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OWCP Lawyer, Jeff Zeelander


 

 

 

Frequently Asked Questions (FAQs)

How does the OWCP process work?
What is FECA?

How can I settle my case?
What is a schedule award?
How do I change doctors?
Why am I paying a co-pay?
Why are my medical bills getting denied for my approved medical condition?

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How Does the OWCP Process Work?

  • If you are injured on the job, you file a claim form through your employing agency to start your case. You may be entitled to receive medical care, lost wages, and a schedule award. There is no time limitation on how long you can receive benefits.
  • OWCP's job is to return you to the work force. This can be back to your employing agency or into the private sector. In some cases, OWCP may issue a decision that you are capable of earning a certain amount of make-believe money in a make-believe job; they will reduce your benefits accordingly, even though no such job actually exists.

  • If you are not going to fully recover from your injury, you may qualify to receive a "schedule award" for the loss of use of specific limbs or organs.

  • Once OWCP accepts your claim, it is OWCP's burden of proof to reduce or modify your benefits. However, on a practical level you must continue treatment for your injury and make sure OWCP continues to receive documentation from your physician(s) for as long as you want to continue to receive benefits.

 

What is FECA?

"FECA" is the Federal Employees' Compensation Act. If you are a federal employee who has sustained an on-the-job injury, FECA entitles you to receive:

  • Medical care,
  • Lost wages,
  • Schedule award for a permanent injury to specific limbs or organs.

As a federal employee, you likely already have health insurance through your job or pension; however, under FECA there is no co-pay. Additionally, traditional health insurance often limits how much treatment you are allowed to receive, whereas FECA frequently provides more physical therapy and other treatments because the goal of the program is to return you to some sort of employment.

 

How can I settle my case?

There is NEVER a settlement of a FECA case!!! For as long as you collect federal workers’ compensation benefits, you need to continue treating and documenting your condition.

This means that if you are totally disabled, you cannot do any type of work or work-like activity for as long as you receive benefits. If your work limitations prevent you from pushing a lawnmower around at your job, you better not be videotaped doing this at home. Work limitations apply to ALL of your activities. For example, you are allowed to have investments, but you cannot be an active investor. You are allowed to own rental property and receive a check; however, your activity must be totally passive. If you change a light bulb, meet with prospective tenants, or do anything other than receive your share of the profits, you are working.

If you are eligible, you can decide to switch to a disability or regular pension. You are paid less, but you are no longer subjected to surveillance and the continuing harassment that comes with the check from OWCP. Remember, though, that your medical care must still go through OWCP as your health insurance is supposed to refuse to pay medical bills that are OWCP's responsibility.

 

What is a schedule award?

If your work injury has had a permanent effect on one of various “rateable” body parts, you may be entitled to an impairment rating, also known as a schedule award. You are compensated for the loss of use of that body part. You must be alive to claim a schedule award; otherwise there is no time limitation. I have helped many clients with old injuries get schedule awards that they had no idea they were entitled to receive.

Click here for more: www.scheduleawards.com

 

How do I change my attending physician?

This is a common question. It depends on your circumstances. If your doctor has retired, moved, or is otherwise no longer available, you simply need to write a letter to your claims examiner stating that Dr. Smith retired, moved, etc., and you have selected Dr. Jones to be your new attending physician.

If, however, your doctor's circumstances have not changed, but you want a new doctor anyway, the process is often more difficult. If you try asking your claims examiner for permission, after a long delay you may well be told "no."

An easier way is to get a letter signed by your doctor advising your claims examiner that he/she is "turning over the function of attending physician to [the new physician you selected]." You may want to create this letter for your doctor and then bring it in to his/her office for a signature. Usually, the doctor you want to leave is just as happy as you are to part company. Once that doctor signs the letter, send it in to OWCP, and you have a new attending physician.

 

Why am I paying a co-pay?

Because the medical bill is being submitted to your health insurance not OWCP! If your doctor or pharmacy asks you for a co-pay, something is wrong. They are billing your health plan rather than OWCP. Although your health plan may pay, this will become a problem eventually. Your bills and your treatment records will not be going to OWCP. Eventually OWCP will notice this and assume you have stopped treating for your injury and, therefore, you must be all better or are ready to go back to work! Make sure the medical bills for your injury are being submitted to OWCP.

 

Why are my medical bills getting denied for my approved medical condition?

It could be that your medical provider is not using the correct ICD-9 code(s) for which your case has been approved. You can request a list of the approved ICD-9 code(s) for your condition from OWCP. Make sure that your medical provider is using the approved injury codes. It is quite common that the code(s) initially approved need to be updated or expanded—for example, your injury could have been coded at first as a “back sprain.” But further testing and treatment documents that you have a “herniated disc.” Your doctor will need to write a report explaining this to get an injury code correction. It’s worth it. OWCP will not pay for treatment related to an injury code that is not approved.

 

OWCP LAWYER'S BLOG
As an advocate for injured federal workers, I take issue with many of the processes and procedures that govern the OWCP. I report these in my OWCP Lawyer's Blog. Subscribe to it to keep up-to-date with the latest news and developments affecting federal workers' compensation.

 

 

 

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