Changes for Filing OWCP Claims for COVID
Changes for Filing OWCP Claims for COVID Diagnosed After January 27, 2023
On March 11, 2021, the American Rescue Plan Act of 2021 (ARPA) was signed into law. This legislation made it possible for federal workers diagnosed with COVID-19 to establish benefits under the Workers Compensation. However, any COVID-19 claim diagnosed after January 27, 2023 must establish the five basic elements causality for adjudication set forth in the FECA regulations, which will make it more restrictive to receive Continuation of Pay (COP) by changing the burden of proof for filing a Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation (CA-1) for COIVD claims.
Previously there was something called Presumptive Service Connection to employees that contracted COVID, stating that it is not necessary for a claimant to identify a specific source of COVID-19 exposure. The American Rescue Act Plan, signed into law last March, provided that federal employees whose job requires contact with the public are automatically approved for “causal relationship”. As a result, a Letter Carrier filing a COVID-19 claim only has to prove two things: 1) That he/she performed his/her assignment at some time during the 21 day period prior to testing positive for COVID-19; and 2) Documentary evidence of the positive test result.
However, starting with cases that have been diagnosed after January 27, 2023, this only extends to claims for occupational disease filed on the CA-2 form. The bottom line is the Employee will not be paid COP, unless they meet the criteria of causality, as the DOL defines it, for an on the job injury in the filling of a CA-1. The following language can be found on the DOL website.
Filing of Cases Involving COVID-19 Diagnosed After January 27, 2023
Policy Applicability. A determination as to whether a claim based on a COVID-19 will be based exclusively on the date of the positive COVID-19 test result. Claims for COVID-19 diagnosed after January 27, 2023 should generally be filed on Form CA-2. This is because in most cases there is no clear, identifiable incident or incidents over a single day or work shift to which the injured worker can specifically attribute the event alleged to have caused the diagnosed COVID-19. While OWCP had previously required these claims to be filed on Form CA-1, which was due to the exigent circumstances and uncertainty regarding COVID-19. Those circumstances have now passed, so this change is being made so that COVID-19 is treated similarly to other airborne infectious disease where the specific etiology is unclear.
Exception: Form CA-1 may be used only if the event alleged to have caused the diagnosed COVID-19 is identifiable as to time and place of occurrence. This must be a specific event or incident or series of events or incidents during a single day or work shift.
If there is no clear, identifiable incident or incidents over a single day or work shift to which the injured worker is attributing the diagnosis of COVID-19, Form CA-2 should be used. If a claim is submitted on a CA-1 but there is no clear, identifiable incident or incidents over a single day or work shift, the claim type will be administratively updated and continuation of pay (COP) adjudicated.
Electronic Filing. The Employees' Compensation Operations and Management Portal (ECOMP) should be used to file new claims. To assist the claimant in filing the correct form, the FECA Program is updating the COVID-19 claims filing process in ECOMP to ask specific questions to direct the claimant to the CA-1 or CA-2 as appropriate.
4. Continuation of Pay (COP). Agencies are directed to process COP following the filing of Form CA-1 in accordance with established procedures.
Case Adjudication Procedures for Claims Involving COVID-19 Diagnosed After January 27, 2023
Claims for COVID-19 diagnosed after January 27, 2023, will be fully developed to establish the five basic elements for claims adjudication under the FECA:
a. The claim was filed within the time limits set by the FECA;
b. The injured worker was an employee within the meaning of the FECA;
c. The claimant provided evidence
1. Of a diagnosis of COVID-19, and
2. That establishes they actually experienced the event(s) or employment factor(s) alleged to have occurred.
d. The alleged event(s) or employment factor(s) occurred while the employee was in the performance of duty; and
e. The COVID-19 is found by a physician to be causally related to the established event(s) or employment factor(s) within the employee’s Federal employment. Neither the fact that the condition manifests itself during a period of Federal employment, nor the belief of the claimant that factors of employment caused or aggravated the condition, is sufficient in itself to establish causal relationship.
With respect to (c)(2) above, in accordance with established FECA procedure, the CE must make a factual determination by reviewing the evidence of file to decide whether the claimant actually experienced the specific event(s), or employment factor(s) claimed on Form CA-1 or CA-2. See FECA Procedure Manual 2-0803(2)(a). In doing so, the CE may credit statements made by the claimant regarding facts of which the claimant has direct knowledge. For example, if the claimant alleges that they were in close contact to 10 individuals at work, which the claimant believes resulted in the claimant getting COVID-19, OWCP may accept as fact that the claimant was in close contact to 10 individuals at work. To provide another example, if the claimant alleges their COVID-19 is the result of “sitting next to an individual that had tested positive for COVID-19,” OWCP may accept as fact that the claimant sat next to the individual, but would require the claimant to provide evidence in support of the allegation that the individual sitting next to them was COVID-19 positive.
A rationalized medical report establishing a causal link between a diagnosis of COVID-19 and factors of Federal employment is required in all claims for COVID-19 diagnosed after January 27, 2023. See FECA Procedure Manual 2-0805.3(d)(2).
IV. Specialized Requirements to Establish a Diagnosis of COVID-19. There are no changes to the specialized requirements for medical evidence needed to establish a diagnosis of COVID-19 as noted in item III(c)(1) above. See also: FECA Bulletin 21-10 and FECA Bulletin 22-06.
Specifically, in order to establish a diagnosis of COVID-19, an employee (or survivor) should submit:
a. A positive Polymerase Chain Reaction (PCR) or Antigen COVID-19 test result; or
b. A positive Antibody COVID-19 test result, together with contemporaneous medical evidence that the claimant had documented symptoms of and/or was treated for COVID-19 by a physician (a notice to quarantine is not sufficient if there was no evidence of illness); or
c. If a positive PCR, Antigen, or Antibody test is not available, a COVID-19 diagnosis from a physician together with rationalized medical opinion supporting the diagnosis and an explanation as to why a positive test result is not available.
In certain rare instances, a claimant may establish a diagnosis of COVID-19 if a physician provides a rationalized opinion with supporting factual and medical background as to why the employee has a diagnosis of COVID-19 notwithstanding a negative or series of negative COVID-19 test results.
Medical reports from nurses or physician assistants are acceptable if a licensed physician cosigns the report. Self-administered COVID-19 tests, also called "home tests”, "at-home tests”, or "over-the-counter (OTC)” tests, are insufficient to establish a diagnosis of COVID-19 under the FECA. This is because there is no way for FECA claims staff to affirmatively establish (1) the date and time the sample was collected and (2) that the sample collected is that of the injured federal employee making the claim. The only exception to this policy is where the administration of the self-test is monitored by a medical professional and the results are verified through documentation submitted by such professional.
Please do your part to spread the word of these changes. If anyone has any questions, please reach out to me at the Branch Office.
