During fiscal year 2000, OWCP’s paid  workers’ compensation totaled about $2.1 billion including wage loss,  medical, and death benefits stemming from job-related injuries and OWCP  received approximately 174,000 new injury claims. To assist us in addressing the objectives, we reviewed a  statistical sample of more than 1,200 of the estimated 8,100 appealed claims  for which a decision was rendered by OWCP’s BHR or DOL’s ECAB during  the period from May 1, 2000, through April 30, 2001, to determine the  following: (1) the primary reasons why appealed decisions were reversed  or claims were remanded to the OWCP district offices for further  development, (2) the amount of time OWCP took to inform claimants of  hearing decisions, (3) whether OWCP used certified and licensed  physicians whose areas of specialty were consistent with the injuries  evaluated, and (4) the methods OWCP uses to identify customer  satisfaction and potential claimant fraud. OWCP has established two goals for the timing of notifying claimants of  final hearing decisions: (1) notifying 70 to 85 percent of the claimants  within 85 calendar days, and (2) informing 96 percent of claimants within  110 calendar days following the date of the hearing. OWCP  claims examiners and employing agencies serve as primary information  sources for identifying potentially fraudulent claims. In the 2000 survey, customers indicated a 52 percent satisfaction rate with  the overall workers compensation program, and a 47 percent  dissatisfaction rate. questions about or problems with initial claims decisions made at OWCP  district offices, we believe it is appropriate to use reversals and remands as  a combined indicator.
Why GAO Did This Study

The Department of Labor's Office of Workers' Compensation Programs (OWCP) paid $2.1 billion in medical and death benefits and received about 174,000 new injury claims during fiscal year 2000.

What GAO Found

GAO found that (1) one in four appealed claims' decisions are reversed or remanded to OWCP district offices for additional consideration and a new decision because of questions about or problems with the initial claims decision; (2) OWCP set a goal of informing 96 percent of claimants within 110 days of the date of the hearing; (3) nearly all doctors used by OWCP to provide opinions on injuries claimed were board certified and state licensed, and were specialists in areas consistent with the injuries they evaluate; and (4) OWCP has used mailed surveys, telephone surveys, and focus groups to measure customer satisfaction. The Labor inspector general is monitoring fraud within OWCP's workers compensation program and using the claims examiners as one source in identifying potentially fraudulent claims.