The provisions of this coverage apply to all employees of the Smithsonian, regardless of the type or length of appointment. However, decisions as to the eligibility of any employee for benefits are made on a case-by-case basis by the Office of Workers' Compensation (OWCP), Department of Labor.
Enrollment and Cost
Enrollment for coverage is automatic, with SAO paying the full cost of this insurance.
The Federal Employment Compensation Act provides benefits for medical care and compensation for time lost. Income protection for on-the-job injuries or occupational disease benefits fall into two categories: Continuation of Pay and Compensation. Continuation of Pay (COP) is awarded to an employee who suffers an on-the-job injury for continuation of regular pay for the period the employee is disabled (not to exceed 45 calendar days). If awarded COP, no sick or annual leave is charged to the employee. COP is taxable income and all regular payroll deductions are withheld from pay.
If disability exceeds 45 calendar days and loss of wage-earning capacity will result, the employee is entitled to file for compensation of wage loss. Wage loss is paid at the rate of 66 2/3% of regular pay to an employee who has no dependents. If an employee has a dependent, the wage loss is paid at the rate of 75% of regular pay. Before a claim for compensation of wage loss can be filed, an employee must be in Leave Without Pay (LWOP) status for 3 days. In cases where the disability extends beyond 14 days, compensation will be paid for the 3-day "waiting period," which will cover the LWOP period. It is important to note that the approval of compensation is not immediate. Adjudication is done only after sufficient medical and job-related evidence is obtained and reviewed by OWCP.
If you die because of a condition suffered in connection with your employment, compensation is paid to your survivors.
Any on-the-job injury, however slight, should be reported to your supervisor and to the CfA Safety Office. You will need to file an SI Occupational Injury and Illness Report, which may be accessed, along with the instructions for completion, on the Safety Webpages. This report is for internal SI reporting purposes.
A formal CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay (see forms link below) report must be completed as a factual record of the accident and as a basis for resolving claims for injury compensation. The completion of this form initiates the claim process. All factual records, including medical reports from the treating physician will be sent to the Office of Workers' Compensation Programs (OWCP), Department of Labor. The CA-20, Physician's Report should be completed by the physician and returned to the employee who will then forward the CA-1 and CA-20 to the SAO Benefits Office for processing. Compensation to a physician for medical expenses is submitted on form OWCP-1500 and forwarded for payment to OWCP. IMPORTANT: To be eligible for Continuation of Pay, a claim must be filed within 30 days of injury. Claims for disability must be filed within three years. Under certain conditions, you will be continued in pay status for up to 45 calendar days after a work-related injury.
If you are injured on-the-job, the first thing you should do is to get medical treatment. Your department/division administrator can provide you with a CA-16, Authorization for Examination. This form can also be issued by your supervisor so that immediate medical care can be obtained at a local treatment facility or by a qualified physician of your choice. This form is not available online - it must be provided to you and signed by your supervisor or department/division administrator to authorize immediate medical treament. If this form is used in place of the CA-20, the attending physician should complete this form and return it to the employee for forwarding to the SAO Benefits Office for processing.
Upon approval of your claim, OWCP will provide you with a publication entitled, "Now That Your Claim Has Been Approved," which is designed to answer basic questions. For further information, please contact the SAO Benefits Office at (617) 495-7371. If a claim is denied, the employee must use sick and/or annual leave to cover the lost time attributable to continuation of pay and will be liable for medical expenses. The employee may appeal any decision made by the Office of Workers' Compensation.
When medical and job-related evidence indicates that the disability will continue beyond 45 days and loss of wage-earning capacity will result, you must file a CA-7, Claim for Compensation. The CA-7 must be filed every two weeks until the claim has been accepted by the Department of Labor for short-term disability. The physician must complete a CA-20 to update the employee's medical status.
Depending on the type of injury, you will be required to complete one or more of the following forms:
||Description of Form|
||Notice of Injury|
||Notice of Occupational Disease|
||Notice of Recurrence of Disability|
||Claim for Compensation|
||Authorization for Examination|
||Duty Status Report|
||Attending Physician's Report|
||Claimant Medical Reimbursement|
||Compensation Program Medical Provider's Claim Form|
Workers' Compensation Forms
Questions should be directed to the SAO Benefits Office at (617) 495-7371.