Workers’ Compensation: Federal Employees’ Compensation
Act (FECA)
General Rules and Procedures
The Federal Employees’ Compensation
Act is the law governing the payment of workers’ compensation
benefits to civilian employees of the United States who suffer
a disability due to personal injury (including occupational disease)
sustained while in the performance of duty. Damage to or destruction
of medical braces, artificial limbs, and other prosthetic devices
incidental to a job-related personal injury is also compensable.
The act also provides for the payment of benefits to dependents
if a job-related injury or disease causes the employee’s
death.
FECA is administered by the Office of Workers’
Compensation Programs (OWCP) in the Labor Department, through
district offices located throughout the United States. Its website
is www.dol.gov/esa/regs/compliance/owcp/fecacont.htm.
FECA forms are found at www.dol.gov/esa/regs/compliance/owcp/forms.htm.
All injuries, including disease proximately
caused by employment, sustained while in the performance of duty
by civilian employees of the United States (with the exception
of non-appropriated fund employees), are covered. Coverage is
provided by special legislation to Peace Corps and VISTA volunteers,
federal petit or grand jurors, volunteer members of the Civil
Air Patrol, Reserve Officer Training Corps cadets, Job Corps,
Neighborhood Youth Corps and Youth Conservation Corps enrollees,
and non-federal law enforcement officers under certain circumstances
(e.g., situations involving crimes against the United States).
Temporary employees are covered on the same basis as permanent
employees.
The employee must provide medical and factual
evidence to establish the essential elements of a claim. These
elements generally include proof that the claim was filed within
FECA’s statutory time requirements, the injured or deceased
person was an employee within the scope defined by FECA, the employee
sustained an injury or disease, the employee was in the performance
of duty when the injury occurred, and the employee’s compensable
condition resulted from the injury.
Benefits cannot be paid if a worker’s
injury or death is caused by the injured employee’s intoxication
or willful misconduct or by an intent to bring about the injury
or death of oneself or another.
All injuries should be reported, since a seemingly
minor injury may develop into a more serious condition. For protection,
the employee should file a report of the injury with the immediate
supervisor when it occurs. Benefits will not be paid unless an
injury is reported.
A traumatic injury is defined as a wound or
other condition of the body caused by external force, including
stress or strain. The injury must be caused by a specific event
or incident or series of events or incidents within a single day
or work shift.
An occupational disease is defined as a condition
produced in the work environment over a period longer than one
workday or shift. It may result from systemic infection, repeated
stress or strain, exposure to toxins, poisons, fumes, or other
continuing conditions of the work environment.
Diseases and illnesses aggravated, accelerated,
or precipitated by the employment are covered. The employee must
submit medical and factual evidence that establishes that the
employment aggravated, accelerated, or precipitated the condition.
A recurrence of an employment-related disability
is covered if an injured employee is again disabled as a result
of the original injury or occupational disease.
:: Back to Top ::
FECA Coverage Rules
Federal employees generally are eligible for
FECA coverage regardless of the length of time they’ve been
on the job or the type of position held. Compensation payments
can be made after wage loss begins and medical evidence shows
that the employee is unable to perform the duties of his or her
regular job.
An employee who sustains a disabling traumatic
injury is entitled to continuation of regular pay (COP) for a
period not to exceed 45 calendar days. This is considered salary
for all intents and purposes, including tax deductions, and not
compensation. In order to be eligible for COP, written notice
of injury must be filed within 30 days of the injury.
Schedule awards are FECA payments that are
provided for specified periods of time for the permanent loss,
or loss of use, of certain parts and functions of the body. Partial
loss or loss of use of these parts and functions is compensated
on a proportional basis. Before payment of a schedule award can
be considered, the condition of the affected part of the body
must reach maximum improvement. This determination involves a
medical judgment that the condition has permanently stabilized.
:: Back to Top ::
FECA Compensation Payments
Total disability benefits may be paid to injured
workers to compensate them for lost wages after the end of a continuation-of-pay
period or from the beginning of pay loss. An employee who receives
disability payments will be notified by letter of the amount of
compensation to be paid, including the pay rate used as a basis
and the resulting compensation rate. Compensation payments for
total disability may continue as long as the medical evidence
substantiates total disability.
No compensation is payable for the first three
days of wage loss unless the disability exceeds 14 days after
the expiration of COP, where COP is payable, or the injury results
in permanent impairment. Injured employees may use sick or annual
leave credited to their account if so desired, in which event
FECA compensation does not begin until the expiration of leave.
Use of personal leave should only be necessary in extreme circumstances.
Monetary compensation is based on the monthly
pay of the injured employee at the time of the injury, at the
time the disability begins, or at the time a compensable disability
recurs (if such recurrence begins more than six months after the
injured employee resumes regular full-time employment with the
United States), whichever is greater.
FECA compensation generally is calculated
at two-thirds of the employee’s monthly pay rate if he or
she has no dependents, or three-fourths of the pay rate if married
or with one or more dependents.
For FECA benefit purposes, a dependent is:
a wife or husband residing with the employee or receiving regular
support payments from him or her; an unmarried child who lives
with the employee or who receives regular support payments from
him or her who is under age 18, or if over age 18 is incapable
of self-support due to physical or mental disability; a student
between 18 and 23 years of age who has not completed four years
of post-high school education and who is regularly pursuing a
full-time course of study; and a parent who is wholly dependent
on the employee.
Locality, night differential, hazard, premium, holiday, and Sunday
pay are included in determining the pay rate on which compensation
is based, although overtime pay is not. The maximum payment per
month cannot exceed three-fourths of the highest rate of basic
pay provided for grade GS-15.
Minimum monthly compensation for total disability
cannot be less than three-fourths of the lowest basic monthly
pay level for GS-2, or the employee’s monthly pay, whichever
is less, except for increases resulting from cost-of-living adjustments.
If, as the result of an on-the-job injury,
an employee returns to work at a lower rate of pay, compensation
for loss of earning capacity is paid at the rate of two-thirds
(without dependents) or three-fourths (with dependents) of the
loss of earning capacity. The wage earning capacity of a partially
disabled employee is determined by actual earnings, or if the
employee has no actual earnings, an amount determined by OWCP
taking into consideration the nature of the injury and other factors
that affect the capacity to earn wages.
Compensation for disability cannot be paid
concurrently with an annuity (including a lump-sum payment) under
the Civil Service Retirement System, or the Federal Employees’
Retirement System, or any other law providing retirement benefits
in lieu of those provided under the CSRS or FERS. An employee
entitled to both types of benefits (i.e., retirement and FECA)
must make an election; however, a new election may be made whenever
it is to the employee’s advantage to do so. (For more detail,
see the section below entitled “Disability Retirement vs.
FECA Benefits.”)
Health Insurance Coverage—Under
provisions of the Federal Employees’ Health Benefits Act,
employees, former employees, and survivors of deceased employees
who meet certain requirements may continue their health benefits
coverage while in receipt of disability or death compensation.
The employee’s or survivor’s share of the cost of
the FEHB insurance is withheld from the compensation.
Cost-of-Living Adjustments—For
individuals who have been in receipt of compensation benefits
for more than one year, those benefits are increased effective
March 1 of each year by any percentage change in the Consumer
Price Index published for December of the preceding year.
:: Back to Top ::
Schedule Awards
FECA may pay a scheduled award for a permanent
impairment to certain members or functions of the body (such as
loss of use of an eye or arm, or loss of function or removal of
a kidney due to injury). The amounts payable are specified by
the Federal Employees Compensation Act.
Schedule awards can be paid during a period
where the employee is receiving federal salary or retirement benefits,
is working for private industry, or is self-employed. Employees
may not receive wage loss compensation and schedule awards benefits
concurrently for the same injury.
If an employee sustains a period of temporary
total disability during the course of the award, it may be interrupted
to pay the period of disability; the schedule award will resume
afterwards. If an employee dies during the course of a schedule
award from causes unrelated to the compensable injury, his or
her dependents are entitled to two-thirds of the balance of the
award.
Schedule award amounts vary from 15 weeks
to 312 weeks of compensation for total loss or loss of use of
designated body parts. There is an additional award for serious
disfigurement of the head, face or neck.
:: Back to Top ::
Medical Care Benefits
FECA covers all medical care that an employee
needs to recover from the effects of a work-related injury, including
hospitalization, nursing service, prosthetic appliances, and services
of an attendant when required in severe injuries. The employee
has the right to initially select a physician to provide medical
services, appliances, and supplies. The term “physician”
includes surgeons, podiatrists, dentists, clinical psychologists,
optometrists, chiropractors (to the extent that such services
are reimbursable under the Act), and osteopathic practitioners
within the scope of their practice as defined by state law. Payments
for chiropractic services are limited to treatment consisting
of manual manipulation of the spine to correct a subluxation that
has been verified by an X-ray. A physician whose license to practice
medicine has been suspended or revoked by a state licensing or
regulatory authority is not a physician within the meaning of
this section during the period of such suspension or revocation.
Medical care coverage also extends to the
necessary cost of transportation and expenses incident to securing
medical services, appliances and supplies. Medical care for a
compensable injury may be continued after a beneficiary accepts
a retirement annuity. Bills for injury-related medical expenses
should be submitted promptly. No bill will be paid for expenses
incurred if the bill is submitted more than one year beyond the
end of the calendar year in which the expense was incurred, or
more than one year beyond the end of the calendar year in which
the claim was first accepted as compensable, whichever is later.
Vocational Rehabilitation—A permanently
disabled employee may be provided with vocational rehabilitation
services and an additional allowance may be paid for necessary
maintenance in an amount not to exceed $200 per month while the
employee is undergoing an approved course of training. Also, an
employee will be paid compensation at the rate for total disability
while pursuing an OWCP-approved training course.
:: Back to Top ::
Survivor and Death Benefits
When an employee dies as a result of a job-related
injury, the individual’s surviving spouse and dependents
may qualify for monthly compensation benefits. The surviving spouse
must be living with or dependent for support on the injured worker
at the time of death (or living apart for reasonable cause or
because of the employee’s desertion).
If no children are eligible, a deceased worker’s
surviving spouse would receive 50 percent of the employee’s
salary. If there are children, a surviving spouse would receive
45 percent of the worker’s salary, plus an additional 15
percent for each child up to a total of 75 percent of salary.
If there is no widow or widower, FECA compensation for the first
child is 40 percent of the employee’s salary and each additional
child is entitled to 15 percent of the employee’s salary,
up to a maximum of 75 percent, payable on a share and share alike
basis.
In rare instances, parents, minor brothers
and sisters, and grandparents and grandchildren who were totally
dependent on the deceased employee at the time of death, may be
entitled to a small portion of survivor benefits. Payments are
not made after a beneficiary marries or completes four years of
study beyond high school.
When survivors are eligible from OPM, they
may be eligible for both death compensation benefits and a survivor
annuity from OPM. They must elect which of the two benefits they
wish to receive.
Survivor benefits will be reduced if the employee
was covered under FERS and the survivors are eligible for Social
Security benefits based on the employee’s federal employment.
FECA provides for payment of reasonable burial
expenses, up to a maximum of $800. Apart from any funeral or burial
expenses, a separate sum of $200 is paid to the personal representative
of a deceased employee for reimbursement of the costs incurred
in terminating the deceased worker’s status as an employee
of the United States.
:: Back to Top ::
Recovery and Job Restoration
OWCP requires most individuals receiving FECA
disability benefits to undergo medical examinations once a year.
The evaluation usually is done by the employee’s own physician.
OWCP may, however, require the employee to be examined by another
physician. FECA compensation will be terminated if medical evidence
is submitted that indicates that the employee no longer has residual
limitations from the accepted condition and can return to the
former job without limitations; or the individual’s employer
makes a suitable job offer which is unreasonably refused by the
employee. OWCP will determine both the suitability of the job
offer and the reasonableness of a worker’s refusal.
Receipt of a schedule award—i.e., an
OWCP payment for a permanent impairment of a specified body member,
function, or organ—does not necessarily mean the individual
has recovered for purposes of job restoration rights. It only
means that part of the employee’s body is considered to
have reached maximum medical improvement.
FECA benefit payments can be suspended if
the employee does not cooperate with a specific directive from
OWCP (such as a request to report for medical examination) or
fails to respond within 30 days to a request for information on
employment/earnings, dependents, or the receipt of dual benefits.
Similarly, FECA compensation can be suspended if a beneficiary
in a death case fails to respond to a request for information
on continuing entitlement, such as verification of student status.
Where an individual’s response to such requests is subsequently
received, OWCP may reinstate benefits retroactive to the date
of suspension, if appropriate.
Job Restoration Rights—If
employees recover from their disability within one year from the
date they became entitled to FECA payments, they have the right
to return to their former jobs or an equivalent position. Even
if their period of disability extends beyond one year, employees
have priority placement rights to their former or equivalent positions.
The restoration rights of employees who sustain
compensable injuries fall into four separate categories depending
on the length and extent of recovery. Other factors affecting
restoration rights are the timeliness of the application for restoration,
the employee’s performance and conduct prior to the injury,
and the availability of positions.
Full recovery is determined by a decision
to terminate FECA benefits on the basis that the employee is medically
able to resume regular employment. For purposes of restoration
rights, a position with the same seniority, status, and pay means
a position that is equivalent to the former one in terms of pay,
grade, type of appointment, tenure, work schedule, and, where
applicable, seniority. An employee’s standing in the organization,
such as first or second supervisory level, is not a factor.
The four categories are:
- Fully recovered within one year. Employees who fully recover
within one year from the date compensation began have mandatory
restoration rights to their former job or an equivalent position.
This basic entitlement is to a position in the former commuting
area. If a suitable vacancy does not exist, the restoration
right is agency-wide. Employees must apply for restoration immediately
and must be restored immediately and unconditionally by their
former agency.
- Fully recovered after one year. If full recovery takes longer
than one year from the date compensation begins, injured employees
are entitled to priority consideration for their former position
or an equivalent one, provided they apply for restoration within
30 days of the date compensation ends. Priority consideration
means the agency enters the individual on its reemployment priority
list. If the agency cannot place such individuals in their former
commuting area, they are entitled to priority consideration
for an equivalent position elsewhere in the agency.
- Physically disqualified. FECA compensationers who are medically
unable to return to their former occupation, but who are able
to do other work, are considered to be physically disqualified.
Such individuals are entitled, within one year of the date compensation
begins, to be placed in a position that most closely approximates
the seniority, status, and pay to which they otherwise would
be entitled, depending on the circumstances of the case. These
restoration rights are agency-wide. After one year, such individuals
are entitled to the same restoration rights as individuals who
fall into the “partially recovered” category described
below. Physically disqualified employees typically have a permanent
medical condition, such as the loss of an arm, that disqualifies
them for their old or an equivalent position and makes it unlikely
that they will ever be able to return to the former position.
- Partially recovered. In contrast to a physically disqualified
worker, a partially recovered employee is expected to fully
recover eventually. These individuals, who have not yet fully
recovered but are able to work in some capacity, are entitled
to be considered for employment in the former commuting area.
The agency must make every effort to place the employee, but
there is no absolute right to restoration. If the individual
is restored at a lower grade or pay level, OWCP will make up
the difference in pay, or the agency may elect to pay the employee
at the former rate. If such employees later fully recover, they
are entitled to the restoration rights of a fully recovered
employee, based on the timing of the recovery. Partially recovered
employees have an obligation to seek employment within their
capabilities. If a partially recovered employee refuses to accept
a suitable job offer, OWCP may terminate compensation. OWCP
determines whether an agency job offer is suitable according
to the individual’s medical restrictions, education, and
vocational background.
:: Back to Top ::
Claims-Filing Time Limits
Written report of a work-related injury must
be given within 30 days to the employee’s immediate superior
and a claim for disability or death compensation must be filed
within three years. The time limitations do not apply to: (1)
minors until they reach the age of 21 or have had a legal representative
appointed and (2) incompetent individuals while they are incompetent
and have no duly appointed legal representative. In cases of latent
disability, the time limitations do not begin to run until the
employee has a compensable disability and is aware, or reasonably
should be aware, that the disability is causally related to employment.
A claim for disability or death compensation filed after the three-year
period may not be allowed, unless the immediate superior had actual
knowledge of the injury or death within 30 days, or written notice
of the injury or death was properly given within 30 days.
:: Back to Top ::
Administration and Appeals
The Act is administered by the Office of
Workers’ Compensation Programs (OWCP) of the U.S. Department
of Labor. Further information regarding the law may be obtained
online at www.dol.gov/esa/regs/compliance/owcp/fecacont.htm
or by writing to the:
| |
Office of Workers’ Compensation
Programs
U.S. Department of Labor
Washington, DC 20210 |
The adjudication and payment of claims is
decentralized into the district offices of the OWCP. Inquiries
concerning specific cases should be directed to the appropriate
district office.
An employee or survivor who disagrees with
a final determination of OWCP may, within 30 days after the date
of the decision, request an oral hearing from the Branch of Hearings
and Review. The hearing will be informal and will be held at a
convenient location. You may be represented at the hearing by
any person authorized by you in writing. As soon as possible after
the hearing, a copy of the OWCP representative’s decision
will be mailed to you. You will have the right to appeal this
decision. The request for hearing should be addressed to the Office
of Workers’ Compensation Programs, Branch of Hearings and
Review, P.O. Box 37117, Washington, DC 20013-7117. Section 8124(b)(1)
of the Act provides entitlement to a hearing only before reconsideration.
In lieu of an oral hearing, you may request
a review of the written record by an OWCP representative at which
you may submit additional written evidence in support of your
claim. The request should be sent to the address above. You may
not have both an oral hearing and a review of the written record
on the same issue.
If you have other evidence you believe to
be pertinent, you may ask the OWCP to reconsider the decision.
No special form is required, but the request must be in writing
and state clearly the grounds upon which reconsideration is requested.
Also, the request must be accompanied by evidence not previously
submitted, such as medical reports, affidavits, or statements.
In order to ensure that you receive a new and independent evaluation
of the evidence, your case will be reconsidered by persons other
than those who made the original determination. Request for reconsideration,
along with new evidence, should be addressed to the office servicing
your case. Reconsideration may be requested within one year of
the most recent decision on the merits of the claim, whether or
not a hearing has been held. Where reconsideration is initially
requested, you are not entitled to a hearing.
If you believe that all available evidence
has been submitted, you have the right to appeal to the Employees’
Compensation Appeals Board for review of the decision. Review
by the Appeals Board is limited to the evidence of record. No
new evidence may be submitted to the Board. Request for review
by the Appeals Board should be made within 90 days from the date
of the decision and should be addressed to the Employees’
Compensation Appeals Board, U.S. Department of Labor, 200 Constitution
Ave., N.W., Rm. N-2609, Washington, DC 20210. If you should request
a hearing or reconsideration by the Office of Workers’ Compensation
Programs as indicated above, the 90-day period within which you
may request review by the Appeals Board will run from the date
of any later decision by the OWCP. For good cause shown, the Appeals
Board may waive the failure to file within 90 days if application
is made within one year from the date.
Decisions of the ECAB are final and may not
be appealed to federal or state courts.
:: Back to Top ::
|
