Long-Term Case Management Procedures and Reviews
Standard Operating Procedures
Long Term Case Management
Last Updated January 2018
2
Table of Contents
–
Page 3. Definitions of DOL’s Case Status Codes
–
Page 4. Long Term Case Review
–
Page 5. PR Case Review
–
Page 6. PN Case Review
–
Page 7. PW Case Review
–
Page 8. Return to Work
–
Page 9. Job Offer
–
Page 10.Vocational Rehab
–
Page 11. DE Case Review
–
Page 12. EN1032 Review
–
Page 13. CA-12 Review
# Boxes refer to Instructional Pages – see specific page
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3
Long Term Case Review
4
Start
Review file
determine case
status
(PR, PN, PW, DE)
Is it
PR?
Is it
PN?
Is it
PW
?
No
No
No
Pg.
11
Pg. 6
Yes
Yes
Yes
Pg. 7
D
E
1
P
W
P
N
Pg. 5
P
R
PR Case Review
Request medical and EN1032 every year
5
Do you have
current medical
w/ restrictions
or current
EN1032?
No
Request current EN1032
&/or medical from OWCP
Current
EN1032 &/or
medical
received?
No
Yes
Yes
Have
medical
residuals
resolved?
No
Yes
OWCP terminates compensation
Update action
log
Case
closed
Can
person
RTW at
least 4
hrs/day?
Yes
Pg. 8
R
T
W
Update
action
log
End
(Review file
next year)
2
5
15
15
No
P
R
EN1032 Review
S
e
e
P
a
g
e
1
2
Start
EN1032 Review
S
e
e
P
a
g
e
1
2
PN Case Review
Request EN1032 every year
OWCP requires updated medical every 3 years
6
PN
Do you have
current
medical w/
restrictions
or current
EN1032?
Request current
EN1032 &/or
medical from
OWCP
No
Yes
EN1032 review
S
e
e
P
a
g
e
1
2
Have
medical
residuals
resolved?
OWCP
terminates
compensation
Current
EN1032
&/or
medical
received?
EN1032 review
S
e
e
P
a
g
e
1
2
No
Yes
Yes
No
Update action
log
End
(Review
file next
year)
Case
closed
Can
person
RTW at
least 4
hrs/day?
Pg. 8
R
T
W
Update action
log
No
Yes
3
15
5
15
PW Case Review
Request EN1032 every year
OWCP requires updated medical every 2 years
PW
Do you have
current medical
w/ restrictions
or current
EN1032?
Request
current EN1032 &/or
medical from OWCP
Have
medical
residuals
resolved?
Current
EN1032
&/or
medical
received?
OWCP terminates
compensation
Update action
log
Case
closed
Update action log
No
Yes
No
Yes
yes
EN1032 review
S
e
e
P
a
g
e
1
2
EN1032 review
S
e
e
P
a
g
e
1
2
No
End
(Review
file next
year)
5
15
15
4
7
Return to Work
8
RTW
Conference
Call or
Meeting with
all involved
parties
Bureau
located
suitable
work?
Yes
Pg. 9
No
R
T
W
RTW
Preparation
Gathering
Pg.
10
V
R
J
o
b
O
f
f
e
r
6
7
Locate
Suitable
Work
8
J
o
b
O
f
f
e
r
s
9
Bureau
makes
job
offer
Does
employee
accept
job?
Yes
No
Yes
Yes
No
No
Send
declination
statement,
job offer &
PD to
OWCP for
suitability
OWCP
determines
job offer
suitable?
No
Yes
Alter job offer
to
accommodate
suitability
determination
Notify
OWCP –
IW refused
job
Loss of
wage
earning?
Notify OWCP - Send
Acceptance
Statement, Job Offer
and PD to OWCP
Complete 60
(Perm)/90
(Temp) day
RTW?
No
OWCP
establish
WEC –PW
OWCP
terminates
compensation
Yes
Case
closed
9
11
18
10
13
12
5
J
o
b
O
f
f
e
r
End
Case status PW
(Review file next
year)
Update
action log
15
OWCP
terminates
compensation
5
Contact CE
for next step
Does
employee
accept
job?
Update
action log
Follow through
with CE
recommendation
V
o
c
a
t
i
o
n
a
l
R
e
h
a
b
10
Obtain
Bureau
written
statement
– ‘Unable
to Return’
Notify OWCP/
Refer to VR
(training or
placement in
private
sector)
Vocational
Rehab
Placement
in private
sector
No
Yes
OWCP
establish
WEC – PW
Employable?
Loss of
wage
earning
capacity?
OWCP
terminates
compensation
Bureau able
to offer job
with work
restrictions?
Yes
Case
closed
No
Yes
Yes
No
No
No
Yes
Complete 60
(Perm)/90
(Temp) days
RTW?
Pg. 9
End
(Review file
next year)
Update action log
J
o
b
O
f
f
e
r
14
16
17
18
5
15
V
V
R
R
End
Case status PW
(Review file
next year)
Update
action log
Update
action log
15
15
Contact CE
for next step
Update
action log
Follow through
with CE
recommendation
DE Case Review
Request CA-12 every year
11
Request CA-12
Red
Flags?
OWCP
terminates
compensation
Contact OWCP for
Red Flags
No
No
Yes
Yes
End
(Review file
next year)
OWCP Reduce
Comp or no
change
20
21
19
End
(Review file
next year)
Update action log
15
15
D
E
Update action log
Case
closed
CA-12 Review
S
e
e
P
a
g
e
1
3
Do you
have
current
CA-12?
No
Yes
Current
CA-12
received?
No
Yes
12
Start
PR –
Return to
page 5
PN –
Return to
page 6
PW -
Return to
page 7
Is employee
currently working
(Employer or Self
Employed)?
Have
dependents
changed
(SpouseChildren)
?
Is employee
receiving other
federal benefits?
Has income
increased 25% for
PW WECs?
Is employee
volunteering?
Does employee
have an OWCP
fraud conviction?
Is employee
receiving 3
rd
party
settlement in
connection with
work injury?
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
No
No
No
No
Was employee
found guilty
and
incarcerated
for crime?
Yes
No
Red flags on
EN-1032 – Note
Red Flags (Go
to C)
Red flags on
EN-1032 –
Note Red
Flags (Go to B)
Red flags on
EN-1032 – Note
Red Flags (Go
to E)
Red flags on
EN-1032 –
Note Reg Flags
(Go to F)
EN1032 Review
22
22
22
22
22
Red flags on
EN-1032 –
Note Red
Flags (Go to
D)
Red flags on EN-
1032 – Note Red
Flags
B
A
C
D
E
F
Contact OWCP
for Red Flags
22
20
13
Start
DE – Return
to page 11
Has beneficiary
remarried before
age 55?
Is beneficiary
receiving other
federal benefits?
Have dependents
changed
(Spouse/kids?
Is beneficiary
receiving 3
rd
party
settlement in
connection with
work injury?
Yes
Yes
Yes
No
No
Yes
Red flags on
CA-12 – Note
Red Flags (Go
to B)
Red flags CA-12
– Note Red Flags
(Go to D)
No
No
CA-12 Review
A
B
C
D
Red flags on
CA-12 – Note
Red Flags (Go
to C)
Red flags on
CA-12 – Note
Red Flags
23
23
23
23
Contact OWCP
CE to discuss all
Red Flags prior to
moving forward
20
This document outlines the Standard Operating Procedures for long-term case management as of January 2018 by the U.S. Department of the Interior, Office of Human Resources. It includes definitions of DOL's case status codes, details on long-term case review, PR case review process, and EN1032 review. The procedures cover different case statuses, entitlements, and closure criteria with a focus on periodic roll payments, medical reviews, and return-to-work assessments.
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Presentation Transcript
Standard Operating Procedures Long Term Case Management Last Updated January 2018 U.S. Department of the Interior | Office of Human Resources
Table of Contents Page 3. Definitions of DOL s Case Status Codes Page 4. Long Term Case Review Page 5. PR Case Review Page 6. PN Case Review Page 7. PW Case Review Page 8. Return to Work Page 9. Job Offer Page 10.Vocational Rehab Page 11. DE Case Review Page 12. EN1032 Review Page 13. CA-12 Review Office of Human Resources # Boxes refer to Instructional Pages see specific page 2
Definitions of DOLs Case Status Codes PR: Entitled to payment on periodic roll. PN: Entitled to payment on periodic roll; formally determined to have no wage earning-capacity or re-employment potential for indefinite future. Office of Human Resources PW: Entitled to payment on periodic roll at a reduced rate, reflecting a partial wage earning capacity or actual earnings. DE: Monthly payments are being made to at least one beneficiary of a deceased Federal employee. MC: Entitled for the time being to medical treatment only. DR: Entitled to payment on daily roll. (Claimant submitting CA-7 s) UN: Case created, not reviewed. This status is automatically generated at the time of case create. UD: Under development. Used whenever further development is needed before pay status or closure status can be assigned. C1: Closed, accepted, no further payments anticipated; no time lost from work. C2: Closed, accepted, no further payments anticipated, time lost covered by leave, leave not repurchased. C3: Closed, benefits denied. C4: Closed, entitled to COP. C5: Closed, previously accepted for benefits, all benefits paid. CL: Administrative closure. RT: Retired or awaiting retirement. ON: Overpayment exists; final decision made on issues of fault and waiver. Claimant not on periodic roll. OP: Overpayment exists; final decision made on issues of fault and waiver. Claimant on periodic roll. PS: Entitled to payment for schedule award. 3 LS: Entitled to payment of a lump sum schedule award.
Long Term Case Review 1 Office of Human Resources Review file determine case status (PR, PN, PW, DE) No No No Is it PW ? Is it PN? Is it PR? Start Yes Yes Yes Pg. 5 PR Pg. 11 DE Pg. 6 PN Pg. 7 PW 4
PR Case Review Request medical and EN1032 every year Office of Human Resources 2 Start Do you have current medical w/ restrictions or current EN1032? No PR Request current EN1032 &/or medical from OWCP Yes End No Current EN1032 &/or medical received? (Review file next year) EN1032 Review See Page 12 15 Yes Can person RTW at least 4 hrs/day? Have medical residuals resolved? No No Update action log EN1032 Review See Page 12 Yes 15 5 Yes Case closed Update action log OWCP terminates compensation Pg. 8 RTW 5
PN Case Review Request EN1032 every year OWCP requires updated medical every 3 years 3 Do you have current medical w/ restrictions or current EN1032? No Office of Human Resources Request current EN1032 &/or medical from OWCP PN Current EN1032 &/or medical received? No Yes End (Review file next year) EN1032 review See Page 12 Yes 15 Can person RTW at least 4 hrs/day? No No Have medical residuals resolved? Update action log EN1032 review See Page 12 Yes Yes 15 5 Pg. 8 OWCP terminates compensation Update action log Case closed RTW 6
PW Case Review Request EN1032 every year OWCP requires updated medical every 2 years 4 Do you have current medical w/ restrictions or current EN1032? No Office of Human Resources Request PW current EN1032 &/or medical from OWCP Yes Current EN1032 &/or medical received? No EN1032 review See Page 12 End (Review file next year) Yes 15 No Have medical residuals resolved? EN1032 review See Page 12 Update action log yes 15 5 OWCP terminates compensation Update action log Case closed 7
Return to Work VR Pg. 10 Office of Human Resources 8 7 6 No RTW Conference Call or Meeting with all involved parties Locate Suitable Work RTW Bureau located suitable work? RTW Preparation Gathering Yes Pg. 9 Job Offer 8
Job Offers Follow through with CE recommendation Update action log Contact CE for next step 9 12 No Office of Human Resources Yes Bureau makes job offer Notify OWCP - Send Acceptance Statement, Job Offer and PD to OWCP Job Offer Complete 60 (Perm)/90 (Temp) day RTW? Does employee accept job? 18 No 10 Yes 11 OWCP establish WEC PW Yes Yes Loss of wage earning? Send declination statement, job offer & PD to OWCP for suitability Does employee accept job? Alter job offer to accommodate suitability determination No 5 End No Case status PW (Review file next year) OWCP terminates compensation 13 5 Yes 15 No OWCP determines job offer suitable? Notify OWCP IW refused job OWCP terminates compensation Update action log Case closed 9
Vocational Rehab 15 14 16 17 No Update action log Obtain Bureau written statement Unable to Return Notify OWCP/ Refer to VR (training or placement in private sector) VR Office of Human Resources Vocational Rehab Employable? End (Review file next year) Yes Yes Bureau able to offer job with work restrictions? Follow through with CE recommendation Contact CE for next step Update action log Pg. 9 5 No 15 No Job Offer No Loss of wage earning capacity? OWCP terminates compensation Update action log Yes Complete 60 (Perm)/90 (Temp) days RTW? Yes Case closed 18 15 Yes Placement in private sector End OWCP establish WEC PW Case status PW (Review file next year) Update action log 10 No
DE Case Review Request CA-12 every year 19 No No Do you have current CA-12? Current CA-12 received? DE Request CA-12 Office of Human Resources Yes Yes CA-12 Review See Page 13 21 No OWCP Reduce Comp or no change OWCP terminates compensation Red Flags? No Yes 15 End Yes 15 (Review file next year) 20 Update action log Update action log Contact OWCP for Red Flags End Case closed (Review file next year) 11
EN1032 Review 22 Yes A Is employee currently working (Employer or Self Employed)? Red flags on EN-1032 Note Red Flags (Go to B) No Is employee volunteering? 22 Office of Human Resources Yes Red flags on EN-1032 Note Red Flags (Go to C) Start No 22 B Yes Red flags on EN-1032 Note Red Flags (Go to D) Has income increased 25% for PW WECs? 22 No Red flags on EN-1032 Note Red Flags (Go to E) PR Return to page 5 PN Return to page 6 PW - Return to page 7 C Yes Have dependents changed (SpouseChildren) ? Yes Was employee found guilty and incarcerated for crime? 22 No Red flags on EN-1032 Note Reg Flags (Go to F) D Yes 20 Does employee have an OWCP fraud conviction? No Contact OWCP for Red Flags No No 22 E Yes F Is employee receiving 3rd party settlement in connection with work injury? Red flags on EN- 1032 Note Red Flags Is employee receiving other federal benefits? Yes No 12
CA-12 Review 23 Yes A Has beneficiary remarried before age 55? Red flags on CA-12 Note Red Flags (Go to B) Office of Human Resources Start No 23 Yes B Have dependents changed (Spouse/kids? Red flags on CA-12 Note Red Flags (Go to C) No 23 C Yes Is beneficiary receiving 3rd party settlement in connection with work injury? Red flags CA-12 Note Red Flags (Go to D) DE Return to page 11 No 23 20 D Yes Is beneficiary receiving other federal benefits? Contact OWCP CE to discuss all Red Flags prior to moving forward Red flags on CA-12 Note Red Flags No 13
