Postal Service Employee Workers' Compensation Claims Not Always Processed Timely, but Problems Hamper Complete Measurement
Highlights
In fiscal year 2000, U. S. Postal Service employees accounted for about one-third of both the federal civilian workforce and the $2.1 billion cost of the Federal Workers' Compensation Program (WCP). During that same year, Postal Service employees submitted 85,000 claims, or one-half of all claims for new work-related injuries, to the Department of Labor's (DOL) Office of Workers' Compensation Program (OWCP), which is charged with administering the program. Because of complaints the subcommittee received from injured federal employees about the untimely receipt of WCP benefits and because Postal Service employees account for such a large portion of the WCP, the Chairman, House Subcommittee on Government Efficiency, Financial Management, and Intergovernmental Relations, Committee on Government Reform, asked us to determine specifically whether Postal Service employees were receiving WCP benefits in a timely manner. For our current review, we agreed to (1) determine the extent to which Postal Service employees provided all of the evidence required by OWCP regulations for determining the claimants' eligibility for WCP benefits and (2) determine whether claims for WCP eligibility and WCP compensation payments for lost wages or schedule awards were submitted and processed within the time frames set forth in OWCP regulations or performance standards. On the basis of our analysis, we estimate that in about 99 percent of the cases involving Postal Service employees who (1) had work-related injuries during the 12-month period beginning July 1, 1997, and (2) filed claims for WCP benefits for lost wages or schedule awards due to these injuries, the employees eventually provided OWCP the evidence it required to make a determination on their eligibility for benefits. However, in about 69 percent of the cases, OWCP claims examiners had to request additional information because all of the required evidence needed to make a determination of WCP eligibility was not provided initially. As a result, claims for WCP eligibility were not always processed within the time frames set forth by OWCP. For those Postal Service employees in our sample cases who were determined to be eligible for WCP benefits and later filed claims for compensation for lost wages or schedule awards, we could not reliably estimate the percentage of claims for compensation that were processed within the time frames set forth by OWCP. This was because the dates we needed to "mark" the beginning and ending actions taken by the injured Postal Service employee and Postal Service supervisor to complete, submit, and forward claims to DWCP were missing from the claim forms.
Recommendations
Recommendations for Executive Action
| Agency Affected | Recommendation | Status |
|---|---|---|
| Department of Labor | To help (1) improve measurement of Federal Workers' Compensation Program (WCP) claims processing activity and (2) ensure the accuracy in awarding WCP benefits, the Secretary of Labor should direct the Office of Workers' Compensation Program (OWCP) administrator to reevaluate and modify as needed OWCP's regulations and performance standards to better ensure that measurements reflect the time associated with the various specific components and parties involved in processing WCP claim forms up to the time WCP eligibility is determined and WCP compensation payments are authorized or denied, and reconsider whether reasonable performance standards for claims for schedule awards could and should be established, and whether SFC cases should be combined with other traumatic injury claims when measuring the timeliness of eligibility determination process. |
Closed – Implemented
The Department of Labor reevaluated its standards for measuring the timeliness of claims processing, but did not make any changes. GAO believes this is partially responsive to its recommendation in that they did reassess their standards, but GAO continues to have concerns that the problems it found associated with the existing standards may continue.
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| Department of Labor | To help (1) improve measurement of Federal Workers' Compensation Program (WCP) claims processing activity and (2) ensure the accuracy in awarding WCP benefits, the Secretary of Labor should direct the Office of Workers' Compensation Program (OWCP) administrator to establish a requirement that the dates needed to determine the various processing times covered by OWCP's regulations or performance standards for all parties involved in processing WCP claims are recorded on the applicable claim forms. |
Closed – Implemented
The Department of Labor told GAO that it had implemented a new computer system in the Spring of 2005 that captures all the dates related to processing claims. It told GAO that it was also seeking approval from OMB to modify the claims form to capture the date the agency actually receives the form from the claimant. GAO believes that, if effectively implemented, this proposal would address its recommendation.
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| Department of Labor | To help (1) improve measurement of Federal Workers' Compensation Program (WCP) claims processing activity and (2) ensure the accuracy in awarding WCP benefits, the Secretary of Labor should direct the Office of Workers' Compensation Program (OWCP) administrator to periodically (1) monitor employee compliance with SFC case selection and processing guidelines and (2) determine whether the SFC case process is achieving OWCP's intended goals and maintaining a cost-effective error rate regarding improperly awarded WCP benefits. |
Closed – Not Implemented
The Department of Labor told GAO that it monitors the performance for timeliness of claims processing, which has consistently improved over the past few years. However, GAO does not believe that this is responsive to its recommendation, which was focused on monitoring employee compliance with the short form closure (SFC) case selection and processing guidelines and whether the SFC case processes are achieving OWCP's intended goals in maintaining a cost-effective error rate. Thus, GAO asked for additional information related to the error rate for the SFC case selection process. DOL responded that the error rate cannot currently be tracked, but full implementation is expected by March 31, 2006. As of September 2006, after several contacts, DOL had not provided any additional information so we closed the recommendation as not implemented.
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| United States Postal Service | To help overcome the delays in processing WCP claim forms for eligibility determination and compensation for lost wages and schedule awards, the Postmaster General should monitor and take appropriate actions to achieve its goal for the preparation and processing of Postal Service employee claims for WCP benefits and ensure that claims submitted to OWCP are as complete as practical. |
Closed – Implemented
On December 20, 2002, GAO recommended that the U.S. Postal Service monitor and take appropriate actions to achieve its goal for the preparation and processing of Postal Service employee claims for WCP benefits and ensure that claims submitted to OWCP are as complete as practical. GAO noted that such actions would help overcome the delays in processing WCP claim forms for eligibility determination and compensation for lost wages and schedule awards. Postal Service officials agreed to set goals for field managers and injury compensation specialists for on-time submission rates and to take steps to better ensure that claim forms being submitted contain all the available information needed by OWCP to process them within the time frame specified by OWCP regulations.
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