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2-0601 Disability Tracking and QCM Tracking Systems TABLE OF CONTENTS Paragraph and Subject Date Trans. No. Table of Contents 01/98 98-04 1. Purpose and Scope 01/98 98-04 2. Measurement of Performance 01/98 98-04 3. Disability Tracking System 01/98 98-04 4. QCM Tracking System 01/98 98-04 5. QCM Codes 01/98 98-04 6. Effect of RTW on QCM Status 01/98 98-04 7. Consistency in Coding 01/98 98-04 8. QCM Resolution 01/98 98-04 Exhibits 1. Disability Tracking and QCM Category Codes 2. Optional QCM Codes 01/98 98-04 01/98 98-04 2-0601-1 Purpose and Scope 1. Purpose and Scope. This chapter describes the Disability Tracking and QCM (Quality Case Management) Tracking Systems, through which periods of disability and QCM interventions are monitored. It also addresses codes and data entry for both of these systems and describes various edits and relationships between them. It does not, however, address reports produced from these systems. Procedures for QCM cases are found in FECA PM 2-0600, and other codes are discussed in FECA PM 2-0401. 2-0601-2 Measurement of Performance 2. Measurement of Performance. These two systems support OWCP's efforts to help injured workers return to full duty in their date-of-injury jobs wherever possible, and they assist employing agencies in reducing their light duty rolls. To measure performance, OWCP tracks all QCM cases for two years from the date the claimant stops work and enters a non-pay status (the date wage loss began). Performance reports are produced quarterly for each district office, with the emphasis on the percentage of QCM cases resolved successfully at the one and two year marks. For this reason, it is important that QCM coding be accurate and current. 2-0601-3 Disability Tracking System 3. Disability Tracking System. Case Management menu item 36 (Disability Tracking) in the Sequent system is used to create records for each period of disability, including those which occur during the COP FECA-PT2 Printed: 06/08/2010 82
period, and each new recurrence. a. Disability Tracking Screen. The system creates an initial disability record (Disab# "00") whenever a TPCUP record is changed to a status of A1, A2, I1, I2, X1, or X2, and no "00" disability record already exists for that case. The system assigns a status of A (Accepted). The Claims Examiner (CE) can also create an initial disability record manually by selecting F1 (ADD STAT). (1) Disability Number and Date. Each new record must be assigned a disability number (Disab#) from 00 to 99 and a disability beginning date (Disab Date). Disab# 00 is for the initial period of disability, while other numbers represent recurrences. (2) Status Codes. For manually added records, the claim status (Status) defaults to U (Undecided), and both the disability claim received date (Recv Date) and status date (Date) default to the current date. Status codes A (Accepted) and D (Denied) should be entered along with the new status date when a decision on the disability claim has been made. Status codes X (Error Record) and N (New Injury) should be entered where appropriate. If a QCM record is associated with the disability record, the QCM record must first be changed to category 0 (NOT A QCM CASE) before any update to the disability record is permitted. For any record with a QCM record that has been "zeroed out", the CE may not change the status from A to another value without deleting the associated QCM record. A prompt "Status change will cause deletion of the associated QCM record. Proceed? Y/N" will be displayed, and N may be pressed to abort the change. (3) Return-to-Work Codes. A pop-up window shows the return-to-work (RTW) codes, which are also listed in Exhibit 1. The CE should enter a code for the associated disability record whenever the claimant's work status changes, regardless of the status of the particular claim for wage loss. (a) For non-QCM cases, RTW status codes must always be added directly. (b) Once a case "drops in" to QCM, RTW codes cannot be entered in the Disability Tracking System. Instead, certain QCM status codes which reflect the claimant's work status automatically update the RTW code. FECA-PT2 Printed: 06/08/2010 83
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LIST OF CHAPTERS PART 2 - CLAIMS (I
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which may be useful to the CE. b. C
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d. Continuation of Pay. An employee
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o. Review of OWCP Decisions. Under
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2-0300 COMMUNICATIONS TABLE OF CONT
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2-0300-4 Regular Correspondence 4.R
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(b) Formal Decision. If a formal de
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If the information requested cannot
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eferred to the NOO for adjudication
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2-0400-6 Requesting Files 6. Reques
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the file. This process should mainl
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2-0400-10 Case Transfers and Loans
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2-0401 AUTOMATED SYSTEM SUPPORT FOR
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names and addresses is optional. By
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PW: Entitled to payment on periodic
Page 31 and 32: AM/C1: Condition accepted. Up to $1
Page 33 and 34: full appeal rights, and the adjudic
Page 35 and 36: B Both A Aggravation 2-0402 SECURIT
Page 37 and 38: a. Signatures. The CE must review c
Page 39 and 40: (a) The particular issues about whi
Page 41 and 42: c. Review by DD. Upon receipt of th
Page 43 and 44: disposition, a report, enclosing th
Page 45 and 46: 2-0500 CONFERENCING TABLE OF CONTEN
Page 47 and 48: necessary to identify the official(
Page 49 and 50: 2-0500-6 Senior CE Actions 6. Senio
Page 51 and 52: 2-0500-9 Due Process 9. Due Process
Page 53 and 54: This chapter outlines the major ste
Page 55 and 56: (d) Been notified that OWCP will pr
Page 57 and 58: 2-0600-4 Initial Actions 4. Initial
Page 59 and 60: 2-0600-5 Nurse Services 5. Nurse Se
Page 61 and 62: assess the claimant's environment a
Page 63 and 64: (4) Timely responses to telephone c
Page 65 and 66: for guidance in composing such ques
Page 67 and 68: (4) Only if the CE has taken these
Page 69 and 70: (1) RS Actions. If the claimant agr
Page 71 and 72: (3) Absent such a recovery, the OWC
Page 73 and 74: (c) After any training or other pre
Page 75 and 76: under way and the CE determines tha
Page 77 and 78: 2-0600 Exhibit 1: Sample Letter to
Page 79 and 80: 2-0600 Exhibit 3: Example of Letter
Page 81: 2-0600 Exhibit 5: Planning Chart fo
Page 85 and 86: a. QCM Screen. When the QCM screen
Page 87 and 88: (c) Confirmation of Data. After ent
Page 89 and 90: (1) NFN*--Referred to Field Nurse.
Page 91 and 92: 2-0601-6 Effect of RTW on QCM Statu
Page 93 and 94: 2-0601 Exhibit 1: Disability Tracki
Page 95 and 96: SRE Referred to SrCE for Conference
Page 97 and 98: 21. FECA Death Gratuity 4/10 10-06
Page 99 and 100: . Claimant. The claimant is respons
Page 101 and 102: 2-0700-6 Adjudication 6. Adjudicati
Page 103 and 104: (3) If the parties lived apart for
Page 105 and 106: (3) If the child does not begin pos
Page 107 and 108: Compensation was terminated effecti
Page 109 and 110: . Dependency Criteria. The test of
Page 111 and 112: (3) Proof of physical or mental inc
Page 113 and 114: The CE should prepare a memorandum
Page 115 and 116: . Employee Status. The $200 payment
Page 117 and 118: (b) Form CA-1617 should be released
Page 119 and 120: 2-0700-20 Gratuity 20. Gratuity fro
Page 121 and 122: 2-0700 Exhibit 1: Percentages of En
Page 123 and 124: 2-0800-2 Definitions 2. Definitions
Page 125 and 126: . Employing Agency. The FECA requir
Page 127 and 128: claimant, the CE should send a copy
Page 129 and 130: (3) The case must be coded as withd
Page 131 and 132: entire group of cases must be adjud
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2-0800-10 Investigation 10. Investi
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2-0800-13 Affirmative Defense 13. A
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2-0801 TIME TABLE OF CONTENTS Parag
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5 U.S.C. 8122 on the ground that no
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(4) If a claim is not received by O
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(1) Disappearance During a Period o
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2-0802 CIVIL EMPLOYEE TABLE OF CONT
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2-0802-1 Purpose and Scope 1. Purpo
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(1) The precise time when the worke
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2-0802-8 Contract Job Cleaners Used
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2-0802-13 Volunteer Workers with th
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(1) Whether, prior to the transfer
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. The pay rate for compensation pur
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2-0802-24 U.S. Park Police and Secr
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a participant or crew leader servin
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2-0803 FACT OF INJURY TABLE OF CONT
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2-0803-4 Development of Factual Evi
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2-0804 PERFORMANCE OF DUTY TABLE OF
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time before or after the end of the
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(a) A diagram showing the boundarie
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d. Workers in a Travel Status. (1)
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2-0804-6 To and From Work 6. To and
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(a) The reason the employee was req
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(1) At the time of the injury, the
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(1) Martha G. List, 26 ECAB 200. Em
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duty, the CE may approve the case.
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action taken; and (4) Statements fr
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2-0804-14 Statutory Exclusions 14.
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would justify such disobedience. (c
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(2) The official superior should al
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c. Development. (1) It is the CE's
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such as soliciting new members or c
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c. Performance Ratings. The Board r
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Where an employee asserts that emot
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The Board noted that Cannon was unl
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Since both cases involve procedures
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Ashberry's disability was not compe
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no longer be considered so in light
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2-0804-18 Employing Agency Physical
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f. This matter was initially addres
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compensation would be payable for t
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limited to the period of work-relat
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(6) Certain other kinds of cases re
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(2) A nurse becomes disabled by pul
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the body originally injured is term
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2-0806 OCCUPATIONAL ILLNESS TABLE O
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the following steps, depending on w
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(4) Exposure to and Identification
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While records of past medical treat
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the medical connection between lift
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(b) The medical evidence presented
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2-080 Exhibit 2: Sample Letter to C
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2-0806 Exhibit 3: Sample Letter to
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TITLE _____________________________
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eason, you should call or write to
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9. [FREE FLOW IF DESIRED] We may wr
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If you do not understand any part o
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stressful situations in your person
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TITLE FECA-PT2 Printed: 06/08/2010
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I am writing in reference to your c
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We may write directly to a physicia
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2-0806 Exhibit 20: Sample Questions
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TA Amputation TB Back strain TC Con
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(D )Other Disability, Occupational
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a. Traumatic Injury. If an air traf
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2-0807-6 Period of Entitlement 6. P
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d. Return to Duty. The injured empl
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f. The injury was not reported on a
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W = Total number weeks worked P/W =
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COP is paid for the entire period o
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(c) When the physician's report ind
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(a) Assign or detail the employee t
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. Monitoring the Claim. (1) If Form
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(4) If conflicting information appe
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a. Permanent Total Disability (PTD)
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(1) Prior to December 7, 1940. No p
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(2) Impairment due to amputation is
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. Claims for Increased Schedule Awa
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compensation for temporary total di
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Medical. 2-0809-2 Introduction 2. I
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CE is ready to evaluate the evidenc
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the physician with a complete pictu
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(3) Personal habits such as smoking
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games or operating a construction b
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Jane Doe, date of birth 04/06/1965,
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elated to the employee’s duties;
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16. Physical Therapy 04/01 01-06 03
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evaluating the merits of medical re
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situation where ten days earlier th
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each opinion. The value of the evid
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manipulation of the body. They incl
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. The DMA's performance of these fu
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evidence from physicians who have n
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e. In cases involving a preexisting
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(1) The consultant should be asked
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value). Based on the results of thi
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However, if the impartial specialis
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2-0810-13 Exclusion of Medical Evid
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Leanna Garlington, 37 ECAB 849). Re
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(d) A suggested supplier, if any. (
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need for further treatment as detai
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2-0810-18 Transfer of Medical Care
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2-0810 Exhibit 1: Information from
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Dear CLAIMANT NAME: We need the fol
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2-0810 Exhibit 3: General Guideline
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2-0810 Exhibit 5: Sample Paragraph
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2-0810 Exhibit 7: Letter of Warning
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In addition, a primary goal of case
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(3) Release Form CA-1008 and Pamphl
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a. Where disability is present, the
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f. If the evidence obtained as a re
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eligible for disability benefits. A
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f. Physician's estimate of the date
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2-0812 PERIODIC REVIEW OF DISABILIT
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determine the status of dependents
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whether disability is related to th
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earnings or activity is in question
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eferred to the Office of Inspector
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. Suspension of Compensation. OWCP
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certification clauses on the CA-103
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SI Payment/Entitlement Suspension i
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with the return to work effort. CFF
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should be placed in a PN status. OP
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force. 10. If the business has had
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I am writing in follow up to the Fo
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2-0812 Exhibit 6 - Periodic Entitle
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Service. On 03/14/2003, the claiman
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Authorized Medical Care for Substan
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a. OPM's regulations on retention r
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d. To identify cases for early inte
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2-0813-7 Communication Among the CE
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d. Cooperative Agreement. The title
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ehabilitation process. 2-0813-11 Fa
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(2) To reduce compensation in this
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The specificity of the reasons offe
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in conjunction with graded conditio
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(1) Where the claimant cannot perfo
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2-0813 Exhibit 2: Non-Cooperation W
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2-0814 REEMPLOYMENT: DETERMINING WA
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Exhibits 1. Sample Letter to Claima
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. Preliminary Assessment of Positio
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(b) If the attending physician cont
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(3) The employing agency will be as
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e. Payment/Reimbursement of Relocat
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have no appeal rights attached. c.
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were not reported to OWCP or were o
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(3) If the employee can work only p
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this instance the CE will need to e
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d. Unacceptable Reasons for Abandon
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closure of an installation, cessati
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Code, and returns to duty under ret
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If you receive an increase in pay o
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2-0814 Exhibit 3: Sample Letter To
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RATE DATE FOR SCHEDULE AWARDS 01/10
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(1) Kinds of Appointments. The Post
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year, in the teaching profession, w
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(b) Census enumerators; (c) Casual
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The CE should consider these factor
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The greatest of these pay rates wil
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the Department of Veterans Affairs
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degree of expense, hardship, and in
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(2) Basic bi-weekly pay x premium p
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2-0900-9 Computing Daily Pay Rate 9
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2-0900-11 Computing Monthly Pay Rat
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The salary for these employees may
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2-0901 COMPUTING COMPENSATION TABLE
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2-0901-2 Related Topics 2. Related
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(4) A GS-12 CE or designated CE may
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2-0901-4 Factors in Computing Compe
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(3) For schedule award payments, th
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(4) Compensation payable for less t
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2-0901-9 Special Determinations 9.
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2-0901-11 Maximum Compensation 11.
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payment. a. Beginning Date. Schedul
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(3) ( ) (a) is capable of earning (
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automatic pay increases. For exampl
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claimant to a higher pay rate under
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(a) the beneficiary's maintenance,
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Letter CA-1208 to the claimant, wit
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01/01/76 4.4 10/10/76 18.96-28.44 9
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01/02/2000 44.98-67.47 224.91-337.3
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10/07/79 144.56 722.78 - (2,891.12)
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*Calendar Days 01/01/2001 3.3 365 1
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PERCENTAGE TABLE OF SCHEDULE AWARDS
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2-0901 Exhibit 6: Activity Codes AC
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12. Tennessee Valley Authority 02/9
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. Death Benefits. When compensation
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(3) Certification. The CE should ha
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elected, refer the case to the inac
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(b) If there is accrued compensatio
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Centers, and DVA Hospitals. If the
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(b) The claimant may be entitled to
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d. Obtaining Elections--Educational
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(3) The CE must advise the claimant
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c. Injuries On and After September
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Based on information contained in t
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2-1000-16 Benefits for Judicial Off
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(a) Calculate the number of weeks w
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I. Claimants must elect between Fed
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2-1000 Exhibit 2: OPM Contact List
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When a third party is or may be leg
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(6) Ltr. CA-1109, Authorization to
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7. Administration of Third Party Ca
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(3) If not accurate or complete, th
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the DCE, is urgent should be sent i
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(3) Provide the claimant or attorne
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for a course of action. All formal
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In any other case, where a judgment
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(b) 5 percent of the total to be al
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To determine the amount to be liste
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(6) Section 8133(a) of the FECA pro
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(2) The initial demand letter in an
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of the employee. The USPS cannot re
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not be referred to the FEEWC until
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FECA-PT2 Printed: 06/08/2010 581
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a. Under 5 U.S.C. § 8127(b) and in
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. Should an application be submitte
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and the requested fee is reduced du
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2-1200 Exhibit 1: Sample Formal Dec
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2-1300 LUMP SUM PAYMENTS TABLE OF C
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2-1300-3 Requests for Lump-Sum Paym
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2-1300-4 Calculating Lump-Sum Sched
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2-1300 Exhibit 2: Sample Appealable
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3. REVIEW BY THE EMPLOYEES' COMPENS
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SIGNATURE _________________________
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We have received your request for a
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2-1400 DISALLOWANCES TABLE OF CONTE
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2-1400-1 Purpose and Scope Purpose
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a. Initial Disallowances. Such disa
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(1) Failure to Appear for Medical A
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(1) The name and location of the em
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injury caused no disability for wor
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(3) A specific service which the cl
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2-1400-7 How to Issue Pre-Terminati
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(a) The case is being referred beca
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(a) Compensation is being terminate
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. Source of Advice. District office
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usual rate, i.e., 75 percent of the
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objective findings to support your
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2-1400 Exhibit 3: Sample Notice of
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2-1400 Exhibit 4: Sample Letter Con
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2-1400 Exhibit 6: Sample Notice of
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2-1400 Exhibit 8: Sample Letter Con
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2-1400 Exhibit 10: Sample Letter De
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2-1500 RECURRENCES TABLE OF CONTENT
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(d) Closure of a base or other faci
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(1) The medical evidence needed to
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c. Case Management. The CE should c
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emains the same regardless of wheth
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2-1600 REVIEW PROCESS TABLE OF CONT
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c. Formal Decision. Chapter 2-1400
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the request. H&R will acknowledge r
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spouse or child prevents his or her
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OWCP shall pay fees requested by wi
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2-1601-9 Cases Returned from H&R 9.
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2-1601 Exhibit 2: Sample Letters Ac
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Exhibit 3, page 1 of 3: Hearing Not
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Exhibit 3, page 3 of 3: Hearing Ins
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2-1601 Exhibit 5: Request for Comme
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2-1602 RECONSIDERATIONS TABLE OF CO
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2-1602-2 Policy 2. Policy. The foll
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d. Decision. An untimely applicatio
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percentage of the award under the S
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(2) The cover letter to the agency
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2-1602 Exhibit 1: Sample Letter Ret
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Dear CLAIMANT NAME: We have reviewe
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2-1602 Exhibit 5: Sample Compensati
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2-1603 APPEALS TABLE OF CONTENTS Pa
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d. Timeliness of Filing. A person r
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2-1603-6 Cases Returned to District
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2-1700 SPECIAL ACT CASES TABLE OF C
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2-1700-4 Peace Corps 4. Peace Corps
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(2) Staff Spouses. (a) The spouses
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Compensation for loss of wages may
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(3) Return from Service Abroad. d.
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Section 5 U.S.C. 8101(4), which pro
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(1)While at a Job Corps Center, an
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(1)Enrollees are required to report
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coverage under 5 U.S.C. 8101. b. Co
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2-1800-2 Authority 2. Authority. Ho
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determined by the type of vehicle,
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greatest current fair market value
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Such certification from an architec
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over $10,000, and that amount must
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2-1800-7 Housing Modifications for
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send an approval letter along with
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By signing this agreement, all part
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By signing this agreement, all part
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Memorandum of Agreement - Modificat
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Memorandum of Agreement - Housing M
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