In March, the Congressional Research Service provided lawmakers some up-to-date information on the Federal Employees’ Compensation Act (FECA). This is the law that shapes workers’ compensation for all federal employees.
While much of the report revisited old materials, it also addressed some of the guidelines new to 2023. These included new, post-pandemic rules for Covid-related claims, as well as stricter regulations for opioid prescriptions. These go along with the new time limit for additional information that the Office of Workers’ Compensation Programs (OWCP) put into effect as of March 7, 2023.
Guidelines for Covid-related claims
During the pandemic, many federal workers benefitted from the presumption that their Covid cases were work-related. This was due in large part to Section 4106 of the American Rescue Plan Act of 2021, which covered workers who got sick between January 27, 2020, and January 27, 2023.
Now, however, workers who contract Covid must generally file Form CA-2, Notice of Occupational Disease. As the Department of Labor notes, this is because workers cannot typically point to a single day or shift that they got sick. If they can clearly trace their illness to a single event, incident or shift, they can file Form CA-1, Notice of Traumatic Injury.
In either case, workers no longer benefit from the same presumption that their illness is work-related. They must submit evidence that supports both their diagnosis and that links it clearly to their work history.
The regulations for opioid prescriptions are not new to 2023, but they still earned notice as a “current issue” in the Congressional Research report.
Since March 2021, the OWCP has mandated that all prescriptions covered by federal workers’ compensation must run through a PBM. This is a third-party company that:
- Establishes formularies
- Identifies preferences for generic drugs
- Deals with pre-authorization
- Reviews the ongoing use of certain drugs
Per the OWCP’s guidance, these PBM’s must also enforce several other rules for opioid restrictions:
- Initial fills for non-cancer pain may not exceed seven-day supplies or dose limits
- Workers must receive prior authorization for all fills after the initial fill
- Limits on the number of opioids prescribed at the same time
- Automatic drug utilization reviews
- “Dose locks” for workers with prescription doses of 90 MME or more
Workers who have medical reasons to seek exceptions to these rules must work with the PBM. They may still appeal any decisions the OWCP makes.
Updated time limit for additional information
Because there was no period for public comment, you may not have noticed that the OWCP quietly extended the amount of time workers have to submit additional information. The final rule for this change went into effect on March 7, 2023, and it doubles the time limit from 30 days to 60.
This is the amount of time you have to provide additional supporting evidence if the OWCP finds that the information in your original claim does not meet your burden of proof.
As the OWCP notes, it made the change to satisfy the demands of the James M. Inhofe National Defense Authorization Act.
Some things don’t change
The laws and rules that govern federal workers’ compensation may change from time to time, but the basics rarely change. If you suffer a work-related injury or illness, you deserve compensation. If the OWCP unfairly rejects your claim, you have the right to appeal. Despite the fact that workers’ compensation is supposed to be non-confrontational, the program is often confusing, and denials are common.
For these reasons, you might want to work with an attorney. However, the rules for your claim are different than those for civilian workers’ compensation. A civilian workers’ comp lawyer won’t serve. You want to make sure your attorney understands the laws and rules specific to your claim.