Archive for September, 2012

Why is it hard to find a federal doctor? Part 6

Wednesday, September 19th, 2012

Continued…

The Claims Examiner from the Office of Workers Compensation has very clear evidence from the emergency doctor that you have a sprained knee that requires ice and rest. Now some new orthopedic doctor is requesting a surgery. This does not compute to the OWCP. They look at the accepted condition, ‘Knee Sprain’ and determine that nothing in the file warrants the operation. It is denied.

This is usually where most doctors feel they have given their best shot. They aren’t attorneys, are they? They often suggest to you that it is time to pursue your legal options and ‘lawyer up’. And don’t forget to let them know if you ever get the surgery approved, as they would be happy to do the operation. Some doctors even suggest attempting to get the surgery approved under your private insurance. While it is possible, it is not always an optimal avenue.

If a doctor does not have experience or spend time learning about the federal workers compensation system, it is unlikely that they will know how to successfully navigate this process and help you get the benefits that you need. A federal doctor, well versed in the OWCP rules and regulations might be able to craft a carefully worded and fully explanatory causation report expanding the claim to include the more severe condition.

Once OWCP expands the claim and adds the additional diagnoses, the surgery is approved and performed and you begin the road to recovery.

Federal employees have a variety of other benefits available to them including lost wage reimbursement, schedule award, loss of wage earnings capacity, etc. that were not covered in this series. Good medical care and correct paperwork from your doctor can help ensure you receive all that you are entitled to if you get injured at work.

Continue to check back or join the email list to be kept up to date about federal doctors and how to pursue your federal workers comp claim with quality medical care. FedDoctor.com is dedicated to finding federal doctors to help you with your OWCP claim.

These last 6 installments have been written for your information and to teach federal employees why it is so hard to find quality federal doctors who care enough about the federal workers to learn the special laws and rules required by the OWCP. This is not legal advice and you should consult with an attorney for advice.

 

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Why is it hard to find a federal doctor? Part 5

Tuesday, September 18th, 2012

Continued…

So it seems that most doctors either don’t do federal workers compensation, or don’t understand it. They may be very compassionate, genuine, caring physicians who just can’t make heads or tails of the OWCP.

If your doctor is eager to help and willing to help you fight your way through the process, you may still be facing an uphill battle. The issue becomes that first visit to the ER or urgent care facility. Remember from Part 3 of this series when the doctor didn’t preform and MRI after your twisted knee injury. The emergency doctor was most likely not especially thorough with the documentation on cause of injury. The report may say ‘slipped on stairs’ when what you need to say is ‘slipped on stairs while working at their job for the federal government’.

I know it seems like a small difference, but the OWCP Claims Examiner will want all of the dots connected. It is not their job to make assumptions. It is their job to examine the evidence presented and make a determination. This case might be denied.

Or even more complicating, imagine the ER doctor did state it was a work injury and the claim is opened with the accepted condition of ‘Knee Sprain’. Now your own doctor is willing to give this a fighting chance and work with you on your federal workers comp claim. First, the doctor orders an MRI and discovers that your injury is more severe than originally thought. You have torn your meniscus and will require a knee operation to return to health. The doctor submits a request for pre-authorization from the ACS website and is flatly denied.

Frustrated, but maybe not yet willing to give up, the doctor writes a letter to the OWCP CE stating that the surgery is necessary for you to get better. Remember, the Examiner is simply evaluating the evidence presented, and so far, doesn’t think your work injury warrants an operation.

To be Continued…

 

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Why is it hard to find a federal doctor? Part 4

Monday, September 17th, 2012

Continued…

Now that the emergency has subsided and you begin the process of visiting your regular doctor, you begin to find that being a federal employee who is hurt on the job, can be a very difficult proposition.

Once you see your doctor and explain the situation, they may be genuinely concerned, but confused on how to proceed. Many doctors do not attempt to help with workers compensation claims at all. They are happy to provide treatment but they have built a practice that does not assist with paperwork. They are allowed to do this! It is your doctor’s business and he/she can run it any way they choose. If they choose to operate a treatment-only practice, that means you need to find a new doctor. Hopefully your doctor can recommend someone else…

Another scenario is that your doctor immediately recognizes your need for a local orthopedic specialist or surgeon and refers you out to their office for further evaluation. Again, you may show up for your appointment only to find that they do not accept work related injury claims and don’t fill out paperwork. You are back to square one.

Commonly, your doctor, or the referred specialist do help with workers compensation claims and are extremely well versed in the laws that govern the state in which you live. Unfortunately, the state laws are very different from the federal law, FECA.

Most doctors do not gear their practices to serve federal employees. And why should they? The federal government and OWCP make it more difficult than most private insurers or state law workers comp. It is also a very small percentage of the overall population. Less than 1 out of every 100 Americans is a federal employee.

A third variable is that a doctor may have had a federal workers compensation claim before. But, if the office staff had trouble with the billing process, or if a requested pre-authorization was denied, the office may have sworn off any future dealings with the OWCP.

To be Continued…

 

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Why is it hard to find a federal doctor? Part 3

Saturday, September 15th, 2012

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…

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Why is it hard to find a federal doctor? Part 2

Thursday, September 13th, 2012

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…

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Why is it hard to find a federal doctor? Part 1

Wednesday, September 12th, 2012

The federal workers compensation system is spread out through the entire nation and even serves civil servants over seas. While it does not cover the armed forces, it does include people who work on military installation around the globe as civilians.

The federal workers comp laws are governed by FECA, the Federal Employees Compensation Act, and is administered by the OWCP (Office of Workers Compensation Programs). The OWCP has a number of regional office across the country that divide the federal population. (Click here for a list of District Offices)

More than 2.5 million people are covered under FECA, which adjudicates all workers compensation injuries for federal employees. Filing a claim after a work injury is the start of a process that may last only a few short days or for the rest of your life. Hopefully, none of you are injured severely.

Unfortunately, the nature of work requires us to perform services and duties and in the course of performing such work, injuries, sometimes serious, will occur.

The federal workers compensation provides benefits to those injured on the job. Whether it is simply medical care, lost wage reimbursement, or payment for permanent damage to the employee, FECA is the exclusive remedy for employer liability.

We at FedDoctor.com are focused on helping injured feds find local physicians that can provide quality care and understand the extra work and requirements that the federal government asks of treating doctors.

Most private sector companies have to purchase workers compensation insurance in case an at work accident or exposure injures one of their employees. The Federal Government decided to self-insure. They created the laws and the administration under the Department of Labor to handle the cases and payments for their own claimants internally.

Hence, the OWCP was born.

However, the OWCP decided to use a very large human resource company called ACS (Affiliated Computer Services, Inc.) to handle the medical payouts to the claimants doctor and treatment facilities. They actually work hand-in-hand to process medical fees and payments when the OWCP has determined that the injury is indeed related to the claimant’s employment with the federal government.

To be Continued…

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Houston doctor is making waves

Tuesday, September 11th, 2012

Dr. Jennifer Johnson-Caldwell is helping federal employees in Houston, Texas. As a board certified specialist in Internal Medicine, Dr. Johnson-Caldwell has had passion for helping federal employees with work injuries for over 10 years.

Texas Wellness and Rehab, Dr. Johnson-Cladwell’s clinic, can help federal employees with ongoing OWCP claims get the diagnosis and treatment that they need to get well and return to their lives and work. She understands the federal workers compensation system and knows how to help with the appropriate paperwork as well as do 6th Edition impairment ratings in accordance with the federal guidelines.

Texas Wellness and Rehab has in house physical therapy and orthopedic specialists to assist as well. If you live in the Houston area, call or visit Dr. Johnson-Caldwell to start getting the treatment you deserve. The OWCP can be intimidating to many people who are unfamiliar with the federal workers comp system. But finding the right care provider can make all the difference.

Dr. Johnson-Caldwell is currently working on an updated website to better serve you and federal employees like you. Please call and check back with FedDoctor.com to learn more.

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