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Sunday, May 27, 2012

Schedule Awards


Schedule Awards
By: Snowed

Often I encounter co-workers and union officials who know very little about schedule awards.  Many times people think that a schedule award is a “settlement,” and very often they are surprised by this benefit they knew very little about.

A schedule award for Federal Employees’ Compensation Act (FECA) claimants is quite different from a “settlement” that happens often when nonfederal employees are injured on the job.  When a federal employee is injured and his injury reaches Maximum Medical Improvement (MMI) he is entitled to a monetary award for permanent impairment of certain members, internal organs or functions of the body.  Since a claimant cannot receive both, compensation for Total Temporary Disability (TTD) or Lost Wage Earning Capacity (LWEC) and a schedule award at the same time, most claimants are either back at work or retired before they file for a schedule award.  However, a claimant can receive both wage loss compensation for one injury and at the same time receive a schedule award for another injury as long as the two injuries do not involve the same part of the body and/or extremity (See FECA pt-2-0808-5).

There never is a “settlement” because if a claimant’s condition worsens over time, then a new schedule award can be paid based on the increased impairment.  Also when a settlement is made to a nonfederal employee, they can no longer receive wage loss. The FECA claimant has the advantage of returning to the periodic roll once the schedule award is paid out if they are still medically qualified.

Permanent impairment or loss of use (either partial or total) of certain internal organs and members or functions are evaluated by OWCP and rated according to the AMA Guides to the Evaluation of Permanent Impairment, 6th Edition. No schedule award will be considered by OWCP if not in accordance with the 6th Edition of the Guides.

The FECA gives each extremity or function a specific number of weeks of compensation which can be paid out either as a lump sum (if qualified) or in periodic payments. A serious disfigurement of the head, face, or neck of a character likely to handicap an individual in securing or maintaining employment an award may also be made for such disfigurement, not to exceed $3,500.00  See 5 U.S.C. §8107(c). 

A schedule award is not paid for the heart, brain or spinal column, but if those injuries affect limbs, body organs or functions of the body such as hearing, then a schedule award can be paid.  For example, 5 U.S.C. §8107(c), lists the following body parts on the schedule:

Body part/function
Weeks compensation
Body part/function
Weeks compensation
Arm (upper extremity)
312
Great toe
38
Leg (lower extremity)
288
2nd finger
30
Hand
244
3rd finger
25
Foot
205
Any other toe
16
Eye
160
4th finger
15
Thumb
75
Loss of hearing (one ear)
52
First finger
46
Loss of hearing (both ears)
200

As of September 7, 1974, 20 C.F.R. §10.404 added these body parts:

Breast (one)
52
Kidney (one)
156
Larynx
160
Lung (one)
156
Penis
205
Testicle (one)
52
Tongue
160
Ovary (one)
52
Uterus/cervix
205
Vulva/vagina
205

For instance, a permanent impairment to the lower extremity is valued at 288 weeks of compensation. This simply means that if you earn $50,000.00 a year, and you have dependents (entitling you to the 75% compensation rate) your weekly compensation rate would be $721.15.

$721.15 X 288 weeks = $207,691.20.

If OWCP awards a 20% permanent impairment to the lower extremity, the claimant would be entitled to receive 20% of $207,691.20, or $41,538.24. Similarly, a 10% award would be $20,769.12; a 40% award would be for $83,076.48, and so on.

Compensation for schedule awards is payable at 66 2/3 percent of the employee's pay, or 75 percent of the pay when the employee has at least one qualified dependent.  If paid in a lump sum, the total amount will be reduced by 4% and paid at one time.  A lump sum payment must be requested and if the claimant has other sustainable income, it will likely be approved.

When seeking out a schedule award, a claimant should find a qualified medical doctor who is familiar with the AMA 6th Edition and also familiar with the ratings as evaluated by OWCP.  This is not an easy task as many states do not require the use of this medical guide and many physicians refuse to take FECA claimants.

In almost all cases, the impairment rating a claimant receives from their chosen physician will be reviewed by OWCP’s District Medical Advisor (DMA) and adjustments may or may not be made.  I have found that many claims examiners and even DMA’s do not know how to properly rate these losses.  For example, The AMA Guides to the Evaluation of Permanent Impairment, 6th Edition, express the impairment of internal organs in terms of the whole person, schedule awards under the FECA are based on the percentage of impairment of the particular organ.  The whole person organ rating may max out at 20% whole body rating but if the organ is totally lost then the 20% should be converted to 100% organ impairment (See FECA pt-3-0700-4-c).

According to FECA manual part 3-0700-3-a-3, “The percentage should include those conditions accepted by OWCP as job-related and any pre-existing permanent impairment of the same member or function. If the work-related injury has affected any residual usefulness in whole or in part, a schedule award may be appropriate.  There are no provisions for apportionment under the Act.  Rated impairment should reflect the total loss as evaluated for the schedule member at the time of the rating exam.  See Raymond E. Gwynn, 35 ECAB 247, 253 (1983) [In determining the amount of a schedule award for a member of the body, preexisting impairments are to be included, citing Larson for the proposition that “the employer takes the employee as he finds him.”]”

 In other words let’s say you already have a severe leg impairment and then had an on the job injury to the same leg.  In this case your pre-existing impairment must be included in the rating.  Many impairment ratings will only focus on the on the job injury but this is incorrect.  The entire effected body part should be rated.

When claiming a schedule award, a claimant needs to submit a CA-7 and the appropriate medical report to OWCP.  Schedule awards are often put on the “back burner” for claimants that are not without other income, therefore a claimant needs to be proactive in pushing their claim along.  Although I have not found a guideline in OWCP literature, OWCP internal guides are 90 days for processing a schedule award.  This is a rarity however, and suggests that if OWCP does not respond within the 90 days, then further action be taken such as writing to the District Director for the status of the claim and reason for the delay.

The schedule award is a benefit provided to injured federal employees and often overlooked and misunderstood.  Employees injured on duty often have lifetime pain and suffering because of their injuries and occupational diseases.  FECA provides the schedule award as a supplement to these unfortunate workers to make life a little more bearable.

See also: http://theowcpclassroom.blogspot.com/2015/02/calculating-schedule-award.html