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Injured
Postal Employees Information |
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The following
information is provided by Harris Federal Law Firm
Web site:
Harris Federal Law Firm
Image: Brad Harris, Attorney at Law (left) and Bo Harris, Federal Claims
Representative |
On this page
Why get an MRI for
your workers comp?
Workers Compensation Causation; Not a Guessing Game
Understanding
Workers' Compensation Retaliation
EEO Hero or Tattle-Tail?
Getting
Continuation of Pay Started Off Right
How to Fight for a Schedule
Award |
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Why get an MRI for
your workers comp?
By
Brad Harris, Attorney at Law
So you are
going to get an MRI to see if you have damage to the disc in your
spine? Imagine taking a photograph of something that can move around
a bit, but declaring the way you photographed it, is the way it
always is.
You might ask for a "stand
up" MRI. The theory is that when a patient is lying down they
do not have the typical weight pressure on their disc as if they
were standing. You don't get to lie down while doing most jobs. Your
spine typically must support the head and upper torso in the real
world.
The lack of typical weight
during an MRI taken while one is lying down may create a likelihood
that it will not show how the pressure from the upper spine
typically effects the extent of the disc abnormality.
Remember, the disc is not
a stable, immovable thing. It is not a bone, it is more like an
oval, or doughnut shaped, inner tube used as a shock absorber. It
is primarily made of water. When healthy it is kind of like a
grape, when it goes bad it loses its watery content (dessication),
its bounce function, and becomes more like a raisin.
Although the outer edge/wall (technically called annular fibrosis)
is supposed to be firm it can be "squashed" in such a way that it
does not spring back to its optimum shape.
Undue sudden pressure
(like when a person falls down, or is whip-lashed in a car wreck, or
even in typical exertion movement) can cause a squeezing of this
doughnut in a way that one outer wall loses its normal height: it
just extends outward, a bulge.
Excessive trauma or just
the passage of time can cause the outer wall to lose its
encapsulating effect; the inner portion of the shock absorber seeps
or extends through, outward and causes additional problems. This
inner area is less dense than its outer edge, like the pulp of an
orange surrounded by its skin. When the outer layer fails to hold
the inner "pulp" in, the nucleus is described as "herniated" thus
the term "herniated nucleus pulposis".
When the abnormality
protrudes out into the surrounding neural area, it sometimes causes
inflammation, decreased mobility, and even impingement on the nerve
root that can result in pain and loss of strength into the extremity
usually serviced by the nerve. The impairment of the extremity may
qualify for a workers compensation schedule award.
When a radiologist reads
an MRI he notes the prominence of the abnormalities and passes
judgment on whether or not he thinks the condition is
problematic. He will also often comment on the state of nearby
structures. For example, irregular joint function can cause
abnormal bone growth such as bone spurs (osteophytes) or the
narrowing of canals in bone structure needed for nerve passageways (foraminal
stenosis).
He will quite often refer
to the abnormalities in your spine as degenerative. Beware of this
term, it is often as generic as using the word disease to describe
any medical problem. Accordingly, while the word "degenerative"
might sound like a bad thing to you, to claims evaluators it is
often dismissed as common for anyone with your age, build, or
whatever.
Anyway, without making it
too confusing, it has been my experience that different MRIs of the
same patient can demonstrate different pictures of the problem.
Additionally the pictures can be interpreted differently by
different radiologists and other medical professionals. And, even if
your MRI does not provide the "objective" evidence of injury that
doesn't mean that a person doesn't have a permanently injured disc.
You should know that any
segmental instability can cause stretching, even tearing of the
innervated ligamentous layer of the outer annulus fibrosis. Even
without escape of nuclear liquid (herniation of the disc's nucleus
pulposis) the condition can be very painful. Innervated means
there's nerves there... so pain can be "regional": to that disc alone.
Radiating tears are mostly
found in the posterior annulus (back wall of the disc) and are
closely related to the presence of severe nuclear degeneration.
Peripheral tears are most often associated with trauma as opposed to
biochemical degradation and develop independently of nuclear
degeneration.
Many people are not aware
that some clinical tests have indicated as many as 18 of 60 negative
MRIs have positive findings in discography. Discography is more
accurate than MRI for the detection of annular pathology: a normal
MRI does not exclude significant changes in the peripheral structure
of the intervertebral disc which, of course, can produce pain.
A wound to the outer wall
of the disc has a limited healing potential and the persisting
defect could provide a pathway for irritating nuclear fluid escape
into our perineural tissue, resulting in persistent pain. Treatment
to this type of injury to the disc usually comes in the form of
percutaneous decompression. Because the injury is less likely to
cause extremity impairment it may not qualify for a workers
compensation schedule award - but it can be just as dehabilitating
as an extremity impairment... and frustrating when not properly
diagnosed and treated.
So make sure you get a
good photograph, and ask for a good, lengthy explanation of it by
someone trained in its full interpretation! Good luck on your MRI.
Brad
Harris can be contacted at (877) 226 -2723 or at
hbharris@iglou.com or at his website www.HarrisFederal.com.
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Workers Compensation Causation; Not a Guessing Game
By Brad
Harris, Attorney at Law
Most
workers understand
that when they are making a federal workers compensation claim it
has to be supported by the professional opinion of a medical
practitioner. What I mean by that is, it doesn't matter what you
say, if the medical evidence does not have the foundation of support
from a qualified person in the practice of medicine you will not be
successful in getting your claim approved. The Employing Agency
(EA) rightfully has an obligation to controvert the claim where
there is a dispute as to the stated facts.
Because the employee has the right to select a physician of his
choice and because the willingness of the physician to connect the
injury to work activity is critical to entitlement to benefits, this
selection may be one of the most important decisions an injured
employee can make. I suggest that the employee contact local
plaintiff attorneys to find out which doctors are likely to be more
responsive to the employee as opposed to the employer.
Moreover, I suggest that you take a special interest in this
because, as you may soon learn, your medical evidence will be called
"insufficient" if it not expressed correctly. Specifically, I think
it is not only necessary but crucial that the medical care provider
state that it is his opinion, within reasonable medical probability,
that an incident at work, or the work conditions themselves, caused
the need for your various medical treatments.
And the
doctor should conduct a thorough examination, including diagnostic
testing, because the OWCP and the ECAB have continually stressed
the need for medical reasons. For example:
"A
physician's opinion supporting causal relationship between a
claimant's disability and a specific employment incident or factors
of employment is not dispositive on the issue of causal relationship
simply because it is rendered by a physician. To be probative value
to an employee's claim, the physician must provide rationale for
the opinion reached. Where no such medical rationale is present
the medical opinion is of diminished probative value."
Because
the concept of reasonable medical probability is often
misunderstood, and because of its necessity I want to take a few
minutes here to describe it to you at length. The law requires
that an expert opinion, from a medical care provider, be expressed
by him/her to a degree of certainty of at least 51% with regard to
two basic issues:
-
does
this person have an injury?
-
what
incident caused the injury?
It's not
really that difficult a concept, but many doctors are unaware of how
simple it is. Does your doctor have any reason to believe that
anything but your report of the injury is true? How closely
connected in time are your symptoms to the incident? Are your
symptoms the type the doctor would expect to see in a person that
has had the type of trauma that you describe? Does his
examination and testing indicate to him that you really have the
problem you complain of? If your doctor doesn't believe you,
or won't put it in writing, the workers compensation is not due.
He only
needs to express that there is a 51% certainty that:
-
the
work incident (or work conditions) caused your injury and,
-
the
medical expenses are both reasonable and due to the injury
Simply
put, if the only medical evidence from your doctor is no more than
guessing:
- "It might have caused it"
or
- "It could have caused it"
or
- "It is a possibility that
it caused it"
- "It was a factor that
contributed to it"
The OWCP may very well decide that the doctor's opinion isn't important,
the vagueness and uncertainty may kill your chances of successfully
having your claim approved. The second opinion doctor hired by the OWCP to review your medical records may decide your problems are
deemed to be of unknown etiology... like they might have come from
outer space. That why I'm writing this letter to you. Most often,
the doctor's notes in your file aren't sufficient to deal with these
issues, and may therefore be essentially useless in terms of winning
your case or convincing the OWCP they are legally liable for the
condition your doctor treated.
This issue
is what we call causation. The doctor should provide a 51%
link between your symptoms, his diagnosis and the injury.
We are not asking that the doctor to say he knows this with 100%
certainty, nor that he knows it beyond a reasonable doubt, but if he
can't honestly say that he has a degree of certainty of at least
that it is more likely than not; 51%, there won't be sufficient
evidence to establish your claim.
If his opinion isn't to a 51% certainty, then I would not recommend
pursuing the case because my best guess is there is insufficient
medical evidence to believe you will succeed. Let's not make
it a guessing game, let's get causation in writing, and therefore
more probable than not that we will be successful.
Brad
Harris can be contacted at (877) 226 -2723 or at
hbharris@iglou.com or at his website www.HarrisFederal.com.
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Understanding
Workers' Compensation Retaliation
By Brad
Harris, Attorney at Law
Workers compensation laws developed as a labor/management trade-off to
benefit society. The employer is relieved of being legally responsible for
an injured worker's pain and suffering but the employee is relieved having
to prove that the employer was negligent in permitting the injury to occur.
This reduction in proof - reduction in benefit tradeoff was supposed to
allow us all to enjoy a less litigious, cantankerous situation when a worker
became injured.
Along those lines, the Federal Employees Compensation Act (FECA) is to be
liberally interpreted in favor of the employee. Of course the worker needs
to establish the basics: he was about the business of his employer when he
became injured and that the injury has caused him to need medical
attention. Thereafter, the proper forms are to be sent to the Office of
Workers Compensation (OWCP) for approval. If there is any question about
any benefits the resolution procedure is designed to not be adversarial in
nature.
On
the other hand the OWCP rightfully should deny requests for payment of
claims that lack documentation to connect the injury to the work incident.
Because the "connection" is typically little more than a worker's report to
the physician that it happened at work, it is important that a doctor
correlate his findings to the worker's description of the injury event.
The
costs of an employee's workers' compensation benefits are deducted (charged
back) from the employing agency. It has a right, perhaps an obligation, to
represent its position and interest to the OWCP. When appropriate, the
employer should "controvert" the claim. For example, if the medical
treatments do not appear to be supported by objective evidence.
It
is natural for the employer to interpret a minimization of payments made in
connection with the claim to be appropriate cost avoidance and thus good
management.
Without a good
understanding of what is happening, and why, the
employee may think the actions by the employer's controversion of his claim
is overly aggressive and the decisions made by the OWCP unintelligible.
Most
of the people assigned to overseeing a workers compensation claim are taught
to be wary of fraud, or at least the potential for fraud. Unfortunately,
emphasis given to fraud can create excessive suspicion and criticism...
especially when the investigator thinks his "discovery" of fraud
demonstrates his competence, his loyalty to his employer, and smoothes the
way to his own job advancement. This is a recurring problem seen in other,
similar jobs, such as an insurance claims adjusters or a police officers who
develop the belief that nearly everyone they see are probably criminals.
Indeed, some government employers have their own "police force" or
"inspectors". They perform eavesdropping and surveillance work of the
injured worker to determine his habits, his hobbies and his away-form-work
activities in an effort to find evidence that might seem to indicate that
the worker has misrepresented his inability to do his government job. They
can make arrests for theft of government property in connection with a
fraudulent OWCP claim.
From
the injured employee's point of view, this can be seen an invasion of their
privacy, humiliating, and even intimidating - particularly when one takes
into consideration that if his claim is labeled "fraudulent" it may put him
at risk for federal criminal prosecution.
This
predicament is often made worse by the fact that managers are often
pressured to avoid costs by getting the employee back to work. The federal
government does have a legal responsibility to reasonably accommodate the
worker by making, where possible, a job assignment suitable to the worker's
current physical limitations. Again, the aim is appropriate; both cost
avoidance and to increase productivity; it's the techniques that feels like
retaliation.
No employer may require an employee to enter into any agreement to waive his
right to claim compensation under FECA. A worker is not to be coerced into
accepting a job that may aggravate his condition or cause re-injury. But
there's a significant counter weight, the employee's refusal to accept a
reasonable job modification can result in termination of his remaining FECA
benefits. That's a scary proposition.
In our next and
final report in this series, we will discuss what are the things a federal
worker can do if he thinks he is facing workers compensation retaliation.
Nosey co-workers? Detectives watching you? What can you do about it?
While most of the non-federal (state) workers compensation laws have
anti-retaliation provisions, FECA, the federal law creating federal
employee's rights to workers compensation, has no such provision. The short
answer is to find a doctor that will take the time to understand your work
duties and report in detail how your physical limitations restrict those
duties. You can also seek union protection by filing a grievance.
Although a criminal statute that makes a supervisor's interference with a FECA claim a crime, it is rarely prosecuted. Interference with your rights
may give rise to a "Bivens" claim for violation of due process rights
guaranteed by the Constitution, but, again, few cases are brought...
probably because the cost to pay an attorney for all the time that would
have to be expended exceeds potential recovery.
Although FECA
doesn't provide benefits for labor-management disputes, it can provide
workers compensation benefits for stress disorder caused by retaliation -
even if no discrimination is proved. There's at least two ways to do it:
If a worker believes that he is experiencing stress and an anxiety condition
as the result of the difficulty in obtaining workers compensation benefits
he may be able to place the costs of the ensuing psychological and
counseling treatment into his existing workers compensation claim as an
additional component. The supporting medical
opinion should be that the condition is the result of work related issues
arising from the preceding work injury.
An
alternative approach, if the disorder is separate and distinct from the old
injury, is to file an additional workers compensation claim using a CA-2
form for occupational injury. I think this is a more difficult approach
under FECA and, even if successful, would probably result in no greater
benefit than stress claim accepted as a component in the initial claim
described above.
Congress passed at least two laws to make sure that one's disabilities are
not held against them with regards to employment - the Rehabilitation Act
and the Americans with Disabilities Act. Although similar to retaliation,
unlawful discrimination is considered as an EEO claim and not within the
scope of the OWCP or this article. We will discuss that at another time and
place. Until then, proceed cautiously... and beware of men with video
recorders.
Brad Harris can be
contacted at (877) 226 -2723 or at
hbharris@iglou.com or at his website www.HarrisFederal.com. |
EEO Hero or Tattle-Tail?
By Brad
Harris, Attorney at Law
In our American culture, particularly at the movies, we have traditionally
honored those who speak up for the rights of others - particularly when they
risk something or otherwise place their own future in peril for doing so.
Some hesitant but potential heroes at work may not be aware that their right
to speak out is sometimes legally protected by what are called
anti-retaliation protections.
Retaliation is the intentionally negative response by a supervisor in
response to an employee's complaint about something he (the employee) has
reason to believe was illegal misconduct (such as racial discrimination).
The employee doesn't necessarily have to be complaining about misconduct to
which he is being subjected; for example if a man complains to management
about the sexist treatment being placed upon his female co-workers and,
thereafter, the employer mistreats him because he asserting those women's
rights, he has been illegally retaliated against.
The person reporting (tattling) about the misconduct does not have to be
right in his assertions, just in good faith. For example, if you think the
victim is being treated in an improper way for a sexist reason, report it,
but it turns out you are wrong, (the mistreatment is for some legitimate
reason) your reporting incorrectly is still protected activity.
Anti-retaliation protection is an important tool to assert at the EEO. It
is essential to the enforcement of anti-discrimination laws. If it were
otherwise reporting the misconduct would result in little more than
additional misconduct and cover up; thereby unraveling the legal protection
from the discrimination.
As it
does with most things in life, our perspective depends upon our relationship
to the issue: Stand up for something I am not interested in? You're a tattletail, probably only motivated by self interest. Report misconduct
that I agree should be eradicated? You're a hero. See you at the movies.
Brad Harris can be
contacted at (877) 226 -2723 or at
hbharris@iglou.com or at his website www.HarrisFederal.com. |
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Getting Continuation of Pay Started Off Right
By Brad
Harris, Attorney at Law
Most federal
employees know that if they are injured on the job they are entitled to
workers compensation, some mistakenly think that all is well with their
workers compensation claim due to the quick start of disability compensation
called the Continuation of Pay (COP) program. The source of this confusion
is that, to some extent, the process of applying for COP overlaps with the
process of applying for workers compensation.
Initially it
should be noted that COP is paid by the employer only in connection with a
traumatic work injury. Employees with occupational disease claims are not
eligible to receive COP. They use a different form (CA-2) to apply for
workers compensation.
COP is the
continuation of an employee's regular pay for up to 45 calendar days of wage
loss due to disability. COP is paid as salary, not compensation. It is
therefore subject to the usual payroll deductions such as income taxes and
retirement contributions. The pay rate includes missing night
differential, hazard, premium, and holiday pay - but neither Sunday pay (see
note) nor
lost overtime is included.
In order to receive COP benefits the employee must file form (CA-1) Federal
Employee's Notice of Traumatic Injury and Claim for Continuation of
Pay/Compensation." It must be filed within 30 days of the injury. If the
employing agency (EA) does not have a signed CA-1 they cannot authorize
medical care or COP benefits.
The employee
cannot be required to use his accumulated leave time when he or she suffers
a traumatic injury, but if his COP is controverted and terminated, due to
financial circumstances he has no choice but to use Form CA-7 to apply for
his accumulated leave time, leave without pay, and regular workers
compensation (which pays a non-taxable percentage of pay rate - 66% if no
minor dependents, 75% if minor dependents).
The employee has the right to select a physician of his choice. Because the
willingness of the physician to connect the injury to work activity is
critical with regard to entitlement to benefits, this selection may be one
of the most important decisions an injured employee can make. I suggest
that the employee contact local plaintiff attorneys to find out which
doctors are likely to be more responsive to the employee as opposed to the
employer. If the medical evidence on its face supports disability due to a
work-related injury the employee is entitled to COP when absent from work
due to the disability. The attending physician reports the employee's
condition on a Form CA 20.
Generally
speaking, once COP has begun the employer must continue paying. Exceptions
to this general rule exist when (1) the employee fails to provide the
employer with medical evidence of a disabling traumatic injury within 10
calendar days of claiming COP (2) the employee's physician has found the
employee to be partially disabled and the employee refuses suitable work or
fails to respond to the job offer or (3) the employee's scheduled period of
employment ends, or employment otherwise ends, provided the period of
employment or date of termination is set before the injury occurs.
The employer does
not have the right to interrupt COP if a disciplinary action has been taken
against an employee unless preliminary written notice of termination or
other action was issued before the injury occurred and the termination or
other action became final during the COP period.
The Employing
Agency (EA) rightfully has an obligation to controvert the claim where
there is a dispute as to the stated facts. They are to assign all claims to
an individual that I will refer to in this article as the EA's workers
compensation (wc) specialist. That person has a responsibility to gather
all facts and circumstance about the claim and to conduct a thorough
investigation whenever circumstances are suspicious.
His or her file typically contains witness statements that are closely
checked to see if the various statements are consistent. The specialist may
choose to inquire as to if the employee was previously expressing any fear
of job security or opinion that he was not being permitted to work in a
particular job or environment. He collects pictures, time sheets, and
creates a report of the circumstances surrounding the injury incident which
includes the employee's then existing leave balance, his prior injury
claims, performance problems, grievances or EEO complaints.
The EA's wc specialist is trained to watch for some obvious concerns:
(a) was the
employee terminated from his job and then claimed he was injured at work?
(b) was the
claimed injury really caused by a work related activity? For example:
1. if the injury
occurred off the employing agency's premises, was he engaged in official
"off-premises" duties?
2. was the injury
caused by the employee's willful misconduct, intent to bring about injury or
death to self or another person, or intoxication?
(c) what
amount of time transpired between the time the injury was allegedly caused
and the employee's report of injury (a delay in reporting is suspicious).
The EA has a
responsibility to monitor the worker's medical progress and duty status by
obtaining periodic medical reports (CA-17). The EA's wc specialist typically
obtains the employee's authorization to obtain medical records. If the
employee refuses to supply the medical records authorization he can
typically get the OWCP to get one because the EA's wc specialist has a
legitimate interest in making sure that the injury wasn't really a
pre-existing condition. He then checks over the medical records very
carefully to determine if there was any pre-existing condition. He also
checks to see if physical complaints during subsequent medical care are
consistent with the initial complaints or simply relate back to employee's
condition prior to the claimed injury date.
The EA's wc
specialist is not to have telephone conversations with the employee's
physician. He is allowed to correspond in writing with the employee's
physician concerning the work limitations and restrictions imposed. He is
required to send copy of such letters and answers to the OWCP. In order to
stay advised, the employee should ask the doctor to be sure to provide him
with copies of any correspondence of this nature.
If the EA's wc
specialist believes the disability claim will extend beyond the 45 day COP
period or if surgery is suggested he or she will seek the assistance of an
RN to assist in the evaluation of the claim. This nurse is often used to
interpret medical jargon and verify medical necessity. For example, he or
she typically communicates directly with the employee's primary treating
physician, seeking to know when the employee can return to work or if the
injured employee has returned to the condition he was in (although it may
have been poor) prior to the work incident.
The EA has the
legal right to require the employee to submit to a medical examination
conducted by a doctor selected by the EA to obtain an opinion regarding the
employee's condition 5 CFR 339.301(c). This report often serves as material
to controvert the employee's claims. The subject of competing medical
examinations is too extensive to cover in this article.
If the EA's wc
specialist believes that the claim is improper he or she can file an
objection to pay with the OWCP. COP generally continues unless the OWCP
claim examiner agrees that the evidence is clear. Under 5 U.S.C. 5584, if
the OWCP later agrees that the COP shouldn't have been paid, the payments,
at the employee's option, are charged back to annual sick leave or LWOP
(overpayment of pay) and reimbursement is required.
Part of the EA's
wc specialist job is to assist the employee in returning to work as soon as
possible 5 U.S.C. 8106. He should work with the employee's supervisor to
see if any accommodation work is available. In those situations where an
agency has advised the employee of its willingness to accommodate the
employee's work limitations and restrictions, the employee is required to
advise his attending physician and request the physician to specify the
limitations and restrictions imposed by the injury. The employee has the
responsibility to advise the employing agency immediately of the limitations
and restrictions imposed.
Whenever the
medical report "Duty Status Report," Form CA-17 indicates that the employee
can return to work (either in an accommodated basis or not) the agency
advises the employee in writing of his or her obligation to return to work
as soon as possible. If an employee refuses an offer of suitable work, his
entitlement to COP (as well as his right to regular workers compensation
benefits) ceases as of the effective date of availability of such work.
The employee can
file grievances with regard to mistakes or misconduct by the EA and its wc
specialist but no grievances are allowed for decisions made by the OWCP
(such as acceptance of the claim as work-related or medical suitability of a
limited-duty job offer).
Disputes regarding the employee's return to work and reasonable
accommodation are controlled by the OWCP. These disputes are often
mistakenly thought by employees to be the basis for asserting an EEO claim.
The topic is too large to address in this article about COP.
Finally, if the
employee believes that his disability will last more than 45 days he should
be entitled to regular workers compensation and be sure to complete and have
the employer submit a Form CA-7 to the OWCP as soon as possible before the
40th day of COP.
Brad Harris can be
contacted at (877) 226 -2723 or at
hbharris@iglou.com or at his website www.HarrisFederal.com. |
Note:
Sunday premium pay is included in the Continuation of Pay (COP) for postal
employees as the result of a grievance settlement dated March 15, 2004. You
can read the entire document, Pre-Arbitration Settlement Concerning Payment
of Sunday Premium for Continuation of Pay (COP) Status, or on Court or
Military Leave, at:
http://apwu.org/dept/ind-rel/awd-set/031504irsunpremset.pdf
This
settlement applies only to postal employees, not to other federal employees. -
Don Cheney, Auburn WA Local |
How to Fight for a Schedule Award
By Brad
Harris, Attorney at Law
One
important federal workers compensation benefit is the scheduled award. It is
payment for the permanent impairment of an extremity as the result of a
work-related injury. Eligible applicants can elect to have it paid over a
period of time or in a present value lump sum payment. When it comes to
filing for schedule award one of the most important aspects of the claim has
nothing to do with you, but your doctor.
First, although it may be obvious to you that you are injured, the award is
not available for impairment of the back (spine), heart or brain. However,
you may still qualify if impairment develops at other parts of your body as
a result of the injury to the ineligible part. For example, nerve root
restriction at the portion of your spine that is injured often develops
impairment at the part of the body serviced by the nerve: lumbar problems
lead to leg problems or neck problems lead to hand problems.
Of course, a person cannot get a scheduled award if they do not have an
accepted workers' compensation claim. For the claim to be accepted, the
employer must agree, or the Office of Workers' Compensation Programs (OWCP)
must decide, that the injury was work related.
This is often an area of hot dispute. It is not unusual for the employer to
hire a consulting doctor for an agency medical exam. Quite often, he
provides the basis for the denial of the worker's claim because his opinion
is that the injury did not really occur at work or that it is "pre-existing"
or merely a "degenerative" condition. Injured workers are sometimes shocked
to find that in their time of need, it seems to them, that this doctor is
not being fair. A lot of people just don't normally attribute the negative
aspects of advocacy to doctors.
Unfortunately, you will need your doctor in your corner during this boxing
match. Most doctors who actually try to help patients are unaware of just
how specific you will need for his or her written opinion to be when
attributing the injury to your work activity. Many treating physicians don't
like having to deal with all of the paperwork and delays required by the
workers compensation laws just for one patient.
When it comes to
debating a consulting doctor's opinion there are few things you need to make
sure to have. First, a detailed responsive report should be obtained and
filed in the record to contradict the agency medical examiner's opinions.
Your doctor is probably not accustomed to having his opinions challenged or
otherwise questioned by a consulting doctor hired by your employer. Treating
doctors can often be uncomfortable in the role of having to become your
advocate. It is easier for them to resort to ambiguous or vague statements
regarding their diagnosis and the cause of your problem. This can have the
effect of decreasing the strength of evidence in your favor when compared to
the certainty expressed by the employer's consulting doctor.
I suggest that you that you take the time and money to obtain a good
responsive report from your treating physician. In doing this, it is
extremely important to get organized. For example, you should put together
all of your medical records in a three ring notebook with tabs, a table of
contents and summaries for your doctor. You may consider hiring a nurse to
be your helper in this. The goal is to make it easier for your treating
physician to review the opinions of the opposing doctors, as well as your
other doctors, in order to incorporate those things into an overall
responsive report.
Of course one of
the primary things upon which he needs to focus is that you were not
experiencing any symptoms in this portion of your body prior to the work
related injury. Your doctor also needs to write about how there is nothing
uncommon about a person already having a weakened "degenerative" condition
without suffering any problems and then, as the result of a particular work
incident, the condition becomes painful or otherwise symptomatic. It can be
the case that a pre-existing, weakened condition can make people more likely
to suffer injury than someone without the pre-existing condition.
Making a statement like this allows your doctor to help you turn what looked
liked a weak case into a stronger case when they attribute your impairments
and restrictions to the work incident. This can be further substantiated by
the fact that your records may clearly reflect that you were not receiving
any medical treatment for those portions of your body during the 12 months
preceding the incident.
In order to get your workers compensation scheduled award, you should make
sure your OWCP scheduled award request file is complete. The most important
document to be put in your file is a rating of your impairment by a
physician.
Generally speaking, the amount of the award is dictated by the extent of
impairment and which body extremity is impaired. For example each limb is
assigned a number of weeks of compensation for its "loss of use". If the
doctor determines you have a 25% impairment of that limb, your award is 25%
of what your workers compensation wage loss benefit would be for those
weeks. Eligible applicants can elect to have it paid over a period of time
or in a present value lump sum payment.
You need your impairment rating to be conducted in accordance with the
strict guidelines required by the federal government. Many doctors are
simply inexperienced in rating impairments in accordance with those
guidelines. Some think they are experienced because they may have done
something similar for a non- federal workers compensation patient in the
past - but they are wrong... the way of calculating the impairment for a
federal employee is not the same as for a non-federal employee.
Unfortunately, some surgeons are very hesitant to help you substantiate the
residual impairment problem because that is like saying that their operation
was not successful. They mistakenly fear that somehow it is like admitting
malpractice. I sometimes think they must be taught to describe every
surgical procedure as a complete success. Fortunately, the rating does not
have to be provided by your treating surgeon.
You should check with the doctor, his staff and other personnel in his
office to make sure that the work is done correctly. They might not be
experienced in this, they might not want to admit it, but you can't afford
to lose a very important benefit because of the possible discomfort of
addressing their experience in the rating process. Good luck!
Brad Harris can be
contacted at (877) 226 -2723 or at
hbharris@iglou.com or at his website
www.HarrisFederal.com |
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