OPM Risks Paying Workers’ Comp for Employees Who Are No Longer Injured

Watchdog recommends that OPM take a more active role in verifying eligibility for long-term benefits.

The Office of Personnel Management may inadvertently be paying workers’ compensation to employees who no longer qualify for the benefit, the agency’s watchdog concluded in a new report.

“OPM’s long-term [Federal Employees Compensation Act] cases may be vulnerable to possible fraudulent payments,” the inspector general’s report stated. “During our evaluation, we identified 15 FECA cases where either the injured employee or the surviving family member had been receiving FECA payments with very limited verification of continued eligibility.”

The Labor Department’s Office of Workers’ Compensation Programs is primarily responsible for checking that federal employees are still eligible for the benefit, the IG report noted. The office collects medical and non-medical evidence from workers’ comp beneficiaries to ensure they still qualify, but there are weaknesses in this process, the report said. For instance, “even though long-term injured employees may be required to provide medical evidence as additional verification for continued compensation, it is not always on an annual basis, allowing a window of opportunity for the risk of fraudulent payments,” the IG found.

Given this weakness, OPM should undertake its own process for verifying eligibility, the IG said. Although Labor administers the workers’ comp program, OPM ultimately foots the bill for its employees who collect payments. The agency paid out $2.49 million in workers’ compensation benefits for 153 work-related injuries, diseases and deaths in fiscal 2015, the time period the IG examined. Of that sum, 76 percent, or $1.91 million, went specifically to wage compensation.

Agency officials disagreed with the IG’s recommendation, saying the responsibility for verifying eligibility fell with the Labor Department. “We have found that DoL complies with its obligations, and the agency does not have the authority or responsibility to replicate this process,” OPM stated. Officials did agree, however, to monitor workers’ comp cases for proper documentation as part of an agency quality review process. The watchdog said this addressed its recommendation.