Following are the key portions of a recent Labor Department IG report on an expected surge in Federal Employees Compensation Act program claims related to covid-19 and how the program plans to respond.
The Division of Federal Employees’ Compensation (DFEC) is expecting a potential strain on resources and claims processing delays as a result of increasing claims and social distancing mandates. To address these potential challenges, DFEC developed a contingency plan, issued new procedures for handling COVID-19 claims, and created a COVID-19 Task Force to oversee claims development and adjudication.
DFEC administers claims filed under the Federal Employees’ Compensation Act (FECA). FECA provides workers’ compensation coverage to approximately 2.6 million federal and postal workers around the world for employment-related injuries and occupational diseases. All federal employees who contract COVID-19 in the performance of their duties as a federal employee are entitled to coverage under FECA.
As of June 16, 2020, DFEC had received 2,866 COVID-19 claims, including 48 death claims, and paid out approximately $30,000 in medical benefits and compensation. DFEC expects to receive an estimated total of 6,000 COVID claims based on current projections through August 4, 2020.
COVID-19 CONTINGENCY PLAN
DFEC developed a contingency plan to address risks caused by the influx of COVID-19 claims and to mitigate impacts on non-COVID claims. Based on its estimates of future COVID-19 claims, potential workload impacts, and resource allocation, DFEC dedicated two Medical Benefit Examiner (MBE) units2 to developing and adjudicating COVID-19 claims. This was done to ensure greater consistency and oversight for COVID-19 claims, and involved repurposing two of the four MBE units that were focused on claimants with opioid prescriptions.
DFEC officials stated they considered the negative impact on the opioid population and determined the two remaining MBE units would be able to follow and manage the most at-risk claimants. In addition to establishing dedicated MBE units, DFEC also provided all MBEs with general adjudication and COVID-19 specific adjudication training. DFEC officials stated they have additional options to expand staffing if the two COVID-19 MBE units are unable to handle the volume of COVID-19 claims.
TARGETED PROCEDURES FOR CLAIMS STAFF
On March 31, 2020, DFEC issued FECA Bulletin No. 20-05 to provide targeted procedures for claims staff on the handling of COVID-19 FECA claims from federal employees. Because it is difficult to determine the precise moment and method of virus transmission, DFEC considers certain federal workers who are required to have in-person and close proximity interactions with the public on a frequent basis, such as front-line medical and public health personnel, to be in high-risk employment.3
If a COVID-19 claim is filed by an individual in high-risk employment, DFEC will accept that the exposure to COVID-19 was proximately caused by the nature of the employment and will only require medical evidence that establishes a diagnosis of COVID-19, such as a positive COVID-19 test result.4 COVID-19 claims filed by individuals who work in positions not considered high-risk are treated the same as all other FECA claims and must provide evidence that the disease was employment-related.
In conjunction with FECA Bulletin No. 20-05, DFEC established a COVID-19 Task Force to support claims examiners and help ensure COVID-19 claims are handled expeditiously in a fair and consistent manner. The Task Force includes high-level officials, such as DFEC’s Director, DFEC’s Policy Chief, and OWCP’s Chief Medical Officer. The Task Force aids claims staff, employing agencies, and the general public by providing advice on evidence needed, and answering questions about the process and legal requirements.
DFEC has introduced some temporary flexibilities to assist claimants during the pandemic. Due to social distancing rules, DFEC provided extensions, in 30-day increments, to claimants having difficulty obtaining medical evidence. DFEC also allowed certain second opinion medical appointments to be deferred until a later date. Since these flexibilities could result in adjudication delays for non-COVID claims, DFEC ended these temporary flexibilities on June 16, 2020. Moving forward, DFEC will only grant extensions and deferrals on an exception basis if supported by the circumstances of the case.
INITIAL IMPACT ON PROCESSING CLAIMS
Processing delays caused by potential backlogs could occur because the Social Security Administration (SSA) was not processing requests for Federal Employees Retirement System (FERS) Offset Calculations, which are required5 for certain death and retirement age claimants. According to DFEC officials, SSA informed them that because this was a paper-based process SSA was not able to respond to these requests until its staff returned to the office. Ultimately, SSA officials agreed to process requests for death claims. SSA notified DFEC it would begin processing FERS Offset Calculation requests on June 22, 2020; however, DFEC had not yet received any responses as of June 25, 2020. Consequently, responses for certain retirement claims have been delayed and a backlog could develop. DFEC officials stated they are documenting these cases with a memo to the file for follow-up with SSA, but were unable to provide the number of cases currently affected.
As of June 16, 2020, the latest performance information available (March and April 2020) indicated the COVID-19 pandemic has not yet impacted DFEC’s performance measures. DFEC met all timeliness goals established in its annual operating plan and quality performance indicators showed a 4 percent improvement when compared to the same time period in 2019.
While DFEC has established a contingency plan and taken action to address the incoming COVID-19 claims, it should continue to monitor non-COVID claims for delays and other potential impacts, particularly for its opioid population who may be at risk while resources are re-allocated to focus on the program’s response to COVID-19. Additionally, DFEC should closely monitor any delays that occur in requesting FERS Offset Calculations from SSA for potential benefit overpayments to claimants, as well as any impact a backlog could have on its ability to timely process claims.