DHS OIG, OIG-14-105, U.S. Immigration and Customs Enforcement’s Management of the Federal Employees’ Compensation Act Program (Revised) (2014)

Department of Homeland Security 2IÀFHRI,QVSHFWRU*HQHUDO U.S. Immigration and Customs Enforcement’s Management of the Federal Employees’ Compensation Act Program OIG-14-105 (Revised) July 2014 OFFICE OF INSPECTOR GENERAL Department of Homeland Security Washington, DC 20528 / www.oig.dhs.gov   JUL12014  CatherineEmerson ChiefHumanCapitalOfficer DepartmentofHomelandSecurity SusanG.Baker ActingHumanCapitalOfficer U.S.ImmigrationandCustomsEnforcement Richard AnneL. AssistantInspec s torGeneralforAudits U.S.ImmigrationandCustomsEnforcement’sManagementof theFederalEmployees’CompensationActProgram MEMORANDUMFOR:           FROM:   SUBJECT:  Attachedforyourinformationisourfinalreport,U.S.ImmigrationandCustoms Enforcement’sManagementoftheFederalEmployees’CompensationActProgram.We incorporatedtheformalcommentsfromtheU.S.ImmigrationandCustomsEnforcement andtheDepartmentofHomelandSecurity(DHS)inthefinalreport.  ThefinalreportwasoriginallydistributedinternallytoDHSonJune6,2014.Wehave revisedourfinalreportbasedontheDepartment’srequesttoprovideanew,consolidated responsetothereport.  ThereportcontainsthreerecommendationsaimedatimprovingtheWorkers’ CompensationProgramattheU.S.ImmigrationandCustomsEnforcementandthe DepartmentofHomelandSecurity.Yourofficesconcurredwithallrecommendations.The OIGconsidersrecommendation#2unresolvedandopen.AsprescribedbytheDepartment ofHomelandSecurityDirective077Ͳ01,FollowͲUpandResolutionsforOfficeofInspector GeneralReportRecommendations,within90daysofthedateofthismemorandum,please provideourofficewithawrittenresponsethatincludesyour(1)agreementor disagreement,(2)correctiveactionplan,and(3)targetcompletiondateforthe recommendation.Also,pleaseincludecontactinformationforresponsiblepartiesandany othersupportingdocumentationnecessarytoinformusaboutthestatusofthe recommendation.Untilwereceiveandevaluateyourresponse,wewillconsiderthe recommendationunresolvedandopen.  Basedoninformationprovidedinyourresponsetothedraftreport,weconsider recommendations#1and#3resolvedandopen.Onceyourofficeshavefullyimplemented  OFFICE OF INSPECTOR GENERAL Department of Homeland Security the recommendations, please submit a formal closeout request to us within 30 days so that we may close the recommendations. The request should be accompanied by evidence of completion of agreed-upon corrective actions. Please email a signed PDF copy of all responses and closeout requests to [email protected]. Consistent with our responsibility under the Inspector General Act, we will provide copies of our report to appropriate congressional committees with oversight and appropriation responsibility over the Department of Homeland Security.

We will post the report on our website for public dissemination. Please call me with any questions, or your staff may contact John E. McCoy II, Deputy Assistant Inspector General for Audits, at (202) 254-4100. Attachment www.oig.dhs.gov 2 OIG-14-105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  TableofContents  ExecutiveSummary.............................................................................................................1  Background........................................................................................................................2  ResultsofAudit...................................................................................................................5  ICEWorkers’CompensationProgramManagement..............................................5  DHSWorkers’CompensationProgramManagement............................................9  Recommendations...............................................................................................10  ManagementCommentsandOIGAnalysis.........................................................11  Appendixes  AppendixA:Objectives,Scope,andMethodology.............................................13 AppendixB:ManagementCommentstotheDraftReport................................15 AppendixC:CaseStudiesonICE’sWorkers’CompensationCases....................20 AppendixD:MajorContributorstoThisReport.................................................22 AppendixE:ReportDistribution........................................................................23  Abbreviations  DHS DOL FECA FY ICE OIG  DepartmentofHomelandSecurity U.S.DepartmentofLabor FederalEmployees’CompensationAct fiscalyear U.S.ImmigrationandCustomsEnforcement OfficeofInspectorGeneral www.oig.dhs.gov  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  ExecutiveSummary  WereviewedU.S.ImmigrationandCustomsEnforcement’s(ICE)managementofits FederalEmployees’CompensationActprogram.TheFederalEmployees’Compensation Actprovideswagelosscompensation,medicalcare,andsurvivors’benefitstocivilian employeesforemploymentͲrelatedtraumaticinjuriesandoccupationaldiseases.In fiscalyear2012,ICEhad2,253casestotalingapproximately$21millioninworkers’ compensationͲrelatedcosts.OurauditobjectivewastodeterminewhetherICEis effectivelymanagingtheprogramtominimizelostworkdaysandrelatedcompensation costs.  ICEhasnoteffectivelymanageditsFederalEmployees’CompensationActprogramto controlcosts.Specifically,ithasnotensuredcorrectprocessingofclaimsand monitoringofworkers’compensationcases.Inaddition,ICEhasnotimplemented managementcontrolsneededtomanagetheprogram.Asaresult,ICEhasnot minimizedlostworkdaysandrelatedcompensationcosts.Forexample,weidentified fivecasesinwhichindividualsreceivedapproximately$1millionincompensationafter theywereclearedtoreturntowork.  Additionally,theDepartmentofHomelandSecurity(DHS)hasnotprovidedformal writtenguidancethatestablishesminimumstandardsforadministeringtheFederal Employees’CompensationActprogramintheDepartmentanditsComponents.  WemadetworecommendationstotheICEActingHumanCapitalOfficerandone recommendationtotheDHSChiefHumanCapitalOfficertoimprovemanagementofthe FederalEmployees’CompensationActprogram.ICEandDHSconcurredwithall recommendations.      www.oig.dhs.gov 1  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  Background  TheFederalEmployees’CompensationAct(FECA)(5U.S.C.§8101,etseq.)provides wagelosscompensation,medicalcare,andsurvivors’benefitstocivilianemployeesfor employmentͲrelatedtraumaticinjuriesandoccupationaldiseases.TheUnitedStates DepartmentofLabor(DOL)PublicationCAͲ810,InjuryCompensationforFederal Employees(guidance)definesatraumaticinjuryasawoundorotherconditionofthe bodycausedbyexternalforce,stresses,orstrain.Thetraumaticinjurymustbe identifiablebytimeandplaceofoccurrenceandpartofthebodyaffected,anditmust becausedbyaspecificeventorseriesofeventsduringasingledayorworkshift.An occupationaldiseaseisaphysicalconditionproducedintheworkenvironmentovera periodlongerthanoneworkday.FECAalsoprovidesforpaymentofbenefitsto dependentsifaworkͲrelatedinjuryordiseasecausesanemployee’sdeath.  DOL’sOfficeofWorkers’CompensationProgramadministerstheFECAprogram.DOL adjudicatesallworkers’compensationclaimsanddeterminesworkers’compensation eligibilitybasedontheinjuredemployees’medicalandfactualevidence.UnderFECA,an employee’ssalarymaycontinueforupto45daysiftheemployeeisabsentfromwork duetodisabilityormedicaltreatmentforaworkͲrelatedinjury.Theagencyis responsiblefortheemployee’spaywhileDOLadjudicatestheclaim.Intheeventthat DOLdeniestheclaim,theagencyshouldrecoverthesalarypaidtotheemployeeby adjustingleavebalancesorcollectingtheoverpayment.  UnderFECA,employeesarecompensatedatarateequalto66.67percent(without dependents)or75percent(withdependents)oftheirsalaryatthetimeofinjuryor illnessfortotaldisability.TheEmployees’CompensationFund,whichisreplenished annuallybychargestoemployingagenciesthroughthe“chargeback”process,finances FECAbenefits.Eachyear,DOLprovidesagencieswithfourquarterlychargebackreports fortheaccountingperiodJuly1 throughJune30.Eachquarterlyreport listscompensationandmedical paymentsmadetoagencies’injured employees.Agenciescanusethe quarterlyreportstoidentifyand correcterrorsbeforetheyappearon theannualbill.Additionally,FederalagenciesareresponsibleforadministeringtheFECA programwithintheiragency,whichincludesadvisingemployeesoftheirFECArightsand responsibilities,processingclaims,andmanagingcompensationcases.   x SubmittingFECAclaimspromptly x Challengingquestionableclaims x Assistingemployeesinreturningtowork x Keepingincontactwithinjuredemployees x Managingcompensationcosts ClaimsProcessingandCaseManagementDuties www.oig.dhs.gov 2  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  DepartmentofHomelandSecurity  DHS’OfficeoftheChiefHumanCapitalOfficerisresponsibleforthemanagement, administration,andcomplianceoftheDepartment’sworkers’compensationprogram. WithintheOfficeoftheChiefHumanCapitalOfficer,theWorkers’Compensation ProgramManagerprovidestechnicaladvice,guidance,andprogramsupportto departmentalsupervisors,managers,andcomponentworkers’compensationprogram officesregardingprogramrequirementsandcompliancewithFederallawsand regulations.  U.S.ImmigrationandCustomsEnforcement  ICEwascreatedin2003throughamergeroftheinvestigativeandinteriorenforcement elementsoftheUnitedStatesCustomsServiceandtheImmigrationandNaturalization Service.ICE'sprimarymissionistopromotehomelandsecurityandpublicsafety throughthecriminalandcivilenforcementofFederallawsgoverningbordercontrol, customs,trade,andimmigration.Infiscalyear(FY)2012,ICEhad20,423employees.  AccordingtoICE,theWorkers’CompensationProgramoffice,withintheOfficeof HumanCapital,managesthecomponent’sFECAprogramandisresponsiblefor providingpolicies,procedures,andtrainingwithinICE.Compensationspecialistsand supervisorsinICEofficesthroughouttheUnitedStatesprocessclaimsandmanage cases.Supervisorsreviewemployeeinjuryandoccupationaldiseaseclaimformsfor completenessandaccuracy,indicatetheirconcurrenceornonͲconcurrencewiththe circumstancesofinjuries,andassistemployeeswithreturningtowork.Compensation specialists’responsibilitiesincludesubmittingclaimformstoDOL,monitoringinjured employees’medicalconditionstoassesstheirabilitytoreturntowork,and communicatingwithDOLandemployeesonthestatusofemployees’cases.  InFY2012,ICEhad2,253casestotalingapproximately$21millioninworkers’ compensationͲrelatedcosts.Ofthe$21million,morethan50percentisattributableto individualswithphysicallydemandinglawenforcementpositions.Figure1depictsthe increaseinnumberofICEworkers’compensationcasesandrelatedcostsfromFYs2009 through2013.1    1FY2013workers’compensationdataisprovidedforcomparisonpurposes.Wedidnotusethisdataduringour analysisofworkers’compensationcasesbecauseitwasnotavailablewhentheauditbegan. www.oig.dhs.gov 3  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security Figure1:ICEFECATrendsfromFYs2009through2013  s n o i l l i M $25 $20 $15 $10 $5 $0 2,350 2,300 2,250 2,200 2,150 2,100 2,050 2,000 1,950 TotalFECACosts No.ofCases FY09 FY10 FY11 FY12 FY13  Source:OIGanalysisofannualchargebackreports  FECAandEmployeeRetirement  UnderFECA,abeneficiarywhobecomeseligibleforFederalretirementmayelectto receivethosebenefitsorcontinuetoreceiveworkers’compensationforthedurationof thedisability.FederalemployeesmayreceivegreatermonetarybenefitsunderFECA thantheywouldiftheyelectedretirementbenefits.  TherehasbeenrecentCongressionalinterestinreducingtheamountofworkers’ compensationthatretirementͲageFederalemployeescanreceive.Forexample,U.S. Senatebill261in2011calledforterminatingworkers’compensationwhenanemployee reachedtheSocialSecurityretirementageof62.Additionally,U.S.Senatebill1789in 2012wouldhavereducedbenefitlevelsforbeneficiariesoverretirementageand requireclaimantstochoosebetweencompensationunderFECAorundertheFederal retirementsystem.TheseSenatebillswerenotenacted.In2013,DOLproposedthat CongressamendFECAtoallowittoreducethecompensationrateforretirementͲage claimantsto50percentofwages.Weidentified46retirementͲageindividualsinICE’sFY 2012chargebackreportwhoreceived$3,126,560incompensationinFY2012.2    2The46retirementͲageindividualsdonotincludeindividualswhoareworkingandarereceivingcompensationdue tolossofwageͲearningcapacity. www.oig.dhs.gov 4  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  ResultsofAudit  ICEhasnoteffectivelymanageditsFECAprogramtocontrolcosts.Specifically,ithasnot ensuredcorrectprocessingofclaimsandmonitoringofworkers’compensationcases.In addition,ICEhasnotimplementedmanagementcontrolsneededtomanagethe program.Asaresult,ICEhasnotminimizedlostworkdaysandrelatedcompensation costs.Forexample,weidentifiedfivecasesinwhichindividualsreceivedapproximately $1millionincompensationaftertheywereclearedtoreturntowork.  Additionally,DHShasnotprovidedformalwrittenguidancethatestablishesminimum standardsforadministeringtheFECAprogramintheDepartmentanditsComponents.  ICEWorkers’CompensationProgramManagement  ICEhasneitherensuredeffectiveclaimsprocessingoversightandcase managementnorreturnedemployeestoworkattheearliestopportunity. AccordingtoDOLguidance,“Intheinterestsofprovidinggoodserviceto employeeswhilecontainingcosts,[OfficeofWorkers’CompensationPrograms] encouragesactivemanagementofworkers'compensationprogramsbyagency personnel.”However,ICEdoesnothavethepolicies,procedures,andtraining necessarytoensureeffectivemanagementofitsFECAprogram.Asaresult,ICE hasnotminimizedlostworkdaysandrelatedcompensationcostsandmayhave beenbilledforinappropriatecosts.  KeyManagementControls  ICEhasnotprovidedguidancetopersonnelresponsibleforprocessingworkers’ compensationclaimsandmanagingcases.ICE’sOfficeofHumanCapitalhas draftedamanagementdirectiveandastandardoperatingprocedure,which includeprogramguidanceandtrainingrequirements.However,accordingtoICE, theseprogramdocumentshavebeenindraftsince2010anditsemployeeswho administertheFECAprogramhavenotusedthem.AccordingtoOfficeof ManagementandBudgetCircularAͲ123,Management’sResponsibilityfor InternalControl,internalcontrolssuchaspolicies,procedures,andtraininghelp ensureagenciesachievetheirobjectives.Theabsenceoftheseinternalcontrols hasresultedintheclaimsprocessingandcasemanagementissuesdiscussedin thisreport.  www.oig.dhs.gov 5  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  ClaimsProcessing  ICEsupervisorsdidnotprocessFECAclaimformscorrectlytoensureaccuracy, completeness,andvalidityoftheclaims.Theydidnotensureclaimforms containedcompletedescriptionsofinjuries,challengequestionableclaims,or identifyresponsiblethirdparties.AccordingtoDOLguidance,supervisors should:  x Reviewclaimformsforcompletenessandaccuracy; x InvestigatethecircumstancesandreporttheresultstoDOLforclaims thatmaynotbecoveredunderFECA; InvestigatethethirdͲpartyaspectofclaimsandsubmitallinformation gathered;and x x SubmitsupportingdocumentationtoDOLforclaimsinvolvingatraffic accident. ClaimsProcessingExamples x Aclaimantwasinjuredwhileeatinglunchoffthe workpremises.Thesupervisordidnotverifythe circumstancessurroundingtheinjuryandreport theresultstoDOL.AccordingtoDOLguidance, injuriesoccurringoffpremisesduringlunchare normallynotcovered,exceptundercertain circumstances.1  Inourreviewof132casestestedforclaimsprocessing,weidentified25 (approximately19percent) thatwerenotprocessed correctly.Forexample,the casesdidnotcontain completedescriptionsofthe circumstancesthatcaused theinjuriestodetermine whether(1)theinjurieswere sustainedinthe performanceofdutyor(2) thirdpartiesmaybe financiallyliableforthe injuries.Asaresult,DOLmay haveapprovedtheseclaims withoutconsideringallthe informationsurroundingthe case.FECAbenefitspaidonthese25claimstotaledapproximately$222,027in FY2012. claimant’scar,buttheclaimformdidnotidentify thethirdparty.DOLguidanceencourages supervisorstoinvestigatethirdͲpartyinvolvement andsubmitsupportingdocumentationtoDOL.2 1DOLPublicationCAͲ810,InjuryCompensationforFederal Employees,3Ͳ4.B.(2) 2DOLPublicationCAͲ810,InjuryCompensationforFederal Employees,4Ͳ1.E. x Aclaimantwasinjuredwhenavehiclestruckthe  InjuryClaimsInvolvingGovernmentͲownedVehicles  Supervisorsdidnotproperlyinvestigateinjuryclaimsresultingfrommotor vehicleaccidentsinvolvinggovernmentͲownedvehicles.Weidentified17claims ofinjuriessustainedwhiledrivingorridinginagovernmentͲownedvehicle.Of www.oig.dhs.gov 6  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  GovernmentͲownedVehicleClaim ProcessingExample Anemployeewasinvolvedinan accidentthreehourspriortothestart ofhisorherworkday.Therewasno evidenceofaninvestigationto determinewhattheemployeewas doingatthattimethatwasworkͲ related. the17claims,12(71percent)warrantedfurtherinvestigationtodetermine whethertheclaimantswereintheperformanceofduty.Theremainingfive claimsofinjuryeitherincludedaninvestigationordidnotneedaninvestigation. Title31U.S.C.§1344permitsuseofgovernmentͲownedvehiclesfor transportationbetweenhomeandwork whenitisessentialforthesafeand efficientperformanceofintelligenceand lawenforcementduties.However,also accordingto31U.S.C.§1344,an individualisnotautomaticallyconsidered tobeintheperformanceofdutyoracting withinthescopeofemploymentsimply becausetheemployeeisauthorizedto driveagovernmentͲownedvehicle.For example,injuriesinvolvingagovernmentͲownedvehiclethatoccuroffͲpremises duringthelunchhourorwhentheemployeehasdeviatedfromthemostdirect routetoandfromworkforpersonalreasonsmaynotbecovered.Forthe12 claimsneedingfurtherinvestigation,claimantsreceived$23,773inworkers’ compensationinFY2012.  SeeappendixCforadditionalexamplesofclaimsprocessingissuesidentified duringthisaudit.  CaseManagement  ICEworkers’compensationspecialistsdidnotmonitorthemedicalandreturnͲ toͲworkstatusofclaimants,retaindocumentationassociatedwithcases,return employeestowork,orrecoversalariesfordeniedclaims.DOLguidance encouragesagenciestomanagecasesactively,whichincludes:  x EstablishingarecordͲkeepingsystemtomaintaincopiesof documentationassociatedwiththecase; x ObtainingmedicalinformationfromDOLorinjuredemployeestoassess potentialtoreturntoworkandadvisephysiciansofanylightduty assignmentsandtheirspecificrequirements; x Communicatingwithinjuredemployeeswhiletheyarereceiving x compensation;and Identifyingjobssuitableforinjuredemployeesandtakingstepsto reemployrecoveredorrecoveringemployeesassoonasthemedical evidenceshowsitispossible.  www.oig.dhs.gov 7  OIGͲ14Ͳ105  OFFICE OF INSPECTOR GENERAL Department of Homeland Security  Weidentifiedmissingcasefilesandcasefilesthatdidnotincludekey documentationnecessaryfortheeffectivemanagementofthecases.NinetyͲsix percentofthe184casesselectedforcasemanagementtestinghadcasefiles.Of the176casefilesreviewed,54(approximately31percent)didnothaveDOLͲ requireddocumentationsuchasclaimformsandsupportingmedical documentation.Forexample,oneclaimantreceived$43,225inFY2012, althoughthecasefiledidnotincludetheclaimformandmedicaldocumentation tojustifycompensation.  LightDutyAccommodations LightDutyAccommodationExample ICEdidnotconsistentlyprovidelightdutyassignmentstoemployeesmedically clearedtoreturntoworkwithrestrictions.Workrestrictionsincludelimitson sitting,standing,orlifting,amongothers.For5(approximately3percent)ofthe 176casesreviewed,individualswereclearedtoreturntoworkinsomecapacity, butICEdidnotprovidelightduty accommodationstotheseclaimants. AsofJune2013,thesefiveindividuals Oneclaimantwasmedicallyclearedtoreturn toworkinalightdutycapacity;however,the hadreceivedapproximately$1 officetowhichtheindividualwasassigned millioninworkers’compensation didnotprovidelightdutypositions.The sincetheywereclearedtoreturnto claimanthasreceivedmorethan$233,000in work.Furthermore,accordingtoICE, workers’compensationsincebeingmedically lightdutyassignmentswerenot clearedtoworkseveralyearsago. offeredinatleast2of18fieldoffices visited.  Ofthe2,253workers’compensationcasesinFY2012,257individualshad multiplecases.Ofthe1,996individualswithworkers’compensationcases,we identified990(approximately50percent)whowereinlawenforcement positionsthatrequiredmoderatetoarduousphysicalexertion,including running,climbing,usingfirearms,andphysicallysubduingandlifting uncooperativeindividuals.Thephysicaldemandsofthesepositionscould increasethedifficultyofquicklyreturningtheseinjuredemployeestoregular duty.However,FECAprovidesservices,suchasvocationalrehabilitation, reemploymentwithaformeragency,assistedreemploymentwithanewagency, andpaymentofrelocationexpenses,toassistclaimantswithreturningtowork consistentwiththeirphysicalabilities.     www.oig.dhs.gov 8  OIGͲ14Ͳ105  OFFICE OF INSPECTOR GENERAL Department of Homeland Security  SalariesforDeniedClaims  ICEdidnotrecoversalariespaidtoemployeeswhoseworkers’compensation claimsweredenied.UnderFECA,anemployee’ssalarymaycontinueforupto45 daysiftheemployeeisabsentfromworkduetodisabilityormedicaltreatment foraworkͲrelatedinjury.AccordingtoDOLguidance,agenciesshouldadjust leavebalancesorrecoverpaymentsmadetoemployeeswhomissedwork,but subsequentlyhadtheirinjuryclaimdeniedbyDOL.Ourreviewofcasefilesand subsequentinterviewsindicatedthatICEdidnotadjustleavebalancesor recoverpaymentstotalingapproximately$19,293forfiveindividualswith deniedclaims,asofNovember2013. SeeappendixCforadditionalexamplesofcasemanagementissuesidentified duringthisaudit.  DHSWorkers’CompensationProgramManagement  DHShasnotprovidedthenecessarysupportandguidancetoComponents’ workers’compensationprogramoffices.AccordingtotheDHSWorkers’ CompensationProgramManager,hisofficeprovidestechnicaladvice,guidance, andprogramsupporttodepartmentalsupervisorsandmanagers,andto Componentworkers’compensationprogramoffices.However,DHShasnot developedandissueddepartmentͲwidepolicyformanagementand administrationoftheFECAprogram.Forexample,accordingtotheProgram Manager,adraftmanagementdirectiveestablishingpoliciesandrequirements forDHSanditsComponentshasbeenawaitingapprovalsincespring2012.If DHShadprovidedformalguidanceandoversighttoitsComponents’workers’ compensationprogramoffices,itmayhavepreventedtheissuesidentifiedin thisreport.  InourDecember2013report,MajorManagementandPerformanceChallenges FacingtheDepartmentofHomelandSecurity,wenotedthatDHScontinuesto facechallengesinitseffortstocombinelegacyagenciesintoonecohesive organizationcapableoffulfillingitsmission.3OurpreviousauditsoftwoDHS components’FECAprogramsidentifiedissuessimilartothoseinthisreport.4  3DHSOIG,MajorManagementandPerformanceChallengesFacingtheDepartmentofHomelandSecurity,DHSOIGͲ 14о17,December2013. 4DHSOIG,TheTransportationSecurityAdministration’sManagementofitsFederalEmployees’CompensationAct Program,OIGͲ07Ͳ45,May2007;andDHSOIG,UnitedStatesCustomsandBorderProtection’sManagementofthe FederalEmployees’CompensationActProgram,DHSOIGͲ12Ͳ63,March2012.AllrecommendationsinOIGͲ07Ͳ45are closed.AllrecommendationsinOIGͲ12Ͳ63areopen. www.oig.dhs.gov 9  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  DepartmentͲwideFECAguidanceandoversightwouldhelpstandardizethe workers'compensationprogramswithinDHS.  Conclusion  DHSandICEcantakeproactivestepstowardmanagementandoversightoftheir workers’compensationprogramstocontrolcosts.ICEmaybeabletoreduce employeelostworkdaysandworkers’compensationͲrelatedcostsbydeveloping andimplementingpoliciesandproceduresthatpromoteconsistentandeffective claimsprocessingandcasemanagement.Additionally,departmentͲwidepolicy formanagementandadministrationofFECAmayhelpstandardizetheworkers' compensationprogramswithinDHSandreduceFECAͲrelatedcostsacrossthe Department.  Recommendations  WerecommendthattheActingHumanCapitalOfficer,U.S.Immigrationand CustomsEnforcement:  Recommendation#1:  Developandimplementpoliciesandproceduresfortheeffectivemanagement ofworkerscompensationcases.Thepoliciesandproceduresshouldaddress:  x Reviewingclaimsforcompleteness,accuracy,andsufficientevidence; x Identifyingthirdpartyliability; x Challengingquestionableclaims; x Recoveringsalariesfordeniedcases; x Managingcases; x Maintainingrecords;and x Trainingpersonnelwithworkers’compensationresponsibilities.  Recommendation#2:  Developandimplementapolicyforprovidinglightdutyassignmentsto claimantsclearedtoreturntoworkwithrestrictions.    www.oig.dhs.gov 10  OIGͲ14Ͳ105  OFFICE OF INSPECTOR GENERAL Department of Homeland Security  WerecommendthattheChiefHumanCapitalOfficer,DepartmentofHomeland Security:  Recommendation#3:  DevelopandimplementpoliciesandproceduresthatestablishDepartmentof HomelandSecurityandComponentrequirementsfortheeffectivemanagement andadministrationofFederalEmployees’CompensationActprogramswithinthe Department. ManagementCommentsandOIGAnalysis  DHSandICEprovidedcommentstothedraftreportandcopiesoftheir responsesintheirentiretyareincludedinappendixB.ICEalsoprovided technicalcomments,whichweincorporatedasappropriate.  DHSandICEagreedwithourrecommendationsforimprovementstothe managementandoversightoftheirworkers’compensationprograms.According toICE,itstartedusingtheEmployees’CompensationOperationand ManagementPortalinJune2013andbegandeploymentofasecondphaseof theportalinFebruary2014.ThissystemwillreportedlyenableICEstaffto downloadcasefilestoaidincasemanagement.Additionally,ICEindicatedthatit hadreceivedapprovaltoobtainamedicalcasemanagementservicescontract, whichwillreducechallengesassociatedwithreturninginjuredemployeesto work.ThefollowingareDHS’sandICE’sresponsestothereport recommendationsandouranalysis.  ICEResponsetoRecommendation#1:ICEconcurredwiththerecommendation thatitdevelopandimplementpoliciesandproceduresfortheeffective managementofworkers’compensationcases.AccordingtoICE,itsdraft workers’compensationprogramdirectiveandstandardoperatingprocedureare proceedingthroughitsinternalreviewandapprovalprocess.TheOfficeof HumanCapitalwillbeginimplementingthepoliciesandproceduresoncethe documentsareapproved.ICEintendstocompleteitsplannedcorrectiveactions byJune30,2015.  OIGAnalysis:TheactionsICEproposessatisfytheintentofthe recommendation.Thisrecommendationisresolved,butwillremainopenuntil ICEprovidessupportthatthedirectiveandstandardoperatingproceduresare approvedandplannedimplementationactionsarecompleted. www.oig.dhs.gov 11  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  ICEResponsetoRecommendation#2:ICEconcurredwiththerecommendation thatitdevelopandimplementapolicyforprovidinglightdutyassignmentsto claimantsclearedtoreturntoworkwithrestrictions.AccordingtoICE,theOffice ofHumanCapitalwilldraftanddisseminateamemorandumfromagency leadershiptoprogramheads,notifyingthemoftheneedtoprovidelimited/light dutytoworkͲrelatedinjuredemployees,examplesofsuchoptions,andthe associatedcostsavingstoICE.ICEintendstocompleteitsplannedcorrective actionsbySeptember30,2014.  OIGAnalysis:AlthoughICEconcurredwiththisrecommendation,itscorrective actionplandoesnotfullysatisfytheintentoftherecommendation.Theintentof therecommendationwasforICEtoinstituteacomponentͲwidelimited/light dutypolicyenforceableateachICElocation.ItisnotclearfromICE’sresponseif theproposedmemorandumwouldrequireindividualfieldofficestoprovide limited/lightdutypositionsorestablishacomponentͲwideprogramtoreturn employeestowork.Wevisited18ICEfieldoffices,someofwhichprovidedlight duty,whileothersdidnothaveorhadrecentlyestablishedapolicy.A limited/lightdutypolicyshouldprovideguidanceandtimelinesforreturning injuredemployeestoworkwithinphysicians’restrictionsandbeenforceableat eachICElocation.ThisrecommendationisunresolvedandopenuntilICE providesadditionalinformationthatdemonstratesitsproposedcorrective actionssatisfytheintentoftherecommendation. DHSResponsetoRecommendation#3:DHSconcurredwiththe recommendationtodevelopandimplementpoliciesandproceduresthat establishDHSandcomponentrequirementsformanagementandadministration ofFECAatDHS.AccordingtoDHS,areviseddraftmanagementdirectivewas clearedbytheOfficeoftheChiefHumanCapitalOfficerandwasforwardedfor clearancethroughtheOfficeoftheUnderSecretaryforManagementinMay 2014.ThedirectivewillestablishadepartmentͲwidepolicygoverningthe workers’compensationprogram,toincludeensuringcomponentspursue efficienciesincontrollingFECAclaimcostsandlimitingunnecessaryprogram costsbyaggressivelyprovidingworktoallinjuredemployeesassoonaspossible afteraninjuryorillness,withinphysicians’restrictions.DHSintendstocomplete itsplannedcorrectiveactionsbySeptember30,2014.  OIGAnalysis:TheDHSresponsesatisfiestheintentoftherecommendation.This recommendationisresolved,butwillremainopenuntiltheDHSmanagement directivefortheworkers’compensationprogramisapprovedandissued.   www.oig.dhs.gov  12  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  AppendixA Objectives,Scope,andMethodology  DHSOIGwasestablishedbytheHomelandSecurityActof2002(PublicLaw107Ͳ296)by amendmenttotheInspectorGeneralActof1978.Thisisoneofaseriesofaudit, inspection,andspecialreportspreparedaspartofouroversightresponsibilitiesto promoteeconomy,efficiency,andeffectivenesswithintheDepartment.  OurauditobjectivewastodeterminewhetherICEiseffectivelymanagingtheFECA programtominimizelostworkdaysandFECAͲrelatedcompensationcosts.  Wereviewedapplicablelaws,regulations,andguidanceconcerningworkers’ compensation.Inaddition,wereviewedpriorOIGauditreportsandU.S.Government AccountabilityOfficereportsontheFederalworkers’compensationprogram.  WeinterviewedDHS’Workers’CompensationProgramManagerandofficialsfromICE’s OfficeofHumanCapital,includingICE’sWorkers’CompensationProgramAssistant DirectorandProgramManager.Additionally,weinterviewedworkers’compensation specialistsandotherICEstaffassignedtoselectedfieldofficesandreviewedcasefiles maintainedinthoseoffices.  Weconductedsitevisitsat18ICEofficelocationsin9cities:Washington,DC;Fairfax, Virginia;HoustonandSanAntonio,Texas;PlantationandMiami,Florida;andLos Angeles,LongBeach,andSanDiego,California.  TodeterminewhetherICEiseffectivelymanagingitsworkers’compensationprogram, weassessedICE’sclaimsprocessing,casemanagementandprocessforreviewingthe DOLquarterlychargebackreports.Weselectedajudgmentalsampleof184casesto determinewhetherICEproperlyprocessedclaimsandmanagedworkers’compensation cases.Wedidnotevaluate52ofthe184casesforclaimsprocessingbecauseeitherthe injuryoccurredpriortothecreationofICEortheclaimformwasmissing.Weevaluated the184casesforcasemanagement.WeusedDOL’sFY2012annualchargebackreport astheuniverseofFECAcasesforoursampleselection.TheFY2013annualchargeback reportwasnotavailablewhenwestartedtheaudit.WedeterminedthatdatainDOL’s FY2012annualchargebackreportwassufficientlyreliableforselectingoursample.  Ourjudgmentalsampleconsistedofperiodicroll,dailyroll,andmedicalpaymentsonly cases.Thesecasesrepresentedthegreatestnumberofcasesandhighestdollar amountsontheFY2012chargebackreport.Periodicrollcasesrepresentclaimantsnot workingandonlongͲtermdisability.DailyrollcasesareshortͲtermcasesinwhichthe www.oig.dhs.gov 13  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  claimantisexpectedtoreturntoworkinarelativelyshortperiodortheclaimantmay beworkingandreceivingpayfortimelostbecauseofmedicaltreatment.Medical paymentsonlycasesrepresentclaimantswhohavereturnedtoworkorretiredbut continuetohavemedicalbills.Inaddition,weselectedcasesthatwereclosedbecause benefitshadbeendeniedtotestwhetherICEwasadjustingleavebalancesofor recoveringoverpaymentsfromclaimantswithdeniedclaims.Table1showsthe breakdownofoursamplebycasetype.  Table1:SampleofFECACasesbyCaseType CaseType PeriodicRoll DailyRoll MedicalPaymentsOnly CaseClosed/Denied Total Numberofcases 50 40 66 28 184 FY2012FECABenefits $3,789,801 $501,817 $1,104,826 $15,020 $5,411,464  WeconductedthisperformanceauditbetweenJune2013andJanuary2014pursuantto theInspectorGeneralActof1978,asamended,andaccordingtogenerallyaccepted governmentauditingstandards.Thosestandardsrequirethatweplanandperformthe audittoobtainsufficient,appropriateevidencetoprovideareasonablebasisforour findingsandconclusionsbaseduponourauditobjectives.Webelievethattheevidence obtainedprovidesareasonablebasisforourfindingsandconclusionsbaseduponour auditobjectives.         www.oig.dhs.gov 14  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  AppendixB ManagementCommentstotheDraftReport   www.oig.dhs.gov 15   OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  www.oig.dhs.gov 16  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  www.oig.dhs.gov 17  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  www.oig.dhs.gov 18  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  www.oig.dhs.gov 19  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  AppendixC CaseStudiesonICE’sWorkers’CompensationCases CaseStudies ClaimsProcessing Aclaimantwasinjuredwhileexercisingoffworkpremisesduringlunchtime.The employeewasnotparticipatinginaFederalfitnessprogramandthesupervisordidnot makenoteofthisfactorexplainwhytheinjuryshouldbecovered.Benefitsreceivedin FY2012totaledapproximately$9,000.  Aclaimantwasinjuredwhileexercisingoffworkpremisesandoutsideofworking hours.Thesupervisordidnotprovideinformationonwhytheemployeewas consideredintheperformanceofduty.Furthermore,inthemedicaldocumentation provided,thephysiciandidnotanswerwhetherhebelievedthatemploymentactivity causedoraggravatedtheinjury.BenefitsreceivedinFY2012totaledmorethan $1,000.  Aclaimantwasinjuredwhiledrivingagovernmentvehicle.Theclaimdidnotprovide sufficientdetailaboutthecircumstancesoftheinjury,andthesupervisordidnot provideinformationtoclarifywhethertheinjuryoccurredintheperformanceofduty. Inaddition,thesupervisordidnotincludeapplicablethirdͲpartyinformation.Benefits receivedinFY2012totaledmorethan$3,000.  CaseManagement Aclaimantsubmittedaclaimforanoccupationaldisease;however,nodocumentation oftheclaimwasonfile.Soonaftersubmittingtheclaim,theclaimantleftICEtowork inanotherFederalagencyandsubsequentlyfiledadditionalclaims.Theworkers’ compensationspecialistwasnotawareoftheclaimant’smedicalstatusandher responsibilitiesregardingmanagementofthecase.BenefitsreceivedinFY2012 totaledmorethan$66,000.  Aclaimantinjuredmorethan40yearsagohasreceivedcompensationontheperiodic rollsinceSeptember1982.ICEhasnotrequestedorobtainedcasedocumentation fromDOLtodeterminewhetherthemedicalstatusoftheclaimantjustifiescontinued compensation.BenefitsreceivedinFY2012totaledapproximately$66,000.Thereis evidencethatthisindividualhasearnedincomefromselfͲemploymentwhilereceiving workers’compensation.ClaimantsarerequiredtoreportallemploymenttoDOLfor determinationofchangesinwageͲearningcapacity.However,thereisnoevidence thattheincomewasreportedtoDOL. www.oig.dhs.gov 20  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  CaseStudies Casefiledocumentationindicatedaclaimantcouldnotperformhispreviousjob. However,theclaimantwasnotmedicallyrestrictedfromworkinginanotherposition. Therewasnodocumentationshowingthattheagencymadeeffortstoreturnthe claimanttoworkinalightdutyoranotherposition.AsofJune2013,theclaimanthad receivedmorethan$256,000afterbeingclearedtoreturntowork.  TheclaimanthadaworkͲrelatedinjurythatdidnotpreventherfromworking,with restrictions.DOLinstructedICEtooffertheclaimantlightduty,butthereisno evidencethatICEdidso.Accordingtotheclaimant’sdoctor,theclaimantalsosuffered fromaseriousnonͲworkͲrelateddisease,whichpreventedherfromworking.Years later,DOLsoughtconfirmationfromtheclaimant’sdoctorthattheclaimant’sworkͲ relatedinjurycontinuedtopreventherfromreturningtowork.Thereisnoevidence thatICEperiodicallyreviewedtheclaimant’sconditiontoseeifshestillsufferedfrom theinitialworkͲrelatedinjurythatentitledhertoworkers’compensation.AsofJune 2013,theclaimanthadreceivedmorethan$231,000afterbeingclearedtoreturnto work. Casefiledocumentationindicatedaclaimantcouldworkinalimiteddutycapacity,but theclaimantcontinuedtoreceivecompensation.However,thereisnodocumentation tosupportentitlementtocontinuedcompensation.AsofJune2013,theclaimanthad receivedmorethan$179,000afterbeingclearedtoreturntowork.     www.oig.dhs.gov 21  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  AppendixD MajorContributorstoThisReport  DonaldBumgardner,Director RobertGreene,AuditManager GloriaMedinaͲOrtiz,SeniorAuditor PolinCohanne,SeniorProgramAnalyst EnriqueLeal,Auditor ShanelleJonesͲQuintanilla,ProgramAnalyst KevinDolloson,CommunicationsAnalyst DianneLeyva,Referencer   www.oig.dhs.gov 22  OIGͲ14Ͳ105 OFFICE OF INSPECTOR GENERAL Department of Homeland Security  AppendixE ReportDistribution  DepartmentofHomelandSecurity  Secretary DeputySecretary ChiefofStaff DeputyChiefofStaff GeneralCounsel ExecutiveSecretary Director,GAO/OIGLiaisonOffice AssistantSecretaryforOfficeofPolicy AssistantSecretaryforOfficeofPublicAffairs AssistantSecretaryforOfficeofLegislativeAffairs ICEAuditLiaison ChiefPrivacyOfficer  OfficeofManagementandBudget  Chief,HomelandSecurityBranch DHSOIGBudgetExaminer  Congress  CongressionalOversightandAppropriationsCommittees,asappropriate  www.oig.dhs.gov 23  OIGͲ14Ͳ105 ADDITIONAL INFORMATION To view this and any of our other reports, please visit our website at: www.oig.dhs.gov. 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