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.
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…
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.
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.
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.
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!
FedDoctor.com is please to announce the addition of federal doctors’ offices in Oklahoma.
At Rehabilitation of Oklahoma, Dr. Stephen Wilson has been treating federal employees that have ongoing OWCP claims in Tulsa and Oklahoma City for years and has two brand new offices in those communities. He has years of experience and a wealth of knowledge about how the Office of Workers Compensation Programs works and understands that the reports that he produces are vital to your claim’s success.
Dr. Wilson also devotes an extraordinary amount of time to staying in tune with the latest requirements of the OWCP with regards to impairment ratings and evaluations. He has a command of the 6th Edition of the AMA Guides to Rating Permanent Impairment and can help you with your schedule award claim.
The Broadway Clinic of Oklahoma City also provides excellent treatment options for federal employees in the OKC area. Dr. J. Arden Blough has spent years learning the intricacies of the federal workers compensation system and in well versed in both the treatment and the documentation of a claim. Broadway Clinic can perform independent medical evaluations and impairment ratings to help you get the best documentation for your schedule award claim.
FedDoctor.com works hard to make sure that federal employees have a place to go to find competent, quality care from a federal doctor that understands the OWCP and the requirements set for physicians who treat federal patients. We are proud that Oklahoma is home to such quality care providers. Check out their listings and make an appointment today.
When federal employees are injured on the job, the Office of Workers Compensation Programs is responsible for helping them with medical expenses and compensation. The OWCP has a number of different district offices that adjudicate claims. Cities like Chicago, IL, Jacksonville, FL, and San Francisco, CA are all homes to OWCP District offices.
Whenever a CA-1, CA-2 or CA-2a is filed at a government agency, the claim is forwarded to the appropriate district office. There, it is assigned to a Claims Examiner for review. The Claims Examiner will determine whether the claim has merit based on the medical evidence in the file. This is why finding a doctor that understands the federal workers compensation system is so important.
Federal workers comp is very different from state law comp. As such, most medical providers do not know how to distinguish between the sets of rules that they must follow and the burdens that they have between the two. That is why FedDoctor.com works so hard to establish an easy way for injured federal employees to find quality medical care from a federal doctor for their OWCP claim.
Remember the term ‘federal doctor’ doesn’t actually distinguish anything different about the medical care. A physician maybe be called a federal doctor, or OWCP doctor simply because of their familiarity with the federal compensation system. FedDoctor.com has sought to find only the best doctors for the injured federal worker and make their presence more known to the federal community.
Remember that having a credible physician that understands the OWCP process and how to help you with you federal workers compensation claim is crucial in having a successful workers compensation claim and gives you the best chance of returning to work after a productive recovery.
Whether you have a minor injury that will heal in a few days, or a major medical condition that may permanently end your career, the right federal doctor can make all the difference in what is covered by the OWCP, and what isn’t. Use FedDoctor for free to find a local doctor that understands the federal workers compensation system. Tell your friends, family, coworkers and union about FedDoctor and let us know if there is no doctor near you, or if you know a great federal doctor that needs to be listed here!
We never want to see anyone injured or struggling with a federal workers compensation claim, but if you are, search our site for information that may change your claim and your life.
Federal employees, stay tuned! FedDoctor has big news coming in the state of Texas. We are always looking for more doctors to help injured federal employees that have federal workers compensation injury claims. Doctors that are familiar with the OWCP and how to help you get the appropriate treatment and benefits are hard to find. Check back with us soon to learn more about the breaking news in the Lonestar State. More soon…
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.