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
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 of Wage Loss. 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 one or more dependents, the wage loss is paid at the rate of 75% of regular pay. Before a claim for compensation 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. This includes close calls and near misses, so that action can be taken to correct a hazard that might cause injury to someone else. A formal incident report, SI Occupational Injury and Illness Report, must be completed online using the Automated Incident Reporting System (AIRS). This report is for internal SI reporting purposes.
A CA-1, Notice of Traumatic Injury and Claim for Continuation of Pay report (or a CA-2, Notice of Occupational Disease, if applicable) must also be completed online using AIRS. The injured worker and his/her supervisor must complete all information requested on the relevant staff and supervisor tabs. If there was a witness to the accident, the information on the witness tab should also be completed. The employee and supervisor will be prompted to generate, sign and date both the Injury Report for the CfA Safety Office and the CA-1 (or CA-2) claim for the SAO Benefits Office. The SAO Benefits Office will review and input to the submission before it is released electronically to the U.S. Department of Labor (DOL). The SAO Benefits Office and the DOL will coordinate to ensure timely processing and issuance of a claim number to the employee.
It is important that all information be correctly entered into AIRS, as the AIRS submission is a factual record of the incident, and will be used as a basis for resolving claims for injury compensation. The AIRS submission 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.
When injured at work, you should immediately seek medical treatment. If you are able to notify your supervisor immediately, you should obtain a CA-16, Authorization for Examination form from your supervisor or department/division administrator. This form authorizes immediate medical care at a local hospital or by a qualified physician of your choice. This form is not available online. If this form is used in place of the CA-20, the attending physician should complete the form and return it to the employee for forwarding to the SAO Benefits Office for processing.
It is not always possible to notify your supervisor before seeking treatment by a medical professional. Be sure to notify the physician or hospital that your injury is work-related. If a CA-16 is not issued, you should obtain a CA-20, Attending Physician's Report from this website or the SAO Benefits Office and provide it to the treating physician to complete and return to you. You can then forward the completed form to the SAO Benefits Office for processing. Medical bills for the services of a physician or hospital must be 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.
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 calendar 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 upon the type of injury, you will be required to complete one or more of the following forms:
- CA-2A, Notice of Recurrence of Disability
- CA-3, Notice of Return to Work
- CA-7, Claim for Compensation
- CA-7A, Time Analysis
- CA-7B, Leave Buyback Worksheet
- CA-17, Duty Status Report
- CA-20, Attending Physician's Report
- CA-35, Evidence Required to Support Claim for Occupational Disease
- OWCP-915, Claim for Medical Reimbursement (Employee)
- OWCP-957, Medical Travel Refund Request
- OWCP-1500, Health Insurance Claim Form (Medical Provider)
Questions should be directed to the SAO Benefits Office at (617) 495-7371.