FEDERAL INJURY COMPENSATION OVERVIEW How Does the Process Work? How Does It All Fit Together?

1. FECA DOL 20 CFR INJURED EMPLOYEE APWU OWCP ELM 540 USPS EL 505 FEDERAL INJURY COMPENSATION OVERVIEWHow Does the Process Work?How Does It All Fit Together?

2. TABLE OF CONTENTS Message from APWU President Burrus and Human Relations Director Susan M. Carney TOPICSLIDE No. OWCP Statistics 9 What It’s All About 10 Who’s Involved In The Claim Process 11 Responsibilities Immediate Supervisor 12 USPS Injury Compensation Specialist 13 Assistance By APWU 14 Five Basic Requirements For Successful Claim 15 Time Limits 16 Civilian Employee 16 Fact of Injury 17 Performance of Duty 19 Causal Relationship 20 Cite Reference Chart: Five Basic Requirements 21

3. TABLE OF CONTENTS (continued) TOPICSLIDE No. Types of Claims Traumatic Injury Definition (Form CA-1) 22 Occupational Disease Definition (Form CA-2) 24 Recurrence Definition (Form CA-2A) 26 Cite Reference Chart: Three Types of Claims 29 Traumatic Injury Form CA-16 Authorization for Examination/Treatment30 Cite Reference Chart: Traumatic Injury (Form CA-16) 32 Continuation Of Pay (COP) 33 Cite Reference Chart: Traumatic Injury: COP 36 Controversion with COP Withheld 38 Cite Reference Chart: Traumatic Injury: COP Withheld 40 Stopping COP Which Has Already Begun 41 Cite Reference Chart: Traumatic Injury: COP Stopped 43 Claim for Compensation (Forms CA-7, CA-20) 44 Cite Reference Chart: Claim forCompensation48 Leave Buy Back (Form CA-7b) 50 Cite Reference Chart: Leave Buy Back (CA-7b) 53

4. TABLE OF CONTENTS (continued) TOPICSLIDE No. Return To Work Capability Medical Restrictions 55 Cite Reference Chart: Return to Work Capability (Medical Restrictions) 57 Job Offers (Limited Duty/Rehab) 58 Cite Reference Chart: Job Offers 62 Rights and Benefits 63 Selection of Physician 66 Postal Physician or Contract Equivalent 68 USPS May Require Medical Examination 70 Physician Changes & Referrals 72 Cite Reference Chart: Selection of Physician 73 Providing Supporting Evidence 74 Employee’s Statement 75 Medical Reports 79 Sample Medical Report Traumatic Injury 83 Sample Medical Report Occupational Disease 84 OWCP Criteria For Evaluating Medical Reports 85 OWCP Directed Medical Exams Second Opinions 86 Referee Specialist 88

5. TABLE OF CONTENTS (continued) TOPICSLIDE No. Postal Service: Fitness for Duty 90 Medical Privacy 92 Schedule Award 95 Cite Reference: Schedule Award99 Challenging Formal OWCP Decisions 100 Oral Hearing 101 Review of the Written Record 103 Reconsideration 105 Review by ECAB 107 Definitions 108 Work Limitation Due To Pain 112 Separation Disability 113 Disability Retirement 114 Medical Bill Payment and Medical Authorization Process 116

6. TABLE OF CONTENTS (continued) TOPICSLIDE No. OWCP Information 118 Federal Employees Compensation Act (FECA), Title 5, Chapter 81 Code of Federal Regulations, Claims for Compensation under FECA, Parts 10 and 25 Questions and Answers About FECA, CA 550 Injury Compensation for Federal Employees, CA 810 When Injured at Work, Guide for Federal Employees, CA 11 OWCP Forms 119 OWCP- Information (Handbooks and Manuals) 120 U.S. Dep’t of Labor, Self-Instructional Injury Compensation Specialist Training Video ELM 540, Injury Compensation Program EL 505, Injury Compensation Letters, MOUS, and Step 4 Decisions 121 Letters: Letter from USPS Labor Relations At Headquarters—Services Policy for Employees that Sustained On-the-job injuries. A1 USPS Sample Letter—Limited Duty Assignments and MOU from Headquarters. A2 Letter from USPS Labor Relations—Local Management . . .Limited Duty A6 Letter from USPS Labor Relations—Use of Medical Reports A9 Letter from USPS. Management’s Discrimination of . . . limited duty vs. light duty assignments . A14 Letter from USPS Labor Relations Discipline for Safety Rule Violation A27

7. TABLE OF CONTENTS (continued) TOPICSLIDE No. National Pre-Arb Settlement: Limited Duty Assignments A3 Limited Duty FTRE . . . with varying report times. A5 Job Related First Aid Injuries A8 Step 4 Decisions: Separation from Postal Service for reasons of disability A4 Reporting an accident A7 Fitness for duty . . . on-the-job injury or illness A10 Availability of CA-8 Forms A11 Limited Duty—Violation of ELM Provisions A12 Locally developed form supplementing data on Form 3996 A15 Use of Locally generated forms A16 Outside party paying medical expenses . . . compensation forms A17 Employee can’t be compelled . . . during non-working hours A18 Light duty/limited duty signing Overtime Desired List A19 Completing form 2488 is voluntary (employee) A20 CA17 usually adequate for medical information A21 Completing PS Form 3971, Continuation of Pay (COP) A22 Limited Duty Employee Coverage by CBR A23

8. TABLE OF CONTENTS (continued) TOPICSLIDE No. Step 4 Decisions (continued): Agreement Violation of Permanently Reassigned Work in another craft A24 Removal from bid while on Limited Duty A25 Limited Duty Withdrawal with subsequent Notice of Proposed Removal. A26 MOUs: (NALC) Limited Duty Grievance Representation A13

9. OFFICE OF WORKERS’ COMPENSATION (OWCP) STATISTICS • Approximately 175,000 Workers’ Compensation Claims Are Filed Annually. • Of These, 85,000 Are Filed By USPS Employees, Representing More than 10% Of The USPS Workforce. • Generally, 90% Of Simple Traumatic Claims And 60% Of Simple Occupational Claims Are Accepted. • In 2003, These Claims Cost The USPS Over $1.5 Billion. • The Future Liability For These Employee Injuries Is Almost $7 Billion.

10. WHAT IT’S ALL ABOUT? Time Limits FECA Q&A ELM OWCP Forms • Federal Employee Compensation Act (FECA) • 20 Code of Federal Regulations (CFR) • Employee Labor Relations Manual (ELM) • EL 505, Injury Compensation

11. WHO’S INVOLVED IN THE CLAIM PROCESS? • Under The Department Of Labor, The Employment Standards Administration Oversees OWCP. • Within OWCP, The Division Of Federal Employees’ Compensation (FEC) Decides Injury Claims. They Are The Determining Office. • In The USPS, The Injury Compensation Specialist (ICS) Is Responsible For Sending Claims To OWCP. The USPS Injury Compensation Office And Their Representatives Are Not An Extension Of OWCP. They Are The Control Point And Have No Authority To Adjudicate Claims. • The USPS Supervisor Forwards Claim Forms To The ICS.

12. RESPONSIBILITIES OF THE IMMEDIATE SUPERVISOR • Immediately Ensuring That Appropriate Medical Care Is Provided. • Form CA-1 (Traumatic), Or Form CA-2 (Occupational) • Provide Form To Employee (Complete Receipt And Give To Employee). • On The Same Day As Received, Complete And Forward Form CA-1 Or Form CA-2 To The ICS [ELM 544.11]. • Permit Employee To Select A Physician/Hospital Of Choice [ELM 545.21]. • If Traumatic Injury Prevents Employee From Working Must Advise Employee Of Right To Choose Continuation Of Pay (COP) [ELM 544.112]. • Cannot Cause An Employee To Forgo Filing A Claim, Or Refuse To Process It [ELM 544.11] .

13. RESPONSIBILITIES OF THE USPS INJURY COMPENSATION SPECIALIST Go See Dr. • Completes Employer Portions Of Forms CA-16 And CA-17. • Advises Employee Whether Continuation Of Pay (COP) Will Be Controverted. • Advises Employee If COP Will Not Be Paid. • Provides Copy Of Completed CA-1, CA-2 Or CA-2a To Employee And Copy Of All Correspondence Between USPS And Employee’s Physician. [ELM 544.12]. • Submits Form CA-1, CA-2, Or CA-2a To OWCP Within 10 Working Days. [ELM 544.212]. • If Traumatic Injury (CA-1) Must Promptly Authorize Medical Care By Issuing Employee Form CA-16 Within 4 Hours Of Receiving Notice Of Claimed Injury. [ELM 545.21].

14. ASSISTANCE BY APWU • Member And Non-Member: If Language Of Collective Bargaining Agreement (CBA) Or A Handbook Or Manual (e.g., ELM 540, EL 505) Has Been Violated By The USPS Make Grievance Decision. Grievances Cannot Be Filed Against OWCP. • Member Only: Provide Information About OWCP Procedures And Appeals. You Do Not Have To Be Employee’s “Authorized OWCP Representative” To Assist Them With Their Claim.

15. FIVE BASIC REQUIREMENTS FORSUCCESSFUL CLAIM In The Order They Are Considered: • Time Limits • Civilian Employee • Fact Of Injury • Performance Of Duty • Causal Relationship (continued)

16. FIVE BASIC REQUIREMENTS(continued) • Written Notice Must Be Given Within 3 Years Of Injury Or Onset Of Medical Condition. • Latent (Not Evident) Disability—Must Be Given Within 3 Years Of Reasonably Knowing Condition Caused By Work Activity. Time Limits Civilian Employee • All USPS Employees Including Casuals And TEs Are Civilian Federal Employees. (continued)

17. FIVE BASIC REQUIREMENTS (continued)Fact Of Injury Two Elements Must Be Met: Occurrence Of Event • The Employee Must Have Actually Experienced The Accident, Event Or Employment Factor. • Determined On The Basis Of Factual Evidence, Including Statements From The Employee, The Supervisor, And Any Witnesses. • An Injury Does Not Have To Be Witnessed To Be Compensable. (continued)

18. FIVE BASIC REQUIREMENTS: (continued) Fact Of Injury Existence Of Medical Condition • The Accident Or Employment Factor Resulted In An Injury Or Disease. However, Employment Is Not Required To Be The Sole Factor To Have Caused An Injury Or Disease, Only A Contributing Factor. • Determined On The Basis Of The Attending Physician’s Statement That A Medical Condition Is Present That Could Be Related To The Incident Though The Medical Report Does Not Have To Relate The Condition To The Incident. • Simple Exposure Does Not Constitute An Injury. (continued)

19. FIVE BASIC REQUIREMENTS(continued)Performance Of Duty • Usually Injury/Illness Must Occur While At Work. • Must Be Performing Expected Job Duties. • Breaks And “Lunches” Covered If On Premises. • For Most APWU Crafts Driving To And From Work Ordinarily Not Covered. (continued)

20. FIVE BASIC REQUIREMENTS(continued)Causal Relationship • Physician Must State To A “Reasonable Medical Certainty” That Work Activity Caused Or Contributed To The Diagnosed Condition. • Physician Must Provide Medical Reasoning (Rationale) To Support Opinion Of Causal Relationship (How Physician Came To The Conclusion That There Is A Causal Relationship Between The Injury And The Workplace). (continued)

21. FIVE BASIC REQUIREMENTS • Time Limits • Civilian Employee • Fact Of Injury • Performance Of Duty • Causal Relationship

22. THREE TYPES OF CLAIMS:TRAUMATIC, OCCUPATIONAL, AND RECURRENCETraumatic Injuries (Form CA-1) Go see Dr. • A Medical Condition Caused By A Specific Incident Or Series Of Incidents In A Single Work Day/Shift. • Specific As To When And Where It Happened. • Specific As To Part Of The Body Injured. • Filed As Traumatic Not By Type Of Medical Condition, But Because Injury Happened On A Single Work Day/Shift. • May Choose COP If Injury Reported On Form CA-1 Within 30 Days Of The Injury. (continued)

23. THREE TYPES OF CLAIMSTraumatic Injury(continued) USPS • Complete CA-1 To Give Notification. • USPS Has Ten (10) Working Days To Submit CA-1 To OWCP. • COP – If Eligibility Requirements Are Met. • CA-1 States Employer Statement And Physician’s Medical Report Are Required. • Follow Instructions On CA-1 To Satisfy Requirements. (continued)

24. THREE TYPES OF CLAIMS(continued)Occupational Disease Or Illness (Form CA-2) Go see Dr. • A Medical Condition Caused By Work Activity Occurring Over More Than A Single Work Day/Shift. • No Entitlement To COP Or Form CA-16. • Filed As An Occupational Not By Type Of Medical Condition But Because It Happened Over More Than One Work Day/Shift. (continued)

25. THREE TYPES OF CLAIMS(continued)Occupational Disease/Illness(Form CA-2) • Complete CA-2 To Give Notification. • USPS Has 10 Working Days To Submit CA-2 To OWCP • No COP Entitlement. • File CA-7 For Wage Loss Compensation • CA-16 (Issuance Very Rare. USPS May Issue Only After Obtaining Approval From OWCP). (continued)

26. THREE TYPES OF CLAIMS(continued)Recurrence(Form CA-2A) Go see Dr. Recurrence Of Disability • Spontaneous Worsening Of An Accepted Condition Without An Intervening Event. • Worsening: Unable To Continue Working The Same Amount Of Hours After Returning To Work, e.g., 40 Hours To 30 Hours, Call-Out Due To Work-Related Injury. • If Accepted Condition Is Worsened By Work Activity, File A New Traumatic Or Occupational Claim. May Be Entitled To COP If Traumatic. (continued)

27. THREE TYPES OF CLAIMSRecurrence Go see Dr. Recurrence Of Disability (continued) • USPS Withdrawal Of Limited Duty/Rehab Job. • Any Reduction In Job Hours. • Recurrence Of A Need For Medical Treatment With No Work Stoppage (Also Reopening A “Closed Claim”). • If No Longer Seeing Physician But Need Additional Medical Care • Continuous Treatment Is Not “Additional” Treatment • Simple Examination By Physician Is Not “Treatment” (continued)

28. THREE TYPES OF CLAIMSRecurrence(continued) Go see Dr. • May Be Entitled To Any COP Balance If Original Injury Traumatic. • Must Provide A Detailed Factual Statement (Comply Fully With Instructions On Form CA-2a). • Medical Evidence Must Establish That The Recurrence Of Inability To Work Is Causally Related To The Original Accepted Injury. • After Returning To Work From Original Disability, Only OWCP Can Declare A Subsequent Absence Compensable, i.e., An “IOD”. (continued)

29. THREE TYPES OF CLAIMS • Traumatic Injury (Form CA-1) • Occupational Disease (Form CA-2) • Recurrence (Form CA-2a)

30. TRAUMATIC INJURY OWCP Form CA-16“Authorization For Examination/Treatment” USPS • Issued For Traumatic Injuries Requiring Medical Care. • Authorizes Medical For 60 Days Unless OWCP Stops Authorization. • Employee Chooses Physician. • Must Be Issued To Employee Within 4 Hours Of Receiving Notice Of Claimed Injury (Within 48 Hours If Initial Authorization Is Verbal). • Not Issued If More Than One Week From Injury Date. (continued)

31. TRAUMATIC INJURY OWCP Form CA-16“Authorization For Examination/Treatment”(continued) USPS • Authorization Includes Subsequent Physicians When Original Physician Refers. • Issuance Required Even If USPS Doubts Injury. • Not Required For First Aid When Employee Voluntarily Accepts Postal/Contract Physician (Maximum 2 Visits). • Not Required For Simple Hazard Exposure Without Medical Condition. (continued)

32. TRAUMATIC INJURYOWCP FORM CA16“Authorization For Examination/Treatment” USPS • Authorizes Medical Care • 60 Day Maximum • Employee Selects Physician • Within 4 Hours • Within One Week Of Injury • Referral To Different Physician • USPS Doubts Injury • First Aid By Postal/Contract • Hazard Exposure

33. TRAUMATIC INJURYContinuation Of Pay USPS • COP Is The Continuation Of Employee’s Regular Salary For Wage Loss Due To Disability And/Or Medical Treatment. • It’s Intended To Eliminate Interruption Of The Employee’s Income While OWCP Processes The Claim. • It Includes N/D, S/P And Holiday Pay. • COP Is Not Considered Compensation. • Is Employer Paid. • Is Subject To Deductions For Income Tax, Retirement, Etc. • Employee Is In Pay Status. (continued)

34. TRAUMATIC INJURY Continuation Of Pay(continued) USPS • Not Available For Occupational Injuries (Form CA-2). • Must File CA-1 Within 30 Days Of Injury. • Must Begin Losing Time From Work Within 45 Days Of Injury. • Employee’s Choice To Use COP—Should Not Be Required To Use S/L Or A/L. If Unaware COP Was An Entitlement/ Choice, Employee Has One Year (From Date Of Use) To Request Adjustment. • Must Provide Prima Fascia Medical Evidence Of Disability (Inability To Work) Within 10 Days Of When COP Begins In Order For COP To Continue. • 45 Calendar Day Entitlement. • Day Of Injury Not Counted As COP (Paid As Administrative Leave). (continued)

35. TRAUMATIC INJURY Continuation Of Pay(continued) USPS • Must Begin Using Any Balance Of COP Within 45 Days Of First Return To Work (RTW)—RTW From Disability Not Date Of Injury. • COP May Be Used Beyond 45 Day RTW Time Limit Provided Employee Begins Using COP Balance No Later Than The 45th Day From Their RTW And Disability Continues Without Interruption. • If Disability Extends Beyond COP Period, File For Compensation. • May Use COP For Medical Treatment/Examination Time. Employee Required To RTW To Complete Work Shift Unless Disabled. • COP Is Counted By Days Not Hours. Partial Days Of COP Count As A Full Day Of COP. • May Later Request COP After Using SL/AL Once Claim Is Approved. • If OWCP Denies Claims COP Must Be Repaid (May Use SL/AL).

36. USPS TRAUMATIC INJURY Continuation Of Pay • Not For “Occupationals” • File Within 30 Days • Lose Time Within 45 Days • Medical Within 10 Days • 45 Day Entitlement • Day Of Injury Not Counted • Repayment (continued)

37. TRAUMATIC INJURY Continuation Of Pay(continued) USPS • Begin Within 45 Days Of RTW • Using Balance (Uninterrupted) • Disability Goes Beyond COP • Physician Visits • Remaining COP • May Request COP Later

38. TRAUMATIC INJURY Controversion With COP Withheld Go see Dr. • The USPS Can Controvert (Challenge, Dispute) An OWCP Claim. However, OWCP Makes The Final Decision As To Whether A Claim Is Accepted Or Denied. • The USPS Can Controvert And Deny Payment Of COP Only For The Following Reasons: • The Disability Was Not Caused By A Traumatic Injury; • The Employee Is Not A Citizen Of The U.S. Or Canada; • No Written Claim Was Filed Within 30 Days From The Date Of Injury; (continued)

39. TRAUMATIC INJURY: CONTROVERSION WITH COP WITHHELD (continued) Go see Dr. • The Injury Was Not Reported Until After Employment Has Been Terminated; • The Injury Occurred Off The Employing Agency’s Premises And Was Not Otherwise Within The Performance Of Official Duties; • The Injury Was Caused By The Employee’s Willful Misconduct, Intent To Injure Or Kill Himself/Herself Or Another Person, Or Was Proximately Caused By Intoxication By Alcohol Or Illegal Drugs; • First Absence Caused By The Injury Was More Than 45 Days After The Date Of Injury. (continued)

40. TRAUMATIC INJURY COP Withheld • Not A Traumatic Injury • Not A Citizen Of U.S. • No Claim Within 30 Days • Injury Not Reported Prior To Termination Notice • Injury Off Premises And Not In Performance Of Duty • Willful Misconduct, Intent To Injure, Intoxication • First Absence More Than 45 Days After Injury

41. TRAUMATIC INJURY Stopping COP Which Has Already Begun USPS After COP Has Been Started It May Be Stopped Only In The Following Circumstances: • Medical Evidence Which On Its Face Supports Inability To Work Due To The Workplace Injury Is Not Received Within 10 Calendar Days After Claim Is Submitted; • Medical Evidence From Employee’s Physician Shows Employee Not Disabled; • Medical Evidence From Employee’s Physician Shows Employee Not Totally Disabled And Employee Refuses Written Job Offer That Is Approved By Employee’s Physician; (continued)

42. TRAUMATIC INJURY Stopping COP Which Has Already Begun(continued) USPS • Employee Returns To Work With No Loss Of Pay; • Specific Term Of Employment Ends; • Termination Of Employment Established Prior To Injury; • OWCP Directs Employer To Stop COP; • And/Or COP Paid For 45 Calendar Days.

43. TRAUMATIC INJURYCOP Stopped • No Medical Evidence Within 10 Days • Medical Evidence Shows No Disability • Medical Evidence Shows Partial Disability And Job Offer Refused • Employee Returns To Work With No Pay Loss • Term Of Employment Ends • Termination Of Employment • OWCP Directs • 45 Days Paid

44. CLAIM FOR COMPENSATION (Form CA-7)(Form CA-20) • Submit Form CA-7 To Supervisor Every Two Weeks And Send Form CA-20, “Attending Physician’s Report” To OWCP. • Wage Loss Compensation Is Paid At Two-Thirds Of Pay Rate If No Dependents And Three-Fourths If One Or More Dependents. • Compensation Is Based On Pay Rate On Day Of Injury Or First Disability, Whichever Is Greater. (continued)

45. CLAIM FOR COMPENSATION(continued) • Night Differential, Sunday Premium And Holiday Pay Are Included In Pay Rate, But Overtime Is Excluded. • Compensation Is Tax Free. The Only Deductions Are Premiums For Health Insurance And Optional Life Insurance. • Payable After Three Day Wait (Non-Work Day, Non-Pay Status), But Waiting Period Waived If Total Disability Exceeds 14 Days. (continued)

46. CLAIM FOR COMPENSATION(continued) • Postal Service Must Submit CA-7 To OWCP Not More Than 5 Working Days After Receipt From Employee. • An Employee Is In A Leave Without Pay (LWOP) Status When Receiving Wage Loss Compensation From OWCP. • Employees In A LWOP Status For Any Reason Do Not Accrue Sick Or Annual Leave Nor Can They Participate In The Thrift Savings Plan. (continued)

47. CLAIM FOR COMPENSATION(continued) • Time Spent In A LWOP Status For Purpose Of Receiving OWCP Compensation Is Computed As Creditable Service For Retirement. • Once Pay Rate For Compensation Is Established It Does Not Change (No Negotiated COLAs Or Raises), Unless Employee Returns To Work For More Than 6 Months Of Regular Full Time Employment . (continued)

48. CLAIM FOR COMPENSATION • Submit Form CA-7 • ⅔ Or ¾ Pay Rate • Pay Rate At Time Of Injury • Sunday Premium, Night Differential, Holiday Pay, Not OT • Tax Free • Three Day Wait (continued)

49. CLAIM FOR COMPENSATION(continued) • Five Working Days, USPS To OWCP • LWOP For Compensation • No Leave Accrual In LWOP • Creditable Service For Retirement • No Contractual Increase In Compensation Pay Rate

50. LEAVE BUY BACK (Form CA-7b) • A Leave Buy Back (LBB) Program Is At The Discretion Of The Employer. It Is Not An OWCP Requirement. • If Employees Use Sick Or Annual Leave While Waiting For Their Claim To Be Approved By OWCP They May Apply To Buy It Back. • The USPS Will Not Process A LBB Request For Leave Used After A Claim Has Been Approved. • File Local Grievance, Hold Pending Adjudication Of National Grievance (Q98C-4Q-C01208677). (continued)