Common Reasons OWCP Claims Are Denied and How to Avoid Them

Federal employees who suffer work-related injuries or illnesses are entitled to benefits through the Office of Workers’ Compensation Programs (OWCP). However, navigating the claims process can be complex, and many claimants find their claims denied for various reasons.

Understanding the common reasons for OWCP claim denials and how to avoid them is crucial for ensuring that injured federal workers receive the benefits they deserve.

Here are some of the most frequent reasons OWCP claims are denied and provide tips on how to prevent these denials.

Failure to Report the Injury Promptly
One of the most common reasons for OWCP claim denials is the failure to report the injury or illness promptly. Federal employees must report work-related injuries or illnesses to their supervisor or employer as soon as possible after they occur. Failure to report the injury promptly can raise questions about the validity of the claim and may result in denial. To avoid this, injured workers should report injuries immediately and ensure that a formal report is filed with their employer as soon as possible.

Lack of Adequate Medical Documentation
Another frequent reason for OWCP claim denials is the lack of adequate medical documentation to support the claim. OWCP requires detailed medical evidence, including medical reports, diagnostic test results, treatment records, and physician statements, to substantiate the claim. If the medical documentation is incomplete, insufficient, or inconsistent, the claim may be denied. To prevent this, injured workers should seek prompt medical treatment, follow their healthcare provider’s recommendations, and ensure that all medical records are submitted with the claim.

Pre-Existing Conditions
OWCP may deny a claim if the injury or illness is deemed to be a pre-existing condition unrelated to work-related activities. In such cases, the burden of proof is on the claimant to demonstrate that the injury or illness was caused or aggravated by work-related factors. To avoid denial on these grounds, injured workers should provide detailed information about how the injury or illness occurred and any work-related factors that may have contributed to it. Additionally, they should ensure that their medical records clearly establish the connection between the work activities and the injury or illness.

Missed Deadlines or Procedural Errors
OWCP has strict deadlines and procedural requirements that must be followed when filing a claim. Failure to meet these deadlines or adhere to the prescribed procedures can result in claim denial. Common procedural errors include submitting incomplete forms, missing deadlines for filing claims or appeals, and failing to provide requested documentation or information. To avoid these pitfalls, injured workers should familiarize themselves with the OWCP claims process, adhere to all deadlines, and ensure that all required forms and documentation are submitted accurately and on time.

Disputes Over Causation or Eligibility
OWCP may deny a claim if there is a dispute over whether the injury or illness is work-related or if the claimant is eligible for benefits. This often occurs in cases where the employer or OWCP questions the validity of the claim or alleges that the injury or illness is not related to work activities. To avoid denial on these grounds, injured workers should provide detailed and consistent information about the circumstances surrounding the injury or illness and any work-related factors that may have contributed to it. It may also be helpful to enlist the assistance of an experienced workers’ compensation attorney to navigate any disputes or challenges to the claim.

Failure to Follow Treatment Plans or Return-to-Work Orders
OWCP may deny a claim if the claimant fails to follow prescribed treatment plans or return-to-work orders. Failure to comply with medical treatment recommendations or return-to-work restrictions can raise doubts about the severity or legitimacy of the injury or illness and may result in claim denial. To prevent this, injured workers should follow their healthcare provider’s treatment recommendations, attend all scheduled appointments, and adhere to any work restrictions or accommodations prescribed by their physician. Compliance with treatment plans and return-to-work orders demonstrates a commitment to recovery and can strengthen the validity of the claim.

Navigating the OWCP claims process can be challenging, and many claims are denied for various reasons. By understanding the common reasons for OWCP claim denials and taking proactive steps to prevent them, injured federal workers can increase their chances of obtaining the benefits they deserve.

Prompt reporting of injuries, thorough documentation of medical evidence, adherence to procedural requirements, and compliance with treatment plans are essential factors in ensuring a successful OWCP claim.

At Federal Injury Centers of Chicago, we are committed to helping injured federal workers navigate the claims process and obtain the benefits they need to recover and return to work.

If you’ve been injured on the job, don’t let a claim denial stand in your way – contact us today at (312) 440-9646 for assistance with your OWCP claim.

from
https://www.pphcc.com/common-reasons-owcp-claims-are-denied-and-how-to-avoid-them/

from
https://drstevearculeo.blogspot.com/2024/11/common-reasons-owcp-claims-are-denied.html

from
https://alfredjohnson0.blogspot.com/2024/11/common-reasons-owcp-claims-are-denied.html

McKinney, Allen, Plano, TX Doctors Who Treat OWCP Federal Workers Comp Injuries According to Federal Guidelines

Thousands of federal employees work or live in McKinney, Allen, Dallas, and Plano, TX, but until recently haven’t had choices of good, qualified doctors who specialize in DOL federal workers comp according to federal guidelines in their area. Most doctors who attempt to treat DOL/OWCP workers comp injuries are South and North of the DFW metroplex, making a trip to the doctor for a federal workers comp claim inconvenient (as if the work injury itself weren’t inconvenient enough).

Federal Injury Centers has opened highly-trained OWCP workers comp programs in areas where people in McKinney, Allen, Plano, and the rest of Collin County have more convenient options when they are inevitably hurt while working for a federal agency such as the postal service (USPS), VA, TSA, FEMA, Homeland Security, and the other federal agencies in and around the Collin County area.

Prior to the opening of these new, more-convenient DOL/OWCP work injury options, injured federal employees in McKinney, Allen, and Plano had to choose between driving a far distance or settling for a primary care doctor or urgent care center in Collin County. While most of these doctors are no doubt good doctors, they are not OWCP experts, and this causes a huge problem for injured federal employees who need to get their OWCP work injury claims accepted.

Not getting OWCP injury claims accepted means federal employees not gaining access to their valuable and earned federal workers compensation benefits. So, Federal Injury Centers has opened OWCP/DOL workers comp programs in McKinney (also serving Allen, Plano and the rest of Collin County), Frisco (serving the 121 Corridor and its surrounding areas), and South-East Dallas (conveniently located on Central Expressway). The addresses for offices located conveniently near you can be found here on our website.

Gaining access to qualified doctors who specialize in DOL federal workers comp according to federal guidelines in and around Collin County should no longer be a problem for federal employees living and working in McKinney, Allen, and Plano, TX. Federal Injury Centers is here to help you get your OWCP workers compensation injury claim accepted so you can focus on getting better and back to making this country go. Our federal employees make this country go. When they break, we have to fix them. FIC has offices ready to help you in Collin County.

from
https://www.pphcc.com/mckinney-allen-plano-tx-doctors-who-treat-owcp-federal-workers-comp-injuries-according-to-federal-guidelines/

from
https://drstevearculeo.blogspot.com/2024/10/mckinney-allen-plano-tx-doctors-who.html

from
https://alfredjohnson0.blogspot.com/2024/10/mckinney-allen-plano-tx-doctors-who.html

10 Horror Stories From Injured Federal Employees Who Needed a Good OWCP-Trained Doctor

Through my interaction with federal employees across the country, I want to share the stories from 10 injured federal employees who were hurt by confusing system after they were hurt at work.

1. A letter carrier broke his ankle while carrying the mail. His supervisor told him it wasn’t broken and to finish out the last half of his shift. The next day, he told his supervisor it was red and swollen and she said, “It’s not broken.” IT WAS BROKEN, but he didn’t get the official medical report until the next day when his union president insisted that he go ahead and get to the doctor. This carrier didn’t realize his rights and responsibilities after he was hurt at work. Simply knowing about the Form CA-10 would have made all the difference.

2. A federal employee was hurt at work and decided to go see his own doctor, as was his right. The supervisor was upset about him choosing his own doctor instead of going to the company doctor first, and she threatened to fire him. He was understandably worried about losing his job until we sent him the law from the DOL web site that says he can choose his own doctor and nobody can prevent him from exercising his right to choose. Needless to say, he wasn’t fired. Nobody was getting fired that day for wanting to go to a doctor he trusted.

3. A federal employee visited another doctor in Denton, TX, and his initial report was buried on a desk for 6 weeks, preventing his OWCP injury claim from even being considered, much less accepted. He was forced to go to another doctor to get help and finally get his injury claim accepted. He had a torn calf muscle that he wasn’t able to get treatment on for 6 WEEKS until he finally found our doctors and was taken care of.

4. A rural carrier was injured in a town nearly 2 hours away from Dallas. The doctor’s office she called said she had to bring in a CA-16 if she was going to be seen at that office. This put her at a serious disadvantage since most supervisors have never heard of this form. She had to drive nearly 2 hours to see our doctor because we see all injured federal employees with or without a CA-16 and with or without an accepted OWCP claim.

5. A supervisor said that a federal employee who was injured lifting a box and falling down, was due to the employee’s “willful misconduct” because that employee was noticeably unstable and unable to walk. That supervisor was trying to prevent an otherwise valid OWCP injury claim from being accepted. The doctor got the case accepted after reporting that the “willful misconduct” was actually due to a supervisor who knowingly put an obviously unstable person in a position to get injured. Case accepted.

6. A letter carrier was injured after his mail truck was hit by another driver, causing serious injury to the carrier – an obvious valid OWCP injury claim. The claim was denied! His previous doctor was completely unable to get such an open-and-shut injury claim accepted. Our doctors are on it now. This case is going to be accepted.

7. Letter carriers in Indianapolis were being forced to drive to MICHIGAN to get help from doctors who were OWCP-trained. I had to ask if Michigan was also a city in Indiana. Having to drive that far was shocking. Not anymore though. There’s a GREAT OWCP-trained doctor in Indy now. Problem solved.

8. Similarly, a carrier was told, by someone that should have known better, that he had to drive 4 hours (8 hours roundtrip) to go to the “nearest” OWCP-trained doctor when she very well knew that a great doctor was trained IN THE CARRIER’S SAME TOWN. Unacceptable.

9. A federal employee was hurt in an obvious work-related accident. All reports were clear. The CA1 form was clear. Every doctor he saw wrote substandard causation reports, including and especially the company doctor. His injury happened several YEARS ago. The claim was never accepted. He paid thousands of dollars out of his own pocket. He’s had his job threatened if he’s unable to physically perform the job, which he can’t. The stress of having to make a living in a heavy job, with severe pain, and under the treat of termination is all due to the fact that he wasn’t able to find a good, qualified, OWCP-trained doctor years ago. Now he has. The doctors that we trained are on it. We’re going to work to get his claim accepted, get his money and time back, and get his life back.

10. A federal employee paid a “case management” group literally thousands of dollars to “manage” his case and help get it accepted. Mission Not Accomplished. His case is still denied. Paying a group for this “service” would seem to lend itself to denials that require more work and thus more payments to handle the appeals after the denials. Maybe I’m wrong about this (doubt it), but every single doctor who we have trained does all of that case management and gets all of those cases accepted WITHOUT CHARGING THE INJURED WORKER. Nobody should ever have to pay for a service that should naturally be a free service from a medical provider.

I can go on. There are 10 more for every 10 I could talk about. Case after case of injured federal employees being hurt by a complicated system after they are hurt by a heavy federal job. The doctors of Federal Injury Centers are solving these problems for injured federal employees. And the doctors outside of our group that we have trained are working with us in that same direction. Federal employees need and deserve better and we’re giving it to you.

from
https://www.pphcc.com/10-horror-stories-from-injured-federal-employees-who-needed-a-good-owcp-trained-doctor/

from
https://drstevearculeo.blogspot.com/2024/10/10-horror-stories-from-injured-federal.html

from
https://alfredjohnson0.blogspot.com/2024/10/10-horror-stories-from-injured-federal.html

OWCP CA-2 Injuries: USPS Letter Carriers, Is Your Job Getting Easier Tomorrow?

Letter Carriers for the United States Postal Service can best be described as FEDERAL ATHLETES.

Your job description describes physical activities that over time must lead to bodies breaking down. The key term there is “over time”. This is exactly why the Department of Labor allows for federal employees to get treatment for conditions that result from hard word done over a long period of time. These conditions are reported using the OWCP form CA-2, “Notice of Occupational Disease and Claim for Compensation”.

The CA-2 is used for reporting injuries and illnesses that develop over 2 or more work shifts. 2 or more. I know letter carriers (and other federal employees from other agencies and within the postal service) who spend entire careers delivering the mail. 2 or more shifts? Try 20 or 30 years or more. The average American probably doesn’t understand what a USPS letter carrier is required to do in a typical work shift. Let’s take a look at some of it here.

A letter carrier is required to work an 8 hour shift, but if asked by the supervisor to work overtime, is required to work up to 4 more hours (for a total of 12). Letter carriers are required to carry a satchel around their back or over their shoulder that weighs up to 35 pounds. All carriers are required to load and deliver packages weighing up to 70 pounds. (Side note: go to a gym today and lift a 50 pound dumbbell and imagine doing that throughout your day, every day. Then add 20 pounds.) When delivering mail, carriers must bend down or stretch over obstacles to place the mail in a box while the 35 pound satchel is on their back or shoulder. And this is done in all weather conditions: extreme heat, pouring rain, freezing ice or snow, which creates a hazard of slips and falls, and carriers are constantly twisting and turning in the vehicle to deliver the mail.

Extreme physical stress is constantly placed on the letter carrier’s back, neck, shoulders, and knees by walking five to eight miles or more a day over all kinds of terrain and in all weather conditions. I talked to a carrier in Dallas, TX who said she walked 23 miles that day. That’s 3 miles short of a marathon.

In extremely hot places like Dallas, TX, carriers are required to do their jobs in 100+ degree temperatures causing heat exhaustion, which can dehydrate and break down muscles. In cold weather places like Boston, MA, carriers are required to do their jobs in frigid temperatures with snow and ice that cause carriers to slip and fall and hurt knees, ankles, backs, and shoulders in the process. I can remember an icy day in Denton, TX where the only vehicles on the roads were mail trucks. Rain, sleet, or snow, the mail gets delivered.

So, does anyone think you’re job is going to get easier tomorrow? Next week? Next month? NO. And too many letter carriers are making the decision to not go through the difficult and complicated OWCP process and just suffer with injuries and struggle through daily work activities. Let me tell you something: just “sucking it up” actually makes your job HARDER. Lift that 70 pound tray with back pain. Step up and down from your mail truck with knee pain. Put that satchel back over your painful shoulder. Limp your way through tomorrow’s 10-mile route.

Your injuries are making your jobs harder and the federal government has given you a way to make it better. FILL OUT YOUR CA-2 FORMS AND TURN THEM IN TO YOUR SUPERVISOR TODAY. This allows you to get your painful condition accepted by OWCP and get treatment while you continue doing your job. THIS MAKES YOUR JOB EASIER. DOL doesn’t want you to suffer with painful conditions. On the CA-10, “What a Federal Employee Should Do When Injured at Work,” DOL mandates that you report your conditions IMMEDIATELY and fill out your CA-2 form with your supervisor. So, do it. Don’t suffer through it.

The CA-2 form exists so that federal employees, such as the USPS letter carrier, can get help for painful conditions and continue to work. America needs its mail delivered, but it doesn’t need it’s letter carriers to break down in the process.

YOUR JOB IS NOT GETTING EASIER TOMORROW. SO GET HELP TODAY. Report your condition to your supervisor. Fill out your CA-2 form. Call the Doctors who specialize in DOL federal workers comp according to federal guidelines at Federal Injury Centers in Denton, Frisco, McKinney, and Dallas, TX, or contact the doctor who specializes in DOL federal workers comp according to federal guidelines in your area. If you can’t find one, contact us here and we’ll try to help guide you to a doctor who understands and is willing to help you with your OWCP CA-2 injury claim.

from
https://www.pphcc.com/owcp-ca-2-injuries-usps-letter-carriers-is-your-job-getting-easier-tomorrow/

from
https://drstevearculeo.blogspot.com/2024/09/owcp-ca-2-injuries-usps-letter-carriers.html

from
https://alfredjohnson0.blogspot.com/2024/09/owcp-ca-2-injuries-usps-letter-carriers.html

Department of Veterans Affairs (VA) OWCP Work Injuries

In 2016, 2.39% of VA employees had OWCP injury claims that were accepted. This accepted OWCP claims rate is lower than the average of all federal agencies (3.19%), and this is due to a number of factors that we will discuss here.

VA employees have a wide range of duties that potentially could lead to work injuries. Nurses have to lift patients. Maintenance staff climb ladders and lift heavy equipment. Janitorial staff could slip on wet floors. Administration staff lift heavy boxes of paper along with a variety of other heavy items. Of course, these are just examples. Lots of other situations could lead to injuries.

So, when VA workers suffer work-related injuries, they have some obstacles that other federal employees rarely have to deal with. First, the VA is a medical agency: hospitals and outpatient facilities. There is a false belief that injured VA employees are required to go to VA doctors when they’re hurt at work. This is simply not true. An excerpt of the law from OWCP says the following:

Agency personnel may not interfere with the employee’s right to choose a physician, nor may they require an employee who claims an injury to go to a physician who is employed by or under contract to the agency before going to the physician of the employee’s choice.

In other words, VA employees can not be forced to go to VA doctors when they suffer OWCP work injuries. Don’t get me wrong – VA doctors are world-class physicians. They are some of the very best doctors in the world. They just aren’t specifically trained in OWCP. Without this specific training, OWCP injury claims get denied.

Another problem VA employees deal with is simply not knowing what to do when they are hurt on the job. DOL has a great document called a CA-10: What a Federal Employee Should Do When Injured at Work. VA employees need to be familiar with this document. It’s so important.

To summarize, here’s what it says:

• Report your injury immediately to your supervisor.
• Tell your supervisor to give you a CA-16 to authorize medical care. This step also says you can choose your own doctor.
• File a CA-1 or CA-2 when reporting your injury. This must be filled out by the injured employee and the supervisor.
• Obtain a receipt from your supervisor for the filing or your CA-1 or CA-2.
• Elect to use sick or annual time or elect Continuation of Pay (COP) in case you have to be off work when you’re unable to work full duty.

The next problem is one that all federal employees deal with, and that is not being able to find a willing and trained doctor who understands and accepts OWCP. The nation’s biggest problem with respect to OWCP federal workers compensation is a massive shortage of willing, trained doctors who specialize in DOL federal workers comp according to federal guidelines. When you can’t find doctors who understand OWCP, injury claims are denied – period. When OWCP injury claims are denied, they’re not counted in the annual injury statistics.

The final problem we’ll discuss here is that many federal employees fear being fired if they report an OWCP work injury. YOU ARE NOT GOING TO BE FIRED FOR REPORTING AN INJURY. Look back at step 1 from the CA-10 above. Federal employees are REQUIRED to report work injuries. Those 5 steps above ARE THE LAW. Supervisors can’t fire you for following the law. Some supervisors aren’t well trained in OWCP and may not understand your rights or their responsibilities. The CA-10 helps with that.

We actually had a supervisor who threatened a federal employee that he was going to be fired. Of course that never happened. We showed him the LAW. That employee still has their job. We’ve talked with lots of federal employees who have had careers of 20 years, 30 years and more. We asked them how many people they ever saw get fired for filing an OWCP federal work injury. Every single person answered “nobody”. In all of their years on the job, these career federal employees couldn’t think of a single person who was fired for filing a work injury. If just doesn’t happen.

2.39% is the percentage of VA employees who have ACCEPTED OWCP INJURY CASES. Denied cases are not counted. The real shame of it all is that VA employees have such an important job helping our nation’s veterans. While they’re helping veterans, who’s helping them? If we don’t take care of our VA personnel, who’s going to help veterans? Federal employees make this country go. When they break we have to fix them. We have to get their OWCP injury claims accepted so they can get better without paying money from their own pocket and without using their own sick and vacation time. When we can get their OWCP claims accepted, they can get all of the treatment needed so they can get back to work without re-injury.

Federal Injury Centers and the doctors around the country that are associated with FIC know how to get OWCP injury claims accepted. While VA employees have a 2.39% accepted claims rate nationwide, Federal Injury Centers patients have a 100% OWCP claims acceptance rate. We’re committed to helping our injured VA employees so they can get back to work helping our nation’s sick and injured veterans.

from
https://www.pphcc.com/department-of-veterans-affairs-va-owcp-work-injuries/

from
https://drstevearculeo.blogspot.com/2024/09/department-of-veterans-affairs-va-owcp.html

from
https://alfredjohnson0.blogspot.com/2024/09/department-of-veterans-affairs-va-owcp.html

Tragically Low OWCP Claims Acceptance Rates for Federal Employees

Over 1 million Federal Employees work for the USPS and the VA, each of which have extremely low OWCP injury claim acceptance rates. We attend meetings every month with rooms full of these federal employees, and when asked for a show of hands as to who is injured or knows someone who is, more than 70% of the room raises their hands.

Look at the picture below taken partially from OSHA.gov’s federal injury and illness statistics. 6.67% of USPS employees and 2.2% of VA employees had accepted OWCP injury claims (in 2017). As you can see, total cases excludes cases that were denied because the person didn’t work for the federal government (so shouldn’t be counted anyways), wasn’t able to prove that an injury actually occurred, couldn’t prove the injury happened while at work, and couldn’t show that the injury was because of work. In other words, BAD DOCTORS’ NARRATIVES ARE CAUSING DENIED CASES.

Why did I say that bad doctors’ narratives are causing denied claims? Because reports should clearly explain these points so the case never gets denied. It’s not enough to fill out and submit your CA1 or CA2 forms. It’s not enough that your supervisors may not dispute your injury. Going to the company doctor and sadly to the VA doctor when you’re injured is almost never good enough. YOU MUST GO TO A DOCTOR WHO IS TRAINED AND COMPETENT IN OWCP.

True Story: I just talked to a lady on the phone who initially chose a doctor who I guarantee will cause her OWCP injury claim to be denied. I never try to get people to leave their doctors. Your doctor is your choice – period. After I explained what was going to almost certainly happen to her, she wanted to go ahead and stick it out. No problem. Call me after Department of Labor has mailed out your denial letter. How can I be so sure the case will be denied? Look again at the picture above: less than 6% of those employees will have an accepted claim. 94% will not until there is a better understanding of what to do and what doctor to go to after an OWCP work injury.

Greater than 97% of Federal Injury Center patients have ACCEPTED OWCP injury claims

We have made it our business to teach federal employees what to do when they’re injured at work. That education is a huge reason the OWCP injury claim acceptance rate will go up in the future. However, while you have the right to choose whatever doctor you want for a federal work injury, the wrong choice will lead to a denied claim. So, choose carefully.

We’re helping to educate injured federal employees all over the country. However, in some places, our doctors can actually help get your OWCP workers comp injury claims accepted so you can get help without paying money out of your own pocket and without using your own sick and vacation time.

If you live in the following areas, we have doctors to help you:

• Dallas, TX
• Quincy, MA
• Norwood, MA
• Montgomery, AL
• Birmingham, AL
• Clearwater, FL

from
https://www.pphcc.com/tragically-low-owcp-claims-acceptance-rates-for-federal-employees/

from
https://drstevearculeo.blogspot.com/2024/09/tragically-low-owcp-claims-acceptance.html

from
https://alfredjohnson0.blogspot.com/2024/09/tragically-low-owcp-claims-acceptance.html

Doctors Who Specialize in DOL Federal Workers Comp According to Federal Guidelines in Dallas, Alabama, Massachusetts

Injured Federal Employees continually tell us that ACS is not working for them when they need a doctor who treats OWCP federal workers comp injuries according to federal guidelines. I just talked to a guy who was out-of-state and couldn’t find a doctor. I went to ACS for him and found 3 doctors for him to call. One was out of business and the other 2 did not accept federal workers compensation. This is an all too common problem for injured federal employees.

I go into whole states where there isn’t a single doctor who promotes him or herself as an FIC Trained Federal Work Injury Doctor and who doesn’t want to help federal employees. Alabama was exactly that sort of state. Not a single doctor was willing to help federal employees with work injuries. But, now we have 2 doctors in Alabama: Montgomery and Birmingham. These new doctors who specialize in DOL federal workers comp according to federal guidelines love federal employees and they are ready to help.

The same is true in Massachusetts and Texas. We have OWCP offices in Quincy, Norwood, and Worcester, MA and in Dallas, Denton, and McKinney, TX. Injured federal employees in these areas fortunately have no need to search ACS for a doctor; they can be found here. ACS causes a difficult situation for any federal employees in need of a doctor who specializes in DOL federal workers comp according to federal guidelines because too many of the listed doctors don’t actually accept DOL OWCP work injuries. So, in Dallas, Alabama, and Massachusetts, we can help you and we want to help you with your OWCP federal workers comp injury claim.

from
https://www.pphcc.com/doctors-who-specialize-in-dol-federal-workers-comp-according-to-federal-guidelines-in-dallas-alabama-massachusetts/

from
https://drstevearculeo.blogspot.com/2024/09/doctors-who-specialize-in-dol-federal.html

from
https://alfredjohnson0.blogspot.com/2024/09/doctors-who-specialize-in-dol-federal.html