We suspect this is something most everyone has probably experienced before, especially at the big federal agency offices around the country. You happen to encounter a work colleague you haven’t seen in awhile and he has a brace on his wrist that wasn’t there before.
Being the caring person you are; you ask what happened. The response is, “Tendinitis. I’m sure it’s work related.” The next question it would seem legitimate to ask is, “Well, have you filed a workers’ compensation claim?” Very often the answer that comes back is, “Wow, I guess I should.”
Many people aren’t familiar enough with the concept of workers’ compensation to appreciate how it applies to them. When they get hurt, their first thought is to go see their regular doctor under their regular health insurance coverage. This could involve them having to pay a deductible or a copayment for the visit.
Workers’ compensation operates differently. It is no-fault coverage provided in recognition that injuries on the job are something that shouldn’t necessarily be counted as normal health and well-being. Further, the system in the federal work environment isn’t handled the same as in the private sector. The laws governing eligibility for benefits and for how long they last are administered by the Office of Workers’ Compensation Programs with the Department of Labor.
Denials are not unheard of. If benefits are approved, it can sometimes be a challenge to navigate the appeals process. To understand your rights as a federal worker and all your options for obtaining optimal coverage, it can take the help of a skilled federal workers’ compensation attorney.
Additionally, once benefits are obtained, it can be a challenge to ensure they last for as long as they are really needed. Workers’ compensation is supposed to be that no-fault safety net that helps workers get the treatment and therapy needed to recover and return to work. The benefit system for federal workers in Texas and across the country is separate from those for the private sector.
Getting and maintaining needed coverage isn’t always easy. Denials occur and the process of going through the appeals process can be complicated and challenging without help of a skilled advocate. Those with experience in this area of practice likely would agree that there are a few common reasons why injured workers might see their benefits terminated. Read on to learn more.
- Insufficient information from the doctor: A diagnosis of tendinitis could lead to physical therapy. If that doesn’t resolve the issue, surgery might be called for. That could be denied if the doctor doesn’t provide regular updates on progress and reinforce that the persistent condition is related to the original work injury.
- Refusing a suitable replacement job: Compensation is meant to be temporary. If your employer offers you a similar position that the evidence indicates you can perform, and you turn it down, benefits could be cut off. You have a right to say no, but to protect yourself and your benefits you should only make such a call after a discussion with your doctor.
- Refusing to participate in vocational rehabilitation without good cause: Not participating in rehab is not an option if it is directed by the OWCP. Wage loss benefits could be at risk. Presenting an effective legal argument for why rehabilitation wasn’t taken may be required.
- Evidence of alleged fraud: This might happen if an agency review of the medical record in your case turns up inconsistencies. A claimant should always try to be fully aware of what his or her medical record contains so that errors or inconsistencies can be spotted and corrected before there’s trouble.
- Ignoring orders to submit to a “second opinion” exam: A second opinion might be sought by the agency if a claim review leads to a conflicting opinion about your case. To clear up the discrepancy, a second opinion with a doctor of the agency’s choosing may be ordered. The worker has limited rights related to information in such cases.
What’s clear is that understanding all of your options is important.
Source: Fedsmith.com, “5 Reasons Your OWCP Workers’ Compensation Benefits May Be Terminated,” Bo Harris, June 26, 2016