ATTACHMENT 1.pdf

ATTACHMENT 1

SOLICITATION: AG-XXXX

Request for Proposal (RFP) for Integrated OSOH/WC Case Management Solution Page 1 of 4

Appendix A: Acronyms Used in this Document

Table 3. Acronyms and Descriptions.

Acronym Description ACS Affiliated Computer Services AD Agriculture Department AGAR Agriculture Acquisition Regulation AQS Agency Query System ASC Albuquerque Service Center ASP Active Server Pages B&F Budget and Finance BEAR Bi-Weekly Examination and Analytical Reporting CA Compensation Act CFR Code of Federal Regulations CIRT Computer Incident Response Team CN Claim Numbers CO Contracting Officer COP Continuation of Pay COR Contracting Officer's Representative COTS Commercial Off-The-Shelf CPT Current Procedural Terminology CRM Customer Relations Manager CRP Coordinated Response Protocol DASHO Designated Agency Safety and Health Officer DoD Department of Defense DDR DOL Data Repository DOB Date of Birth DOI Date of Injury or Department of Interior (context) DOL Department of Labor ECAB Employees' Compensation Appeals Board EDI Electronic Data Interchange EEO Equal Employment Opportunity EIT Electronic and Information Technology EMIS Equipment Management Information System ER/LR Employee Relations/Labor Relations ERS Employee Relations Specialists FAQ Frequently Asked Questions FAR Federal Acquisition Regulation

Request for Proposal (RFP) for Integrated OSOH/WC Case Management Solution Page 2 of 4

Acronym Description FECA Federal Employees Compensation Act FEHB Federal Employee Health Benefits FIPS Federal Information Processing Standard FISMA Federal Information Security Management Act FLA Facilitated Learning Analysis FOIA Freedom of Information Act FPS Federal Protective Service FS Forest Service GSA General Services Administration HCM Human Capital Management HR Human Resources HRIS Human Resources Information System HRM Human Resources Management HSPD Homeland Security Presidential Directives ICAM Identity, Credential and Access Management ICD International Classification of Diseases IN Incident Numbers IPS Integrated Project Solution IT Information Technology LBB Leave Buy-Back LEI Law Enforcement Investigations LRB Learning Review Board LTA Lost Time Away LTAR Time Case Rate LWEC Loss of Wage Earning Capacity LWEC PW Loss of Wage Earning Capacity in Place LWOP Leave Without Pay MMI Maximum Medical Improvement MVA Motor Vehicle Accident NDC National Drug Code NFC National Finance Center NIST National Institute of Standards and Technology

NIST SP National Institute of Standards and Technology Special Publication

NTE Not to Exceed NTSB National Transportation Safety Board OMB Office of Management and Budget OPM Office of Personnel Management

Request for Proposal (RFP) for Integrated OSOH/WC Case Management Solution Page 3 of 4

Acronym Description OSHA Occupational Safety and Health Administration OSOH Office of Safety and Occupational Health OWCP Office of Workers’ Compensation Programs PAO Public Affairs Office PAR Personnel Action Processing PD Position Description PDF Portable Data Format PEER Protecting Employees, Ensuring Reemployment PII Personally Identifiable Information PIV ID Personal Identity Verification Identification PN Periodic Roll, no wage earning capacity POC Point of Contact POV Privately Owned Vehicle

POWER Protecting Our Workers and Ensuring Reemployment

PR Periodic Roll R/S Region/Station RAC Risk Assessment Code SAI Serious Accident Investigation SAIT Serious Accident Investigation Team SCEP Student Career Experience Program SF Standard Form SHMD Safety and Health Management Division SLA Service Level Agreements SME Subject Matter Expert SOP Standard Operating Procedure SPE Safety Program Evaluation SSS Single Sign-on Server SSD Self-Service Dashboard SSN Social Security Number SSO Single Sign On STEP Student Temporary Employment Program T&A Time and Attendance TTD Temporary Total Disability USDA United States Department of Agriculture WC Workers’ Compensation WEC Wage Earning Capacity WSDL Web Services Description Language

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Business Process Standardization Appendix B Forest Service (FS)

Office of Safety and Occupational Health (OSOH) and Workers’ Compensation (WC) Workstream Integrated Case Management and Incident Reporting and Recording Solution

February , 2021

SOLICITATION: AG-7604-S-13-0033

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Revision History Authors:

OSOH/WC Workstream

Date Document Version Document Revision Description

1/9/2013 0.9 Initial version 1/24/2013 1.0 Incorporated comments from Project Management Office (PMO) review 7/26/2019 1.0a Updated

10/30/2020 2.0 Updated 2/18/21 v1 Updated

Approval History Approval

Date Approved Version PMO Acceptance Log Number Change Request Number (if applicable)

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Table of Contents

1. INTRODUCTION

1.1 Purpose

1.2 Scope

1.3 Approach

1.4 Process Mapping Legend

2. OWCP CASE MANAGEMENT AND CASE ALIGNMENT

2.1 Case Management

2.2 Initial Case Management Alignment

2.3 Intermediate Case Management Alignment

2.4 Complex Case Management Alignment

3. OWCP BUSINESS PROCESS MAPS

3.1 CA-16 Authorization for Examination and/or Treatment

3.2 CA-1

3.3 CA-2 Occupational Disease (On-the-Job)

3.4 CA-2a

3.5 COP

3.6 Return-To-Work Determination (Maximum Medical Improvement (MMI))

3.7 Return to Work

3.8 Appeals

3.9 Congressional/Freedom of Information Act (FOIA)

3.10 LWOP or Extension to LWOP

3.11 CA-7 Claim for Compensation

3.12 Leave Buy-Back

3.13 Medical Bills

3.14 Modified or Light-Duty Offer for a WC Claim (Temporary Total Disability (TTD)) 36

3.15 Employee Job Offer Activities

3.16 Employee Death

3.17 Convert to One Year Appointment

3.18 ER/LR, EEO Claim

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3.19 Investigative Services Anonymous Tip

3.20 Investigative Services

4. OSOH BUSINESS PROCESSES

4.1 Employee Injury or Illness Reporting

4.2 Employee Injury/Illness Claim for Compensation ...... Error! Bookmark not defined.

4.3 Witness Statement

4.4 Anonymous Safety Story

4.5 Safety Story

4.6 Report of Lost, Unserviceable or Damaged Government-Owned Property (i.e., AD- 112)

4.7 Investigation into Injury/Illness or Safety Story

4.7.1 SAI Management ......................................................... Error! Bookmark not defined.

4.7.2 Non-Serious Incident Investigation Management ....... Error! Bookmark not defined.

4.8 MVA

4.9 OSHA 300A Summary and Log Reporting

4.10 MVA Frequency Rate

4.11 Facility Inspections

4.12 Safety Program Evaluation (SPE)

4.13 Aviation Mishap Reporting.......................................... Error! Bookmark not defined.

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1. Introduction

1.1 Purpose

This document presents the future-state, standardized functional business processes with supporting process narratives to be used across the FS in regard to the OSOH and WC. The purpose of the overall standardization activity is to streamline the execution of day-to-day functions, improve OSOH incident filing and WC filing, improve tracking processes and achieve the goals outlined in the 2020 Protecting Employees, Ensuring Reimployment (PEER) Initiative, Department-wide, to improve overall customer service and increase efficiency. This document serves as a reference guide for the Human Resources (HR) Organization when performing OSOH and WC-related transactions.

1.2 Scope

This document reflects the future-state, standardized functional business processes for OSOH and WC.

1.3 Approach

The documented business processes were updated and refined based on:

WC Business Processes originally gathered in Quarter (2) in Fiscal Year (FY) 2012.

Available documentation, including Standard Operating Procedures (SOPs) Feedback provided from the Functional FS Subject Matter Experts (SMEs) in the OSOH

Business Process Requirements Session and from the Functional FS and United States Department of Agriculture (USDA) WC Business Process Requirements Session

Documented business requirements Desired standardization across all Agencies within the USDA

1.4 Process Mapping Legend

The following table identifies and describes the shapes used in the business process maps.

Process Shape Description

Used to represent the initial step in a process. Often labeled as “Start.”

Represents an encapsulated process that is detailed elsewhere in the process maps.

This end-to-end process is established in another process flow representation. +

Sub-Process

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Represents a specific task in a process.

Should only include one task per box.

Represents a decision that is made during a process, the outcome of which results in one of multiple paths.

Used to identify two separate tasks that occur simultaneously.

Unless otherwise noted, both tasks must be completed prior to moving forward in a process.

Used to connect the tasks, decision points, etc. of a process.

Used to represent the end of a process. Often labeled as “End.”

Identifies the individual or group that conducts a specific task within the process.

Helps to assist in identifying roles and responsibilities in a process.

Task

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2. OWCP Case Management and Case Alignment

2.1 Case Management

Trigger/Input

An Employee incident results in the need for a WC Case Manager to initiate a case. Examples include, but are not limited to: Compensation Act (CA)-1; CA-16; CA-2 and/or CA-2a; death;

medical billing issue; call received from Employee about a medical bill; call received from provider about unpaid medical bill; copy received of medical bill in mail; items are being denied in the Agency Query System (AQS); collection agency sends medical bill or notification.

Process Description

The initial Case Manager receives documentation. If the documentation is related to a Congressional, Employee Relations (ER)/Labor Relations (LR) case or an Equal Employment Opportunity (EEO) claim, it is escalated to a Complex Case Manager. If it is not, documentation related to the original submission is gathered and processed, as appropriate. If the documentation is related to loss of pay; light-duty work restrictions; Leave Without Pay (LWOP); Leave Buy- Back; more than 30 days of Continuation of Pay (COP) use or death, then it is escalated to an Intermediate Case Manager. If it is not, then case management activities are conducted. Upon completion of these activities, the case is reviewed to ensure all criteria have been met. If they are, the case is closed. If not, it is then elevated to the Intermediate Case Manager. Case information is then organized and assigned within Intermediate Case Management and processed, as appropriate. If documentation is not older than 271 days and all criteria have been met, the case is closed. If these criteria are not met, then the case is escalated. The Complex Case Manager then organizes the documentation, as appropriate, processes appropriate documentation and conducts case management activities until the case is fully resolved.

Frequency This process occurs on an ad-hoc basis when a notice or documentation is received.

Roles Initial Case Manager, Intermediate Case Manager, Complex Case Manager Results Case is reviewed and escalated as appropriate, with the case being updated and closed

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2.2 Initial Case Management Alignment

2.3 Intermediate Case Management Alignment

2.4 Complex Case Management Alignment

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3. OWCP Business Process Maps

3.1 CA-16 Authorization for Examination and/or Treatment

Trigger/Input Contact from Employee/representative requesting CA-16; and/or Employee develops work related condition.

Process Description

The Employee or Manager/Supervisor contacts the Human Resources Management (HRM) Contact Center; the request is assigned a case number, and it is submitted to the WC queue. The WC Case Manager retrieves the case from the queue and determines if the request meets the Employee checklist criteria. If it does not, the Employee is notified to complete the appropriate claim document (CA-1, CA-2, CA-2a). If it does meet the checklist criteria, the Employee or Manager/Supervisor provides the Medical Provider contact information to the Case Manager.

Upon receipt of the contact information, the Case Manager issues a CA-16 to the Medical Provider. The Medical Provider will then provide treatment, as appropriate, and submit applicable medical reports to the Case Manager and Department of Labor (DOL) OWCP. Recommendations for the Employee’s next steps are then provided, and a case is created in the WC case management solution/database.

Frequency This process occurs on an ad-hoc basis when a CA-16 is requested or received, or a work related condition has developed.

Roles Employee, Manager/Supervisor, WC Case Manager, HRM Contact Center, Medical Provider

Results If checklist criteria are not met, a request for the Employee to complete the relevant data is made.

If criteria are met, a case is created and managed, as appropriate.

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OSOH/WC Business Process Standardization Page 12 of 73

3.2 CA-1

Trigger/Input An Employee develops an illness or disease and contact from Employee/Representative requesting information or authorization is received.

Process Description

If a claim is submitted through Customer Relationship Management (CRM), the Employee or Manager/Supervisor contacts the Contact Center describing the work related condition. CRM creates a case number and submits it to the WC Case Manager. If it was not initiated through CRM, the Case Manager receives the inquiry through other measures (e.g., fax, Safety and Health Information Portal System (SHIPS), DOL, etc.). Upon receipt of the inquiry, the Case Manager will advise the Employee on the next steps that should be taken. The Employee then initiates completion of the CA-1 form, and the Manager/Supervisor will complete it prior to submitting to the Case Manager. If the Employee is not requesting the claim be filed to DOL OWCP, a WC database record is created, and the CA-1 form is scanned to the medical folder for documentation.

If it is intended to be filed with DOL OWCP, the Case Manager creates and updates the file, subject to Federal Employees Compensation Act (FECA) and Privacy Act regulations, as well as creates a file in the WC database (and CRM if applicable). The form is reviewed for objections, and the Case Manager states the Agency’s position. The CA-1, along with the Agency’s position, is then submitted to DOL, where a case number is issued and additional documentation is requested from applicable parties, if required. The Case Manager receives the DOL case number and issues a letter to the Employee with his/her rights and responsibilities. If the case does not need to be elevated, case management activities are conducted; if it does need to be elevated, then the Case Manager determines if the case warrants an intermediate or complex designation per the SOP criteria. The applicable parties are then advised of the appropriate next steps, and the Employee or Manager/Supervisor will gather documentation, as available, to submit to the Case Manager. This documentation is submitted to DOL, along with the Agency’s response. DOL then adjudicates the claim and notifies the Employee and Agency of the decision. If the claim was accepted, case management activities will be conducted. If it was not accepted, the Employee is advised of his/her appeal rights and will choose to either appeal or end the process.

Frequency This process occurs on an ad-hoc basis when a request or documentation is received.

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Roles DOL OWCP, WC Case Manager, Employee, Manager/Supervisor, HRM Contact Center Results Case management activities are conducted or the appeals process is initiated.

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3.3 CA-2 Occupational Disease (On-the-Job)

Trigger/Input Employee develops illness or disease and contact from Employee/Representative requesting information or authorization (CA-16) is received.

Process Description

If a claim is submitted through CRM, the Employee or Manager/Supervisor contacts the HRM Contact Center, describing the work related condition, and CRM creates a case number and submits it to the WC Case Manager. If it was not initiated through CRM, the Case Manager will receive the inquiry through other measures (e.g., fax, SHIPs, DOL, etc.). Upon receipt of the inquiry, the Case Manager will advise the Employee on the next steps that should be taken, including the applicable CA-35. The Employee will then initiate completion of the CA-2 form, and the Manager/Supervisor will complete it prior to submitting to the Case Manager. If the Employee is not requesting for the claim to be filed to DOL OWCP, a WC database record is created and the CA-2 form is scanned into the medical folder for documentation purposes. If it is intended to be filed with DOL OWCP, the Case Manager creates and updates the file subject to FECA and Privacy Act regulations, as well as creates a file in the WC database (and CRM if applicable). The CA-2 form is reviewed for objections and the Case Manager states the Agency’s position. The CA-2, along with the Agency’s position, is then submitted to DOL, where a case number is issued, and additional documentation is requested from applicable parties, if required.

The Case Manager receives the DOL case number and issues a letter to the Employee with his/her rights and responsibilities. The applicable parties are then advised of the appropriate next steps on how to respond to the request from DOL and address the CA-35 checklist. The Employee or Manager/Supervisor will gather documentation, as available, for CA-35 A-H, and submit to the Case Manager. This documentation is submitted to DOL, along with the Agency’s response.

DOL then adjudicates the claim and notifies the Employee and Agency of the decision. If the claim was accepted, case management activities will be conducted. If it was not accepted, the Employee is advised of his/her appeal rights and will choose to either appeal or end the process.

Frequency This process occurs on an ad-hoc basis when a request or documentation is received.

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3.4 CA-2a

Trigger/Input Employee has recurrence of an injury or illness and contact from Employee/Representative requesting information or authorization (CA-16) is received.

Process Description

If a claim is submitted through CRM, the Employee or Manager/Supervisor contacts the HRM Contact Center, describing the work related condition, and CRM creates a case number and submits it to the WC Case Manager. If it was not initiated through CRM, the Case Manager will receive the inquiry through other measures (e.g., fax, DOL, etc.). Upon receipt of the inquiry, the Case Manager will advise the Employee on the next steps that should be taken. The Employee will then initiate completion of the CA-2a form, and the Manager/Supervisor will complete it prior to submitting to the Case Manager. The Case Manager creates and updates the file subject to FECA and Privacy Act regulations, as well as creates a file in the WC database (and CRM if applicable). The CA-2a form is reviewed for objections, and the Case Manager states the Agency’s position. The CA-2a, along with the Agency’s position, is then submitted to DOL;

when this is not a recurrence, and the CA-1 and/or CA-2 process is initiated. If it is a recurrence, it is assigned to the original case number and additional documentation is requested from applicable parties, if required. The Case Manager receives DOL correspondence. The applicable and parties are then advised of the appropriate next steps, and the Manager/Supervisor will provide a response to DOL. DOL then adjudicates the claim and notifies the Employee and Agency of the decision. If the claim was accepted, case management activities will be conducted.

If it was not accepted, the Employee is advised of his/her appeal rights and will choose to either appeal or end the process.

Frequency This process occurs on an ad-hoc basis when a request or documentation is received for a recurrence.

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3.5 COP

Trigger/Input Employee identifies COP on the CA-1, enters COP on timesheet or the WC Case Manager identifies it on the COP report.

Process Description

An Employee elects to receive COP; the Manager/Supervisor reviews the request and utilizes the controversion checklist to determine eligibility with assistance from the WC Case Manager. If the Employee meets any of the nine conditions, he/she is informed of the decision to deny, and the process ends. If the Employee does not meet the conditions, the Case Manager reviews to determine if the COP should be controverted for other reasons. If it is, a ruling is requested, and DOL OWCP reviews the information. If they decide to deny the COP, the Employee is informed, and correspondence is given to the Case Manager. The Case Manager then requests an Employee timesheet correction and then monitors the case to ensure completion of the correction. If DOL does not deny the COP request, or it is not controverted by the Case Manager, the Employee uses COP. The Case Manager obtains a copy of the Time and Attendance (T&A) record, with supporting medical documentation, for each pay period. It is then reviewed to determine appropriate use of COP. If it is not appropriate and is unauthorized use, the Employee and Supervisor are notified of determination to terminate COP, a timesheet correction is requested, and the case is monitored, ensuring compliance. If it is not an appropriate use of COP, but is in fact authorized, the Employee and Supervisor are notified for the need to correct the timesheet. If there is appropriate use of COP, time is tracked and monitored. If COP usage will not continue beyond 30 days, the Employee will return to work. If usage will be greater than 30 days, the case is elevated to the intermediate Case Manager, and a determination is made of whether the Employee will be able to return after 45 days, per available medical evidence. If he/she is able to return to work on or before the 46th day, he/she will do so, and the process ends. If he/she is not, then the CA-7 process is initiated.

Frequency On an ad-hoc basis when COP is being requested or has been identified.

Roles Employee, Manager/Supervisor, WC Case Manager, DOL OWCP

Results COP is used and the Employee returns to work, or COP is used and after 45 days, the CA-7 process is initiated.

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3.6 Return-To-Work Determination (Maximum Medical Improvement (MMI))

Trigger/Input An Employee has not been able to perform his/her job-related duties and has received work related restrictions.

Process Description

The WC Case Manager receives work related restrictions in regard to an Employee. It is then reviewed to determine if accommodation is possible. If accommodation is possible, it is determined if restrictions are permanent. If they are, the return to work process is initiated; if they are not permanent, the modified or light duty job offer process is initiated. If accommodation is not possible, and the Employee is not permanent, he/she is terminated and advised on his/her compensation. Case management activities are conducted, and the process ends. If he/she is a permanent Employee, he/she is advised of compensation options, and a course of action is determined, based upon Case Manager advisement. Case management activities then occur, and the process ends.

Frequency An Employee has received his/her work related restrictions and has been cleared to return to work in some capacity

Roles WC Case Manager

Results An Employee is advised of his/her options and the appropriate course of action is taken, based on appointment status and ability to accommodate. Case Management activities are also conducted.

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3.7 Return to Work

Trigger/Input It is determined that an Employee can be accommodated, and he/she is able to return to work in some capacity (but not perform his/her prior job duties).

Process Description

If a classified position is available within the Employee’s documented limitations, the Case Manager will consult with the applicable or relevant branches within the Agency, obtaining required documentation. Determinations are then made to offer the Employee either a modified, equivalent or lower paying position. If one of these options is offered and the Employee is permanent, the job offer process is initiated. If he/she is temporary, he/she is converted or placed into a new Not to Exceed (NTE) one year appointment, and a Wage Earning Capacity (WEC) is requested between 90 to 120 days of the new appointment. Case management activities occur, and the process ends. If one of the offers is not made, a Rehabilitation Counselor is requested and assigned by DOL OWCP; the Employee is interviewed and his/her skills are assessed. The Case Manager can then either reconsider making a job offer or have the process to pursue another Agency, private sector or training opportunities begin for the Employee, and the process ends. If a classified position is not available, the Case Manager will pursue opportunities within another Agency. After exhausting all intra-Agency options and determining the Employee can be placed within another Agency, reassignment activities will be conducted, and a request for a WEC determination will be made to DOL OWCP. If he/she cannot be placed within another Agency, a Rehabilitation Counselor is requested and provided by DOL OWCP, where the Employee interviews and assessments will occur. The Case Manager can then either reconsider making a job offer or have the process to pursue another Agency, private sector or training opportunities begin for the Employee, and the process ends.

Frequency Occurs when a determination has been made that an Employee can be accommodated, and his/her restrictions are permanent.

Roles WC Case Manager, DOL OWCP Results An Employee returns to work or is assisted in pursuing training or additional job opportunities.

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3.8 Appeals

Trigger/Input An Employee is denied a specific OWCP benefit request and appeals the decision.

Process Description

DOL notifies an Employee and the WC Case Manager of the formal decision to deny a specific OWCP benefit. The Employee can then request a hearing within 30 days; if he/she decides to do so, the Case Manager will have the opportunity to participate in the oral hearing or request a transcript with written responses. DOL conducts the oral hearing and issues a written transcript to the Employee and Case Manager. The Case Manager then has the opportunity to provide a response, and DOL will make a decision to deny or overturn their original decision. If it is not upheld, all applicable parties are notified of the decision to all the OWCP benefit. If the decision is upheld or the Employee has elected to not request a hearing, he/she may request reconsideration. If reconsideration is requested, DOL will submit the request along with any new documentation to the District Director for reconsideration. If the original decision is not sustained, all applicable parties are informed of the decision to allow the OWCP benefit. If it is sustained, the Employee is formally notified. After notification, or if the Employee does not request reconsideration, the Employee has 180 days to appeal to the Employees' Compensation Appeals Board (ECAB). If he/she elects not to appeal to ECAB, case management activities are conducted until expiration of the appeal timeline. If appealing to ECAB, the Employee will submit the appeal, and ECAB will make the decision to deny or overturn the decision. If the decision is upheld, the process ends; if it is not, all applicable parties are notified of the decision to allow the OWCP benefit.

Frequency Occurs on an ad-hoc basis when an Employee appeals a decision denying an OWCP benefit Roles Employee, WC Case Manager, DOL OWCL, ECAB Results The appeal is denied after exhausting all venues or the specific OWCP benefit is allowed.

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3.9 Congressional/Freedom of Information Act (FOIA)

Trigger/Input An Employee initiates a claim that has resulted in a Congressional inquiry.

Process Description

The Public Affairs Office (PAO) receives a request and forwards it to the applicable parties. The Congressional/FOIA Point of Contact (POC) researches to identify the WC Case Manager responsible for the constituent’s region. The Case Manager reviews the inquiry and investigates the areas of concern, while reviewing applicable regional laws, regulations and policies. A narrative response to the inquiry is then completed. The Congressional/FOIA POC reviews the narrative response and determines if the inquiry requires changes. If it does, the POC and Branch Leadership will coordinate with the Case Manager to make changes. After changes are made, or if the inquiry did not require changes, it is forwarded for final review to the Branch Leadership, where additional changes would be made if needed, and then it would be submitted to the PAO. A draft letter of response is then prepared by the Director and is sent to the Case Manager for final review. The draft letter is then submitted to Branch Leadership, where changes are made, if needed, and the letter is submitted to the PAO. The final copy is then submitted with the appropriate signatures to the Case Manager, and the process ends.

Frequency Occurs on an ad-hoc basis where PAO receives a request warranting action.

Roles WC Case Manager, Branch Leadership, Congressional/FOIA POC, PAO Results A signed letter is submitted to the Case Manager for documentation purposes.

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3.10 LWOP or Extension to LWOP

Trigger/Input Employee is unable to return to work; COP ends; Employee is not eligible for COP.

Process Description

The WC Case Manager receives a notification that an Employee requires LWOP or an extension of LWOP and submits the notification to the Manager/Supervisor to initiate an SF-52. The Supervisor initiates the SF-52 action to affect the LWOP and provides notification. The WC Case Manager will attach the SF-52 to an SF-2810, if applicable, and assign the case to the WC Supervisor. The WC Supervisor signs the SF-52 and submits it to Personnel Action Processing (PAR). PAR processes the action and notifies Benefits to process the SF-2810 to transfer Federal Employee Health Benefits (FEHB) to the DOL. The WC Case Manager will monitor the SF-52 and SF-2810 to ensure they have processed, and determine if the Employee will return prior to the NTE date. If the Employee returns prior to the NTE date, the WC Case Manager will initiate the Return to Work Process. If the Employee does not return to work prior to the NTE date, the WC Case Manager will determine if LWOP will be extended. If LWOP will be extended, the LWOP extension is initiated, and the process begins with receiving notification to initiate the SF-52. If LWOP will not be extended, the WC Case Manager will consult with necessary groups (i.e., Employee Relations Specialists (ERS)) to determine Employee removal.

The LWOP extension will be reconsidered if the Employee will not be removed. If removal from the role is determined, ERS will conduct non-disciplinary removal actions; the WC Case Manager conducts case management activities, and the process ends.

Frequency This process occurs on an ad-hoc basis when an Employee is placed on LWOP or requires an extension to LWOP.

Roles WC Supervisor, Benefits Specialist, Manager/Supervisor, WC Case Manager, PAR, ERS Results Employee is placed on LWOP; LWOP is extended; Non-disciplinary removal action is completed

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OSOH/WC Business Process Standardization Page 30 of 73

3.11 CA-7 Claim for Compensation

Trigger/Input COP ends; Employee is unable to work when COP has ended; Schedule Award; Other Wage Loss.

Process Description

The Employee notifies the WC Case Manager of an inability to work, receives advice on the next steps and completes a CA-7 Page 1. The WC Case Manager receives the completed CA-7 Page 1 from the Employee and calculates and certifies the Employee’s pay. The claim is submitted to DOL OWCP with supporting medical documentation. DOL OWCP will review the claim and determine if additional information is required. If required, additional information is requested from all applicable parties. If additional information is not required, DOL OWCP will render a formal decision on the compensation request. If the compensation request is granted, the WC Case Manager will conduct case management activities, and the process ends. If the compensation request is not granted, the Employee is advised on his/her appeal rights and determines if he/she wants to appeal. If the Employee appeals, the appeals process is initiated; otherwise, the process ends.

Frequency This process occurs on an ad-hoc basis when an Employee is unable to continue work.

Roles Employee, WC Case Manager, DOL OWCP Results CA-7 form is completed and submitted to DOL OWCP; Compensation Request Approved

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3.12 Leave Buy-Back

Trigger/Input Employee ineligible for compensation/COP; claim under review at DOL OWCP and then accepted; Employee elected to use annual/sick leave and wants to buy back leave used.

Process Description

The Employee works with the WC Case Manager to request leave buy-back. The WC Case Manager counsels the Employee on the leave buy-back process and determines eligibility. If the Employee is not eligible, the process ends. If the Employee is eligible, the WC Case Manager provides counsel, and the Employee makes a determination if he/she still wants to pursue leave buy-back. If the Employee determines to proceed with the leave buy-back, the CA-7/CA-7a forms are completed and submitted. The Employee’s salary is calculated, timesheets are verified and the WC Case Manager completes the Agency portion of the CA-7/CA-7b. The forms are submitted to the National Finance Center (NFC) to provide an estimate and complete the remaining CA-7b.

Based on NFC’s estimate, the Employee determines whether to continue the leave buy-back process. If the Employee does not want to continue the leave-buy back, the process ends. If the Employee determines he/she wants to continue the leave buy-back, he/she completes the CA-7b and submits. The WC Case Manager will determine if the forms are complete. If the forms are not complete, they are returned to the Employee for completion. If the forms are complete, Pay will be notified, and all applicable documentation will be submitted. DOL OWCP will determine if additional information is required to render a formal decision. If additional information is required, it is requested from the applicable parties; otherwise, DOL OWCP will review and determine if the case is accepted. If the case is accepted, a check will be distributed to NFC. NFC will generate a bill for the Employee portion of the leave buy-back. The Employee will pay the bill, and upon receipt of final payment, NFC notifies the Agency. Pay/Leave will adjust the leave in the system, notify the applicable parties, and the process ends. If the case is not accepted, the WC Case Manager will be notified, provide advice to the Employee on his/her appeal rights, and the Employee will determine whether to appeal the decision. If the Employee determines he/she does not want to appeal, the process ends. If the Employee appeals the decision, the appeal process is initiated.

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Frequency This process occurs on an ad-hoc basis when the Employee wants to reinstate annual/sick leave used.

Roles Employee, WC Case Manager, NFC, DOL OWCP, Pay/Leave Specialist Results Annual/Sick Leave reinstated

OSOH/WC Business Process Standardization Page 34 of 73

3.13 Medical Bills

Trigger/Input An Employee and/or Medical Provider contacts WC regarding an unpaid bill; an unpaid bill is received in the mail; medical payments are denied in Affiliated Computer Services (ACS) Web bill processing portal; a collection agency sends a bill or delinquent notification.

Process Description

The WC Case Manager receives notice of an unpaid medical bill and researches for an existing WC claim in applicable databases. The WC Case Manager will determine if the bill is a denial. If the bill is not a denial, the WC Case Manager will determine if the medical bill is for an Agency Employee. If the medical bill is not for an Agency Employee, it is returned with an explanation, and the process ends. If the medical bill is for an Agency Employee, but the Employee does not have a WC claim, the medical bill is returned with an explanation, and the process ends. If the medical bill is for an Agency Employee with a valid WC claim and the paperwork has not been submitted, the WC Case Manager will refer to the CA-1 process. If the medical bill is for an Agency Employee with a valid WC claim and the paperwork has been submitted, the WC Case Manager contacts the medical provider to request resubmission of the medical bill or authorization request. If the bill has been denied, ACS is verified for prior authorization, denial code or payment status. The WC Case Manager advises the Employee on the next steps and contacts the medical provider to request resubmission of medical bill or authorization request. The WC Case Manager monitors ACS to receive status of billing; at the same time, the Manager/Supervisor will make determination on the bill. Once the billing status has updated, the WC Case Manager will notify the Employee/medical provider, as appropriate, and the process ends.

Frequency This process occurs on ad-hoc basis when a medical bill has not been paid.

Roles Medical Provider, WC Case Manager, Manager/Supervisor Results Medical Bill is Paid, Medical Bill is denied with explanation

OSOH/WC Business Process Standardization Page 35 of 73

OSOH/WC Business Process Standardization Page 36 of 73

3.14 Modified or Light-Duty Offer for a WC Claim (Temporary Total Disability (TTD))

Trigger/Input WC receives work restrictions for an Employee; an Employee has been injured and can no longer perform prior job duties, but is capable of light/modified job duties.

Process Description

WC Case Manger receives Employee work-related restrictions and reviews to determine if accommodation is possible. If accommodation is not possible, the Employee is advised of compensation options (e.g., CA-7, COP, etc.). The Employee will determine action based on WC Case Manager advisement, and the process ends. If accommodation is possible, light-duty tasks are requested. The Supervisor will provide a list of light-duty assignments available; the WC Case Manager will prepare a light or modified duty letter, submit to the Employee, and initiate the job offer process.

Frequency This process occurs on an ad-hoc basis when work restrictions are received and the Employee is offered modified or light-duty.

Roles Employee, WC Case Manager, Supervisor/Manager, DOL OWCP Results Light/Modified Duty Letter Issued; Employee accepts Light/Modified Job Offer made

OSOH/WC Business Process Standardization Page 37 of 73

OSOH/WC Business Process Standardization Page 38 of 73

3.15 Employee Job Offer Activities

Trigger/Input Employee receiving WC is offered Date of Injury (DOI) position or position of similar pay/duties to return to work.

Process Description

The Employee will receive a job offer and determine if he/she accepts the offer. If the job offer is accepted, the Employee will return to work. If the job offer is not accepted, the Employee provides a response for declining. The WC Case Manager submits to DOL OWCP for a suitability determination. DOL OWCP responds to suitability request. If the job offer is not suitable, WC Case Manger will conduct Case Management activities. If the job offer is suitable, the Employee will have the option to reconsider. If the Employee accepts the suitability determination, he/she will return to work and the WC Case Manager will monitor until the Employee is able to return to full duties. When the Employee is able to return to full duty, the WC Case Manager will notify the applicable parties, and the process ends. If the Employee declines the suitability determination, a declination is submitted. DOL OWCP reviews and determines to accept/decline the Employee response. If the Employee declination is accepted, the WC Case Manager will conduct case management activities. If the Employee response is not accepted, the Employee is notified of compensation loss. The WC Case Manager will inform the Employee of appeal rights. If the Employee appeals, the appeals process is initiated; otherwise, the process ends.

Frequency This process occurs on an ad-hoc basis when an Employee on WC is offered a job.

Roles Employee, WC Case Manager, DOL OWCP Results Job Offer Accepted; DOL OWCP Suitability determination made

OSOH/WC Business Process Standardization Page 39 of 73

OSOH/WC Business Process Standardization Page 40 of 73

3.16 Employee Death

Trigger/Inputs Employee passes due to work related incident.

Process Description

The WC Case Manager will receive fatality notification and inform applicable groups. If the death is not work related, the WC Case Manager will search for existing WC claims and provide appropriate documentation to Benefits/DOL OWCP, and the process ends. If the death is work related, the applicable parties (e.g., Benefits) will be notified and the POC is informed of next steps. The POC will complete and submit a CA-6. The CA-6 is reviewed and submitted to DOL OWCP with the Agency's stated position. DOL OWCP issues a claim number to the WC Case Manager and coordination with the POC will occur to obtain all necessary documentation. A letter is submitted to the Survivor/Estate Representative. The POC assists with completion and submission of the CA-5/CA-5b and supporting documentation. The documentation is reviewed by the WC Case Manager and submitted. DOL OWCP will determine to accept or deny the claim. If the claim is accepted, the WC Case Manager and Survivor/Estate Representative are notified of the benefits payment. The WC Case Manager will provide notification to Budget and Finance (B&F) of eligibility for death gratuity, monitors the claim to ensure payment, and the process ends. If the claim is not accepted, it is determined if the denial was due to insufficient documentation. If the denial is due to insufficient documentation, DOL OWCP will request additional information from the Survivor/Estate Representative, until the required documentation is submitted, and the claim is accepted. If the denial is not due to insufficient documentation, the decision may be appealed. If the Survivor/Estate Representative appeals, the appeals process is initiated; otherwise, the process ends.

Frequency This process occurs on an ad-hoc basis when an Employee passes as a result of a work related incident.

Roles WC Case Manager, Supervisor/Manager (POC), DOL OWCP, Survivor/Estate Representative Results Death Gratuity payments are made

OSOH/WC Business Process Standardization Page 41 of 73

OSOH/WC Business Process Standardization Page 42 of 73

3.17 Convert to One Year Appointment

Trigger/Input 1,039 hours are received and a determination is made that the Employee will not return to work or full-duty prior to expiration of the NTE date.

Process Description

The WC Case Manager will obtain and submit all applicable documentation (e.g., resume, Position Description (PD), etc.). Staffing/PAR will determine if the Employee qualifies for a new position. If the Employee does not qualify for a new position, notification is submitted to the WC Case Manager, and a new PD is requested from the Supervisor. If the Employee qualifies for the position, the WC Case Manager will create a job offer letter and complete the job offer process.

Frequency This process occurs on an ad-hoc basis when an NTE appointment will expire prior to the Employee being able to return to full duty.

Roles WC Case Manager, WC Supervisor, Staffing/PAR, Supervisor/Manager Results Employee qualifies for new position and the Job Offer process is initiated.

OSOH/WC Business Process Standardization Page 43 of 73

OSOH/WC Business Process Standardization Page 44 of 73

3.18 ER/LR, EEO Claim

Trigger/Input Designated POC will respond to an ER/LR/EEO/Union inquiry.

Process Description

The designated POC will receive, review and determine the WC Case Manager. The WC Case Manager will coordinate with applicable parties to provide considerations and assist the POC to draft an inquiry response. The POC and WC Case Manager will determine if Leadership approval is required. If Leadership approval is required, Leadership will review and approve the inquiry.

Upon Leadership approval, or if Leadership approval is not required, the POC and WC Case Manager finalize and submit the inquiry.

Frequency This process occurs on an ad-hoc basis when an ER/LR/EEO/Union inquiry is made.

Roles WC Case Manager, Designated POC, Union/Civil Rights/ER/LR/EEO Results ER/LR/EEO/Union inquiry is finalized and submitted

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OSOH/WC Business Process Standardization Page 46 of 73

3.19 Investigative Services Anonymous Tip

Trigger/Input WC receives a tip regarding potential WC fraud.

Process Description

An individual contacts WC via the hotline/Web site to report potential WC fraud. WC documents information in the claim case file and determines if the individual will sign a witness statement. If the individual will sign a witness statement, WC requests the information, documents the additional information in the claim case file and initiates the investigative services process. If the individual will not sign a witness statement, WC will initiate the investigative services process.

Frequency This process occurs on an ad-hoc basis when tips regarding potential WC fraud are received.

Roles Anonymous tip, WC Results Information is obtained regarding the potential fraud and investigative services are initiated.

OSOH/WC Business Process Standardization Page 47 of 73

OSOH/WC Business Process Standardization Page 48 of 73

3.20 Investigative Services

Trigger/Input WC Case Manager will receive evidence/information and identify claim to perform claim ranking score.

Process Description

The WC Case Manager will identify claim, perform evidence checklist and obtain claim ranking score. If the fraud risk score does not indicate the need for an investigation and evidence received does not indicate discontinued compensation, the WC Case Manager will continue to monitor the claim and update the fraud risk score as information/evidence is made available, and the process ends. If the fraud risk score indicates further investigation is warranted, the WC Case Manager will provide justification for investigative services to WC Leadership. WC Leadership will confirm funding is available and release authorization to perform investigative services. Upon authorization, the Third Party Investigator will conduct investigation, document and report findings to the WC Case Manager. The WC Case Manager will attach the investigation findings to the claim and review to determine if the claim will be challenged. If the claim will not be challenged, the WC Case Manager will document justification for not challenging the claim, continue to monitor/update the claim with new evidence, and the process ends. If the claim is challenged, the WC Case Manager will document justification and submit to DOL with request to suspend compensation. DOL will review the justification and evidence to determine if compensation will be suspended. If compensation is suspended, DOL will provide notice to the WC Case Manager. The WC Case Manager will document notice of suspended compensation, provide to the claimant, and the process ends. If DOL does not approve suspension of compensation, they will submit reason for denial to the WC Case Manager. The WC Case Manager will determine if additional information is available and submit to DOL; otherwise, the process ends.

Frequency This process occurs on an ad-hoc basis when evidence/information is received regarding a WC claim that requires investigation.

Roles WC Case Manager, WC Leadership, Third Party Investigator, DOL

Results Investigation is completed; Determination is made to challenge WC claim and discontinue compensation.

OSOH/WC Business Process Standardization Page 49 of 73

OSOH/WC Business Process Standardization Page 50 of 73

4. OSOH Business Processes

4.1 Employee Injury or Illness Reporting

Trigger/Input An Employee becomes ill or injured on duty while employed at the Agency.

Process Description

The Employee identifies if the injury/illness occurred during official duty hours. If the injury did not occur during official duty hours, the Employee will not document the injury/illness sustained during off-duty hours, and the process ends. If the injury/illness occurred while in active status, the Employee will report the details of the work-related injury/illness and determine if they will file a worker’s compensation claim.