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 28 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.
What is a consequential injury or condition?
1. Define ‘consequential illness/injury or conditions
2. List the steps required to develop for a consequential illness/injury including for psychological conditions.
Consequential Injury: Any injury or illness occurring as a result of/due to treatment of accepted occupational illness or covered condition .Consequential condition, injury or illness must occur AFTER primary condition accepted.
For establishing a consequential condition, the FECA act and the DFEC procedure manual clearly outline that if the second injury or medical condition is a result of an accepted OWCP injury then the second injury is a consequence of the original injury and the second injury would be accepted by OWCP. After the original acceptance of a claim, an injury occurring outside the performance of duty may affect the compensability of an existing accepted injury. Consequential Injury. This kind of injury occurs because of weakness or impairment caused by a work-related injury, and it may affect the same part of the body as the original injury or a different area altogether. See transcript for further information...
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:
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.
FECA - OWCP DEVELOPMENT REQUIREMENTS FOR
A CONSEQUENTIAL ILLNESS/INJURY
1. Today’s podcast is going to explain how to Define ‘consequential illness/injury’
2. The second part of the podcast is going to List the steps required to develop for a consequential illness/injury including for psychological conditions.
Introduction – What is a consequential injury or condition?
▪ Any injury or illness occurring as a result of/due to treatment of accepted occupational illness or covered condition. Ok, so what does that mean? As an injured federal worker, you may find yourself experiencing a worsening of your actual compensable work-related condition or your actual compensable work-related condition causing or precipitating an injury in a completely different area of your body or a secondary psychological condition all as a result of sustaining a secondary injury off work as a result of your first and primary injury. You don not have to have be working to have a consequential injury and most consequential injuries happen to people years later after they have retired or are not working anymore. I will explain some examples of these type of consequential conditions later in the podcast.
▪ Second point to be made about FECA – OWCP requirements for a consequential condition or injury is that the Illness or injury must occur AFTER primary condition accepted; however, one type of exception to this would be in secondary cancer cases.
In short there are steps that must be satisfied to establish that there must be a direct link between the accepted work-related condition/injury and the consequential conditions/injury.
For establishing a consequential condition, the FECA act and the DFEC procedure manual clearly outline that if the second injury or medical condition is a result of an accepted OWCP injury then the second injury is a consequence of the original injury and the second injury would be accepted by OWCP. DFEC procedure manual part 2-805, section 7 (2014) lists;
“Consequential and Intervening Injuries: After the original acceptance of a claim, an injury occurring outside the performance of duty may affect the compensability of an existing accepted injury. Consequential Injury. This kind of injury occurs because of weakness or impairment caused by a work-related injury, and it may affect the same part of the body as the original injury or a different area altogether” (FECA-OWCP-DFEC, 2014).
First, OWCP defines a Consequential Condition or injury in the FECA Procedure Manual Part 2, as defined as a “Consequential Condition that arises from the effect of an accepted occupational injury or occupational illness under Part B and/or covered illness under Part E in causing, contributing to or aggravating an injury, illness, impairment, or disease is considered a consequential condition” (FECA-OWCP-DFEC, 2014). A claims examiner is to accept as compensable any claimed consequential condition(s) that is documented properly by substantive, well-rationalized medical evidence. Consequential conditions can arise for any reason established as being medically linked to a previously accepted work-related illness. In some instances, a “chain of causation” can result in a series of injuries, illnesses, impairments, or diseases, which are a direct consequence of an accepted work-related illness. When medical evidence is present to establish such a scenario, the resulting consequential condition(s) in the causal chain are all compensable under the FECA act.
The logic of a consequential injury involves the chain of causation theory. If the second injury or medical condition is a direct result of an accepted OWCP injury being aggravated or accelerated by the original work-related accepted permanent condition, then the second injury is a consequence of the original injury and the second injury would be accepted by OWCP. The OWCP causality requirements require that a treating physician present convincing and well-rationalized evidence conclusions as to whether the consequential injuries are a direct consequence of the original accepted OWCP compensable injuries causing, contributing to or aggravating an injury, illness, impairment, or disease. The original presentation of the consequential injury additional diagnosis expansion request, addressed in great detail how the additional consequential injuries are a direct consequence of the accepted musculoskeletal conditions aggravating and accelerating the OWCP accepted compensable permanent diagnosis to deteriorate into additional consequential diagnosis.
Ok, gang some Consequential Illness Examples
▪ Radiation pneumonitis
▪ Burns as a result of radiation treatment
▪ Osteoporosis, hip fractures, chronic pain
▪ L or R leg/knee injury affecting the opposite leg areas due to chronic gait changes
▪ spinal conditions affecting your nerves and subsequently affecting your arms or legs
Other examples of consequential injuries include such incidents as:
• An employee is injured in a car accident while on the way to a doctor’s appointment for treatment of an accepted medical condition.
• An employee falls on ice when entering a radiology clinic for treatment of an accepted cancer and breaks her/his leg.
• While walking down a hospital corridor after a chemo therapy treatment for an accepted cancer, the employee falls on a water spill and breaks her/his arm.
These are common examples that most patients and doctors do not understand can be actually be a part of an existing work-related condition. Most patients and doctors do not understand these rules and provisions or even the methodologies to establish consequential injuries.
These illnesses and injuries are examples of medical conditions that may be a result of an employee’s medical treatment for an accepted occupational illness/condition.
Another type of medical condition that may be a result of a consequential injury is psychological conditions. Psychological conditions can occur as an aggravation or are precipitated by your existing chronic pain conditions leading to the development of the psychological injuries. (including sleep disorders)
OWCP requirements for successful OWCP document submission to successfully establish a consequential injury:
Ok here is the official FECA- OWCP requirements first in their wording.
▪ Must have an accepted primary occupational illness or covered condition
▪ Claimant must provide written statement describing consequential condition
▪ Medical evidence establishing causal connection between consequential condition and accepted occupational illness or covered condition
Now here is the Dr. Taylor breakdown of those listed requirement
For psychological consequential injury to be successfully established, the injured federal workers is required to have a causation statement by your treating doctor in a medical narrative that includes an explanation of how the psychological conditions are a direct result of the compensable work-related conditions precipitating the development of the psychological conditions. Then a psychologist or psychiatrist needs to confirm the diagnosis to assist in establishing the psychological diagnosis along with agreeing that you developed the psychological injuries a direct consequence of your work-related musculoskeletal conditions aggravating either a pre-existing psychological condition leading to a deterioration of the pre-existing psychological conditions. Or, a new psychological condition developed as a consequence of the chronic pain directly causing the precipitation of a consequential psychological condition. Lastly, fill in form CA-2, attach it to the doctor’s medical report and send it over to OWCP through the ECOMP portal. So you the federal worker’s consequential injury submission would require your written statement, your treating doctor narrative that you have developed a consequential psychological condition along with a psychological evaluation/narrative report confirming your diagnosis after an evaluation is performed with a causation statement that the psychological conditions are consequential injuries that have developed as a consequence of your work-related compensable injuries aggravating and precipitating the psychological consequential injuries.
In order for a claims examiner to accept a consequential condition upon receipt of medical evidence from treating physician a relationship has to be satisfied in the following examples per FECA guidelines.
▪ In some complex cases, may find relationship between claimed consequential condition and accepted
condition questionable -- may require clarification from treating physician, DMC review or second opinion
▪ Natural progression illnesses – result from treatment of silicosis and CBD; Usually accept these conditions based on a diagnosis and medical rationale from a physician
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 OWCP Or FEDERAL Maritime-Longshorman or federal disability 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 in Florida who is recently injured or has an older case that is receiving a lot of denials, you can email or call my clinic at 813-877-6900. Also, if you are in another state and you want me to assist you with any claim questions or assistance for you and your doctor you can email me at email@example.com. I do this for free as a service to you. I know that I cannot be everywhere…and sometimes YOU need to teach this stuff to YOUR doctor.