Workers' Compensation Claims Examiner (2024)

Department of Labor

Office of Workers' Compensation Programs

Division of Energy Employees Occupational Illness Compensation

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Summary

This position is located in the Department of Labor (DOL), Office of Workers' Compensation Programs (OWCP), Division of Energy Employees Occupational Illness Compensation (DEEOIC), Final Adjudication Branch (FAB).

This position is 100% remote. Salary posted reflects nationwide locality pay range. Once the selection has been made, the salary will be set per the selectee's home worksite.

This position is inside the bargaining unit.

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Overview

  • Accepting applications
  • Open & closing dates

    05/17/2024 to 05/30/2024

  • Salary

    $103,409 - $167,336 per year

  • Pay scale & grade

    GS 13

  • Help

    Location

    2 vacancies in the following location:

    • Anywhere in the U.S. (remote job)

  • Remote job

    Yes

  • Telework eligible

    Not applicable, this is a remote position.

  • Travel Required

    Occasional travel - You may be expected to travel up to 5% of the time for this position.

  • Relocation expenses reimbursed

    No

  • Appointment type

    Permanent

  • Work schedule

    Full-time

  • Service

    Competitive

  • Promotion potential

    None

  • Job family (Series)

    0991 Worker's Compensation Claims Examining

  • Supervisory status

    No

  • Security clearance

    Not Required

  • Drug test

    No

  • Position sensitivity and risk

    Moderate Risk (MR)

  • Trust determination process

    Credentialing

    Suitability/Fitness

  • Announcement number

    MS-24-PHIL-OWCP-12415215-LS

  • Control number

    791795400

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This job is open to

  • Career transition (CTAP, ICTAP, RPL) Federal employees who meet the definition of a "surplus" or "displaced" employee.
  • Internal to an agency Current federal employees of this agency.

Clarification from the agency

Open to all current DOL Office of Workers' Compensation Program employees with competitive status, and CTAP eligibles.

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Duties

This position serves as the FAB's authority and representative in reviewing claims, conducting hearings, and issuing determinations.

Major duties of this position include:

  • Independently reviews the evidence of record and the recommended decisions issued by the DEEOIC District Offices for factual and legal accuracy prior to scheduling a hearing. Responsibilities include: researching the associated employment-related illness; thoroughly reviewing and evaluating voluminous evidentiary documents (e.g., medical reports, employment evidence, hearing transcripts, exposure information, medical documentation, and other types of documents submitted to support a claim for benefits) from a variety of sources that the District Office used as the basis for the recommended decision; carefully analyzing, cross-checking, and interpreting data; and determining whether or not the recommended decision has been properly adjudicated.
  • Schedules and conducts hearings by telephone, videoconferencing, and in-person. Hearings are non-adversarial, and proceedings are not limited by legal rules of evidence or procedures. Participates on interagency taskforces, workgroups, and industry groups (e.g., State or private sector) within area of expertise to develop and implement more effective business processes.
  • Collaborates with other claims examiners and hearing representatives in adjudicating complex and unusual cases to ensure each case is properly reviewed and each decision is factually accurate. Conducts research into, and analysis of complex court decisions, policies, and procedures.
  • Reviews claimant requests for reconsideration of final decisions with delegated authority to finalize or modify decisions of the initial claims examiner. This involves screening the case to determine if the new evidence or correspondence constitutes a request for reconsideration; determining if the request was timely filed; collaborating with the District Office with jurisdiction over the claim for review; and issuing a final decision or order to grant or deny the reconsideration request.
  • As an Energy Employees Occupational Illness Compensation Program Act (EEOICPA) technical expert, advises interested parties (e.g., claimants, medical providers, unions, Solicitor's office, survivors, OWCP staff, authorized representatives, etc.) by telephone and/or in writing of applicable provisions of the EEOICPA in accordance with established procedures and precedents furnished in decisions emanating from the Final Adjudication Branch and various Federal courts.
  • Serves a key role in providing mentoring, guidance, and training to new staff as well as reviewing the work of FAB claims' examiners to ensure that they are fully prepared to draft decisions in accordance with the law and governing regulations, policies, and procedures.
  • Crafts a final decision to either affirm the recommended decision or remand the case back to the District Office for further development and the issuance of a new recommended decision.
  • Crafted documents are a complete decision or order based on a thorough review of a wide array of medical, employment, and other related evidence.

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Requirements

Conditions of Employment

  • Must be a U.S. Citizen.
  • Must be at least 16 years old.
  • Candidate required to obtain the necessary security/investigation level.
  • Requires a probationary period if the requirement has not been met.

Qualifications

In describing your experience, please be clear and specific. Position titles alone cannot be used to determine if you are qualified. Please list dates in MM/DD/YYYY format. This is imperative in determining if you have at least one year of creditable specialized experience. Dates will not be assumed.

Specialized Experience is the experience that equipped the applicant with the particular knowledge, skills, and abilities (KSA's) to perform the duties of the position successfully, and that is typically in or related to the position to be filled. To be creditable, specialized experience must have been equivalent to at least the next lower grade level.

For the GS-13 grade level: applicants must have 52 weeks of specialized experience equivalent to at least the next lower grade level, GS-12, in the Federal service. Qualifying specialized experience includes:

  • Applying the Division of Energy Employees' Occupational Illness Compensation Act related laws, regulations, program policies, procedures, and operational practice to controversial benefits claims.
  • Communicating technical information to internal or external customers to resolve complicated issues or concerns.
  • Issuing decisions on workers' compensation benefits.
  • Adjudicating highly complex cases for benefits based on evidence.

Education

There is no substitution of education for experience at this grade level.

Additional information

Read more

How You Will Be Evaluated

You will be evaluated for this job based on how well you meet the qualifications above.

Evaluation Factors (Competencies) - All qualified applicants will be evaluated on the following key competencies:

  • Oral Communication
  • Problem Solving
  • Technical Competence
  • Writing

Click here for evaluation details.

You may preview questions for this vacancy here: https://apply.usastaffing.gov/ViewQuestionnaire/12415215

The information you provide may be verified by a review of your paid, unpaid, volunteer, and other lived experience, as it demonstrates the competencies or skills required for the position to be filled. Your evaluation may include an interview, reference checks, or other assessment conducted by HR specialists, subject matter experts, or panel members and may include other assessment tools (ex. interview, structured interview, written test, work sample, etc.). The examining Office of Human Resources (OHR) makes the final determination concerning applicant ratings. Your resume MUST provide sufficient information to substantiate your vacancy question responses. If not, the OHR may amend your responses to more accurately reflect the level of competency indicated by the content of your resume.

INFORMATION FOR CTAP ELIGIBLE(S) ONLY: If you are eligible for special priority selection under CTAP, you must be well-qualified for the position to receive consideration. CTAP eligible(s) will be considered well-qualified if they attain at least a rating score of 85 in a numerical rating scheme. Be sure to review the eligibility questions to reflect that you are applying as a CTAP eligible and submit supporting documentation.

  • As a new or existing federal employee, you and your family may have access to a range of benefits. Your benefits depend on the type of position you have - whether you're a permanent, part-time, temporary or an intermittent employee. You may be eligible for the following benefits, however, check with your agency to make sure you're eligible under their policies.

    The following documents must be submitted by 11:59 p.m. (ET) on the vacancy closing date.

    ELIGIBILITY REQUIREMENTS: Applicants must meet the eligibility requirements of time-in-grade (52 weeks at the next lower grade), time-after-competitive-appointment (90 days), and minimum qualifications (52 weeks equivalent to the next lower grade in federal service). These requirements must be met within 30 days of 05/30/2024 the announcement closing date.

    The following documents are required from all applicants (PLEASE READ CAREFULLY):

    • STATUS FEDERAL EMPLOYEES: If applying as a status candidate with current or former Federal Service, please provide a copy of your last or most recent SF-50, Notification of Personnel Action which shows your appointment eligibility for the position for which you are applying. Your SF-50 must identify the highest grade you held on a permanent basis, Pay Plan/Pay Schedule, Series, Grade/Pay Band, and career status. Multiple SF-50 may be submitted to demonstrate your highest previous rate and eligibility.

    *WARNING: An award SF-50 (ex. cash or time off award) may not indicate grade, step, and competitive status. For current DOL employees, an award SF-50 DOES NOT indicate grade and step.

    • Resumes are required- provide a resume either by creating one in USAJOBS or uploading one from your profile. To receive full consideration for relevant and specialized experience, please list the month, year, and number of work hours worked for experience listed on your resume. We also suggest that you preview the vacancy questions, and confirm that your resume supports your question responses.
    • Most recent performance appraisal/evaluation signed and dated within 18 months is requested by the agency, but will not disqualify candidates if not submitted. If not submitted during the application process, one may/will be requested at the time of the interview if the opportunity is extended. *In most cases, CTAP applicants must submit this document - see the CTAP link below for more details.

    The following documents are required (if applicable):

    • Displaced Employee Placement Documents: Only required if requesting priority consideration under Career Transition Assistance Plan (CTAP) Eligibility. Click/Review this CTAP link to confirm what must be submitted as proof that the requirement has been met.

    Cover Letters are not mandatory and will not be used to verify experience but may be submitted.

    Do not upload password-protected documents.

    Applicants selected for employment who are not current DOL employees will be required to provide proof of citizenship, and the E-Verify system will be used to confirm the employment eligibility of all new hires.

  • Agency contact information

    Linda Stowell

    Phone

    215-861-5032

    Email

    stowell.linda.m@dol.gov

    Address
    Office of Workers Compensation Programs
    200 Constitution Avenue NW
    Washington, DC 20210
    US

    Learn more about this agency

    Next steps

  • The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

    • Equal Employment Opportunity (EEO) Policy
    • Criminal history inquiries
    • Reasonable accommodation policy
    • Financial suitability
    • Selective Service
    • New employee probationary period
    • Signature and false statements
    • Privacy Act
    • Social security number request

Help

Required Documents

The following documents must be submitted by 11:59 p.m. (ET) on the vacancy closing date.

ELIGIBILITY REQUIREMENTS: Applicants must meet the eligibility requirements of time-in-grade (52 weeks at the next lower grade), time-after-competitive-appointment (90 days), and minimum qualifications (52 weeks equivalent to the next lower grade in federal service). These requirements must be met within 30 days of 05/30/2024 the announcement closing date.

The following documents are required from all applicants (PLEASE READ CAREFULLY):

  • STATUS FEDERAL EMPLOYEES: If applying as a status candidate with current or former Federal Service, please provide a copy of your last or most recent SF-50, Notification of Personnel Action which shows your appointment eligibility for the position for which you are applying. Your SF-50 must identify the highest grade you held on a permanent basis, Pay Plan/Pay Schedule, Series, Grade/Pay Band, and career status. Multiple SF-50 may be submitted to demonstrate your highest previous rate and eligibility.

*WARNING: An award SF-50 (ex. cash or time off award) may not indicate grade, step, and competitive status. For current DOL employees, an award SF-50 DOES NOT indicate grade and step.

  • Resumes are required- provide a resume either by creating one in USAJOBS or uploading one from your profile. To receive full consideration for relevant and specialized experience, please list the month, year, and number of work hours worked for experience listed on your resume. We also suggest that you preview the vacancy questions, and confirm that your resume supports your question responses.
  • Most recent performance appraisal/evaluation signed and dated within 18 months is requested by the agency, but will not disqualify candidates if not submitted. If not submitted during the application process, one may/will be requested at the time of the interview if the opportunity is extended. *In most cases, CTAP applicants must submit this document - see the CTAP link below for more details.

The following documents are required (if applicable):

  • Displaced Employee Placement Documents: Only required if requesting priority consideration under Career Transition Assistance Plan (CTAP) Eligibility. Click/Review this CTAP link to confirm what must be submitted as proof that the requirement has been met.

Cover Letters are not mandatory and will not be used to verify experience but may be submitted.

Do not upload password-protected documents.

Applicants selected for employment who are not current DOL employees will be required to provide proof of citizenship, and the E-Verify system will be used to confirm the employment eligibility of all new hires.

Help

How to Apply

Read more

Agency contact information

Linda Stowell

Phone

215-861-5032

Email

stowell.linda.m@dol.gov

Address
Office of Workers Compensation Programs
200 Constitution Avenue NW
Washington, DC 20210
US

Learn more about this agency

Next steps

Read more

Fair & Transparent

The Federal hiring process is set up to be fair and transparent. Please read the following guidance.

  • Equal Employment Opportunity (EEO) Policy
  • Reasonable accommodation policy
  • Criminal history inquiries
  • Financial suitability
  • Selective Service
  • New employee probationary period
  • Signature and false statements
  • Privacy Act
  • Social security number request

This job originated on www.usajobs.gov. For the full announcement and to apply, visit www.usajobs.gov/job/791795400. Only resumes submitted according to the instructions on the job announcement listed at www.usajobs.gov will be considered.

Workers' Compensation Claims Examiner (2024)

FAQs

What not to say to a Workmans Comp adjuster? ›

For this reason, you should avoid giving any personal or unnecessary information, especially if it can be misconstrued by the adjuster. Some examples of statements in this nature to avoid include: “I woke up with a major hangover because I went out drinking the night before.”

How long do most workers comp settlements take? ›

You can receive a workers' comp settlement offer at any time throughout a case. However, most cases are settled within 6 months and are almost always paid out after the injured worker has reached maximum medical improvement (MMI) – the point where a doctor has determined the injured worker has recovered.

What is the most common cause of workers compensation claims? ›

Common Causes of Workers' Compensation Claims
  • Strains and Sprains. Strains and sprains are by far the most common on-the-job injury for workers. ...
  • Cuts and Punctures. ...
  • Severe Cuts and Lacerations. ...
  • Overuse or Repetitive Stress Injuries, Including Back Injuries. ...
  • Fractures.

Which type of workers compensation claim is easiest to process? ›

Medical benefits claims are often considered the simplest type of workers' compensation claim to handle. These claims focus on covering the costs of medical treatments for work-related injuries. Employers typically need to report injuries promptly to ensure timely medical treatment for their employees.

Can you argue with an adjuster? ›

If you find yourself at odds with a claims adjuster over a settlement amount, it's important to advocate for the payment you deserve. Don't simply accept an offer you believe to be inadequate. Instead, arm yourself with evidence, negotiate firmly but politely, and don't be afraid to dispute their decision if needed.

Can workers' comp follow you around? ›

When Does Workers' Comp Start Surveillance? Any time after you file a claim, an investigator may follow you or investigate you. You're more likely to be placed under investigation if you have a large claim, have filed claims before or if the insurance company has any reason to be concerned about fraud.

What is the highest paid workers' comp settlement? ›

10 highest workers comp settlement payouts in the US
  • $13.2 million workers comp settlement for ironworker struck by a car (California) ...
  • $12 million workers comp settlement for a nursing home worker with carpal tunnel syndrome (South Dakota)
Jun 9, 2023

How long does it take for compensation to be paid? ›

It takes between two weeks and a month for compensation to be paid if your claim is settled in your favour.

Does surgery increase workers' comp settlement in California? ›

Short answer: Typically in California, undergoing surgery for a work-related injury results in an increased workers' compensation settlement. In California, workers' compensation generally covers the costs of necessary surgeries related to work injuries.

What are the two factors that determine worker's compensation claims? ›

The first step in any workers' compensation claim is determining whether or not you are covered. Generally, there are two main factors that determine your coverage: Whether you are an employee. Whether your injury occurred as a result of your employment.

Which profession has the highest workers compensation claims? ›

Industries with the Highest Workers Comp Claims
  1. Nursing care and residential care facilities. Workers in this industry experience an extraordinary rate of injuries. ...
  2. Animal production. ...
  3. Couriers. ...
  4. Wood product manufacturing. ...
  5. Air transportation.

What is the #1 cause of employee injury? ›

1. Overexertion. Overexertion can happen with lifting, pushing, pulling, holding, carrying, or throwing objects.

What is the highest priority in workers compensation placed on? ›

Return to work is the foremost priority for workers' compensation organizations (WCOs) globally, which support the health and wellness of injured workers.

Why is workers' comp so hard to deal with? ›

One of the biggest problems with California's workers' compensation system is that it is too slow to respond to the needs of injured workers. Injured workers are often made to wait for months – even years in some cases – before they can get the treatment and compensation they need.

How are compromise and release settlements calculated? ›

To calculate a Compromise and Release settlement, three factors need to be considered: permanent disability rating, future medical treatments, and attorney fees.

Do insurance adjusters make mistakes? ›

Mistakes happen. The difference between the excellent adjuster and the so-so adjuster is the number of mistakes made. Claims management, supervisors, and managers also make errors in judgment or unwittingly commit an oversight.

How stressful is claims adjuster? ›

Insurance claims adjusting is a high-stress job that can be mentally and emotionally draining. Claims adjusters often work long hours, handle difficult clients and situations, and have to manage multiple claims simultaneously. All of these factors can lead to stress and burnout.

Who pays your health insurance while on workers' compensation in Indiana? ›

Generally, if you were receiving health insurance benefits through your employer before your injury, your employer will continue to pay for your health insurance premiums, assuming you also continue to pay your portion, if any.

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