BASIC (09-08)

The OREO program processes WC/PDB inputs that cannot be processed correctly using ICF #32. The OREO program will not perform any calculations, and it uses the same input screens as ICF #31 and #32. Although OREO does not perform its own calculations, it will allow propagation from #31 or #32. You may be able to produce an accurate calculation in #31 or #32 and then use that information in OREO. Only the incorrect data needs to be overkeyed. The completed information is propagated into MACADE by the Benefit Authorizer (BA)/Benefit Technical Examiner (BTE).

A. When to use OREO

Use OREO when:

• ICF #31 and #32 are unable to perform an accurate offset calculation;

• the system will not produce any calculation; or

• the system produces a calculation that needs to be changed.

1. Systems limitations that require manual processing

Refer to the following guidelines:

• See Limitations for ICF Functions 31 and 32 in MSOM ICFT2 031.001D.

• See Interactive Computation Facility (ICF) Resource Page for WC/PDB Offset Computations – Click here.

2. WC/PDB action creates an underpayment and an overpayment for the same period previously waived

• The underpayment needs to be used to lower the amount of the waived overpayment.

• Annotate instructions for the BA/BTE regarding the overpayment.

• Failure to account for this situation results in a payment that is not due to the beneficiary.

3. Applying administrative finality

Administrative finality can affect the WC/PDB offset computation. For detailed information, see GN 04030.080 - Reopening When Workers' Compensation/Public Disability Benefits Offset is Involved.

NOTE: Monthly benefit amounts (MBAs) payable after WC/PDB offset cannot be changed if they are protected by administrative finality. If at least one rate must remain unchanged due to administrative finality, add a Special Message to the MBR per instructions in DI 52165.020A.3.a. and DI 52165.020A.3.b.

a. All MBAs are protected

• Process a pre-adjudicate datasheet to document the period(s) protected by administrative finality. This establishes a datasheet showing all rates that should have been paid.

• Include a remark in the Special Instructions field on the ICF Disposition (WCDP) screen explaining that these rates cannot be paid because of administrative finality.

• Print and fax a copy of the datasheet into NDRed. Processing Centers (PCs) will also scan a copy of the datasheet into the Paperless Processing Center (PPC).

• Include a Special Message on the MBR indicating the months protected by administrative finality and stating that a copy of the datasheet showing all rates that should have been paid is in NDRed.

b. Not all MBAs are protected

• Follow instructions in DI 52165.020A.3.a. to document the period(s) protected by administrative finality.

• Use ICF #32 to adjudicate the action if ICF will correctly calculate the offset. ICF #32 allows the selection of a later “Start date,” and therefore a specific time period for offset calculation. Select a “Start Date for Current Action” equal to the first month NOT protected by administrative finality. This ensures that only the non-protected period will be adjusted on the MBR. If the case does not process through T2R (Title 2 Redesign), only the non-protected rates will be available for propagation by the BA/BTE. Include Special Instructions remark in ICF and Special Message on MBR per DI 52165.020A.3.a. instructions.

• Use ICF #34 (OREO) if ICF #32 cannot accurately process the action. Input the data for the months that are NOT protected by administrative finality to provide the BA/BTE with the proper data for processing the MACADE action for the non-protected period. Include Special Instructions remark in ICF and Special Message on MBR per DI 52165.020A.3.a. instructions.

4. Retirement insurance benefit (RIB) election involved

• Months when RIB is paid will not be offset.

• If RIB is elected and there is no new period of DIB, code the RIB month of entitlement on the WCGI screen in the “Date of Termination” field. Failure to code the termination date will continue to add the WC offset amount as a taxable amount on the 1099.

• If DIB is reelected, code OREO as if DIB was continuous. Months in which RIB was paid constitute a break in offset for purposes of triennial redeterminations. Delete the months in which RIB benefits were paid and alert the BA that some months are not offset due to the higher RIB election.

5. When to suppress the automated systems notice

• If you need to update information on the MBR, get the case into the ICF system and no notice is needed, use OREO.

• If you want to be sure certain language is in the notice and cannot rely on T2R to generate the language; or, you want to dictate language to explain a complicated situation. Data input using ICF #32 is passed to T2R (Title 2 Redesign). T2R uses the input data to calculate the offset and generate a complete notice. The notice data that was input in the ENB field on the WCEP screen is ignored by T2R. The only way to be certain the T2R notice is not generated and released is to process the case through OREO.

B. OREO limitations

The OREO program has limitations. If you cannot process a case using a single OREO, manually code the WC benefit data into MACADE. Even for OREO limitations, the case may require one or more OREO inputs in order to process the case. See OREO Limitations - MSOM ICFT2 036.001G.

C. Help screens in OREO

WC ICF help screens provide information about each field. To access the help screens, position your cursor in the field you want more information and push your F1 key.

D. Processing WC/PDB using OREO

The OREO program functions similar to ICF #31 and #32. The screens and the navigation keys are the same. See DI 52165.010 - How to Complete ICF WC/PDB Screens.

1. Gathering OREO data

OREO will not perform calculations, but it allows you to propagate information.

• ICF function #31 or #32 may perform some or all of the offset calculation depending on the limitation.

• Manually calculate any calculation that cannot be performed and propagated by ICF #31 or #32 and enter in OREO.

• You can use the e2455+ tool or the Monthly WC Calculator when calculating offset rates. The e2455 tool propagates the offset rates into OREO.

• ICF #9 and #28 can help to perform manual calculations. See DI 52170.001 - Manual Calculations and DI 52165.025 – for ICF 9 and 28.

2. F10 key

ICF allows you to save information and exit the system by pressing the F10 key. It saves the record in pre-adjudicate format for later propagation.

3. Adjudication

OREO adjudicates through the system just like ICF #32. However, it does not use T2R to post changes to the MBR. OREO makes the information available in MACADE to a BA/BTE in the PC.

4. Documentation

Prior to adjudication, annotate the exception or limitation that requires using OREO in the “Special Instructions” field of the WCDA screen.

E. References

• DI 52165.010 - How to Complete ICF WC/PDB Screens

• DI 52170.000 - Manual Calculations

• DI 52165.025 - ICF 9 and 28.