OWCP - DOL Initial Claims Processing Tutorial

OWCP CLAIMS PROCESSING –

Certain procedures and responsibilities have to be accomplished once the

forms and information have reached OWCP for appropriate adjudication of

claim.

A. Initial Processing –

Once claim is received with all supporting documentation (when possible)

claim number will be assigned to the case. OWCP will notify the

employee and agency once claim has been received. Uncontroverted

claims with medical bills totaling less than $1500 will be administratively

closed by OWCP. Thos claims not meeting that criteria will be assigned to

a claims examiner for formal adjudication. When additional information is

required, the claims examiner will notify the employee by letter in ECOMP with a 

copy to all parties to the claim. For more information click on the podcast transcript.

The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant for Oberheiden Law Firm.  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, Jacksonville, Pensacola Florida, Southern Mississippi or Daphne Alabama   you can make an appointment to see Dr. Taylor, or Dr. Sullivan   at the clinic at  FWC Medical Centers or M & R Medical Centers. To make a consultation with Dr. Taylor  call the clinic at 813-215-4356 or 813-877-6900 in Tampa  go  to our website at https://fwcmedicalcenters.net/     or     https://fedcompconsultants.com/

Transcript

HI I’m Dr. Stephen Taylor a federal Workers Compensation Consultant and a medical provider in Tampa & Pensacola Florida who has been helping government employees with work-related injuries, disability, FERS Disability, VA disability and other types of Federal program filings for 30 years. I have helped too many people to count  all over the country with properly filing their Federal Workers Compensation Claims and/or disability claims for about three decades. After all these years I have decided  to create a tutorial podcast to assist with all kinds of topics related to injured federal workers and/or contractors. The name of this tutorial podcast is  Federal Workers Compensation Coffee break Podcast. It is based on the lunch and learn short learning format.  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 over a cup of coffee. I cover these relevant topics in a short coffee break style format because in order to discuss topics that  government employees always ask for assistance on for all of these years.  I do this to assist you the government employee, you and your doctor or your coworkers with claim filing denials or with appropriate filing of benefit claims, disability or injured worker claims. The best part about this podcast and all of it’s tutorials for successfully navigating DOL, FERS & OWCP benefits… is that I do it all for free. All you need is a cup of coffee and a notebook.

Today we are going over Initial claims processing from the claims examiner's training reference guide's perspective. We are continuing our series covering the OWCP claims examiner's training manual and reference guide. Today we are covering Initial Claims Processing. This is one an area of problems that I see handled poorly due to an overburdened system for claims examiners with hundreds of case files. So, I will give some tips on how to help your case be established. I  receive many questions about this process. I am going to cover some tips to have  your claim processed quicker for  initial claims processing,  wage Loss, or  when a employer agency does not provide a CA-16 and the problems this creates with initial  claims processing the first several weeks after filing a CA-1 traumatic injury. 

Ok let's get out coffee going and  READY---LET'S BEGIN?

CLAIMS PROCESSING –

Certain procedures and responsibilities have to be accomplished once the

forms and information have reached OWCP for appropriate adjudication of

claim.

A. Initial Processing –

Once claim is received with all supporting documentation (when possible)

claim number will be assigned to the case. OWCP will notify the

employee and agency once claim has been received. Uncontroverted

claims with medical bills totaling less than $1500 will be administratively

closed by OWCP. Thos claims not meeting that criteria will be assigned to

a claims examiner for formal adjudication. When additional information is

required, the claims examiner will notify the employee by letter in ECOMP with a 

copy to all parties to the claim.

B. Requesting Information –

Request for information is request by written notification. The employee

and the agency is entitled to receive under the Privacy Act, one copy of

the case file from OWCP free of charge. Request for records is not

necessary under the Freedom of Information Act.

C. Representation –

Representation is not required, but if employee desires to be represented

they must designate in writing before OWCP will recognize them, and they

can only have one representative at a time. Such representatives may

include, attorney, union representatives, family member or friend. OWCP

does not pay representative fees. However, OWCP must approve such

payments before payment is made by employee .

D. Third Party. -

OWCP may seek damages if a party other than the injured employee or

another employee of the agency appears to be responsible. OWCP may

advise the employee to request damages from that individual, company,

or product manufacturer. Supervisors are encouraged by OWCP to

investigate the possible Third Party of any claim and provide all

information obtained. An employee should not attempt to settle claim

without first obtaining approval from OWCP. Medical and compensation

benefits will be paid while claim is pending against possible Third Party. If

any monies are awarded, OWCP will determine distribution.

E. Burden of Proof –

Responsibility for establishing Burden of Proof is the claimant’s. OWCP

will assist the claimant to meet this responsibility. By law, any information

requested by OWCP is to be provided by the agency, but this does not

relieve the claimant from their responsibility of burden of proof to provide

medical or factual evidence to adjudicate their claim. When this process is

not timely met, delays in OWCP adjudicating cases and paying claims will

result. Information requested by OWCP should be received within 30

days from the date of the request. When additional evidence is requested

by OWCP to the supervisor, a copy will be sent to the employee and vice

versa. Once claim is accepted, the burden of proof shifts from the

employee to OWCP.

OK, I think we have covered enough today, so let's wrap this episode up. 

So,  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, Jacksonville  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 

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!. Also remember there is power in prayer. Pray for your nation, coworkers and for God's providence in current times of unrest and war. God Bless.

See you next time.