Par.

1. Purpose

2. References

3. Definitions

4. General Information

5. Responsibilities

6. Continuation of Pay

7. Compensation

8. Forms

9. Reporting Procedures

1. PURPOSE. To establish responsibilities and reporting procedures relating to Federal Highway Administration (FHWA) employee injuries or deaths while on the job.

2. REFERENCES. Title 5, U.S. Code, Sections 810l-8193.

3. DEFINITIONS.

   1. 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 be caused by a specific event or incident or series of events or incidents within a single day or workshift. Traumatic injuries also include damage or destruction to prosthetic devices or appliances, exclusive of eyeglasses or hearing aids unless the eyeglasses or hearing aids were damaged incidental to a personal injury requiring medical services.

   2. Non-traumatic Injuries - occupational diseases or 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.

   3. 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.

   4. Controversion of Pay - the option of the agency to oppose Continuation of Pay.

   5. 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.

   6. 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.

4. GENERAL INFORMATION. The Federal Employees Compensation Act (FECA) is a law which provides 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), U.S. Department of Labor, through district offices located throughout the United States.

5. RESPONSIBILITIES.

   1. Servicing Personnel Offices are responsible for:

      (1) assisting and advising employees and supervisors in carrying out responsibilities under the Act;

      (2) reviewing and processing OWCP claims forms as needed. Prepare cover letter to send materials to OWCP giving a general review of the claim (see sample Attachment for case involving traumatic injury, no time lost, medical expenses only);

      (3) establishing an OWCP file for injured employee;

      (4) advising the FHWA 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.

   2. The FHWA Safety Officer is responsible for reviewing accident reports to determine any needed measures in conjunction with FHWA internal safety programs.

   3. Supervisors are responsible for:

      (1) ensuring that all on-the-job injuries are promptly reported to the servicing personnel office and/or Safety Officer;

      (2) authorizing necessary medical care for the injured employee on Form CA-16;

      (3) 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 supevisor's portion and return the Receipt of Notice of Injury which is attached to the CA-1 and CA-2 forms;

      (4) 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;

      (5) informing the employee whether continuation of pay will be "controverted" and if so, whether it will be terminated, and the basis for such action;

      (6) assisting the employee in the completion and submission of forms to the personnel office;

      (7) notifying the personnel office when the employee returns to work by filing Form CA-3, unless this information has been previously submitted on Form CA-1 or CA-2;

      (8)completing Form CA-17, Duty Status Reports, in accordance with instructions printed on the form; and

      (9) completing accident report forms.

   4. Employees are responsible for:

      (1) immediately reporting to the supervisor all injuries sustained in the performance of duty;

      (2) obtaining medical attention as soon as possible;

      (3) executing and forwarding all necessary forms to the supervisor; and

      (4) submitting medical examination reports as required by OWCP.

6. CONTINUATION OF PAY.

   1. When an employee sustains a disabling job-related traumatic injury, his/her pay may be continued for a period not to exceed 45 days (interpreted as calendar days) with no charge to his/her leave record. This pay is subject to income tax, retirement and other deductions.

   2. To be eligible for continuation of pay, Form CA-1 must be filed 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, compensationwill be substituted for continuing pay.

   3. 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 injury.

   4. Pay continues until the employee is no longer disabled, or FHWA is notified by OWCP that pay should be terminated, or at the expiration of 45 calendar days.

   5. 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.

7. COMPENSATION.

   1. 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 causing wage loss exceeds 14 days.

   2. 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 is one or more dependents.

8. FORMS. Basic forms needed for the proper recording and reporting of injuries are maintained by the personnel office, as follows:

   Form No.

   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-17: Duty/Status Report

   CA-20: Attending Physicians Report

   OWCP-1500a: Medical Provider's Claim Form

9. REPORTING PROCEDURES. Instructions for the completion of claims are printed on the claim forms. It is important that all forms be properly completed and that all information requested be submitted, otherwise adjudication information of the claim will be delayed. Claim forms should include the agency code 253100. All claims for benefits under the Compensation Act are reviewed and transmitted to OWCP by the personnel office.

   1. Traumatic Injuries.

      (1) 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 completed Form CA-1 with medical bills attached is submitted by the supervisor to the personnel office for transmittal to OWCP. However, submission of the CA-1 should not bedelayed pending receipt of medical bills, as they may be transmitted separately (see sample transmittal letter, attached).

      (2) When the disability continues beyond the 45 days of continuation of pay, the employee and supervisor must complete Form CA-7 and the employee must 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 CA-7 is submitted by the supervisor to the personnel office for transmittal to OWCP.

      (3) 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 personnel office where it is carefully reviewed and submitted to OWCP.

      (4) When the injured employee returns to work or when disability ceases, the supervisor files Form CA-3.

   2. Non-traumatic Injuries.

      (1) The employee or someone acting on his/her behalf should complete Form CA-2, items 1 through 21. The supervisor will complete items 19 through 34. Employee and supervisor should follow instructions attached to Form CA-2. The completed Form CA-2 and related statements are submitted by the supervisor to the personnel office for transmittal to OWCP.

      (2) Claims for compensation for wage loss or permanent disability are made on Form CA-7 which is 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.

      (3) 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 personnel office. The personnel office will review Form CA-8 for completeness prior to its submission to OWCP.

      (4) When the injured employee returns to work or when disability ceases, the supervisor must file Form CA-3.

   3. Schedule Awards. Form CA-7 is used when an injured employee suffers a permanent impairment (see paragraph 3f). The completed Form CA-7 and attached Form CA-20 are submitted by the supervisor to the personnel office for transmittal to OWCP.

   4. Recurrence of Traumatic Injury.

      (1) 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.

      (2) 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 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.

      (3) If the disability recurred after 6 months have expired or if the 45-day continuation of pay period has been exhausted, Form CA-7 may be filed to claim any wage loss.

      (4) The supervisor must file Form CA-3 when the employee returns to work.

   5. Recurrence of Non-Traumatic Injury.

      (1) Form CA-2a is filed when, after returning to work, an employee is again disabled and stops work as a result of the occupational disease.

      (2) The employee may claim compensation by filing Form CA-7 if one was not submitted following the original injury. If Form CA-7 was previously submitted, the claim for compensation should be made by filing Form CA-8, with supporting medical evidence.

      (3) The supervisor must file Form CA-3 when the employee returns to work.

   6. Death Benefits.

      (1) 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 personnel office.

      (2) Dependents may claim compensation from OWCP by filing Form CA-5 or CA-5a, or both. Instructions regarding the purpose and procedures for completion of these forms are printed on the forms.