What is rehabilitation services and claims manual

The CE's responsibilities include, but are not limited to, the following: referring appropriate cases for rehabilitation services; evaluating medical determinations in cases; responding to requests from the RS or RC; reviewing rehabilitation plans for medical suitability; advising the RS and RC of any changes in the medical or factual evidence which might alter any current course of action; issuing warning letters if non-cooperation occurs; and issuing notices of proposed actions and formal decisions pertaining to a claimant's entitlement to compensation.

Compensation Entitlement during and after Vocational Rehabilitation. Compensation for Wage Loss. Section b of the FECA provides that an individual undergoing an OWCP-approved rehabilitation program is entitled to receive compensation at the rate for total disability, less any earnings received from employment which is not undertaken as a specific part of the rehabilitation program.

Retirement Benefits. An election offer should be issued if the claimant states this is his or her choice. A claimant may not receive vocational rehabilitation services simultaneously with retirement benefits from OPM. However, a claimant may not use the retirement process to avoid the obligation to undergo vocational rehabilitation when directed by OWCP.

Despite issuing an election letter, the CE and RS should pursue case management and rehabilitation to its logical conclusion. Sending the election letter does not guarantee OPM election.

Until the claimant actually submits a signed election form choosing OPM benefits, he or she is required to participate fully in rehabilitation or be subject to the sanction process. When reviewing instances of non-cooperation in conjunction with an OPM election during the vocational rehabilitation process, it is important to focus on the behavior and level of non-cooperation. Sanctions may apply to the non-cooperative behavior but not to the choice to elect OPM.

If the claimant does not cooperate during the election process, any behavior which is deemed to be non-cooperation will be subject to sanctions pursuant to 5 U. A non-cooperation sanction under 5 U. It may only be finalized following an OPM election if the warning letter was issued while the claimant was in receipt of FECA benefits.

Schedule Awards. If a claimant requests a schedule award while participating in vocational rehabilitation, development of the award should proceed. Payment of the award, however, should usually be deferred until the completion of rehabilitation, since payment of a schedule award is most beneficial after a return to employment, as it may not be made concurrently with compensation for wage loss, and a claimant will often opt to receive OPM benefits concurrently with a schedule award, and concurrent receipt of OPM and OWCP benefits is prohibited during a period in which vocational rehabilitation services are being provided.

If a claimant is already receiving compensation for a schedule award while in rehabilitation, he or she should continue receiving those benefits unless the claimant is also receiving an annuity from OPM, in which case the claimant should be advised that he or she cannot be provided with vocational rehabilitation services while receiving an OPM annuity.

The claimant should be offered an election, and if he or she elects OWCP benefits, the schedule award payments should be converted to payments for temporary total disability until completion of the rehabilitation effort.

If the claimant elects OPM benefits, the schedule award benefits should continue, and medical and factual development should be undertaken to determine the claimant's LWEC entitlement at the end of the schedule award, but vocational rehabilitation efforts should be terminated. The loss of wage-earning capacity determination performed pursuant to 5 U.

It also permits the adjustment of compensation to reflect partial rather than total disability, if the requirements of the law are strictly met. The worker's salary, after placement in a lower-paying position, may be used as a basis for LWEC determination if it fairly reasonably represents the worker's earning capacity.

The worker receives compensation based on the difference between the pre-injury and post-injury wages. If an injured worker does not return to work during the rehabilitation effort, OWCP may find that work suitable to the worker's physical condition, vocational abilities, and educational background was reasonably available in the worker's commuting area or, in some cases, the area where the worker resided when injured.

At the end of a rehabilitation program, if the claimant does not return to work, the RC is required, if possible, to provide relevant information for two available and appropriate jobs, including salary and an explanation of how any specific vocational preparation requirements are met.

Based on this information, the CE determines whether these jobs are suitable to form the basis of an LWEC determination. The RC or RS should use available non-private sources, including the state employment services, to provide this information.

Compensation may also be reduced following successful completion of training, to reflect the worker's earning capacity as a result of training. If the worker drops out of or refuses training without a good reason, compensation may be reduced to reflect likely earnings had the training been completed.

In both cases, the suitability and availability of the specific types of positions and the typical earnings must be documented. Restoration Rights with the Federal Government. Section of the FECA provides civil service retention rights to Federal employees who have recovered either fully or partially from an employment-related injury or illness, and who can perform the duties of the original job or its equivalent.

The EA must restore a permanent employee i. This provision does not apply to temporary or term employees. They require agencies to grant leave without pay LWOP to disabled workers for at least the first year the injured worker is receiving compensation. OPM has jurisdiction and is responsible for enforcing these regulations.

See Charles J. An injured worker who has been terminated and who wishes to reclaim his or her job should be advised to contact the EA. In addition, 5 U. If this course is also unsuccessful, the injured worker may be advised to exercise his or her appeal rights as provided by OPM.

It should also be noted that not all individuals covered by FECA are entitled to restoration rights. Medical Rehabilitation Services. Medical Rehabilitation refers to those medical and related services necessary to correct, minimize or modify the impairment caused by a disease or injury so that the injured worker can return to an adequate level of function and employment.

Thus, it is distinguished from actual medical treatment to cure or relieve the effects of the injury. Various medical rehabilitation services can be provided during this phase. Substance abuse treatment may be considered if substance abuse prevents an injured worker from participating in a rehabilitation plan or returning to work. Housing and vehicle modifications can also be provided under the rehabilitation program.

The concurrent payment of these benefits, in conjunction with retirement benefits, is permitted based on the amendments to the Compensation Act Public Law Vocational Rehabilitation Services. Active vocational rehabilitation services are based on stable and well-defined work tolerance limitations which may or may not have been established during a period of medical rehabilitation FCE, work hardening, or other physical therapy program aimed at producing work restrictions.

Vocational rehabilitation services include counseling and guidance, selective placement assistance i. Long term training is considered only in exceptional circumstances, and self-employment assistance is provided only in very rare instances. Medical rehabilitation may also be provided in conjunction with vocational rehabilitation, but, as indicated in paragraph 6. Substantial Services. Injured workers are considered rehabilitated if they return to an appropriate occupation within their physical and vocational limits, after receiving substantial services which include professional counseling and guidance, placement assistance, training, medical rehabilitation, or any combination thereof.

Injured workers returning to their pre-injury occupation are not considered rehabilitated unless medical rehabilitation, significant accommodation, or placement assistance was provided. Intermittent requests for return-to-work status updates either to the EA or the claimant are not considered substantial services.

The record, including RS and RC reports, must demonstrate and fully document the substantial services provided. Back to List of Chapters. While this chapter focuses on referrals for vocational rehabilitation services, there is no requirement under the FECA to provide such services. However, when an employee is no longer disabled within the meaning of the FECA, there is no entitlement to vocational rehabilitation benefits under the Act.

ECAB has stated "There is no requirement that vocational rehabilitation be afforded each and every claimant who is permanently disabled due to a compensable condition under the Act. ECAB has recognized that the vocational rehabilitation provisions of the FECA vest OWCP with discretionary powers and a decision granting or denying an application for training will not be set aside by ECAB unless it represents an abuse of discretion, that is, a manifestly unreasonable exercise of judgment.

See Mabel R. Porter 29 ECAB 15 The fact that an employee sustains a physical impairment permanent in nature is not sufficient to warrant the provision of vocational rehabilitation, as there must be a showing of a loss of wage-earning capacity. The purpose of providing training under the Act is to upgrade the skills and education of beneficiaries who cannot return to their former federal employment in order that they may qualify for other suitable employment to restore lost earning capacity.

See Gary L. Loser , 38 ECAB Purpose and Scope. Referral screening is the process through which the Rehabilitation Specialist RS determines whether vocational rehabilitation services are needed to return an injured worker to employment and productivity.

Referral screening may also be undertaken for other limited purposes. Referral screening has two related steps: the review of the compensation case file and the outcome determination. This chapter explains and describes the procedures for evaluation of injured workers for rehabilitation services.

This chapter also explains the sources of referrals, includes referral requirements depending on level of service, discusses referral statuses, and provides procedures for the closure of rehabilitation referrals.

Referral Sources and Mechanics. The probability of effective rehabilitation, resulting in the best return-to-work arrangement, is greatly increased when such efforts begin as early as possible in the recovery process. Generally, it is the policy of the Office of Workers' Compensation Programs OWCP to offer rehabilitation services to any claimant who is potentially permanently disabled for the job held at the time of injury, if needed, provided that the condition has stabilized sufficiently, work tolerances are well defined, and a realistic goal can be identified.

Federal injured workers have a right to return to their original jobs if they recover fully within one year. Civil service retention and restoration rights are not within OWCP jurisdiction or control; the Office of Personnel Management has jurisdiction over matters arising under 5 U.

It is generally easier for agencies to offer jobs to injured workers if they have not been separated from Federal service, which may happen routinely after one year of disability.

For this reason, the Department of Federal Employees Compensation DFEC has instituted intensive early case management procedures for its disability cases. The responsibility for referring injured workers for rehabilitation services rests primarily with the Claims Examiner CE , who oversees the disability management process and is in the best position to act promptly when services are needed. A sufficient number of referrals is necessary to reach program goals related to return to work.

If cases are not being referred by the CEs in sufficient numbers or are being referred long after the medical condition stabilizes, the RS should use the supplemental sources described below to look for potential vocational rehabilitation candidates. The RS should normally obtain the concurrence of the CE for referrals obtained from any of these sources, since the CE is responsible for medical determinations in cases. Unless there is recent documentation from the CE regarding the weight of the medical evidence of record, e.

The CE should promptly refer the case for rehabilitation services except where the medical evidence establishes that the case is not in posture for such referral.

See paragraph 7 below. FNs who are monitoring the injured worker's medical care are also referral sources, as they are able to offer pertinent and timely information regarding the condition of the injured worker from their contact with claimant and physician. The FN may recommend a vocational rehabilitation referral at any time, or specifically at the end of nurse services or if the claimant has not collaborated with or fully benefited from nursing services.

The nurses' referrals will be transmitted by the CE. If the agency indicates its interest in the reemployment of the injured worker, via phone for example, the RS should document the agency's request with a CA or equivalent and request that the CE determine whether the medical evidence warrants such referral. If a physician notes that vocational rehabilitation services are warranted in a medical report to the CE, the CE should initiate the referral process. Rarely, a physician may contact the RS directly requesting rehabilitation services for a particular injured worker.

The RS should ask the physician to submit a report which clearly establishes that the claimant has stable and well-defined residuals. The RS may also request that the physician include an accompanying statement that the injured worker is ready to undertake a vocational rehabilitation program.

Injured workers may contact the RS or other district office staff to inquire about the availability of rehabilitation services. Referrals or inquiries may also be initiated by attorneys, union representatives, or RCs. Referral Requirements. If the current medical evidence indicates that the claimant has objective residuals of the work-related condition and has stable, well-defined work limitations which allow him or her to work 8 hours per day, the case should be referred for vocational rehabilitation services.

Cases must be referred promptly when the injured worker is receiving compensation and no light duty offer has been made by the agency. These cases are given immediate attention and ideally a plan should be in place within one year of the first day of compensable disability, though circumstances vary by case. The referral should include:. The accepted conditions in the case , as well any accepted conditions in other FECA files that are pertinent with regard to medical restrictions.

Other significant non-work related conditions should also be noted. The physician's name and date of medical report which represents the weight of medical evidence. The date on which disability or recurrent disability began , to identify the one-year time frame for placement with the previous employer.

The gross amount of compensation the claimant is awarded each week and the pay rate on which this amount is based. Any medical or adjudicatory action which is in process or imminent e. An indication as to whether or not Field Nurse FN services are active and, if applicable, the reasons for continued FN service e. The CE may authorize such contact when it will not potentially disturb the weight of medical evidence concerning work limitations.

However, the CE should not authorize such contact when work tolerance limitations have been established by a second opinion or referee examination. If the agency has specifically indicated that placement services with the previous employer are unavailable or inappropriate, the CE should provide notification of such.

Any pertinent notes regarding a request for specific services ; for example, the injured worker has returned to work part-time but medical reports indicate capacity for full-time work, and the CE wants an RC to work with the previous employer to obtain longer hours within the injured worker's work limitations.

When the case is being referred on a limited basis , the CE should include the nature of the limited referral, the CE's assessment of the situation, and the desired action from the RC. Once the referral has been completed and made a part of the case record, the CE should send a Vocational Rehabilitation referral to the RS via the case management system, which will automatically populate the appropriate code in the Disability Management DM record.

Active FN cases may be referred for dual tracking. The referral in these cases will be for "Medical Rehabilitation" and the period will usually be limited to 3 months for concurrent services.

In some dual tracking cases, the restrictions may not be completely defined. As a result, full plan development cannot begin immediately with these claimants, but in the interest of expediting the return to work, the RC may assist with work hardening and functional capacity evaluation scheduling and begin the groundwork for the development of a return-to-work plan by obtaining the claimant's work history, performing preliminary labor market surveys and conducting a transferable skills analysis.

The FN will focus on the medical aspects of the case, and the RC will focus on the vocational aspects of the case. Once the claimant has stable and well- defined restrictions, nurse intervention will cease and the RS will direct the RC to begin actual plan development. For instance, if vocational testing, an ergonomic evaluation, or assistive technology would enable the employing agency to offer a job to the claimant or explore job opportunities for placement in another departmental position, a dual assignment would be appropriate for this purpose.

Screening a case provides the RS with basic information regarding the injured worker's medical condition, work capabilities, reemployment potential and other data which will determine whether or not the case is in posture for referral to an RC. The goal of screening is to confirm that the injured worker needs vocational rehabilitation services to return to employment and achieve a productive level of functioning. Rehabilitation referrals should be reviewed and recorded in the case management system within five work days of receipt by the RS.

Accurate and prompt recording of cases is key to maintaining the efficiency of the rehabilitation work flow in the district office. Medical Information.

The major sources of medical information in the case file are OWCP standard forms and narrative medical reports submitted by the treating physician and other medical professionals involved in the case. It may be from an attending physician, second opinion physician, or referee specialist. Other reports may give supplementary information, but work limitations which differ from those the CE has designated should not be used as the basis for the rehabilitation effort.

The OWCP will also indicate whether the physician may be contacted for clarification which is normally granted only if the claimant's attending physician provided the work tolerance limitations. Standard forms may also serve this purpose. Form OWCP-5, Work Capacity Evaluation provides specific limitations recommended by the examining physician and an estimate of the number of hours per day the injured worker is able to perform certain activities. Non-Medical Information.

The RS also needs information about the employer or agency, education and history of employment. Forms which may contain this information are the CA-1 and CA-2, cited above.

An application for employment, if available, provides the injured worker's work history and other pertinent data, while the position description gives the physical demands for the date of injury job. Evaluation of Injured Worker Information. The RS assesses the information in the case file, with emphasis on the present accepted medical and vocational condition of the injured worker and the feasibility of rehabilitation and reemployment.

At the same time, the RS proceeds to the next step in the referral. The RS should continue with the referral process in cases with the exception of injured workers who have successfully returned to work. These cases should be closed and recorded appropriately in the case management system. Referral Outcome.

Closing a Case from Referral. A case can be closed from referral if the injured worker has successfully returned to work or will return to work shortly without benefit of rehabilitation intervention; or if the injured worker is not able to work four hours per day and there is no possibility of improvement. The RS may recommend additional medical development and subsequent referral at a later date.

If the case is closed for medical infeasibility, the CE should concur that this is what the medical reports indicate. The case should then be coded in the case management system. Opening a Case. If the injured worker has not returned to work, is unable to perform his or her usual work because of the compensable injury, and will benefit from rehabilitation services, the case can be opened using form OWCP-3 or equivalent. Note - If this information the EA's declination is not clear and evident in the file, the RC should be instructed to contact the EA to determine if a return to work with the EA is possible.

However, the RC should also proceed with the preliminary Plan Development components during this period so that an appropriate plan is not delayed if the former agency is unable to reemploy the claimant. The RC will work directly with the injured worker, and develop and implement a rehabilitation program. The RS authorizes services as required, approves or disapproves the recommended program, and evaluates the quality and timeliness of services. However, where this is not possible e.

This should happen only when services are not otherwise available or if the RS is able to accommodate any limited services requested. See paragraph 7 of this chapter for more information regarding limited referrals. The form authorizes counseling, guidance, testing by an outside vendor arranged by the RC, and placement services by the RC or by a placement professional supervised by the RC.

The goal is to help restore the injured worker to the level of work and earnings they had prior to their injury. The services may include but are not limited to:. These programs and services are best used at the earliest point that a vocational need is identified. They help the injured worker and employer maintain or restore the injured worker to the job. When an injured worker is eligible to receive vocational services and is willing and able to participate in a vocational rehabilitation program, a vocational rehabilitation case manager is selected.

Like other providers, the injured worker chooses the vocational rehabilitation case manager with assistance from their MCO. The vocational rehabilitation case manager helps assess the injured worker's current vocational needs by meeting with the worker, employer and medical providers.

After completing the needed assessments, the case manager makes recommendations for services to the MCO and BWC for approval. When an injured worker receives re-employment services in a vocational rehabilitation plan, the worker living in Ohio must enroll with Ohio Means Jobs to access re-employment services offered to help in securing employment.

The Ohio Means Jobs website offers a variety of tools and resources to help the injured worker in their job search. When this occurs, vocational services can be coordinated with both agencies to help the injured worker in returning to work.

Living Maintenance Benefit — Compensation paid to an injured worker who is actively participating in an MCO-approved vocational rehabilitation assessment plan or comprehensive vocational rehabilitation plan. Living Maintenance Wage Loss LMWL — May be paid to an injured worker who completed a comprehensive vocational rehabilitation plan or a job retention plan, continues to have restrictions and experiences a wage loss upon returning to work.

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