MYTH #5: Because FECA Is So Different From State Workers’ Compensation Systems, Private Sector Case Management Best Practices Won’t Work

There are many differences between the federal and most state workers’ compensation systems.

The federal system features include:

• Federal agency inability to choose a third party administrator. (All federal workers’ compensation claims are managed by the Department of Labor.)
• There are no settlements – injured federal workers currently have the right to be paid workers’ compensation for life if unable to return to work. (There is legislation pending that would impact this.)
• 45 days of continuation of regular pay by the employing agency early in traumatic injury claims. (There is legislation pending that would impose a 3-day waiting period for this continuation of pay)
• No system for routine utilization review. (There are certain requirements currently for Prior-Authorization but not for Second Opinions or IME’s; there is pending legislation that would require regular independent medical evaluations.)
• Free choice of treating provider
• Limited clinical resources available to the Department of Labor Claims Examiners, who make all adjudication and ongoing benefits decisions.

These differences are frequently cited as reasons that private sector case management best practices won’t work in a federal environment; however, evidence suggests otherwise. Several federal agencies have experienced significant improvement in the performance of their workers’ compensation program when they adopted industry best practices such as:

• Agency directed telephonic case management
• Early intervention
• Focused legacy case management programs
• Ancillary networks including but not limited to pharmacy benefits management, physical therapy, durable medical equipment and diagnostic radiology
• Stay-at-Work and Return-to-Work initiatives
• Internal data and trend analysis including but not limited to chargeback audits and the new federal agency performance metrics, POWER (Protecting Our Workers and Ensuring Re-employment). http://www.dol.gov/owcp/dfec/power/

Agencies that have adopted these and other best practices and aggressively monitor and manage ALL open cases have lower costs and disability case rates than agencies that take a more passive approach, relying on Department of Labor and monitoring cases for return to work issues. 

Original Source

Contact Neil O'Toole and John Sbarbaro

at the Law Office of O'Toole & Sbarbaro, P.C.

Phone: 303-595-4777

Located in the Denver Metro area.

226 West 12th Avenue Denver, Colorado 80204

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