U.S. Postal Service
Workers' Compensation Benefits for Postal Employees Gao ID: GAO-02-729T May 9, 2002In fiscal year 2002, U.S. Postal Service employees accounted for one-third of both the federal civilian workforce and the $2.1 billion in overall costs for the Federal Workers' Compensation Program (WCP). Postal workers submitted half of the claims for new work-related injuries that year. Postal Service employees with job-related traumatic injuries or occupational diseases almost always provided the evidence required to make a determination on their entitlement. In two percent of the cases, the Office of Workers' Compensation Program (OWCP) found that evidence was missing for one or more of the required elements. However, the length of time taken to process claims varied widely even though all were subject to the same OWCP processing standards. OWCP claims examiners took 59 days to process traumatic injury claims after receiving the notice of injury claim forms from the Postal Service--a process that should take 45 days for all but the most complex cases, according to OWCP performance standards. The case files lacked the information necessary to determine whether the claims for compensation were prepared and filed by the employees within the time frame set by OWCP regulations. OWCP claims examiners took 23 days to process traumatic injury compensation claims for wage loss and schedule awards. OWCP's performance standard states that all payable claims should be processed within 14 days from the date of receipt.
GAO-02-729T, U.S. Postal Service: Workers' Compensation Benefits for Postal Employees
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United States General Accounting Office:
GAO: Testimony:
Before the Subcommittee on Government Efficiency, Financial
Management and Intergovernmental Relations, Committee on
Government Reform House of Representatives:
For Release on Delivery at 10:00 a.m. EDT on Thursday May 9, 2002:
U.S. Postal Service:
Workers‘ Compensation Benefits for Postal Employees:
Statement of Bernard L. Ungar, Director Physical Infrastructure Issues
GAO- 02-729T:
Mr. Chairman and Members of the Subcommittee:
Thank you for the opportunity to testify on the Department of Labor‘s
(DOL) Office of Workers‘ Compensation Program‘s (OWCP)
administration of the Federal Workers‘ Compensation Program (WCP)
as it pertains to Postal Service employees. In fiscal year 2000, Postal
Service employees accounted for about one-third of both the federal
civilian workforce and the $2.1 billion in total WCP costs. Postal
Service employees also submitted about one-half, or about 85,000, of
the
claims during that year to OWCP for new work-related injuries. Because
U.S. Postal Service employees account for such a large portion of the
WCP, you asked us to determine whether Postal Service employees were
receiving the benefits to which they were entitled in a timely manner.
We provided an initial response to your request on December 21, 2001.
[Footnote 1]
Among other things, we reported that about 7 percent of the Postal
Service‘s approximately 901,000 total employee workforce filed an
annual average of 82,594 WCP claims during the period we reviewed.
Of these claims, about 88 percent were approved and about 12 percent
were denied annually. We also reported that the automated file records
indicated a wide variance in the time between the date of injury and
(1)
the date of OWCP‘s decision regarding the claimant‘s entitlement to
benefits [Footnote 2] and (2) the date of OWCP‘s first compensation or
schedule award payment. [Footnote 3] However, the automated records
we reviewed did not contain the specific information we needed to
identify how long it took the injured employees, Postal Service
supervisors, and OWCP claims examiners to make and process WCP
claims; nor did the records indicate the amount of time, if any, during
which injured employees were without income while waiting for
decisions regarding their claims.
For our current review, we agreed to:
determine the extent to which Postal Service employees provided all of
the evidence required by OWCP regulations for establishing the
claimants‘ entitlement to WCP benefits; and:
identify the length of time taken by the claimant, Postal Service, and
OWCP, where applicable, to perform the step-by-step process to (1)
establish the claimant‘s entitlement to benefits; and (2) subsequently
apply for, approve, and make the first payments for compensation or
schedule awards. Where applicable, we also compared these times to
program requirements or performance standards.
We have not completed our analyses, but we are able to provide for this
testimony some preliminary data on compensation for wage loss and
schedule awards for injuries or diseases that occurred or were
recognized as job-related during the 12- month period beginning July 1,
1997. Because our review is still in process, the data we are
presenting
should be viewed as preliminary. We plan to complete our data analyses,
discuss the results with Postal Service and OWCP officials, and provide
a final report to you later this summer.
Results in Brief:
The preliminary results of our work so far indicate that the Postal
Service employees covered by our review who had job-related traumatic
injuries or occupational diseases almost always provided to OWCP the
evidence required to make a determination on their entitlement to
benefits. [Footnote 4] In about 2 percent of the cases, OWCP found that
evidence was missing for one or more of the elements required by
OWCP regulations. However, the length of time taken to process claims
to determine a claimant‘s entitlement to WCP benefits or to approve or
deny claims for compensation varied widely even though all of the cases
are subject to the same OWCP processing standards. [Footnote 5]
Because of this variance, we are using the median time to report the
results of our analyses to compensate for the extreme cases. The median
time means that 50 percent of the cases were processed at the median
time or less and 50 percent of the cases were processed in more time
than the median time during the period covered by our review.
Accordingly, 50 percent of the cases greater than the median time may
or may not have met OWCP program requirements or processing
standards.
The preliminary data indicated the following regarding the median time
to process (1) claims establishing entitlement to WCP benefits and (2)
claims for compensation for wage loss and schedule awards.
Specifically, for median claims processing times for establishing
entitlement to WCP benefits:
Postal Service employees and Postal Service supervisors met the
applicable time frames set forth by OWCP regulations to process these
claim forms for both traumatic injuries and occupational diseases.
OWCP claims examiners took 59 days to process traumatic injury
claims after receiving the notice of injury claim forms from the Postal
Service. OWCP‘s annual operational plan‘s performance standards state
that this process should take 45 days for all but the most complex
cases.
However, our data may include ’administratively closed“ cases, which
could mean that the overall processing time for these cases is
overstated.
[Footnote 6] Prior to this hearing, we did not have time to consider
what
portion, if any, of our traumatic injury claims were administratively
closed for any period of time, but we plan to do so when we complete
our data analysis. For occupational disease claims, our analysis showed
that OWCP processed these forms within the 6- to 12-month time limit
for simple to complex occupational disease cases set by OWCP‘s
performance standards.
Regarding the median time to process compensation claims for wage
loss or schedule award:
The case files did not contain the information that would enable us to
determine whether the claims for compensation were prepared and filed
by the employees within the time frame set forth by OWCP regulations.
Once a traumatic injury or occupational disease claim form for
compensation was prepared and submitted to the Postal Service
supervisor, the supervisor completed the agency portion of the forms
and
transmitted them to OWCP within the time limit set forth by OWCP
regulations.
OWCP claims examiners took 23 days to process traumatic injury
compensation claims for wage loss and schedule awards. OWCP‘s
performance standard for these claims, excluding schedule awards, state
that all payable claims should be processed within 14 days, as measured
from the date of receipt to date payment is entered into OWCP‘s
automated compensation payment system. Prior to this hearing, we did
not have the time to consider what portion of our cases were claims for
schedule awards nor their impact, if any, on the claims processing
times.
We plan to do so when we complete our analysis. For occupational
disease claims, our analysis showed that upon receipt, OWCP claims
examiners took 22 days to make the initial payment for the approved
claims. OWCP did not establish an administrative performance standard
for occupational disease claims.
Finally, the preliminary results of our case file review indicate that
during the time between the date of injury or recognition of the
disease
as job-related to the date of the first compensation payment, injured
employees often (1) continued working in a light-duty capacity, (2)
received continuation of pay (COP) [Footnote 7], while absent from
work for up to 45 days, or (3) went on paid annual or sick leave until
the
point at which they actually missed work and their pay stopped. We
have not had time to determine prior to this hearing how many, if any,
employees went without income while waiting for their first
compensation payment or whether annual or sick leave was restored
after compensation was approved.
Scope and Methodology:
Before presenting additional preliminary results, I would like to
provide
some information on our scope and methodology. Specifically, we are
interviewing key OWCP and Postal Service officials in Washington,
D.C., to discuss and collect pertinent information regarding the
employees‘ claims for WCP eligibility and for compensation for lost
wages and schedule awards. Additionally, we collected and reviewed a
total of 483 Postal Service employee WCP case files located at the 12
OWCP district offices throughout the country. For the 12-month period
beginning July 1, 1997, we randomly selected the claims and obtained
case file records for injuries that occurred or were recognized as job-
related during this period on the basis of the type of injury involved:
traumatic or occupational; and on the basis of their approval or
nonapproval for WCP benefits and compensation or schedule award
payments. We chose this period of time because we believed it was
current enough to reflect ongoing operations, yet historical enough for
most, if not all, of the claims to have been decided upon. Also, in
discussing the preliminary results, we generally present our analyses
of
claim processing times in terms of the ’median“ time to process cases
covered by our review. This means that 50 percent of the cases were
processed in the median time or less, and 50 percent of the cases were
processed in more time than the median.
We did our work from January to May 2002 in accordance with
generally accepted government auditing standards. We have not had
enough time to fully analyze all of the data we collected, including
analyzing the total percentage of claims processed within specified
processing standards, or to fully discuss the data with Postal Service
or
OWCP officials. Accordingly, we are limiting our discussion to median
time intervals between the major steps in the WCP claims process up
until the time of the decision on the claim and initial compensation
payment.
Among other things, prior to this hearing, we did not have the time to
(1)
pinpoint and evaluate specific problems that may have affected the time
to process the cases we reviewed, (2) address issues OWCP raised on
how the claims processing times might be affected by ’administrative
closures“ or schedule awards, or (3) evaluate numerous other factors
that
may have affected overall claims processing. Our work has not included
an analysis of any time involved in the appeal process of any claim we
reviewed, nor did we evaluate the appropriateness of OWCP‘s decisions
on approving or denying the claims. More detail about our sampling
plan is presented in appendix I.
Background: Employing Agencies Partner With OWCP to Administer
WCP:
Although OWCP is charged with implementing the WCP, there is a
federal partnership between OWCP and the employing federal agencies
for administering the WCP. In this partnership, federal agencies,
including the Postal Service, provide the avenue through which injured
federal employees prepare and submit their notice of injury forms and
claims for WCP benefits and services to OWCP. Additionally,
employing agencies are responsible for paying normal salary and
benefits to those employees who miss work for up to 45 calendar days,
during a 1- year period, due to a work-related traumatic injury for
which
they have applied for WCP benefits. After receiving the claim forms
from the employing agencies, OWCP district office claims examiners
review the forms and supporting evidence to decide on the claimant‘s
entitlement to WCP benefits or the need for additional information or
evidence, determine the benefits and services to be awarded, approve or
disapprove payment of benefits and services, and manage and maintain
WCP employee case file records. If additional information or other
evidence is needed before entitlement to WCP benefits can be
determined, OWCP generally corresponds directly with the claimant or
the WCP contact at the applicable Postal Service locations.
Evidence Required by OWCP Regulations to Determine Entitlement to
WCP:
Benefits Is Nearly Always Provided:
OWCP regulations require that evidence needed to determine a
claimant‘s entitlement to WCP benefits meet five requirements. These
requirements are as follows:
The claim was filed within the time limits specified by law.
The injured or deceased person was, at the time of injury or death, an
employee of the United States.
The injury, disease, or death did, in fact, occur.
The injury, disease, or death occurred while the employee was in the
performance of duty.
The medical condition for which compensation or medical benefits is
claimed is causally related to the claimed job-related injury, disease,
or
death. [Footnote 8]
Such evidence, among other things, must be reliable and substantial as
determined by OWCP claims examiners. If the claimant submits factual
evidence, medical evidence, or both, but OWCP determines the evidence
is not sufficient to meet the five requirements, OWCP is required to
inform the claimant of the additional evidence needed. The claimant
then has at least 30 days to submit the evidence requested.
Additionally,
if the employer-in this case, the Postal Service-has reason to disagree
with any aspect of the claimant‘s report, it can submit a statement to
OWCP that specifically describes the factual allegation or argument
with
which it disagrees and provide evidence or arguments to support its
position.
According to the files we reviewed, about 99 percent of the Postal
Service employees‘ traumatic injury claims contained evidence related
to
the five requirements set by OWCP regulations. About 1 percent of the
traumatic injury claims were not approved, according to the case files
we reviewed, because evidence was not provided for one or more of the
requirements. About 97 percent of the claims filed by Postal Service
employees for occupational disease claims contained evidence related to
the five requirements. The remaining claims, or about 3 percent, did
not
include all of the required evidence. Generally, the evidence not
provided for both types of claims pertained to either (1) the
employee‘s
status as a Postal Service employee or (2) whether the claim was filed
within the time limits specified by law. We did not evaluate OWCP‘s
decisions regarding the sufficiency of the information provided.
Median Processing Time to Determine Entitlement to WCP Benefits:
During the period covered by our review, OWCP regulations required an
employee who sustained a work-related traumatic injury to give notice
of the injury in writing to OWCP using Form CA-1, ’Federal
Employee‘s Notice of Traumatic Injury and Claim for Continuation of
Pay/Compensation,“ in order to claim WCP benefits. To claim benefits
for a disease or illness that the employee believed to be work-related,
he
or she was also required to give notice of the condition in writing to
OWCP using Form CA-2, ’Notice of Occupational Disease and Claim
for Compensation.“ Both notices, according to OWCP regulations,
should be filed with the Postal Service supervisor within 30 days of
the
injury or the date the employee realized the disease was job-related.
[Footnote 9] Upon receipt, Postal Service officials were supposed to
complete the agency portion of the form and submit it to OWCP within
10 working days if the injury or disease was likely to result in (1) a
medical charge against OWCP, (2) disability for work beyond the day or
shift of injury, (3) the need for more than two appointments for
medical
examination/or treatment on separate days leading to time lost from
work, (4) future disability, (5) permanent impairment, or (6) COP.
[Footnote 10]:
OWCP regulations, during the period covered by our review, did not
provide time frames for OWCP claims examiners to process these
claims.
Instead, OWCP‘s operational plan for this period specified performance
standards for processing certain types of WCP cases within certain time
frames. Specifically, the performance standard for processing traumatic
injuries specified that a decision should be made within 45 days of its
receipt in all but the most complex cases. The performance standards
for
decisions on occupational disease claims specified that decisions
should
be made within 6 to 12 months, depending on the complexity of the
case.
The case files we reviewed indicated that the length of time taken to
process a claim-from the date of traumatic injury or the date an
occupational disease was recognized as job-related to the date the
claimant‘s entitlement to benefits was determined-varied widely. For
example, we estimate that 25 percent of the claims were processed in up
to 48 days for traumatic injury and in up to 78 days for occupational
disease. We estimate that 90 percent of the claims were processed in up
to 307 days for traumatic injury and in up to 579 days for occupational
disease. Finally, we estimate that 50 percent of the claims were
processed in up to 84 days for traumatic injuries and in up to 136 days
for occupational disease. Specifically, Postal Service employee claims
for injuries or diseases covered by our review took the median times
shown in table 1 to complete.
Table 1. Median Length of Time to Process Claims to Determine
Entitlement to WCP Benefits for Injuries or Diseases Recognized as
Job-Related During the Period July 1, 1997, through June 30, 1998:
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Traumatic injury.
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Date of traumatic injury to date injured Postal
Service
employee prepared notice of injury form; OWCP regulations or
performance standards: 30 days; Estimated median time to complete
steps: 1 day.
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Date Postal Service employee prepared notice of
injury form to date Postal Service supervisor signed form; OWCP
regulations or performance standards: [Empty]; Estimated median time
to complete steps: 1 day.
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Date Postal Service supervisor signed notice of injury
form to date OWCP received form; OWCP regulations or performance
standards: 10 working days; Estimated median time to complete steps: 9
calendar days.
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Date OWCP received notice of injury form to date of
notice that entitlement to benefits has been established; OWCP
regulations or performance standards: 45 days; Estimated median time to
complete steps: 59 days.
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Occupational disease; OWCP regulations or
performance standards: [Empty]; Estimated median time to complete
steps: [Empty].
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Date of occupational disease recognized as job-related
to date Postal Service employee signed notice of occupational disease
form; OWCP regulations or performance standards: 30 days; Estimated
median time to complete steps: 23 days.
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Date Postal Service employee signed notice of
occupational disease form to date Postal Service supervisor received
notice of occupational disease form; OWCP regulations or performance
standards: [Empty]; Estimated median time to complete steps: 3 days.
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Date Postal Service supervisor signed notice of
occupational disease form to date OWCP received form; OWCP
regulations or performance standards: 10 working days; Estimated
median time to complete steps: 11 calendar days.
Points in time during the process to apply for and determine
entitlement
to WCP benefits: Date OWCP received notice of occupational disease
form to date of notice that entitlement to benefits has been
established;
OWCP regulations or performance standards: 6 to 12 months; Estimated
median time to complete steps: 63 days.
[A] Median processing time includes time to process both claims for
wage loss and claims for schedule awards.
Source: GAO analysis of OWCP data:
[End of table]
The median elapsed time taken by Postal Service employees and Postal
Service supervisors met the applicable time frames set forth in OWCP
regulations. As shown in table 1, the median time taken by Postal
Service employees to prepare and submit the claim forms needed to
make a determination on their entitlement to WCP benefits for traumatic
injuries to the Postal Service supervisor was 2 days from the date of
the
injury, well within the 30-day time frame set by OWCP regulations.
For occupational disease, Postal Service employees signed and
submitted the notice of disease form to the Postal Service supervisor
in a
median time of 26 days from the date the disease was recognized as job-
related, or 4 days less than the 30-day time frame set by OWCP
regulations. Upon receipt, the Postal Service supervisor then took up
to a
median time of 11 calendar days-also within the time limit of 10
working days set forth in the regulations-to complete the form and
transmit it to OWCP.
Also as shown in table 1, once OWCP received the form from the Postal
Service, our preliminary analysis showed that OWCP claims examiners
processed these notice of injury forms for traumatic injuries in a
median
time of 59 days to determine a claimant‘s entitlement to WCP benefits.
As mention earlier, the performance standard for these types of cases
was 45 days, or 14 days less than the median time taken. According to
OWCP officials, the 59-day median processing time inappropriately
included the time during which certain types of claims were
’administratively closed,“ then reopened later when a claim for
compensation was received. We plan to determine the effect to which
these types of claims may have affected the processing times as we
complete our review. For occupational disease claims, the data showed
that OWCP processed these forms at the median time of 63 days, which
was within the 6 to 12-month time frame for simple to complex
occupational disease cases specified by OWCP‘s performance standards.
Median Processing Time to Approve and Make First Compensation
Payments:
During the period covered by our review, OWCP regulations stated that
when an employee was disabled by a work-related injury and lost pay
for more than 3 calendar days, or had a permanent impairment, the
employer is supposed to furnish the employee with Form CA-7, ’Claim
for Compensation Due to Traumatic Injury or Occupational Disease.“
This form was used to claim compensation for periods of disability not
covered by COP as well as for schedule awards. The employee was
supposed to complete the form upon termination of wage loss-the period
of wage loss was less than 10 days or at the expiration of 10 days from
the date pay stopped if the period of wage loss was 10 days or more-
and
submit it to the employing agency. Upon receipt of the compensation
claim form from the employee, the employer was required to complete
the agency portion of the form and as soon as possible, but not more
than 5 working days, transmit the form and any accompanying medical
reports to OWCP.
For the period covered by our review, OWCP regulations did not
provide time limits for OWCP claims examiners to process these claims.
Instead, OWCP‘s annual operational plan for the period of our review
specified a performance standard for processing wage loss claims.
Specifically, the performance standard stated that all payable claims
for
traumatic injuries-excluding schedule awards- should be processed
within 14 days.
This time frame was to be measured from the date OWCP received the
claim form from the employing agency to the date the payment was
entered into the automated compensation payment system. No
performance standard was specified for occupational disease
compensation claims.
The case file data showed that the processing time--from the date the
claim for compensation was prepared to the date the first payment was
made-varied widely. For example, we estimate that to process 25 percent
of the claims, it took up to 28 days for traumatic injuries and up to
32 days for occupational diseases. To process 90 percent of the claims,
it
took up to 323 days for traumatic injuries and up to 356 days for
occupational diseases. To process 50 percent of the claims, it took up
to
49 days for the traumatic injuries and up to 56 days for the
occupational
diseases. Specifically, the median times to process the claims for
compensation for the traumatic injury and occupational disease claims
covered by our review are shown in table 2.
Table 2. Median Length of Time to Process Claims, Step by Step, for
Compensation for Injuries and Diseases, Recognized as Job-Related
During the Period July 1, 1997, through June 30, 1998:
Traumatic Injury:
Points in time to apply, review, and approve first compensation
payment: Date of traumatic injury to date Postal Service employee
signed claim for compensation; OWCP regulations or performance
standards: See footnote [A]; Estimated median time for steps to be
completed: 135 days.
Points in time to apply, review, and approve first compensation
payment: Date Postal Service employee signed claim for compensation
to date Postal Service supervisor signed claim; OWCP regulations or
performance standards: See footnote [A]; Estimated median time for
steps to be completed: 7 days.
Points in time to apply, review, and approve first compensation
payment: Date Postal Service supervisor signed claim to date OWCP
received claim; OWCP regulations or performance standards: 5 working
days; Estimated median time for steps to be completed: 4 calendar days.
Points in time to apply, review, and approve first compensation
payment: Date OWCP received claim for compensation to date of first
compensation payment made; OWCP regulations or performance
standards: 14 days; Estimated median time for steps to be completed: 23
days.
Occupational Disease:
Points in time to apply, review, and approve first compensation
payment: Date occupational disease was recognized as job-related to
date Postal Service employee signed claim for compensation form;
OWCP regulations or performance standards: See footnote [A];
Estimated median time for
steps to be completed: 320 days.
Points in time to apply, review, and approve first compensation
payment: Date Postal Service employee signed the claim for
compensation to date Postal Service supervisor signed the claim; OWCP
regulations or performance standards: See footnote [A]; Estimated
median time for steps to be completed: 11 days.
Points in time to apply, review, and approve first compensation
payment: Date Postal Service supervisor signed claim to date OWCP
received claim; OWCP regulations or performance standards: 5 working
days; Estimated median time for steps to be completed: 7 calendar days.
Points in time to apply, review, and approve first compensation
payment: Date OWCP received compensation claim to date payment
entered into automated compensation payment system; OWCP
regulations or performance standards: Standard not provided; Estimated
median time for steps to be completed: 22 days.
Footnote [A] Data were not available for us to determine whether
claimants filed for compensation within the time frame set forth in
OWCP regulations. Specifically, the regulations provide that once
entitlement to WCP benefits is established, the claimant should submit
a
claim for compensation up to 10 days from the day pay stops. Prior to
this hearing, we were not able to obtain the information regarding the
time the claimant‘s pay stopped. We plan to do so and perform the
analysis in our final report.
Source: GAO analysis of OWCP data.
[End of table]
The case files we reviewed did not contain the information that would
have enabled us to determine whether the claims for compensation were
prepared and filed by the employees within the time frame set forth by
OWCP regulations. However, as shown in table 2, once a claim was
prepared, at the median time, we found that after receipt of a claim
for
compensation for a traumatic injury, the Postal Service supervisor
completed the agency portion of the form and transmitted it to OWCP in
4 calendar days, which was less than the 5 working days required by
OWCP regulations. For occupational disease compensation claims, we
found that upon receipt of the claim form from the employee, the Postal
Service supervisor took 7 calendar days, which was also within the 5
working day requirement imposed by OWCP regulations, to transmit the
claims to OWCP.
As also, as shown in table 2, once OWCP received a traumatic injury
compensation claim form, the median time for OWCP claims examiners
to process the claim was 23 days, which was longer than the 14 days
specified by OWCP‘s performance standard-excluding schedule awards.
However, our data included claims for schedule awards. As mentioned
earlier, prior to this hearing we did not have time to evaluate the
effect
that schedule awards might have had on the median processing time. We
plan to do so in our analysis for the final report. For occupational
disease
claims, our analysis showed that upon receipt, OWCP claims examiners,
at the median processing time, took 22 days to make the initial payment
for the approved claims. OWCP did not specify a performance standard
for occupational disease claims.
Finally, our preliminary analysis of case file data showed that during
the
time between the date of injury or recognition of a disease as job-
related,
injured employees often (1) continued working in a light-duty capacity,
(2) received COP while absent from work, or (3) went on paid annual or
sick leave until the time they actually missed work and their pay
stopped. In fact, the data showed that the median elapsed time from the
date the injury occurred or the disease was recognized as job-related
to
the beginning date of the compensation period was 98 days for traumatic
injuries and 243 days for occupational disease claims.
Mr. Chairman, this concludes my prepared statement. I will be pleased
to answer any questions you or other Members of the Subcommittee
may have.
Contacts and Acknowledgments:
For further information regarding this testimony, please contact
Bernard Ungar, Director, or Sherrill Johnson, Assistant Director,
Physical Infrastructure Issues, at (202) 512-4232 and (214) 777-5699,
respectively. In addition to those named above, Michael Rives,
Frederick Lyles, Melvin Horne, John Vocino, Scott Zuchorsky, Maria
Edelstein, Lisa Wright-Solomon, Brandon Haller, Jerome Sandau, Jill
Sayre, Sidney Schwartz, and Donna Leiss made key contributions to this
statement.
Sample Plan:
The population from which we selected our sample reflects Postal
Service employees who, as of June 30, 2001, submitted claims for
compensation for lost wages or schedule awards (Form CA-7) for
injuries that occurred, or were recognized as job-related, during the
12-
month period beginning July 1, 1997. In order to report results for
traumatic injury and occupational disease claims, and to report results
on
claims of both types whether compensation was paid or not, we
stratified
our population into the following four strata on the basis of
information
from the sample frame:
The employee filed a ’Federal Employee‘s Notice of Traumatic Injury
and Claim for Continuation of Pay/Compensation (Form CA-1) and
received payment for compensation of lost wages or a schedule award.
The employee filed a ’Federal Employee‘s Notice of Traumatic Injury
and Claim for Continuation of Pay/Compensation (Form CA-1) and did
not receive payment for compensation of lost wages or a schedule
award.
The employee filed a ’Notice of Occupational Disease and Claim for
Compensation (Form CA-2), and received payment for compensation.
The employee filed a ’Notice of Occupational Disease and Claim for
Compensation (Form CA-2), and did not receive payment for
compensation.
The size of the population in each of these four strata was 3,872;
1,232;
2967; and 873, respectively. The number of usable sample cases
obtained from each of the four strata was 198, 106, 143, and 96,
respectively. We initially selected somewhat higher numbers of sample
cases. If we were not able to obtain the file for a particular sample
case,
we substituted cases from the additional randomly sampled cases.
We followed a probability procedure to obtain the 483 usable claim
files
in total from the four strata. Of the 543 claims files, 483 were usable
(173, 97, 127, and 86 in each strata, respectively. The 95 percent
confidence interval for proportion estimates of the total population
was
no greater than plus or minus 5 percentage points. The 95 percent
confidence interval for proportion estimates applied to individual
strata
was no greater than plus or minus 10 percentage points. Confidence
levels for other types of estimates, such as averages, medians, and
totals,
depended on the variability of the sample values. We used SAS and
SUDAAN software to make population projections.
(543019):
FOOTNOTES
[1] U.S. General Accounting Office, Administration of the Workers‘
Compensation Program by the Postal Service and the Department of
Labor,
(Washington, D.C.; December 21, 2001).
[2] WCP provides for payment of several types of benefits, including
compensation for wage loss, schedule awards, medical and related
benefits, and vocational rehabilitation services for conditions
resulting
from injuries sustained or occupational disease or illness contacted in
performance of duty while in the service of the United States. WCP also
provides for payment of monetary compensation to specified survivors
of an employee whose death results from work-related injury or disease
and for payment of certain burial expenses.
[3] An injured employee can claim compensation as a (1) wage
replacement benefit for lost wages, (2) schedule award if the employee
has a permanent impairment to a member or function of the body, or (3)
both.
[4] WCP allows for two types of work-related injuries for which
benefits
and services can be claimed: ’traumatic injury“ and ’occupational
disease or illness.“ Traumatic injury means a condition of the body
caused by a specific event or incident, or series of events or
incidents,
within a single day or work shift. Such condition must be caused by an
external force, including stress or strain, that is identifiable as to
time
and place of occurrence and member or function of the body affected.
Occupational disease or illness is a condition produced by the work
environment over a period longer than a single day or work shift.
[5] Unless stated otherwise, calendar days are used throughout this
statement.
[6] OWCP officials told us that OWCP permits certain, uncontested
types of injury claims-those having medical bills totaling less than
$1,500, no claims for compensation, and no potential third-party
liability
after payment of any outstanding medical bills-to be closed without
formal adjudication to establish a claimant‘s entitlement to WCP
benefits. If any of these factors change, then formal adjudication
begins.
Thus, processing time for such cases may prolong the overall processing
time because of the ’down time“ experienced before the claim for
compensation is received by OWCP.
[7] COP is a WCP benefit that is intended to provide workers income
while their claims for WCP benefits are being processed by OWCP.
COP is not considered WCP compensation.
[8] For wage loss benefits, the claimant must also submit medical
evidence showing that the condition claimed is disabling.
[9] Generally, the employee has up to 3 years from the date of the
injury
to establish his or her entitlement to OWCP benefits.
[10] If none of these conditions exist, the employer is supposed to
retain the CA-1 and CA-2 as a permanent record in the Employee
medical Folder in accordance with Office of Personnel Management
guidelines.
