HELP I JUST GOT INJURED!
Step by Step guideline!
You have been injured on the job. What are you supposed to do? What type of a condition is it, and what paperwork is required? This handbook will walk you through the basic steps of getting the needed medical care, and then guide you through the sometimes complicated and confusing steps of reporting and documenting your compensation case. Anytime you have questions or need assistance in dealing with a workers' compensation issue, you can call and ask to see me for a consultation at ELLIS CLINIC in Oklahoma City and/or speak with our Workers' Compensation Specialist Paige Matli for assistance and advice.
This podcast episode does not cover all the details of the Federal Employee's Compensation Act or all the benefits employees may be due. Rather, it is intended to provide quick and simple guidance that will help you through the majority of the situations you will encounter if you suffer a job-related injury or disease.
WHAT TYPE OF CONDITION DO I HAVE?
Most work-related medical conditions fall into two categories: (1) traumatic injury (Form CA-1, Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation), and (2) occupational disease (Form CA-2, Notice of Occupational Disease and Claim for Compensation). You will need to be familiar with these categories so you can help make sure that you complete the correct paperwork. The easiest way to identify the difference between the categories is to identify how long it took for the medical condition to occur.
Traumatic Injury (Form CA-1): If the condition happened in the course of one work shift, the condition is an injury. Examples: cut finger; tripped and fell; hit by forklift, etc. Sometimes the reported condition may not seem like an injury, such as mental stress or back strain. However, if you identify the condition as occurring in the course of one work shift, the condition is still considered to be a traumatic injury. CA-1 form for a One shift incident ….Got it!?
Occupational Disease (Form CA-2): If the condition happened because of events in more than one work shift, the condition is an occupational disease. Examples: back strain from unloading trucks for the past two weeks; carpal tunnel from daily use of computer keyboard, etc. So CA-2 if your condition occurs over a period of 2 or more shifts. GOT IT?!
Now there is third common type of injury that you need to know as well. THE RECURRENCE or CA-2A! You may be suffering a recurrence of a prior injury or disease and may want to file for benefits under the prior claim using Form CA-2a, AKA -Notice of Recurrence. A recurrence is defined as a return of symptoms related to the original injury or disease for no explainable reason other than there was a prior medical condition and it has returned. If a new event or series of events (e.g., bent over to tie shoes, moved boxes, etc.) causes a return in symptoms, the condition must be treated as a new injury or disease as described above even if the exact same part of the body is affected. If symptoms do begin for no explainable reason other than the prior injury or disease, you can file for a recurrence under the prior claim.
HOW DO I GET MEDICAL ATTENTION?
Regardless of the category of the medical condition/injury, you need to determine whether you need immediate medical care. If immediate care is required, make arrangements to go to the nearest health care facility or to your private health care provider. You can ask your supervisor for assistance in making your transportation arrangements, or in calling for an ambulance. Your supervisor can authorize the medical treatment by telephone to the private provider or hospital, and follow-up with the Authorization for Examination and/or Treatment (Form CA-16, Authorization for Examination and/or Treatment) to the medical facility within 48 hours. This CA-16 form allows you to go anywhere and be treated if you have a traumatic injury regardless of whether they are OWCP approved providers. If your injury needs more than 1 day urgent care then you need to follow up with an OWCP approved provider ASAP.
Remember that your supervisor cannot authorize medical treatment in CA-2 occupational disease claims without prior Office of Workers' Compensation (OWCP) approval. Forms required to obtain medical care are:
1. Traumatic injuries within the last 48 hours. Form CA-16 - Authorization for Examination and/or Treatment. This form guarantees payment to the care provider if the employee requires medical treatment because of a work-related traumatic injury. Your supervisor should complete page 1 of Form CA-16 and provide it to you within 4 hours of injury reporting for your attending physicians information. You should present this form to your attending physician and request that they complete page two of the form and forward it to the OWCP.
2. Occupational Diseases or traumatic injuries that occurred more than 48 hours ago. Form CA-35 and/or CA-20 - Attending Physician's Report. Because it is harder to prove that occupational diseases or injuries that are not recent were caused at work, a form that guarantees payment for something that may not be the government's responsibility would not be appropriate. If your claim is accepted, the medical bill will be paid even though a CA-16 was not issued.
It is recommended that you take with you a form CA-17 – Work Duty Status Report to give to the attending physician. This form provides your supervisor and OWCP with interim medical reports containing information as to your ability to return to any type of work.
I'VE GOT MEDICAL CARE, NOW HOW DO I FILE THE CLAIM?
Effective October 1, 2012, claims for workers' compensation must be filed electronically using the Employees' Compensation Operations and Management Portal (ECOMP). ECOMP allows Federal employees to file claims for benefits under the FECA online. You will begin by registering with the ECOMP website: https://ecomp.dol.gov. Employees are required to register and create an ECOMP account. You should also contact your Workers' Compensation Specialist for guidance before getting started with ECOMP. OR email or call Ellis clinic in OKC for assistance.
You should report all work-related conditions to your supervisor and file the Form CA-1 or Form CA-2, even if there is no lost time or medical expense. Currently these forms can be filled out electronically in Ecomp. The Department of Labor (DOL) considers claims to be “allowable” if they are reported within three years; however, it will be easier for you to prove your case if the claim is recorded and documented in ECOMP.
Traumatic Injuries: Use Form CA-1. After you register and create an ECOMP account, you will then be able to initiate your claim by filling out the CA-1. Completion of your claim requires close coordination between you, your supervisor, Occupational Safety and Health Administration Specialist and your Workers' Compensation Specialist. I also recommend that you fill out an OSHA 301 incident form as well.
Occupational Disease/injury: Use Form CA-2. After you register and create an ECOMP account, you will then be able to initiate your claim. Completion of your claim requires close coordination between you, your supervisor, Occupational Safety and Health Administration Specialist and your Treating doctor.
NOTE: In many instances, some of the blocks on Forms CA-1 and CA-2 will not apply to your situation. Rather than leave them blank (which will result in them being returned to you and delaying your claim), indicate not applicable or "N/A".
All documents pertinent to your workers' compensation should be electronically uploaded and submitted during the ECOMP initiation of the claim. If this is not possible, you are encouraged to submit supporting documentation for inclusion in the file to your Workers' Compensation Specialist as soon as you can to assist OWCP with development and adjudication of your claim. I also recommend that you have experience OWCP treating providers assist you in uploading the documents that you need. I highly recommend that you write a hand written incident report and sign it as part of the documents that you submit with your initial uploads into ECOMP. Upon completion of your claim in ECOMP, the receipt of notice of injury portion will be printed, signed and returned to you. This is your receipt that your supervisor has acknowledged your claim. Your supervisor is required to complete their portion of the required data in ECOMP so that OWCP can promptly adjudicate your claim.
You may submit medical updates, supporting documentation, etc. to your supervisor and/or your Workers' Compensation Specialist for inclusion in your file. All original documents must be included in the agency reference case file and processed through OWCP.
HOW DO I COVER MY ABSENCES?
Benefits to cover absences differ based on whether you suffered a traumatic injury or an occupational disease. We will cover each separately.
Traumatic Injury
Continuation Of Pay (COP): You may be eligible for uninterrupted pay beyond the date of injury without charge to leave. This benefit is called continuation of pay and is granted if all the following conditions are met:
1. You suffered a traumatic injury and filed form CA-1 within 30 days from the date of the injury.
2. You have provided your supervisor with valid medical documentation to show that the inability to work in any capacity is due to the injury.
3. The absences due to the injury began within 45 days from the date of injury.
4. Your absences do not exceed a total of 45 calendar days of COP. COP counts in whole day increments. If you work partial days, but are entitled to COP for the remainder of the work day, the few hours of COP count as a whole day of the 45 day entitlement.
5. If you return to work, but have a recurrence of disability within the 45 days, you may receive COP for any of the remaining 45 day period that you have not yet expended, even if the disability extends beyond the 45 day period.
Denial Of COP: COP can only be denied based on the following reasons (if COP already began, it will be terminated) :
1. The disability is caused from an occupational disease rather than a traumatic injury.
2. You are not a U.S. citizen or a resident of the U.S. or Canada.
3. The injury occurred off government premises and you were not involved in official "off premise" activities.
4. The injury was caused by your willful misconduct.
5. The injury was not reported on Form CA-1 within 30 days of the injury.
6. Work stoppage first occurred more than 45 days after the injury.
7. You initially reported the injury after your employment was terminated.
8. You are enrolled in the Civil Air Patrol, Peace Corps, Job Corps, Youth Conservation Corps, Work Study Program, or other similar groups covered by special legislation.
9. You are a volunteer working without pay or for nominal pay or you are a person appointed to the staff of a former President.
Note: If you are eligible for COP, but the claim is later denied, DOL will direct the Department of Justice to recoup the COP and change the COP absences to annual or sick leave or issue an overpayment. Also, COP can be terminated if you refuse a job offer within your restrictions and limitations, or if you fail to respond to a job offer.
After COP Expires: If you were eligible for COP, but are absent beyond the 45 day limit or do not become disabled within the 45 day window, you have two options:
1. You can use sick or annual leave to continue uninterrupted pay, or:
2. You can elect to go on Leave Without Pay and submit Form CA-7 - Claim for Compensation to request wage loss payments from the DOL. Form CA-7 alerts the DOL that you are not receiving any income and initiates wage loss pay. Form CA-7 is also used to claim absences at 2-week intervals if the absences continue beyond the period claimed on the initial form CA-7. You are responsible for submitting medical documentation to support that the ongoing absences are related to the work-injury and should anticipate at least a 3-4 week delay before you receive pay from DOL. The delay can be longer if a claim is incomplete or controversial. Employees who elect to use their own leave can later repurchase the leave. Form CA-7 is to be completed using ECOMP.
Occupational Disease: COP is not a benefit for occupational disease. If you cannot work due to the claimed condition, two options are available:
1. Use sick or annual leave to continue uninterrupted pay or:
2. Elect to go on Leave Without Pay and submit forms CA-7 to request wage loss benefits from the DOL. Form CA-7 initiates wage loss pay, and continues wage loss at bi-weekly intervals if the absences continue beyond the initial period claimed on the form CA-7. You are responsible for submitting medical documentation to demonstrate that the absences are related to the claimed work condition. Because occupational disease claims take longer to adjudicate, it can take several weeks or even several months before you can expect to receive pay from the DOL. As a result, most employees elect to use their own leave and then later repurchase the leave. Medical documentation must accompany all Form CA-7's and cover the dates indicated on the form.
Note: If disability continues beyond the date shown on the initial CA-7, subsequent Form CA-7s should be submitted 5 to 7 days before the end of the period claimed on the last claim form submitted.
Dr. Stephen Taylor at https://mrtherapycenter.com/