Continued…
The Claims Examiner from the Office of Workers Compensation has very clear evidence from the emergency doctor that you have a sprained knee that requires ice and rest. Now some new orthopedic doctor is requesting a surgery. This does not compute to the OWCP. They look at the accepted condition, ‘Knee Sprain’ and determine that nothing in the file warrants the operation. It is denied.
This is usually where most doctors feel they have given their best shot. They aren’t attorneys, are they? They often suggest to you that it is time to pursue your legal options and ‘lawyer up’. And don’t forget to let them know if you ever get the surgery approved, as they would be happy to do the operation. Some doctors even suggest attempting to get the surgery approved under your private insurance. While it is possible, it is not always an optimal avenue.
If a doctor does not have experience or spend time learning about the federal workers compensation system, it is unlikely that they will know how to successfully navigate this process and help you get the benefits that you need. A federal doctor, well versed in the OWCP rules and regulations might be able to craft a carefully worded and fully explanatory causation report expanding the claim to include the more severe condition.
Once OWCP expands the claim and adds the additional diagnoses, the surgery is approved and performed and you begin the road to recovery.
Federal employees have a variety of other benefits available to them including lost wage reimbursement, schedule award, loss of wage earnings capacity, etc. that were not covered in this series. Good medical care and correct paperwork from your doctor can help ensure you receive all that you are entitled to if you get injured at work.
Continue to check back or join the email list to be kept up to date about federal doctors and how to pursue your federal workers comp claim with quality medical care. FedDoctor.com is dedicated to finding federal doctors to help you with your OWCP claim.
These last 6 installments have been written for your information and to teach federal employees why it is so hard to find quality federal doctors who care enough about the federal workers to learn the special laws and rules required by the OWCP. This is not legal advice and you should consult with an attorney for advice.
Tags: causation report, federal workers comp doctor, federal workers compensation doctor, local orthopedic doctor, owcp doctor, schedule award doctor