OWCP Validity of Claims & DOL - FECA Benefits

CHALLENGING VALIDITY OF OWCP CLAIMS –
If the validity of a claim is questioned, the Agency supervisor should investigate the circumstances and report the results to OWCP. However, filing of the claim
should not be delayed whether the claim is disputed or what OWCP calls controverted. 
A. Allegations Must be supported by factual evidence.
1) Different Versions of incident by several witnesses, whose accounts
differ, should provide supervisor with written statements of their
information.
2) Previous Injury – Agency should request statements from witnesses if
on the date on the claimed injury the appearance of a previous
condition or injury.
3) Time Frame – Agency should provide written statement if the injury is
reported after a lapsed time from the reported date of injury.
4) Outside of Employment – If employed outside of the agency and
injury is claimed, supervisor should inquire about the duties of the
other employment and report it to OWCP.
B. Notifications and Decisions – for more information click on the show transcript!

The podcaster is Dr. Stephen Taylor, OWCP medical-legal consultant for Oberheiden Law Firm.  Dr. Taylor’s contact email information is:

https://fedcompconsultants@protonmail.com If you need a medical provider or assistance with an OWCP /  DOL claim in  Pensacola Florida you can make an appointment to see Dr. Taylor  at the clinic at  FWC Medical Centers . To make a consultation with Dr. Taylor  call the clinic at 813-215-4356  in Florida. 

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 "Challenging of Validity of Claims  & part 1 of FECA Benefits from the claims examiner's training reference guide's perspective. This is one on the biggest problems that are  mishandled by everyone involved including the injured worker, claims examiner and /or Employee agency. We will cover this in-depth  today and how to understand when and how to understand what is required on these topics.  

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

BUT I want to make a big announcement first:

CHALLENGING VALIDITY OF CLAIMS –

If the validity of a claim is questioned, the Agency supervisor should investigate the

circumstances and report the results to OWCP. However, filing of the claim

should not be delayed whether the claim is disputed or what OWCP calls controverted. 

A. Allegations

Must be supported by factual evidence.

1) Different Versions of incident by several witnesses, whose accounts

differ, should provide supervisor with written statements of their

information.

2) Previous Injury – Agency should request statements from witnesses if

on the date on the claimed injury the appearance of a previous

condition or injury.

3) Time Frame – Agency should provide written statement if the injury is

reported after a lapsed time from the reported date of injury.

4) Outside of Employment – If employed outside of the agency and

injury is claimed, supervisor should inquire about the duties of the

other employment and report it to OWCP.

B. Notifications and Decisions –

OWCP will notify employee by letter when claim is accepted, additional

information is requested, or denied.

1) Hearing – Employee is entitled to an oral hearing, requested in writing

within 30 days of the decision and if reconsideration has not already

been requested. The request for oral hearing should be sent to the

Branch of Hearings and Review at the address stated in the decision

letter and hearings will be held within 100 miles of the employee’s

home. Employee may provide oral testimony or written evidence in

support of the case. If review of the record is chosen, employee may

not present oral testimony but may submit additional written evidence.

Agency will be notified of the date and time and may send

representative to the hearing and request a copy of the transcript

unless specifically invited by the employee or the OWCP

representative. The agency may not participate in the proceedings.

OWCP will allow the agency representative 20 days to submit

additional comments or documents, which will then grant the employee

an additional 20 days to review and comment. OWCP will then issue a

formal decision, which will include further appeal rights for the

employee.

2) Reconsideration – Employee is entitled to a reconsideration of a

formal decision requested in writing within one (1) year of the date that

the formal decision was issued. This request should include the

reason for the reconsideration and be supported by relevant evidence

not previously submitted. If criteria is met, OWCP will provide the

agency with a copy of the request and allow 20 days for additional

comments and/or documents to be submitted. The employee will be

allowed to review and comment for an additional 20 days from the date

that the formal decision was issued. OWCP will then issue a formal

decision, which will include further appeal rights for the employee.

3) Employees’ Compensation Appeals Board (ECAB) – A request by

the employee for the ECAB to review should be requested within 90

days of the date of decision if residing within the continual U.S. or

Canada, and 180 days if residing elsewhere and filed directly with the

ECAB at the address shown in the formal decision. ECAB may for

good cause excuse failure for timely file if request is received within

one (1)year of the date of decision. This is the highest authority in

FECA claims. New evidence is not considered when ECAB is

reviewing the case.

BENEFITS UNDER FECA

Medical services are authorized for treatment of any condition, which is

casually related to factors of federal employment. There is no monetary limit

imposed on the amount of medical expenses or for the length of time for

which they are paid. Reasonable and customary fees must be shown for the

services and treatment that are required. Medical bills may be reduced due

to exceeding the amount allowed by the OWCP Fee Schedule.

Examinations, treatment, and related services such as, medications,

hospitalization, and transportation are included in medical care. Preventative

care is not authorized.

A. Physician Definition–

A physician is defined as a surgeon, podiatrist, dentist, clinical

psychologist, optometrist, osteopathic, practitioners, and chiropractor

within the scope as defined by state law. The term “physician” doesn’t

include physician assistants or nurse practitioners.

1) Chiropractors may be reimbursed only for treatment consisting of

manual manipulation of the spine to correct a subluxation as

demonstrated by X-ray to exist, except that a chiropractor may also

provide services in the nature of physical therapy under the direction of

a physician. (A subluxation is defined as an incomplete dislocation, off

centering, misalignment, fixation or abnormal spacing of the vertebrae

anatomically, which must be demonsratable on any X-ray film.) If

Form CA-16, is issued to a chiropractor of emergency care and the

condition is diagnosed other than a subluxation, then OWCP will honor

the charges incurred and terminate the authority of the Form CA-16.

Employee is then entitled to select another attending physician.

2) Excluded Physicians include those whose licenses to practice

medicine have been suspended or revoked by a state licensing or

regulatory authority or who have been excluded from payment under

FECA.

B. Physician Choice –

The entitlement to choose a physician for initial treatment is made by the

employee.

1) Employee may choose any licensed physician who is not excluded or

if available, may choose to be treated at a Government medical facility.

Employing agency may not interfere with the employee’s right to

choose a physician or require an employee to go to a physician who is

employed by the agency or under a contract. However, except for

referral by the attending physician, any change in treating physicians

after the initial choice must be authorized by the OWCP; otherwise,

OWCP will not be liable for the expenses of the treatment and the

employee may be responsible for the cost of the unauthorized medical

care.

2) Physician Referrals – Initial physician may refer employee to

facilities, which provide laboratory services, X-rays, or the services of

specialists.

3) Change of Physician – Authorization for any change of a treating

physician, other than a referral must be authorized by OWCP or

payment will not be made for treatment. This request should be made

in writing to include the reason for request.

4) Transfer of Medical Facility – Agencies do not have the authority to

transfer medical care. If medical care is not available locally or the

transfer of medical care is recommended, the agency must contact

OWCP.

C. Medical Treatment –

The following medical treatment and services should be approved by

OWCP to guarantee payment in advance. Treating physician is

responsible for requesting services:

1) Non emergency surgery may not be approved without Second opinion.

2) Medical supplies, to include hospital beds, wheel chairs, etc.

3) Private hospital rooms.

4) Orthopedic shoes and appliances.

5) Nursing homes.

6) Physical Therapy.

7) Lip reading and hearing aid services.

8) Hearing and Seeing Eye dogs.

9) Health Club Memberships.

I think we have covered enough today. 

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 5 star review on the platform you found this podcast, like or subscribe to any of the major podcast platforms 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 Pensacola helping Dr. Sullivan but you now can find me in Texas. To make a consultation with me to discuss your case or if you know someone if  who is recently injured you can call the clinic at 813-215-4356 or in Texas 737-358-9307 if you are in Austin or San Antonio Texas or go  to our website at https://fedcompconsultants.com &/or https://fcwtexas.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. 

See you next time.