Filing of COVID-19 Claims – Updated Guidance

We are resending this information in case you did not receive it on February 16, 2022.

We have received an increasing number of inquiries from both employing agencies and claimants regarding evidence needed to substantiate a COVID-19 claim under the American Rescue Plan Act of 2021 (ARPA) and eligibility for Continuation of Pay (COP).  We have issued guidance that addresses both of these issues.

FECA Bulletin 22-06 (Updates to COVID-19 Claims Processing Guidelines Relating to Reinfections and Home Tests) provides updated guidance on the following topics:

• Reinfection claims (a claim for COVID-19 will be considered a new injury when the employee tests positive for COVID-19 90 days or more from the date of the employee’s previous positive COVID-19 test);
• Self-administered COVID-19 tests (these are insufficient to establish a diagnosis of COVID-19 under the FECA, with only one exception); and
• Administratively closed claims (clarifying that a formal decision denying COP may be issued even if the case remains in an administrative closure status).

We have also issued a set of COVID-19 FAQs that provide easy-to-understand information on COP, including the type of evidence required during the first 10 days of COP, and thereafter. 

We encourage everyone to read the Bulletin and the FAQs and kindly ask that you forward them to all employees who file COVID-19 claims, so that they may understand their responsibilities when they file a COVID-19 claim.

If you have any questions on these topics, or any other COVID-19 related question, please contact Mr. Daisuke Miyazono, (Miyazono.Daisuke@dol.gov) Technical Assistant with the Branch of Technical Assistance.    

Thank you.

______________________________________________________________________________________________

From: United States Department of Labor <subscriptions@subscriptions.dol.gov>

Sent: Friday, January 14, 2022 3:46 PM

Subject: Filing of COVID-19 Claims – Reminders

On March 26, 2021, (email below) employing agencies were provided with information related to ECOMP enhancements made to facilitate COVID-19 claims filing.  The Program has seen an increase in the amount of challenges and/or Continuation of Pay (COP) controversions for COVID-19 claims that are contrary to the intent of The American Rescue Plan Act (ARPA) of 2021 and purpose of the March 26, 2021 communication.

ARPA makes it easier for federal workers diagnosed with COVID-19 to establish coverage under the Federal Employees’ Compensation Act (FECA). A federal employee who is diagnosed with COVID-19 and carried out any duties that required contact with patients, members of the public, or co-workers, or included a risk of exposure to the novel coronavirus during a covered period of exposure (within 21 days of the COVID-19 diagnosis) is deemed to have an injury that is proximately caused by employment. 

The work interaction does not have to be direct physical contact. Nor is there a specified time for such interaction, any duration qualifies. General office contact and interaction is sufficient. This includes but is not limited to interaction in shared workspaces such as lunchrooms, break areas and common restrooms.

Please refer to the Supervisor User Guide Video Reviewing Form CA 1 under the Help tab for guidance on appropriately challenging and controverting COP.  The guidance appears at about the four (4) minute and (20) twenty second mark of the video and explains that if you controvert the employee’s entitlement to Continuation of Pay (COP), Question 36 on the CA-1, the reason must be stated and based on one of the valid controversion reasons listed in the help text. If COP is not controverted, this section should be left blank.

Agencies should challenge a COVID-19 claim if:

• The employee had no work exposure (i.e., did not carry out duties that required contact with patients, members of the public, or co-workers, or included a risk of exposure to the novel coronavirus) within 21 days of the COVID-19 diagnosis, or
• The employee was exclusively teleworking during the 21 day period prior to the diagnosis.

Even if there was the possibility of non-work exposure, if there was any work-related exposure during that 21 day period, the criteria for a work-related COVID-19 injury has been met.

Please see Reference FECA Bulletin 21-09 (Processing FECA Claims for COVID-19 under the American Rescue Plan Act of 2021) and FECA Bulletin 21-10 (Establishing FECA Claims for COVID-19 under the American Rescue Plan Act of 2021 through Antigen Testing) for more detailed information regarding FECA coverages for COVID-19.

Additionally, the “REQUEST COVID-19 INITIAL REVIEW” (see below) feature in ECOMP is being incorrectly used by the employing agency for reasons such as challenging claims, COP controversion or making miscellaneous statements. This feature is intended to be used by the claimant only, so please do not use this feature and use the upload function in ECOMP instead. 

Finally, please ensure that claims for COVID-19 are correctly filed by selecting the option in ECOMP noting “FILE CA-1 COVID-19” as reflected below.  Incorrect filing of COVID-19 claims lead to delays in processing. 

Please contact Mr. Daisuke Miyazono, (Miyazono.Daisuke@dol.gov) Technical Assistant with the Branch of Technical Assistance for any questions related to ARPA and/or this notice.

Thank you    

_____________________________________________________________________________________________

From: United States Department of Labor <subscriptions@subscriptions.dol.gov>

Sent: March 26, 2021 3:13 PM

Subject: FECA Claims for COVID-19 (ECOMP enhancements)

FECA Claims for COVID-19 (ECOMP enhancements)

The American Rescue Plan Act of 2021 (section 4016) makes it easier for federal employees diagnosed with COVID-19 to establish coverage under the Federal Employees’ Compensation Act.  A federal employee diagnosed with COVID-19 who carried out duties that required contact with patients, members of the public or coworkers within a covered period of exposure prior to that diagnosis, is deemed to have an injury proximately caused by their federal employment.  Benefits paid for these claims will not be included in the agency's chargeback bill.

On or about March 26, the Office of Workers' Compensation Programs (OWCP) will be enhancing ECOMP to facilitate COVID-19 claims.  While the CA-1 claims filing process will not change, ECOMP has been enhanced with helpful tool tips for both the injured worker and the employing agency if a CA-1 is filed for a COVID-19 claim.  Additionally, certain information will be pre-populated once the filer indicates that the CA-1 is for a COVID-19 injury.

ECOMP PROMPTS/GUIDANCE FOR CLAIMANTS

Claimant portion of the CA-1: Claimants will be advised they must use FORM CA-1 for COVID-19 claims.  Helpful tool tips and certain injury data will be visible or pre-populated to assist the filer navigate through the workflow of filing a CA-1 for COVID-19.

• Question 10 - Date and Time Injury Occurred. The claimant should enter the last date he/she was exposed to other people (such as patients, members of the public, or coworkers) in the work setting, prior to the onset of COVID-19 symptoms or a COVID-19 positive test result. The claimant should not use a date where they were teleworking.

• Question 13 - Cause of Injury. The claimant will be asked to explain who he/she was exposed to in the work setting (including members of the public, coworkers, patients, etc.), and the frequency and nature of those interactions. Interactions while teleworking should not be included.

• Question 14 - Nature of Injury. The claimant should explain why he/she is filing the claim.  For example, has he/she experienced symptoms he/she believes are attributable to COVID-19? If so, the claimant should describe and provide the date the symptoms began.  Has the claimant received a positive COVID-19 test result?  If so, what is the date of that test?  If the claimant has communicated with or seen a medical professional, describe that contact.

• Upload Attachments Option. The claimant should upload a copy of a positive COVID-19 test result and any documentation of contact with a medical professional. If not available at time of filing, the claimant should upload within 10 days of filing. Failure to do so could affect the claimant’s entitlement to benefits, including Continuation of Pay (COP).

ECOMP PROMPTS/GUIDANCE FOR SUPERVISORS

Supervisor Portion of the CA-1. In COVID-19 claims, agencies are provided with specific questions that deviate from the routine process as outlined below:

• CHALLENGES: If a supervisor disagrees or wants to challenge the claim, he/she will have the opportunity to do so prior to Certifying the Form. To challenge, the supervisor will need to upload a specific statement explaining the challenge and providing additional factual details to support the challenge. In making challenges, be mindful that under the new provisions, a claimant need not have close, frequent or sustained contact with patients, coworkers or members of the public. Nor does the claimant need to show that any of those contacts had COVID-19. The new provisions do not apply for telework.

• Question 28 - Performance of Duty (POD). The employing agency is advised to only indicate the employee is not in POD if the employee was not working or teleworking on the date of injury, or if the supervisor disagrees substantively with the employee’s description of injury.

• Question 30 - Third Party Liability. The answer to this question will default to no third party liability for COVID-19 cases.

• Anatomical Location, Nature of Injury, Cause of Injury. These fields will be auto-filled with COVID-19 related codes.

• Question 35 - Agreement with the Employee. The employing agency will be advised to only indicate “no” if the employee was not working or teleworking on the date of injury, or if the supervisor disagrees substantively with the employee’s description of injury.

• Question 36 - Controversion of COP. The employing agency will be advised to only controvert COP if one of the specific nine regulatory reasons applies. That reason must be selected and explained.

• CA-16: The employing agency is prompted to provide a CA-16 if they do not substantively dispute the employee's description of Cause and Nature of Injury, and if the claim was submitted within 1 week of the Date of Injury, or the date the employee had symptoms of COVID-19 or received a positive test result. Issuing the CA-16 will allow the claimant to obtain the necessary test to confirm COVID-19 and receive medical treatment, if indicated.

The process of replacing the prefix in certain COVID-19 claims from "55" to "19", as noted in our original message of March 12^th, is nearly complete. A complete list of your agency's converted cases will be provided to you by your assigned Technical Assistant (TA) no later than March 30, 2021. The conversion letters will display in your CE-LinQ dashboard in ECOMP.

Thank you