HEALTH BENEFITS

Initiating Actions for Continuing Health Benefits Enrollment
Reviewing the Medical Documentation to Assess the Duty Status
Authority for Medical Issues

Initiating Actions for Continuing Health Benefits Enrollment

If the total period of disability is less than 29 days, no action needs to be taken on health benefits enrollment. When the total period of disability is more than 29 days in an LWOP-IOD status, coordinate with the personnel services office to ensure that necessary and appropriate actions are taken:

• If the employee is separated, contact OWCP to determine whether or not the enrollment can be transferred to OWCP.
  • If enrollment can be transferred, OWCP will request transfer by letter.
  • If OWCP does not request transfer for the employee who has been in LWOP-IOD status for 10 months, ICCO will coordinate with the personnel services office to send out a letter of transfer with supporting documentation to transfer health benefits enrollment to OCP.
  • If enrollment cannot be transferred, terminate the enrollment.
• If the employee makes any permissible change in enrollment, notify OWCP by letter as soon as possible of the change and its effective date and file the letter in the IC file.
• If the enrollment has been transferred to OWCP and the employee subsequently is separated, notify OWCP by letter of the separation so that OWCP knows how to dispose of the enrollment if compensation payments cease.

Currently, OWCP attempts to have nurse intervention occur within 45-90 days after the date of injury. The OWCP claims examiner decides which cases will be referred to the program. The program is especially useful in cases of orthopedic disability. Cases involving surgery, prolonged treatments such as physical therapy without clear goals or direction, multiple concurrent medical and psychological issues, and catastrophic injuries are also likely to benefit from the program.

Although the claims examiner decides whether a case should be referred for inclusion in this program, the ICCO may request the claims examiner to consider specific cases for referral. While the program is designed to target new injuries, other cases may also be recommended (e.g., medically stagnant cases).

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Reviewing the Medical Documentation to Assess the Duty Status

When an employee is not totally disabled or has partially overcome the injury or disability, the USPS must make every effort to assign the employee to limited duty consistent with the employee’s work limitation tolerance. The ICCO or the control point may contact the treating physician concerning the employee’s work limitations and restrictions imposed by the effects of the injury and possible job assignment. However, when possible, this contact should be made by either the health unit or USPS medical provider personnel. No other contact with the treating physician for medical information is authorized by OWCP for any reason.

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Authority for Medical Issues

No administrative action may be taken to change the employee's compensation or duty status until all medical issues are resolved. When the USPS contract medical provider does not agree with the treating physician, the injured employee’s duty status may not be changed without the concurrence of the treating physician.

OWCP has sole authority regarding the disposition of medical issues, and the medical data on which the OWCP decision is based become the ruling medical authority. OWCP will determine if a second opinion or an independent medical examination (IME) is required and will schedule the appropriate examinations.

For purposes of work assignment, the USPS contract medical provider is permitted to further restrict an employee’s work activities, but cannot less the restrictions placed on the employee by the treating physician or the OWCP’s medical authority determination.

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