Management’s Violations of Federal Employees Compensation Act (FECA) Part 2
ATTENTION ALL CARRIERS THAT HAVE FILED A CLAIM TO OWCP. Once you receive a Development Letter, YOU MUST CONTACT ME IMMEDIATELY. Call 631-789-1616 so we can review your claim to determine what you need to do in order to help get your case approved. Failure to contact me could result in your claim being denied.
In last month’s Article on Managements Violations of FECA requirements. The March 2019 Limb Article in this space discussed 4 common mistakes and violations that managers make in processing letter carrier's workers compensation claims. Those errors in processing letter carrier's workers compensation claims already discussed included the following:
1. Failing to advise carrier of the right to choose a physician.
2. Failing to provide a receipt for a submitted CA-1 or CA-2
3. Failure to provide a CA- 16:
4. Failing to provide completed copy of CA-1 or CA-2
Please refer to the March edition of the LIMB Leader for more detailed information on the above violations. This Article will continue with detailed information on additional Management's violations of FECA and the applicable citations from the FECA and management's Handbooks and Manuals that are pertinent to each violation.
5. Providing a CA-2a instead of a CA-1 or CA-2
Management providing a CA-2a instead of a CA-1 or CA-2 is one of the more often violations that occur. This may occur because the distinction in defining how to report an injury to the same part of the body that has already been accepted as an on the job injury by OWCP is a little complex.
To understand when a CA-1 or CA-2 is to be used instead of a CA- 2a, one should look at the following reasons for filing the appropriate OWCP forms.
Form CA-1, Federal Employee's Notice of Traumatic Injury, is used to report injuries caused by work factors that occur during the course of one work shift or workday.
Form CA-2, Federal Employee's Notice of Occupational Disease, is used to report injuries caused by work factors that occur over the course of more than one work shift or workday.
Form CA-2a, Notice of Recurrence, is used to report recurrences of previously accepted injuries. However, the OWCP definition of recurrence is highly technical and commonly
misunderstood. In the context of on-the-job injuries, recurrence is defined at 20 CFR 10.5(x):
…an inability to work after an employee has returned to work, caused by a spontaneous change in a medical condition which had resulted from a previous injury or illness without an intervening injury or new exposure to the work environment that caused the illness.
20 CFR 10.104 adds:
…a notice of recurrence should not be filed when a new injury, new occupational disease or new event contributing to an already-existing occupational disease has occurred. In these instances, the employee should file Form CA-1 or CA-2.
The key to understanding when to use a CA-2a as opposed to a CA- 2 or a CA-1 is the phrase "spontaneous change… without an intervening injury or new exposure to the work environment that caused the illness."
Some supervisors frequently provide a Form CA-2a to injured letter carriers in circumstances that call for a CA-1 or CA-2. Unsuspecting carriers then complete and submit the wrong form. This results, at best, in long delays in payment of compensation, medical benefits, and so on.
Very few supervisors are aware of the technical distinction between a recurrence and a new injury. Many assume that if a condition involves the same diagnosis and the same body part as a previous injury, it is a recurrence.
The contractual citations can be found in management's Handbooks and Manuals and can be grieved under Article 19 of The National Contract. The ELM and EL 505 require supervisors to discuss the situation with an employee when he or she reports a recurrence, and determine if the situation involves a new injury. Those citations are as follows:
ELM 541.2p restates the OWCP definition of recurrence. EL 505, page 124 also restates that definition.
EL 505, Exhibit 5.1 provides a 40 page explanation of how to distinguish between new injury and recurrence, and gives several examples.
EL 505, page 118 requires the supervisor to discuss the situation with the employee when he or she reports a recurrence. It also requires the supervisor to review Exhibit 5.1 and determine if a recurrence or new injury exists.
The above citations require management to discuss the situation with an injured letter carrier to determine what form should be used. If this discussion does not take place notify you're Shop Steward so a grievance can be filed. If there is any doubt to what form should be used even after discussing it with a supervisor, it is recommended that one call the Branch office.
6. Delaying forwarding of CA_1 or CA-2 to OWCP When OWCP does not timely receive a CA-1 or CA-2, acceptance of the claim and payment of benefits are delayed. Generally, if you are a injured letter carrier and has not received a claim number from OWCP by the end of three weeks after submitting a CA-1 or CA-2, ask the steward to investigate. The investigation should start with an interview of the supervisor who received the form and then proceed to an interview of ICCO personnel. Often such interviews result in quick transmittal of the delayed form to OWCP.
Provisions in both the law and the contract are plentiful and require management to complete and transmit Form CA-1 and CA-2 to OWCP within 10 working days after receipt from the employee.
20 CFR 10.110(a) requires the employer to complete and transmit the form to OWCP no more than 10 working days after receipt from the employee, in almost all cases. The limited exceptions include situations where there is no medical charge against OWCP, no disability beyond the day of injury, no need for more than two appointments for medical examination and/or treatment, and so on.
20 CFR 10.110(c) specifically cautions the employer to not wait for submittal of supporting evidence before sending the form to OWCP.
ELM 544.12 states: Control office and control point supervisors are responsible for reviewing all claims for accuracy and completeness and for forwarding claims and related documents to OWCP within prescribed FECA time frames.
ELM 544.212 states: The control office or control point submits to the appropriate OWCP district office within 10 working days after it is received from the employee: a. Completed Form CA-1 or Form CA-2.
ELM 545.12 states: Control point personnel must not, under any circumstances or for any reason, delay timely submission of reports or claim forms to the control office.
ELM 545.75d states: Submission of Form CA-1 to OWCP must not be delayed, under any circumstances…
EL 505, Section 4.4 states: Under no circumstances may ICCO personnel…delay submission of the CA-1 to the OWCP within 10 working days from the date received by the supervisor.
EL 505, page 176 states: Do not delay submitting the claim pending collection of data to support a controversion or challenge.
EL 505, page 218 states: Do not delay submitting the CA-1, CA-2, CA- 5 or CA-5b pending receipt of third party information.
Timely submissions by the USPS of Forms CA-1 and CA-2 to OWCP are important to injured letter carriers. Shop Steward should enforce the applicable regulations by citing the above referenced citations.
7. Failing to provide notice of controversion and challenge information. When the USPS controverts a claim, OWCP requires it to advise the employee of the challenge and its basis. Postal regulations also require written notification to the employee in all controversions and challenges.
Despite the regulations, supervisors and managers often fail to notify employees of controversions and challenges. When this occurs lack of notice usually works to the injured Letter Carriers disadvantage.
20 CFR 10.211(c) requires management to: Inform the employee of any decision to controvert COP and/ or terminate pay, and the basis for doing so.
ELM 544.12 states: The control office or control point must advise the employee whether COP will be controverted and whether pay will be interrupted.
ELM 545.731 states: Controversion means to dispute, challenge, or deny the validity of a claim. The Postal Service may controvert a claim by completing the indicated portion of Form CA-1 and submitting detailed information in support of the controversion to OWCP (see 545.75).
ELM 545.75 states: Proper identification of controverted claims is essential to permit the OWCP to give these claims priority in processing and to avoid the possibility of substantial,
erroneous payments of regular pay. If a written explanation of the controversion is not submitted, OWCP may accept as factual the employee's report of injury. When a claim is controverted, the control office or control point must ensure that the following actions are taken:
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e. The employee, employee beneficiary, or representative must be furnished with a written explanation for the basis of the controversion.
EL-505 Section 8.15 states: Notify the employee, in writing, that his or her claim is being controverted or challenged (See Exhibit 8.5, example Letter: Employee's Notice of Controverted or Challenged Claim).
EL-505 Appendix C defines challenge and controversion: challenge: The formal administrative procedure through which USPS management presents evidence to OWCP to dispute any element of an employee's claim for benefits that appears questionable.
Controversion: The formal administrative procedure through which USPS management presents evidence to OWCP to dispute an employee's claim for COP.
As with the other violations already discussed Shop Steward's should enforce the applicable regulations concerning notification of controversion and challenge information by citing the above referenced citations in grievances when violations occur.
More examples of violations along with relevant information will continue in next month’s LIMB Leader in Part 3 of Management's Violations of FECA. There should be zero tolerance for any mistakes by postal managers when it comes to processing an injured letter carrier's claim for an on the job injury.
I would like to take a moment to wish everyone a Happy Easter and Passover.
