FECA Claimat Survey Package

Injured Worker Survey
1. Injured Worker Satisfaction Survey
We are conducting a Customer Satisfaction Survey and would like to know about your experience after
you sustained an injury at work. We are particularly interested in the effectiveness of the OWCP
program in assisting you in your recovery and return to work.
Your participation in this survey is crucial to OWCP in determining what changes need to be made to the
program to improve services to injured workers to help them recover and return to work.
Your answers are completely anonymous and will have no impact upon your relationship with OWCP and
its employees.
The survey should take approximately 15 minutes to complete.

2. Questions About Your Non-Emergency Medical Treatment
We are interested in whether or not you had a difficult time finding a physican to treat you, your level of
recovery and your satisfaction with medical treatment. This section asks questions about your treating
physican, your treatment, your recovery and your satisfaction with your medical care.

1. Did you have trouble finding a physican to treat you for your injury or
illness for other than emergency care?
j
k
l
m
n

Yes

j
k
l
m
n

No

If yes, please tell us about it?

5
6

2. How long did you have to wait between first trying to get non-emergency
care and actually seeing a provider for your work injury or illness?
j
k
l
m
n

Same

j
k
l
m
n

1 day

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m
n

2 days

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l
m
n

3 days

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n

day

4-7 days

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m
n

8-14

days

j
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l
m
n

15 or

more days

j
k
l
m
n

I did

not think I
needed care
right away

3. Overall, thinking about all the treatment you received for your injury or
illness, how satisfied were you with that care?
j
k
l
m
n

Very Satisfied

j
k
l
m
n

Somewhat Satisfied

j
k
l
m
n

Somewhat Unsatisfied

j
k
l
m
n

Very Unsatisfied

If unsatisfied, can you tell us why?

5
6

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Injured Worker Survey
4. How often did the doctor or health care professional you saw for the
majority of my non-emergency treatment talk to you about:
My daily job tasks and
duties
What to expect from
my condition (for

Did not apply to

Not at all

Very little

Some

A lot

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my injury/illness

example, what to
expect about pain or
recovery time)
Different treatments
for my work related
injury/illness
Side effects of
medications or other
treatments prescribed
Activities I should
avoid and activities I
could do while
recovering
The date I could return
to work
Changes to my work
such as reduced hours,
or changed work layout
or equipment
Ways to prevent
getting injured again
Ways to prevent my
illness from reoccurring

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Injured Worker Survey
5. Comparing your status before your injury or illness and after you were
done with your medical treatment, how have the following elements
changed?
(Select one for each item):
Lower than before

About the same

Higher than before

Not applicable

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n

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n

Your stress level

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n

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n

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n

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n

Your self confidence

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n

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n

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n

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n

Your ability to earn the

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n

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n

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n

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m
n

Your general level of
health (fitness,
fatigue, pain)
Your ability to perform
all your work activities
Your ability to
participate in social
activities outside your
family
Your physical ability to
partake in hobbies
outside of work
activities

wage you did prior to
injury

3. Your Experience With Rehabilitation Nurse Services
This section asks you about your experience and satisfaction with a rehabilitation nurse if one was
assigned to you. For purposes of this section, questions 6 through 10 ask about a nurse who may have
contacted you by phone early in your claim. For the remainder, when we ask about a "field nurse", they
would have more than likely met with you personally at the doctor's office or another public place and
kept in contact with your over a longer period of time.

6. Were you contacted by telephone by a nurse asking about your recovery
and medical treatment within the first 45 days after your injury or illness?
j
k
l
m
n

Yes

j
k
l
m
n

No [Skip to Question 11]

j
k
l
m
n

Don't know or don't remember [Skip to Question 11]

7. Who did this nurse work for?
j
k
l
m
n

OWCP

j
k
l
m
n

My employing agency

j
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l
m
n

An external contractor hired by my employing agency

j
k
l
m
n

Don't know or don't remember

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Injured Worker Survey
8. How soon after your injury or illness did this nurse contact you?
j
k
l
m
n

Within the first week

j
k
l
m
n

Within the second week

j
k
l
m
n

Within the third week

j
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l
m
n

Within the fourth week

j
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l
m
n

Between 1 and 2 months

j
k
l
m
n

More than 2 months after my injury or illness

j Don't know or don't remember
k
l
m
n
Other

9. Did this nurse assist you in obtaining and/or understanding the medical
treatment you needed?
j
k
l
m
n

Yes

j
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l
m
n

No

j
k
l
m
n

Don't know

j
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l
m
n

Other

Please explain:

5
6

10. Did the actions of this nurse have a positive impact on your ability to
return-to-work?
j
k
l
m
n

Yes

j
k
l
m
n

No

j
k
l
m
n

Don't know

Comments:

5
6

4. Nursing Services (continued)

Page 4

Injured Worker Survey
11. How quickly after your injury did a Field Nurse contact you?
j
k
l
m
n

Less than 4 weeks from the date of injury or reported illness

j
k
l
m
n

Between 4 weeks and 8 weeks

j Between 8 weeks and 12 weeks
k
l
m
n
Other
j
k
l
m
n

More than 12 weeks after the injury or reported illness

12. How did the nurse describe his or her role in your recovery?
5
6

13. How would you rate the Field Nurse's assistance in each of the following
areas?
Not
Extremely Helpful

Helpful

Somewhat Helpful

Not Helpful

Applicable/Don't
Know

Understanding your
medical situation
Facilitating activities
which sped recovery
Participating in
discussions with your

j
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m
n

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n

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n

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medical provider
regarding your
recovery
and return to
Other
work
Involvement in
medical provider visits
Assisting you in your
return to work
Other (please explain
in the box below)
Additional Comments

5
6

14. Would earlier intervention by the nurse have been helpful to you in your
recovery or return to work?
j
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l
m
n

Yes

j
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m
n

No

j
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n

Don't know

Page 5

Injured Worker Survey
15. How often did the Field Nurse accompany you to the medical provider's
office?
j
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l
m
n

Always

j
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m
n

Frequently

j
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m
n

About half the time

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m
n

Whenever necessary

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m
n

Rarely

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m
n

Never

16. Did the Field Nurse stay involved until you had returned to work?
j
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m
n

Yes

j
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m
n

No

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m
n

I have not returned to work and the nurse is still involved

j
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m
n

I have not returned to work yet, but the nurse is no longer involved

Other
j Other (please specify)
k
l
m
n

5
6

17. How important was it (or is it) to you that the nurse stay involved until
after you returned to work?
j
k
l
m
n

Extremely important

j
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m
n

Somewhat important

j
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m
n

Not important

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m
n

Don't know/no opinion

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Injured Worker Survey
18. If the Field nurse did not stay involved in your case until after your had
returned to work, how would additional nurse services been helpful to you?
(Check all that apply)
c
d
e
f
g

Better understanding of my ongoing medical situation

c
d
e
f
g

Better communication with my medical provider

c
d
e
f
g

Improved communication with my employer

c
d
e
f
g

Faster return to work

c
d
e
f
g

More permanent return to work

c
d
e
f
g

Other (please specify)

5. Vocational Services Provided
This section asks you about your experience with any vocational counselors that may have been
assigned to assist you in returning to work.

19. Did you recieve vocational services during your Workers' Compensation
claim?
j
k
l
m
n

Yes

j
k
l
m
n

No [Skip to Question 23]

j
k
l
m
n

Not yet, but my claim is still open [Skip to Question 23]

j
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l
m
n

Don't know or don't remember [Skip to Question 23]

20. At what point in the claim did a Vocational Counselor first contact you?
j
k
l
m
n

Within 3 months of the date I filed a claim

j
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m
n

Between 3 months and 6 months

j
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m
n

Between 6 months and 1 year

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m
n

Between 1 year and 2 years

j
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l
m
n

More than 2 years after I filed a claim

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Injured Worker Survey
21. How would you rate the value of the following vocational services in
helping you return to work?
Not
Extremely Helpful Somewhat Helpful

Not Very Helpful

Not At All Helpful

Applicable/Don't
Know

Vocational evaluation

j
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m
n

j
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n

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n

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n

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n

Specialized ergonomic

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n

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Work hardening

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n

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n

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n

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n

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n

Transferable skills

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n

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Testing

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Retraining

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n

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n

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n

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n

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job and home
Other
modification
services
Transitional (Light
Duty) job identification
and definition
Functional Capacities
evaluation

analysis
Job seeking skills
training
Detailed job analysis
of a proposed job
Referral for short term
training or refresher
courses

Additional Comments

5
6

22. Would earlier access to vocational services have helped you return to
work faster?
j
k
l
m
n

Yes

j
k
l
m
n

No

j
k
l
m
n

Don't know

6. Information About Your Work
This information will assist OWCP in providing assistance to Federal employers to help them better deal
with injuries or illnesses like yours in the future.

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Injured Worker Survey
23. How long had you worked for your employer at the time of your injury
or illness?
j
k
l
m
n

Less than a month

j
k
l
m
n

1 month or more, but less than 6 months

j
k
l
m
n

6 months or more, but less than 1 year

j
k
l
m
n

1 year or more, but less than 5 years

j
k
l
m
n

5 years or more, but less than 20 years

j 20 years or more
k
l
m
n
Other

24. How would you describe the level of activity needed to perform the job
you had at the time of injury or illness?
j
k
l
m
n

Light work activity(less than 10 pounds lifting regularly and usually sitting or standing)

j
k
l
m
n

Moderate work activity (more than 10 pounds but less than 20 pounds lifting regularly,and regularly standing,

walking, pulling or pushing)

j
k
l
m
n

Strenuous activity (more than 20 pounds but less than 50 pounds lifting repeatedly and/or constant climbing,

overhead motions, or restraining of others

j
k
l
m
n

Very strenuous activity (repeated lifting. pulling or pushing of over 50 pounds and constant climbing, overhead

motions or restraining of others)

25. At the time of your injury or illness, how many employees worked at
your worksite?
j
k
l
m
n

Less than 4

j
k
l
m
n

4 or more, but less than 10

j
k
l
m
n

10 or more, but less than 25

j
k
l
m
n

25 or more, but less than 50

j
k
l
m
n

Over 50

26. At the time of your injury or illness, approximately how many employees
at your work site had the same duties as you did?
j
k
l
m
n

I was the only one with my duties

j
k
l
m
n

2 or more, but less than 5 of us had similar duties

j
k
l
m
n

5 or more, but less than 10 of us had similar duties

j
k
l
m
n

More than 10 of us had similar duties

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Injured Worker Survey
27. How often did your employer/supervisor contact you while you were
disabled as a result of your injury or illness?
j
k
l
m
n

Daily

j
k
l
m
n

Weekly

j
k
l
m
n

Monthly

j
k
l
m
n

Less than once a month

j Not until I returned to work
k
l
m
n
Other
j
k
l
m
n

Never [Skip to Question 32]

28. If your employer/supervisor did contact you regularly, how did this
discussion make you feel?
j
k
l
m
n

I was glad they were thinking about me

j
k
l
m
n

It was OK

j
k
l
m
n

I felt uncomfortable with our conversations

j
k
l
m
n

I felt they did not trust me

j
k
l
m
n

Other (please specify)

29. How helpful was your employer in assisting you with return to work?
j
k
l
m
n

Extremely Helpful

j
k
l
m
n

Somewhat Helpful

j
k
l
m
n

Not Very Helpful

j
k
l
m
n

Not At All Helpful

j
k
l
m
n

Don't Know

30. Following your injury or illness, did your employer/supervisor discuss a
return to work plan with you?
j
k
l
m
n

Yes

j
k
l
m
n

No [Skip to Question 32]

Comments:

5
6

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Injured Worker Survey
31. Which of the following possible return to work options did your
employer/supervisor discuss with you?
(Please check all that apply):
c
d
e
f
g

Part-time work while you were healing

c
d
e
f
g

Part-time work after you were healed

c
d
e
f
g

Modified work while you were healing

c
d
e
f
g

Modified work after you were healed

c
d
e
f
g

Your return to work only after you were fully healed

c
d
e
f
g

Other (please specify)

7. Services Provided By The Office of Workers Compensation
Programs
This section asks you about your level of satisfaction with the services that may have been provided by
the Office of Workers' Compensation Programs.

32. Who communicated with you the most and answered your questions
about the Federal Employees' Compensation Act after your injury or illness?
j
k
l
m
n

My employer

j
k
l
m
n

The nurse who contacted me

j
k
l
m
n

The claims examiner from OWCP

j
k
l
m
n

The attorney I used

j
k
l
m
n

My physician

j
k
l
m
n

Other (please specify)

33. How would you rate the level of usefulness of the information given you
by the person you listed in the previous question?
j
k
l
m
n

Extremely Helpful

j
k
l
m
n

Somewhat Helpful

j
k
l
m
n

Not Very Helpful

j
k
l
m
n

Not At All Helpful

j
k
l
m
n

I was not able to get useful information from anyone

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Injured Worker Survey
34. How effective was OWCP in meeting your needs in the following areas:
Extremely Effective Somewhat Effective
Timely delivery of
wage loss benefits
Timely approval of
medical treatment
Assistance with return
to work
Serving as a liaison
between you and your

Somewhat

Extremely

Ineffective

Ineffective

Not
Applicable/Don't
Know

j
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m
n

j
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n

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n

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j
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employer
Additional Comments

5
6

35. How often did you communicate with the claims examiner at OWCP at
any time during your treatment for this injury or illness?
j
k
l
m
n

Frequently

j
k
l
m
n

When I felt it was needed

j
k
l
m
n

Rarely

j
k
l
m
n

Never

j
k
l
m
n

Other (please specify)

36. If you did communicate with one or more claims examiners from OWCP,
how would you rate that interaction on the following:
Did they answer your
questions?

Never

Sometimes

Usually

Always

j
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l
m
n

j
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m
n

j
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n

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n

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j
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n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

(responsiveness)
Were they respectful in
their interactions with
you? (courteous)
Did they return your
phone calls in a timely
fashion? (timely)
Comments:

5
6

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Injured Worker Survey
37. If you were assigned a nurse at any time during your recovery, how
would you rate that interaction on the following:
Did they answer your
questions?

Never

Sometimes

Usually

Always

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

j
k
l
m
n

(responsiveness)
Were they respectful in
their interactions with
you? (courteous)
Did they return your
phone calls in a timely
fashion? (timely)
Comments:

5
6

8. Return to Work information
This information will aid OWCP in providing future assistance to Federal employees to help them return to
work after injuries or illnesses.

38. How much TOTAL time from work (whether compensated or not) did
you miss as a result of your injury/illness?
j
k
l
m
n

None or less than one day

j
k
l
m
n

1 thru 6 days

j
k
l
m
n

7 thru 15 days

j
k
l
m
n

16 thru 45 days

j
k
l
m
n

46 thru 60 days

j
k
l
m
n

61 thru 90 days

j
k
l
m
n

91 to 180 days

j
k
l
m
n

More than 180 days

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Injured Worker Survey
39. Have you returned to work?
j
k
l
m
n

Yes, full-time

j
k
l
m
n

Yes, part-time

j
k
l
m
n

No, I am not working, but it is not related to my injury [Skip to Question 41]

j
k
l
m
n

No, I am not working because of my injury [Skip to Question 41]

j
k
l
m
n

Other (please indicate your current employment status)

5
6

40. When you returned to work after your injury or illness, which of the
following best describes your return to work situation?
j
k
l
m
n

Returned to work at my same employer doing the same work I did the time of my injury

j
k
l
m
n

Returned to work at my same employer doing the same job with modifications

j
k
l
m
n

Returned to work at my same employer doing a new job

j
k
l
m
n

Returned to work with a new employer

9. Demographic information
Your completion of the following questions will allow us to sort results in a manner that may help improve
services in specific offices, geographical areas, or for workers like you. All responses are anonymous.

41. What was the nature of your injury or illness? (Check all that apply)
c
d
e
f
g

Allergic reaction

c
d
e
f
g

Burn or chemical exposure

c
d
e
f
g

Emotional or mental stress

c
d
e
f
g

Fracture (broken bone)

c
d
e
f
g

Occupational disease (not listed here)

c
d
e
f
g

Repetitive stress injury due to repeated motions

c
d
e
f
g

Scrape, cut, skin rash, bruise, swelling or inflammation

c
d
e
f
g

Sprain strain, or other injury of a muscle or joint

c
d
e
f
g

Vehicular accident

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Injured Worker Survey
42. Which part(s) of your body were affected? (Please check all that apply)
c
d
e
f
g

Head, including brain, face, eyes, and ears

c
d
e
f
g

Back

c
d
e
f
g

Shoulder

c
d
e
f
g

Arm, hand(s), fingers(s)

c
d
e
f
g

Leg, knee, ankle, foot or toe(s)

c
d
e
f
g

Internal organs (circulatory system, stomach, liver, lungs, etc.)

c
d
e
f
g

Other (please specify)

43. Which OWCP District Office did you communicate with most often during
this injury/illness?
j
k
l
m
n

Boston

j
k
l
m
n

Chicago

j
k
l
m
n

Cleveland

j
k
l
m
n

Dallas

j
k
l
m
n

Denver

j
k
l
m
n

Jacksonville

j
k
l
m
n

Kansas City

j
k
l
m
n

New York

j
k
l
m
n

Philadelphia

j
k
l
m
n

San Francisco

j
k
l
m
n

Seattle

j
k
l
m
n

Washington, D.C.

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Injured Worker Survey
44. Which Federal agency did you work for at the time of your
injury/illness?
j
k
l
m
n

Department of Agriculture

j
k
l
m
n

Department of Homeland Security

j
k
l
m
n

Department of Justice

j
k
l
m
n

Department of the Air Force

j
k
l
m
n

Department of the Army

j
k
l
m
n

Department of the Interior

j
k
l
m
n

Department of the Navy

j
k
l
m
n

Department of the Treasury

j
k
l
m
n

Department of Veterans Affairs

j
k
l
m
n

U.S. Postal Service

j
k
l
m
n

Other (please indicate your agency in the box below)

45. What is your gender?
j
k
l
m
n

Female

j
k
l
m
n

Male

46. How old were you at the time of this injury?
j
k
l
m
n

Under 20

j
k
l
m
n

20 through 29

j
k
l
m
n

30 through 39

j
k
l
m
n

40 through 49

j
k
l
m
n

50 through 59

j
k
l
m
n

60 through 69

j
k
l
m
n

Over 69

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Injured Worker Survey
47. What was the highest level of education you had achieved at the time of
your injury?
j
k
l
m
n

Some high school

j
k
l
m
n

High school diploma or equivalence

j
k
l
m
n

Vocational or 2 year college diploma

j
k
l
m
n

Over two years of college

j
k
l
m
n

College degree

j
k
l
m
n

Advanced degree after college

48. What was the zip code of where you lived when you were receiving
most of your treatment and recovering from your injury or illness?
(Note, if you were injured outside the U.S. please use the zip code of where
you lived when you were recovering or your current zip code. If none are
applicable, enter 00000)

Page 17