Office of Workers' Compensation Programs:

Further Actions Are Needed to Improve Claims Review

GAO-02-637: Published: May 9, 2002. Publicly Released: May 9, 2002.

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The Department of Labor's Office of Workers' Compensation Programs (OWCP) paid $2.1 billion in medical and death benefits and received about 174,000 new injury claims during fiscal year 2000. GAO found that (1) one in four appealed claims' decisions are reversed or remanded to OWCP district offices for additional consideration and a new decision because of questions about or problems with the initial claims decision; (2) OWCP set a goal of informing 96 percent of claimants within 110 days of the date of the hearing; (3) nearly all doctors used by OWCP to provide opinions on injuries claimed were board certified and state licensed, and were specialists in areas consistent with the injuries they evaluate; and (4) OWCP has used mailed surveys, telephone surveys, and focus groups to measure customer satisfaction. The Labor inspector general is monitoring fraud within OWCP's workers compensation program and using the claims examiners as one source in identifying potentially fraudulent claims.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: Office of Workers' Compensation Programs (OWCP) officials agreed with the recommendation and in response, as of July 2006, have implemented a computer system, which among other things, tracks the specific reasons claims decisions are reversed or remanded. For example, the computer system shows decisions that were reversed before the hearing because new evidence was presented and others that were remanded back to the district office before the hearing on the decision because no new evidence was presented. In a discussion with an OWCP official in July 2006, this information has enhanced OWCP's ability to analyze the reasons for remands and reversals.

    Recommendation: The Secretary of Labor should require the director of OWCP to examine the steps now being taken to determine whether more can be done to identify and track specific reasons for remands and reversals--including improper evaluation of evidence and mismanagement of claim files--and address their underlying causes.

    Agency Affected: Department of Labor

 

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