Schedule Awards Compensation for permanent impairment
One small branch @ 100 members LCSchedule Award Amount SR $ 46,000 CR $ 8,500 DS $ 7,000 CB $ 6,500 JR $103,000 JH $151,000 TH $ 90,500 MF $ 13,500 ES $ 20,000 KE $ 48,000 PR $ 9,500 FA $ 23,000 DC $ 68,000
5 USC 8107 Compensation Schedule (a) If there is permanent disability involving the loss, or loss of use, of a member or function of the body,… the employee is entitled to basic compensation for the disability, as provided by the schedule in subsection (c) of this section…
Webster’s Ninth Collegiate Dictionary • Schedule: a written or printed list, catalog, or inventory; also: timetable
5 USC 8107(c) • The compensation schedule is as follows: • (1) Arm lost, 312 weeks’ compensation • (2) Leg lost, 288 weeks’ compensation • (3) Hand lost, 244 weeks’ compensation • ….. • (22) For permanent loss or loss of use of any other important… internal organ… as determined by the Secretary… not to exceed 312 weeks’ compensation
20 CFR 10.404(a) • Pursuant to the authority provided by 5 USC 8107(c)(22), the Secretary has added the following organs to the compensation schedule… • Breast 52 weeks compensation • Kidney 156 weeks compensation • Larynx 160 weeks compensation • Lung 156 weeks compensation • ….
How is weekly compensation determined? The highest of pay on: • date of injury; • date of first disability; or • date of recurrence 20 CFR 10.5(s): Pay rate for compensation purposes means… the employee’s pay… at the time of injury, the time disability begins or the time compensable disability recurs if the recurrence begins more than six months after [return to full-time work]… whichever is greater.
Sample computation • A letter carrier earns $20/hour, has one or more dependents and has 42% impairment of the right arm: ???
Sample computation • A letter carrier earns $20/hour, has one or more dependents and has 42% impairment of the right arm: • $20/hour X 40 hours X .75 = $600/weekly compensation rate • 42% X 312 weeks = 131 weeks • $600 X 131 weeks = $78,600
Does receipt of a schedule award terminate further OWCP benefits? NO! See Publication CA-810 Section 6-1: The FECA at 5 USC 8103 authorizes medical services for treatment… No limit is imposed on the amount of medical expenses or the length of time for which they are paid…
Requirements to qualify a schedule award: • Have an accepted OWCP claim; • Reach maximum medical improvement; • Suffer permanent impairment to a scheduled body part or function; • Acquire and submit the necessary medical report; • Claim the schedule award.
How to claim a schedule award • Submit a CA-7; or • write a letter 20 CFR 10.103 Form CA-7 is used to claim compensation for impairment to a body part covered under the schedule established by 5 USC 8107. If Form CA-7 has already been filed to claim disability compensation, an employee may file a claim for such impairment by sending a letter to OWCP…
When a CA-7 is used: • Complete the front side of CA-7 • Submit CA-7 to USPS • Postmaster • Manager, Injury Compensation Office • Supervisor • At the same time, submit a written request for a complete copy of the CA-7
When a CA-7 is used (continued): Sample cover letter requesting copy of CA-7: Date_____ To: Postmaster Please find attached a Form CA-7 requesting a schedule award. In accordance with the Privacy Act and Handbook AS 353 Section 3-4.1, I am requesting a complete copy of the CA-7, after the Postal Service completes the agency portion. Signature
When a CA-7 is used (continued): • If no copy is provided, alert your shop steward to initiate grievance investigation • When the CA-7 is received, carefully review Section 8 for USPS errors • Base pay, night shift differential, Sunday premium • Ensure USPS forwards the CA-7 to OWCP within 5 working days
When a CA-7 is used: • Do not send the medical report (the impairment rating) to USPS. • Send, or have the rating physician send, the medical report directly to OWCP. • PO Box 8300, London KY 40742 • Ensure your claim number is on the report
When a letter requesting schedule award is used: sample letter [Claim number] [Date] Office of Workers’ Compensation Programs PO Box 8300 London KY 40742-8300 In accordance with 20 CFR 10.103, please consider this my request for a schedule award. I have enclosed a medical report by Dr. [name] dated [date] which provides an impairment rating. Please let me know if there is any further action required on my part to qualify for a schedule award. Thank you, [Signature]
The medical report must include: • Date Maximum Medical Improvement (MMI) was reached; • Percentage of impairment of the body part or function (not whole body) being rated, with explanation; • Reference to the tables, charts, and page numbers in the AMA Guides to the Evaluation of Permanent Impairment, 5th Edition, that were used.
How is the amount of permanent impairment determined? • By medical evidence, in accordance with the AMA Guides to the Evaluation of Permanent Impairment, 5th edition. • 20 CFR 10.333 To support a claim for a schedule award, a medical report must contain accurate measurements of the function of the organ or member, in accordance with the American Medical Association’s Guides to the Evaluation of Permanent Impairment.
Is use of AMA Guides mandatory? Yes! Use of the AMA Guides to the Evaluation of Permanent Impairment is mandatory. 20 CFR 10.404 OWCP evaluates the degree of impairment… according to the standards set forth in the specified (by OWCP) edition of the AMA Guides to the Evaluation of Permanent Impairment.
What edition of the AMA Guides is currently specified by OWCP? The 5th edition is currently specified. FECA Bulletin 01-05, January 29, 2001 All Claims Examiners and Hearing Representatives should begin using the fifth edition of the AMA Guides effective February 1, 2001.
What if the attending physician does not do impairment ratings? Many physicians do not do impairment ratings. Among those who do, not all do them in accordance with the AMA Guides, 5th edition.
What if the attending physician does not do impairment ratings? Injured workers should ask the attending physician if he or she does impairment ratings using the AMA Guides, 5th edition. If so, schedule an examination. If not, ask the attending physician for a referral to a physician who does impairment ratings in accordance with the AMA Guides, 5th edition.
What kind of measurements are used to determine impairment? • Loss of range-of-motion; decrease in strength; disturbance of sensation; pain; and more. • 20 CFR 10.333 …measurements may include: the actual degree of loss of active or passive motion or deformity, the amount of atrophy; the decrease.. in strength…
What does OWCP do when it gets a schedule award request? • The Claims Examiner is required to send the medical report received from the injured worker to the District Medical Advisor (DMA) for an opinion on whether the rating is correct. • The Claims Examiner then issues a formal decision either denying or granting a schedule award.
What if a claim for schedule award is denied? • Formal OWCP appeal rights apply • 30 days to request oral hearing • 1 year to request Reconsideration • 90 days to appeal to ECAB • Claimant should make a written request to OWCP for a copy of the DMA’s report • The DMA’s and attending physician’s reports should be carefully analyzed
What if the amount of the schedule award is disputed? • Formal OWCP appeal rights apply • 30 days to request oral hearing • 1 year to request Reconsideration • 90 days to appeal to ECAB • Claimant should make a written request to OWCP for a copy of the DMA’s report • The DMA’s and attending physician’s reports should be carefully analyzed