This documentation gives complete steering on navigating the claims course of for office accidents or diseases coated underneath the related federal statute. It outlines eligibility standards, required documentation, claims procedures, and appeals processes, serving as a vital useful resource for each workers and businesses. For instance, it would element the precise types wanted for reporting an damage, the method for acquiring medical evaluations, and the steps concerned in interesting a denied declare.
Entry to clear and complete procedural info is important for guaranteeing equitable and well timed dealing with of office damage claims. This useful resource empowers federal workers to know their rights and navigate the system successfully, selling a way of safety and facilitating a easy return to work. Traditionally, the evolution of those procedures displays a rising dedication to worker well-being and a streamlined method to claims administration.
The next sections will delve deeper into particular facets of the method, together with eligibility necessities, declare submitting directions, and accessible assets for additional help.
1. Eligibility Standards
Eligibility standards type a cornerstone of the claims course of outlined inside the Federal Staff’ Compensation Act process guide. These standards outline the scope of protection, figuring out which people and accidents or diseases qualify for advantages. A transparent understanding of those standards is important for each workers and businesses to make sure applicable utility of the Act. Eligibility sometimes hinges on components equivalent to the person’s employment standing (e.g., a federal civilian worker), the time and place of damage or sickness onset (e.g., throughout efficiency of official duties), and a causal hyperlink between the damage/sickness and the employment. As an illustration, a postal employee sustaining a again damage whereas lifting heavy packages would possible meet the standards, whereas an worker’s pre-existing situation exacerbated outdoors of labor may not. This direct hyperlink between eligibility and the documented procedures underscores the significance of correct record-keeping and adherence to reporting tips.
Navigating the complexities of eligibility typically necessitates cautious evaluate of particular situations detailed inside the process guide. This useful resource gives detailed explanations and examples that handle numerous conditions, equivalent to recurring accidents, occupational ailments, and psychological well being situations associated to employment. For instance, the guide might specify how the “course of employment” is decided for workers who journey often or work remotely. Understanding these nuances permits for correct assessments of eligibility and prevents pointless delays in claims processing.
Correct willpower of eligibility is essential for guaranteeing the equitable and environment friendly distribution of advantages. Misunderstandings or misapplication of those standards can result in denied claims, protracted appeals processes, and potential hardship for injured workers. Due to this fact, an intensive understanding of eligibility standards, as outlined inside the process guide, is key to the integrity and effectiveness of the whole compensation system. This information facilitates correct claims submitting, streamlines administrative processes, and contributes to a extra simply and supportive atmosphere for federal workers.
2. Damage Reporting
Well timed and correct damage reporting is a vital part of the Federal Staff’ Compensation Act process guide. It initiates the claims course of and gives important info for figuring out eligibility, calculating advantages, and facilitating a secure return to work. Adherence to established reporting procedures ensures environment friendly claims processing and safeguards the rights of injured federal workers.
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Preliminary Report:
The preliminary report serves as the muse of the declare. It needs to be submitted as quickly as potential after the damage or sickness onset, sometimes inside a specified timeframe outlined within the process guide. This report typically contains particulars such because the date, time, and site of the incident, an outline of the damage or sickness, and the names of any witnesses. A immediate preliminary report permits for well timed investigation and prevents potential disputes relating to the circumstances of the incident. For instance, a postal employee experiencing sudden again ache whereas lifting a bundle ought to instantly report the incident to their supervisor, initiating the documentation course of.
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Medical Documentation:
Medical documentation performs a vital position in substantiating the reported damage or sickness. The process guide outlines the required documentation, which can embody doctor’s stories, diagnostic check outcomes, and remedy plans. This documentation establishes a hyperlink between the reported incident and the medical situation, supporting the declare for advantages. As an illustration, within the case of the postal employee, an X-ray or MRI confirming a herniated disc would strengthen their declare.
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Supervisory Accountability:
Supervisors play a key position in guaranteeing correct and well timed damage reporting. The process guide outlines their tasks, which regularly embody offering quick help to the injured worker, initiating the reporting course of, and guaranteeing the preservation of any related proof. Efficient supervisory involvement promotes immediate medical consideration, minimizes misplaced time, and reinforces adherence to established procedures. A supervisor’s immediate motion in documenting the postal employee’s incident and guaranteeing they obtain applicable medical care is essential for a profitable declare.
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Comply with-up Reporting:
Comply with-up reporting is important for monitoring the progress of the damage or sickness and any subsequent remedy. The process guide specifies the frequency and kind of follow-up stories required, which can embody updates on medical remedy, return-to-work standing, and any adjustments within the worker’s situation. Constant follow-up reporting ensures the continued accuracy of the declare and facilitates efficient communication between the worker, the company, and medical suppliers. For the postal employee, common updates on their bodily remedy classes and progress in direction of restoration could be important parts of follow-up reporting.
These aspects of damage reporting type a vital framework inside the Federal Staff’ Compensation Act process guide. They guarantee a scientific method to documenting office accidents or diseases, defending the rights of workers whereas streamlining the executive course of for businesses. By emphasizing the significance of correct and well timed reporting, the process guide contributes to a extra environment friendly and equitable system of compensation, in the end supporting a safer and extra productive workforce.
3. Medical Documentation
Medical documentation types a cornerstone of the claims course of underneath the Federal Staff’ Compensation Act. Its significance is underscored inside the process guide, serving because the evidentiary foundation for establishing the validity and extent of claimed accidents or diseases. Complete and correct medical documentation is important for establishing a causal hyperlink between the claimed situation and the work atmosphere, instantly impacting eligibility for advantages and subsequent case administration.
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Preliminary Medical Analysis:
The preliminary medical analysis is essential for documenting the character and severity of the damage or sickness. This analysis, sometimes carried out shortly after the incident, establishes a baseline report of the worker’s situation. The process guide typically specifies the forms of medical professionals certified to carry out this preliminary evaluation, guaranteeing a standardized method to documentation. For instance, a federal firefighter presenting with smoke inhalation may endure a pulmonary perform check as a part of their preliminary analysis, establishing a report of their respiratory perform.
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Diagnostic Testing:
Diagnostic exams play a significant position in confirming diagnoses and assessing the extent of accidents or diseases. The process guide outlines acceptable diagnostic procedures and their relevance to particular forms of claims. This ensures that medical proof aligns with established requirements and gives a transparent image of the situation. As an illustration, an MRI scan may be needed to substantiate a suspected spinal damage sustained by a building employee on a federal undertaking, offering goal proof of the damage’s severity.
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Therapy Information:
Complete remedy data present a longitudinal perspective on the worker’s medical progress. These data, which embody particulars of medicines, therapies, and surgical interventions, display the continuing medical administration of the situation. The process guide typically specifies the format and content material of required remedy data, facilitating constant monitoring and analysis of the worker’s restoration. A bodily therapist’s notes documenting the progress of a postal employee recovering from a rotator cuff damage would exemplify this sort of documentation.
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Impartial Medical Examinations (IMEs):
In sure conditions, an unbiased medical examination (IME) could also be required. IMEs, carried out by physicians not concerned within the worker’s ongoing remedy, provide an unbiased evaluation of the situation. The process guide outlines the circumstances underneath which an IME could also be requested and the standards for choosing an unbiased medical expert. This course of ensures objectivity and impartiality in assessing the extent and impression of the claimed damage or sickness. An IME may be requested in a posh case involving a federal air visitors controller claiming post-traumatic stress dysfunction after a near-miss incident, offering an goal evaluation of their psychological situation.
The rigorous requirements for medical documentation emphasised inside the Federal Staff’ Compensation Act process guide are integral to a good and environment friendly claims course of. This meticulous method ensures that selections relating to eligibility and advantages are based mostly on verifiable medical proof, safeguarding each the worker’s well-being and the integrity of the compensation system. By adhering to those tips, businesses and workers contribute to a clear and reliable course of, fostering confidence within the administration of the Act.
4. Claims Processing
Claims processing types a central pillar inside the framework of the Federal Staff’ Compensation Act process guide. This course of, ruled by established laws and detailed inside the guide, encompasses all levels from preliminary declare submission to ultimate willpower of eligibility and profit disbursement. Its efficient execution hinges on correct adherence to procedural tips, guaranteeing each equitable outcomes for workers and environment friendly administration for businesses. A transparent understanding of this course of is essential for all stakeholders.
The process guide dictates particular timelines for every stage of claims processing, selling well timed decision and stopping pointless delays. As an illustration, the guide may stipulate a timeframe for businesses to acknowledge receipt of a declare and provoke the evaluate course of. This structured method facilitates accountability and transparency. Moreover, the guide particulars the required documentation for substantiating claims, equivalent to medical stories and witness statements. A declare filed by a park ranger injured throughout a rescue operation, for instance, may require incident stories, medical evaluations, and witness testimonies from fellow rangers. The guide guides the compilation and submission of those supplies, guaranteeing complete evaluate and knowledgeable decision-making.
The guide’s steering extends to the adjudication course of, outlining standards for evaluating eligibility and figuring out the suitable stage of advantages. As an illustration, the guide might element the calculation strategies for wage-loss compensation or the procedures for authorizing medical remedy. This structured method ensures constant utility of laws throughout totally different circumstances and businesses. Take into account a state of affairs the place a Bureau of Land Administration worker develops carpal tunnel syndrome resulting from repetitive pc work. The guide gives steering on evaluating the occupational hyperlink to the situation and figuring out the suitable advantages, guaranteeing a standardized method no matter the worker’s particular company. Understanding claims processing as outlined inside the Federal Staff’ Compensation Act process guide is due to this fact important for navigating the system successfully, selling well timed decision of claims, and fostering belief within the equity and integrity of the method.
5. Appeals Procedures
The Federal Staff’ Compensation Act process guide gives a clearly outlined course of for interesting selections associated to claims. This appeals course of is essential for guaranteeing equity and due course of for workers who disagree with preliminary determinations relating to eligibility or the extent of advantages awarded. Understanding the appeals procedures, as outlined within the guide, empowers workers to navigate the system successfully and advocate for his or her rights.
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Reconsideration:
The primary stage of enchantment sometimes includes requesting reconsideration of the preliminary resolution. The process guide outlines particular timelines and procedures for submitting a reconsideration request, together with the required documentation and supporting proof. For instance, an worker denied advantages for a carpal tunnel damage may submit further medical documentation linking the situation to their office duties when requesting reconsideration.
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Listening to earlier than an OWCP consultant:
If reconsideration fails to resolve the dispute, the worker might request a listening to earlier than an Workplace of Staff’ Compensation Packages (OWCP) consultant. The guide particulars the procedures for requesting and getting ready for such a listening to, together with the chance to current proof and authorized arguments. An worker contesting the denial of advantages for a again damage sustained whereas lifting heavy gear, for instance, might current witness testimony and professional medical opinions at this listening to.
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Evaluate by the Staff’ Compensation Appeals Board (ECAB):
If the listening to resolution stays unsatisfactory, the worker might enchantment to the Staff’ Compensation Appeals Board (ECAB). The guide outlines the procedures and timelines for interesting to the ECAB, which gives an unbiased evaluate of the case. An worker disagreeing with a listening to resolution that lowered their advantages for a repetitive stress damage, as an illustration, might enchantment to the ECAB for a ultimate willpower.
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Judicial Evaluate:
In sure circumstances, a ultimate resolution by the ECAB will be appealed to the federal courts. This selection, whereas much less frequent, gives an additional avenue for authorized redress. An worker contesting a posh authorized interpretation of the Act utilized by the ECAB of their case involving a traumatic mind damage, for instance, may search judicial evaluate.
The structured appeals procedures detailed inside the Federal Staff’ Compensation Act process guide play a significant position in upholding the rules of equity and accountability. These procedures be sure that workers have avenues for difficult disputed selections and searching for applicable redress. By offering a transparent roadmap for navigating the appeals course of, the guide contributes to a extra simply and clear system of compensation for federal workers.
6. Profit Calculations
Profit calculations symbolize a vital side of the Federal Staff’ Compensation Act process guide. These calculations, ruled by particular laws and detailed inside the guide, decide the monetary assist offered to eligible workers for misplaced wages and medical bills ensuing from work-related accidents or diseases. Accuracy and consistency in profit calculations are important for upholding the Act’s function of offering equitable compensation and guaranteeing monetary stability for injured federal staff.
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Wage-Loss Compensation:
Wage-loss compensation goals to switch a portion of the revenue misplaced resulting from an worker’s incapability to work. The process guide specifies the formulation and components used to calculate these advantages, typically based mostly on a proportion of the worker’s pre-injury earnings. Several types of wage-loss advantages, equivalent to momentary complete incapacity or everlasting partial incapacity, have distinct calculation strategies detailed inside the guide. For instance, a firefighter briefly unable to work resulting from burn accidents would obtain wage-loss compensation based mostly on a selected proportion of their common wage, calculated in line with the guide’s tips.
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Medical Expense Reimbursement:
Reimbursement for medical bills incurred on account of the work-related damage or sickness is one other key part of profit calculations. The process guide outlines eligible medical bills, together with physician visits, hospital stays, drugs, and assistive units. It additionally specifies procedures for submitting claims for reimbursement and the documentation required, equivalent to receipts and medical payments. As an illustration, a postal employee requiring bodily remedy for a shoulder damage sustained on the job would submit their remedy payments for reimbursement in line with the guide’s directions.
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Schedule Awards:
Schedule awards present compensation for everlasting impairments, equivalent to lack of perform or disfigurement, ensuing from a work-related damage. The process guide features a schedule of impairments, outlining the precise advantages payable for several types of everlasting impairments. This standardized method ensures constant utility of advantages throughout numerous circumstances. A federal mechanic struggling everlasting listening to loss resulting from office noise publicity, for instance, would obtain a schedule award based mostly on the severity of the listening to loss as outlined within the guide.
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Survivor Advantages:
In circumstances the place a work-related damage or sickness leads to an worker’s dying, survivor advantages are payable to eligible dependents. The process guide outlines eligibility standards for survivor advantages and the strategies for calculating these advantages, which regularly think about components such because the deceased worker’s earnings and the variety of dependents. For instance, the surviving partner and youngsters of a federal legislation enforcement officer killed within the line of responsibility would obtain survivor advantages calculated in line with the guide’s tips.
The clear and complete method to learn calculations detailed inside the Federal Staff’ Compensation Act process guide contributes to a clear and equitable system of compensation. By adhering to those tips, businesses guarantee consistency and accuracy in profit supply, offering injured federal workers with the monetary assist they want throughout their restoration. Understanding these calculations empowers workers to navigate the system successfully and guarantee they obtain the suitable advantages to which they’re entitled underneath the Act.
7. Return-to-Work Packages
Return-to-work packages symbolize a vital part of the Federal Staff’ Compensation Act process guide, bridging the hole between damage restoration and reintegration into the workforce. These packages, guided by established laws and detailed inside the guide, purpose to facilitate a well timed and secure return to work for injured federal workers, minimizing misplaced productiveness whereas supporting their total well-being. A complete understanding of those packages is important for each workers and businesses.
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Modified Obligation Assignments:
Modified responsibility assignments provide a structured method to reintroducing injured workers to the office. The process guide outlines tips for creating and implementing modified responsibility assignments, guaranteeing they align with the worker’s purposeful limitations and promote gradual restoration. These assignments might contain adjusted work schedules, lowered bodily calls for, or various job duties. For instance, a postal employee recovering from a again damage may be assigned to desk duties or gentle sorting duties moderately than heavy lifting, permitting a gradual return to full performance.
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Vocational Rehabilitation:
Vocational rehabilitation providers play a vital position in helping workers whose accidents forestall them from returning to their earlier roles. The process guide particulars eligibility standards for vocational rehabilitation and the forms of providers accessible, equivalent to retraining packages, job placement help, and assistive expertise. As an illustration, a federal air visitors controller with everlasting imaginative and prescient impairment may obtain vocational rehabilitation providers to transition to a distinct profession inside the company or in a associated subject.
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Medical Monitoring:
Medical monitoring in the course of the return-to-work course of is important for guaranteeing the worker’s security and selling profitable reintegration. The process guide might define tips for medical monitoring, together with follow-up examinations and communication between medical suppliers and the company. This ongoing monitoring ensures the modified responsibility assignments or vocational rehabilitation actions stay applicable for the worker’s restoration trajectory. For instance, a building employee returning to work after a hand damage may require common check-ups with a hand therapist to observe their progress and regulate their work duties accordingly.
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Employer Duties:
The process guide clarifies employer tasks inside the return-to-work framework. These tasks might embody offering appropriate modified responsibility assignments, facilitating entry to vocational rehabilitation providers, and sustaining open communication with the injured worker. As an illustration, a federal company should be sure that a park ranger returning to work after a leg damage has entry to applicable transportation and assistive units inside the park atmosphere, facilitating a profitable return to their duties.
The emphasis on return-to-work packages inside the Federal Staff’ Compensation Act process guide underscores the significance of a collaborative method to damage restoration and reintegration into the workforce. These packages present a structured framework for supporting injured workers, minimizing misplaced productiveness, and selling profitable outcomes. By adhering to those tips, businesses display a dedication to worker well-being whereas upholding the rules of effectivity and financial duty inside the federal compensation system.
Often Requested Questions
This part addresses frequent inquiries relating to the processes and procedures outlined inside the Federal Staff’ Compensation Act process guide. Readability on these factors is important for efficient navigation of the system.
Query 1: What constitutes a work-related damage or sickness underneath the Act?
A piece-related damage or sickness is outlined as a situation proximately attributable to employment components encountered whereas performing official duties. This contains traumatic accidents, occupational ailments, and situations exacerbated by office components.
Query 2: What are the timelines for reporting a work-related damage or sickness?
Well timed reporting is essential. Reporting necessities fluctuate relying on the character of the incident, however typically, accidents or diseases needs to be reported as quickly as potential, typically inside a selected timeframe outlined inside the process guide.
Query 3: What forms of medical documentation are required to assist a declare?
Required documentation sometimes contains preliminary medical evaluations, diagnostic check outcomes, remedy data, and in some circumstances, unbiased medical examination stories. Particular necessities are detailed inside the process guide.
Query 4: How are profit quantities calculated, and what forms of advantages can be found?
Profit calculations think about components equivalent to pre-injury earnings, the character of the damage or sickness, and the extent of incapacity. Accessible advantages might embody wage-loss compensation, medical expense reimbursement, schedule awards for everlasting impairments, and survivor advantages.
Query 5: What’s the course of for interesting a choice relating to a declare?
Appeals procedures sometimes contain requesting reconsideration, adopted by a listening to earlier than an OWCP consultant, and doubtlessly evaluate by the Staff’ Compensation Appeals Board (ECAB). Particular steps and timelines are outlined inside the process guide.
Query 6: What assets can be found to help workers navigating the claims course of?
Sources embody company personnel specialists, OWCP representatives, and authorized counsel specializing in federal staff’ compensation. Contact info and additional steering on accessible assets can typically be discovered inside the process guide or on the OWCP web site.
Understanding these key facets of the Federal Staff’ Compensation Act process guide is essential for guaranteeing efficient and well timed claims processing. Thorough familiarity with the guide facilitates a easy and equitable expertise for all concerned.
For additional info and detailed steering, consulting the entire Federal Staff’ Compensation Act process guide is really helpful. This complete useful resource gives in-depth explanations and particular examples to deal with a variety of situations.
Suggestions for Navigating the System
Efficiently navigating the complexities of the federal staff’ compensation system typically hinges on proactive measures and a transparent understanding of established procedures. The next ideas present sensible steering for successfully using the data contained inside the governing process guide.
Tip 1: Preserve Thorough Information
Meticulous record-keeping is paramount. Documenting all related particulars, together with dates, occasions, places, witnesses, and medical interactions, strengthens claims and facilitates correct profit calculations. An in depth logbook or journal can show invaluable. For instance, an in depth account of a slip and fall incident, together with the precise location, time, and witnesses, can considerably expedite the claims course of.
Tip 2: Report Accidents Promptly
Well timed reporting is essential for preserving the integrity of a declare. Delays in reporting can increase questions and doubtlessly compromise eligibility. Adhering to established reporting timelines, as outlined within the process guide, is important. A upkeep employee experiencing sudden chest ache, as an illustration, ought to report the incident instantly, even when signs appear minor initially.
Tip 3: Safe Complete Medical Documentation
Detailed medical documentation substantiates claims and guides profit determinations. Acquiring complete medical stories, together with diagnostic check outcomes and remedy plans, is important. A transportation safety officer searching for compensation for a repetitive stress damage, for instance, ought to guarantee their doctor gives detailed documentation of the prognosis, remedy, and prognosis.
Tip 4: Perceive Eligibility Standards
A transparent understanding of eligibility standards, as detailed inside the process guide, is important for a profitable declare. Reviewing these standards earlier than submitting ensures alignment between the declare and established necessities. As an illustration, a border patrol agent claiming advantages for a pre-existing situation aggravated by work duties ought to perceive the standards for establishing the work-related connection.
Tip 5: Familiarize Your self with Appeals Procedures
Understanding the appeals course of, as outlined within the process guide, prepares workers for potential challenges to preliminary selections. Realizing the timelines, required documentation, and ranges of enchantment empowers people to advocate successfully for his or her rights. For instance, a librarian contesting a denied declare for carpal tunnel syndrome ought to familiarize themselves with the appeals course of and deadlines.
Tip 6: Make the most of Accessible Sources
Leveraging accessible assets, equivalent to company personnel specialists and OWCP representatives, can present invaluable steering and assist. Consulting these assets can streamline the claims course of and guarantee entry to correct info. A park ranger unsure in regards to the documentation required for a declare, as an illustration, might seek the advice of with an company personnel specialist for steering.
Tip 7: Preserve Open Communication
Constant communication with supervisors, medical suppliers, and OWCP representatives ensures a easy and clear claims course of. Clear and proactive communication fosters collaboration and prevents misunderstandings. A customs officer present process bodily remedy for a work-related damage, for instance, ought to preserve open communication with their therapist and supervisor relating to their progress and return-to-work plan.
By adhering to those sensible ideas, federal workers can successfully navigate the employees’ compensation system and guarantee their claims are dealt with effectively and equitably.
In conclusion, understanding and adhering to the established procedures inside the Federal Staff’ Compensation Act process guide is paramount. This complete useful resource empowers people to navigate the system successfully, safeguarding their rights and selling a well timed return to work.
Conclusion
This exploration of the Federal Staff’ Compensation Act process guide has highlighted its essential position in navigating the complexities of office damage and sickness compensation inside the federal authorities. Key facets mentioned embody eligibility standards, reporting procedures, medical documentation necessities, claims processing, appeals procedures, profit calculations, and return-to-work packages. Understanding these parts is key for each workers and businesses to make sure honest and environment friendly administration of the Act.
Efficient utilization of this procedural guide contributes considerably to a clear and equitable compensation system. Adherence to established tips ensures applicable dealing with of claims, safeguards worker rights, and promotes well timed decision of office damage and sickness circumstances. Continued evaluate and refinement of the guide, knowledgeable by evolving finest practices and legislative updates, will additional strengthen its effectiveness in supporting the well-being of federal workers and the integrity of the compensation system.
