Episode 31 Federal Workers Compensation Coffee Break Podcast - Eligibility & Exceptions for Scheduled Awards

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.
The Office of Workers Compensation Programs (OWCP) has strict criteria and guidelines for eligibility. Your claim must be established in a very specific manner. Our clinic has 28 years of experience providing impairment rating evaluations that are  needed to make a successful scheduled award claim. In order to qualify for a scheduled award an impairment rating evaluation needs to be completed by a OWCP approved and properly qualified physician who must submit a narrative report with a description of the medical evidence that satisfy the necessary procedural requirements for a valid impairment including MMI, use of AMA’s 6th edition Guides, calculation of rating, citation of AMA tables, etc.  BUT the purpose of this podcast is to make sure you understand if you are actually qualified to receive a scheduled award based on your federal work-related injury. 
The OWCP lists specific body parts that qualify for receiving a schedule award. Does your injury meet the basic qualifications before you go through the award process? These are the body parts that qualify:
Arm, Leg, Hand, Fingers, Foot, Eye, Breast, Skin, Kidney, Lung, Skin, Throat, Penis, Testicle, Tongue , Ovary, Uterus, Vagina, Toes. Unfortunately, if you have an injured body part, not on the list, you do not qualify for an award.
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 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:
https://fedcompconsultants@protonmail.com

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.

Transcript

Some Disqualifying Restrictions to Receiving a Schedule Award as an Injured Federal Worker 

What is a Schedule Award?

If you are a current or past federal employee and were permanently injured while on the job, then you could be entitled to receive compensation for your injury. This type of compensation is what is known as a schedule award. Applying for this type of award is a time consuming and meticulous process. We don’t recommend going through the approval process by yourself. Embarking on a claim without the right expertise could cause unnecessary frustration through the process.

The Office of Workers Compensation Programs (OWCP) has strict criteria and guidelines for eligibility. Your claim must be established in a very specific manner. Our clinic has 28 years of experience providing impairment rating evaluations that are  needed to make a successful scheduled award claim. In order to qualify for a scheduled award an impairment rating evaluation needs to be completed by a OWCP approved and properly qualified physician who must submit a narrative report with a description of the medical evidence that satisfy the necessary procedural requirements for a valid impairment including MMI, use of AMA’s 6th edition Guides, calculation of rating, citation of AMA tables, etc.  BUT the purpose of this podcast is to make sure you understand if you are actually qualified to receive a scheduled award based on your federal work-related injury.  Going through the process is not worth your time if you have one of the following disqualifying exceptions to receiving an award.

What if you get denied but believe you still have a case? Let us know. We’re here to help.

 What is a Non-Qualifying Injury

The OWCP lists specific body parts that qualify for receiving a schedule award. It is worth taking the time to check if your injury meets the basic qualifications before you go through the award process. There must be permanent damage to the body part that results in loss of functionality. These are the body parts that qualify:

 Arm

Leg

Hand

Fingers

Foot

Eye

Breast

Skin

Kidney

Lung 

Skin

Throat

Penis

Testicle

Tongue 

Ovary

Uterus

Vagina

Toes

Unfortunately, if you have an injured body part, not on the list, you do not qualify for an award. Heads, necks and backs are not part of the schedule list. There is, however, some opportunity to obtain an award for the effect of a spinal injury on a covered extremity – if the medical proof is substantial. Psychiatric injuries are also not covered on the schedule list. 

Certain injuries can be evaluated without reference to the Sixth Edition of the AMA Guides. Vision loss and hearing loss are two such conditions. Despite the clear statement of the law, the OWCP often gets it wrong. For example, the OWCP says if you lose total vision in one eye, you are entitled to a 50% impairment award because you have the sight in your other eye, however ECAB does not agree. 

 Previously Paid a Scheduled Award

If you received a prior award, already have federal workers compensation schedule award and you want to apply for a new award, it may not be beneficial to you. This is because if the new award you are applying for is less than your previous award, the OWCP will classify it as an overpayment. Prior percentages are subtracted from present awards.

 If you have an existing award consult with a legal professional to make sure you will not be charged with an overpayment.

 Receiving a Federal Workers’ Compensation Award of Temporary Total Disability or Loss of Wage Earning Capacity conflicts.

You cannot receive two types of federal workers’ compensation at the same time. It’s not in your best interest to apply for a schedule award while receiving either temporary total or loss of wage earning capacity in most instances. However these are exceptions and you should check this out.

There are several different types of federal workers’ compensation benefits such as medical services, partial and total disability, vocational rehabilitation, and aggravation of a pre-existing medical condition. To see a full list and get more information, go to the Division of Federal Employees Compensation Act.

 Receiving Loss of Wage Earning Compensation

Loss of wage earning compensation is another type of benefit an injured federal worker may receive. Loss of wage earning compensation is a benefit that takes into account a permanent injury that would prevent the federal worker from being able to earn a living. Loss of wage earning compensation is a very complex issue. 

If you are receiving a loss of wage earning capacity compensation, this will stop while you are receiving the schedule award. For instance, it would be like using your own money to pay the schedule award. 

 Pension or Disability Coverage

Certain types of pensions or disability insurance policies may offset a schedule award. Social Security Disability will offset up to 80% of any schedule award.

 So if you already have a form of disability coverage or a pension, you might be best off waiting until you receive social security retirement. A pension or disability benefit is most likely a greater benefit to you then what you would receive from a schedule award. Also VA service connected benefits may be impacted by an award.

 Qualified Impairment Rating Physician

Obtaining a competent, fully rationalized medical report is the most important additional component of ascertaining a successful scheduled award. An impairment evaluation performed by a OWCP approved qualified physician is the basis for OWCP  determination of impairment benefit entitlement. Therefore, the physician’s impairment rating report is to include narrative text that clearly communicates the physician’s opinion, and that provides a convincingly descriptive rationale in support of the stated impairment rating.

(1) Evaluation. An impairment evaluation of the employee must be based upon the 6th Edition of the AMA’s Guides.

 (2) Rating Physician Qualification. A physician who performs an impairment evaluation must satisfy certain criteria. In order for OWCP  to accept an impairment rating, the rating physician must hold a valid medical license and Board certification/eligibility in his/her field of expertise (e.g., toxicology, pulmonary, neurology, occupational medicine, etc.). In addition, the physician must meet at least one of the following criteria: certified by the American Board of Independent Medical Examiners (ABIME); certified by the American Academy of Disability Evaluating Physicians (AADEP); possess knowledge and experience in using the AMA’s Guides; or possess the requisite professional background and work experience to conduct such ratings.

 Getting the process and paperwork done right the first time is critical. Make sure the physician is experienced in the federal rules and guidelines for completing a proper medical evaluation for a schedule award and all the necessary paperwork is filled out accurately.

 Interaction of Body Parts and Previous Awards

ECAB issued a precedent forming decision on November 19, 2018, G.B. and Department of Navy, Docket No. 18-0545

 “The Board also notes that appellant was granted a prior schedule award for permanent impairment of the right wrist and shoulder.  The current schedule award claim is for permanent impairment of his right elbow. OWCP regulations provide that benefits payable under section 8107(c) shall be reduced by the period of compensation paid under the schedule for an earlier injury if: (1) compensation in both cases is for impairment of the same member or function or different parts of the same member or function; and (2) OWCP finds that the later impairment in whole or in part would duplicate the compensation payable for the preexisting impairment.  As OWCP did not adequately explain why appellant’s current claim would duplicate his previous compensation, upon remand if OWCP determines that appellant claimant has a permanent impairment of his right elbow, it shall obtain clarification from an OWCP medical advisor regarding whether the latest rating would in whole or in part duplicate of the prior schedule award.” So there is legal precedent for multiple scheduled awards to the same body area if further permanent damage is found after the original impairment rating and scheduled award. 

OK< that is a lot to cover….So, If you do not think you have any of the  restrictions we have gone over in this episode that apply to receiving a schedule award, then you can move forward with the claim process. Applying for a schedule award and gaining approval can take some time. At M&R Medical & Therapy we specialize in doing impairment ratings for scheduled awards for patients, other doctors and even attorneys. So if you are one of the people who fits the scheduled award categories that we have covered  today, or you and your doctor or attorney need an impairment rating for a scheduled award you can  contact our office at 813-877-6900 to get started with your schedule award claim.

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 the clinic 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

 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!

 C-ya next time of to get my coffee warmed up. Keep sending those emails and questions and comment. I appreciate hearing from all of you.