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NRX OWCP Guide

 

 

National Air Traffic Controllers Association

 

NRX OWCP Guide

Region X

 

 

 For Facility Representatives

 


 

INTRODUCTION

 

This guide has been developed to assist NATCA Facility Representatives in helping members of their bargaining unit who have sustained a work related injury and/or occupational disease or illness.  Because of the complex nature of an OWCP claim, this guide cannot be all-inclusive.  Facility Representative should obtain the information contained in appendix 1.  That information, in conjunction with this guide, will help you understand what is required when filing an OWCP claim.

Most importantly as a Fac Rep you need to ensure either yourself or the claimant contacts your regional OWCP Rep immediately to ensure your claim is properly handled.

 

 

INJURY COMPENSATION

 

“Check your Bargaining Unit Contract which has additional information on your rights for Injury Compensation as each Region X unit has their own stipulations”.

 

 

“TRAUMATIC   INJURY”

 

Defined as a wound or other condition 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.  It must be caused by a specific event or incident or series of events or incidents within a single day or work shift.

To report a traumatic injury, an employee must complete Form CA-1,  “Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation.”

The injured employee will be assigned a file number and a claims examiner from the Department of Labor District Office.

 

 

WHAT DO YOU DO?

 

To protect entitlements the injured employee must file a CA-1 form within 30 days after sustaining an injury.  Another person, including the Fac Rep, acting on behalf of an injured employee may complete this form.  However, The employee has only 10 days to get medical attention after filing the CA-1. This is an important time frame and must be emphasized. Note:  By statutory right, the employee does have up to three years to file an injury claim -- This is accomplished by utilizing CA-7 form.

Ensure that the employee receives Form CA-16, “Authorization for Examination and/or Treatment.”  The employee’s supervisor should complete the front of this form within four hours of the request.   In an emergency, the agency may authorize medical treatment by telephone and then forward the completed CA-16 to the medical facility.

Ensure Form OWCP 1500, (also called HCFA-1500) “American Medical Association Standard Health Insurance Claim Form,” accompanies Form CA-16.  If not available, the medical facility most likely will have this form.

The injured employees absence from work is to be charged as TRAUMA LEAVE.  Unless he/she elects, the bargaining unit member is not to be charged with annual or sick leave.

The injured employee is entitled to forty five (45) calendar days of Continuation of Pay (COP) provided the claim has been initiated within the 30-day time requirement.  The FAA continues to compensate the employee the same if he/she were still available for duty.  However, pursuant the FAA Appropriations Act of 1996, the employee is not entitled to Sunday pay.  Also, overtime pay is usually excluded by FECA.

If it appears that the employee will go beyond the 45 days Continuation of Pay, Form CA-7, “Claim for Compensation on Account of Traumatic Injury or Occupational Disease,” must be completed and submitted to the OWCP district office no later than the 40th calendar day of COP.

The agency will request the employee’s complete medical history.  Advise the employee to authorize (in writing) release of medical information that PERTAINS ONLY to the situation that caused his/her injury.  Also, a reasonable time limit should be placed on the authorization, e.g., "Authorization for release of this medical information is valid ONLY for six months from the date of signature."

Gather as much evidence as possible to support the facts, e.g., witness statements, copy of audiotapes, list of witnesses, etc.  All are useful in the appeal process or if the filing of a grievance becomes necessary.  Strongly recommend to the member to keep a diary of all telephone calls including dates, name of person to whom he/she spoke with, subject of discussion, and commitments made.  Additionally, copies of all documents should be retained.

Provide a copy of Appendix 2 to the member prior to completing the CA-1 form.

 

 

“OCCUPATIONAL   DISEASE   OR   ILLNESS”

 

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.

To a report an occupational disease or illness, an employee must complete Form CA-2, “Federal Employee’s Notice of Occupational Disease and Claim for Compensation.”

The Department of Labor District Office will assign the injured employee a file number and a claims examiner.

 

 

WHAT DO YOU DO?

 

Ensure the employee files a CA-2 form within 30 days from the date the he/she realized the disease or illness was caused or aggravated by employment.  If in doubt, the employee should file!  Another person, including the Fac Rep, acting on behalf of an injured employee may complete this form.  Note:  By statutory right, the employee does have up to three years to file an injury claim -- This should be accomplished by utilizing Form CA-7.

Advise the bargaining unit member to seek medical attention from a physician who has experience with the Office of Workman's Compensation Program.  It is recommended that the physician be "board certified."

Advise the employee of the importance of selecting the right physician.  If after the initial choice, the employee wishes to change physicians, he/she must contact OWCP in writing for approval and include the reasons for requesting the change.

Ensure the employee files Form CA-7 at the appropriate time.  According to OWCP literature, this form should be submitted as soon as pay stops.  The employee can best ascertain when to file this form by contacting his/her OWCP claims examiner.

Form CA-16 is not given in a occupational disease or illness claim.  In order for the employer to authorize medical treatment, they must first receive OWCP approval.  Also, COP is not authorized in connection with an occupational disease or illness.

The employee has the right to use annual leave, sick leave, or leave without pay, pending adjudication of the claim.  Once the claim has been approved, leave taken can be restored.  The employee should make his/her request for "leave buy back" by submitting Form CA-7 to OWCP.

The agency will most likely ask for the employee’s complete medical history.  Advise the employee to authorize (in writing) release of medical information that PERTAINS ONLY to the situation that caused his/her injury.   A reasonable time limit should be placed on the authorization, e.g., "Authorization for release of this medical information is valid ONLY for six months from the date of signature."

Gather as much evidence as possible to support the facts, e.g., witness statements, copy of audiotapes, list of witnesses, etc.  All are useful in the appeal process if the claim is denied or if the filing of a grievance becomes necessary.  Strongly recommend to the bargaining unit member to keep a diary of all telephone calls including dates, name of person to whom he/she spoke with, subject of discussion, and commitments made.  Additionally, copies of all documents should be retained.

 

Provide the member with a copy of Appendix 3 prior to completing the CA-2 from.

 

 

ADDRESS & TELEPHONE NUMBERS

 

For NATCA Assistance

Region X Regional Vice President

Mike MacDonald

100 Cummings Center, Suite 339-D

Beverly, MA 01915

978-232-9111
 -- NATCA/NRX Office

978-232-9113 -- NATCA/NRX Fax

800-266-0895 -- Pager  PIN 32000

E-Mail: mmacdonald@natca.net

NATCA Region X OWCP Representatives

John Timony

National Air Traffic Controllers Association

18 Argilla Rd.

Methuen, MA 01844

978-866-7622 -- Cell

603-881-1281 -- Work

978-208-8817 -- Home

Fax

800-266-0895 -- Pager  PIN 32011

E-Mail: owcp.rgnxrep@natca.net

E-Mail: john.timony@natca.net

E-Mail: jtcivilpe@comcast.net

 

 

 

 

 

Remember:   Follow-up to ensure that the rights of the bargaining unit member are protected.  Keep in mind time limits for the proper filing of grievances.

 

 

 

For assistance, do not hesitate to contact the NATCA OWCP Representatives listed above.

OWCP District Office Jurisdiction

District Office 1 – Boston

http://www.dol.gov/esa/owcp/contacts/bos/

(state coverage)

Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont

Susan Morales, District Director
617-624-6600

U.S. Dept. of Labor, OWCP
JFK Federal Building, Room E-260
Boston, MA 02203

617-624-6600
Fax: 617-624-6618

 

District Office 2 – New York

http://www.dol.gov/esa/owcp/contacts/ny/

(state coverage)

New Jersey, New York, Puerto Rico, Virgin Islands

Zev Sapir, District Director
646-264-3046

U.S. Dept. of Labor, OWCP
201 Varick Street, Room 740
New York, NY 10014

DFEC: 646-264-3000
World Trade Center cases: 646-264-3030
DFEC Fax: 646-264-3006
Longshore: 646-264-3010
Longshore Fax: 646-264-3002

 

District Office 3 – Philadelphia

http://www.dol.gov/esa/owcp/contacts/phi/2phife.htm

(state coverage)

Delaware, Pennsylvania, West Virginia, Maryland when the claimant's residence has a zip code beginning 21***

John Mckenna, District Director
215-861-5481
 

U.S. Dept. of Labor, OWCP
Curtis Center, Suite 715 East
170 S. Independence Mall West
Philadelphia, PA 19106-3308

215-861-5481 or 5482
Fax: 215-861-5453

 

District Office 6 – Jacksonville

http://www.dol.gov/esa/owcp/contacts/jac/6dfecstart.htm

(state coverage)

Alabama, Florida, Georgia, Kentucky, Mississippi, No. Carolina, So. Carolina, and Tennessee

Magdalena Fernandez, District Director
904-357-4777

U.S. Dept. of Labor, OWCP
400 West Bay Street, Room 826
Jacksonville, FL 32202

904-357-4777 or 4778
Fax: 904-357-4773

 

District Office 9 – Cleveland

http://www.dol.gov/esa/owcp/contacts/cle/

(state coverage)

Indiana, Michigan, Ohio; All special claims and all areas outside the U.S., its possessions, territories and trust territories

Robert Sullivan, District Director
216-357-5390

U.S. Dept. of Labor, OWCP
1240 East Ninth Street, Room 851
Cleveland, OH 44199

216-357-5100
Fax: 216-357-5378

 

District Office 10 – Chicago

http://www.dol.gov/esa/owcp/contacts/chicago/

(state coverage)

Illinois, Minnesota, Wisconsin

Joan Rosel, District Director
312-596-7157

U.S. Dept. of Labor, OWCP
230 South Dearborn Street, Eighth Floor
Chicago, IL 60604

312-596-7157
Fax: 312-596-7145

 

District Office 11 – Kansas City

http://www.dol.gov/esa/owcp/contacts/kansas/

(state coverage)

Iowa, Kansas, Missouri, and Nebraska; all employees of the Department of Labor, except Job Corps enrollees, and their relatives

Lois Maxwell, District Director
816-502-0301

U.S. Dept. of Labor, OWCP
Two Pershing Square Building
2300 Main Street, Suite 1090
Kansas City, MO 64108-2416

816-502-0301
General Fax: 816-502-0314

 

District Office 12 – Denver

http://www.dol.gov/esa/owcp/contacts/denver/

(state coverage)

Colorado, Montana, No. Dakota, So. Dakota, Utah, and Wyoming

Shirley Bridge, District Director
720-264-3000

U.S. Dept. of Labor, OWCP
1999 Broadway, Suite 600
Denver, CO 80202

720-264-3000
Fax: 720-264-3124

 

District Office 13 – San Francisco

http://www.dol.gov/esa/owcp/contacts/sfc/9sffe.htm

(state coverage)

Arizona, California, Hawaii, and Nevada

Andy Tharp, District Director
415-625-7500

U.S. Dept. of Labor, OWCP
90 Seventh St., Suite 15300
San Francisco, CA 94103

415-625-7500
Fax: 415-625-7450

 

District Office 14 – Seattle

http://www.dol.gov/esa/owcp/contacts/seattle/

(state coverage)

Alaska, Idaho, Oregon, and Washington

Marcus Tapia, District Director
206-398-8100

U.S. Dept. of Labor, OWCP
1111 Third Avenue, Suite 650
Seattle, WA 98101-3212

206-398-8100
Fax: 206-398-8151

 

District Office 16 – Dallas

http://www.dol.gov/esa/owcp/contacts/dallas/

(state coverage)

Arkansas, Louisiana, New Mexico, Oklahoma, and Texas

Frances Memmolo, District Director
972-850-2300

U.S. Dept. of Labor, OWCP
525 South Griffin Street, Room 100
Dallas, TX 75202

972-850-2300
Fax: 972-850-2301

 

District Office 25 – Washington, D.C.

http://www.dol.gov/esa/owcp/contacts/washingtondc/

(state coverage)

District of Columbia, Virginia; Maryland when the claimant's residence has a zip code other than 21***

Linda DeCarlo, District Director
202-513-6800

U.S. Dept. of Labor, OWCP
800 N. Capitol Street, N.W., Room 800
Washington, D.C. 20211

202-513-6800 (D.C., Maryland and Virginia)
Fax: 202-513-6806

Note:   In the event the employee encounters problems with the District OWCP office, or the facility, the option to file a complaint with the District Senior Claims Examiner or the District OWCP Administrator should be considered.

* Each employee should ascertain his/her Claims Examiner FAX number.

 

 

APPENDIX 1

 

Pursuant to Article 75 Section 4, the FAA shall make accessible the following information:

OWCP Pamphlet CA-550 -- Federal Injury Compensation Questions and Answers.

OWCP Publication CA-810 -- Injury Compensation for Federal Employees.  (This handbook "will probably provide answers to 90% of questions you or the injured employee may have.")

Federal Register -- Part II DOL Office of Workers' Compensation Programs 20 CFR Parts 10 and 25.

CA-700 -- Federal Employees' Compensation Act as Amended.

Note: It is recommended that you contact the Department of Labor District Office to obtain the information for your Local.  Please become familiar with the material.

These forms are available on both the NATCA
OWCP website and the DOL OWCP website.

 

For Help on the WEB:

 

 

OWCP Home Page:
http://www.dol.gov/esa/regs/compliance/owcp/fecacont.htm

 
OWCP Forms Page:
http://www.dol.gov/esa/regs/compliance/owcp/forms.htm

 
Research source:
http://www.fedworkerscomp.net/

Pursuant to Article 75 Section 4, the FAA shall maintain an inventory of FECA claim forms at all air traffic control facilities.

CA-1 -- Federal Employee's notice of Traumatic Injury and Claim for Continuation of Pay/Compensation.

CA-2 -- Notice of Occupational Disease and Claim for Compensation.

CA-2A -- Federal Employee's Notice of Recurrence of Disability and Claim for COP/Compensation.

CA-5 -- Claim for Compensation by Widow, Widower and/or Children.

CA-7 -- Claim for Compensation on Account of Traumatic Injury or Occupational Disease.

CA7a -- Time Analysis Form, used for claiming compensation, including repurchase of paid leave.

CA7b -- Leave Buy Back (LBB) Worksheet/Certification and Election

CA10 -- What A Federal Employee Should Do When Injured At Work

CA11 -- When Injured at Work Information Guide for Federal Employees

CA-16 -- Authorization of Examination and/or Treatment.  (sample for example)

CA-17 -- Duty Status Report.

CA-20 -- Attending Physician's Report.

CA-35a-h -- Occupational Disease Checklists.  Available in Appendix "C" of Publication CA-810.

OWCP-1500 -- Health Insurance Claim Form.

 

 

APPENDIX 2

 

FILLING OUT THE CA-1

 

If you are injured at work SEEK APPROPRIATE MEDICAL ATTENTION. Do not let pressure force you into filling out the CA-1 form until you are ready and capable. You have thirty (30) days to file the CA-1. Also, you do not have to fill it out. Someone else, your Fac Rep, can complete it and file on your behalf. I would advise against allowing your supervisor or manager to complete it for you. If management tells you they need the CA-1 in order to give you a CA-16 (Authorization for Examination and Treatment) they are mistaken. Authorization to examine and treat can be provided prior to completing the CA-1. If necessary authorization can be given over the phone with management to follow-up with the CA-16 later.
 

Fill in the appropriate parts of the form:
 

  1. Blocks 1-8 are self explanatory
  2. Block 9 is your your facility and the place within the facility that the injury occurred (i.e.
    Podunk ATCT, Tower Cab or USA TRACON, IFR Room).
  3. Block 10 & 11 are self explanatory
  4. Block 12 your occupation is AT-2152 Air Traffic Control Specialist
  5. Block 13 Describe the incident that caused the injury (i. e. While walking down the tower
    stairs, I tripped and fell). In case of a traumatic stress claim put the following verbiage on
    the CA-1:Out of and in the course of my Federal employment as an Air Traffic Control
    Specialist, I suffered a traumatic emotional condition when two aircraft (or other similar
    specifics) under my control came in a close proximity to each other forcing me to take
    action
  6. Block 14 Describe the injury in detail (i.e. Fracture to my right forearm). In case of a
    traumatic stress claim put the following verbiage on the CA-1: Severe emotional and
    psychological distress.
  7. Block 15 Indicate whether you are requesting COP or Leave and the type of leave you are
    requesting.
  8. Block 16 give the CA-1 to anyone who witnessed the injury or the result of the injury. The
    individual did not have to see you fall; they can be a witness to your broken arm. In case of
    a traumatic stress claim the individual should state what your reaction was to the event (i.e.
    Mr. Controller was shaking, pale and very upset. He appeared slow to respond and almost
    incoherent.)
     

Have the supervisor/manager complete and sign their portion, then have the employee sign and copy the form. This way you will have a completed copy of what the OWCP Claims Examiner has. If the supervisor/manager is unwilling to do that, copy the form and submit it. Within nine (9) calendar days of filing the CA-1 request, in writing, a copy of the entire form when it is completed by the Agency (Article 75 Section 9).
 

Within four (4) hours of submitting the CA-1 the supervisor/manager should give you a CA-16 and an OPM-1500. This will give authorization to your medical professional to treat and examine you. You are required to provide the name and address of your chosen medical professional prior to receiving the CA-16 unless there is an emergency or unusual situation.
 

You have 10 days after filing the CA-1 to receive an examination and receive treatment.

There are 9 reasons that allow the Agency to refuse deny COP; they are:

  1. The disability is a result of an occupational disease or illness

  2. The employee comes within the exclusions of 5USC 8101 (1) (B) or (E) -this does not apply to ATCS

  3. The employee is not a citizen or resident of the USA

  4. The injury occurred off the employing agency's premises and the employee was not engaged in official "off-premises" duties

  5. The employee caused the injury by his/her willful misconduct, or the employee intended to bring about his or her injury or death or that of another person, or the employee's intoxication was the proximate cause of the injury

  6. The injury was not reported on a form approved by OWCP (usually Form CA-1) within 30 days of the injury

  7. Work stoppage first occurred more than 45 days after the injury

  8. The employee first reported the injury after employment was terminated

  9. The employee is enrolled in the Civil Air Patrol, Peace Corps, Job Corps, Youth Conservation Corps, work-study program, or other group covered by special legislation.

OWCP approves/denies claims, NOT the FAA. Some Supervisors do not understand this fact and will try to refuse COP on grounds other than the 9 reasons listed above. The agency may controvert for any reason. However, they can only deny/refuse COP for the above 9 reasons.

The most common (wrong) reason is lack of witnesses.

 

 

Sample Letter


Name
Address
City, State Zip Code


Name, Manager
ATCT
Address
City, State Zip Code
 

Date

Dear Manager:
 

In accordance with Article 75, Section 9, I request a completed copy, to include the supervisor's report, of the CA-1 (Federal Employees notice of Traumatic Injury and Claim of Pay/Compensation) that I filed on (date). I need and expect to receive this information no later than seven (7) calendar days from today.
 

Thank you in advance.
 

Sincerely,
Injured worker
 

____________________________                     ____________________________
Signature                                                                   Date Received
 

Two (2) copies need to be given to the manager. He signs and dates one and returns it to you.
This is important to protect the timelines they are required to meet.

 

 

APPENDIX 3

 

FILLING OUT THE CA-2

 

You have thirty (30) days after you first realize that your disease or illness was caused by or aggravated by your employment to file a CA-2 from (Notice of Occupational Disease and claim for Compensation. Another person, including the Fac Rep, acting on behalf of an injured employee, may complete this form. Note: By statutory right, the employee does have up to three years to file an injury claim--this should be accomplished by utilizing Form CA-7. I would advise against allowing your supervisor or manager to complete it for you. A CA-16 from is not given to you from the Supervisor/Manager. Authorization for examination and/or treatment can only be given by OWCP. Continuation of Pay (COP) is not allowed when filing a CA-2 form.
 

Fill in the appropriate parts of the form:
 

  1. Blocks 1-8 are self explanatory

  2. Block 9 is AT-2152 Air Traffic Control Specialist

  3. Block 10-12 are self explanatory

  4. Block 13 be very specific about the details.

  5. Block 14 what the doctor said

  6. Block 15 is only to be completed if you miss the 30 day timeframe

  7. Block 16 is only to be completed if you do not give the needed statement

  8. Block 17 is only completed if you do not attach the required medical reports.
     

It is important that you read and complete the form and all supporting documentation is provided. Including your statement and the medical reports. Address each issue in the "Employee's statement". If you have never experienced a similar condition, you must say so. You need to provide a Medical report with the CA-2. The report must address all items in the "Medical report" section. Copies of your medical records may suffice, but will usually result in a request for more information. Do not miss the 30 day timeframe waiting for reports.
 

Have the supervisor/manager complete and sign their portion, then have the employee sign and copy the form. This way you will have a completed copy of what the OWCP Claims Examiner has. If the supervisor/manager is unwilling to do that, copy the form and submit it. Within nine (9) calendar days of filing the CA-2 request, in writing, a copy of the entire form when it is completed by the Agency (Article 75 Section 9).
 

OWCP approves/denies claims and authorizes treatment, NOT the FAA.

 

 

Sample Letter


Name
Address
City, State Zip Code


Name, Manager
ATCT
Address
City, State Zip Code
 

Date

Dear Manager:
 

In accordance with Article 75, Section 9, I request a completed copy, to include the supervisor's report, of the CA-2 (Notice of Occupational Disease and Claim for Compensation) that I filed on (date). I need and expect to receive this information no later than seven (7) calendar days from today.
 

Thank you in advance.
 

Sincerely,
Injured worker
 

____________________________                     ____________________________
Signature                                                                   Date Received
 

Two (2) copies need to be given to the manager. He signs and dates one and returns it to you.
This is important to protect the timelines they are required to meet.

 

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