this initiative is "to
provide employees injured on the job with a standardized administrative
process built on eliminating ambiguous and subjective assumptions by placing
employees in assignments that support the employees' recovery plan as well
as meet organizational goals. Equally important, management must ensure
that existing and new limited duty and rehabilitation assignments comply
with all laws and postal policies while, at the same time, provide meaningful
work for employees within their medical restrictions."
This initiative begins with the updating of medical information for each
employee who is currently assigned to a limited duty or rehabilitation assignment.
Each employee should expect to receive a letter requesting this updated
medical restriction list from their treating physician. In most cases, the
letter contains information concerning who will pay for this updated medical
report. The Postal Service is responsible for the cost, if a claim with
OWCP has been closed. If the claim is still open and active with OWCP, the
doctor visit would be covered by OWCP for billing purposes because updated
medical reports and restriction lists are required for the claim. During
this initial stage, the supervisor will also be asked to complete a worksheet
that clearly delineates the current job functions and duties that the employee
is performing, including the amount of time spent performing each duty.
Once this information is gathered, the original job offer, the actual duties
being performed and the listed medical restrictions are reviewed. This process
will determine if the injured employee still requires alternate work assignments,
and ensure that hours are being charged to the proper operation number.
Some employees may require medical reassessment and some may be reassigned.
The critical element of this initiative, according the Postal Service is
to ensure that LDC 68/69 employees are performing work within his or her
craft to the maximum extent within their medical limitations.
The team will review whether the employee's assigned duties appear to exceed
medical restrictions, whether the employee is being underutilized because
the medical restrictions allow for more extensive work assignments, or whether
the employee is being assigned duties that are not part of the original
job offer. In each of these instances, the appropriate action will be taken
and will, in nearly all cases, result in a new written offer being provided.
(source: NALC)
USPS Forms 2498x and 2499x
Many of you may have seen
the PS 2499x and PS 2498x "Offer of Modified Assignment" forms being
used in Postal Service Districts throughout the country. These forms are
in draft status and are currently being reformatted by Postal Service
Headquarters. Along with the final versions of the forms, the Postal
Service will be issuing National Guidelines for its use.These forms are part of
the LDC 68/69 Reassessment Initiative and will be useful to injured
letter carriers being offered Limited Duty or Permanent Rehabilitation
Assignments. The forms will provide a uniformity of job offers that we
have been striving toward, for some time. The offers will now include
all the required information and will stop the practice of using the
phrase "other duties as assigned within medical restrictions".When the final versions
of the forms are available, we will publish them in
The Postal Record (source: NALC)
CA-14 Revised / Replaces Notification Postcard
As part of their new communication initiative, OWCP has revised the
process for notifying claimants of their entitlements and claim number.
The CA-14
pamphletwill replace the
normal postcard notification system.
When an injured employee files a CA-1 or CA-2 for an on-the-job
injury, they will no longer receive a little green postcard with OWCP's
address and the claim number assigned to their claim. They will now receive
a blue pamphlet that outlines all the benefits associated with the Federal
Employees' Compensation Act. The claim number will be printed on the pamphlet.
Please retain this pamphlet for your records and do not simply dispose
of it once read
OWCP implements a centralized mail process
OWCP is implementing a new process for handling mail for each of their
District Offices. They have created one central mail room to service the
entire country. The central mail room contractor has the capacity to rapidly
scan large volumes of documents and create quality images. They system
will route these imaged documents to the appropriate District Office and
directly to the assigned responsible claims examiner for review. The paper
submitted will never return to the District Office. It is anticipated
that this system will actually assist the mail in reaching the responsible
claims examiner quicker than through the existing methods. The possibility
of misplacing mail or filing it in the wrong case file will be greatly
diminished.
The new address for all mail submitted by injured
employees nationwide is:
U.S. Department of Labor
Federal Employees' Compensation
PO Box 8300
London, KY 40742-8300
In Case of Injury, obtain first aid or medical
treatment even if the injury is minor. While many minor injuries heal without
treatment, a few result in serious prolonged disability that could have been
prevented had the employee received treatment when the injury occurred.
For traumatic injuries, ask your employer to authorize medical treatment
on Form CA-16 BEFORE you go to the doctor. Take Form CA-16 when you go
to the doctor, along with Form OWCP-1500, which the doctor must use to submit
bills to OWCP. Your employer may authorize medical treatment for occupational
disease ONLY if OWCP gives prior approval.
Submit bills promptly, as bills for medical treatment may not be paid if
submitted to OWCP more than one year after the calendar year in which you received
the treatment or in which the condition was accepted as compensable.
Report Every Injury to your supervisor. Submit
written notice of your injury on Form CA-1 if you sustained a traumatic injury,
or Form CA-2 if the injury was an occupational disease or illness. (Forms CA-1
and CA-2 may be obtained from your employing agency or OWCP.)
Form CA-1 must be filed within 30 days of the date of injury to receive continuation
of pay (COP) for a disabling traumatic injury. COP may be terminated if medical
evidence of the injury- related disability is not submitted to your employer
within 10 workdays. YOU ARE RESPONSIBLE FOR ENSURING THAT SUCH MEDICAL EVIDENCE
IS SUBMITTED TO YOUR EMPLOYING AGENCY. Form CA-2 should also be filed within
30 days. Any claim which is not submitted within 3 years will be barred by statutory
time limitations unless the immediate superior had actual knowledge of the injury
or death within 30 days of occurrence.
Establish the Essential Elements of Your Claim.
You must provide the evidence needed to show that you filed for benefits in
a timely manner; that you are a civil employee; that the injury occurred as
reported and in the performance of duty; and that your condition or disability
is related to the injury or factors of your Federal employment. OWCP will assist
you in meeting this responsibility, which is called burden of proof, by requesting
evidence needed to fulfill the requirements of your claim.
File a Claim for Compensation. File Form CA-7,
Claim for Compensation on Account of Traumatic Injury or Occupational Disease,
if you cannot return to work because of your injury and you are losing (or expect
to lose) pay for more than three days. Give the form to your supervisor seven
to ten days before the end of the COP period, if you received COP. If you are
not entitled to COP, submit Form CA-7 when you enter or expect to enter a leave
without pay status. All wage loss claims must be supported by medical evidence
of injury-related disability for the period of the claim.
If you continue to lose pay after the dates claimed on Form CA-7, submit
Forms CA-8 Claim for Continuing Compensation on Account of Disability, through
your employer to claim additional compensation until you return to work or until
OWCP advises they are no longer needed. You are not required to use your sick
or annual leave before you claim compensation.
If you choose to use your leave, you may, with your agency's concurrence,
request leave buy-back by submitting Form CA-7 to OWCP through your employing
agency. Any compensation payment is to be used to partially reimburse your agency
for the leave pay. You must also arrange to pay your agency the difference between
the leave pay based on your full salary and the compensation payment that was
paid at 2/3 or 3/4 of your salary. Your agency will then recredit the leave
to your leave record.
Return To Work As Soon As your Doctor Allows You To Do
So. If your employing agency gives you a written description
of a light duty job, you must provide a copy to your doctor and ask if and when
you can perform the duties described. If your agency is willing to provide light
work, you must ask your doctor to specify your work restrictions. In either
case, you must advise your agency immediately of your doctor's instructions
concerning return to work, and arrange for your agency to receive written verification
of this information. COP or compensation may be terminated if you refuse work
which is within your medical restrictions without good cause, or if you do not
respond within specified time limits to a job offer from your agency.
In appropriate cases, OWCP provides assistance in arranging for reassignment
to lighter duties in cooperation with the employing agency. In addition, injured
employees have certain other specified rights under the jurisdiction of the
Office of Personnel Management, such as reemployment rights if the disability
has been overcome within one year.
Tell Your Familyabout the benefits
they are entitled to in the event of your death. For assistance in filing a
claim they may contact your employing agency's personnel office or OWCP.
Any employee who gets injured on the job has the right to see their own
physician. (ELM Section 545.4)
545.4 Implementing Medical Care
545.41 Emergency Treatment
An employee needing emergency treatment must be sent to the nearest available
physician or hospital or to a physician or hospital chosen by the employee
or the employee’s representative. The physician who provides emergency treatment
is not considered the employee’s initial choice of physician.
545.44 Outside Treatment in a Nonemergency Situation
In a nonemergency situation, if an employee does not accept treatment
at a Postal Service occupational health services office or contract facility,
the employee may select a physician or hospital within approximately 25
miles of his or her home or worksite. The physician’s office should be contacted
by telephone by the control office or control point to determine if the
physician is available and will accept the employee for treatment under
FECA. If not, the employee must select another qualified physician or hospital.
A postal supervisor is not authorized to accompany the employee to a medical
facility or physician’s office in nonemergency situations
Editor's note: Over the years I have witnessed many employees injured
at work and fail to request to see their own physician. The people at medical
units and US Postal Service contract physicians (in my opinion) are
not acting in the best interest of the employee but in the interest of the
USPS and that is >>>to get injured employees back to work as soon as possible
regardless of the well-being of the an employee.
Federal agencies are required by regulation
to submit an employee's Notice of Injury (Form CA-1 or CA-2) within 10working days (or 14 calendar days) of receiving it from an employee,
if lost time from work or medical expenses are claimed or anticipated [20
CFR 10.110(a)]. Regulations require that the CA-7 should be submitted
no later than 5working days (or 7 calendar days) after its receipt
from the employee [20 CFR 10.112(b)]. This prompt submission is critical
if OWCP is to be able to serve injured workers' needs, and especially to
ensure that medical bills can be processed timely.
INFORMATION
TO ASSIST DOCTOR IN DETERMINING CAUSAL RELATIONSHIP FOR AN OWCP CLAIM:
To a physician, "cause" may refer only to direct or principal
cause, but for the law of Workers' Compensation, a variety of contributing
causes must be considered. Under the Federal Employees Compensation Act
(FECA), any disease or disability is compensable when it is proximately
caused or materially aggravated by an employment-related injury or condition
of employment. Proximate cause is that which, in a natural and continuing
sequence, produces the disability. However, natural progression of a disease
while a person is working does not constitute cause or aggravation. For
conditions of employment to bring about aggravation of any underlying disease,
the employment factors must be capable of aggravating or accelerating the
disease.
There are two kinds of aggravation:
TEMPORARY AGGRAVATION: The pre-existing condition is worsened or made
more severe for a time with no residual alteration of the underlying condition
and without leaving any continuing impairment beyond that time.
PERMANENT AGGRAVATION: There is a continuing and irreversible
change in the underlying condition, thus adversely altering the course of
the condition or disease process.
FECA DEFINITIONS: MEDICAL RATIONALE: A logical explanation for the physician's underlying
opinions, fundamental reasons and beliefs concerning causal relationship.
PROXIMATE CAUSE: That which produces the injury in a natural and
continuous sequence, unbroken by an efficient and intervening cause and
without which the result would not have occurred.
AGGRAVATION: A documented physiological process by which a single
occupational act, or series of acts over a period of time intensified the
severity of a physical or mental problem which pre-existed the occupational
disease.
ACCELERATION: A documented physiological process by which a single
occupational act, or series of acts, can be shown to have increased the
expected speed of progression in a pre-existing condition documented to
be progressive in nature.
PRECIPITATION: Hastening the occurrence of an event or causing
to happen or come to crisis suddenly, unexpectedly, or too soon.
Contacting Your Federal Employees'
Compensation District Office
If you are an employee or representative, and you would like detailed
GENERAL information about claims under the Federal Employees' Compensation
Act, please call our new toll-free information line. The number is
1-866-999-3322, or
1-877-889-5627 for TTY, and the lines are available from 8 AM to
5 PM, Monday through Friday.
In addition, OWCP now has a toll-free automated system that provides
a variety of information regarding specific claims. By calling
1-866-OWCP-IVR (1-866-692-7487), injured
workers and their representatives may access information regarding case
status, compensation payments, reimbursement of treatment and travel expenses,
and authorization of medical treatment such as physical therapy and diagnostic
testing. Medical service providers may also access case status and treatment
authorization through 1-866-OWCP-IVR, as well as information regarding
bill payments. Injured workers should have their 9-digit case file or
claim number and social security number when calling. Medical providers
should have the 9-digit case file or claim number and their tax identification
number.
Please note: We ask that our customers
first contact a district office to resolve any issues that may arise.
Problems may also be addressed to the District Directors for the Federal
Employees' Compensation Program, and the Regional Directors for the Office
of Workers' Compensation Programs. A list of these offices and their geographical
jurisdictions is found below. The program is headed by Deborah B. Sanford,
Director for Federal Employees' Compensation.
