In our practice representing federal employees, we find it is one thing to know the law and quite another to watch how it is administered.
This is particularly true in the area of FECA – workers’ compensation claims for federal employees under the Federal Employees’ Compensation Act. We have written recently about the problem of administrative decisions that seem to make no sense, logically or legally, but which can nevertheless have devastating effects on our clients. This is especially true where the administrative process violates basic constitutional principles of due process of law. Here are a few recent examples of practices by the U. S. Department of Labor (USDOL) and its Office of Workers’ Compensation Programs (OWCP) that thwart the purposes of the law.
- Case #1: OWCP recognized that an injured worker was entitled to an award for permanent partial loss of use of his arm, but the claims examiner refused to process the payment because the worker was also entitled to awards for other body parts, and those awards had not yet been calculated. The claims person said he wanted to “process them all at the same time” — but meanwhile the injured worker gets paid nothing (with no interest or penalty for the delay).
- Case #2: OWCP’s message system created havoc. The system allows a caller to leave a voicemail with details of the client, case number, and reason for the call. But when attorneys leave such messages, OWCP claims examiners don’t bother to listen to them, instead opting to just call up the injured worker. The worker, of course, isn’t always aware of the call or why it was placed; so the worker gets panicked and confused and the claims examiner wastes time.
- Case #3: OWCP accepted a claim but refused to pay lost wage benefits for periods when the client was on (unpaid) Family Medical Act leave. The law says wage loss benefits can’t be paid for periods when the worker is on paid leave, but this distinction is somehow lost on the claims examiner.
- Case #4: OWCP accepted a claim and was paying wage-loss benefits for 6 hours per day for periods after the employer offered light duty for 2 hours per day. A claim for total (8 hours per day) wage-loss benefits for prior time off was denied on the basis that the employer made the light duty job offer and the employee rejected it — but it’s obvious that that job offer was not made until after the period in question so the employee could not possibly have rejected it..
- Case #5: In a related type of case that seems to be recurring more often, OWCP accepts a claim but refuses to pay wage-loss benefits on the basis that the employer – after the fact – says it “would have” made a job offer earlier. In several such cases, the injured worker provides documentation that s/he asked for work repeatedly, only to be ignored or turned down by the same employer; but the OWCP claims examiner always seems to believe the employer’s self-serving statements in this situation. Result: lost wage benefits are denied in violation of the law, based on obviously flawed logic.
Do these practices seem fair to you? In my opinion these claims-handling methods do not assist in reaching a fair resolution for any stakeholders in the system and cannot be justified. They create unnecessary financial hardship in a system that does not provide for interest or attorney fees to be added to benefits when payments are delayed. Employees hear about them and lose confidence they will be compensated if they get injured. Employers see opportunities to “game the system” and take advantage. Claims handling procedures are well beyond the reach of the courts, which have no jurisdiction even over challenges to formal decisions in such cases. When there is no incentive for the government’s self-insured system to work properly, and no real accountability for OWCP employees using such tactics, there is no adequate remedy for the injured worker.
NOTE: Congress recently passed laws that limit the civil service rights of VA employees. Many feel such changes are the “tip of the iceberg”, signaling similar erosion of federal employee rights generally. The problem, of course, is that federal employees do important work for the country and must be shielded from the whims of the current political climate — regardless of which party is in power.