Discussing OWCP Federal Workers’ Compensation

Jan 19, 2016

owcp compensation

OWCP federal workers’ compensation is a completely different ball game compared to state workers’ compensation. Doctors’ are oftentimes justifiably hesitant to partake in a federal workers’ compensation case, because they don’t understand how the process differs from state workers’ compensation. The federal workers’ compensation process is much different, and in many ways, less of a burden for the doctor. Here are some important points a federal worker should explain to their doctor when filing for a federal workers’ compensation claim:

No deposition is required in federal workers’ compensation

Unlike several states workers’ compensation programs, the doctor will not have to partake in a deposition — which is a relief! Depositions can be time consuming and stressful for the doctor. All correspondence in a federal workers’ compensation case is written. The doctor may have to clarify his or her opinion in writing; however, they will not have to undergo cross examination from an attorney.

A work factor can contribute to the injury in ANY WAY (Or to Any Degree)

In the majority of states, a doctor must testify the work incident was the “major contributing cause” of an injury for it to qualify for workers’ compensation. In federal workers’ compensation cases, the causal factor doesn’t have to be as direct. In fact, the doctor doesn’t even have to report the work incident was “more likely than not” the cause of the injury. If a work factor contributes in any way or to any degree to the medical condition, it qualifies as evidence for a federal workers’ compensation claim.

When handling an initial injury, the doctor should record what the patient reports, what the doctor found when examining the patient and the doctor’s overall conclusion as to if the injury is work-related.

For example:

The patient reported to the doctor:

  • They were hurt while at work
  • They fell down
  • They twisted their left knee
  • They were trying to move a PX149

While examining the patient, the doctor found:

  • The patient had a contusion on their knee
  • The knee was swollen
  • The knee was red
  • The patient could barely walk with the injured leg

Because the patient’s report to me correlates with my findings upon clinical examination, it is my opinion that, although I wasn’t there to see it, the work factor of trying to move the PX149 at least contributed to the knee injury, which I diagnosed as 2015/16 ICD-10-CM Diagnosis Code m22.2×2 Patellofemoral disorders, left knee.

                                                Signed and dated,

                                                            Dr. X

Again, a doctor just has to verify the work-related injury contributed “at least in part” to the patient’s injury. A federal worker should be direct when communicating this with their practitioner:

“Dr.X, did this work activity contribute in any way, or to any degree to my medical condition? If so, the entire claim is payable in federal workers’ compensation.”

Updating a change in diagnosis is critical

Most doctors understand they may need to change their diagnosis occasionally; however, the patient needs to make sure they do so in a timely manner. Failure to update a diagnosis may prevent or postpone the approval of OWCP coverage for important medical procedures. For example, if a federal worker goes to a doctor with a sore back, the doctor may initially diagnose a back sprain. If the injury is later discovered to be a herniated disc, which requires surgery, the doctor MUST update the patient’s diagnosis for the procedure to be approved for workers’ compensation.

OWCP federal workers’ compensation covers more than you may realize

Doctors can generally tell when a work activity causes a preexisting medical problem to become worse; however, many don’t realize this aggravation is fully covered by federal workers’ compensation. Federal workers’ compensation coverage is based on a patient’s current medical issue. The coverage will not be reduced by the degree of the preexisting portion. Unlike state OWCP, no apportionment is needed. Federal workers’ compensation aggravation claims can apply to non-work related injuries, which occurred both before or after the claimant was employed by the federal government.

An injured or disabled federal worker should ask their doctor if their work activity contributes in any way (or to any degree) to the aggravation of the medical problem they had before (or even during) federal employment. If the answer is yes, the entire claim is payable in federal workers’ compensation.

The doctor should write a report explaining the following:

  • What was/is the patient’s work activity that caused the aggravation?
  • What was found when the patient was examined?
  • How can the doctor reasonably conclude there has been an aggravation to the patient’s medical problem?
  • Does the doctor believe the aggravation will be permanent (over 12 months) or temporary (less than 12 months)?

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