Federal Workers Compensation Coffee Break
Federal Workers Compensation Coffee Break
Understanding the New 2025 OWCP Permanent Impairment Ratings and Schedule Awards System (Episode 55)
On January 10, 2025, the Division of Federal Employees' Compensation (DFEC) announced significant updates to the Federal Employees' Compensation Act (FECA) Procedure Manual, specifically Chapter 2-0808, addressing schedule awards and permanent disability claims. These updates, outlined in FECA Transmittal 25-03, introduce changes aimed at enhancing fairness and efficiency in the claims process.
The Office of Workers' Compensation Programs (OWCP) recently introduced updates to its impairment rating system, aiming to create a more equitable and comprehensive approach for injured federal workers. These changes seek to balance medical assessments and rating methodologies, ensuring that workers with complex or unique cases receive fair evaluations. This balance directly benefits injured workers by accommodating conditions that may not fit traditional assessment models, allowing for more individualized determinations that better reflect their true level of impairment.
These changes mark a significant step toward a fairer system that recognizes the full impact of workplace injuries, ultimately benefiting workers who rely on impairment ratings for their compensation and long-term financial stability.
1. Introduction of Forma new CA-9 ( click on link for the form) I will provide the link on the podcast landing page.
- The Office of Workers' Compensation Programs (OWCP) has introduced Form CA-9, which must now be used to file for schedule awards. Form CA-7 will no longer be accepted for this purpose and will remain dedicated solely to filing for disability compensation.
- This streamlined approach ensures clarity and precision in the schedule award claims process.
2. Flexibility in AMA Guides
- OWCP now permits the use of either the Fifth Edition or the Sixth Edition of the American Medical Association's (AMA) Guides to the Evaluation of Permanent Impairment for impairment ratings.
For more information click on transcript and links:
The podcast Dr. Taylor’s contact information is:
https://fedcompconsultants@protonmail.com If you need a medical provider or assistance with an OWCP / DOL claim in Tampa, Pensacola Florida or Mobile Alabama you can make an appointment to see Dr. Taylor, or Dr. Sullivan at the clinic at FWC Medical Centers. To make a consultation with Dr. Taylor call the clinic at 813-215-4356 or go to our website at https://mrtherapycenter.com/or https://fedcompconsultants.com/
FEEDSPOT TOP 15 National Workers Compensation Podcast: https://podcast.feedspot.com/workers_compensation_podcasts/?feedid=5557942&_src=f1_featured_email
Welcome to another episode of of Federal Workers Compensation Coffee break Podcast. I am your host Dr. Taylor. I am an OWCP & Federal Health Care consultant who has been assisting and working with clients for over 30 years in the work comp arena. I offer this podcast for free to give back to government workers and other doctors or future doctors who want to participate in Federal Workers Compensation claims by doing a podcast to assist with all types of topics of government related healthcare filings.
The only thing I ask for from you her at the at the podcast is that if you find this information to be helpful ….PLEASE like, share or leave a review of the podcast for others to be able to find this subject matter material on the internet 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 (modeled after the lunch and learn style) to assist you….the government employee/contractor with filing your claim, understanding your rights, responsibilities & relevant rules and provisions
I also like to cover topics that people email me requested information on… to help you successfully navigate the convoluted waters of all types 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’s podcast is a special edition version that I wanted to get out to you sooner than later because it immediately impacts so many injured workers right now.
Today we are covering the announcement this month that there have been Key Changes to the OWCP Schedule Award Process and the dual use of Fifth and Sixth Editions of the AMA Guidelines for impairment rating examinations for a scheduled awards. This is a huge announcement that for once is positive for federal injured workers… Let’s dive in and cover all of it….READY….OK…
Lets get our coffee started and start on this huge new announcement!
Understanding the New OWCP Permanent Impairment Ratings and Schedule Awards System
On January 10, 2025, the Division of Federal Employees' Compensation (DFEC) announced significant updates to the Federal Employees' Compensation Act (FECA) Procedure Manual, specifically Chapter 2-0808, addressing schedule awards and permanent disability claims. These updates, outlined in FECA Transmittal 25-03, introduce changes aimed at enhancing fairness and efficiency in the claims process. Today we will do a general breakdown of this information in a way that helps you understand how these changes affect you and we will break down the key aspects of these changes and explain how they benefit all injured federal workers. The most important thing to comprehend from today’s presentation is that…
if you are pending a schedule award exam with a doctor…STOP…and reconsider presenting a schedule award that has been recently completed.
The new scheduled award guidelines may affect you and the size of your settlement. Let’s review this information and see how it applies to you.
First, let me explain some terminology about this new announcement.
Some of you may be well versed in the impairment rating evaluations, maximum medical improvement and schedule award process but others listening may not know anything about these subjects and how it affects them. For those unfamiliar with the impairment rating process, it's important to understand a few key terms:
So let’s review and explain these terms before we dive into how the new changes affect you.
First, Key Terms to Understand
An Impairment Rating Evaluation is a medical assessment by an approved OWCP medical provider used to determine the extent of permanent damage or functional loss caused by a work-related injury. This evaluation assigns a percentage of impairment based on established medical guidelines, which then helps determine eligibility for compensation.
Maximum Medical Improvement (MMI) refers to the point at which a medical condition has stabilized and is unlikely to improve significantly with further treatment. Once a worker reaches MMI, an impairment rating evaluation can be conducted to assess any lasting functional limitations. MMI must be established and agreed upon by the treating doctor prior to the impairment rating evaluation.
A Schedule Award is a form of compensation settlement provided to federal employees who have a permanent impairment affecting certain body parts, such as the arms, legs, or vision. The amount of the award is based on the impairment rating percentage and the OWCP schedule of benefits, ensuring that injured workers receive appropriate compensation for their long-term disability.
An injured worker should only apply for a Schedule Award after having reached maximum medical improvement (MMI) and are back to work full time (even in a limited duty capacity) or retiring. You have to be one or the other is required to receive your schedule award settlement. The OWCP will not pay compensation for wage loss (i.e., time in LWOP-IOD being paid by OWCP) and a Schedule Award at the same time.
The treating physician should be advised to use the American Medical Association's Guides to the Evaluation of Permanent Impairment, Sixth & 5th Edition, and to report findings in accordance with those guidelines. Injuries sometimes leave objective or subjective impairment that cannot easily be measured by the AMA Guides. Some examples are: pain, atrophy, deformity, loss of sensation, loss of strength, marked sensitivity to heat or cold, and soft tissue damage such as scarring and discoloration. The effects of such factors should be explicitly considered along with the impairment measurable by the AMA Guides (6th Edition).
To support a Schedule Award, your submitted impairment rating evaluation must contain competent medical evidence which:
1.Shows that the impairment has reached a permanent and fixed state (MMI) and indicates the date on which this occurred (date of maximum medical improvement).
2.Describes the impairment in sufficient detail for the Claims Examiner to visualize the character and degree of disability; and
3. Gives a percentage evaluation of the impairment (in terms of the affected member or function, not the body as a whole, except for impairment to the lungs).
4. The treating physician should also provide a detailed description of the impairment which includes, where applicable, the loss in degree of active and passive motion of the affected member or function, the amount of any atrophy or deformity, decreases in strength or disturbances of sensation, or other pertinent description of impairment.
Once all of the medical evidence has been submitted to OWCP, the Claims Examiner will review the file for completeness and forward the entire case file to the District Medical Advisor (DMA) for verification. If there is no conflict in medical option, you will be notified of the details concerning your Schedule Award. If there is a conflict, the Claims Examiner will schedule a second opinion or contact the physician for clarification. Ok… now your caught up on the terminology and basic process for submitting appropriate evidence for a settlement for your permanent injuries. Ok… your up to speed on the process…might need to listen to this podcast more than once. You also will want to share this episodes with all of your co-workers.
So, NOW….let’s cover the major changes to this scheduled award process that are exciting changes.
Key Changes to the OWCP Schedule Award Process
OWCP Impairment Rating Changes: What Injured Workers Need to Know
The Office of Workers' Compensation Programs (OWCP) recently introduced updates to its impairment rating system, aiming to create a more equitable and comprehensive approach for injured federal workers. These changes seek to balance medical assessments and rating methodologies, ensuring that workers with complex or unique cases receive fair evaluations. This balance directly benefits injured workers by accommodating conditions that may not fit traditional assessment models, allowing for more individualized determinations that better reflect their true level of impairment.
Understanding the New Changes
The revised impairment rating guidelines are designed to:
- Align with modern medical advancements and best practices.
- Provide a more transparent and standardized approach to impairment evaluation.
- Ensure consistency in the assessment of permanent impairments related to work injuries.
- Address discrepancies that previously led to unfair ratings for certain conditions.
How These Changes Benefit Injured Workers
For injured workers, these updates mean a fairer, more accurate reflection of their medical conditions when determining impairment ratings. By updating the methodology, OWCP aims to reduce discrepancies and improve the process for evaluating impairments that were previously underestimated or misclassified.
What Injured Workers Should Do
Workers who have received an impairment rating in the past but believe their condition was not properly assessed may want to consider seeking a re-evaluation under the new system. Consulting with an experienced OWCP physician or specialist can help determine whether the updated guidelines could result in a higher impairment rating and increased compensation.
Staying informed about these changes is crucial for injured federal employees to ensure they receive the full benefits to which they are entitled. If you have questions about your impairment rating or how these updates may apply to your case, consider speaking with an OWCP-trained medical provider or legal expert.
These changes mark a significant step toward a fairer system that recognizes the full impact of workplace injuries, ultimately benefiting workers who rely on impairment ratings for their compensation and long-term financial stability.
1. Introduction of Forma new CA-9 ( click on link for the form) I will provide the link on the podcast landing page.
- The Office of Workers' Compensation Programs (OWCP) has introduced Form CA-9, which must now be used to file for schedule awards. Form CA-7 will no longer be accepted for this purpose and will remain dedicated solely to filing for disability compensation.
- This streamlined approach ensures clarity and precision in the schedule award claims process.
2. Flexibility in AMA Guides
- OWCP now permits the use of either the Fifth Edition or the Sixth Edition of the American Medical Association's (AMA) Guides to the Evaluation of Permanent Impairment for impairment ratings.
- Injured workers and their physicians can choose the edition that most accurately reflects the worker’s impairment, promoting individualized evaluations.
3. New Claimant Options for Medical Evidence
- Claimants can now elect to provide an impairment rating from their own physician or undergo a second opinion evaluation arranged by OWCP.
- This flexibility empowers claimants to actively participate in their claims process and ensures that all relevant medical evidence is considered.
4. Updated Claims Processing Procedures
- Claims examiners now follow revised procedures to review and validate impairment ratings, ensuring accurate and fair assessments.
- Additional safeguards have been implemented to address discrepancies in impairment ratings through referee examinations when necessary.
Differences Between the Fifth and Sixth Editions of the AMA Guides
The decision to allow both editions of the AMA Guides stems from key differences in their methodologies:
Fifth Edition AMA Guides to Impairment:
- Focuses on functional impairments, with ratings based on measurable limitations such as range of motion, strength, and sensory deficits.
- Allows for greater consideration of subjective factors like pain and the treating physician’s clinical judgment.
- Suitable for cases where individualized assessment is critical.
Sixth Edition AMA Guides to Impairment:
- Primarily diagnosis-based, utilizing standardized grids with limited adjustment factors for functional deficits.
- Reduces variability between raters but has been criticized for undervaluing subjective symptoms and over-standardizing assessments.
- Some studies show that impairment ratings under the Sixth Edition may result in lower compensation compared to the Fifth Edition.
By permitting the use of either edition, OWCP aims to balance the scientific rigor of the Sixth Edition with the individualized assessment strengths of the Fifth Edition.
How Injured Federal Workers Benefit from These Changes
1. Enhanced Fairness in Impairment Ratings
- Claimants can now select the edition of the AMA Guides that provides the most accurate representation of their impairment, ensuring fair compensation.
- Physicians are encouraged to provide ratings under both editions to maximize the claimant’s options before finalizing the impairment rating.
2. Streamlined Filing Process
- The introduction of Form CA-9 simplifies the schedule award process, reducing confusion and improving claim processing times.
3. Greater Transparency and Empowerment
- Claimants have more control over their claims by choosing between providing their own medical evidence or undergoing OWCP-directed evaluations.
- Clear guidelines for resolving discrepancies in impairment ratings ensure that decisions are based on objective and comprehensive evidence.
4. Improved Compensation Outcomes
- The flexibility to use the Fifth Edition addresses concerns that the Sixth Edition’s diagnosis-based approach undervalues certain impairments, leading to more equitable compensation for injured workers.
- Historical data showing reduced ratings under the Sixth Edition supports the importance of allowing both editions.
Examples of Medical Conditions that would have uniquely different outcomes using the 5th edition versus 6th edition.
For example, consider the case of a federal worker suffering from Complex Regional Pain Syndrome (CRPS). Previously, CRPS was often difficult to quantify due to its fluctuating symptoms and subjective pain assessments. Under the updated guidelines, more advanced diagnostic criteria and functional assessments can lead to a more accurate impairment rating, ensuring these workers receive appropriate compensation and benefits.
Example 2, Similarly, a worker with a severe spinal injury resulting in chronic nerve damage may benefit from the revised system. Older guidelines may have provided a lower impairment rating due to rigid assessment criteria that didn't fully capture nerve-related functional limitations. The updated methodology allows for more comprehensive evaluations that factor in mobility restrictions, chronic pain, and neurological deficits, leading to a more just & fair impairment rating.
What Injured Federal Workers Should Do
- Consult with Your Physician: Work closely with your physician to obtain impairment ratings under both the Fifth and Sixth Editions of the AMA Guides. This dual approach ensures that you can choose the rating that maximizes your benefits.
- Familiarize Yourself with Form CA-9: Ensure you use the correct form when filing for a schedule award to avoid delays in processing.
- Understand Your Options: Discuss with your claims examiner whether to submit your own medical evidence or undergo a second opinion evaluation. Make an informed decision based on your case specifics.
- Monitor Changes: Stay updated on additional procedural changes or clarifications from OWCP to maximize your understanding and benefits under FECA.
Lastly, 2 things..
First, There are way more doctors that are well versed in 5th edition v. 6th edition AMA guides due to most states using the 5th edition guides. That has been a significant factor in very small numbers of doctors trained in 6th edition and able to provide impairment ratings for federal employees. This new change should increase the amount of doctors who are able to assist with providing the type of settlement exams. ( That is a good thing)
Second, the new changes to the OWCP impairment rating process do not automatically apply to impairment ratings that were completed prior to the date of the legislated change in the DFEC Procedure Manual. However, injured workers who previously received an impairment rating may request a reevaluation under the updated guidelines if they believe their condition was not adequately assessed using the prior methodology.
If an injured worker believes their impairment rating should be reconsidered based on the new standards, they may need to submit a request for an updated evaluation and provide supporting medical documentation. The decision to allow a reevaluation will depend on DFEC policies, the timing of the original impairment determination, and whether the change in methodology materially affects their impairment rating.
So in review….in my honest opinion…
the updates to FECA Procedure Manual Chapter 2-0808 reflect OWCP’s new attitude and commitment to fairness, transparency, and efficiency in serving injured federal workers under this new administration. By allowing claimants to choose between the Fifth and Sixth Editions of the AMA Guides and introducing a dedicated schedule award form, OWCP empowers federal employees to achieve more equitable outcomes. If you have any questions or need assistance navigating these changes, consider consulting a knowledgeable representative or your physician for guidance.
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 any of the major podcast platforms 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 still find me in Tampa and Pensacola. 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
Also there is a brand new Provider Manual that has been placed on the DOL website covering all recent and relevant topics for all divisions of Fed COMP that I will be covering in the near future. So, your going to want to hit that subscribe button and keep up with these big new changes.
Ok… I think that is enough for today…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 this is my 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!
