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OWCP -DOL Work Injury Claim Denials & Appeals

By In Uncategorized On April 9, 2022



Federal Workers Comp Coffee Break Podcast
Initial Denial —Burden of Proof:

•The claimant has the burden to establish the components of his/her claim.
•However, the Office of Workers’ Compensation Programs (OWCP) is not a disinterested arbiter.

•Thus OWCP shares in the responsibility to establish the claim if prima facie evidence has been established. ( I know that is what the DFEC procedure manual says but the level of attempts to share in this responsibility is simply astounding in my experience. If OWCP denies your initial claim, a formal denial will be issued.
The DENIAL decision will contain the following:
•describe the nature of the injury;
•summarize the evidence initially submitted with the claim and provide an explanation as to why it was deficient;
•summarize what was requested upon development;
•describe all evidence received after development; and

•explain why the evidence is insufficient to support the claim.

•A denial decision should describe which of the five basic elements have or have not been met, the specific element upon which the claim is being denied, and a clear discussion of the necessary evidence to support the claim. (remember if you receive a denial and it list one of the five basic elements as having not been satisfied go back and listen to podcast # 11 & 16 for assistance with your denial response.
•Formal denials must always include appeal rights! These appeal rights are usually listed on the last page of the denial letter and require you to sign and date that appeals page and return it to your claims examiner by the deadlines that are assigned to the type of appeal you choose.
You are typically granted three types of appeals:
1. Appeal to ECAB, or the Employees’ Compensation Appeals Board
2. Appeal to the Branch of Hearings and Review
3. Reconsideration carried out by the District Office

Dr. Taylor’s educational podcast utilizes his experience and history as a DOL – OWCP provider and his years of consulting and teaching all things federal workers compensation related. This is an educational short form format for learning how to successfully file federal workers compensation claims. So grab a cup of coffee and lets begin.

Dr. Taylor’s contact information for more information or assistance is: fedcompconsultants@protonmail.com
If you need a provider or assistance with a DOL claim in Tampa, Jacksonville or other areas of Florida you can make an appointment to see him and the other providers at M & R MEdical & Therapy Center at : 813-877-6900
His clinic website is https://mrtherapycenter.com/federal-work-injury-blog/


About the Author

jorge.rodriguez

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