NE-TF1 Worker's Compensation Manual

Injury Reporting:  It is the responsibility of every Task Force member who incurs an injury, possible injury, or exposure to report all injuries to the Medical Team Manager if on deployment, or the Lead Instructor if during training, at the time of injury.   

 

After the Medical Team Manager or Lead instructor are notified the member must go to the ECOMP web site and complete a CA-1 form for the purpose of filing for coverage under Federal Worker's Compensation following the process documented below.   Should a member be physically or mentally unable to complete and submit the CA-1 form, the Medical Team Manager or Lead Instructor shall do so for them.  Click HERE to complete the CA-1 form.  You will need to print and scan or convert the completed form to a .pdf.  Then you will need to register with ECOMP and upload your completed CA-1.  A CA-1 form should be submitted within 24 hours of injury!   You do not need to have a confirmed injury to report.  If you think you may have been injured, or something just doesn't feel right, report it!  It is better to report and not need follow-up care than to not report and require medical treatment.

If your are a member of a Fire Department you should notify your Agency as you normally would if injured on the job.

Injured Member

STEP 1.  Register with ECOMP  

 

Step-by-Step Instructions:

   

Welcome, Register & Upload your CA-1  

                                       

Filing Claims as an Injured Worker in ECOMP

                                       

Types of Injury and Appropriate Forms

STEP 2.  LOG IN and complete and submit the OSHA 301 form, and then submit your CA-1 at https://www.ecomp.dol.gov/

STEP 3.  You will be emailed an EComp case number and ECN number.  Send these to the NE-TF1 Grant Coordinator within 24 hours.

STEP 4.  Watch for communications from the U.S. Department of Labor Worker's Compensation Office with additional instructions.  FORWARD ALL COMMUNICATIONS TO THE NE-TF1 GRANT COORDINATOR.  If you have not received any communications from them within 30 days of submitting your CA-1 in ECOMP, notify the NE-TF1 Grant Coordinator!

STEP 5. 

NON FIRE PERSONNEL:  When receiving any follow-up treatment for your injury, inform the provider that this is a Federal Worker's Comp injury. They should work directly with the Federal Office of Worker's Compensation regarding treatment approval and payment for services.  You will also need to regularly log in to your ECOMP account to check for status updates, notifications, or documentation requests.

FIRE DEPARTMENT PERSONNEL:  Once your CA-1 form has been submitted if follow-up treatment is required you should follow your agencies internal worker's compensation process.  If you find that your treatment will not be completed within 5 months of the date of the injury you need to notify the NE-TF1 Grant Coordinator ASAP.  

STEP 6.  You must forward copies of ALL correspondence that you receive from The US Department of Labor Worker's Compensation office to the NE-TF1 grant coordinator within 3 days of receiving.  You may scan and email to sschneider@lincoln.ne.gov or send via U.S.P.S. to the NE-TF1 office.

 

 

Reference: PD 2015-007 Worker's Compensation Program (WCP) Procedure

Medical Team Manager

Injury Reporting:  Once an injury or exposure has been reported to you, after notifying the Task Force Leader and treating the patent, you must fill out a CA-20, Attending Physician's Report and forward to the NE-TF1 Grant Coordinator sschneider@lincoln.ne.gov within 24 hours.  It is important that you document possible causation.  E.g. "the patient is complaining of ________.  While an affirmative diagnosis cannot be made without addition testing, the individual was climbing, lifting, kneeling which could result in. . . . ___,____,or_____"

Lead Instructors: Notify the Program Manager of any injury as soon as possible and within 24 hours  

       

Additional Federal Worker's Compensation Forms & Reference Documents

All US D.O.L Worker's Compensation Forms

Ground Zero Health Resources

US D.O.L Office of Worker's Compensation Programs (OWCP) Procedural Manual (PartsI and II )

PD 2016-114 Passing the National US&R Response System Act of 2016 (S3971)

NE-TF1 ADMINISTRATION Responsibilities

Injury Reporting:  Once an injury or exposure has been reported, the Grant Coordinator will be the keeper of all documentation and communications with the Federal Worker's Compensation office.  In ALL cases of traumatic injury completed CA-1 and CA-20 forms must be received.  If not received within 24 hours of the injury contact must be made with the member, the lead instructor, and or the medical team manager to obtain copies of those forms.

If the member or lead instructor has not provided an ECOMP & ECN Number within 24 Hours of reporting an injury contact must be made with the member or lead instructor to obtain that information.

If the member has not forwarded any documentation received from the Federal Worker's Compensation Office within 30 Days of an injury contact must first be made with the member to verify if any was received.  If no communications were received then the Grant Coordinator must contact District Office #11 at 816-268-3040 to inquire about the status of the claim.  It is their policy to send instructions via U.S.P.S. to all claimants within the first 30 days following submission of a CA-1.

The following items must be on file by NE-TF1 Administration until each claim is resolved.  Once resolved, the documents will be scanned to the injured member's personnel file.

CA-1

CA-20

Roster (Training or Deployment)

Activation & Demobilization Order if injury occurred during deployment.

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