UNCLASSIFIED (U)

3 FAM 3660

COmpensation for certain injuries

(CT:PER-994;   05-28-2020)
(Office of Origin:  GTM/ER; MED)

3 FAM 3661  AUTHORITY AND PURPOSE

(CT:PER-994;   05-28-2020)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Foreign Service and Civil Service Employees)

a. Pursuant to Public Law 116-94, Division J, Title IX, section 901, Congress allows the Secretary of State to pay benefits to certain Department of State personnel under chief of mission authority who incurred a qualifying injury and are receiving benefits under section 8105 or 8106 of Title 5, United States Code.  It further authorizes the Secretary of State to pay for the costs of diagnosing and treating a qualifying injury of a covered employee, as defined in 3 FAM 3662, that are not otherwise covered by chapter 81 of Title 5, United States Code (the Federal Employees Compensation Act (FECA)) or other provision of Federal law; and to pay the costs of diagnosing and treating a qualifying injury of a covered individual or covered dependent, as defined in 3 FAM 3662, that are not otherwise covered by Federal law.

b. The Bureau of Global Talent Management (GTM) administers this program.

c.  Under this program, covered employees, as defined in 3 FAM 3662, may qualify for a monthly monetary benefit if they are receiving benefits under section 8105 or 8106 of Title 5, United States Code.

d. Under this program, a covered employee, covered individual, or covered dependent, as defined below, may qualify for reimbursement for the costs of diagnosing and treating a qualifying injury which are not otherwise covered.

e. Payments made under this provision are not considered workers' compensation payments.

3 FAM 3662  DEFINITIONS

(CT:PER-994;   05-28-2020)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Foreign Service and Civil Service Employees)

Covered employee:  An employee of the Department of State who, on or after January 1, 2016, becomes injured by reason of a qualifying injury and was assigned to a duty station in the Republic of Cuba, the People's Republic of China, or another foreign country as designated by the Secretary of State under 3 FAM 3666.

(1)  For purposes of 3 FAM 3663, the following career-type employees are considered "employees of the Department of State" to whom this benefit may apply:  Department of State Foreign Service Officers, Department of State Foreign Service Specialists, and career Department of State Civil Service employees working overseas on detail or a Limited Non-Career Appointment (LNA).

      The following are not considered "employees of the Department of State" for purposes of 3 FAM 3663:  retired employees and employees of other agencies; employees on limited appointments including LNAs (except as discussed above), Family Member Appointments (FMA), Foreign Service Family Reserve Corps (FSFRC), Expanded Professional Associates Program (EPAP), and Consular Affairs - Appointment Eligible Family Member (CA-AEFM) Adjudicator positions. Employees hired on a Personal Services Agreement (PSA) or Personal Services Contract (PSC) are also not employees under this section. 

(2)  For purposes of 3 FAM 3664, the following employees are considered "employees of the Department of State" to whom this benefit may apply: Department of State Foreign Service Officers; Department of State Foreign Service Specialists; Department of State Civil Service employees; employees on Limited Non-Career Appointments (LNA), Family Member Appointments (FMA), Foreign Service Family Reserve Corps (FSFRC), Expanded Professional Associates Program (EPAP), and Consular Affairs - Appointment Eligible Family Member (CA-AEFM) Adjudicator positions.

      The following are not considered "employees of the Department of State" for purposes of 3 FAM 3664:  employees hired on a Personal Services Agreement (PSA) or Personal Services Contract (PSC); retired employees, and employees of other agencies.

Covered individual:  An individual who, on or after January 1, 2016, becomes injured by reason of a qualifying injury and is

(1)  detailed to a duty station in the Republic of Cuba, the People's Republic of China, or another foreign country designated by the Secretary of State under 3 FAM 3666; or

(2)  affiliated with the Department of State, as determined by the Secretary of State.

(3)  Per Memorandum signed 24 April 2020, the Under Secretary for Management has determined that other agency employees under chief of mission authority are "affiliated with the Department of State."

Covered dependent:  A family member of a Federal employee who, on or after January 1, 2016,

(1)  accompanies the employee to an assigned duty station in the Republic of Cuba, the People's Republic of China, or another foreign country designated by the Secretary of State under 3 FAM 3666; and

(2)  becomes injured by reason of a qualifying injury.

Family member:  An individual who is an "Eligible Family Member" as defined in 14 FAM 511.3.

Qualifying injury:  The term "qualifying injury" means the following:

(1)  With respect to a covered dependent, an injury listed in (3) below incurred

(a)  during a period in which a covered dependent is accompanying an employee to an assigned duty station in the Republic of Cuba, the People's Republic of China, or another foreign country designated by the Secretary of State under 3 FAM 3666;

(b)  in connection with war, insurgency, hostile act, terrorist activity, or other incident designated by the Secretary of State; and

(c)  that was not the result of the willful misconduct of the covered dependent.

(2)  With respect to a covered employee or a covered individual, an injury listed in (3) below incurred

(a)  during a period of assignment to a duty station in the Republic of Cuba, the People's Republic of China, or another foreign country designated by the Secretary of State under 3 FAM 3666;

(b)  in connection with war, insurgency, hostile act, terrorist activity, or other incident designated by the Secretary of State; and

(c)  that was not the result of the willful misconduct of the covered employee or covered individual.

(3)  Recognized and eligible qualifying injuries, as of 26 June 2018, based on the University of Pennsylvania-identified criteria, include the following:  sharp localized ear pain; dull unilateral headache; tinnitus in one ear; vertigo, visual focusing issues; disorientation; nausea; extreme fatigue; cognitive problems, including difficulty with concentration, working memory, and attention; recurrent headache; high-frequency unilateral hearing loss; sleep disturbance; and imbalance walking.

3 FAM 3663  MONTHLY MONETARY BENEFIT   

(CT:PER-994;   05-28-2020)
(State only)
(Applies to Foreign Service and Civil Service Employees)

a.  The Department may pay an additional monthly monetary benefit to a covered employee who is receiving benefits under section 8105 or 8106 of Title 5, United States Code (FECA), and may determine the amount of each monthly monetary benefit amount by taking into account -

(1)  the severity of the qualifying injury;

(2)  the circumstances by which the covered employee became injured; and

(3)  the seniority of the covered employee, particularly for purposes of compensating for lost career growth.

b. The Bureau of Global Talent Management, Office of Employee Relations Care Coordination team (GTM/ER/Care Coordination) is responsible for processing applications for the monthly monetary benefit, in coordination with the Office of Performance Evaluation (GTM/PE), the Office of the Comptroller and Global Financial Services (CGFS), and the Office of the Under Secretary for Management (M).

c. Eligibility for the monthly monetary benefit is limited to covered employees, as defined in 3 FAM 3662.  Employees on non-career-type limited appointments are not eligible for this benefit, which was designed to address lost career growth due to qualifying injury.

d. Eligible employees may apply for the monthly monetary benefit if they believe they have sustained lost career growth (e.g., promotion) due to a qualifying injury.  To apply for the benefit, they must submit the documentation listed in 3 FAM 3665.1 via email to the Senior Care Coordinator (HRCWG@state.gov).

e. Additionally, employees on FECA leave without pay (LWOP) receiving full wage loss compensation under section 8105 of chapter 81 of Title 5 may submit a claim for a monthly monetary benefit in the amount of any missed step increase that they would have been eligible to receive if they had been working and performing in a satisfactory fashion.

3 FAM 3664  MEDICAL COST REIMBURSEMENTS

(CT:PER-994;   05-28-2020)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Foreign Service and Civil Service Employees)

a. Costs for Treating Qualifying Injuries.  The Department may pay the costs of or reimburse for diagnosing and treating:

(1)  a qualifying injury of a covered employee for such costs, that are not otherwise covered by chapter 81 of Title 5, United States Code, or other provision of Federal law; or

(2)  a qualifying injury of a covered individual, or covered dependent, for such costs that are not otherwise covered by Federal law. 

b. The State Department's Bureau of Medical Services (MED) is responsible for accepting and processing claims under this section for reimbursement of the costs of diagnosing and treating qualifying injuries, in coordination with CGFS.

c. Eligibility:  Covered employees, covered individuals, and covered dependents as defined in 3 FAM 3662 may be eligible for payment or reimbursement of medical costs related to the qualifying injury. 

d. Covered Employees:  FECA remains the sole recourse for Federal employees for costs associated with diagnosing and treating a work-related injury.  Employees must file a claim under FECA with respect to the qualifying injury before filing for payment or reimbursement from MED under this section. The Department may only pay the costs of or reimburse for diagnosing and treating a qualifying injury that are not otherwise covered under FECA, or other provision of Federal law. 

(1)  If an employee's claim under FECA is for medical costs related to a qualifying injury is denied, the employee must supply information requested by the Department of Labor's Office of Workers' Compensation Programs and receive a final decision from OWCP.  An OWCP decision that denies medical benefits on the ground that the employee failed to respond to inquiries and failed to submit any supportive evidence is insufficient to establish that the costs are not covered by FECA. 

(2)  If the employee's FECA claim is unsuccessful, the employee must then make a claim through their primary health insurance. 

(3)  An employee may file a claim for reimbursement with MED, as provided in 3 FAM 3665.2, only after completing the actions described in subparagraphs (1) and (2).

e. Covered individuals:  FECA remains the sole recourse for Federal employees for costs associated with diagnosing and treating a work-related injury.  Covered individuals who are Federal employees must file a claim under FECA with respect to the qualifying injury before filing for payment or reimbursement from MED under this section. The Department may only pay the costs of or reimburse for diagnosing and treating a qualifying injury that are not otherwise covered under FECA, or other provision of Federal law.

(1)  If a covered individual's (who is a Federal employee) claim under FECA for medical costs related to a qualifying injury is denied, the individual must supply information requested by the Department of Labor's Office of Workers' Compensation Programs and receive a final decision from OWCP.  An OWCP decision that denies medical benefits on the ground that the individual failed to respond to inquiries and failed to submit any supportive evidence is insufficient to establish that the costs are not covered by FECA. 

(2)  If the individual's claim is unsuccessful, the individual must then make a claim through their primary health insurance. 

(3)  A covered individual may file a claim for reimbursement with MED, as provided in 3 FAM 3665.2, only after completing the actions described in subparagraphs (1) and (2).  

f. Covered dependents:  Covered dependents with qualifying injuries, as defined in 3 FAM 3662, must first file a claim under their primary health insurance. 

(1)  If private health insurance denies the claim or does not pay it in full, the dependent must file an appeal.

(2)  If the claim is accepted, but not paid in full, the claim must be appealed.  After the appeal is completed, the dependent may then file a claim for reimbursement of the unreimbursed cost of treatment with MED, as provided in 3 FAM 3665.2.  Private insurance copays for dependents are eligible for reimbursement by MED.

3 FAM 3665  RESPONSIBILITIES

3 FAM 3665.1  Covered Employees - Monthly Monetary Benefit

(CT:PER-994;   05-28-2020)
(State only)
(Applies to Foreign Service and Civil Service Employees)

Covered employees are responsible for:

(1)  Assembling the following required documentation for a monthly monetary benefit claim:

(a)  a copy of travel orders showing assignment and travel, on or after January 1, 2016, to a duty station in Cuba, China, or another foreign country designated by the Secretary of State;

(b)  a copy of the Department of Labor FECA claim acceptance letter;

(c)  a copy of the Department of Labor FECA letter that outlines the employee's payment and computation of payment; and

(d)  a short statement from the employee describing the harm to potential career growth that the employee believes they have suffered.  The statement should address their career growth only and should not include any medical information. 

(2)  Submitting the required application documentation to the GTM/ER/Care Coordination team (HRCWG@state.gov) to apply for the monthly monetary benefit; and

(3)  Providing any additional documentation or information to the GTM/ER/Care Coordination team, as requested.

3 FAM 3665.2  Covered Employees, Covered Individuals and Covered Dependents - Medical Cost Reimbursement

(CT:PER-994;   05-28-2020)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Foreign Service and Civil Service Employees)

Covered Employees, covered individuals, and covered dependents are responsible for:

(1)  Assembling documentation required for submitting a claim for reimbursement of qualifying medical diagnosis or treatment costs.  Covered employees and covered individuals may submit documentation for their covered dependents.

(a)  The following documentation is required:

(i)  a copy of travel orders showing assignment and travel, on or after January 1, 2016, to a duty station in Cuba, China, or another foreign country designated by the Secretary of State;

(ii)  copies of the Explanation of Benefits (EOB) or other bills from your private insurance that show the diagnosis codes from your claim; and

(iii)  documentation of your out-of-pocket expenses, and documentation that you paid them.

(b)  Do not send copies of your medical files or medical history.

(2)  Submitting the documentation to MED via email (MEDCLAIMS@state.gov).  The applicant should use the following email subject line:  Last name, First name - 3 FAM 3664.

(3)  Providing any additional relevant documentation to MED related to submitted claims, as requested.

3 FAM 3665.3  Bureau of Global Talent Management, Office of Employee Relations (GTM/ER)

(CT:PER-994;   05-28-2020)
(State only)
(Applies to Foreign Service and Civil Service Employees)

The GTM/ER Care Coordination team coordinates the monthly monetary benefit application process and has responsibility to:

(1)  Process applications for the monthly monetary benefit from employees;

(2)  In coordination with the Bureau of Global Talent Management Performance Evaluation Office (GTM/PE), the Bureau of the Comptroller and Global Financial Services (CGFS), and the Office of the Under Secretary for Management (M), determine eligibility for the benefit, the amount of the benefit, and process payment of the benefit; and

(3)  Notify employees upon receipt of their applications and when a monthly monetary benefit decision is made.

3 FAM 3665.4  Bureau of Medical Services (MED)

(CT:PER-994;   05-28-2020)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Foreign Service and Civil Service Employees)

The Bureau of Medical Services (MED) will accept applications for payment or reimbursement and has responsibility to:

(1)  Receive applications for reimbursement of diagnosis and treatment of qualifying injuries via email (MEDCLAIMS@state.gov);

(2)  Process applications for reimbursement of diagnosis and treatment of qualifying injuries as defined in 3 FAM 3662.

(3)  Notify employees of the status of their applications for the payment or reimbursement benefit;

(4)  Track and share information related to amounts paid for treatment of qualifying injuries, as defined in 3 FAM 3662, to Federal employees on a quarterly basis with the Department of Labor, to avoid duplicate or otherwise improper payments.  

3 FAM 3665.5  Bureau of Global Talent Management Office of Performance Evaluations (GTM/PE)

(CT:PER-994;   05-28-2020)
(State Only)
(Applies to Foreign Service and Civil Service Employees)

In coordination with GTM/Office of Organization and Talent Analytics (OTA), GTM/PE has the responsibility to, upon request from GTM/ER, compile promotion statistical data for employees in the same cone or specialty and with similar lengths of service as the applicant, and provide it to GTM/ER.  GTM/ER will use the data to determine whether a covered employee applicant has likely suffered lost career growth based upon a comparison of the average promotion time for the similarly situated group and the applicant.  GTM/ER will make a recommendation to M to approve (or not approve) the application for the monthly monetary benefit.

3 FAM 3665.6  Bureau of the Comptroller and Global Financial Services (CGFS)

(CT:PER-994;   05-28-2020)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Foreign Service and Civil Service Employees)

a. Upon receipt from GTM/ER, the Office of Global Compensation (CGFS/GC) will process all approved monthly monetary benefit payments.

b. Upon receipt from MED, the Office of Claims (CGFS/F/C) will process payments for all approved claims.

3 FAM 3665.7  Office of the Under Secretary of State for Management (M)

(CT:PER-994;   05-28-2020)
(State Only)
(Applies to Foreign Service and Civil Service Employees)

The Under Secretary of State for Management will:

      Upon receipt of an Action Memo from GTM/ER, review and make a final determination on a covered employee's monthly monetary benefit application.

3 FAM 3666  Secretary of State Country Designation

(CT:PER-994;   05-28-2020)
(Uniform State/USAID/USAGM/Commerce/Foreign Service Corps-USDA)
(Applies to Foreign Service and Civil Service Employees)

a. Under Public Law 116-94, Division J, Title IX, section 901, the Secretary of State may designate another foreign country for the purposes of this section, provided that the Secretary reports such designation to the Committee on Foreign Relations of the Senate and the Committee on Foreign Affairs of the House of Representatives, and includes in such report a rationale for each such designation.

b. The Secretary of State may not designate an added foreign country or duty station for the purposes of providing additional monetary benefit pursuant to 3 FAM 3663 or 3 FAM 3664 for a qualifying injury to covered employees, covered dependents, or covered individuals under this section unless the Secretary of State

(1)  provides to the Committees on Foreign Relations of the Senate and the Committee on Foreign Affairs of the House of Representatives 30 days' notice of the designation of a particular additional country or duty station and the rationale for such an addition; and

(2)  provides no such additional monetary benefit pursuant to 3 FAM 3663 or 3 FAM 3664  to covered employees, covered dependents, or covered individuals for a qualifying injury until the 30-day notice period expires, unless there is written agreement by both the Chair and Ranking Members of both the Committee on Foreign Relations of the Senate and the Committee on Foreign Affairs of the House of Representatives that there is no objection to proceeding with provision of such monetary benefit compensation in less than 30 days.

3 FAM 3667 THROUGH 3669  UNASSIGNED

 

 

UNCLASSIFIED (U)