Continued…
Now that we have discussed the structure that the government uses to adjudicate work injury claims and the process of filing a new claim, we will begin to discuss why it is hard to find a doctor that is familiar with the federal system.
When the OWCP Claims Examiner opens (if they do not require additional evidence) a new federal workers compensation claim, they accept certain medical conditions as being work related. If you twist your knee and your doctor diagnoses a knee sprain, the claim will be opened and treatment that typically is prescribed is approved at the treating physician’s discretion.
The Claims Examiner notifies the ACS and all medical bills should be sent directly to the ACS through an online portal. If the treatment rendered and billed falls under the normal scope of treatment, it is approved. If not, the doctor’s bill will be rejected. It seems fairly reasonable on paper, doesn’t it?
Unfortunately, it can be much more cumbersome in real life.
If you were to twist your knee on the job and go to a hospital or urgent treatment center, they often will provide you with immediate and necessary care. Once the injury has been determined to be less than life threatening, a frequent recommendation is to ice, take some over-the-counter pain reliever and follow up with your regular doctor at your (or their) earliest convenience.
An MRI is rarely preformed. The rarity is due to many factors, one of which is often the amount of swelling that may be present in the knee. Doctors are often (and rightly so) conservative with these types of treatment plans. No one wants some doctor they barely know to rush them to surgery only to find once they are in the middle of a procedure that it was less than necessary. Most patients, and certainly the insurance company or federal workers compensation office, would be unhappy, to say the least.
To be Continued…
Tags: causation report, federal comp doctor, federal doctor, federal workers compensation doctor, local doctor, owcp doctor, postal doctor