Insult To Injury

First, a terrorist attack maims you. Then, the government jerks you around.
Everything was going as well as could be expected for Martin Cash until his teeth started falling out. Then the government said it wouldn't pay his $14,000 dental bill.

Cash got 15 new tooth implants about a year after a truck bomb destroyed the Murrah Federal Building in Oklahoma City. On the morning of April 19, 1995, Cash was in the Veterans Affairs Department's regional office on the fifth floor when the north face of the building collapsed. In the blast, he lost his left eye and a quarter-sized piece of his skull, his left shoulder was partly separated, his left wrist was shattered and an unhealthy dose of shrapnel was embedded in his forehead. A heavy blow to his jaw resulted in his loss of teeth a year later.

The government-specifically the Labor Department's Office of Workers' Compensation Programs (OWCP)-had taken good care of Cash until then. His medical bills were paid quickly, the disability checks that replaced three-fourths of his salary arrived on time, and the claims examiner dedicated to Oklahoma City bombing victims at OWCP's Dallas regional office was attentive and responsive to his calls.

But after about a year, the Dallas office returned the dedicated examiner to normal duty. The special treatment stopped, and the office began to treat Cash and other Oklahoma City survivors the same way it treats many other federal workers who file claims-badly. That's when the office refused to pay for Cash's new teeth. Or for special eyeglasses, to help him see through his remaining eye, which was damaged in the bombing.

Getting nowhere with the new claims examiner or the nurse assigned to help him, Cash called a Labor Department official in Washington to complain. "The next day, he called me back and read me the riot act, including telling me that I was to have no further contact with his employee, the nurse, and making veiled threats if I did," Cash says.

Cash wasn't the only Oklahoma City survivor who started having problems once the special treatment stopped. Eight months after the problems started, and with the help of Oklahoma City Federal Executive Board Director LeAnn Jenkins, the survivors got the Dallas office to rededicate an examiner to Oklahoma City claims. Service improved.

A year after Sept. 11, federal employees are reflecting on the terrorist attacks-from Oklahoma City to East Africa to the Pentagon-that have killed or injured hundreds of civil servants over the past seven years. Many survivors say they've been treated well by the office that is supposed to help them recover and get back to work. But others say the government has added insult to their injuries by treating them poorly. In response to injured workers' complaints, the office is struggling to improve.

BALANCING ACT

Mention the Office of Workers' Compensation Programs to federal managers, and many shake their heads in frustration. They believe that too many employees shirk work by filing fraudulent workers' compensation claims and going on disability. Federal workers' compensation, which costs the government $2 billion a year, is too generous and the workers' compensation office is too lenient, managers complain.

Mention OWCP to disabled workers, and some will send you copies of hundreds of pages of documents to show how heartless OWCP employees are. OWCP doesn't care about injured workers, they say. It only cares about saving the government money.

OWCP's 639 claims examiners in 12 regional offices handle 170,000 federal employee injury claims a year. The examiners process millions of forms and medical documents and answer 2 million to 3 million phone calls. Examiners first determine whether injuries occurred while employees were performing their regular duties. If so, examiners decide whether to provide compensation for lost wages during the recovery period and whether medical expenses are justified. While employees are off the job, examiners must determine whether they remain incapacitated or should return to work. "A claims examiner has to have a hard skin, otherwise they will get trampled," says Ed Daniel, a former OWCP claims examiner in the Dallas office. "The examiner has to try to apply the law fairly. They have to say, 'I'm sorry you have cancer and that's caused you to be disabled, but this was not caused by work-related factors.' It can get really heart wrenching sometimes, and sometimes examiners get defensive."

Even employees who have survived terrorist attacks have been on the receiving end of that defensiveness. More often, though, survivors say they're on the receiving end of silence-their phone calls aren't returned and their letters to examiners go unanswered. The documents they send to OWCP are lost. They resend them and they're lost again. Their claims are challenged or denied without adequate explanations.

Many survivors of the 1995 Oklahoma City bombing and the 1998 attacks on the U.S. embassies in Nairobi, Kenya, and Dar es Salaam, Tanzania, continue to deal with the workers' compensation office today. Many survivors report that dealing with OWCP has been a roller coaster ride: Responsive, competent claims examiners ease some interactions, while nonresponsive, incompetent examiners mar others.

CASES IN POINT

On Aug. 7, 1998, Ellen Bomer heard a pop-pop sound and was plunged into darkness. She woke up lying in 2 to 3 feet of debris. She doesn't remember the bomb blast itself. A Foreign Commercial Service officer on a temporary assignment at the U.S. embassy in Nairobi, Bomer had finished her 30-day tour of duty the day before, but she had agreed to stay on to help prepare for an upcoming visit by then-Commerce Secretary William Daley. The terrorists' bomb blast left her blind. Her arm was broken, and severe cuts covered her face and body.

Don Bomer, Ellen's husband, says OWCP was responsive early on, though a contractor hired to process medical claims seemed oddly parsimonious-approving payment for a treatment to remove marks on Ellen's face known as "debris tattoos," but refusing to pay for the anesthesiologist. Soon afterward, the Bomers were handed off to an OWCP claims examiner. "When we told her what was going on, she took immediate care of our needs," Don Bomer says. "[She] stuck by the rules, but I think she tried to treat us as fairly as possible within their constraints, and I can't fault her for that."

Things went downhill when the claims examiner passed off Bomer's case to someone else. OWCP would reimburse Bomer for drugs one time, but on subsequent claims would require additional paperwork for the same drugs. OWCP took a year to pay an anesthesiologist's bill. The office usually takes months to pay a claim, Don Bomer says.

Most frustrating to the Bomers is how long it has taken OWCP to compensate Ellen for her lost vision. Under federal law, the government pays employees for permanent damage to body parts. So-called schedule awards vary by body part and by the severity of damage. For example, complete loss of an eye, or the use of an eye, is worth about two-thirds of an employee's salary for 160 weeks. Loss of peripheral vision could be worth, say, 18 percent. Schedule awards range from 15 weeks for loss of a pinkie to 312 weeks for the loss of an arm.

It took four years, until this summer, for OWCP to offer a schedule award for Ellen's eyes. Because Ellen could see light and dark, the OWCP-designated doctor found she was due only 90 percent of the full schedule award. "Stupid," says Don Bomer. OWCP decided not to provide a schedule award for the loss of feeling in a thumb and two fingers due to nerve damage during one of Ellen Bomer's 25 surgeries since the bombing. "After we got a lawyer, OWCP changed their tune and are currently preparing to pay 100 percent on each eye and a couple of percent on her hand," Don Bomer said in mid-July.

The Bomers' experience mirrors that of Frank Pressley, a State Department worker who also was severely injured in the Nairobi bombing. Pressley's tribulations with workers' compensation were detailed in The Washington Post in March. The article described Pressley's dispute with OWCP over how much he was due for having his shoulder blown off. Three days before the article ran, and a day after the author called OWCP for comment, Pressley got a call from OWCP officials who said they would settle the dispute in Pressley's favor. A few days later, he got a check for the first installment of the schedule award. The Post ran another story saying the government finally had taken care of Pressley. "Once [OWCP] got the follow-up article, they dropped me like a lead balloon," Pressley says. He's now trying to get the office to respond to his request for faster payment of the full award.

Pressley says all his dealings with the workers' compensation office have been bumpy. Dealing with the State Department has been little better. The department is revamping its often-criticized handling of workers' compensation cases. Pressley says OWCP and State officials repeatedly would tell him his case file was in order, only to ask later for more documentation or send him for another medical exam. Every time he called OWCP for information, he got a different person; not one provided useful information. "I felt like a ping-pong ball," Pressley says. "Do this now. Now go do this. Now do this."

"The system is not a bad system," he adds. "People need to just be more responsive to customers."

BEHIND THE SCENES

For victims of the Oklahoma City and embassy bombings, the pattern of treatment by OWCP was similar: At first, when the office provided them with special treatment, they felt well cared for. As it did after Sept. 11, the office reinvented itself, at least for short periods, as a customer-first organization. For example, though New York subways weren't running Sept. 12, claims examiners walked to work so they could start on workers' compensation claims related to the World Trade Center attack. OWCP sent claims examiners to a special recovery center in Arlington, Va., near the Pentagon, to handle claims from that attack. OWCP dispatched nurses to Washington-area hospitals to help burn victims obtain services.

But once the special treatment ended, survivors of the earlier attacks fell under OWCP's standard operating procedures. Being one of 170,000 claims divided among 639 examiners was a letdown. "We became one of the many who are treated as whining toe-stubbers," Don Bomer says.

Shelby Hallmark, who heads the OWCP, is well aware of its shortcomings. Most of the 1,500 claimants who left phone messages with OWCP's district offices in July and August 2001 were treated abysmally, according to a customer satisfaction survey last year. At the best-performing office, in Boston, only 56.7 percent of claimants were satisfied with the way their calls were handled. Only 25.4 percent were satisfied with how the Washington office treated their inquiries, and the figure was 18.9 percent for Dallas. "We don't have a happy clientele, and we know that," Hallmark says.

Hallmark is betting that technology will help improve OWCP's responsiveness. Over the past two years, the office has begun investing heavily in hardware and software that will turn OWCP into a paperless operation. For years, examiners have kept claimants' files in folders, organizing them with little yellow stick-on labels. They've struggled to keep from being overwhelmed by the mounds of documents that accompany many claims.

Under the new system, all OWCP mail is routed to a London, Ky., contractor. The contractor scans the mail into a central database organized by claimant. Claims examiners can log in to the system and view any document related to a case. The system promises to resolve the complaint that OWCP loses documents. "Gradually, people will forget about the bad old days," Hallmark says.

Of course, it takes time for people to learn new systems, and OWCP's productivity fell as examiners adjusted to the new, paperless environment. Examiners still are waiting for upgrades to other parts of their computer system, much of which was designed in 1975 and runs nearly the same way now as it did 27 years ago. Examiners still waste time re-entering data into several different systems for tracking and other purposes. "The system is anything but smooth and it's in dire need of being replaced," Hallmark says. Replacement is due next year.

Already in place is a new online tracking system through which district office employees, workers' compensation officials at other agencies and even some union representatives can check the status of claims. In addition to upgrading technology, Hallmark has assigned communications specialists to each district office. The specialists try to make sure telephone systems work well and that claimants get quick answers to their questions. The office also is preparing to outsource its handling of medical bills. "We are a program in transition," Hallmark says.

People with complaints about OWCP generally want two things. They want claims examiners to be nicer to them. And, of course, they want their claims approved. Former claims examiner Ed Daniel now assists claimants dealing with OWCP. He has seen the system from the inside: "Claims examiners are human beings," he says. "There are bad apples and good apples. If you come to them in a belligerent manner, they're going to act in the same way." And he has seen it from the outside: "Claimants didn't ask to be injured. They were the breadwinners. They could go hunting; they could go fishing. Those are things they can no longer do, and they're angry about it," Daniel says. "They direct that anger to the people in OWCP, because now some faceless bureau- crat in another state has total control over their livelihood."

The psychology of workers' compensation and injuries further complicates the system. For example, studies have found that employees with unsupportive supervisors are less likely to return to work than employees with supportive supervisors. The more stressful the work environment, the longer an employee is likely to stay out on disability. "When we look at predictors of time off work, most of it is social support, ergonomic factors in the workplace, how the supervisor reacts to the worker, and how the work is paced," says Dr. Michael Feuerstein, a specialist in such issues at the Uniformed Services University of the Health Sciences, the Defense Department's medical school.

Those factors often play roles in cases involving claims of post-traumatic stress disorder (PTSD), acute stress and chronic pain. A Customs Service employee who worked at Six World Trade Center has been out of work on disability since September. The woman, who requested anonymity, says she is suffering from PTSD. She says the nurse assigned to her by OWCP has been helpful in getting forms processed and questions answered, but it's impossible to get OWCP claims examiners to respond to her inquiries.

More troubling, though, is the treatment she has received from the Customs Service. "The agency is not responsive to any kind of accommodation," she says. "Under the doctor's advice, I was encouraged not to go back to work. But I felt pressure from the agency. They wanted me to get back." She's been fighting for a transfer out of New York because the memories of Sept. 11 are too much for her, but so far, the agency isn't sympathetic. "My goal is to not stay on disability," she says. "But I don't want to live here anymore."

Such cases show how tough it is to balance the competing demands of claimants and their employers. Should the woman be held responsible for her inability to cope with Sept. 11? Or should OWCP and Customs do their best to help the employee get back to work wherever she would be most comfortable doing so? Hallmark says it's OWCP's duty to take care of injured workers and to watch out for the bottom line. "We have an obligation to the taxpayer and to the employer to administer the program in a fair way," he says. "Return to work is the goal."

In fact, many survivors of terrorist attacks have great things to say about OWCP, praising the office's quick responses and efficient service. "From the very beginning, I have received benefits in a timely manner and have been treated with respect every time I have had to contact OWCP," says Jenny Parsley, a Housing and Urban Development employee in Oklahoma City. She received counseling after the 1995 bombing as well as after Sept. 11, when the attacks triggered a need for follow-up. In both cases, OWCP made it easier to get the service. "When OWCP has denied claims, I feel confident they had cause. I feel sorry for those who think the government owes them for the rest of their lives," she says.

John Morrissey is another satisfied OWCP customer-albeit a patient one.

On Sept. 11 at 10:30 a.m., the Federal Emergency Management Agency activated Morrissey and the rest of the Massachusetts Task Force 1 Urban Search and Rescue Team. Twelve hours later, the team was at Ground Zero. Morrissey, a medical team manager and paramedic, spent the next six days in the search for survivors and remains in the World Trade Center's rubble. On Sept. 16, he fell off a metal beam and dropped 30 feet before grabbing another beam, where a fellow crew member hoisted him to safety. Had he fallen another 20 feet, he would have landed in a tangled pile of steel bars. He noted that fact, felt a strain in his shoulder and kept working through the next day. It wasn't until he got back to Massachusetts that he realized he had torn his rotator cuff, a group of muscles covering the shoulder. He ended up in surgery for three hours and spent five months out of work.

Morrissey says the claims examiners at OWCP, the workers' compensation coordinator at FEMA and the nurse manager assigned by OWCP to his case were very helpful, quickly approving all of his procedures and prescriptions. Whenever he needed medical help, one of them took care of it. "I wish state workers' compensation worked as well as federal workers' compensation," Morrissey says. "It was a pleasant experience, other than a little wait."

The little wait was the 10 weeks that Morrissey went without a paycheck. He chalks it up to bureaucracy-various offices had to coordinate to figure out how to compensate him because he is paid a different salary when he's working for FEMA than when he works his usual job with American Medical Response, a paramedic firm in Natick, Mass. He and his wife, a social worker, lived off their savings for two-and-a-half months. Then he called his nurse manager and told her that they wouldn't be able to make their mortgage payment the next month if he didn't get paid. The nurse manager worked the bureaucracy for three days and got the disability checks rolling until Morrissey went back to work. "Waiting for the money was frustrating," Morrissey says. "But it was fine once everything was squared away."

So far, most Sept. 11 claimants are positive about OWCP, though some are starting to feel pressure to return to work before they think they're ready. Sept. 11 claimants who stay out of work for a long time may be treated the same way as the Oklahoma City and embassy bombing survivors.

But that may just be the way it is with a small bureaucracy that has to handle hundreds of thousands of cases involving complex medical and psychological issues.

Hallmark expects the changes at OWCP to better satisfy all claimants. He also has been working with Bush administration officials on a legislative reform package aimed at controlling the costs of the program. In the end, he says, his program cannot satisfy all the people all the time. "You're going to have a cohort of people who are always going to be unhappy because they don't get the outcome they wanted."

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