540 Injury Compensation Program
ELM 16 ContentsEmployee BenefitsInjury Compensation ProgramSummary of Changes541.14540 Injury Compensation Program541541.1541.11OverviewBackgroundLawUnder the provisions of the Postal Reorganization Act, 39 U.S.C. 1005 (c), allemployees of the United States Postal Service are covered by the FederalEmployees’ Compensation Act (FECA), 5 U.S.C. 81.541.12AdministrationFECA is administered by the Office of Workers’ Compensation Programs(OWCP), United States Department of Labor. OWCP determines whether theemployee, or a survivor of the employee, is entitled to benefits under FECA.The director of OWCP and his or her designees have the exclusive authorityto administer, interpret, and enforce the provisions of the Act.541.13541.131CoverageDisabilityFECA provides that employees who suffer job-related disabilities are entitledto:a.Continuation of pay (COP) for the period of the disability, up to amaximum of 45 calendar days, for a traumatic job-related injury (see541.2d).b.Compensation for wages lost as a result of job-related injury or diseaseor illness.c.Medical care for disability due to:d.541.132(1)Personal injuries sustained while in the performance of duty.(2)Diseases proximately caused, aggravated, or accelerated bypostal employment.Vocational rehabilitation.DeathFECA provides for payment of monetary compensation to specified survivorsof an employee whose death results from a work-related injury oroccupational disease or illness and payment of certain burial expensessubject to the provisions of 5 U.S.C. 8134.541.133Schedule AwardsCompensation is provided for the permanent loss, or loss of use, of each ofcertain members, organs, and functions of the body.541.14Privacy ActInjury compensation records are maintained by the Postal Service within theprivacy system of records identified as USPS 120.098 (OWCP RecordCopies). (See 314 for a full explanation of injury compensation case files.)ELM 16, August 2000473
ELM 16 ContentsSummary of ChangesEmployee BenefitsInjury Compensation Program541.2541.2DefinitionsExcept where the content clearly indicates otherwise, the following definitionsapply:a.474Benefits or compensation — any of the following:(1)Money paid to claimants by OWCP because of loss of wages orearning ability.(2)Money paid in the form of schedule awards (e.g., loss of finger).(3)Money paid as reimbursement for medical diagnostic andtreatment services supplied under FECA.(4)Money paid as reimbursement for the replacement or repair ofmedical braces, artificial limbs, and other prosthetic devices, andfor time lost while such devices or appliances are being replacedor repaired. However, a claim is not appropriate for thereplacement or repair of eyeglasses and hearing aids except asprovided in 541.2h.(5)Money paid to specified survivors of employees whose death isjob-related.(6)Certain payments to individuals who are participating in anapproved vocational rehabilitation program.b.Claim — an assertion, in writing, of an individual’s entitlement tobenefits under FECA. This claim must be submitted on a form asrequired by 542. A claim may be filed for a traumatic injury, anoccupational disease or illness, or death.c.Claimant — an individual whose claim for benefits and/or compensationhas been filed in accordance with FECA and the provisions of 542.d.Continuation of pay (COP) — continuation of the employee’s regularpay for a period of 45 calendar days. The first COP day is the first daydisability begins following the date of injury (except where the injuryoccurs before the beginning of the work day or shift, in which case thedate of injury is charged to COP). COP can be received only if thedisability begins within 45 days of the date of the injury or within 45days from the date the employee first returns to work following the initialperiod of disability. Examples are as follows:(1)If an employee is called in ahead of the employee’s scheduledtour, is injured during the call-in period, and is unable to continueto work due to the injury, the 45-calendar-day period begins at thestart of the scheduled tour.(2)If an employee is injured during the scheduled tour and is unableto work due to the injury, the 45-calendar-day period begins onthe next calendar day.(3)If an employee works only a portion of a day or tour (other thanthe day or tour when the injury occurred), that day or tour iscounted as 1 calendar day toward the 45-day period.ELM 16, August 2000
ELM 16 ContentsSummary of ChangesEmployee BenefitsInjury Compensation Programe.Control office — a unit staffed with an Injury Compensation managerand human resources specialists responsible for injury compensationprogram administration.f.Control officer — the Injury Compensation manager who heads thecontrol office and manages the administration of the injurycompensation program within a performance cluster.g.Control point — an individual who is designated by the district managerand/or installation head to coordinate claim management activity withthe control office and is one of the following:(1)A human resources specialist if an injury compensation unit isavailable and staffed.(2)The postal physician or occupational health nurse administrator ifan occupational health services office is available and staffed.(3)An appropriate designated supervisor (full-time or collateral duty).h.Injury — a traumatic injury (see 541.2r) or an occupational disease orillness (see 541.2j), including damage to or destruction of medicalbraces, artificial limbs, and other prosthetic devices. The term does notinclude the damage or destruction of eyeglasses and hearing aids,unless the damage or destruction is a direct result of a personaljob-related injury requiring medical services.i.Monthly pay — the greatest of the following:j.ELM 16, August 2000541.2(1)Monthly pay at the time of injury.(2)Monthly pay at the time disability begins.(3)Monthly pay at the time compensable disability recurs if therecurrence begins more than 6 months after the injured employeeresumes full-time employment with the Postal Service or othergovernment agency.Occupational disease or illness — an illness or disease produced byone of the following:(1)Systemic infections.(2)Continued or repeated stress or strain.(3)Exposure to toxins, poisons, fumes, etc.(4)Other continued and repeated exposure to conditions of the workenvironment over a longer period of time than a single day orwork shift.k.Occupational health nurse administrator — a career postal or contractoccupational health nurse who, at the district level, is responsible forthe oversight and management of the medical and occupational healthservices.l.Official supervisor — an individual who is responsible for thesupervision, direction, or management of employees.475
ELM 16 ContentsSummary of ChangesEmployee BenefitsInjury Compensation Program541.2m.Physician — any surgeon, podiatrist, dentist, clinical psychologist,optometrist, chiropractor, or osteopathic practitioner used within thescope of his or her practice as defined by state law. Exceptions are asfollows:(1)Chiropractors are included only to the extent that theirreimbursable services are limited to treatment to correct a spinalsubluxation as demonstrated by X ray to exist.Note: “Subluxation as demonstrated by X ray to exist” mustappear in the chiropractor’s report for OWCP to considerpayment of a chiropractor’s bill. Also, a chiropractor may providephysical therapy under the direction of a physician.476(2)Clinical psychologists serve as physicians within the scope ofpractice as defined by state law. Unless the state law allowsclinical psychologists to treat physical conditions, a clinicalpsychologist may not serve as a physician when a conditionincludes a physical component.(3)Naturopaths, faith healers, and other practitioners of the healingarts are not recognized as physicians within the meaning ofFECA.n.OWCP — the Office of Workers’ Compensation Programs, EmploymentStandards Administration, of the Department of Labor.o.Postal physician — a Postal Service physician, medical designee, orcontract physician.p.Recurrence of disability — an employee’s inability to work, after returnto work, that is caused by a spontaneous change in the employee’smedical condition and is related to a previous injury or illness withoutintervening injury or new exposure.q.Recurrence of medical condition — a documented need for furthermedical treatment after release from treatment for the acceptedcondition or injury when there is no work stoppage.r.Traumatic injury — a condition of the body caused by external force,including stress or strain. The injury:(1)Must be identifiable as to time and place of occurrence andmember or function of the body affected.(2)Must be caused by a specific event or incident, or series ofevents or incidents, within a single day or work shift.ELM 16, August 2000
ELM 16 ContentsSummary of ChangesEmployee BenefitsInjury Compensation Program541.3541.3FormsEach installation head must maintain an adequate supply of the followingbasic forms, which are needed for recording and reporting injuries:FormTitleCA-1Federal Employee’s Notice of Traumatic Injury and Claim forContinuation of Pay/CompensationCA-2Notice of Occupational Disease and Claim for CompensationCA-2aNotice of Federal Employee’s Recurrence of Disability andClaim for Pay/CompensationCA-5Claim for Compensation by Widow, Widower, and/orChildrenCA-5bClaim for Compensation by Parents, Brothers, Sisters,Grandparents, or GrandchildrenCA-6U.S. Department of Labor Official Superior’s Report ofEmployee’s DeathCA-7/20Claim for Compensation on Account of Traumatic Injury orOccupational Disease/Attending Physician’s ReportCA-7aTime Analysis FormCA-7bLeave Buy-Back Worksheet/Certification FormCA-10What a Federal Employee Should Do When Injured at WorkCA-11When Injured at WorkCA-16Authorization for Examination and/or TreatmentCA-17Duty Status ReportCA-35AEvidence Required in Support of a Claim for OccupationalDiseaseCA-35BEvidence Required in Support of a Claim for Work-RelatedHearing LossCA-35CEvidence Required in Support of a Claim for AsbestosRelated IllnessCA-35DEvidence Required in Support of a Claim for Work-RelatedCoronary/Vascular ConditionCA-35EEvidence Required in Support of a Claim for Work-RelatedSkin DiseaseCA-35FEvidence Required in Support of a Claim for Work-RelatedPulmonary Illness (not asbestosis)CA-35GEvidence Required in Support of a Claim for Work-RelatedPsychiatric IllnessCA-35HEvidence Required in Support of a Claim for Carpal TunnelSyndromeCA-915Claimant Medical Reimbursement FormHCFA-1500 Health Insurance Claim FormPub 71ELM 16, August 2000Notice for Employees Requesting Leave for ConditionsCovered by Family and Medical Leave Policies477
ELM 16 ContentsSummary of ChangesEmployee BenefitsInjury Compensation Program542542542.1542.11542.111FormTitlePS 2488Authorization for Medical ReportPS 2491Medical Report — First Aid InjuriesPS 2556Third Party Statement of RecoveryPS 2557Employee’s Third Party Recovery StatementPS 2559Third Party Claim — Information RequestPS 2560Referral of Third Party MaterialPS 2562Injury Compensation Program — Notice of Potential ThirdParty ClaimPS 2573Request — OWCP Claim StatusPS 2577Assignment of Claim to the Postal ServiceFECA Claim RequirementsEmployee Claims for Injury or IllnessTraumatic InjuryNoticeThe notice of traumatic injury is given on Form CA-1.542.112Time LimitFECA requires that written notice of a traumatic injury be given by theemployee, or person acting on behalf of the employee, within 3 years of theinjury. However, failure to give notice on Form CA-1 within 30 calendar daysfrom the date the injury occurred will result in a loss of entitlement to COPand may also result in a loss of compensation rights if the claim forcompensation is not filed within 3 years. In order to protect their own interestsand to ensure an uninterrupted income, employees should give notice orhave someone give notice on their behalf, immediately after the traumaticinjury occurs.542.12542.121Occupational Disease or IllnessNoticeThe notice of occupational disease or illness is given on Form CA-2.542.122Time LimitFECA specifies that notice be given by the employee, or person acting onbehalf of the employee, within 3 years of the onset of the condition. In casesof latent disability, the time for filing the claim does not begin to run until theemployee has a compensable disability and is aware, or reasonably shouldbe aware of the causal relationship between the disability and theemployment. Failure to give notice within this time period may result in a lossof compensation rights. If the claim is not filed within 3 years, compensationmay still be allowed if notice of injury was given within 30 days or theemployer had actual knowledge of the injury or death within 30 days after478ELM 16, August 2000
ELM 16 ContentsSummary of ChangesEmployee BenefitsInjury Compensation Program542.21occurrence. This knowledge may be evidenced by written records or verbalnotification.Note: Continuation of regular pay is not applicable in instances ofoccupational disease or illness.542.13542.131RecurrenceNoticeThe notice of recurrence is given on Form CA-2a.542.132Time LimitA specific time limit for giving the notice of recurrence is not specified byFECA. The recurrence should be reported by the employee if it causes theemployee to lose time from work and incur a wage loss or if the employeeexperiences a renewed need for treatment after previously being releasedfrom care.542.14542.141Survivor Claim for Death BenefitsClaimA claim for compensation benefits by a survivor of an employee whose deathwas related to a job-related injury or illness is made on Form CA-5 or FormCA-5b by the survivors or person acting on behalf of the survivors. The formis given to the control office. The survivors may also submit the completedForm CA-5 or CA-5b directly to OWCP.542.142Time LimitA claim for death benefits must be filed within 3 years of the death. The filingof a notice of injury or occupational disease will satisfy the time requirementsfor a death claim as a result of the same injury or disease. In the case ofdeath due to latent disability, the time for filing does not begin until thesurvivors are aware, or reasonably should be aware, of the causalrelationship between the death and factors of the employee’s postalemployment.542.2542.21Evidence RequiredGeneralForms CA-1, CA-2, CA-2a, CA-5, and CA-5b describe the evidence required.The evidence submitted must be reliable, probative, and substantial. Theemployee is responsible for establishing that five requirements have beenmet for a claim to be accepted. The five requirements are:ELM 16, August 2000a.The claim was filed within the time limits specified by FECA.b.The injured person was, at the time of injury, an employee of the UnitedStates as defined in 5 U.S.C. 8101.c.The fact that an injury, disease, or death occurred.d.The injury, disease, or death occurred while the employee was in theperformance of duty.e.The medical condition for which benefits are claimed is causally relatedto the claimed injury, disease, or death.479
ELM 16 ContentsSummary of ChangesEmployee BenefitsInjury Compensation Program542.22542.22Medical ReportsThe employee is responsible for submitting a medical report from theattending physician. (See 545.5 and 545.51 for requirements of medicalreports and rules governing submission to OWCP.)542.23DisabilityThe employee must submit medical evidence to substantiate any claimeddisability.In COP cases, the employee must ensure the following:542.3542.31a.That medical evidence supporting disability resulting from the claimedtraumatic injury, including a statement as to when the employee canreturn to his or her date-of-injury job, is provided to the control office orcontrol point within 10 calendar days after the claim for COP is filed.b.That the treating physician specifies work limitations and provides themto the control office or control point and representatives of OWCP.PenaltiesPenalty for False StatementAny employee, supervisor, or representative who knowingly makes a falsestatement with respect to a claim under FECA may be subject to a fine of notmore than 10,000 or 5 years in prison, or both.542.32Penalty for False ClaimAny employee, supervisor, or representative who, with respect to a claimunder FECA, enters into any agreement to obtain the payment or allowanceof any false or fraudulent claim may be subject to a fine of not more than 10,000 or 10 years in prison, or both.542.33Penalty for Refusal to Process ClaimAny employee or supervisor responsible for making reports in connectionwith an injury who willfully fails, neglects, or refuses to do so; induces,compels, or directs an injured employee to forego filing a claim; or willfullyretains any notice, report, or paper required in connection with an injury maybe subject to a fine of not more than 500 or 1 year in prison, or both.542.34Loss of Benefits for Beneficiary Who Defrauds the GovernmentA beneficiary who pleads guilty or is found guilty of federal or state criminalcharges of defrauding the federal government in connection with a claim forbenefits is barred from entitlement to all future benefits for any injuryoccurring on or before the date of guilty plea or verdict. The effective date oftermination of benefits is the date the guilty plea is accepted or the date averdict of guilty is found after trial.480ELM 16, August 2000
ELM 16 ContentsSummary of ChangesEmployee BenefitsInjury Compensation Program543543.1543.42Employee RightsWaiver of Compensation RightsNo employer or other person may require an employee or other claimant toenter into any agreement, either before or after an injury or death, to waivehis or her right to claim compensation under FECA. No waiver ofcompensation rights shall be valid.543.2Withdrawal of ClaimAn employee may withdraw his or her claim (but not the notice of injury) byso requesting in writing to OWCP at any time before OWCP determineseligibility for benefits. Any COP granted to an employee after a claim iswithdrawn must be charged to sick or annual leave or considered anoverpayment of pay at the employee’s option.543.3Medical CareFECA guarantees the employee the right to an initial choice of physician. Theemployee is entitled to receive all medical services, appliances, or suppliesthat a qualified physician prescribes and OWCP determines necessary totreat the injury. For continued payment of medical expenses by OWCP, achange of the employee’s initial choice of physician is permitted only withOWCP approval. Referrals for further examination, testing, or medical careby the physician designated on the Form CA-16 are covered. (See 545.4 forimplementing medical care.)543.4Continuation of Regular Pay or Leave for Disabling InjuriesIf the injury is disabling, an eligible employee may elect to have regular paycontinued for up to 45 calendar days or to use annual leave or sick leave.(See 545.72 for explanation of eligibility for COP.)543.41Continuation of Regular PayFor most employees who sustain a traumatic injury, FECA provides that theemployer must continue the employee’s regular pay during any periods ofresulting disability up to a maximum of 45 calendar days (see 545.72 forexplanation of eligibility for COP). Such pay is subject to taxes and all otherusual payroll deductions. If an employee elects COP and the claim issubsequently denied, any COP granted to the employee must be charged tosick or annual leave or considered an overpayment of pay at the employee’soption (see 437).543.42Sick or Annual LeaveThe following provisions apply:ELM 16, August 2000a.The use of annual or sick leave does not extend the 45-calendar-dayCOP period, which begins with the first period of time lost after the dayor shift of injury.b.Leave is limited to the amount that the employee has accrued.481
ELM 16 ContentsSummary of ChangesEmployee BenefitsInjury Compensation Program544544544.1544.11544.111c.An employee
Employee Benefits Injury Compensation Program 541.14 ELM 16 Contents Summary of Changes ELM 16, August 2000 473 540 Injury Compensation Program 541 Overview 541.1 Background 541.11 Law Under the provisions of the Postal Reorganization Act, 39 U.S.C. 1005 (c), all
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TABLE OF CONTENTS UNIT LESSON TITLE PAGE NO. I 1.1 Compensation 3 1.2 Compensation Responsibilities 17 1.3 Compensation System Design Issues 23 1.4 Compensation Philosophies 29 1.5 Compensation Approaches 34 II 2.1 Fringe Benefits 41 2.2 Strategic Compensation
Clinic compensation (Total Compensation -Academic Compensation) 170,000 Dr. Smith earned 5 points in 3 different categories in calendar year 2018. Dr. Smith has therefore met the expectations for 100% the benchmark. Dr. Smith's compensation in FY20 is 200,000 30,000 (Academic Compensation) 170,000 (Clinical Compensation)
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