capitol-z.gif (3368 bytes)
FedupFeds.org
networking, information,
legislative reform, fairness
for injured federal workers
   "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

 

[w]ith more comprehensive use of nurse services, and attention to these [initial periods of disability], the FEC nurse program helped the office resolve 73 percent of disability cases within one year of the datethat disability began. Several offices began to meet the second goal, that of resolving 90 percent within two years.(*163)

However, what does the term "resolved' mean? Although nurses are required to follow the injured employee's progress for a period of 60 days, DFEC has not reported what this monitoring reveals. Furthermore, DFEC does not report how many of these "resolutions" were successful, i.e., how many of these return-to-work efforts were sustained on appeal and how many injured workers actually remain employed. The return to work success could be measured by determining how many of the Claimant receiving early nurse intervention services suffer a recurrence of disability. Similarly, it would be worthwhile to know how many Claimants actually find early nurse intervention to be better service since this is one of the reasons DFEC implemented the process.(*164)

DFEC Tightens the Screws

(*165) Section 10.150(b)(*166) of the current regulations states

In the administration of the Act, the Office has one general policy, which is to follow and to adhere to the principles of workers' compensation law as stated in the opinions of the Supreme Court, the Federal Circuit Courts of Appeal, and the District Courts of the United States, as they may appropriately be applied or have been determined by the Employees' Compensation Appeals Board (ECAB) to apply in like situations arising under the Act. In addition, decisions and opinions of the judicial tribunals of the several States furnish principles of law of general applicability in the specialized field of

___________________________________________________
*163 FY96 Report at 38.

*164 "To provide better service to Claimants and effect cost savings as well, DFEC instituted new case management procedures in 1993.... They rely heavily on the use of registered nurses under contract to OWCP to work with ] Claimants and their physicians to clarify the nature and extent of injury-related disability." Id. It would also be useful to know how Claimants'physicians view this service.

*165 62 Fed. Reg. 67,120 (1997) (to be codified at 20 C.F.R. pt. 10).

*166 20 C.F.R. § 10.150(b) (1996).

Page 71

 

=============================================================

workers' compensation, which form parts of the foundation of general principles relied upon in the application and interpretation of the Act. The Office applies the provision of the Act applicable in respect to a particular case or situation, to the extent that such provision can readily be applied without extrinsic aid, but where such aid is necessary the source thereof is the body of principles embodied in authoritative decisions of the courts and the ECAB within such well-recognized branch of the law.

     DFEC proposes to drop this language as unnecessary.(*167) DFEC wants to further divorce itself from the general concept of workers' compensation and the equitable principles which form the basis for this remedial social covenant.

     As noted above, injured employees are not given enough time to submit necessary information. As a result their claims are prematurely denied and this results in an inevitable remand. The current regulations state

If a Claimant initially submits supportive factual and/or medical evidence which is not sufficient to carry the burden of proof, the Office will inform the Claimant of the defects in proof and grant at least 30 calendar days for the Claimant to submit the evidence required to submit the evidence required to meet the burden of proof.(*168)

Director, DFEC Markey has already acknowledged that District Offices are not complying with this regulation. Furthermore, it is obvious that 30 days is too short a period. Acting Director Hallmark testified that the 30 day period would be extended for good cause. However, rather than modify the regulation to incorporate the good cause extension, DFEC instead has shortened the period. The proposed regulation states

___________________________________________________
*167 62 Fed. Reg. 67,121.

*168 20 C.F.R. § 10.110.(b).

Page 72

 

=============================================================

If the Claimant submits factual evidence, medical evidence, or both, but OWCP determines that this evidence is not sufficient to meet the burden of proof, OWCP will inform the employee of the additional evidence needed. The Claimant will be allowed up to 30 calendar days to submit the evidence required.(*169)

Where 30 days had been the minimum time period allowed for the submission of evidence, it has now become the maximum. As noted above, it does not appear reasonable to grant injured employees less time to submit evidence when they already have insufficient time.

     Similarly, when DFEC intends to reduce or terminate benefits, the proposed regulations state

OWCP will provide the beneficiary with written notice of the proposed action and give him or her 30 days to submit relevant evidence or argument to support entitlement to continued payment of compensation. This notice will include a description of the reasons for the proposed action and a copy of the evidence upon which OWCP is basing its determination. Payment of compensation will continue until any evidence or argument submitted has been reviewed and an appropriate decision has been issued, or until 30 days have elapsed if no additional evidence or argument is submitted.(* 170)

The proposed regulations further state: "OWCP will not grant any request for an extension of this 30-day period."(*171)

     With respect to the development of evidence, DFEC has chosen to neglect its obligation to see that justice is done by sharing in the burden of going forward with the evidence, In the preamble to its proposed regulations DFEC states:

___________________________________________________
*169 Section 10.121 at 62 Fed. Reg. 67,143 (emphasis added).

*170 Section 10.540(a) at 62 Fed. Reg. 67,156.

*171 Id., Section 10.541(a).

Page 73

 

=============================================================

The discussion of development of claims by OWCP found in current § 10.110(b) has been omitted from the proposed regulations. This discussion has proven to be misleading, and was mistakenly assumed to be a commitment by OWCP to undertake development, despite the fact that it only describes what OWCP may, on an ad hoc basis, do even though the burden of proof to establish the elements of the claim is on the Claimant at all times.(*172)

The FECA is remedial legislation and DFEC is charged with insuring that injured employees are treated in a fair and equitable manner. Since proceedings under the FECA are not adversarial, principles of equity demand that DFEC not act as a disinterested arbiter but assist Claimants with the development of their claims. This assistance does not replace the Claimant's ultimate burden of persuasion but represents DFEC's duty to see that justice is done,

     In addition to stiffening a Claimant's burden of persuasion, DFEC has eliminated its own burden of proof for rescinding acceptance of claims. It is well established by ECAB case law that once DFEC accepts a claim, it has the burden of justifying termination of modification of compensation. (*173) This holds true where DFEC later decides that it has erroneously accepted a claim for compensation. To justify rescission of acceptance, DFEC must establish that its prior acceptance was erroneous based on new or different evidence or through new legal argument and/or rationale.(*174)

     In Daniel E. Phillips(*175) the ECAB held that in order to reopen and rescind its prior acceptance of a claim, DFEC "must establish that its prior acceptance was

___________________________________________________
*172 62 Fed. Reg. 67,121.

*173 See Frank J. Mela, Jr., 41 ECAB 115 (1989); Harold S. McGough, 36 ECAB 332 (1984).

*174 See Laura H. Hoexter (Nicholas P. Hoexter), 44 ECAB 987 (1993); Alphonzo Walker, 42 ECAB 129 1990), petition for recon. denied, 42 ECAB 659 (1991); Beth A. Quimby, 41 ECAB 683 (1990); Roseanna Brennan, 41 ECAB 92 (1989), petition for recon. denied, 41 ECAB 371, (1990); Daniel E.Phillips, 40 ECAB 1111 (1989), petition for recon. denied, 41 ECAB 201 (1990).

*175 40 ECAB 1111 (1989), petition for recon. denied 41 ECAB 201 (1989).

Page 74

 

=============================================================

erroneous through new or different evidence and that it is not merely second-guessing the initial set of adjudicating officials." In Roseanna Brennan(*176) the ECAB indicated that DFEC was obliged to "[introduce] new evidence, legal arguments, and rationale which justify its rescission" of the prior acceptance. In Beth A. Quimby(*177) the ECAB stated: "to justify a rescission of acceptance of a claim, [DFEC] must show that it based its decision on new evidence, legal arguments and/or rationale.'

     The proposed regulations eliminate this requirement noting: "[the ECAB reached [its] conclusion without specifying any statutory or regulatory basis for this limitation. Its only rationale was its opinion that reopening a decision should not become a surreptitious route for OWCP to readjudicate a claim."(*178) DFEC states that the proposed regulation "adopts the long-standing position of the Director [OWCP] that the plain language of section 8128(a) authorizes the Director, without pre-condition, to review a decision "at any time."

     It is questionable whether DFEC has the authority to limit the jurisdiction of the ECAB to review the actions of the Director in rescinding the acceptance of claims. Section 8149 of the FECA describes the authority of the Secretary with regard to the ECAB. This authority has not been delegated, along with the other powers of the Secretary under the FECA, to the Director, OWCP. Similarly, the principle of  stare decisis would appear to deprive DFEC of the authority to question the legitimacy of ECAB case law in this manner.

___________________________________________________

*176 41 ECAB 92 (1989), petition for recon. denied 41 ECAB 371 (1990).

*177 41 ECAB 683 (1990).

*178 62 Fed. Reg. 67,127.

Page 75

NEXT PAGE                                                                arrowright_w.gif (314 bytes)

 

flagsline.jpg (3206 bytes)

|    Contents - Perez Testimony   |   FedupFeds Report -- survey results  |   Appendix to Report   |
  |   Earlier Perez Papers     |   Return to FedupFeds home page   |


Copyright 1999 FedupFeds All Rights Reserved. 
May be copied and distributed only in its entirety without alteration.