OWCP Claims

WORKER’S COMPENSATION BENEFIT EXPLAINED

Federal workers’ compensation laws exist to ensure that you receive the care and protection you deserve when you sustain a work-related injury, whether it occurs suddenly or develops over time, such as with a repetitive strain injury. These laws outline several benefits, including two significant ones that work in your favor: coverage for your medical treatments and the right to choose your own medical practitioner. 

You should not have to pay out-of-pocket expenses for doctor’s visits or deplete your sick leave to receive the necessary care for your recovery. Your federal workers’ injury benefits are designed to protect you from these and other challenges. Under FECA, your medical treatments, travel to and from appointments, medications, and any required devices are all covered, ensuring that you receive the comprehensive care you need without facing financial burdens. 

Additionally, if your rehabilitation requires diagnoses, devices (such as a brace, for instance), medications, and other treatments, these are all covered under federal workers compensation laws.   

To learn more about workers’ compensation benefits and determine your eligibility, reach out to us and speak with one of our knowledgeable specialists. We are here to provide you with the information and assistance you need to navigate the process and understand the benefits you may qualify for.  

WORK INJURY COMPENSATION

At Fedmed, our team specializes in providing comprehensive care to federal employees who have experienced workplace injuries, ensuring their swift recovery while simplifying the OWCP claim process with our complimentary claims assistance.   It is crucial to receive treatment from a DOL doctor who is well-versed in OWCP procedures and requirements to expedite the approval of your FECA claim without any unnecessary delays or denials for a wide range of diseases and injuries, including: 

Neck or back pain • Hand or wrist pain • Repetitive strain injuries • Knee pain Foot or ankle pain • And more… 

FECA laws protect all civil federal employees and officers, including those employed by: 

Postal Employees (USPS) • TSA Employees • Internal Revenue Service (IRS) • Social Security Administration (SSA) • Homeland Security (DHS) • Department of Defense (DOD) • Veterans Affairs (VA) •Immigration & Customs (ICE) • Federal Bureau of Prisons (BOP) • Border Protection Agency 

Coverage also extends to volunteers of certain organizations as well as members of the American Federation of Government Employees union. If you are not sure if you are covered by FECA and the OWCP, call our offices and speak to an OWCP expert for guidance. 

THIRD PARTY CLAIMS

Injuries caused by third-party incidents, such as car accidents, are considered occupational injuries under the OWCP and are eligible for coverage under federal workers’ compensation. However, it is unfortunately common for federal employees to handle these accidents as standard personal injury cases. Many mistakenly seek out a personal injury lawyer and pursue legal action against the other driver’s insurance. This is a critical error that federal employees should avoid when involved in a car accident while on the job. 

It is crucial to avoid contacting a personal injury (PI) lawyer if you are a federal employee injured in a car accident. PI lawyers often lack understanding of the OWCP rules and may treat your claim like any other personal injury case. This can result in denial of your OWCP injury claim. While you may eventually receive a settlement from the third party involved in the accident, a significant portion of it will go towards paying the doctor and lawyer fees. As a result, you may receive little compensation, and worst of all, you will not be entitled to lifetime medical benefits, reimbursement for time off work, out-of-pocket expenses, or a schedule award. In addition, if your condition worsens in the future, you will have nowhere to turn for coverage except your personal health insurance, which means you will have to pay copays and deductibles out of your own pocket. 

A more appropriate course of action is to engage a federal OWCP lawyer to handle your third-party claim and ensure that you receive all the benefits entitled to you for your OWCP injury. According to 5 USC 8131, federal employees who sustain injuries in the line of duty due to a third-party may be required to pursue compensation from the third-party. Your agency is likely to send you a letter informing you of this responsibility, and it can work to your advantage. 

By taking this approach, you can receive at least 20% of any settlement, after legal fees, and have 100% coverage for all your medical bills through your OWCP injury claim approval. You will not have to personally bear the burden of paying these bills. Additionally, you may be eligible for reimbursement of time off work, and in the future, you could potentially qualify for a schedule award, which would mean more money in your pocket. 

Having a skilled federal lawyer and a qualified OWCP injury doctor working together can have a significant impact on your case. 

COVID-19 ClAIMS

To establish a COVID-19 claim for the period of January 27, 2020, to January 27, 2023, while employed in the Federal service, you would need to provide evidence of the following: 

• Diagnosis of COVID-19 through a positive test result (excluding home tests) or confirmation from a medical professional. 
• Performance of duties within 21 days of the COVID-19 diagnosis that required contact with patients, members of the public, or co-workers. 

The updated procedures for COVID-19 compensation under the Office of Workers’ Compensation Programs (OWCP) require that claims filed for COVID-19 diagnosed after January 27, 2023, must establish the following five elements for adjudication in accordance with the Federal Employees’ Compensation Act (FECA): 

• Timely filing of the claim within the FECA’s set time limits. 
• Verification that the injured worker was an employee as defined by the FECA. 

• Provision of evidence that includes a diagnosis of COVID-19 and establishes that the claimant experienced the alleged event(s) or employment factor(s). 
• Confirmation that the alleged event(s) or employment factor(s) occurred while the employee was performing their duty. 
• Medical determination by a physician that the COVID-19 diagnosis is causally related to the established event(s) or employment factor(s) within the employee’s federal employment. Merely manifesting during a period of federal employment or the claimant’s belief of employment-related causation or aggravation is not sufficient to establish causal relationship on its own. 

Our experienced staff can help you navigate the process of establishing a claim for COVID-19 related injuries.  

WORKER’S COMPENSATION LAWS

In 1916, the Federal Employees’ Compensation Act (FECA) was implemented to safeguard federal workers against injuries or illnesses sustained in the course of their employment. The Office of Workers’ Compensation Programs (OWCP) under the Department of Labor (DOL) is responsible for overseeing the federal workers’ compensation programs. 

FECA is designed to prevent federal workers from being deprived of wages in the event of a workplace injury. It mandates that the OWCP, under the DOL, covers all necessary medical care, supplies, and treatments. Additionally, FECA ensures that workers are entitled to at least two-thirds of their pre-injury wages, with higher benefits for those with dependents or traumatic injuries. These benefits are guaranteed to be provided for the duration of the disability. 

FECA laws prioritize the well-being of federal workers by ensuring prompt medical care and rehabilitation, aimed at facilitating their return to work and full wages. Additionally, FECA allows workers the freedom to select their own medical provider, instead of being restricted to a doctor designated by their manager. This empowers workers with greater control over their healthcare decisions and promotes their recovery and return to the workforce. 

In the event that your injury has resulted in an inability to perform your previous job duties, OWCP provides options for vocational rehabilitation and job placement into a new position under the provisions of FECA. 

Furthermore, if you are able to return to your previous position, FECA mandates that your employer treats you as if you had never left in terms of your length of employment and associated benefits. In other words, the clock continues to run without interruption, ensuring that you are not disadvantaged due to your injury in terms of your employment tenure and benefits with your employer. 

In the unfortunate event of a federal worker’s passing due to an injury or disease related to their work duties, FECA provides set benefits to their survivors. 

While the laws governing federal worker benefits are clear, the claims process can often involve complex administrative procedures. Our team of specialized administrators is well-versed in handling the necessary red tape to ensure successful filing of claims and receipt of owed benefits. We offer comprehensive support services to our patients throughout the entire claims process, free of charge, to assist them from start to finish. 

SCHEDULE AWARDS

In the Office of Workers’ Compensation Programs (OWCP), a Schedule Award refers to a predetermined schedule of payments for impairment of extremities (such as arms and legs) or other allowed body parts as defined by the Department of Labor OWCP. This means that if you meet the criteria for an OWCP Schedule Award, depending on the body part that was injured, you may be entitled to a financial award based on a specific number of weeks outlined in the OWCP impairment chart.

It is worth noting that the impairment chart does not include a specific schedule for the spine, including cervical, thoracic, and lumbar areas. However, if the injuries to the spine result in symptoms that radiate into the extremities or cause other permanent impairments to the extremities, the rating for the impairment will be based on the extremities rather than the spine.  

The payments for OWCP Schedule Awards can vary, ranging from small to significantly large, depending on the level of permanent impairment as determined by your OWCP Injury Doctor. However, to be eligible for a Schedule Award, your OWCP injury claim must first be approved by your DOL claims examiner. The choice of doctor plays a crucial role in getting your OWCP claim approved successfully. The knowledgeable team at Fed Med can provide valuable assistance in navigating the complex process of getting your claim approved. 

 Here are the key steps to obtain a Schedule Award through OWCP: 

1. Get your OWCP injury claim approved by consulting with a doctor who is skilled in crafting winning OWCP narrative reports. 

2. It is crucial to follow your doctor’s advice and adhere to your treatment plan until you have reached Maximum Medical Improvement (MMI). 

MMI refers to the point at which your doctor determines that you have achieved the best possible medical improvement. At that stage, your doctor should conduct an Impairment Rating according to the American Medical Association’s 6th Edition Guide to Permanent Impairment. Please note that some doctors may only be familiar with the 5th edition, which will result in denial of your claim. Therefore, always ensure that your   doctor is trained in performing 6th edition impairment ratings for OWCP. 

3. After obtaining your doctor’s impairment rating, you need to attach a copy to a Form CA-7, Claim for Compensation, and select letter D, Schedule Award. Complete the entire first page of the form and ensure that your supervisor fills out page 2. Submit the entire packet to your claims examiner, and make sure to retain a copy for your records. 

4. After submitting your Form CA-7 with the impairment rating to your OWCP claims examiner, you will need to wait for their decision on whether it is approved or denied. If it is approved, you will start receiving payments based on the schedule mentioned earlier. However, if it is denied, you will need to take the denial letter back to your doctor. Your doctor can then address the denial with a new narrative report or a revised impairment rating to potentially overturn the decision. 

5. If your OWCP claims examiner denies your schedule award, hiring a federal OWCP attorney may be necessary as a last resort. Having an experienced attorney can make a difference in getting your claim approved and receiving the benefits you deserve. It is crucial to ensure that your doctor is knowledgeable of impairment ratings for OWCP cases, as this can impact the outcome of your claim.