Identification Number:
DI 52115 TN 2
Intended Audience:See Transmittal Sheet
Originating Office:ORDP OISP
Title:Federal Workers Compensation (WC) Payments
Type:POMS Transmittals
Program:All Programs
Link To Reference:
 

PROGRAM OPERATIONS MANUAL SYSTEM
Part DI – Disability Insurance
Chapter 521 – Workers' Compensation/Public Disability Benefit (WC/PDB) Offset
Subchapter 15 – Federal Workers' Compensation (WC) Payments
Transmittal No. 2, 12/02/2019

Audience

PSC: BA, CA, DS, IES, PETE, RECONR, SCPS;
OCO-OEIO: BIES, BTE, CR, CTE, ERE, FCR, PETL, RECONE, RECONR, RECOVR;
OCO-ODO: BTE, CR, CST, CTE, CTE TE, PAS, PETE, PETL, RCOVTA, RECONE, RECOVR;
FO/TSC: CS, CS TII, CS TXVI, CSR, CTE, OA, OS, TA, TSC-CSR;

Originating Component

OISP

Effective Date

Upon Receipt

Background

We are adding new policy to give the ability for FO technicians to contact their predetermined assigned Regional subject matter expert (one per region) via vHelp to have them obtain an AQS query for needed FECA proof per case. Per EM-19007 SEN published 03/07/19 we incorporated the EM material into POMS. Also added new policy on FECA maximums.

Summary of Changes

DI 52115.010 Federal Employees’ Compensation Act (FECA)

Subsection D. FECA Cost of Living Adjustments (COLA's) and Maximums

D.2. - Added new policy for FECA maximum rates.

Subsection E. rearranged PC Instructions a. and b.

1. PC Instructions -

a. and b. together - Moved b. PC development of FECA proof under 1. to have all PC instructions in one area for better flow.

Changed NOTE: to read: Field office (FO) technicians do not have individual access to AQS.

2. FO Instructions - FO development of FECA proof - added new heading

Added new section with policy steps to have FO technicians to contact their predetermined regional SME per local procedures via vHelp to have them obtain an AQS query for needed FECA proof per case.

DI 52115.010 Federal Employees’ Compensation Act (FECA)

The Department of Labor, Office of Workers' Compensation Programs (DOL/OWCP) administers FECA payments through its Division of Federal Employees' Compensation (DFEC). FECA provides benefits for on-the-job injuries or illnesses sustained by civilian employees of the Federal government and certain other individuals, as provided by Federal law. FECA also provides benefits to survivors of employees who die from work-related injuries or diseases. FECA payments are offsettable as workers’ compensation (WC).

A. Applying offset to FECA payments

Use the gross amount of FECA payments (before any deductions) to calculate disability insurance benefit (DIB) offset. FECA cost-of-living adjustment (COLA) increases are offsettable. Life and health insurance premiums may be deducted from FECA payments but we do not consider these excludable expenses. For general information and instructions on excludable expenses, see DI 52150.050.

B. Types of FECA payments

1. Periodic wage loss payments

Periodic wage-loss payments are WC. These payments are normally two-thirds of the previous wages, but if the number holder (NH) has one or more dependents, the payment rises to three-quarters of the previous wage. Offset DIB using the entire gross FECA payment, whether paid at the two-thirds amount or the three-quarters amount.

DOL pays short-term FECA benefits weekly and long-term FECA benefits every 28 days. To determine the monthly equivalent, follow Determining the Workers’ Compensation/Public Disability Benefit (WC/PDB) Amount Used to Compute Offset instructions in DI 52150.035C.

Since it is not always possible to determine how long the injury or illness will prevent the NH from working, many FECA cases begin with weekly payments and progress to 28-day long-term disability payments (see E. in this section).

2. FECA schedule awards

FECA schedule awards are offsettable WC payments that compensate number holders (NHs) for the work-related loss of, or loss of use of, one or more body parts. Schedule awards are not paid simultaneously with regular wage-loss payments for the same injury. These awards begin once maximum medical improvement has occurred for the body part involved. FECA schedule awards pay WC for a statutory number of weeks depending on the body part(s) affected. For example, FECA may allot 46 weeks for a pointer finger or 312 weeks for an arm.

Schedule awards not paid simultaneously with regular wage-loss payments can continue while the NH receives a disability retirement pension under the Civil Service Retirement System (CSRS) or the Federal Employee Retirement System (FERS). We consider both the CSRS and FERS payments as federal public disability benefits (PDBs). Therefore, it is possible for PDB offset and WC offset to apply if the claimant receives both FECA (WC) and a CSRS or FERS disability retirement pension (PDBs).

DOL pays schedule awards without regard to loss of earning capacity. The NH can actually receive a schedule award after going back to work even if the work is in the same or different employment.

3. Disfigurement payments under FECA

Disfigurement payments compensate NHs whose injury causes permanent damage to the head, face, or neck. FECA disfigurement is a separate, offsettable award of up to $3,500.00.

4. Vocational Rehabilitation (VR) payments

VR may pay up to $200.00 monthly and is usually paid in addition to WC. Therefore, it is rarely subject to offset. For VR payment offset rules, see DI 52110.005.

C. FECA payment adjustment, suspension, and termination events

DOL may decrease, increase, suspend, or terminate payments. FECA payments are subject to change as follows:

1. Reasons for FECA payment decrease

FECA payments may decrease in the following situations:

  • The only dependent child, spouse, or parent no longer qualifies as a dependent;

  • The NH reenters the workforce or is able to reenter the workforce at a lower salary than prior to becoming disabled; or

  • The NH refuses to participate in a VR program or make a good faith effort to obtain reemployment.

2. Reasons for FECA payment increase

FECA payments may increase in the following situations:

  • FECA cost-of-living adjustments (see section D. below);

  • A qualifying dependent child, spouse, or parent becomes entitled on the NH’s record;

  • Payments previously reduced due to a work attempt are no longer reduced when the NH becomes unable to work.

3. Reasons for FECA payment suspension

FECA payments may require suspension in the following situations:

  • NH fails to comply with a specific request from DOL (failure to attend a medical exam, for example) or fails to respond to requests for information; or

  • NH confined due to the conviction of a felony.

NOTE: If DOL suspends FECA, take into consideration the reason for suspension and whether it affects DIB.

4. Reasons for FECA payment termination

FECA payments may terminate when the NH:

  • dies;

  • returns to work with no loss of wages;

  • is no longer medically disabled;

  • refuses to work when medically able to;

  • quits a job for other than medical reasons;

  • never suffered any work-related injury (i.e., if there is a disability, investigation reveals it is not work-related);

  • refuses to file a third-party lawsuit related to the work injury when compelled by the government to do so; or

  • is guilty of fraud in connection with the WC claim.

NOTE: If DOL terminates FECA, take into consideration the reason for termination, and whether it affects DIB. For example, if the NH’s FECA terminates for work activity, the work may be considered substantial gainful activity (SGA) for DIB purposes.

D. FECA Cost of Living Adjustments (COLAs) and Maximums

1. DOL/OWCP pays COLA increases to all eligible NHs each year. However, COLAs are not payable for the first 12 months of entitlement to FECA.

  • NEPSC Workers’ Comp Info Page has a COLA calculator that computes the effect of COLA increases on a NH’s FECA payments. The calculator lists the COLAs retroactive to June 1975.

  • Beginning in 1981, COLA increases take effect on March 1. Payment Center (PC) technicians should set a diary for March of each year to adjust the WC offset to reflect the FECA COLA increase.

NOTE: If we do not receive FECA COLA information from the NH or the NH’s representative payee, and the FECA COLA increase results in lower DIB payable after offset, send a due process notice. Due process is not required if the FECA COLA increase has no effect on the DIB payable.

For notice information, see

  • GN 03001.015 Notices Required Before And After Taking A Title II Adverse Action

  • NL 00703.511 Due Process Notice To Disabled Number Holder (NH)

2. FECA maximum rates

  • If a claimant's weekly compensation rate is greater than the MAX, compensation is limited to the maximum amount.

  • When a new MAX is established, it is compared to the amount of compensation in each case at MAX. If the compensation is greater than the old MAX but less than the new, compensation may be paid at the regular rate. Adjustments are made retroactive to the effective date of the new MAX, which is generally the date of an increase in the Federal pay scale.

  • Consumer Price Index (CPI) increases do not affect the allowable MAX, though a claimant may be subject to MAX after the application of CPIs.

E. Obtaining verification (“proof”) of FECA payments

Contact the NH to obtain proof of the gross benefits before any deductions. Bank statements are not valid because they show only the net amount. DOL sends written notification of any payment changes, so proof should be readily available.

1. PC Instructions

a. PC online access to DOL's Agency Query System

All PCs have a limited number of employees with access to DOL’s Agency Query System (AQS). AQS is an online tool containing payment records for NHs receiving WC FECA benefits. AQS displays the gross payment amounts needed to apply offset. However, AQS information is not available for every case.

Information from online access is a third-party report. Third party reports that result in adverse action (reduction of benefits) requires advance due process notification prior to DIB benefit reduction. For due process notice information see NOTE in section D.

Consult your PC’s local procedures to route requests for FECA verification to the PC personnel with designated AQS access.

NOTE: Field office (FOs) technicians do not have individual access to AQS. See the FO instructions below for the process FO technicians should follow.

b. PC development of FECA proof

If the NH is unable to provide proof and information is not available from the online access described in this section, follow DOL mail contact guidelines in F.2., and take the following actions:

1.) Set a diary for 35 days for receipt of proof from DOL.

2.) When the diary matures, check for any paper and paperless responses from DOL. Check all pending and closed actions to be sure the proof is not attached to another action control record (ACR) or set up under an incorrect type of event level (TOEL) code.

  • If you receive a response that contains only net amounts or is otherwise inadequate, follow telephone contact instructions with DFEC district office per F.3. below.

  • If you do not receive a response, send another written request for information to DOL as described in F.2. Indicate the mailing date of the first request. Write “Second Request” in red at the top of the form and mail the form to the same address.

  • Set a diary for another 35 days.

  • When the diary matures, check for any paper and paperless responses from DOL. Check all pending and closed actions to be sure the proof is not with another ACR or set up under an incorrect TOEL.

  • If you do not receive a response, or the response contains only net amounts or is otherwise inadequate, contact the DFEC district office by following the instructions for telephone contact in F.3., below.

3.) Once you receive documentation proof, review the master beneficiary record (MBR) and the electronic record for possible necessary adjustments. The proof from DOL is a third-party report. Third-party reports that result in adverse actions require advance due process notification prior to DIB benefit reduction.

For notice information, see Notices Required Before And After Taking A Title II Adverse Action in GN 03001.015, and Due Process Notice To Disabled Number Holder (NH) in NL 00703.511.

4.) Provide due process, if necessary, then process any needed adjustment action. Retain all FECA proof per Retention of Workers’ Compensation/Public Disability Benefit (WC/PDB) Proofs instructions in DI 52145.015.

5.) Set a stand-alone diary for the following March to develop changes and adjust benefits for the FECA COLA.

2. FO Instructions - FO development of FECA proof

Take the following actions to request proof of FECA payments:

  1. a. 

    Contact the NH first and try to obtain proof of FECA payments and allow 10 business days.

  2. b. 

    If you cannot obtain proof from the NH, contact your predetermined assigned Regional subject matter expert (SME) using vHelp. Submit your request for FECA under Primary Topic “Disability” and subtopic “FECA”. Allow 10 business days for the Regional SME to provide proof of FECA payments.

  3. c. 

    If the FO technician does not receive a response by vHelp within 10 business days, send a follow-up with normal established procedures. If follow-up is unsuccessful, proceed to step d.

  4. d. 

    Follow the guidelines for DOL direct mail contact shown in section F.2.

    • Establish a tickle date for 35 days.

    • If no response is received within 35 days, or the response is inadequate, contact the DFEC district office by telephone following instructions in section F.3. below.

  5. e. 

    When you receive the requested proof, review the MBR and the electronic record for any necessary adjustments.

  6. f. 

    Set a stand-alone diary for March of the following year per section D. for the PC follow-up to develop for changes and adjust benefits for the FECA COLA.

  7. g. 

    Retain the FECA proof following Retention of Workers' Compensation/Public Disability Benefit (WC/PDB) Proofs procedure in DI 52145.015.

F. Verifying FECA payments

1. FECA claim number

The DOL claim number for FECA payments is a nine-digit number that begins with a two-digit code separated from the other seven digits by a hyphen (e.g., 01-2345678). The first two digits identify the DOL district office that handled the claim. If the worker relocates, the originating office retains jurisdiction. Include the DOL claim number and the Social Security Number (SSN) on any correspondence sent to DOL. If the DOL claim number on our records is incorrect, they may be able to use the SSN to access the information.

2. Requesting proof from DOL

Take the following actions to request proof from DOL:

  1. a. 

    Submit all initial requests for information in writing. Generally, DOL does not respond to faxed requests. Do not send a fax unless DOL requests that you do so.

  2. b. 

    Use Form SSA-1709 (Request for Workers’ Compensation/Public Disability Benefit Information) or local version of the DOL Information Request Form.

  3. c. 

    Complete and date the form.

  4. d. 

    If you need extensive information, request a complete history for the period(s) involved.

  5. e. 

    In the PC, scan the completed form into the paperless system and add to the ACR. If working with a paper folder, scan the document with the TOEL code of “FILE WC” and prong-file a copy in the folder.

  6. f. 

    Mail requests to:

    U.S. Department of Labor
    DFEC Central Mail room
    P.O. Box 8300
    London, KY 40742-8300

DOL scans the requests into a database and then forwards electronically to the appropriate DFEC district office for their action.

3. Follow-up calls to DFEC

If you do not receive a timely response, contact the appropriate DFEC office at the phone numbers listed on the United States Department of Labor, Office of Workers’ Compensation Programs (OWCP), DFEC website.

Contact the office servicing the state where the NH resides or, if different, the state where the injury took place. Use the public contact number, not the Director’s office number. DFEC needs the DOL claim number and the claimant’s name. Identify yourself as a representative from the Social Security Administration (SSA). Explain that we need proof of the gross FECA payment before any deductions, and that we previously requested this information in writing. DFEC should advise when to expect the proof.

4. DOL requests written authorization from the NH

Sometimes a DOL representative will ask for written permission from the NH before releasing any information to SSA. This authorization is unnecessary. If the DOL representative insists on the authorization, notify the appropriate regional office (RO) or PC WC analyst, using proper channels. The RO or PC analyst notifies the Office of Income Security Programs, Office of Applications and Electronic Services Support Policy (OISP/OAESP) WC analyst, who then contacts DOL to resolve the issue.

G. No proof available

If no FECA proof is available, thoroughly document your efforts to obtain proof and follow instructions in DI 52145.001 G.2.

H. Relationship between FECA and federal PDB

Regular periodic wage-loss payments from FECA stop if the NH receives a federal disability pension from CSRS or FERS. If the NH receives a FECA schedule award, those payments continue through the statutory number of weeks depending on the body part(s) affected. If FECA payments stop or DFEC responds “No claim found” and the NH does not appear to be working, contact the Office of Personnel Management (OPM) for proof of possible federal public disability benefits per instructions in DI 52130.001D.

I. Third party settlements involving FECA payments

Disabled federal employees sometimes sue and recover monetary damages from third parties who cause or contribute to an on-the-job injury or illness. Third-party settlements are not offsettable. However, Federal law requires repayment of FECA WC. For complete instructions on third-party settlements, see DI 52105.010.


DI 52115 TN 2 - Federal Workers Compensation (WC) Payments - 12/02/2019