Episode Details
Back to Episodes(Chats 5-15-19) The Specialist Trap: Why Your Orthopedic Surgeon is Getting You Denied
Description
Chris and Gini explain the "nearly impossible" challenge of changing doctors once a specialist is chosen and why an OWCP-trained doctor should always be your first call. They also discuss how to handle auto accidents in government vehicles (LLVs) and the strategy of using third-party lawsuits to secure extra compensation.
Key Takeaways & Show Notes
1. The Specialist Trap
One of the most common mistakes is going to an Orthopedic Surgeon or a Specialist as your first treating doctor.
- The Problem: Specialists are trained for surgery, not for writing the multi-page medical narratives required by the DOL.
- The Trap: Once you designate a specialist as your "Physician of Record," the DOL often denies requests to switch to a general practitioner or an OWCP specialist later, labeling it a "move to a lower level of care."
- The Solution: Choose an OWCP-trained treating doctor first. They will get the claim accepted and then refer you to a surgeon if medically necessary.
2. Auto Accidents & Third-Party Claims
For letter carriers and rural carriers who are hit by other drivers:
- Dual Filing: This is both an OWCP claim (CA-1) and a Personal Injury case.
- The 20/80 Rule: If you sue the at-fault driver and win a settlement, federal law generally allows you to keep 20% of the settlement (after expenses) as a "guaranteed share," while the other 80% is used to reimburse the DOL for medical bills they paid.
- Legal Tip: You need a lawyer who understands both personal injury and the "FECA" (Federal Employees' Compensation Act) lien process so you don't lose your settlement to the government.
3. Adhering to the CA-17 (Duty Status Report)
Chris introduces a new mantra: #FileAGrievance.
- If your doctor provides a CA-17 with restrictions (e.g., "4 hours of work" or "20 lb lifting limit") and management ignores it, it is a violation.
- The "As Tolerated" Warning: Never let a doctor write "as tolerated" on your restrictions. Management will interpret this as "full duty." Ensure your doctor lists specific, numbered limitations.
4. Reopening Closed Claims
A common myth is that once a case is closed, it's gone forever.
- The Reality: Claims can be reopened via a CA-2a (Notice of Recurrence) or by providing new medical evidence that the condition has worsened.
- Timeline: Reopening a claim typically takes 4 to 6 weeks for processing.
Actionable Advice
- Travel Reimbursement: If your case is accepted, use Form OWCP-957 to backdate and claim mileage for all doctor visits.
- Avoid Kaiser/Urgent Care: While good for emergencies, these facilities rarely have the administrative staff to handle the long-term paperwork required to keep a federal claim active.
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Wednesday Night OWCP Chats with Chris & Gini