Emplyee Rights & Respnsibilities Page 1 f 4 Traumatic Injury/Frm CA-1 The Federal Emplyees Cmpensatin Act (FECA) utlines the benefits fr federal emplyees injured in the perfrmance f their duties. The Office f Wrkers Cmpensatin Prgrams (OWCP) administers, interprets and ensures cmpliance f the FECA and is the sle adjudicatr f all wrkers cmpensatin claims fr pstal emplyees. Yu have the right t file a claim fr FECA benefits with the DOL, OWCP. Upn filing a claim yur benefits and respnsibilities under the FECA are as fllws: MEDICAL TREATMENT Encmpasses all necessary and custmary medical services, including testing, treatment, and interventin t assist in the recvery f yur wrk related injury. (e.g., dctr appintment(s), X-rays, physical therapy, prescriptins, etc.) BENEFITS: Yu are entitled t receive immediate medical treatment frm a physician f yur chice. The FECA utlines the term physician t be a licensed Medical Dctr (M.D.) r Dctr f Ostepathy (D.O.). Selectin f any ther type f medical practitiner may delay claim adjudicatin r payment f services. If yu elect t receive medical treatment yu must prvide yur supervisr with the dctr s name, address and phne number. Yur supervisr r Health and Resurce Management (HRM) Cntrl Office will determine if the physician is available and will prvide medical treatment under the FECA. Yu will be advised f the earliest appintment time and date. A Frm CA-16, Authrizatin fr Examinatin and/r Treatment, will be issued t yur physician, if applicable. Once yur chice f physician has been established, any change must be submitted by yu in writing t the OWCP, fr apprval, with the exceptin f yur treating physician s referrals. Yu must ntify the HRM Cntrl Office f any change in physicians. RESPONSIBILITIES: It is yur respnsibility: T prvide yur supervisr with the name, address and phne number f yur treating physician. T ensure Frm CA-17, Duty Status Reprt, is cmpleted by yur treating physician at the initial visit. Yur supervisr cmpletes Side A, and Side B is fr yur physician t cmplete. T btain a cmpleted CA-17 frm yur supervisr r the HRM Cntrl Office fr all subsequent dctr appintments assciated with this claim. Yu must ntify yur supervisr f each fllw-up medical appintment(s) until yu recver frm yur injury. T prvide yur treating physician the letter addressed t the Medical Services Prvider. T return t wrk after the initial medical appintment, unless it is after yur tur r yu are directed therwise by yur physician. If it is after yur tur, it is yur respnsibility t ntify yur supervisr r designated manager f yur status, by phne, immediately fllwing yur medical appintment. If there are n supervisrs available at that time, yu must cntact yur supervisr prir t the start f yur next scheduled wrkday, unless returning t wrk. It is yur respnsibility t ntify yur supervisr immediately when medical infrmatin indicates that limited duty has been apprved by yur treating physician. This will help facilitate an immediate ffer f mdified assignment frm yur supervisr. NOTE: Chirpractic Services: FECA has specific guidelines fr defining the term physician, in that they shuld be a licensed M.D. r D.O. Chirpractrs usually d nt meet this definitin; hwever, their services can be cvered under certain cnditins. If yur chice f physician is a chirpractr, please be advised that payment r reimbursement fr fees and services is at the discretin f the OWCP. If yu elect a chirpractr, please cntact yur HRM Cntrl Office r the OWCP fr assistance.
NOTE: In nn-emergency situatins, yu may be required first t be evaluated by a pstal physician r cntract equivalent. An evaluatin by a pstal physician r cntract equivalent des nt cnstitute yur chice f treating physician, unless elected by yu. Emplyee Rights & Respnsibilities Page 2 f 4 Traumatic Injury/Frm CA-1 LIMITED DUTY Limited duty is the temprary mdificatin f regular wrk duties r the assignment f ther available necessary wrk tasks that allws an injured emplyee t recuperate and/r rehabilitate frm their n-the-jb injuries while wrking. BENEFITS: It is yur right: T be prvided an pprtunity t wrk in a mdified assignment (limited duty) while recuperating frm yur wrk related injury. The Pstal Service will make every effrt t accmmdate yur medical limitatins and wrk capabilities if such wrk is available within yur medical restrictins. T receive a PS Frm 2499, Offer f Mdified Assignment, Limited Duty, if such an assignment is identified in accrdance with the medical limitatins/restrictins utlined by yur treating physician. Yur supervisr will develp the mdified wrk assignment and will interactively discuss yur wrk capabilities and assignment wrk tasks. T ensure the mdified (limited duty) assignment is in cmpliance with the physical limitatins/restrictins utlined by yur treating physician in rder t facilitate a full recvery. RESPONSIBILITIES: It is yur respnsibility: T return t full duty. Yu must advise yur treating physician that mdificatin f yur present jb assignment is available t yu. T request yur treating physician specify yur medical limitatins/restrictins in writing. T avid any n duty r ff duty activities incnsistent with the medical limitatins/restrictins established by yur treating physician. T return t wrk when yur physician determines that yu are capable f ding s, unless yu request and receive cverage under the Family and Medical Leave Act (FMLA) and are willing t frg the COP under FECA. T accept suitable emplyment. The USPS may terminate Cntinuatin f Pay (COP) r the OWCP may terminate cmpensatin if a suitable ffer f mdified duty is refused. T cmply with medical limitatins/restrictins impsed by yur treating physician. T furnish medical evidence t supprt the cntinuatin f yur mdified assignment (limited duty) during the recvery perid frm yur wrk related injury. T ntify yur supervisr immediately, if during the perid f recvery frm yur injury, yu are unable t finish yur tur r yu are unable t reprt fr yur next scheduled tur. ABSENCE FROM WORK Absence frm wrk refers t any time away frm wrk due t the wrk related injury and includes, but is nt limited t, time lss fr dctr s appintments, medical treatments, and/r any perids f wrk disability. BENEFITS: It is yur right: T elect Cntinuatin f Pay (COP), Sick Leave r Annual Leave if yu are ttally r partially disabled frm wrk, r lse time frm wrk because f dctr visits r medical treatment due t a wrk-related traumatic injury. T receive COP; yu must elect COP n Frm CA-1. The CA-1 must be filed within 30 days f the date f injury, and initial time lss frm wrk r wrk disability must be within 45 calendar days f the injury. If the USPS has nt received prima facie medical evidence f an n-the-jb injury related wrk disability within 10 calendar days, COP may be terminated. There is a 3 day waiting perid befre COP payment fr wrk disability begins. Emplyee s wh experience a wrk related traumatic injury that results in wrk disability must wait 3 days befre COP will be authrized fr further time lss due t wrk disability. The emplyee must select SL, AL, r LWOP/IOD fr the first 3 days f wrk disability (waiting days). A nn-electin f leave r LWOP/IOD by the emplyee will be recrded as LWOP/IOD.
If yur claim is denied by the OWCP, any COP used will be changed t sick leave (S/L) r annual leave (A/L), as elected by yu, t the extent such leave is available. If leave is nt available, leave withut pay (LWOP) will be charged. Emplyee Rights & Respnsibilities Page 3 f 4 Traumatic Injury/Frm CA-1 T change S/L r A/L as elected n the CA-1, t COP. If yu were eligible fr COP but elected S/L r A/L n Frm CA-1, and later wish t change the leave t COP, the request must be made in writing within ne year frm the date the leave was used r the date OWCP apprved yur claim, whichever is later. T file an OWCP Frm CA-7, Claim fr Cmpensatin, if a wrk disability cntinues beynd the 45- day COP entitlement r after the COP eligibility perid expires. All absences frm wrk after the 45- day COP entitlement perid are charged as SL, AL, r Leave Withut Pay (LWOP), as per yur electin, when cmpensatin is claimed thrugh OWCP. (See Leave-Buy-Back). COP waiting days cunt tward a 3 day LWOP-IOD waiting perid if the entire 3 day COP waiting perid is nt met during the COP eligibility perid T knw that emplyees wh are n LWOP r LWOP-IOD fr a perid, r perids, ttaling 80 hurs (nrmal number f wrk hurs in ne pay perid) during a leave year d nt earn leave and will have their accrued leave credits reduced by the amunt f leave earned in ne pay perid, if leave is credited in advance. T request and receive cverage (if eligible) under the Family and Medical Leave Act (FMLA). Publicatin 71, Ntice fr Emplyees Requesting Leave fr Cnditins Cvered by the Family and Medical Leave Act, will be prvided t yu. Yur District FMLA Crdinatr will address questins cncerning eligibility and requirements. T knw that if yu are eligible fr FMLA prtectin and yur wrk related injury qualifies as a serius health cnditin cvered by the Act, absences frm wrk r absences due t yur injury cvered by leave, COP r LWOP-IOD will be charged against yur 12 week FMLA entitlement. RESPONSIBILTIES: It is yur respnsibility: T submit a new Frm CA-7 every tw weeks (n a pay perid basis) absent ther instructins frm OWCP. T submit PS Frm 3971, Request fr Ntificatin f Absence, t yur supervisr fr all absences due t the wrk related injury. T ensure that all jb-related absences frm wrk be supprted with medical dcumentatin that includes the diagnsis, prgnsis, bjective findings, duratin f disability, and expected date f return t wrk. LEAVE BUY BACK Leave Buy Back refers t the prcess f buying back sick r annual leave that was used fr any absence frm wrk due t receiving medical treatment r perids f wrk disability relating t the accepted traumatic injury while awaiting the OWCP adjudicatin f yur claim. (Sectins 512.923 and 545.84 f the Emplyee and Labr Relatins Manual) Once yur claim (CA-1) has been accepted by OWCP, Leave Buy Back fr any leave used beynd the OWCP adjudicatin date f yur CA-1 claim, including leave used fr a recurrence (CA-2a) related t yur CA-1 claim, will nt be authrized. BENEFITS: Yu have the right, upn acceptance f yur claim by OWCP: T request buy back f any leave used while awaiting adjudicatin f yur claim except leave used in lieu f COP as elected n frm CA-1. Pstal Regulatins, ELM 512.12, d nt permit emplyees t carry-ver int the next leave year mre than the allwable maximum number f hurs f annual leave. When an emplyee buys back annual leave in an amunt that exceeds the applicable maximum carryver, such excess will be autmatically frfeited. Fr every 80 hurs f leave bught back and changed t LWOP/IOD, bth annual and sick leave must be adjusted by the amunt earned in a pay perid.
Yu must be a current/active emplyee n the rlls f the Pstal Service. A leave buy back cannt be prcessed after yu have been separated frm the Pstal Service rlls. All indebtedness must be paid t the Pstal Service befre any leave is credited. : Emplyee Rights & Respnsibilities Page 4 f 4 Traumatic Injury/Frm CA-1 RESPONSIBILTIES: It is yur respnsibility T initiate the request fr leave buy back, in writing, t HRM Cntrl Office within ne year fllwing yur return t duty date, r within ne year f the date that OWCP apprves yur claim, whichever is later. T ensure bjective medical dcumentatin supprting all absences claimed t receive medical treatment and/r wrk disability due t the wrk related traumatic injury is prvided t the HRM Cntrl Office. FECA CLAIM NUMBER Yur FECA claim number is a unique number that is assigned by the OWCP fr yur wrk-related claim. OWCP will ntify yu directly by pstcard f the claim number assigned t yur claim. Once issued a claim number, please ensure all crrespndences submitted t the HRM Cntrl Office and/r OWCP has this number clearly written n the upper right hand crner. Cntact OWCP directly if yu have any questins relative t crrespndence yu receive frm the OWCP. OUT OF POCKET COSTS Out f pcket csts are any injury-related service r expense, directly paid by the emplyee fr which the prvider des nt bill the OWCP fr payment. Medical Services The Pstal Service participates in First Script, an nline pharmacy benefits prgram. This prgram is available fr yur use when filling prescriptins related t yur traumatic injury. Use f this prgram requires NO ut-f-pcket expense and NO need t file fr reimbursement. Refer t the infrmatin sheet and temprary card that will be prvided t yu by yur supervisr. Yu shuld cmplete a Frm OWCP-915, Claimant Reimbursement Frm, when yu are requesting reimbursement fr physician appintments, prescriptin bills, c-pays and ther services paid directly by yu. Transprtatin Expenses: Yu are entitled t reimbursement f reasnable and necessary transprtatin expenses in btaining authrized medical services and treatment by submitting a cmpleted Frm OWCP 957 t the OWCP. Generally 25 miles frm the wrksite, place f residence r place f injury is cnsidered reasnable. ADDITIONAL INFORMATION Any persn wh files a false reprt t btain FECA benefits is subject t criminal prsecutin A fine up t $10,000.00, imprisnment fr nt mre than five years, r bth. Disciplinary actin by the U.S. Pstal Service may be taken irrespective f any criminal prsecutin. Yu are nt entitled t receive cmpensatin after yu return t wrk. Upn yur return t wrk, yu must cntact OWCP immediately t avid an verpayment f cmpensatin benefits. It is recmmended yu cntact the OWCP by phne and ntify yur HRM Cntrl Office. If yu d receive a cmpensatin payment frm OWCP after returning t wrk, return the check immediately t OWCP thrugh the HRM Cntrl Office, r write a persnal check t the OWCP if the payment was direct-depsited int yur accunt.
A cpy f this dcument has been prvided t the injured emplyee. Supervisr s Printed Name Supervisr s Signature Date