Continued…
To understand the way the OWCP operates, you must first understand mechanism of injury, or causation.
For the purposes of the federal workers compensation system, there are two different types of cause; traumatic and occupational (Read about Traumatic here, Occupational here).
A traumatic injury occurs at a given time. For instance, an automobile accident. An occupational injury occurs due to a repetitive hazard or peril such as carpal tunnel syndrome or chemical inhalation.
Both are legitimate injury types and can be caused at the work place or while in the performance of duty. Federal employees are often exposed to these risks on a daily basis. CA-1 and CA-2 forms can be filed based on the type of injury that has occurred.
Once a claim form has been submitted to the agency, it must forward the claim information to the appropriate district office for adjudication. The case will be given a claim number and assigned to a claims examiner (CE). The claims examiner does not have formal legal or medical training. Rather, they work for the Department of Labor and spend the majority of their time looking over submitted evidence to determine whether a claim is legitimate, or not.
Like in any profession, there are some CE’s that are better than others. Essentially what they are looking for is the correct forms to be used by the claimant and for the supporting documentation from the treating physician to be thorough, clear, easy to understand to a lay person, and to clearly identify the cause of injury. Along with any diagnostic studies that could be provided, the CE will use that information to decide whether or not a claim should be opened for compensation, or closed due to lack of evidence.
That does not mean that the more information you send a claims examiner, the better. On the contrary, the CE has dozens, if not hundreds of files that they are responsible for. Your doctor needs to be clear and concise, yet build the cause of injury information and documentation from the ground up.
To be Continued…
Tags: 6th edition ama guides, causation report, federal comp doctor, federal doctor, federal workers comp doctor, federal workers compensation doctor, owcp doctor