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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

The FY96 Report contains the following data:

Table 1: Relationship between Injuries and Growth of Periodic Roll
Year	Injuries(13)	Change	Periodic Roll		Total	PR Change
			Short Term	Long Term

1991	96356	(0.7%)	355	51679	52034	3.2%
1992(14)	98458	2.2%	1339	51763	53102	2.1%
1993(15)	107167	8.8%	2616	50312	52928	(0.3%)
1994	113722	6.1%	3009	50538	53547	1.2%
1995	105483	(7.2%)	2383	50685	53068	(0.9%)
1996	100064	(5.1%)	1955	50021	51976	(2.1%)

The FY96 Report also revealed that total compensation benefits had risen, over the same period, from $1.6 billion to $1.9 billion. (16)

The DFEC Response

DFEC responded to the growth in compensation expenditures, and to address the complaints of employing agencies,(17) by adopting several management strategies. To address the growth of the periodic roll, DFEC proposed, and Congress approved, the Periodic Roll Management Project which began in April 1992. DFECstated that the function of the Periodic Roll Management Project is to screen the long-term disability roll for cases needing medical examination, medical and

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11 Data derived from FY96 Report, Tables A-1, A-2.

12 Totals exclude death cases.

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

14 Periodic Roll Management (PRM) Project begins April 1992.

15 Quality Case Management (QCM) procedures implemented.

16 FY96 Report, Table A-3. Up from $1 billion in 1984 (Table A-3, FY93 Report).

17 Of the $1.9 billion compensation benefits paid in FY 1996, the three largest chargeback bills went to the Department of Defense ($597.4 million), the U.S. Postal Service ($547.2 million), and the Department of Veterans Affairs ($140.7 million). See FY96 Report at 8, and Table A-3.

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registered nurse, under contract to DFEC, would work with injured employees, their physicians and the employing agency to clarify the nature and extent of injury-related disability and arrange for the Claimant to return to work as soon as possible. By FY94, Quality Case Management (QCM) and early nurse intervention procedures were fully implemented.

DFEC also set goals for timely decision making. The FY95 Report stated that [t}he FEC program regularly meets high standards of timeliness in deciding and paying claims. For example, 94 percent of traumatic injury claims are decided(23) within 45 days of receipt and 83 percent of wage loss claims are paid within 14 days.(24)

For simple occupational disease cases, DFEC determined that a decision would be issued within 90 days; for the large majority of occupational illness cases, which require more extensive evidentiary development, a decision would be forthcoming within six months of receipt; and,. for very complex occupational illness cases, a decision would be rendered within 10 months of receipt.(25)

The Impact

Although OWCP and DFEC continually state that service to injured employees is paramount, the data published by OWCP in its Annual Reports to Congress appear to contradict this claim. In fact, implementation of the Periodic this claim.

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23 As discussed below, most cases are not in fact decided. See n.62 infra and accompanying text. Furthermore, the decisions that are made are wrong nearly 50% of the time. See n.47 infra and accompanying text.

24 FY95 Report at 10. According to the most recently published figures, in FY 1996, 20,392 new wage loss claims were initiated. See FY96 Report, Table A-2. This means that at least 3,466 claims were not paid timely. Going without funds for more than 2 weeks is a hardship for most people who live from paycheck to paycheck.

25 From DFEC's Customer Service Plan.

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(there is no number 8 page in the original testimony draft, but no text is missing)

Roll Management Project, Quality Case Management procedures and the early nurse intervention initiative appears to have resulted in a 22% increase in the number of hearing requests.(26) For example, as shown in Table 2, there is a positive correlation between the number of hearing requests and the number of cases screened by the Periodic Roll Management Project.

Table 2: Correlation between PRM Activity(27) and Hearing Requests
Year	PR Cases (28)	Screened	Terminations	Hearing Requests	ROR (29) Requests	Remand Rate

1993	52928	6133(30)	2267(31)	6710	544	45%
1994	53547	4000	2200(32)	6703	583	40%
1995	53068	7400	2700(33)	7250	806	38%
1996	51976	7000	1900(34)	7991	830	43%

Average		6133	2267		693	42%

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26 For purposes of this discussion, the term "hearing request!' includes requests for written reviews.

27 According to DFEC "[s]ince the project's inception [in April 1992], claims examiners have reviewed over 36,000 disability cases and acted on over 10,400 cases (28 percent of those screened by September 1996)." FY96 Report at 10. This means that, on average, DFEC screened 8004 cases per year and acted on 2,241 of the cases screened (28%). However, as with so much of the data OWCP publishes, these figures do not add up. For example, from FY94 to FY96 DFEC screened 14,800 cases leaving 21,200 cases which must have been screened in the 18 months from April 1992 to September 1993, or an average of 14,133 cases screened per year. This is twice the rate in the most active years for which DFEC has provided yearly data.

28 Represents long-term and short-term periodic roll.

29 'In lieu of an oral hearing, a Claimant shall be afforded an opportunity for a review of the written record [ROR] by an Office representative designated by the Director [OWCP]. Such review will not involve oral testimony or attendance of the Claimant; however, the Claimant may submit any written evidence or argument which he or she believes relevant." 20 C.F.R. � 10. 13 1(b).

30 Represents an average of the 3 years of data actually reported by DFEC.

31 Represents an average of the 3 years of data actually reported by DFEC.

32 "In FY 1994, nearly 4,000 cases were screened and 2,200 had benefits adjusted or terminated.. . FY94 Report at 13.

33 "In FY 1995, 7,400 cases were screened and benefits were adjusted or terminated in 2,700 cases . . . . FY95 Report at 12.

34 "In FY 1996, nearly 7,000 [Periodic Roll] cases were screened and benefits were adjusted or terminated in 1,900 cases where beneficiaries had potential return to duty or where their injuryelated disabilities had been resolved." FY96 Report at 10. According to Director, DFEC Markey, 40% of these 1,900 Claimants did not reply. Of the 60% who did reply and request a hearing, an average 45% of the decisions were reversed.

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