Posts Tagged ‘federal workers compensation doctor’

Getting an OWCP claim accepted

Thursday, February 7th, 2013

Getting a federal workers compensation claim accepted by the OWCP can be difficult. In order to have an accepted claim, you must prove that the injury occurred as a result of your employment.

It sounds simple and it should be, however, medical documentation is necessary to establish the cause of injury. Often, this evidence is hard to get right, even for doctors that typically deal with workers compensation issues.

Part of the reason OWCP can be difficult for physicians is that the rules are different for federal workers comp than most state comp laws. Many doctors that are used to state law comp (which is far more common) are not aware of how the OWCP claims examiners adjudicate claims. The cause of injury must be very clear if not exhaustive.

Normal logical thinking would lead one to understand that if a doctor indicates in medical notes that the injury is work related, that would be enough to conclude that a claim should be opened and approved. But OWCP often requires more. A more detailed causation report may be required to describe exactly what actions or movements caused the particular injury.

These reports require much more time than most doctors are used to giving in these matters. Generally, doctors want to get going on the treatment and help their patients heal and return to full capacity as soon as possible. But if the claim is not accepted, the treatments may never be authorized.

That is why selecting a physician for your federal workers compensation claim is so important to your benefits. Without good documentation, your claim may never get off the ground and could result in a long drawn out fight with OWCP to get any benefits at all.

FedDoctor is here to help you with this particular problem. You don’t have to switch all of your care to your federal doctor, but it can be beneficial to at least see them for your work injury. While many FedDoctors treat other injury and illness types, they all spend a significant portion of their time trying to stay on top of the federal comp rules and regulations to ensure that when you present in their office with a federal on-the-job injury, they can help you get the treatment you are entitled to.

Many federal employees unfortunately think that they will not get injured at work and that this information doesn’t apply to them. The numbers indicate differently. 1 in 17 federal employees files a claim every year. Many never file claims because they have heard horror stories from those that have.

This kind of action can lead to even bigger problems later on. If an initial injury is never accepted by OWCP, later injuries that stem from them won’t be covered either. If a minor injury now develops into a major problem later, the employee can have a hard time getting the federal workers compensation office to accept it later. Claims examiners can point the previous, unaccepted condition as a “preexisting condition” and deny coverage based on a lack of relevant causation.

Whether you have an ongoing claim, or you were just injured, or even if you have never had an injury, understanding the difficulties that federal employees face is important. Share this information with you union and and encourage your coworkers to be prepared in case an injury occurs.

FedDoctor wants all federal employees to find competent care for federal workers compensation injury claims. We are constantly looking to add more federal doctors in your area. We don’t accept just any doctors to be on the site. We seek doctors who have a specific interest in helping with federal comp claims. If you are seeing a good federal doctor now, let us know! We want to help them treat more federal employees!

Whether you need a causation report or an impairment rating for a schedule award, FedDoctor is here to help you. Start your search for quality care today.

Understanding a Schedule Award – Part 4

Monday, February 4th, 2013

… Continued from Part 3

 

Hopefully now, you have had an independent medical evaluation by a quality federal doctor (hopefully FedDoctor was helpful!). Once you get your report back, it is time to go to work.

In order to get a good handle on how to calculate what your award might be, the next step is to understand what the OWCP List of Scheduled Members looks like. The federal workers compensation office uses this list of body parts to value each individual section of your body based on its importance to the whole body. Remember, this is very different from Whole Person Impairment (WPI) but uses the same type of principles.

For instance, an entire leg is valued at 288 weeks of compensation. A toe (other than great toe) is only worth 16 weeks. Here is a list of the other body parts and their corresponding weeks of compensation:

Arm 312 weeks
Fourth Finger 15 weeks
Leg 288 weeks
Hearing (1 ear) 52 weeks
Hand 244 weeks
Hearing (both) 200 weeks
Foot 205 weeks
Breast 52 weeks
Eye 160 weeks
Kidney (1) 156 weeks
Thumb 75 weeks
Larynx 160 weeks
First Finger 46 weeks
Lung (1) 156 weeks
Great Toe 38 weeks
Penis/Female Sex Organs 205 weeks
Second Finger 30 weeks
Testicle/Ovary (1) 52 weeks
Third Finger 25 weeks
Tongue 160 weeks
Toe (other) 16 weeks

The new impairment rating that your doctor provided to you is multiplied by the body part’s number of weeks of compensation. If your doctor assigned a 10% impairment to your leg, that would correspond to 28.8 weeks of compensation.

Your compensation rate is the same as your lost wage reimbursement rate. 75% of pay if you have dependents, and 66% if you do not. Multiply that weekly comp rate by the number of weeks of compensation from your impairment rating and body part and voila! You have your schedule award amount.

Now comes the hard part, submitting your claim to OWCP and hoping it is approved for the full amount! A good doctor, like the ones on this site, will be helpful. The stronger the report, the better your chances are of getting the claim approved for the highest amount of impairment.

Good luck, and don’t be afraid to ask an attorney for help. This is not legal advice, but it may be a good idea to get some!

Understanding a Schedule Award – Part 3

Friday, February 1st, 2013

… Continued from Part 2

 

In the 6th edition, it specifically requires you to be at MMI before the impairment can be rated. Have patience! Getting the rating appointment with a good doctor could be a waste of time if you haven’t allowed an adequate amount of healing time to elapse.

Federal workers compensation is difficult enough without having to redo your work or take more time to see a doctor. It is important to try to get it as right as you can on the first try. Once the fight begins, you will benefit from having all of your ducks in a row.

FedDoctor is the only place online to find quality federal doctors all over the country that help the federal employee! Using this resource and sharing it with your friends and co-workers can net you more money when it comes time to file the schedule award claim.

So now that you have reached MMI, schedule your visit with a qualified doctor to have your impairment rated. You can use your treating physician, but make sure that they fully understand the type of report they are generating.

As we discussed previously, the rating must be done in accordance with the AMA Guides 6th edition. Not all doctors know how to use this version as most states have chosen not to adopt this version. In addition to being done using the 6th edition, federal workers compensation schedule awards are not done using Whole Person Impairment (WPI), but rather stay at the local level using Regional Impairment.

To explain the difference, here is an example. If you have a 10% loss of use to your upper extremity (UE) that may equate to a 2% loss of the whole person. The difference is clear: 2% WPI vs. 10% UE.

OWCP does not accept WPI ratings at all. If your report is done using WPI, you have a significant chance of having the entire report thrown out by the district medical advisor in your OWCP regional office.

Your impairment rating should be left in the regional format. In addition, it is generally not helpful to have your doctor rate additional parts of your body that are not included on that claim number. If you have multiple claims, have separate reports done. OWCP often has different claims examiners responsible for different claims and they won’t necessarily both get a copy of the report. This seems like a minor detail, but it can cause confusion and delay or ruin your schedule award claim.

To be continued…

Understanding a Schedule Award – Part 2

Tuesday, January 29th, 2013

… Continued from Part 1

 

So if your physician is not a federal doctor (a doctor who simply understands the differences between federal and state workers compensation law), it is important that you know and understand schedule award calculations.

Now that you understand that you are not going to forfeit any future compensation benefit rights, it is now time to understand when and why a schedule award may be the next logical step in your claim process.

Federal workers compensation laws require that you reach Maximum Medical Improvement (MMI) before you get your impairment rated by a doctor (Read more about Maximum Medical Improvement here). MMI is determined when your physician determines that your recovery has plateaued. This doesn’t mean that you will never, ever get any better, simply that you are unlikely to substantially improve over the next twelve months.

If you are about to have surgery, MMI is usually not reached until approximately one year has elapsed after the operation, especially if the nature of your injury is neurological.

The rules that doctors follow when evaluating an impairment are laid out by the American Medical Association. The AMA Guidelines to Rating a Permanent Impairment 6th Edition are the most recent version of those rules and are the ones adopted by the OWCP (read more about the AMA 6th Ed. here).

These are likely different than the version used in your home state, another reason why FedDoctor is so helpful to injured federal employees. We help you locate federal doctors around the country that understand the 6th edition and how it relates to your schedule award. There may be one in your back yard!

OWCP claimants are allowed to travel to see a doctor to have their impairment rated for a schedule award claim. While OWCP may not reimburse you for travel expenses, you are allowed to have a one time visit with for an independent medical evaluation without preauthorization and without having to change treating physicians.

To be continued…

 

 

 

A Quick Note on Maximum Medical Improvement

Friday, January 25th, 2013

Maximum Medical Improvement, or MMI, is a term that doctors use to indicate that an injury or injured person’s ailment has somewhat stabilized. If it is unlikely that your injury will significantly improved over the next 12 months, a doctor can place you at MMI.

The OWCP and AMA Guides 6th edition require that your doctor indicates MMI before you have an impairment evaluation done for the purposes of a schedule award benefit. Read more about Schedule Award benefits here.

Understanding a Schedule Award – Part 1

Wednesday, January 23rd, 2013

OWCP Schedule Awards are a unique benefit to federal employees that have accepted federal workers compensation claims. This benefit is paid for permanent impairment to a part of their body as a result of a work related injury.

While most federal employees that have OWCP claims understand that the benefits exist, they rarely understand them, and even more rarely understand the process that goes into figuring out if they are entitled to one. That doesn’t even begin to touch on the subject of how much there schedule award will be.

First, the biggest difference between a federal workers comp schedule award and a state law workers compensation settlement (from most states) is that a schedule award does not signify the end of compensation benefits for the injured worker. Just because a schedule award is given, does not mean that your claim is over.

Under the most common state laws, a final settlement means that payment will cover the rest of the injury’s life. This means that the settlement would cover any future lost wages as well future medical bills related to the injury.

Under OWCP, the schedule award doesn’t mean that the claimant is not allowed future coverage for medical benefits or lost wage reimbursement. A schedule award only stops lost wage payments during the period of award.

Let’s dig a little deeper…

A schedule award is calculated using a formula that incorporates the injured federal employee’s pay rate, or compensation rate. This is the same figure that is used to calculate lost wage payments. All impairment ratings and scheduled members will equate to a corresponding number of ‘weeks’ of compensation. So once that period has elapsed, the claimant is again eligible to file for lost wage reimbursements at their typical rate.

The medical benefits are never extinguished in this scenario. It is important to know this when you are working with your doctor. They may not know the differences between the federal and state laws when it comes to ‘settling’ your claim. That is why it is best to work with a federal doctor (like the ones found on FedDoctor) who understands those different concepts.

To be continued…

OWCP vs. Health Insurance

Wednesday, January 16th, 2013

Many injured employees don’t understand the difference between there employer sponsored group health insurance and their workers compensation medical benefits when they are hurt at work. This can be especially true of federal workers compensation claimants as there are few doctors that accept OWCP as a form of payment or truly understand the OWCP.

Federal workers comp will pay for any medical treatments and costs associated with an accepted work-related medical condition to a federal employee. However, federal doctors can be very difficult to find. Many doctors don’t understand the differences between state and federal law when it comes to workers compensation medical billing. While it is not necessarily difficult, it can be confusing and it is usually much different than operating under the laws in their own state.

These differences can make it hard to find a physician that understands how to best help federal employees that are injured on the job. Many doctors can treat the injury, but their understanding of the billing system keeps them from taking on federal OWCP patients.

In fact, once you are in the doctor’s office and they discover you are a federal workers compensation patient, they may tell you that they can only treat you under your regular health insurance. Many injured workers give the doctor their insurance information and proceed to get the treatment, and this may be the best decision because the end goal is to get the most out of your recovery and the best results and residuals possible. If you have already selected this doctor based on credentials/reputation, it may be worth it to let the OWCP chips fall and pursue the health care out of your own pocket.

However, if this doctor is not interested in working with the federal workers compensation representatives and submitting bills to the OWCP, it may pose a big issue in the process of filing a new claim, getting monetary benefits, and having the work injury medical bills paid.

Using a federal doctor can be the answer. FedDoctor.com tries to help federal employees nationwide understand the differences between the state and federal workers composition systems. We want every federal employee to be able to find a top quality local physician that can help them recover from their injury as well as help them with the paperwork required by the OWCP to get all of the other benefits they are entitled to.

Tell your friends and co-workers to use FedDoctor and let your union know that this is a place that supports the federal workforce. It is free to use and if we don’t have a doctor listed in your area, submit your info to us and let us know you are looking. When we find someone there, we will let you know.

Whether you need an impairment ratings for a schedule award claim, a total knee replacement operation, or maybe just a few visits with a physical therapist, FedDoctor wants to help you get on your way back to recovery.

What about a recurrence?

Monday, January 7th, 2013

Injured federal employees often face one of the most unfamiliar puzzles in the federal workers compensation system: When do I file for a recurrence of injury?

Recurrence is a touchy subject and some OWCP claims examiners do not even fully understand the differences between a new injury, and aggravation of a pre-existing injury and a true recurrence.

There are two separate definitions you should be aware of: Recurrence of a medical condition, and recurrence of disability.

Recurrence of a medical condition is defined as the documented need for additional medical treatment after release from treatment for a work-related injury claim. Continuing, or getting additional treatments for the original injury is not part of recurrence a CA-2a is not required.

Recurrence of disability is a little different. A recurrence of disability is of course a work stoppage. However, it must be caused by a spontaneous return of symptoms, without an intervening cause, of a previously accepted OWCP claim’s medical condition. This can be either injury or occupational illness.

Recurrence of disability can also be filed on behalf of a consequential injury. A consequential injury is when an existing, accepted federal workers compensation claim injury/illness causes another medical condition or disability to arise because of impairment or weakening to the claimant.

A federal employee also must file a CA-2a form when a specific light duty assignment is withdrawn by the agency for some reason other than misconduct or non-performance of duty.

If a re-exposure to the cause of the original injury occurs, or a new incident contributes to your detrimental medical condition, that is not a recurrence, but a new injury and should be filed as such.

Consequential injuries, spontaneous worsening and withdrawal of light duty are the only reasons any federal employee should file a recurrence of injury CA-2a claim with the OWCP.

If you have been hurt on the job, or your claim is being denied because the medical documentation has confused your doctor or claims examiner, find a federal physician who understands what it takes to straighten things out. Here at FedDoctor.com, we want every federal employee to find a doctor that understands the OWCP rules and regulations and can get you the right medical care and the federal paperwork needs to appease your claims examiner and help you get your benefits.

Use FedDoctor for free and help other federal employees find out about us by sharing these articles. We want to help federal employees that are stuck in the cycle of dead-ends that often accompanies a federal workers compensation claim. Let us know if you have see a doctor who helps federal employees with these claims as we want other federal employees get the help they need.

OWCP doctors and Second Opinion examinations

Monday, December 17th, 2012

There is often a lot of confusion about the difference in a federal doctor from an OWCP doctor, a District Medical Advisor, and a second opinion or referee doctor. Hopefully, this article will shed some light on the differences and help you understand why having a doctor that understands how the OWCP works to treat you is so important.

The terms ‘federal doctor’ and ‘OWCP doctor’ do not actually define how a doctor practices medicine. They are terms used by people within the federal community to denote a physician that has special understanding or familiarity with the Office of Workers Compensation Programs and their procedures. Those terms help you know which doctors might be helpful with your injury claim.

However, it is important to be careful and understand that sometimes the term ‘OWCP doctor’ might insinuate that the doctor works for the federal government. The OWCP does not directly employ any physicians that actually examine claimants. However, some doctors are occasionally contracted to see a federal claimant for a second opinion or referee exam.

When the medical evidence in you federal workers compensation claim are not sufficient to make a decision on the case, the claims examiner may schedule an appointment for you to see one of those contract doctors. Often those doctors do not establish a patient/doctor relationship and simply render an opinion based on the questions asked by the claims examiner. This is not your doctor. Some may be helpful, but often they are making a determination on the merits of your case with a 1o minute exam and may not be able to give your case the time that it deserves.

Similarly, a referee doctor is used as a third and final say when two doctors have a disagreement about your medical file. They may choose to side with your treating doctor, or the second opinion doctor. Sometimes they even come up with their own opinion that is different entirely.

Understanding the differences between these terms is important for any federal employee that has an ongoing workers comp file. FedDoctor is always looking to find doctors that understand the federal workers compensation system and can help you get the treatment and documentation that you need. Keep checking back and share this information with your fellow federal employees. We want the federal employee to be informed on their medical care rights and understand that their health care choices make a difference when it comes to a workers compensation claim.

Why doesn’t FedDoctor have federal doctors everywhere?

Friday, December 14th, 2012

Thanks to a recent comment on our Facebook page, (please Like!) we thought it would be a good idea to inform our subscribers and viewers to learn about why FedDoctor doesn’t have a federal doctor in every city.

First, FedDoctor would love to bring that type of coverage to the entire country and we are actively looking for new federal doctors all of the time. We want every federal employee with a workers compensation injury to get top quality medical care in their local commuting area.

Because the federal government workers compensation system and OWCP have made the process of treating patients more difficult than simply visiting a doctor under your private health insurance, many doctors make a business decision to not accept OWCP as a form of payment. Additionally, the federal workers comp system requires an unusually high volume of paperwork and documentation. Many doctors are not interested in committing the massive amount of time necessary to fully understand all that is required to successfully treat and help federal employees with work related injuries.

This leaves a void for the federal compensation claimant. Finding a doctor that is willing to take on the OWCP and also understands the paperwork and billing differences can be difficult, especially if the state that they practice in has significantly different laws. It would be like learning a new language.

To make it even harder for the doctor to justify the time necessary to help federal claimants the right way, there are far fewer federal employees than non-federal. Only 1 in 50 working Americans may even be covered under the OWCP. It would follow that only 1 in 50 doctors, within a specialty, would consider the focus on a federal practice a prudent business decision.

That is why the doctors on this site are so helpful. They dedicate an enormous amount of time to understanding the OWCP and the federal workers compensation rules and regulations.

Help us find more doctors that want to help federal employees! If you are treating with a great doctor for an ongoing federal workers compensation claim, give us their name and we will contact them about their interest in expanding their practice even more! Ask your coworkers and union members who they see when they get hurt on the job. We want to have doctors on this site for every federal employee!

 

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