WAYS TO APPEAL A CLOSED CASE
If you receive a Notice of Decision letter from DOL/OWCP denying your claim, you have one (1) year from the date of the denial letter to appeal your decision. Also, if you have an accepted OWCP case that is closed due to inactivity or your case worker does not think that your case should be kept open due to your OWCP case diagnosis. You can appeal your closed case as well. One of the most common emails or patient questions I receive the one that I receive the most is what is the best way to dispute a closed case. There are two types of closed cases that are typical. The first is the OWCP case that is outright denied after the CA forms and the doctor’s reports are reviewed and a decision to deny the claim for some missing element required to establish a claim. The second type of closed case is an administrative closure due to a specific resolvable diagnosis or due to inactivity on the case. Administrative closure usually happens when a patient’s OWCP case is closed due to "no activity" in your case for a period of 120 or 180 days. Many people do not understand why OWCP providers always tell their patients that they need to be careful to maintain a presence with their medical providers if they have a permanent diagnosis. People always think that when they are told they have a permanent accepted work related condition that they have lifetime medical benefits but case workers will close your case due to inactivity. So my advice is to not take too much time off from your providers in order to prevent your case workers from closing your case. But if you have experienced an administrative closure of your account there are remedies that are afforded to injured workers to get your case reopened. One of the most common ways to appeal a closed case is over the phone. Oral hearings can be attended Telephonically!
There are three types of appeals: We covered this before but lets review the type of appeals.
ORAL HEARINGS OR REVIEW OF THE WRITTEN RECORD. The provision for this appeal is found under 5USC.8128 (a) which states: "Before review (reconsideration). A claimant not satisfied with a decision of the Secretary of Labor OWCP) is entitled, on request made within thirty days after the date of the issuance of the decision, to a hearing on his claim before a representative of the Secretary." An oral hearing or review of the written record is not permitted if the employee has previously been granted reconsideration. In other words, an oral hearing or review of the written record can precede, but not follow, reconsideration by OWCP.
Oral hearings can be attended Telephonically! One of the most common ways to appeal a closed case is over the phone. OWCP Oral Hearings can now be conducted telephonically saving you the trouble and cost of attending your OWCP Oral Hearing in person. Your doctor, your union representative or a OWCP consultant or lawyer or even just you representing yourself …ORAL hearing appeals process telephonically allow you or your representative to represent you during your OWCP Oral Hearing via telephone conference call. Although the FECA was intended to be non-adversarial, the law is complicated. 5 USC 8127 allows an injured worker to appoint a representative to act for him or her in any proceeding under the Act. A representative such as a union steward or attorney experienced in the ins and outs of this program can help an injured worker. The provision for this type of appeal is found under 5USC.8128(a). This pretty much means that an injured employee who does not agree with DOL & OWCP case decisions, They can then appeal orally but under an oral appeal there is the telephonic option. Which saves the injured employee time by not having to travel to meet in person.
Written Request
An injured federal employee can go the route of doing things in the written format. Now, to go that route you have to have it submitted within one year of the last decision on record. The written way is pretty much asking the Secretary of Labor to review new arguments or request that were not put on the last request to see if the injured employee can get their case reopened. New arguments or evidence can include a new medical report, and/or a new witness that saw the accident happened during a regular work duty.
ECAB
The ECAB is a panel of three members. They are a panel of the Department of Labor but separate of OWCP. These members are appointed by the Secretary of Labor. Any appeal made this way has to be done within 180 days of the OWCP’s original decision. This appeal can be done after there has been a decision on an oral hearing. No new evidence or request can be submitted for this appeal. The depiction that comes out of this hearing is valid for one year. After that year, the injured federal employee can file for reconsideration and submit new evidence to reopen their case. A request for an appeal with the Employees’ Compensation Appeals Board should be addressed to: Employees' Compensation Appeals Board, 200 Constitution Ave NW, Room S-5220, Washington, DC 20210.
Ok, now if you want to request an oral hearing for a denied or closed case hear are the steps to filing an oral hearing request. A request for an Oral Hearing or a Review of the Written Record with the Branch of Hearings and Review should be addressed to: Branch of Hearings and Review, Office of Workers' Compensation Programs, P. O. Box 37117, Washington, DC 20013-7117. Review any formal decision you may have received for more information regarding the appellate process. If you have a written denial there is a last page of the OWCP denial letter that request your signature and has all three types of appeals listed. If you want to dispute your case denial and you have that OWCP denial letter for an oral hearing
1st check the box for an oral hearing telephonically
2nd sign the sheet
3rd send the request to the branch of hearings and review at the address that is listed on your OWCP denial letter.
10.617 How is an oral hearing conducted?
(a) The hearing representative retains complete discretion to set the time, place and method of the hearing, including the amount of time allotted for the hearing, considering the issues to be resolved. Any requests for reasonable accommodation by individuals with disabilities should be made through the procedure described in the initial acknowledgement letter.
(b) Unless otherwise directed in writing by the claimant, the hearing representative will mail a notice of the time, place and method of the oral hearing to the claimant and any representative at least 30 days before the scheduled date. The employer will also be mailed a notice at least 30 days before the scheduled date.
(c) The hearing is an informal process, and the hearing representative is not bound by common law or statutory rules of evidence, by technical or formal rules of procedure or by section 5 of the Administrative Procedure Act, but the hearing representative may conduct the hearing in such manner as to best ascertain the rights of the claimant. During the hearing process, the claimant may state his or her arguments and present new written evidence in support of the claim. Hearings are limited to one hour; this limitation may be extended in the discretion of the hearing representative.
(d) Testimony at oral hearings, including those conducted by teleconference, videoconference or other electronic means, is recorded, then transcribed and placed in the record. Oral testimony shall be made under oath. The transcript of the hearing is the official record of the hearing.
(e) OWCP will furnish a transcript of the oral hearing to the claimant and the employer, who have 20 days from the date it is sent to comment. The employer shall send any comments to OWCP and the claimant, who will have 20 more days from the date of the agency's certificate of service to comment.
(f) The hearing remains open for the submittal of additional evidence until 30 days after the hearing is held, unless the hearing representative, in his or her sole discretion, grants an extension. Only one such extension may be granted. A copy of the decision will be mailed to the claimant's last known address, to any representative, and to the employer.
In a FECA claim, its OWCP's burden of proof to end, terminate, your benefits. However, when there has been "no activity" in your case for a period of 120 or 180 days, sometimes a subsequent bill will trigger the provider being advised that there was an administrative closure, and that the claimant needs to call to address that.
DO NOT file a Recurrence if there is an administrative closure in your case. Your claims examiner should agree to remove the closure when you call and say there is a doctor bill. If there has been no decision terminating your claim, and your doctor did not write a report saying you are all better and discharging you, a claims examiner is supposed to remove the closure. If they tell you to file a Recurrence, they are wrong, and you should nicely ask them to have a Supervisor call you to discuss the situation.
If you file a Recurrence due to an administrative closure, you are making the process vastly more difficult for yourself.
Well that does it for this episode of Federal Workers Comp Coffee break Podcast.
I want to thank you for listening and want to remind you to share this podcast with other federal workers you think would benefit from this information. Also if you need an approved medical provider for your DOL -OWCP Or Longshore case in Florida you can find me in Tampa at two different locations and in Jacksonville. To make a consult with me to discuss your case or if you know someone if Florida who is recently injured you can call M & R Medical & Therapy centers at 813-877-6900. Also if you are in another state and you want me to assist you with claim questions or assistance for your doctor you can email me at fedcompconsultants@protonmail.com