Federal Workers Compensation Coffee Break

This episode is an OWCP training session physicians who want to work with OWCP and federal Workers Compensation or patients who are looking to provide their physician assistance in filing a recurrence of disability. This episode outlines  completing a proper Recurrence of Disability medical narrative to support a OWCP injured worker who is filling a CA-2A Recurrence of Disability form. So, if you’re a treating OWCP provider this is an important episode for you to take notes and if you are an injured federal worker and you think that you have sustained a recurrence of disability and your doctor’s reports are not working…or you are receiving the classic, “Claims Examiner excuse of Insufficient evidence” …this is the episode transcript you want to take to your doctor.

In the OWCP response letters requesting treating physician to respond to a series of  questions,  OWCP requires response explanation to a series of questions. Typically these involve the following- first, what qualifies for a recurrence of disability and what are the requirements that need to be satisfied for a medical narrative supporting document when a patient is filing a CA-2A form for a recurrence of disability. 

What should a worker provide to OWCP if that workers cannot continue to perform their current work requirements and/or light duty due to increasing pain and dysfunction to their original injury or increasing pain and dysfunction to a new body part that is being aggravated by the inability to use their original body part injury? What is right way to handle this scenario when modified duty has to be changed due to a deterioration in their original condition or an adjacent body part without a new injury? Is this a recurrence of disability? The answer is yes. 

For the second part of the OWCP treating physician’s questions OWCP requires an OWCP treating physician’s medical narrative explanation to support a CA-2A recurrence of disability…I will give the exact 8 bulletin points that need to be in the medical narrative. For more information click on the transcript.

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

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

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For responses email Dr. Taylor at [email protected]

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 A growing problem that injured federal workers keep running into: employing agencies that try to short-circuit the OWCP process by offering modified duty straight to the injured employee—or handing them agency medical-clearance forms—while deliberately leaving the claims examiner out of the loop. That’s not just poor practice. In many cases it violates the Federal Employees’ Compensation Act.”

Core Problem with this process first under the OWCP and FECA ACT rules: 

Agencies are increasingly making written or verbal modified-duty offers directly to the injured worker (or the treating physician) without concurrent notice to, or approval by, the OWCP claims examiner.

They often attach arbitrary return-to-work deadlines and imply that failure to report will result in loss of compensation or disciplinary action.

Separately, agencies are giving injured workers their own “medical clearance” or fitness-for-duty forms and instructing the worker to have the OWCP-authorized physician complete them—again without routing the form through the claims examiner for suitability review.

Both practices are becoming routine and are being used to pressure workers off the compensation rolls while not following OWCP procedures. For more click on the show transcript...

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

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

For responses email Dr. Taylor at [email protected]

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For responses email Dr. Taylor at [email protected]

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Today we’re talking about a common challenge: when an OWCP second opinion (SECOP) doctor gives an opinion you disagree with, leaves key questions unanswered, or when the claims examiner misinterprets the report.

You don’t have to accept incomplete or unclear medical evidence. There are established procedures under the FECA Act, the DFEC Procedure Manual, and related guidance that allow you (or your treating physician) to push for clarification through a supplemental report. Let’s walk through the steps.

Section 1: When a Supplemental Report Makes Sense

OWCP often refers claimants for a second opinion exam (authorized by 5 U.S.C. §8123) to clarify the accepted condition, disability status, work capacity, treatment needs, or other issues.

Common scenarios where a supplemental report is appropriate:

The report is equivocal, lacks sufficient rationale, or fails to address the specific medical questions posed.

It contains incomplete information or overlooks key records.

The claims examiner (CE) appears to misinterpret the findings.

New evidence from your treating physician creates a need for the second opinion doctor to review and respond.

For more information click on the show's transcript...

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

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

For responses email Dr. Taylor at [email protected]

For responses email Dr. Taylor at [email protected]

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What Is the Bruner Presumption?

Facing a potential adverse action due to a medical issue as a federal employee can be incredibly difficult and stressful. However, a powerful but often underutilized tool — the Bruner Presumption — can significantly strengthen your FERS disability retirement application if you understand the ins and outs of this tool in your disability application. 

Stemming from the 1993 Federal Circuit case Bruner v. OPM, this presumption kicks in when your agency takes an adverse action (like removal or termination) based on your medical inability to perform the essential functions of your job.

The Game-Changer: Burden Shifting

Normally, you carry the full burden of proving to OPM that you’re disabled and unable to do your job. But with the Bruner Presumption, your agency’s own action becomes prima facie evidence of disability. This shifts the burden from you proving your disability to the agency along with OPM must now produce their evidence to disprove your entitlement. It’s a major strategic advantage.

For more information click on the show's transcript...

For more information on this topic click on the show transcript...

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

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

For responses email Dr. Taylor at [email protected]

Support the show

For responses email Dr. Taylor at [email protected]

Support the show

FEEDSPOT TOP 10 National Workers Compensation Podcast: 

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This episode is an emailer asking a question and being answered in the podcast episode. The scenario the emailer presented for an injured federal employee is the following:

An injured worker  came in her OWCP doctor's office  for an urgent care visit appointment due to her shoulder being in severe pain and cannot raise it. This shoulder injury is an accepted condition and she is on modified duty. She has been working 8 hours with restrictions but today has been removed from work for 5 days. In circumstances like this, would she file a CA-2A for recurrence of disability? My second question would be, if a patient is removed from work due to worsening of an injury whether it be 2 days or 30 days, is a CA-2A filed? 

Great question: Here is what the FECA ACT says about this …

(DFEC) FECA Part 1 Chapter 1-0400 Sub-sec: 9

A Recurrence of Disability is a work stoppage caused by:

1. A return or increase of disability due to a consequential injury (defined as one which occurs due to weakness or impairment caused by a work-related injury);

2. Withdrawal of a specific duty assignment when the employee cannot perform the full duties of the regular or limited duty position.

For more information on this topic click on the show transcript...

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

fedcompconsultants@protonmail 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 or check out the webiste at fedcompconsultants.com To make a consultation with Dr. Taylor  call the clinic at 813-215-4356  in Florida.

For responses email Dr. Taylor at [email protected]

Support the show

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For responses email Dr. Taylor at [email protected]

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There is recent evidence that OWCP (under the U.S. Department of Labor) has increasingly began to outsource significant portions of claims-related services for FECA (federal workers' compensation) to third-party vendors, including private companies traditionally known for state workers' compensation claims management. This is a change in the entire structure of the FECA and OWCP government division's responsibilities. 

OWCP has been slowly outsourcing divisions of OWCP to outside contracts in the form of third party vendors. This began with  medical bill processing (e.g., past transitions to vendors like CNSI now called ACCENTRA) and  medical authorizations.  This began when OWCP decided to outsource the pharmacy benefits to an outside corporate vendor called OPTUM, a pharmacy benefit manger to manage all of OWCP's pharmacy benefits. We can expect to see an increasing amount of companies continue to be added for specifically handling broad OWCP claims adjudication, the overall trend of outsourcing to experienced private-sector TPAs vendors from the state workers’ comp ecosystem is now the wave of the future. 

For more information read the show transcript. 

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

https://[email protected] 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.

For responses email Dr. Taylor at [email protected]

Support the show

FEEDSPOT TOP #1 Federal Workers Compensation Podcast & #6 National Workers Compensation Podcast:

For responses email Dr. Taylor at [email protected]

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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://[email protected] 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. 

For responses email Dr. Taylor at [email protected]

Support the show

FEEDSPOT TOP #1 Federal Workers Compensation Podcast & #6 National Workers Compensation Podcast:

For responses email Dr. Taylor at [email protected]

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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://[email protected] 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/

For responses email Dr. Taylor at [email protected]

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For responses email Dr. Taylor at [email protected]

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Continuation of Pay (COP) is continuation of regular pay up to 45 calendar

days for periods of disability and or medical care, which occur in connection

with a Traumatic Injury. COP must begin within 45 days of the injury.

A. Entitlement –

Permanent and Temporary employees are entitled to COP when

Traumatic Injury is reported within 30 days. Medical documentation must

support all periods of COP. Normally, COP will begin the day following

the date of the traumatic injury. Except for Injuries that occurred prior to

the start of the workday, then COP will begin on date of injury. Medical

documentation must be received within 10 days of the injury to receive

COP and COP will be terminated if medical documentation is not received

within the allotted time frame. For any additional details, please click on the show transcript!

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

https://[email protected] If you need a medical provider or assistance with an OWCP /  DOL claim in Tampa, Jacksonville, Pensacola Florida, Southern Mississippi or Da

For responses email Dr. Taylor at [email protected]

Support the show

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For responses email Dr. Taylor at [email protected]

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OWCP Claims for Compensation for federal - civil employees injuries, must meet certain requirements before being accepted.  These five (5) requirements ( also known as the 5 elements of coverage determination criteria) must be met within the sequence below and if not, claim will be adjudicated or held up by requesting information from the injured work to satisfy each of the 5 element requirement in sequential order to be given due process:

A. Time                                                                                                                                        

B. Civil Employee                                                                                                                    

C. Fact of Injury or Occupational Disease or Illness                                                          

Two factors are involved in the determination of whether the employee did in fact suffer the injury: 

                 1) Occurrence of the Event                                                                                                              2) Existence of a Medical Condition          

D. Performance of Duty                                                                                                        

E. Causal Relationship  

Each of these 5 requirements (elements) for establishing conditions of coverage criteria are covered in detail in this podcast episode to assist civil employees with successful claim adjudication of an on the job injury or illness.  This episode is utilizing OWCP claims examiner training materials to explain how to meet the eligibility requirements from the claims examiner's training and understanding. It helps to understand how to speak the language that the OWCP claims examiner is trained in. 

Click on the transcript for more information to source for Initiating Claims with OWCP

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

https://[email protected] If you need a medical provider or assistance with an OWCP /  DOL claim in Tampa, Jacksonville, Pensacola Florida, Southern Mississippi or Da

For responses email Dr. Taylor at [email protected]

Support the show

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