The Federal Workers' Compensation Program: Are Injured Federal Workers Being Treated Fairly? Greg Fox Sept. 21, 2000

TESTIMONY of Greg Fox
Office of Workers Compensation Program Representative
American Federation of Government Employees
before a hearing of the Subcommittee on Government Management, Information, and Technology

September 21, 2000

In the beginning, the Office of Workers Compensation and Pension (O.W.C.P) was designed to be a non-adversarial process in that the injured worker could receive wage loss compensation and the medical bills associated with the work related injury would be paid accordingly.

Unfortunately, since 1994 the mandated O.W.C.P. “charge back process” to the host agency has indeed become very adversarial.

As a result, this process has become incredibly stressful for the claimant, the claimant’s family, the Claims Examiners, Hearings and Review Officers, as well as the Employees Compensation Appeals Board.

These are some examples:

Claimants, also known as injured employees, from the moment they are injured are labeled by the agency management as “crooks”, “thieves”, and simply too “lazy” to work.

Nothing could be farther from the truth. The Claimants in the majority of cases are well tenured and dedicated employees. They would choose not have been injured and would prefer to do the job they were hired for. Unfortunately, injuries do occur and now the Claimant becomes a victim of the very system that has been put into place to protect them. Why? Initially because of over zealous agency supervisors’ compensation specialists and Human Resources Personnel, if the Claimant has committed a crime, it is simply that they hired on with the federal government.

Claimants
As a consequence, Claimants go without pay, have unpaid medical bills, are forced to file for bankruptcy, and experience foreclosures of their homes. Utilities, water, gas, electricity, and telephones are cut off. Automobiles are repossessed, the divorce rate for Claimants is skyrocketing and diagnoses of chronic pain, depression has lead to attempted suicides. Sadly, some of those attempts have been successful. Imagine for a moment what the Claimants family is going through during this entire process.

The department repeatedly sends claimants to Physician after Physician; this is a Physician that the Department has chosen, not the Claimants primary care provider. This is a Physician that the Department knows will contradict the Claimants primary care provider.

This action is for the most part a result of the agency Compensation Specialist hounding the Claims Examiner to find a reason to deny any compensation. Generally if the Claims Examiner is resistant to the pressure of the agency the Compensation Specialist will simply call the Department Director who will in turn “fix the problem.” This results in the Claims Examiner in being over ruled.

Agency Compensation Specialists frequently brag about harassing Claims Examiners by repeatedly calling and complaining that they are approving too many claims. Forget about the merits of the claim; it just does not apply. They could care less about the Claimant and the negative impact this action will have not just on the Claimant, but the Claimants family as well.

Imagine you’ve been hurt at work. It does not stop there, now you can’t pick up your children, mow your yard, and many of the other activities you were able to do prior to the injury/ There is no compensation for this.

It is nearly impossible for a back, upper extremity of soft tissue injury to heal when the Claimant is subjected to this unimaginable amount of stress.

Agencies are very well aware of this, so while they have the Claimant on the ropes they really pour it on. Why? So down the road the agency can simply say that the Claimant does not want to get better, or has been faking the injury all along in spite of what diagnostics and the Primary Care Provider reveal in their reports.

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Claims Examiners
There are good Claims Examiners and there are Bad Claims Examiners. It is believed that most want to do a good job and that most try to help Claimants; however, the Department has set unrealistic workload expectations. It is common belief that it is nearly impossible for the Claims Examiners to do the job that is expected of them with the resources they have available. There is obviously not enough staff. A well known fact is that the Department is again proposing other changes that will only increase the workload further without increasing the staff ratio.

The agencies do not respect the Claims Examiners.

When you couple this with the fact that the agencies are regularly hounding them and the Department also subscribes to these tactics, in some cases peer pressure is a factor. This can only result in a Claimant being harmed.

This could also explain the turn over rate with Claims Examiners. However we must remember there are also some bad, and some very bad Claims Examiners out there.

Hearings and Review
These officers appear to be somewhat aggravated by the tremendous workload and with the frequency that they are compelled to remand or turnover the Claims Examiners previous decisions. There are a high percentage of reversal rates here.

Employees Compensation Appeals Board
The reversal rate under E.C.A.B. is also high. Interestingly there appears to be a pattern here in reference to voting records. The waiting periods for the Board to act are excessive (generally 2-3 years). This excessive wait time is due to the number of appeals, which are a result of bad adjudication at the claims examiners level. This is also true at the hearings and review level.

There are great many other issues with the entire process and the authorities that administer them. Unfortunately, there is not enough time to cover all issues.

Respectfully Submitted,

Gregory A. Fox