Archive for January, 2013

Understanding a Schedule Award – Part 2

Tuesday, January 29th, 2013

… Continued from Part 1

 

So if your physician is not a federal doctor (a doctor who simply understands the differences between federal and state workers compensation law), it is important that you know and understand schedule award calculations.

Now that you understand that you are not going to forfeit any future compensation benefit rights, it is now time to understand when and why a schedule award may be the next logical step in your claim process.

Federal workers compensation laws require that you reach Maximum Medical Improvement (MMI) before you get your impairment rated by a doctor (Read more about Maximum Medical Improvement here). MMI is determined when your physician determines that your recovery has plateaued. This doesn’t mean that you will never, ever get any better, simply that you are unlikely to substantially improve over the next twelve months.

If you are about to have surgery, MMI is usually not reached until approximately one year has elapsed after the operation, especially if the nature of your injury is neurological.

The rules that doctors follow when evaluating an impairment are laid out by the American Medical Association. The AMA Guidelines to Rating a Permanent Impairment 6th Edition are the most recent version of those rules and are the ones adopted by the OWCP (read more about the AMA 6th Ed. here).

These are likely different than the version used in your home state, another reason why FedDoctor is so helpful to injured federal employees. We help you locate federal doctors around the country that understand the 6th edition and how it relates to your schedule award. There may be one in your back yard!

OWCP claimants are allowed to travel to see a doctor to have their impairment rated for a schedule award claim. While OWCP may not reimburse you for travel expenses, you are allowed to have a one time visit with for an independent medical evaluation without preauthorization and without having to change treating physicians.

To be continued…

 

 

 

A Quick Note on Maximum Medical Improvement

Friday, January 25th, 2013

Maximum Medical Improvement, or MMI, is a term that doctors use to indicate that an injury or injured person’s ailment has somewhat stabilized. If it is unlikely that your injury will significantly improved over the next 12 months, a doctor can place you at MMI.

The OWCP and AMA Guides 6th edition require that your doctor indicates MMI before you have an impairment evaluation done for the purposes of a schedule award benefit. Read more about Schedule Award benefits here.

Understanding a Schedule Award – Part 1

Wednesday, January 23rd, 2013

OWCP Schedule Awards are a unique benefit to federal employees that have accepted federal workers compensation claims. This benefit is paid for permanent impairment to a part of their body as a result of a work related injury.

While most federal employees that have OWCP claims understand that the benefits exist, they rarely understand them, and even more rarely understand the process that goes into figuring out if they are entitled to one. That doesn’t even begin to touch on the subject of how much there schedule award will be.

First, the biggest difference between a federal workers comp schedule award and a state law workers compensation settlement (from most states) is that a schedule award does not signify the end of compensation benefits for the injured worker. Just because a schedule award is given, does not mean that your claim is over.

Under the most common state laws, a final settlement means that payment will cover the rest of the injury’s life. This means that the settlement would cover any future lost wages as well future medical bills related to the injury.

Under OWCP, the schedule award doesn’t mean that the claimant is not allowed future coverage for medical benefits or lost wage reimbursement. A schedule award only stops lost wage payments during the period of award.

Let’s dig a little deeper…

A schedule award is calculated using a formula that incorporates the injured federal employee’s pay rate, or compensation rate. This is the same figure that is used to calculate lost wage payments. All impairment ratings and scheduled members will equate to a corresponding number of ‘weeks’ of compensation. So once that period has elapsed, the claimant is again eligible to file for lost wage reimbursements at their typical rate.

The medical benefits are never extinguished in this scenario. It is important to know this when you are working with your doctor. They may not know the differences between the federal and state laws when it comes to ‘settling’ your claim. That is why it is best to work with a federal doctor (like the ones found on FedDoctor) who understands those different concepts.

To be continued…

OWCP vs. Health Insurance

Wednesday, January 16th, 2013

Many injured employees don’t understand the difference between there employer sponsored group health insurance and their workers compensation medical benefits when they are hurt at work. This can be especially true of federal workers compensation claimants as there are few doctors that accept OWCP as a form of payment or truly understand the OWCP.

Federal workers comp will pay for any medical treatments and costs associated with an accepted work-related medical condition to a federal employee. However, federal doctors can be very difficult to find. Many doctors don’t understand the differences between state and federal law when it comes to workers compensation medical billing. While it is not necessarily difficult, it can be confusing and it is usually much different than operating under the laws in their own state.

These differences can make it hard to find a physician that understands how to best help federal employees that are injured on the job. Many doctors can treat the injury, but their understanding of the billing system keeps them from taking on federal OWCP patients.

In fact, once you are in the doctor’s office and they discover you are a federal workers compensation patient, they may tell you that they can only treat you under your regular health insurance. Many injured workers give the doctor their insurance information and proceed to get the treatment, and this may be the best decision because the end goal is to get the most out of your recovery and the best results and residuals possible. If you have already selected this doctor based on credentials/reputation, it may be worth it to let the OWCP chips fall and pursue the health care out of your own pocket.

However, if this doctor is not interested in working with the federal workers compensation representatives and submitting bills to the OWCP, it may pose a big issue in the process of filing a new claim, getting monetary benefits, and having the work injury medical bills paid.

Using a federal doctor can be the answer. FedDoctor.com tries to help federal employees nationwide understand the differences between the state and federal workers composition systems. We want every federal employee to be able to find a top quality local physician that can help them recover from their injury as well as help them with the paperwork required by the OWCP to get all of the other benefits they are entitled to.

Tell your friends and co-workers to use FedDoctor and let your union know that this is a place that supports the federal workforce. It is free to use and if we don’t have a doctor listed in your area, submit your info to us and let us know you are looking. When we find someone there, we will let you know.

Whether you need an impairment ratings for a schedule award claim, a total knee replacement operation, or maybe just a few visits with a physical therapist, FedDoctor wants to help you get on your way back to recovery.

What about a recurrence?

Monday, January 7th, 2013

Injured federal employees often face one of the most unfamiliar puzzles in the federal workers compensation system: When do I file for a recurrence of injury?

Recurrence is a touchy subject and some OWCP claims examiners do not even fully understand the differences between a new injury, and aggravation of a pre-existing injury and a true recurrence.

There are two separate definitions you should be aware of: Recurrence of a medical condition, and recurrence of disability.

Recurrence of a medical condition is defined as the documented need for additional medical treatment after release from treatment for a work-related injury claim. Continuing, or getting additional treatments for the original injury is not part of recurrence a CA-2a is not required.

Recurrence of disability is a little different. A recurrence of disability is of course a work stoppage. However, it must be caused by a spontaneous return of symptoms, without an intervening cause, of a previously accepted OWCP claim’s medical condition. This can be either injury or occupational illness.

Recurrence of disability can also be filed on behalf of a consequential injury. A consequential injury is when an existing, accepted federal workers compensation claim injury/illness causes another medical condition or disability to arise because of impairment or weakening to the claimant.

A federal employee also must file a CA-2a form when a specific light duty assignment is withdrawn by the agency for some reason other than misconduct or non-performance of duty.

If a re-exposure to the cause of the original injury occurs, or a new incident contributes to your detrimental medical condition, that is not a recurrence, but a new injury and should be filed as such.

Consequential injuries, spontaneous worsening and withdrawal of light duty are the only reasons any federal employee should file a recurrence of injury CA-2a claim with the OWCP.

If you have been hurt on the job, or your claim is being denied because the medical documentation has confused your doctor or claims examiner, find a federal physician who understands what it takes to straighten things out. Here at FedDoctor.com, we want every federal employee to find a doctor that understands the OWCP rules and regulations and can get you the right medical care and the federal paperwork needs to appease your claims examiner and help you get your benefits.

Use FedDoctor for free and help other federal employees find out about us by sharing these articles. We want to help federal employees that are stuck in the cycle of dead-ends that often accompanies a federal workers compensation claim. Let us know if you have see a doctor who helps federal employees with these claims as we want other federal employees get the help they need.

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