DI 52115.010: Federal Employees’ Compensation Act (FECA)

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~~Effective Dates: 03/12/2018 - Present~~
Effective Dates: 04/03/2018 - Present
TN 1 (01-14)
DI 52115.010 Federal Employees’ Compensation Act (FECA)
The Department of Labor, Office of Workers' Compensation Programs (DOL/OWCP) administers FECA payments through its Division of Federal Employees' Compensation (DFEC). FECA provides benefits for on-the-job injuries or illnesses sustained by civilian employees of the Federal government and certain employees of State and local governments and private employers as provided by Federal law. FECA also provides benefits to survivors of employees who die from work-related injuries or diseases. FECA payments are offsettable as workers’ compensation (WC).
A. Applying offset to FECA payments
Use the gross amount of FECA payments (before any deductions) to calculate disability insurance benefit (DIB) offset. FECA cost-of-living adjustment (COLA) increases are offsettable. Life and health insurance premiums may be deducted from FECA payments but we do not consider these excludable expenses. For general information and instructions on excludable expenses, see DI 52150.050.
B. Types of FECA payments
1. Periodic wage loss payments
Periodic wage-loss payments are WC. These payments are normally two-thirds of the previous wages, but if the number holder (NH) has one or more dependents, the payment rises to three-quarters of the previous wage. Offset DIB using the entire gross FECA payment, whether paid at the two-thirds amount or the three-quarters amount. DOL pays short-term FECA benefits weekly and long-term FECA benefits every 28 days. To determine the monthly equivalent, follow Determining the Workers’ Compensation/Public Disability Benefit (WC/PDB) Amount Used to Compute Offset instructions in DI 52150.035C.
Since it is not always possible to determine how long the injury or illness will prevent the NH from working, many FECA cases begin with weekly payments and progress to 28-day long-term disability payments.
2. FECA schedule awards
FECA schedule awards are offsettable WC payments that compensate NHs for the work-related loss of, or loss of use of, one or more body parts. Schedule awards are not paid simultaneously with regular wage-loss payments for the same injury. These awards begin once maximum medical improvement has occurred for the body part involved. FECA schedule awards pay WC for a statutory number of weeks depending on the body part(s) affected. For example, may allot 46 weeks for a pointer finger or 312 weeks for an arm.
Schedule awards not paid simultaneously with regular wage-loss payments can continue while the NH receives a disability retirement pension under the Civil Service Retirement System (CSRS) or the Federal Employee Retirement System (FERS). We consider both the CSRS and FERS payments as federal public disability benefits (PDBs). Therefore, it is possible for PDB offset and WC offset to apply if the claimant receives both FECA (WC) and a CSRS or FERS disability retirement pension (PDBs).
DOL pays schedule awards without regard to loss of earning capacity. The NH can actually receive a schedule award after going back to work even if the work is in the previous employment.
3. Disfigurement payments under FECA
Disfigurement payments compensate NHs whose injury causes permanent damage to the head, face, or neck. FECA disfigurement is a separate, offsettable award of up to $3,500.00.
4. Vocational Rehabilitation (VR) payments
VR may pay up to $200.00 monthly but usually paid in addition to WC. Therefore, it is rarely subject to offset. For VR payment offset rules, see DI 52110.005 Vocational Rehabilitation (VR) Payments.
C. FECA payment adjustment, suspension, and termination events
FECA payments are subject to change. The following describes when DOL may decrease, increase, suspend, or terminate payments.
1. Reasons for FECA payment decrease
FECA payments may decrease in the following situations:
* The only dependent child, spouse, or parent no longer qualifies as a dependent;
* The NH reenters the workforce or is able to reenter the workforce at a lower salary than prior to becoming disabled; or
* The NH refuses to work after progressing through VR to the point that suitable work is identified. (DOL then reduces FECA payments by the amount the NH would have earned.)
2. Reasons for FECA payment increase
FECA payments may increase in the following situations:
* FECA cost-of-living adjustments (for additional information, see DI 52115.010D in this section);
* A qualifying dependent child, spouse, or parent becomes entitled on the NH’s record;
* Payments previously reduced due to a work attempt are no longer reduced when the NH becomes unable to work.
3. Reasons for FECA payment suspension
FECA payments may require suspension in the following situations:
* NH fails to comply with a specific request from OWCP (failure to attend a medical exam, for example) or fails to respond to requests for information; or
* NH confined due to the conviction of a felony.
See NOTE regarding suspension and termination of FECA in DI 52115.010C.4. in this section below.
4. Reasons for FECA payment termination
FECA payments may terminate when the NH:
* dies;
* returns to work with no loss of wages;
* is no longer medically disabled;
* refuses to work when medically able to;
* quits a job for other than medical reasons;
* never suffered any work-related injury (i.e., if there is a disability, investigation reveals it is not work-related);
* refuses to file a third-party lawsuit related to the work injury when compelled by the government to do so; or
* is guilty of fraud in connection with the WC claim.
NOTE: If DOL suspends or terminates FECA, take into consideration the reason for suspension or termination; and whether it affects title II (DIB). For example, if the NH’s FECA terminates for work activity, it may be substantial gainful activity (SGA) for DIB purposes.
D. FECA Cost of Living Adjustments (COLAs)
OWCP pays COLA increases to all eligible NHs each year. However, COLAs are not payable for the first 12 months of entitlement to FECA.
* NEPSC Workers’ Comp Info Page http://sharepoint.ba.ssa.gov/dco/ny/NYnet/NEPSC/Pages/WC-Information-Page.aspxhas a COLA calculator that computes the effect of COLA increases on a NH’s FECA payments. The calculator lists the COLAs retroactive to June 1975.
* NEPSC Workers’ Comp Info Page here has a COLA calculator that computes the effect of COLA increases on a NH’s FECA payments. The calculator lists the COLAs retroactive to June 1975.
* Beginning in 1981, COLA increases take effect on March 1. Processing center (PC) technicians should set a diary for March of each year to adjust offset to reflect the FECA COLA increase.
NOTE: If we do not receive FECA COLA information from the NH or the NH’s representative payee, and the FECA COLA increase results in lower DIB payable after offset, send a due process notice. Due process is not required if the FECA COLA increase has no effect on DIB payable. For notice information, see Notices Required Before and After Taking a Title II Adverse Action in GN 03001.015, and Due Process Notice to Disabled Number Holder (NH) in NL 00703.511.
E. Obtaining verification (“proof”) of FECA payments
Contact the NH to obtain proof of the gross benefits before any deductions. Bank statements are not valid because they show only the net amount. DOL sends written notification of any payment changes, so proof should be readily available.
1. PC online access to DOL’s Agency Query System (AQS)
All PCs have a limited number of employees with access to DOL’s Agency Query System (AQS). AQS is an online tool containing payment records for NHs receiving WC FECA benefits. AQS displays the gross payment amounts needed to apply offset. However, AQS access is not available for every case.
Information from online access is a third-party report. Third-party reports that result in adverse actions require advance due process notification prior to DIB benefit reduction. For due process notice information, see NOTE in DI 52115.010D in this section.
Consult your PC’s local procedures to route requests for FECA verification to the PC personnel with designated AQS access.
NOTE: Field offices (FOs) do not have access to AQS.
2. FO development of FECA proof
If you cannot obtain proof from the NH:
* Follow the guidelines for DOL mail contact shown in DI 52115.010F in this section.
* Establish a tickle date for 35 days.
* If no response is received in 35 days, contact the DFEC district office by telephone following instructions in DI 52115.010F in this section.
* When you receive the requested proof, review the master beneficiary record (MBR) and the electronic record for any necessary adjustments.
NOTE: Proof from DOL is a third-party report. Third-party reports that result in adverse actions require advance due process notification prior to DIB benefit reduction. For due process notice information, see the NOTE in DI 52115.010D in this section.
* Retain the FECA proof following Retention of Workers’ Compensation/Public Disability Benefit (WC/PDB) Proofs procedure in DI 52145.015.
3. PC development of FECA proof
If the NH is unable to provide proof and information is not available from the online access described in DI 52115.010E.1. in this section; follow DOL mail contact guidelines in DI 52115.010F.2.f. in this section, and take the following actions:
* Set a diary for 35 days for receipt of proof from DOL.
* When the diary matures, check for any paper and paperless responses from DOL. Check all pending and closed actions to be sure the proof is not attached to another ACR or set up under an incorrect type of event level (TOEL) code.
* If you receive a response that contains only net amounts or is otherwise inadequate, follow telephone contact instructions with DFEC district office per DI 52115.010F.3. in this section.
* If you do not receive a response, send another written request for information to DOL as described in DI 52115.010F.2. in this section. Indicate the mailing date of the first request. Write “Second Request” in red at the top of the form and mail the form to the same address.
* Set a diary for another 35 days.
* When the diary matures, check for any paper and paperless responses from DOL. Check all pending and closed actions to be sure the proof is not with another ACR or set up under an incorrect TOEL.
* If you do not receive a response, the response contains only net amounts or is otherwise inadequate, contact the DFEC district office by following the instructions for telephone contact in DI 52115.010F.3. in this section.
* Once you receive documentation proof, review the MBR and the electronic record for possible necessary adjustments. The proof from DOL is a third-party report. Third-party reports that result in adverse actions require advance due process notification prior to DIB benefit reduction. For notice information, see Notices Required Before and After Taking a Title II Adverse Action in GN 03001.015, and Due Process Notice to Disabled Number Holder (NH) in NL 00703.511.
* Provide due process, if necessary, then process any needed adjustment action. Retain all FECA proof per Retention of Workers’ Compensation/Public Disability Benefit (WC/PDB) Proofs instructions in DI 52145.015.
* Set a stand-alone diary for the following March to develop changes and adjust benefits for the FECA COLA.
F. Verifying FECA payments
1. FECA claim number
The DOL claim number for FECA payments is a nine-digit number that begins with a two-digit code separated from the other seven digits by a hyphen (e.g., 01-2345678). The first two digits identify the DOL district office that handled the claim. If the worker relocates, the originating office retains jurisdiction. Include the DOL claim number and the Social Security Number (SSN) on any correspondence sent to DOL. If the DOL claim number on our records is incorrect, they may be able to use the SSN to access the information.
2. Requesting proof from DOL
Take the following actions to request proof from DOL:
* Submit all initial requests for information in writing. Generally, DOL does not respond to faxed requests. Do not send a fax unless DOL requests that you do so.
* Use Form SSA-1709 (Request for Workers’ Compensation/Public Disability Benefit Information) or local version of the DOL Information Request Form.
* Complete and date the form.
* If you need extensive information, request a complete history for the period(s) involved.
* In the PC, scan the completed form into the paperless system and add to the ACR. If working with a paper folder, scan the document with the TOEL code of “FILE WC” and prong-file a copy in the folder.
* Mail requests to: U.S. Department of Labor DFEC Central Mailroom P.O. Box 8300 London, KY 40742-8300
DOL scans the requests into a database and then forwards electronically to the appropriate DFEC district office for their action.
3. Follow-up calls to DFEC
If you do not receive a timely response, contact the appropriate DFEC office at the phone numbers listed on the United States Department of Labor, Office of Workers’ Compensation Programs (OWCP), DFEC website.
Contact the office servicing the state where the NH resides or, if different, the state where the injury took place. Use the public contact number, not the Director’s office number. DFEC needs the DOL claim number and the claimant’s name. Identify yourself as a representative from the Social Security Administration (SSA). Explain that we need proof of the gross FECA payment before any deductions, and that we previously requested this information in writing. DFEC should advise when to expect the proof.
4. DOL requests written authorization from the NH
Sometimes a DOL representative will ask for written permission from the NH before releasing any information to SSA. This authorization is unnecessary. If the DOL representative insists on the authorization, notify the appropriate regional office (RO) or PC WC analyst, using proper channels. The RO or PC analyst notifies the Office of Income Security Programs, Office of Applications and Electronic Services Support Policy (OISP/OAESP) WC analyst, who then contacts DOL to resolve the issue.
G. No proof available
If no FECA proof is available, thoroughly document your efforts to obtain proof and follow instructions in DI 52145.001G.2.
H. Relationship between FECA and federal PDB
Regular periodic payments from FECA stop if the NH receives a federal disability pension from CSRS or FERS. If the NH receives an FECA schedule award, payments continue through the statutory number of weeks depending on the body part(s) affected. If FECA payments stop or DFEC responds “No claim found” and the NH does not appear to be working, contact the Office of Personnel Management (OPM) for proof of possible federal public disability benefits per instructions in DI 52130.001D.
I. Third party settlements involving FECA payments
Disabled federal employees sometimes sue and recover monetary damages from third parties who cause or contribute to an on-the-job injury or illness. Third-party settlements are not offsettable. However, Federal law requires repayment of FECA WC before the NH receives payment of any third-party settlement proceeds. For complete instructions on third-party settlements, see DI 52105.010.

POMS Reference

DI 52115.010: Federal Employees’ Compensation Act (FECA)