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(Chats 4-17-19) - The Woodshed: Filing Claims Without Fear

Published 3 months, 1 week ago
Description

1. Why Claims Get Denied: The Doctor Problem

Chris identifies six categories of medical professionals who frequently (and often unintentionally) cause federal claims to be denied because they lack OWCP-specific training:

  • Family Practice Doctors: Don't understand the complex narrative requirements.
  • Chiropractors (Non-Specialized): Often miss the medical connection needed by DOL.
  • Urgent Care Centers: Frequently use Nurse Practitioners; DOL requires an MD signature for forms to be valid.
  • Specialists (Surgeons): Focused on surgery, not the administrative "medical rationale" required for claim acceptance.
  • ER Doctors: Too busy for the multi-page narrative reports needed.
  • VA Doctors: Excellent clinicians, but not trained in the specific "Fed Comp" system.


2. The CA-10: Your Legal Roadmap

The CA-10 is the official instruction manual for what a federal employee should do when injured.

  • The Legend of the Bulletin Board: By law, this form must be posted on the employee bulletin board, yet almost no one sees it.
  • Immediate Action: You must report injuries immediately to secure benefits like COP (Continuation of Pay).


3. The "Shall" Rule: CA-16 and Initial Choice

Chris highlights two powerful laws found in the Code of Federal Regulations (CFR):

  • CA-16 (Authorization for Examination): If you have a traumatic injury (CA-1), management shall issue this form within 4 hours. It pays medical bills for 60 days even if the claim is eventually denied.
  • Initial Choice of Physician: You have the legal right to choose your doctor. Management cannot force you to see "their" doctor or a contract facility like Concentra.


4. Five Ways to Fight Back Against Management

If management "wrongfully impedes" a claim (which is a federal crime), Chris provides a five-point checklist for protection:

  1. File a Grievance: Build a "mountain of grievances" to force agency compliance.
  2. Contact EAP: Use Employee Assistance to mediate or document the stress of the situation.
  3. File an EEO: If you are being targeted or harassed, call an EEO expert to see if you have a claim.
  4. Call OSHA (1-800-321-OSHA): Employees have a right to report injuries. If a supervisor prevents you from filing or orders you into a dangerous situation, it is a safety violation.
  5. NLRB (National Labor Relations Board): File a complaint regarding labor board violations.


Important Statistics

Chris highlights the disparity between workers' perceived injury rates and official acceptance rates:

  • The 1-out-of-19 Stat: In 2018, only 1 out of every 19 federal employees had an accepted claim (roughly 5.2%).
  • Social Security Administration: Acceptance rates were as low as 1 out of 50.
  • Perceived vs. Actual: While employees estimate that 50% to 90% of their coworkers have work-related conditions, the lack of training leads to an "underwhelming" number of attempted and accepted claims.



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Wednesday Night OWCP Chats with Chris & Gini

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