U.S. Department of Transportation
Federal Highway Administration
1200 New Jersey Avenue, SE
Washington, DC 20590
FHWA Order M3000.1C
|FHWA Personnel Management Manual; Part 1: Personnel Systems & Procedures, Chapter 10: Retirement, Insurance, Income Protection, and Other Employee Services, Section 5: Workers' Compensation|
|M3000.1C||November 4, 2005|
Does this directive cancel an existing FHWA directive? Yes. This section cancels FHWA Personnel Management Manual (PMM) Part 1, Chapter 10, Section 1, On-the-Job Injury Compensation, dated June 28, 1996.
Title 5, United States Code (U.S.C.), Sections 810l-8193.
Departmental Personnel Manual Letter 810-1, dated August 3, 1992.
Injury Compensation for Federal Employees, U.S. Department of Labor (DOL) Publication, dated January 1999.
Federal Employee’s Compensation Act (FECA).
Title 29, Code of Federal Regulations (CFR), Part 1904, Recording and Reporting Occupational Injuries and Illnesses.
Title 29, CFR, Section 1960, Federal Employees Programs.
Department of Transportation (DOT) Order 3903.1, Occupational Safety and Health: Incident Investigation, Reporting and Recordkeeping, dated November 10, 2004.
Traumatic injuries. Wounds or other adverse conditions of the body caused by external force, including stress or strain. The injury must be identifiable as to time and place of occurrence and member or function of the body affected, and it must be caused by a specific event or incident or series of events or incidents within a single day or work shift. Traumatic injuries also include damage or destruction to prosthetic devices or appliances, exclusive of eyeglasses or hearing aids unless they were damaged incidental to a personal injury requiring medical services.
Non-traumatic injuries. Occupational diseases and illnesses caused by systemic infections; continued or repeated stress or strain; exposure to toxins, poisons, fumes, etc., or other continued and repeated exposure to conditions of the work environment over a longer period of time.
Continuation of pay. Full payment of salary for a period not to exceed 45 calendar days to an employee who sustains a disabling job-related traumatic injury.
Controversion of pay. The option of the Agency to oppose continuation of pay.
Compensation. Partial payment to the employee who is disabled on the job and in a non-pay status for more than three calendar days or is unable to resume his/her usual work.
Schedule awards. Awards for permanent impairment of certain members or functions of the body, including certain internal and external organs (such as loss of use of an eye, arm, or function or removal of a kidney due to an injury); or for serious disfigurement of the head, face, or neck.
How does Workers' Compensation affect FHWA employees? The FECA is the law that requires Federal agencies to pay compensation benefits to civilian employees of the United States for 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 personal injury is also compensable. The FECA also provides for the payment of benefits to dependents if job-related injury or disease causes the employee's death. The FECA is administered by the Office of Workers’ Compensation Programs (OWCP), DOL, through district offices located throughout the United States.
What forms are needed for the proper recording and reporting of injuries? The following OWCP forms, maintained by the servicing human resources office, are needed for the proper recording and reporting of injuries:
|CA-1:||Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation|
|CA-2:||Federal Employee's Notice of Occupational Disease and Claim for Compensation|
|CA-2a||Notice of Employee's Recurrence of Disability and Claim for Pay/Compensation|
|CA-3||Report of Termination of Disability and/or Payment|
|CA-5||Claim for Compensation by Widow, Widower and/or Children|
|CA-5b||Claims for Compensation by Parents, Brothers, Sisters, Grandparents, or Grandchildren|
|CA-6||Official Superior's Report of Employee's Death|
|CA-7||Claim for Compensation on Account of Traumatic Injury or Occupational Disease|
|CA-8||Claim for Continuing Compensation on Account of Disability|
|CA-16||Authorization for Examination and/or Treatment|
|CA-20||Attending Physicians’ Report|
Servicing human resources offices are responsible for:
Assisting and advising employees and supervisors in carrying out responsibilities under the FECA;
Determining who should conduct the investigation of the accident;
Reviewing and processing OWCP claims forms as needed, and preparing the cover letter to send materials to OWCP by giving a general review of the claim;
Establishing an OWCP file for injured employees;
Advising the supervisor, the appropriate collateral duty Safety Officer, and the servicing payroll office of each reported on-the-job injury; whether pay is continued or loss of wages occurs; and the date the employee returns to duty; and
Recording and reporting occupational injuries and illnesses in accordance with DOT Order 3903.1, Occupational Safety and Health: Incident Investigation, Reporting and Recordkeeping.
The FHWA Washington Headquarters Office of Human Resources will submit the annual safety report to the Assistant Secretary for Administration, Office of the Secretary of Transportation (OST), when requested.
Supervisors are responsible for:
Ensuring that all on-the-job injuries are promptly reported to the servicing human resources office;
Authorizing necessary medical care for the injured employee on Form CA-16;
Providing the employee with Form CA-1 for reporting the injury or Form CA-2 for reporting the occupational disease. (When the employee returns the completed form, the supervisor should complete the supervisor's portion and return the Receipt of Notice of Injury which is attached to the Form CA-1 and Form CA-2.);
Advising the employee of his/her right to: (a) elect continuation of regular pay (traumatic injuries only), or (b) request use of sick or annual leave, if the injury is disabling;
Informing the employee whether continuation of pay will be "controverted" and, if so, whether it will be terminated along with the basis for such action;
Assisting the employee in the completion and submission of forms to the servicing human resources office;
Notifying the servicing human resources office when the employee returns to work by filing Form CA-3, unless this information has been previously submitted on Form CA-1 or Form CA-2;
Completing Form CA-17, in accordance with instructions printed on the form; and
Completing an accident report on Form CA-1 or Form CA-2.
Employees are responsible for:
Immediately reporting to the supervisor all injuries sustained in the performance of duty;
Obtaining medical attention as soon as possible;
Completing and forwarding all necessary forms to the supervisor; and
Submitting medical examination reports as required to OWCP at the DOL.
How do I make a report? Instructions for completing claims are printed on the claim forms. It is important that all forms be properly completed and that all information requested be submitted, otherwise processing the claim will be delayed. Claim forms should include the FHWA agency code “253100.” All claims for benefits under the FECA are reviewed and transmitted to OWCP by the servicing human resources office.
The employee, or someone acting on his/her behalf, should complete Form CA-1, items 1 through 15, and submit it along with any available medical bills incurred in connection with this injury to the employee's supervisor for completion of items 17 through 38. Item 16 is to be completed by a witness to the injury. The supervisor submits the completed Form CA-1, with medical bills attached to it, to the servicing human resources office for transmittal to OWCP. However, submission of the Form CA-1 should not be delayed pending receipt of medical bills, as they may be transmitted separately.
When the disability continues beyond the 45 days of continuation of pay, the employee and supervisor must complete Form CA-7. The employee must also submit a medical report showing continued disability for work beyond the end of the 45-day period in order to request compensation for wage loss. The supervisor submits Form CA-7 to the servicing human resources office for transmittal to OWCP.
Form CA-8 is used to claim compensation for additional periods of wage loss not covered by Form CA-7. The employee and supervisor should complete Form CA-8 in accordance with instructions on the form and submit it to the attending physician. The physician will complete the attached Form CA-20. Form CA-20 is returned to the servicing human resources office where it is reviewed and submitted to OWCP.
When the injured employee returns to work or when disability ceases, the supervisor sends Form CA-3 to the servicing human resources office.
The employee or someone acting on his/her behalf should complete Form CA-2, items 1 through 18. The supervisor will complete items 19 through 35. The employee and supervisor should follow instructions attached to Form CA-2. The supervisor should submit the completed Form CA-2 and related statements to the servicing human resources office for transmittal to OWCP.
Claims for compensation for wage loss or permanent disability are made on Form CA-7. This form must be completed by the employee, supervisor, and physician. The claim should be filed with OWCP as soon as pay stops or upon the employee's return to work, whichever occurs first.
Form CA-8 is used to claim compensation when loss of pay goes beyond the time covered in Form CA-7. The employee and supervisor should complete Form CA-8 in accordance with instructions on the form and submit it to the attending physician, who will return it to the servicing human resources office. The servicing human resources office will review Form CA-8 for completeness prior to its submission to OWCP.
When the injured employee returns to work or when disability ceases, the supervisor must send Form CA-3 to the servicing human resources office.
Schedule awards. Form CA-7 is used when an injured employee suffers a permanent impairment (see paragraph 4f). The supervisor submits the completed Form CA-7 and attached Form CA-20 to the servicing human resources office for transmittal to OWCP.
Recurrence of traumatic injury
Form CA-2a is used if, after returning to work, an employee is again disabled and must stop work as a result of the original injury.
The employee may continue to receive regular pay or request the use of sick or annual leave for the period of absence. Pay may be continued provided that the 45 calendar days were not all used during the initial period of disability and the disability recurred during a 6 month period beginning from the date the employee first returned to work following the initial disability.
If the disability recurred after 6 months have passed or if the 45-day continuation of pay period has been exhausted, Form CA-7 may be filed to claim any wage loss to their servicing human resources office.
When the employee returns to work, the supervisor must send Form CA-3 to the servicing human resources office.
Recurrence of non-traumatic injury
Form CA-2a must be submitted to the servicing human resources office when, after returning to work, an employee is again disabled and stops work as a result of the occupational disease.
The employee may claim compensation by completing Form CA-7 if one was not submitted following the original injury. If Form CA-7 was previously submitted, the claim for compensation is made by sending Form CA-8, with supporting medical evidence, to the servicing human resources office.
The supervisor must send Form CA-3 to the servicing human resources office when the employee returns to work.
When an employee dies because of a personal injury incurred while in the performance of duty, the supervisor reports the death by filing Form CA-6 with the servicing human resources office.
Dependents may claim compensation from OWCP by filing Form CA-5 or Form CA-5a, or both. Instructions regarding the purpose and procedures for completing these forms are printed on the forms.
Compensation based on loss of wages is payable after a three-day waiting period. However, no waiting period is required when there is permanent disability or where the disability that caused wage loss exceeds 14 days.
Compensation generally is payable at the rate of 2/3 of the employee's salary if there is no dependent, or 3/4 of the salary if there are one or more dependents.
When an employee sustains a disabling job-related traumatic injury, his/her pay may be continued for a period not to exceed 45 calendar days with no charge to his/her leave record. This pay is subject to income tax, retirement, and other deductions.
To be eligible for continuation of pay, Form CA-1 must be sent to the servicing human resources office within 30 days following the injury; however, to avoid possible interruption of pay, the form should be filed within two working days. If the form is not filed within 30 days, compensation will be substituted for continuing pay.
The employee remains in a pay status for any fraction of a workday on which the disability occurs with no charge to the 45 day continuation of pay period. The period starts at the beginning of the first full workday following the date of the injury.
Pay continues until (1) the employee is no longer disabled, (2) FHWA is notified by OWCP that pay should be terminated, or (3) at the expiration of 45 calendar days.
If the employee works only a portion of a workday (other than the workday when disability began), that workday will be considered as one calendar day against the 45-day maximum period for continuation of pay.