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"The punishment which the wise suffer who refuse to take part in government, is to live under the government of worse men" - Plato 427-347 BC

Similarly, as shown in Table 3, there is a positive correlation between the number of QCM cases processed, the number of second opinion medical examinations (SECOP) scheduled and the number of hearing requests. As the number of QCM cases processed increased the numbers of cases referred for early nurse intervention also increased. However, it is important to note that the number of hearing requests is negatively correlated with the actual number of injuries which actually fell by 12% since 1994.

Table 3: Correlation between QCM Cases and Hearing Requests
Year	Injuries (35)	QCM Cases	SECOPs	Hearing Requests	ROR Requests	Remand Rate

1994 (36)	113722	4300	1000	6703	583	40%
1995	105483	9500(37)	2000	7250	806	38%
1996	100064	10500(38)	3400	7991	830	43%

Average						40%

The FY94 Report described QCM in the following manner

[t]he guiding principle of this new approach . . . is early, active management of the case through staff teamwork, leading to return to light or alternative work if possible. If intervention by the occupational health or rehabilitation nurse does not lead to return to work, the case is expected to move quickly to medical and vocational evaluation. If evaluation supports a wage-earning capacity, the injured worker is advised that OWQP judges him or her to be partially disabled, and that benefits will be adjusted.(*39)

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35 For purposes of this table, "injury" means "lost time injury" and occupational disease.

36 "FY 1994 was the first full year of experience for FEC's new comprehensive approach to disability [QCM]." FY94 Report at 12.

37 "Over 7,800 cases assigned to rehabilitation nurses [in FY95] versus 4,300 in 1994." FY95 Report at 11.

38 "Over 9,700 cases assigned to nurses v. 7,800 last year." FY96 Report at 10. At a September 30, 1997, Oversight hearing, Acting Director Hallmark testified that DFEC received approximately 10,000 serious injuries each year.

39 FY94 Report at 17 (emphasis added).

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In describing the purpose of the PRM and QCM procedures, OWCP's FY96 Report states

[class actions under the PRM initiative, along with QCM's success in returning injured employees to work, have reduced the size of the periodic roll by two percent. Previously, the roll had been increasing by four percent annually.(40) At the end of FY 1996 58,329 beneficiaries(41) were receiving long-term compensation, the lowest number on the roll since 1990. With very low administrative costs, less than $14 million for the PRM project's 4 1/2 years, PRM is an extremely cost-effective initiative that has contributed to the reversal in compensation payment increases and assisted in curtailing the increase in the size of the disability roll.(42)

It therefore appears that the 22% increase in hearing requested is related to the activities of the Periodic Roll Management Project, the increased implementation of QCM procedures and increased referrals for rehabilitation nurse intervention. These activities appear to be suspect in light of the fact that the remand rate, for appealed decisions, has averaged 42% since FY92.

It also appears that DFEC has chosen to address the imbalance in the traditional workers' compensation covenant, i.e., predictable compensation costs in exchange for timely payment of benefits, by adopting measures designed to reduce the amount of benefits paid. In addition, DFEC began measuring its success by the amount of compensation benefits saved rather than service to injured employees.

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40 This "factoid" is not supported by the data published in Table A-1 of the FY96 Report or OWCP's prior statement, in its FY93 Report, quoted above. See n.10 supra, and accompanying text.

41 This figure includes recipients of death benefits.

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Measuring Success

Although the FY92 Report described the early nurse invention program as one of several "new initiatives to streamline and improve our case management and service to injured workers,"(*43) its results were actually reported in terms of reduced benefits.(*44) Similarly, the FY92 Report described the criteria for success of the Periodic Roll Management Project in the following manner:

[f]or each injured worker restored to employment with no loss of wageearning capacity, average s!vings of $20,000 are estimated for each successive year that the worker would have remained a recipient. At the end of FY 1992, after only three months of activity, the four project teams had already taken actions which would directly result in savings to the compensation fund of $13 million over the next four years. (The full four Office project is currently expected to save more than $100 million after the cost of staff is subtracted.)(*45)

DFEC's number one Strategic Goal is to reduce the number of lost production days. "Lost production day" is a euphemism for disability for work caused by injury or illness. In its Strategic Plan, DFEC has established yearly goals, through 2002, for reducing disability. This goal is placed before improving the quality of decisions and improving customer service. The goal of reducing "lost production days' implies that compensation is being paid for periods where employees are not actually disabled. How will DFEC achieve its goal once disabled employees cannot be returned to work sooner? The fact that an increase in the activities designed to return Claimants to work sooner has resulted in a 22% increase in the number of hearings, and the fact that the remand rate for appealed decisions is nearly 50%, appears to suggest that such a Strategic Goal is in fact forcing injured employees back to work too soon.

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42 FY96 Report at 10 (emphasis in original, italics added).

43 FY92 Report at 8 (emphasis added). DFEC states "it is clear from anecdotal evidence thatClaimants are well disposed to intervention by the nurses." (Id. at 9) OWCP has never supported this claim with data from its customer surveys.

44 'In a controlled study of 224 lost-time injury cases, Claimants receiving [early nurse] intervention services within 100 days of injury experienced fewer days lost from work, fewer weeks on the compensation rolls, and lower compensation costs." FY92 Report at 8-9 (emphasis added).

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DFEC's Strategic Plan publicly states that reducing the amount of compensation paid for disability is more important than any other goal. However this emphasis on reducing compensation costs is not without consequences for injured workers. As part of the workers' compensation covenant, injured employees are entitled to receive prompt payment of compensation and medical bills. significant number of injured employees experiencing problems with compensation claims demonstrates that the covenant has broken down.(46)

Injured Federal Employees Are Not Receiving the Benefit of Their Covenant

Although increased implementation of the Periodic Roll Management Project and QCM case procedures appears to have increased the number of decisions which are appealed, the data indicates that the quality of these decisions is poor. For example, as shown in Table 4, OWCP's statistics reveal that Hearings and Review (H&R) has consistently remanded(47) an average of 45% of the decisions denying or reducing benefits. Similarly, data provided by OWCP discloses that the Employees' Compensation Appeals Board (ECAB), the highest appellate body under the FECA, has remanded 41% of the cases it considered.(48) The ECAB remand rate is very

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45 FY92 Report at 9 (emphasis added).

46 Query: by considering employing agencies customers, has DFEC neglected its primary mission, of providing compensation for injured workers, in favor of providing "service" to agencies?

47 If an appealed decision is incorrect, H&R may reverse the decision or vacate the decision and remand the case to the District Office for additional development and a de novo decision. In its Annual Reports OWCP has not indicated how many remanded cases are actually reversals. 48 According to data provided by DFEC, the Employees' Compensation Appeals Board (ECAB) completed 11,785 cases from the beginning of FY89 to the end of April 1996. Of these cases, the ECAB sustained 6,930 (59%) of the decisions appealed and modified, reversed or remanded 4,855 (41%) of the decisions appealed.

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significant since no new evidence can be submitted. This means that 41% of the decisions considered by the ECAB are incorrect on their face without the submission of evidence not considered by the decision makers. Such an error rate is compelling evidence that DFEC's procedures are not designed to provide "swift benefit delivery [and] cost-effective and people-oriented administration.

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