Federal Workers Compensation Coffee Break Podcast is about all things related to Federal Workers Compensation, FECA, OWCP, DOL & Longshore claim filing as an injured federal worker. The podcast is an educational and informative training on how to navigate the DOL -OWCP claims filing process for all types of injured US government and federal workers. The podcaster has 27 years in assisting with federal workers compensation as a consultant and trainer. The podcast is free and is educational. If you need help with anything related to a federal workers compensation claim...help is just a cup of coffee away.
In order to receive a Schedule Award, the person must be rated by a physician, using the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, otherwise known as the AMA GUIDE 6th Edition. Prior to receiving the rating, the person has to have reached Maximum Medical Improvement, which is referred to as MMI. This rating should not be for the whole body, but for the injured body area or body part, such as 25% of the right lower extremity. When the physician rates the injured employee, YOUR physician is required to reference the page number and paragraph of the sixth edition guides to the evaluation of permanent impairment that relates to the employee’s ratings.
Please be aware that one does not have to accept surgery before receiving a Schedule Award. No invasive procedure can be performed on the claimant if he or she objects to it. Invasive procedures are considered anytime you penetrate the skin, such as injections or other procedures such as surgeries.
What should the employer do when an employee files an initial claim for compensation due to disability or permanent impairment ?
Upon receipt of Form CA-7 from the employee, the employer shall complete the appropriate portions of the form. As soon as possible, but no more than five (5) working days after receipt from the employee, the employer shall forward the completed Form CA-7 and accompanying medical report to OWCP. OWCP clarifies schedule award procedures, including how pre-existing or ,nonindustrial medical conditions affect these important permanent disability awards.
I want to talk about a common misunderstood and misused category that claims examiners and second opinion doctors attempt to utilize that is not included in the DFEC procedure manual or Code of Federal Regulations. The word that I am referring to is called apportionment.
Under federal law, there is no "apportionment" - that is, if your employment contributed to any degree to the medical condition causing the disability, the entire disability is covered in full.
Link to the DFEC Procedure Manual portion:
https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECA-PT2/group2#20808
Happy Hunting! :)
Dr. Taylor's educational podcast utilizes his experience and history as a DOL - OWCP provider and his years of consulting and teaching all things federal workers compensation related. This is an educational short form format for learning how to successfully file federal workers compensation claims. So grab a cup of coffee and lets begin.
Dr. Taylor's contact information for more information or assistance is:
https://fedcompconsultants@protonmail.com
If you need a provider or assistance with a DOL claim in Tampa, Jacksonville or other areas of Florida you can make an appointment to see him and the other providers at his clinic at 813-877-6900.
In order to receive a Schedule Award, the person must be rated by a physician, using the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, otherwise known as the AMA GUIDE 6th Edition. Prior to receiving the rating, the person has to have reached Maximum Medical Improvement, which is referred to as MMI. This rating should not be for the whole body, but for the injured body area or body part, such as 25% of the right lower extremity. When the physician rates the injured employee, YOUR physician is required to reference the page number and paragraph of the sixth edition guides to the evaluation of permanent impairment that relates to the employee’s ratings.
Please be aware that one does not have to accept surgery before receiving a Schedule Award. No invasive procedure can be performed on the claimant if he or she objects to it. Invasive procedures are considered anytime you penetrate the skin, such as injections or other procedures such as surgeries.
What should the employer do when an employee files an initial claim for compensation due to disability or permanent impairment ?
(C) Upon receipt of Form CA-7 from the employee, or someone acting on his or her behalf, the employer shall complete the appropriate portions of the form. As soon as possible, but no more than five (5) working days after receipt from the employee, the employer shall forward the completed Form CA-7 and any accompanying medical report to OWCP.OWCP clarifies schedule award procedures, including how pre-existing or nonindustrial medical conditions affect these important permanent disability awards.
There have been lots of problems in Federal Employees' Compensation Act (FECA - workers' compensation for federal employees) cases in the amount of awards for permanent impairments. I want to talk about a common misunderstood and misused category that claims examiners and second opinion doctors attempt to utilize that is not included in the DFEC procedure manual or Code of Federal Regulations. The word that I am referring to is called apportionment.
Under federal law, there is no "apportionment" - that is, if your employment contributed to any degree to the medical condition causing the disability, the entire disability is covered in full. Now why is that important to know? Because Claims examiners try to deny cases with this all of the time. They basically ignore the law and try to suggest that the pre-existing conditions such as degenerative changes or arthritis etc. are not ratable and can not be part of the injury. So they try to circumvent the law by saying that the portion of your injury that is pre-existing, degenerative or arthritic etc. is not included in your injury and that portion is not qualified to be accepted as a work-related portion of your work-related injury or is ratable as an impairment for a scheduled award.
OWCP claims examiners and their small little team of examining second opinion physicians have for years been calculating some scheduled awards based only on the work-related portion of the disability or impairment. For example, a worker with pre-existing arthritis in his left hip who injures it at work, requires surgery for a torn labrum, and now has more hip impairment due to both medical conditions ( the hip arthritis and the torn labrum) …. Ignoring the hip arthritis would be incorrectly evaluated with regard to the surgical result only,…. They like to ignore the arthritis portion which is also affecting his hip and contributing to a higher level of impairment. This is how they use apportionment philosophically, when it is actually against the federal rules and provisions of the FECA ACT. SO know your rights…and write this down …to present to your claims examiner….. READY….There are no provisions for apportionment in FECA, so impairment ratings should include both work-related and non-work-related impairments to the affected body part.
Apportionment by definition is the act of apportioning. The condition of having been apportioned. means distribution or allotment in proper shares. Or in laymen’s terms they are picking and choosing the portion that they want to accept in bodily injures and ignoring other portions that they believe is pre-existing or outside of the federal comp coverage. Apportioning injuries into ignoring pre-existing or degenerative or arthritic portions has never been correct, and has resulted in large numbers of appeals that have to be filed just to present the applicable law, rules and provisions of the FECA act… that there is no apportionment in these fed comp cases and therefore the scheduled awards most of the time are qualified for higher impairments and scheduled awards.
What aggravates me is that most claims examiners that do this cherry picking of acceptance… know they are circumventing federal law of the FECA act. SO let’s go over what the FECA act actually says about this.
In FECA Transmittal No. 17-02 issued in 2017, OWCP revised its DFEC Procedure Manual to clarify a number of things regarding permanent disability schedule awards: and most people and/or treating doctors and federal injured workers are not aware of this change and how it affects MMI, Impairment ratings and scheduled awards.
When OWCP's District Medical Adviser ("DMA" -a referee doctor) from now on we will call the District Medical Adviser the DMA….When the DMA disagrees with its Second Opinion doctor on an issue, this disagreement doesn't create a conflict in medical evidence requiring yet another evaluation. Yet, the claims examiner attempts to schedule one anyway.
When OWCP has already sent you …the injured worker….to a referee (independent) medical examiner, there is no need for the government to have the DMA review the referee's opinion. Referees see injured workers where the treating doctor and the government 's doctor disagree. This change only applies, however, when the referee's report fully resolves the earlier conflict in medical opinions and provides a through explanation of the medical impairment.
This third part we just covered… is the most important one. This should result in larger and more timely schedule awards for injured federal workers where, before, errors had been made in the award calculation that resulted in appeals and other challenges. If the awards are going to be calculated correctly, you the injured federal worker can avoid long delays and/or costly appeals and the correct (higher) amount of scheduled award benefits can be paid in a timely manner. When you present these facts to your claims examiner
Another thing to cover here in this FECA Transmittal No. 17-02 bulletin from 2017, is that… this change clarifies that the disability rating must include all conditions affecting the affected body part as of the time of the rating examination. This means that, under this explanation, a worker could suffer another injury after the work-related initial injury one …but before the rating exam, and the effects of that extra injury would also have to be included in the rating. It also means that the effects of any other non-industrial injuries ( pre-existing injuries) have to be included in the rating as well.
All this makes is clearly outlined administratively but we exist in very adversarial times and system currently. FECA is designed to not be a adversarial system. Where both sides have lawyers that fight it out. Litigation in other workers' compensation systems is often complicated by the need to apportion disabilities, ascribing a percentage to different causes -- but those are adversarial systems where both sides have attorneys and a judge makes the decision. FECA is not designed as an adversarial system that could handle such disputes. It also makes perfect sense legally, since the federal rules against apportionment means there is no need to attribute percentages to the various causes. So the Practical explanation here is that …. it is difficult for a doctor to determine how much the knee (in the above example) was affected by more than one cause. So they allow in the rules of federal comp to cover all of the area. Now, how many people listening out there new that…..see why I tell you …that you should share this podcast with your coworkers…
These cover relevant items in this procedure revision of 2017 are unobjectionable and should result in much faster resolution and adjudication of your scheduled award claims. Considering how slow OWCP is to finalize so many actions on FECA claims, presenting these facts with your CA-17 and in your physicians medical narrative with his impairment rating should speed up your scheduled award claims. The claims examiner will know that you know your rights and the federal rules and that she can not circumvent them.
There are other types of awards for permanent injuries in FECA claims, including lost wage benefits for both total and partial disability, but those are not affected by this change of 2017 in the Procedure Manual.
So lets review… we have covered a lot of material in these two podcasts. Ok…first….
In order to receive a Schedule Award, you the injured federal worker must be rated by a qualified a nd approved DOL OWCP physician, using the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, otherwise known as the AMA GUIDE 6th Edition. Prior to receiving YOUR rating, YOU have have to have your doctor state that YOU have reached Maximum Medical Improvement, which is referred to as MMI. This rating should not be for the whole body, but for the injured member such as 25% of the right lower extremity. When your physician rates injured body parts or areas, your physician should write the page number and paragraph of the 6th edition guides that relates to the employee’s ratings.
Remember we covered already that you do not have to accept or complete surgery before receiving a Schedule Award. No invasive procedure can be performed on you if you object to it. Invasive procedures are considered anytime you penetrate the skin, such as injections or other procedures such as surgeries. You do not get to reject much in fed comp but you can reject invasive procedures.
What should the employer do when YOU file an initial claim for compensation (scheduled award) due to disability or permanent impairment ?
First, When you are disabled by a work-related injury and loses pay for more than three calendar days, or have a permanent impairment or serious scarring or disfigurement as described in 5 U.S.C. 8107, the employer shall furnish YOU with a Form CA-7 for the purpose of claiming compensation in the form of a scheduled award.
2nd, If you are receiving continuation of pay (COP) , the employer should give Form CA-7 to YOU by the 30th day of the COP period and submit the form to OWCP by the 40th day of the COP period. If the employee has not returned the form to the employer by the 40th day of the COP period, the employer should ask you the injured federal worker to submit it as soon as possible.
3rd, Upon receipt of Form CA-7 from you , or someone acting on your behalf, (attorney or advocate) YOUR EMPLOYER should complete the appropriate portions of the CA-7 form. As soon as possible, but no more than five (5) working days after receipt from you giving it to your employer, the employer shall forward the completed Form CA-7 and any accompanying medical report to OWCP.
Now one last thing before we wrap up this 2 pat series on scheduled awards…
If you end up with a high enough impairment rating due to your medical condition causing a lot of impairment, or illness that is preventing your from being qualified for performing your original official duties or requirements of your job, or any limited or modified duty offers… you may want to look into filing for federal disability retirement. NOW this part I have to let you know that I can only give you so much information on this topic because each branch of government service has different employment packages for disability and retirement. Depending on which federal retirement system you fall under, you will either need to file for Civil Service Retirement System (CSRS) Disability
or Federal Employees Retirement System (FERS) Disability.
Now one thing I do know here on this disability topic is that before you can be considered for disability retirement under either of those systems, you will need to apply for Social Security Disability, whether you qualify for it or not.
This is a prerequisite requirement under both retirement systems and you most likely will be denied Social Security Disability the first time you apply. Yet you have to go through that process.