Workers' Compensation: How to File a Claim
Civilian federal workers are covered under the Federal Employees’ Compensation Act (FECA), which provides benefits for Federal workers who are injured on the job, or who have sustained a work-related illness.
Although, the Department of Labor/Office of Workers’ Compensation Programs (DOL/OWCP) administers the FECA program, the Department of Commerce (DOC) contracts with Managed Care Associates (MCA) to provide processing and liaison services for all DOC organizations and bureaus. MCA has extensive experience processing Federal government workers' compensation claims and supporting Federal employees injured at work. In the event of an injury, all claims and claims-related material should be sent to MCA. The DOC organizations and bureaus Workers’ Compensation Coordinators (or specialists) work closely with MCA and the DOL/OWCP to ensure all claims are processed timely.
All claims and claims-related information should be filed using the DOL Employees’ Compensation Operations and Management Portal (ECOMP) and then forwarded to MCA.
As of October 1, 2014, Department and bureau employees filing workers’ compensation forms are required to file forms electronically using the ECOMP (https://www.ecomp.dol.gov/#).
In order to ensure timely claims submission, please use ECOMP (https://www.ecomp.dol.gov/#) to file initial claims (CA-1's and CA-2's) and claims for disability compensation (CA-7's).
MCA can be reached at the following address and phone number:
DOC Workers’ Comp Claims Center
C/O Managed Care Advisors
P.O. Box 30640
Bethesda, MD 20824
Phone: 1-844-DOC-CLAIM (1-844-362-2524) or 1-202-684-3081
If you have any questions or concerns, or if you have suggestions which may help us to serve you better, you may contact DOC Office of Occupational Safety and Health (OOSH), Workers’ Compensation, at (202) 482-4935, or Sandra Williams, Workers’ Compensation Specialist, at (202) 482-0799, sWilliams@doc.gov.
These instructions for filing a Workers’ Compensation Claim apply to all Department of Commerce operating units, bureaus, agencies, offices, and other organizations or components.
However, operating units, bureaus, agencies and offices may develop supplementary Workers’ Compensation claims information, reporting procedures, and instructions, and work-related injury or illness reporting procedures to complement and enhance the Departmental reporting requirements.
For example, the Census Bureau (BOC) developed a comprehensive claims filing and management system that works in concert with Managed Care Advisors (MCA). BOC broadcasts specific Workers’ Compensation Claims information and instructions to its employees and incorporates that information into training and other communications. BOC employees who are injured while at work or sustain a work-related illness should follow the BOC-specific procedures for filing a Workers’ Compensation claim.
Additionally, NOAA uses an alternate safety reporting system. NOAA reporting requirements and associated links are located in NOAA Manual 209-10. All line offices shall utilize the online reporting tool located at https://secure.seco.noaa.gov/default.html to conduct all initial reporting.
If you are injured while at work or while conducting tasks for work, you should:
• Notify your supervisor as soon as possible.
• Visit your health unit, or seek appropriate medical attention, if necessary.
• File an injury/illness report using the DOC form CD-137, “Report of Incident, Injury, Illness, Motor Vehicle Accident, Property Damage, or Fatality (or additional equivalent bureau incident reporting procedures, if applicable and/or appropriate); (http://ocio.os.doc.gov/s/groups/public/@doc/@os/@ocio/@oitpp/documents/content/dev01_002416.pdf). This accident form must be completed within 24 hours of the incident, and the supervisor needs to submit a signed copy to the Bureau Safety Manager/Coordinator within five working days.
Note: Prior to filing a Workers’ Compensation claim or a work-related injury or illness report, check and follow your Bureau specific requirements (if any). If your Bureau chooses to use ECOMP to maintain its injury and illness records by filing an OSHA-301 form, follow the instructions provided below in the “Optional Use of ECOMP to File and Maintain OSHA Occupational Injury and Illness Records” section. Always check and follow your Bureau’s work-related injury or illness reporting procedures.
• File the appropriate WC forms [https://www.ecomp.dol.gov/# (CA-1, CA-2, etc.)]:
CA-1 claim forms are used when a work-related traumatic injury occurs. (i.e., Single incident injury, or repetitive injury, which occurs during one work shift).
CA-2 claim forms are used when a work-related occupational illness occurs. (i.e., Exposure to work factors for more than one work shift which causes an injury/illness).
Injured workers have a legal burden to prove that their medical condition was work-related. (The workers’ compensation contractor, MCA, can advise you of the type of evidence you need to support your claim.)
Keep your supervisor and the workers’ compensation contractor, MCA, informed of the status of your condition.
You must also provide your supervisor and the workers’ compensation contractor, MCA, with medical reports to support your disability.
You are still required to request leave (COP, Annual Leave, Sick Leave and/or LWOP) from your supervisor.
If your physician releases you to return to light duty or to full duty, you should return to work. The Department of Labor will not authorize compensation for employees who refuse suitable work.
PRESCRIPTION DRUG BENEFITS FOR INJURED WORKERS
As of August 1, 2016, MCA has partnered with Helios Federal Services (Helios) to manage the Department’s workers’ compensation pharmacy benefits. DOC offers a voluntary Workers’ Compensation prescription drug card program for employees who initiate a CA-1 claim for an injury on the job. It is the responsibility of the workers’ compensation coordinator or specialists and/or supervisor to provide a First Fill card to employees at the time the CA-1 is initiated. Injured or ill employees initiating a CA-1 claim form may also contact MCA [1-844-DOC-CLAIM (1-844-362-2524)] to obtain a First Fill card. The First Fill card enables employees to receive up to a 30-day supply of prescribed medication(s) at a participating pharmacy. Providing a First Fill does not obligate DOC or Department of Labor to accept the claim for workers’ compensation or make additional payments.
As a pharmacy benefit manager (PBM), Helios aims to provide: convenient and comprehensive pharmacy programs to injured workers; timely access to safe medications; and access to discounted rates.
If your physician prescribes medication for a work-related injury or illness, notify your supervisor as soon as possible. Your supervisor will provide you with a temporary Helios fill card along with instructions for filling out the card. Also, temporary Helios fill cards are available from your bureau’s workers’ compensation coordinator or specialist.
Fill out the temporary Helios fill card according to the instructions provided by your supervisor or workers’ compensation specialist and take the card to any Helios Tmesys network pharmacy and present it to the pharmacist with your prescription. The pharmacist will fill your prescription.
Most pharmacies, such as Walgreens, CVS, Kroger, Walmart, and Target, are included in the Tmesys network. To find a network pharmacy call (855) 924-8777 or visit: http://www.helioscomp.com/resources/pharmacy-locator.
If your workers’ compensation claim is accepted by DOL/OWCP, you will receive a more permanent pharmacy card in the mail. You may then use the card for other work-related injury or illness prescriptions.
If you have any questions or require further assistance, please call the Helios Retail Pharmacy Help Desk at (855) 260-1778.
Compounded Drug Medications
Effective October 14, 2016, the Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) Division of Federal Employees' Compensation (DFEC) has implemented a new prior authorization policy for processing requests for compounded drug medications for claimants under the Federal Employees' Compensation Act (FECA) Program. As noted in previous guidance issued on September 12, 2016, A Letter of Medical Necessity (also referred to as LMN or Form CA-26) must be fully completed by an injured workers' treating physician prior to authorization of any compounded medication by DFEC. OWCP will return all incomplete CA-26s to the provider without further processing. Authorizations for compounded drug prescriptions are limited to a maximum of 90 days, with initial fills and refills to be issued in 30-day supplies.
The Letter of Medical Necessity (LMN/Form CA-26) is accessible to OWCP registered providers on the Xerox/ACS website and must be completed by the treating physician and submitted electronically. Instructions on how to submit the LMN are available on the Latest Developments section of the Xerox/ACS website.
Additionally, DFEC recently issued FECA Bulletin No. 17-01, which provides further information on the compounded drug medications policy.
If you have an employee who has been injured, or an employee who wishes to file a claim for traumatic injury, you should:
• Assist the employee in receiving first-aid and/or advise the employee to seek other medical attention.
• Assist the injured employee to file an injury/illness report using the DOC form CD-137, “Report of Incident, Injury, Illness, Motor Vehicle Accident, Property Damage, or Fatality; (http://ocio.os.doc.gov/s/groups/public/@doc/@os/@ocio/@oitpp/documents/content/dev01_002416.pdf). This accident form must be completed within 24 hours of the incident, and the supervisor needs to submit a signed copy to the Bureau Safety Manager/Coordinator within five working days.
Note: Prior to filing a Workers’ Compensation claim or a work-related injury or illness report, check and follow your Bureau specific requirements (if any). If your Bureau chooses to use ECOMP to maintain its injury and illness records by filing an OSHA-301 form, follow the instructions provided below in the “Optional Use of ECOMP to File and Maintain OSHA Occupational Injury and Illness Records” section.
• Contact the workers’ compensation contractor, MCA, at 1-844-DOC-CLAIM or 1-202-684-3081 if an employee suffers a traumatic injury (single episode injury or repetitive injury which occurs during one work shift). MCA will issue a CA-16, Authorization for Examination and/or Treatment. This form generally should not be issued more than 7 days after a traumatic injury. This form should not be issued for occupational illness claims.
• Use ECOMP (https://www.ecomp.dol.gov/#) to review initial claims (CA-1's and CA-2's) and claims for disability compensation (CA-7's) in order to ensure timely claims submission. Ensure that all items on the CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation, are completed. (Note: Witness statements are not mandatory). Complete supervisor's part of the CA-1/CA-2 form and forward to MCA.
• Provide an employee reporting to you (who sustained a work-related traumatic injury or illness, has initiated a CA-1 claim, and needs a prescription filled), with a temporary Helios First Fill card along with instructions for filling out the card. Assist the employee in completing the First Fill card.
• Provide an employee reporting to you (who sustained a work-related traumatic injury or illness, has initiated a CA-1 claim, and needs a compounded drug prescription filled), with assistance in obtaining the required and appropriately completed Letter of Medical Necessity (also referred to as LMN or Form CA-26). The Letter of Medical Necessity must be fully completed by the injured workers' treating physician.
• Contact the workers’ compensation contractor, MCA, at 1-844-DOC-CLAIM or 1-202-684-3081, for specific instructions if an employee reporting to you wishes to file a claim for an occupational illness (CA-2 form).
Additional ECOMP Capabilities
Optional Use of ECOMP to File and Maintain OSHA Occupational Injury and Illness Records (29 CFR 1904)
Form 301 (Injury and Illness Incident Report)
In addition to supporting Workers’ Compensation claims filing and processing, ECOMP also supports the filing of OSHA-301 forms and maintaining the associated work-related injury and illness records. DOC elected to make the option to use ECOMP for filing OSHA-301 forms available to Bureau safety and health representatives or other designated personnel responsible for OSHA reporting. If a Bureau elects to use ECOMP to maintain its injury and illness records, it must have at least one assigned OSHA Record Keeper (ORK), who is responsible for receiving OSHA 301 forms completed by injured employees. Before OSHA Record Keepers may be assigned to agency organizations, they must be registered as users in ECOMP. Contact Steve Weisz, Occupational Safety and Health Specialist, at (202) 482-1002, email@example.com to register as a Bureau ORK in ECOMP.
If your Bureau chooses to use ECOMP to maintain its injury and illness records the injured or ill employee will be required to file an OSHA-301 form before filing a workers’ compensation CA-1 or CA-2 claim form. The data entered in the OSHA-301 form will automatically populate the CA-1 or CA-2 claim form.
An ORK may file an OSHA-301 form on behalf of an injured or ill employee who is unable to initiate the form.
To learn more about using ECOMP to maintain your Bureau’s injury and illness records, complete the OSHA Recordkeeper User Guide tutorial accessible from the ECOMP home page. The tutorial demonstrates how to file, review, and manage OSHA-301 forms which have been completed and forwarded by Bureau employees who sustained an occupational injury or illness.
Resources and References
The following documents provide additional policy, guidance and information regarding the Department’s Workers’ Compensation Program:
The following links provide additional guidance, information and training regarding the DOL/OWCP’s FECA (Workers’ Compensation Program), ECOMP, and OSHA’s Injury and Illness Recordkeeping and Reporting Requirements:
• Injury Compensation for Federal Employees, Publication CA-810, prepared by the Office of Workers’ Compensation Programs, Employment Standards Administration, DOL.
• Questions and Answers, Publication CA-550, prepared by the Office of Workers’
Compensation Programs, Employment Standard Administration, DOL.
• OSHA Injury and Illness Recordkeeping and Reporting Requirements Frequently Asked Questions (FAQ) and Answers
Updated: October 24, 2016