 denotes special
topic pages in this site |
| Knowing and
following the rules may not be enough to protect you. But if you DO have to appeal,
then you need an airtight case with a paper trail that shows YOU followed the rules, and
THEY didn't. OR, you may need to find what the proper procedure was, in order to
correct it for appeal. Cases are decided on the paperwork in their file and the
rules that apply. There are also many mistakes that can't be fixed later. The
system IS too complicated without being allowed to use attorneys from the start (and get
them paid fairly under the laws). Fair treatment should be automatic and guaranteed,
but of course that requires reforming the laws that OCWP (mis)manages under. |
| 1.
Delayed filing or failing to meet YOUR deadlines in responding to OWCP at any step |
You're a good worker; you don't want
trouble; you don't know if it's bad enough to make a big deal about it; you're unsure
because you have an underlying or previous condition that also contributed to it; it got
worse over a period of time and you don't know if that's an on the job injury or not;
you're afraid of being accused of filing a false claim if you lose your case. All
these things cause people to hesitate.
Weigh the consequences if you DON'T file when the time is right.
It can get worse. You can lose protections the law intended you to have. LET
YOUR DOCTOR DECIDE WHETHER IT IS WORK RELATED.
SEE also Underlying conditions, Acceleration or precipitation
in Help Index , Medical treatment
from CA-550 # 4
4.Is it necessary to report all injuries that occur at work, even minor injuries such as a
scratched finger or bumped knee?
All injuries should be reported, since a seemingly minor injury may develop into a more
serious condition. For protection, the employee should file a report of the injury with
the immediate supervisor when it occurs. Benefits cannot be paid unless an injury is
reported.
from CA-810
2-2. Traumatic Injury
......
b. Medical Treatment--Form CA-16
(1) Delayed Report of Injury. If an employee has reported an injury several days after the
fact, or did not request medical treatment within 24 hours of the injury, the supervisor
may still authorize medical care using Form CA-16. Agency personnel are encouraged to use
discretion in issuing authorizations for medical care under such circumstances, but
employees should not be penalized for short delays in reporting injuries. The supervisor
may, however, refuse to issue a CA-16 if more than a week has passed since the injury on
the basis that the need for immediate treatment would normally have become apparent in
that period of time. An employee may not use Form CA-16 to authorize his or her own
medical treatment.
from CA-810 5-3.
Controversion (situations where COP is NOT paid, and you need to apply for compensation
instead SEE Compensation)
......
f. The injury was not reported on a form approved by OWCP (usually Form CA-1) within 30
days following the injury; |
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from CA-550
# 7
7.Is there a specific form to be used for reporting an injury?
Form CA-1, "Federal Employee's Notice of Traumatic Injury and Claim for Continuation
of Pay/Compensation" is the form to use when reporting a traumatic injury. Form
CA-2, "Federal Employee's Notice of Occupational Disease and Claim for
Compensation," is the form for reporting an occupational disease. In addition, the
employee should be given two copies of the appropriate checklist, Form CA-35A through H,
for the disease claimed (specific checklists have been devised for various conditions in
order to facilitate submission of evidence).
Instructions attached to Forms CA-1 and CA-2 should be followed carefully. Form CA-1
should be filed within 30 days following the injury, and Form CA-2 should be filed within
30 days from the date the employee realized the disease or illness was caused or
aggravated by the employment. The forms may be obtained from the employing agency or from
OWCP. |
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from CA-810 2-2.
Traumatic Injury
a. Notice of Injury--Form CA-1
......
(3) Sign and return to the employee the receipt attached to Form CA-1 and give a copy of
the form to the employee if requested; |
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Do your investigating
BEFORE making your initial choice of physician (NEVER use the agency choice of doctors,
unless you're unconscious in an emergency, and not then either). Barb urges people
to have the doctor lined up IN ADVANCE of injury--when you're hurting and injured is not a
good time to think clearly. ASK if they're willing to do the paperwork for OWCP and
keep you advised. Emergency doctor does not count as physician of record just
because you went to ER, but if you return for an appointment he becomes your physician of
record. Any treating physician who is your physician of record can also make a
referral to a board certified specialist who can be authorized additionally by OWCP.
Use specialists whenever possible. It can be very difficult to switch
physicians of record with OWCP, and OWCP does not pay physicians they have not authorized.
(In occupational illness
cases [not traumatic] you can use any doctors you choose with your own health insurance
BEFORE the claim is accepted. You're not stuck with one who's too busy to see you or
do the paperwork.)
SEE Physician of record in Help Index
from CA-810 2-2.
Traumatic Injury
b. Medical Treatment--Form CA-16
.....
(2) Choice of Physician. The employee is entitled to select the physician or facility
which is to provide treatment. The provider must meet the definition of
"physician" under the FECA and must not have been excluded from payment under
the program (refer to Chapter 6 for guidance in authorizing providers). An agency may make
its own facilities available for examination and treatment of injured employees, but may
not mandate use of its facilities to the exclusion of the employee's choice. Physicians
employed by or under contract to the agency may examine the employee at the agency's
facility in accordance with OPM regulations, but the employee's choice of physician must
be honored, and treatment by the employee's physician must not be delayed.from CA-550
# 11
11.Is an injured employee entitled to medical care, and if so, how is it obtained?
......
If the employee requires medical treatment because of a disease or illness which is
believed to be work related, the employee should arrange for the necessary medical
treatment. If OWCP accepts the claim, they will pay for medical treatment that is required
by the condition(s) accepted, including treatment received prior to acceptance. An agency
may issue a CA-16 for an occupational disease or illness ONLY after obtaining approval
from OWCP. |
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Many times in the
written reports to OWCP, the doctor is not specific enough about HOW the exact activities
caused the medical condition. This work connection statement can be especially
critical in occupational illness cases, and in cases where your condition becomes worse
unexpectedly, or you have a secondary condition as a result of the first.
You can't assume your doctor knows how to handle OWCP paperwork.
Explain IN ADVANCE about the paperwork needed from the doctor (including medical
rationale for causal relationship), and their other duties to respond to OWCP. Tell
the doctor you want to pick up copies of all correspondence between them and OWCP, and be
notified of all other contacts with your agency, OWCP, or an "intervention
nurse"
Your doctor's statement of your medical limitations on CA-17 must
cover ALL limitations. This is what you have to refer to when you tell OWCP that a
job offer is not within your limitations and therefore unsuitable. Don't even think
about arguing a limitation that your own doctor did not include on CA-17.
They will argue that pain per se is not a disabling
condition. Make sure your doctor cites the condition causing the pain, rather than
the pain itself, as a limiting factor on your activities.
On the
question of how much the work needs to contribute to the condition, and how much proof the
doctor needs, see Cause of Injury by H.L. Graham.
SEE Medical
reports
"Proving causal
relationship-reprise" -Bert Doyle, NALC
What the physician statement should include in cases that are
not obviously job related-- IMPORTANT --This is where the physician needs to verify that
he has read/included the employee's statement of work activity that he bases the
injury-work connection on! In some cases they will claim that your doctor is basing
his opinion on a work activity or condition that did not even occur.
Barb recommends keeping a copy of your current job description,
as well as a narrative of the work activities you normally carry out, or may be expected
to carry out, as a precaution. This is an important part of your file to give to
your doctor when you need to describe or document the work that contributed to your
condition.
"Medical rationale" - Bert Doyle,
NALC
“Causal relationship” includes, as indicated in earlier
articles, direct cause, permunent or temporary aggravation, acceleration (hastening), or
precipitation. Excluding injuries where the initial diagnosis is obvious (e.g., a letter
carrier is struck by a vehicle and fractures a leg), medical rationale is a necessary part
of all medical reports.
"While sometimes misunderstood, medical rationale is simply
a physician’s written reasons in support of his or her medical opinion concerning the
causal relationship between the diagnosis and the description of the injury or conditions
of employment furnished by the employee.
"It is essentially an explanation of how the physician
arrived at his or her medical opinion-and should contain, as a minimum, an explanation of
the pathological or other medical relationship between the diagnosis and the injury or
conditions of employment. The need for medical rationale has been stressed in hundreds of
Employees’ Compensation Appeals Board decisions..."
This is from ECAB decision Michael Stockert, 39 ECAB 1186, 1988:
“A physician’s opinion supporting causal relationship between a claimant’s
disability and a specific employment incident or factors of employment is not dispositive
on the issue of causal relationship simply because it is rendered by a physician. To be of
probative value to an employee’s claim, the physician must provide rationale for the
opinion reached. Where no such rationale is present the medical opinion is of diminished
probative Value.”
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Mistakes here can cost
you your health as well as your job, home, and family. Use the CA-810 procedures in
Return to work issues link. Accepting a phone offer of alleged "light
duty", or accepting a written offer that is vague about exact duties fitting
your doctor's limitations can leave you working in pain, worsening your condition, and
losing protections. Any discussion about the suitability of the work must be in
writing between you and OWCP. Your boss has no authority to cut your compensation;
only OWCP can do that. And only for the situation described in the CA-810.
It's not your supervisor you have to convince; it's OWCP.
SEE Return to work issues |
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Reporting employment income to OWCP
- Bert Doyle, NALC
"Failure to report employment or to understate earnings while in receipt of OWCP
compensation benefits can result in extremely serious if not devastating problems"
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There are traps for
cutting off your payments, whether you're on COP or compensation. Knowing where the
traps are is the first step to avoiding them.
Conditions
for not paying COP in CA-810 5-3. Controversion
Conditions for
ending COP in CA-810 5-6. Light Duty Assignments, and 5-8. Terminating COP
from CA-550
# 91
91. Under what circumstances can compensation be terminated or suspended?
(a) Compensation will be terminated if medical evidence is submitted which indicates that
the employee no longer has residual limitations from the accepted condition and can return
to the former job without limitations.
(b) Compensation will be terminated if the previous employer makes a suitable job offer
which is refused by the employee, and the cause for refusal is not considered reasonable.
OWCP will determine the suitability of the job offer and refusal.
(c) Compensation can be suspended if the employee does not cooperate with a specific
directive from OWCP (such as a request to report for medical examination).
(d) Compensation can be suspended for failure of the employee to respond within 30 days to
a request for information on employment/earnings, dependents, or dual benefits.
(e) Compensation can be suspended for failure of a beneficiary in a death case to respond
to a request for information on continuing entitlement, including student status.
Where response is subsequently received, reinstatement of benefits is retroactive to date
of suspension, if appropriate. |
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The error of waiting
for someone else to tell you what needs to be done, a supervisor, doctor, union, lawyer,
or OWCP, not learning your rights and verifying everything by going to the regulations
yourself. Put everything in writing and keep copies of everything, in chronological
order with most recent on top.
SEE "Don't Give Up!" from FedupFeds Director, Barb
Sweeney
SEE "Communicating With
OWCP" from Bert Doyle, NALC
SEE "Burden of Proof"
from Bert Doyle, NALC |
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