Injured on Duty: Know the Basics
(This article first appeared in the January-February 2005 issue of The American Postal Worker magazine.)
Understanding basic information regarding the Office of Workers’ Compensation Programs (OWCP) claims process can be beneficial in expediting an injured employee’s claim approval and receipt of benefits.
Five Requirements for Claim Approval
Civilian Employee: USPS employees are civilian employees covered by the Federal Employees’ Compensation Act (FECA).
Timely Filed: Claims for traumatic injury, occupational disease or illness and death must be filed within three years of the injury or onset of the condition or in cases of latent disability three years from when the claimant became aware the medical condition was caused by employment. “Recurrence claims” have no regulatory time limits.
Fact of Injury: In order to have a fact of injury there must be an event (an accident or performing duties qualify as an event) and a resulting medical condition.
Performance of Duty: Performing assigned duties or engaging in an activity that is reasonably associated with the employment, whether on or off premises. Breaks and lunch taken on the employer’s premises are also covered.
Causality: The work environment or working conditions caused or contributed to the claimed medical condition. Aggravation, acceleration or precipitation of a pre-existing condition can also be considered causal. Simply being at the worksite or on-the-clock does not necessarily make your medical condition causal to your employment. Consequential and intervening injuries may also be covered.
Demonstrating causality is the most common obstacle to a claim’s approval. Causality must be demonstrated through a medical narrative. Treating physicians must provide their medical rationale, definitively indicating how they came to the conclusion that employment factors contributed to or caused the condition. Claimants whose doctors state only that a condition “was caused by” specified employment factors and fail to provide their reasoning can expect to have their claim denied for failure to prove causality regardless of their impressive credentials or satisfying other required elements of the medical report.
In addition to medical reasoning regarding causality, the medical report should also include dates of examination and treatment, history of injury given by the employee, physical findings, test results, diagnosis, course of treatment (given and recommended), work limitations due to injury, non-work-related conditions to be considered in alternative duty assignments, and prognosis for recovery.
Types of Claims, Forms
The period of time it takes the work environment to cause the medical condition determines which claim to file.
Traumatic Injury / CA1: Caused by a specific event or incident or a series of events or incidents within a single workday or shift. The employer is also required to issue Form CA-16 “Authorization for Examination and / or Treatment” to the employee when notification is given within 7 days of the injury date.
Occupational Disease or Illness / CA2: Caused by a series of events or incidents over a period longer than a single workday or shift.
Recurrence / CA2a: Spontaneous worsening of an accepted condition without an intervening event (performing work duties is an event) or when a limited duty or rehabilitation assignment is withdrawn (partially or in-full). If a condition worsens due to a work event – even if it was a previously accepted condition (same diagnosis, same body part), it is considered a new injury, disease or illness (determined by the duration of time specified above). It is not a recurrence.
It is the employer’s obligation to make CA forms available to employees. Upon receipt from the employee, the employer has 10 business days to forward the CA forms to OWCP.
The USPS and its designees (Injury Compensation or Shared Services) have limited roles in the claims process. They are not an extension of OWCP. Only OWCP has the authority to approve or deny your claim.
Contact your local or state union representative with questions relating to your rights and responsibilities, and employer obligations under the FECA. Publication CA-550 is also an informative resource www.dol-esa.gov link to DFEC. Employer violations of your rights or failure to meet its obligations should be grieved.
On a personal note, I would like to offer my sincere thanks to the APWU membership for your continued support. It is truly my honor and privilege to have been re-elected (unopposed) to serve as your APWU National Human Relations Director.