Welcome to Federal Workers Compensation Coffee break Podcast. I am your host Dr. Taylor.
I am an OWCP consultant who has been assisting and working with clients for over 29 years in the work comp arena. I have been providing assistance for several years to giving back to government workers and to doctors who want to participate in OWCP & Federal Workers Compensation….by doing a free podcast to assist with all types of government related work injury healthcare rules and provisions. I do this for free…to assist those who need help, in understanding the basic rules and provisions of Federal Workers Compensation.
The only thing I ask for here at the podcast is that if YOU find this information to be helpful PLEASE leave a review, share the podcast with others, like, follow or subscribe and maybe send me an email to let me know that you benefitted from this free information. Here at this podcast we discuss all sorts of topics related to federal workers compensation, Department of Labor, OWCP, FECA ACT, FERS, longshore-maritime, DOD contractors, VA benefits. I cover these relevant topics in a short coffee break style format because we like to discuss topics that are related to helping you the government employee with filing your claim, understanding your rights and responsibilities, relevant rules and provisions.
I also like to cover topics that people are always wanting information on to help you successfully navigate the convoluted waters of federal claim filing. I do this to assist you, you and your doctor or your coworkers with claim filing denials or with appropriate filing of benefit claims, disability or injured worker claims.
Today is a Q & A based on some frequently asked questions. This is part 2 of a two part series on FAQ about questions regarding OWCP attorneys, consultants and required response to deadlines!
Ok so lets start the Q & A! Do I qualify for OWCP Work-injury benefits?
An employee seeking benefits under FECA has the burden of establishing the five essential elements. To file a claim you must:
1. Be an employee of the United States government;
2. File a claim within applicable time limits;
3. Sustain an injury;
4. The injury must be related to the employee’s work; and
5. The disability and/or specific condition is causally related to the employment factors with rationalized medical evidence.
On any claim for disability or death compensation, the injured employee must file the written claim for compensation within three years after the injury. However, if you are injured, and you promptly and properly report the injury within 30-days of the occurrence, you can usually extend the three-year filing requirement.
Termination of your Work injury benefits
When OWCP terminates your benefits, it’s important to understand the reason behind their decision. To do so, you should carefully review any OWCP correspondence you receive on your claim regarding the termination decision. To summarize, the most common reasons include:
Medical Improvement: OWCP may terminate your wage-loss benefits if they feel your accepted condition improves and allows you to work. Additionally, OWCP may terminate your medical benefits if it determines that you no longer need treatment for your accepted condition.
Lack of Medical Evidence: If OWCP believes the medical evidence is insufficient to support your continuing benefits, they may also terminate those benefits. It’s crucial that your medical records and documentation accurately reflect the ongoing impact of your work-related injury or illness.
OWCP-Directed Examinations: If OWCP sends you to a second opinion or referee examination, they may also use that medical examiner’s opinions to terminate your benefits. Specifically, if the second opinion or referee examiner finds that you are able to work or that your accepted medical condition has resolved, OWCP may side with that medical examiner over your own treating medical provider.
Failure to Comply: If you fail to comply with OWCP requirements, such as attending scheduled second opinion or referee examinations or providing information OWCP requests, OWCP may terminate your benefits. You should ensure you understand and adhere to all the necessary obligations.
Steps you can take If you disagree with OWCP’s decision to terminate your benefits, you can:
1. Contact OWCP: You may reach out to your assigned claims examiner to express your disagreement with the decision. You should prepare to provide any additional evidence or documentation that supports your disagreement. If OWCP believes they should terminate your benefits based on a second opinion exam, you can further request that OWCP conduct a referee examination.
2. Prepare a Written Statement: You can prepare a detailed written statement explaining why you believe the termination decision is incorrect. In it, you should clearly outline the reasons why you believe OWCP should reinstate your benefits. Then upload it to ECOMP portal.
Gather Supporting Evidence: You should collect any additional medical records, test results, diagnostics, or letters from medical providers that support your claim for continuing benefits. These pieces of evidence can strengthen your arguments that OWCP should reinstate your benefits.
Seek Legal Representation: We highly recommend that you engage the services of an experienced OWCP attorney. Doing so can significantly increase your chances of success. They can guide you through the process, ensure your rights are protected, and help you argue a strong case.
File an Appeal: Once you take the above steps, you can file an appeal on the termination decision. Before you do, you should review the OWCP’s correspondence to familiarize yourself with the different types of appeals and understand their deadlines. Additionally, you should carefully follow the OWCP’s specific instructions for submitting your appeal. Finally, you must meet any filing deadlines and submit your statement and supporting evidence. If you don’t know what to do, consult with an attorney. An attorney can help you gather all relevant evidence and construct a persuasive argument for why the termination decision was incorrect or unjustified.
How Can Attorneys Assist Federal Employees with Work-Related Benefit Issues?
Navigating the complex world of federal workers' compensation can be daunting for many employees. From denied claims to the termination of existing benefits and securing scheduled awards, the process is filled with legal and bureaucratic hurdles. This is where attorneys specializing in Federal Employees' Compensation Act (FECA) cases step in, providing invaluable assistance. Here's a detailed look at how attorneys can help federal employees and how they are compensated for their services.
Denial of Federal Employee’s Work-Related Benefits
One of the most challenging aspects for federal employees is dealing with the denial of work-related benefits. Attorneys play a crucial role in this area by:
1. Reviewing Denial Notices: Attorneys carefully examine the reasons provided for the denial of benefits. This includes scrutinizing the documentation and evidence submitted with the initial claim.
2. Gathering Additional Evidence: If necessary, attorneys help in gathering additional medical records, witness statements, and other pertinent evidence to strengthen the case.
3. Filing Appeals: Attorneys are well-versed in the appeals process, including deadlines and specific forms required. They prepare and file appeals on behalf of the employee, ensuring that all procedural requirements are met.
4. Representing Employees at Hearings: In cases where a hearing is required, attorneys represent employees, presenting the evidence and making legal arguments to support the claim.
Termination of Existing Benefits
Federal employees who are already receiving benefits under FECA may face termination of these benefits for various reasons. Attorneys assist in the following ways:
1. Challenging Termination Notices: Attorneys review the justification for terminating benefits and identify any procedural errors or lack of substantial evidence.
2. Requesting Reconsideration: If benefits are wrongfully terminated, attorneys can request reconsideration or modification of the decision, presenting new evidence or arguments as needed.
3. Navigating Administrative Procedures: Attorneys ensure that all necessary administrative procedures are followed, reducing the risk of procedural dismissals.
Assisting with Scheduled Awards
Scheduled awards under FECA provide compensation for permanent impairment to specific body parts. Attorneys assist with scheduled awards by:
1. Determining Eligibility: Attorneys help employees understand if they qualify for a scheduled award based on their medical condition and impairment rating.
2. Filing Claims for Scheduled Awards: Attorneys guide employees through the process of filing claims for scheduled awards, ensuring that all necessary medical documentation and forms are correctly submitted.
3. Appealing Denied Scheduled Awards: If a claim for a scheduled award is denied, attorneys can file an appeal and represent the employee during the appeals process.
How Attorneys Are Paid Under the FECA Act
Under the FECA Act, attorney fees are subject to approval by the Office of Workers' Compensation Programs (OWCP). Here are some key points regarding attorney compensation:
1. Contingency Fees: In many cases, attorneys work on a contingency fee basis, meaning they only get paid if the employee wins the case or receives a settlement. The fee is typically a percentage of the compensation awarded.
2. Fee Approval: All attorney fees must be approved by OWCP. This ensures that fees are reasonable and commensurate with the services provided. Attorneys must submit a fee application detailing the work performed and the amount charged.
3. Direct Payment: In some instances, OWCP may approve direct payment of attorney fees from the employee's compensation benefits. This arrangement is designed to ensure that employees do not have to pay out-of-pocket for legal representation.
4. No Upfront Fees: Attorneys typically do not require upfront payment, making legal assistance accessible to employees who may already be facing financial difficulties due to their work-related injury or illness.
Conclusion
Attorneys play a vital role in assisting federal employees with various aspects of their work-related benefits under the FECA Act. From challenging denials and terminations to securing scheduled awards, their expertise ensures that employees receive the benefits they are entitled to. With a clear understanding of how attorneys are compensated, federal employees can confidently seek the legal help they need without worrying about upfront costs.
Ok…here are some common attorney questions that I get asked all of the time.
OWCP Attorneys--How much does an OWCP attorney cost?
For OWCP cases, attorneys can only charge reasonable hourly rates. Contingency fees are expressly prohibited, so if an attorney asks for a percentage of your award, that is not typical and you should consider whether that is an appropriate attorney for you! Fortunately, attorney’s fees go through an approval fee process and require the client’s consent. However, the client is responsible for paying the attorney, not OWCP, even if you win.
For this reason understand your rights and responsibilities when you chose an attorney. You should make sure your attorney sends you a detailed monthly billing statement so you can keep up with what your attorney is doing from month to month. The hourly rate largely depends on the complexity of the case, the likelihood of success, and where your OWCP case sits in the administrative process. For example, ECAB hearings require significantly more work than filing a reconsideration letter. If you want to know how much it would cost to pursue your type of denial or assistance with your claim, make sure you ask specific questions to each law firm to get a feel for how much your medical/legal needs.
How long does it take to adjudicate a claim denial or a dispute portion of an OWCP claim with an attorney?
Some cases only require small amounts of additional information to paperwork for the claim to process smoothly, other cases require developing significant amounts of medical evidence and types of required testimony. For deadlines, there is only a 30-day window to request an oral hearing while claimants get an entire year to file for reconsideration. OWCP processes claims fairly quickly for a government agency. Claims can be processed quickly or they can take years, again, it depends on the case’s specific facts. However, in my opinion it’s best to hire an attorney early, rather than later, to make sure your claim is solid before lasting damage is done.
Your rights as an injured federal worker are protected under FECA legislation, but you can lose your rights under the FECA act for missing deadlines attached to denials, terminations or requested responses from you or your medical provider. That said, it is important that you agree to all requests sent over by OWCP such as requests or treatment, examinations and submission of all paperwork in a timely manner to avoid missing required deadlines that OWCP -DOL does not forgive. These deadlines most of the time can not be corrected with a qualified medical provider or an attorney. Missing a notification deadline is considered refusing an OWCP directive. Refusing an OWCP directive in their mind would be almost stating in a roundabout way that you’re no longer injured or have fully recovered therefore their rationale to withdraw medical benefits, off-work benefits and/or a schedule award may be justified. So if you are considering an attorney or you are facing a deadline for a dispute understand that you need to respond to these type of denials with either an attorney, or an OWCP consultant as soon as possible.
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 be kind enough to leave a review on the platform you found this podcast, like or subscribe to the podcast platform or our youtube channel so others will also find 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 and Pensacola and in Georgia in Atlanta and in Mobile Alabama. To make a consultation with me to discuss your case or if you know someone if Florida who is recently injured you can call the clinic at 813-215-4356 or 813-877-6900 or go to our website at https://fedcompconsultants.com/ & https://mrtherapycenter.com/ 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 or send me a message on the website at fedcompconsultants.com
I need to warm up this coffee and get going. As usual I want to thank all of you who put on that uniform, that badge, deliver that mail, take care of our veterans and make this government run… a big thank you. I do this for free just for you…We could not do this without all of the work all of you out there do…so a big thank you. And remember if you have an injured federal claim and you need assistance….I am here to help!.
See you next time.
Off to get my coffee!
