OWCP Appeals Process Tutorial FEDCOMP Coffee Break Podcast

In this episode of the Federal Workers Compensation Coffee Break Podcast, Dr. Taylor, a seasoned OWCP and federal healthcare consultant, provides an update on the OWCP Appeal Process. Dr. Taylor discusses FECA ACT § 10.600 which covers how can final decisions of OWCP be reviewed?

There are three methods for reviewing a formal decision of the OWCP (§§ 10.125 through 10.127 discuss how decisions are made). These methods are: reconsideration by the district office; a hearing before an OWCP hearing representative; and appeal to the Employees' Compensation Appeals Board (ECAB). For each method there are time limitations and other restrictions which may apply, and not all options are available for all decisions, so the employee should consult the requirements set forth below. Further rules governing appeals to the ECAB are found at part 501 of this title.  Dr. Taylor discusses the 3 different types of appeals, rights, responsibilities, rules and provisions of each type of appeal. Dr. Taylor also discusses tips, strategies and tutorials for each type of appeal. Dr. Taylor presents ways to understand how to successfully navigate the appeals process.

Dr. Taylor’s contact information is: fedcompconsultants@protonmail.com 

If you need a medical provider or assistance with an OWCP /  DOL claim in Tampa, Jacksonville, Pensacola Florida, south Georgia, Mississippi or Daphne 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://fedcompconsultants.com/   or https://fwcmedicalcenters.net/

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Transcript

SPEAKER_00: 0:56

Back. Good to have you here. This is a good one. I've had a lot of questions about this one, so I decided to do a quick one before I travel. Still recovering from neck surgery. But I'm talking about the OWCP appeal process. I had a lot of questions about this. I thought I'd just do a review. I haven't done one in a couple of years. So I thought I would just jump in and... Start having this one revisited because a lot of people have been asking a lot of questions on stuff that I've covered. So first of all, welcome to the podcast. I am Dr. Taylor, your Federal Workers' Compensation... I've been doing this for a little over 30 years in a workers' comp arena. Here at the podcast, we discuss all sorts of topics related to workers' compensation federal that has to do with DOL, OWCP, the FICA Act, federal employment retirement system, longshore maritime, and other relevant topics in a short coffee break format, similar to Lunch and Learn, because we like to discuss topics that you, the injured worker, bring to me or things that I present to you to assist you with filing your claim, understanding your rights and responsibilities, responsibilities and relevant rules and provisions. I also like to cover topics that people are always wanting information on and I get lots of emails and this is basically why I'm doing this one is because it is difficult to navigate the waters of federal claim filing and I do this because it's important for you to understand your rights and the provisions of federal workers comp that you're afforded and most people don't know enough about where to go and who is able to help them and so I get a lot of emails on these kind of processes because most people seek me out when they've had a denial. So let's dive in. We're going to do the OWCP appeals process today. So let's get our coffee going. And let's dive into the OWCP appeals process. All right, so if you find yourself being one of those people that is, unfortunately, got a rejected claim, okay? This is for people that have a rejected claim. That means you have a denial letter in writing that in the denial letter, it says what element of the five elements you're being denied for, and it explains what your rights, responsibilities, are what your deficiency are according to their position and what your appeals process rights are. And on the last page, it describes three different appeals processes. And those three appeal process can be a little bit burdensome and lengthy and difficult to get through and understand. And so I'm gonna try to make you understand what to expect and what the process is. And of those three options on the last page, you're gonna see the first one be called an oral hearing or review of the reading record. The second one with a little box to check is reconsideration by OWCP. And the third one has a little box that says appeal to the Employee Compensation Appeals Board or ECAB. We affectionately know it as ECAB. Okay, for any of these options, you must be extremely detailed and complete in how you got hurt. There's podcasts I've done in the past, very detailed about how to do this correctly for an occupational injury like a CA1 filing, or an occupational injury that's over a date range of two or more shifts like a CA2 filing, where you have to put the where, the when, the how, the why, and who, all in great detail. And when I say great detail, I mean you have to say who you are, what division of government you work for, what's your job title, how many years, and you have to go into the details of what your job requirements are and go through all the activities of what you do on a day-to-day basis, or what you did on an average day versus the day that you got injured if it was a one-time incident. Those appeals processes are really big on your injury statement as an injured worker. It's got to be extremely detailed. It's got to be thorough on all of those categories. So let's go over the options. The first appeal, like I said, is called an oral hearing or review of the record. It's offered when the claims examiner denies your claims as choice number one. Now, you have the ability to choose which type of appeal you want, but you must choose one and you cannot have both. Don't forget that. You only have 30 days from the day you receive your initial claim rejection letter from OWCP to ask for whichever type of appeal you choose. Remember, that's always important when OWCP gives you a deadline because deadlines are hard lines. very difficult for you to get something even to be accepted at all. If you miss a deadline, you got to have really good reasons. And even then, most of the time, they just ignore you because they can, because they give you 30 days to respond. Now, it's important for you to understand that whichever type of appeal, whichever you do, you have to understand that in order for you to win your claim, you have to know how to present what type of evidence for what type of situation in these type of appeals process. I want you to win, but you're not always going to win every single time. Most of the time people win on the second or third appeal, believe it or not. So it's important for you if you're going to have a chance to win your claim to understand which one's best for you in this process. So let's begin. Now, when I talk about winning the claim, you have to understand that the vast in the appeal is that you or if you're going to use a representative are allowed to enter into the official record additional documents and details about your case which have not been previously presented so if you think you weren't thorough enough on a certain point you have newer evidence or additional evidence that's what they are going to focus on on each appeal each appeal is going to be based on additional evidence I don't care which of the three you choose okay now If your appeal fails and you have extra details in the official record, you want to make sure that it's added to your file. These extra details can prove valuable at every level of the appeal, so you want to be thorough and you want to aggregate as much new information as you can for each appeal. If you happen to win the first appeal, then you're lucky, as most people don't, in my opinion, unless you get people that really know what they're doing and know how to do the first appeal that have experience like me or certain attorneys. and consultants and union stewards. If you happen to not win, don't fret. There's some valuable information here that you can use to help assist you with your multiple appeal denials. First of all, let's talk about the first one, oral hearing and review of the record. You have a review of the record option. That one is held by the branch of hearing and review. Now, this decision is made by what's called a hearing officer. You or your rep can submit new evidence in writing prior to the decision in order to best document your case file. And I impress upon you that you should do this because the oral hearing is by far, in my opinion, a better option than the review of the written record as it is transcribed by a court reporter and you and your rep have a chance to speak and ask questions and to also testify when necessary to further add information or further document correct any and all of the deficiency claims that your claims examiners put in your current case file denial. The oral hearing also allows you to have witnesses testify as well as subpoena witnesses to testify on your behalf that don't want to. Sometimes people don't want to get involved, and you say, well, you saw it. I'm going to subpoena you. Now, there are two types of oral hearings. There's an in-person oral hearing, and there's a remote oral hearing. In my opinion, the remote oral hearing is the better one, and I'll explain why here in a second. But let's talk about the in-person oral hearing first. The in-oral hearing, you and or your rep will have a hearing officer and a transcriber physically in the same room. The transcriber is going to record for the record all of the conversation, all the evidence that's entered into the record. Now, your agency, the OWCP agency, can have a representative at the hearing. But listen, an OWCP representative, like a claims examiner or their supervisor, they are not allowed to testify or participate in the hearing, only observe. Now, this type of oral hearing is conducted face-to-face and can take up to six months in my opinion sometimes even longer to get a date for you to have your hearing heard which in my opinion is risky so you got to be careful about doing it face to face because you may have to wait an additional six months before you're actually going to get any treatment or you may not be getting paid or you know there's a lot of benefits that you're going to miss out offer for you know months and months and months so consider that when you're considering doing an oral hearing face-to-face. Now the other type of oral hearing which I like is the telephonic oral hearing and it's better for the follow two reasons in my opinion. First, the time to have the hearing is reduced usually from a few weeks to about a couple of months. The reason for that is that the hearing officer does not have to travel to conduct a hearing and is held over the telephone which allows all the parties to attend from a remote location which makes a geographic much easier to get it scheduled in a faster time period. So in my opinion, I would request a telephonic oral hearing, but that's just my opinion. Now, at the oral hearing, the claimant has a right to do a pre-hearing conference where they can discuss with the hearing officer the issue to be discussed, and that's usually done in the form of a response letter back and forth. You usually get a hearing officer that'll send you a letter requesting more information about the appeal, And I've had some people that have won on their oral hearings on just their presentation pre-hearing to the hearing officer. But anyway, you present that and in the pre-hearing officer, the hearing officer will review the pre-hearing conference documents. before they start the hearing. And it'll discuss what the case is lacking if asked. So if you can, make sure you're detailed in your pre-hearing discussion points that are requested of you by the hearing officer so that they have a good review and a good understanding of your hearing complaint from your pre-hearing documents. So now that we're going to start the hearing, after the pre-hearing, the pre-hearing the hearing officer will go on the record and describe what was discussed in all that pre-hearing back and forth written responses. The reporter will transcribe the hearing and the transcription will be entered into the record. Now in that record will be contained what is needed to win your claim and or what is deficient in your claim. The hearing officer will swear everyone and his witnesses over the phone and you will be asked to testify at the hearing or your representative can testify. Then turns the case over to you and the claimant or your rep and during this phase the claimant can testify but also any of the witnesses you've asked or subpoenaed and your representative can all speak. And your representative can ask for an additional 30 days if they feel like they've got further evidence that they can submit, including other medical evidence that will be needed to win your claim. So that is something that's allowable post-hearing. All right, you can ask for, you have up to 30 days to submit further evidence once the testimony phase of the oral hearing is over when everyone hangs up. So for this reason, the oral hearing is by far the best way to further document your case file and have a chance to win, in my opinion. Now you have the right to skip an oral hearing or review of the written record and move directly to a reconsideration, but I don't advise you to do this because what you don't understand is that your reconsideration is going to be reconsidered by the exact same people who denied your claim in the first place. So that's not the audience you want to go back to. This is the same audience that said, nope, and denied your claim. So you're going to reconsider it to the same audience that's already denied it? That's not a good idea. That typically doesn't go well for the first deal of appeal. Now, I cannot distress to you in my opinion how important oral hearing is to avoid further and further delays by phone. You have exactly 30 days from the date of the initial decision letter that you receive to ask for this very important appeal. So remember, of all the appeals process, the shortest date of response to request this type of hearing or this hearing appeal is the oral hearing. 30 days. So you only have 30 days to respond and don't forget that. Reconsiderations are different and even ECABs are different and we'll talk about those in a second. So let's dive into reconsideration because it's the next type of appeal or number two on that sheet. That is called a reconsideration. When you check off the box number two, a reconsideration, you're basically can request that any adverse decision made in your claim, including an adverse decision made by ECAB. However, to request a at reconsideration, you must have the date of the decision which is being appealed and either a legal argument or new medical evidence which was not in the record at the time that the decision for you requesting this reconsideration was made. Sometimes reconsideration appeal is necessary in order to further document your case prior to submitting your case to ECAP, and I've done it that way before. One point is to remember that a reconsideration is not an absolute right. If you, the claimant, do not have a legal argument or substantial new medical evidence to submit in support of your claim, then OWCP has the right to deny your request for reconsideration at face value because nothing new has been submitted. Now, the last type of appeal, well, hold on, let me finish reconsideration. The one thing about reconsideration that I see done successfully that does work well is if you really get good causation narratives by experienced OWCP medical personnel. If you've got a medical provider who really knows what they're doing and knows how to explain how work-related factors cause the work-related injury and explain with medical evidence and citation references what supports that this kind of activity causes these kinds of strains or dislocations or tears or fractures or whatever, that type of evidence is really good for reconsideration. if you didn't do it the first time. Now, the last type of appeal that we have is called an ECAB. That's the Employees Compensation Appeals Board. Now, with an ECAB, you have to understand that this one has, oh, wait a minute, I made a mistake. Let's go back. In a reconsideration, it has one advantage. I forgot. The one advantage about a reconsideration is if you miss the deadline for an oral hearing, let's say you miss the 30-day deadline, a reconsideration, you have one year, one year of time in order to file and before your expiration date expires. So they send you a letter, you have one year to respond if you're going to go for a reconsideration. Okay, sorry, I forgot. Now going back to ECAP, when you're sending your case to the appeals board, you cannot add any new evidence or information to your case file. Did you hear me? Listen again. You cannot add any new information or evidence in your case file to an ECAB appeals board. The case must be appealed with the record as it is. Now, in that particular type of filing, they give you six months to file for an appeal panel board decision, or appeal board panel board members to review your case for a decision. uh... When you appeal to this board, this appeal is handled in Washington, D.C. by a three-member panel that's appointed by the Department of Labor. Remember, these three members are OWCP employees. You have exactly one year from the date of the latest decision in your case to request an ECAB appeal. If you let the one-year limit time expire, then your case is over. If you choose either an oral hearing or a review of the record, then you never lose the right to a reconsideration of your claim as long as you ask for a reconsideration within a year of any decision in your case. Remember to always read whatever decision you receive thoroughly to see why your case was denied and if there are any new legal arguments you can make, or if there are any new medical evidence you can use to better document your case in order to win it. you have one year from the date of the ECAB decision to file a reconsideration. Now what I see done and this is what I recommend is that you do the oral hearing and then after the oral hearing if you don't win you start the reconsideration process. The reconsideration process Um, you want to start developing new medical evidence in your, in your reconsiderations because you're building a case file. Once you've gotten enough reconsideration evidence, then all that evidence can be submitted. If you will lose it, all three appeals, uh, to the ECAB appeal board, who's going to look at the entire record from start to finish. And most of the time, if I don't win an oral hearing, which I have only lost, I then the reconsideration, I usually win by the second appeal. But most of the time, if you do reconsiderations, like in my office, the reconsiderations are usually won on the first try because I'm good at doing causation narratives and understand how to satisfy the medical legal arguments for the five element argument, you know, and I very rarely go to ECAB because ECAB rulings are very difficult to win because usually the problem is in the medical documentation. There's holes in it. So that's the appeals process. So I wanted to go over that with you and make sure that you had an understanding of how to figure out which of those three types of appeals process is the best fit for you. Okay? Now, if you're in the process and you're running out of time and you're having a difficult time figuring out what should I do, what type of appeal, you can always reach out to me. But I will tell you, there are many people that reach out to me that are looking for an appeal that there's too much damage done to their case or they've missed a deadline and I can't help you. So if you think you need help and you want me to help you or you want somebody around you to help you, make sure you pay attention to the deadlines, okay? all right i think that's it i believe i hear the music coming so I think that does it for this episode of Federal Workers' Comp Coffee Break Podcast. I want to thank you for listening. I want to remind you to share this podcast with other federal workers you think would benefit from this information. Be sure and leave a five-star review of whatever podcast platform that you found this at so other federal workers could find me online if you think you would like to help others because it was other people doing the same thing that helped you find my podcast online and it helps benefit everyone that's in government Thank you. 813-215-4356 and or 813-877-6900. Also, if you're in another state and you want me to assist you with your claim questions or assistance for your doctor, you can email me at fedcompconsultants at protonmail.com. All right, guys, I think that's good enough. I'll warm up this coffee and get going. As usual, I want to thank all of you that are listening, who put on that uniform, that badge, deliver that mail, take care of our veterans, and make this government run. This is my big thank you to you. I do this for free just for you. We couldn't do this without all the work all of you out there do, so thank you very much for your service. I know it's not an easy job. And remember, if you have an injured federal worker's claim and you need assistance, I'm here to help. All right, see you next time. Off to get my coffee warm. Keep sending those emails, questions, and comments. I appreciate hearing from all of you. See you next time.