Federal Workers Comp Coffee Break Podcast

Federal Workers Comp Coffee Break
Federal Workers Compensation Coffee Break Podcast is about all things related to Federal Workers Compensation, FECA, OWCP, DOL & Longshore claim filing as an injured federal worker. The podcast is an educational and informative training on how to navigate the OWCP claims filing process for all types of injured US government and federal workers. The podcaster has 26 years in assisting with federal workers compensation as a consultant and trainer. The podcast is free and is educational. If you need help with anything related to a federal workers compensation claim…help is just a cup of coffee away. The short coffee break format highlights solutions and gives directions on how to successfully resolve any federal workers compensation claim related issue. So if you are a federal employee and you want to learn about OWCP – DOL & FECA workers compensation….pour a cup of coffee and drop by…you will be glad you did.

Federal Workers Compensation Coffee Break Introduction
Episode 1 is an introduction to Dr. Taylor and his history as an OWCP – DOL 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

https://feeds.buzzsprout.com/1902653.rss

Be sure to check out all of our other Federal Workers Comp Coffee Break Podcast episodes for all of OWCP/DOL needs.

Help is just a click away!

https://www.buzzsprout.com/1902653/9707697

Episode 2 – Filing a new OWCP/DOL Claim

In this 2nd episode of the Federal Workers Compensation Coffee Break Podcast episode we discuss the overall general information of what is involved in filing a new federal workers compensation claim with DOL, OWCP and FECA claims. The basics of what is needed immediately after you have been injured. What are the forms? Who do I talk to? Who do I file with? Where do I find a doctor? Will I get paid? Is there anyone out there that can help me?
RELAX pull up a chair, poor a cup of coffee and take notes on how to get started with filing the most common type of federal workers compensation claims.

https://www.buzzsprout.com/1902653/9707821-federal-workers-compensation-coffee-break-episode-3-ecomp-basics

Episode 3- All About Using ECOMP

Welcome to episode 3 of the Federal Workers Compensation Coffee Break Podcast. This episode discusses how to communicate with your claims examiner, upload files, check for responses and keep up to date with any development with your OWCP or FECA claim. This episode is all about “ECOMP!”

ECOMP is a free web-based application hosted by the Office of Workers’ Compensation Programs (OWCP) that provides Federal agencies with an electronic system for recording workplace injuries and illnesses, and processing claims under the Federal Employees’ Compensation Act (FECA). ECOMP features include FECA claim submission, Agency Query System, Claimant Query System (CQS), CE-LinQ for Employing Agencies, OSHA reporting, and many more. ECOMP also allows for uploading of supporting documents to FECA case files. BEFORE WE GET STARTED…. Go TO the FOLLOWING TWO WEBSITES…

https://www.ecomp.dol.gov/#/help/userguide/claimant/Registration

https://www.ecomp.dol.gov/#/

https://www.buzzsprout.com/1902653/9795666-episode-4-federal-workers-comp-travel-reimbursement-form-957

Episode 4- Get Paid for Travel/Transport

Episode 4 of Federal Workers Compensation coffee break discusses the reimbursement of travel to and from doctors appointments, treatment visits, diagnostic visits and requested doctor visits. The CA-957 form itself allows for reimbursement of travel for different scenarios that we discuss in this podcast.
The Ca-form 957 can be found at:
https://www.dol.gov/sites/dolgov/files/owcp/dfec/regs/compliance/owcp-957.pdf
So sit back with your cup of coffee and enjoy another coffeebreak with your OWCP consultant Dr. Stephen Taylor and lets learn how to get reimbursed for your travel expenses.

The instructions to completing the form is listed below:
Instructions (Form OWCP-957) 1. Enter claimant’s full name: last name, first name, middle initial. 2. Enter claimant’s claim/case file number. 3. Enter payee’s full name (if person other than the claimant is to be reimbursed): last name, first name, middle initial. A payee other than the claimant must have special authorization. Please explain the following: a. Relationship to the claimant b. The reason you are requesting reimbursement 4. Enter the address of the person to be reimbursed. The address is to include: Street/RFD, City, State, Zip Code Note: If your claim is filed under the Federal Employees’ Compensation, please enter the following as an address: the House Number and Street Name, City/Town, State, and Zip Code. For the FECA program to effectuate proper claims management, a FECA claimant is expected to provide the home address where he or she resides. A Post Office (PO) Box or attorney/representative address does not suffice for this purpose. 5. 6, and 7. Complete a separate block for each medical facility visited on the same day. For travel on different days, complete one block for each date. a. Enter date of travel. b. Mark one box only. c. Mark one box only. d. Mark one box only. e. Enter the name and address of the medical facility. f. Mark each box for which you are claiming reimbursement and list the amount of money spent for each item. g. Enter the total number of miles traveled by private automobile. h. The physician or designee is to complete this item (for Black Lung use only). 8. The person claiming reimbursement must sign here. Attach all original receipts for expenses listed in 5f, 6f, and 7f. The claimant’s full name and Social Security Number should appear on each receipt.
If you need a Tampa OWCP approved medical provider: call 813:877-6900 or email at fedcompconsultants@protonmail.com

https://www.buzzsprout.com/1902653/9804817-episode-5-federal-workers-compensation-coffee-break-podcast-ca-7-forms

Episode 5 – FORM CA17- GET PAID FOR LOST WAGES OR LEAVE TIME

Episode 5 is all things related to the CA-7 Form for obtaining your lost wages & leave time while receiving your medical treatment. In order to be re-compensated for your lost wages for time off of work in order to make your doctor appointments and treatment you should file a CA-7 Claim for Compensation form for your lost wages. The reason OWCP created this form was for injured federal workers that got injured on the job to not lose your off time or use up your sick leave for days off for your doctors’ appointments or treatments. You have rights and provisions that are afforded you as a DOL federal worker claimant. Let’s teach you the basics on how to get reimbursed for your time off for your medical care, when you miss time off of your regular shift.

Here is the link for the FORM CA-7 Claim for Compensation:
https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7.pdf
If you need a Tampa Bay OWCP approved medical provider:

Dr. Taylor is located at M & R Medical & Therapy in Tampa at 4150 N. Armenia Ave. Ste. 102, Tampa Florida 33607 (813) 877-6900

https://www.buzzsprout.com/1902653/9815121-episode-6-federal-workers-compensation-coffee-break-podcast-how-to-file-a-ca-1-traumatic-injury-claim

Episode 6- DOL Traumatic injuries – FORM CA-1 -ESTABLISHING A NEW TRAUMATIC INJURY CLAIM

FECA defines traumatic injuries as a wound or other condition of the body caused by an external force, including stress or strains, which is identifiable as to the time or place of the occurrence and the members or functions of the body affected. The injury must be caused by a specific event or incident or a series of incidents within a single workday or shift. A traumatic injury (TI) is defined as:

•A wound or other condition of the body caused by external force, including stress or strain. The injury must be identifiable as to time and place of occurrence and member or function of the body affected. It must be caused by a specific event, incident, or series of events or incidents during a single day or work shift.

CA-1 form link: https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-1.pdf

•Form CA-1 Notice of Traumatic Injury should be completed by the injured employee and the employing agency (EA) supervisor or injury compensation specialist. The front portion of the CA-1 should be completed by the injured employee unless incapacitated at which time the form may be completed by the supervisor or other authorized EA official.

•The injured employee must indicate a specific date of injury and date of notice on the CA-1.

•The CA-1 must be submitted to the Employment Agency (EA) within 30 days of the date of injury in order for the injured employee to be eligible for Continuation of Pay (COP). COP will be discussed in more detail further in the presentation.

Not all CA-1 forms are submitted from the EA to OWCP; follow the filing instructions on the back of the form (i.e., cases with no lost time and no medical expense).

•If the form should be filed, it must be transmitted to OWCP within 10 work days from the date the EA received notice (not necessarily 10 days from the date that the form was actually signed).

https://www.buzzsprout.com/1902653/9840366-episode-7

Episode 7 – ESTABLISHING AN OCCUPATIONAL INJURY OR ILLNESS CA-2

Federal Workers Compensation Coffee Break Podcast is about all things related to Federal Workers Compensation, FECA, OWCP, DOL & Longshore claim filing as an injured federal worker. The podcast is an educational and informative training on how to navigate the OWCP claims filing process for all types of injured US government and federal workers. The podcaster has 26 years in assisting with federal workers compensation as a consultant and trainer. The podcast is free and is educational. If you need help with anything related to a federal workers compensation claim…help is just a cup of coffee away. This episode covers tips on how to successfully submit a DOL – OWCP, Federal Workers Compensation CA-2 Occupation Illness or Injury clam.

Occupational illness is defined as a medical conditioning produced in the work environment over a period longer than a single work day or shift and caused by such factors as system infection, continued or repeated stress or strain or exposure to hazardous elements such as, but not limited to, toxins, poisons, fumes, noise, particles of radiation, or other continued or repeated conditions or factors of the work environment.

Things to note about establishing the history of a beyond a single day event or single shift type of injury:

First, understand that to establish an occupational illness or injury the responsibility falls mostly on the injured federal worker. The burden of proof standard required for proving the history of the injury for these types of claims falls squarely on the injured federal worker’s ability to prove that the occupational Injury/illness is directly related to employment conditions and/or factors or aggravated by employment. required activities.
The short coffee break format highlights solutions and gives directions on how to successfully resolve any federal workers compensation claim related issue. So if you are a federal employee and you want to learn about OWCP – DOL & FECA workers compensation….pour a cup of coffee and drop by…you will be glad you did.
Here is the link for the CA-2: https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-2.pdf
Here is the link for the CA-35: https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-35.pdf

https://www.buzzsprout.com/1902653/9936007-episode-8-federal-workers-compensation-coffee-break-podcast-ca-2a-recurrence

Episode 8 – A DOL – OWCP CA-2a: Recurrences or New Injuries, New Illnesses

A DOL – OWCP Federal Workers Compensation injury known as a recurrence of an injury is described as one of the following:

1. A spontaneous return of the symptoms of a previous injury or occupational disease without intervening cause.

2. A return or increase of disability due to a consequential injury: Example Something that occurs due to weakness or impairment caused by a work related injury.

3. Withdrawal of a specific duty assignment when the employee cannot perform the full duties of the regular or limited duty position.

There are two types of recurrences:

•A recurrence of the medical condition is the documented need for additional medical treatment after release from treatment for the work related injury. Continuing treatment for the original condition is not considered a recurrence.

•A recurrence of disability is an inability to work after an employee has returned to work, caused by a spontaneous change in a medical condition which had resulted from a previous injury or illness without an intervening injury or new exposure to the work environment that caused the illness.

DOL – OWCP form: CA-2A link: https://www.nalc283.org/pdf/ca-2a.pdf

https://www.buzzsprout.com/1902653/9986139-episode-9-federal-workers-compensation-coffee-break-podcast-story-time-version-probably

Episode 9 – Choosing the right doctor/office for your OWCP/DOL injury.

This episode is a Story Time Version that discusses the common problem of using inexperienced doctors and clinics that do not understand federal rules and provisions regarding causation and employment factors.

If you’re an injured federal worker filing a work related injury claim for workers’ compensation benefits, your doctor must provide an acceptable diagnosis that is sufficient to establish the required 5 elements of causation and appropriate diagnosis. For example, if you are initially diagnosed only with “pain” and later find out that the source of your pain is a torn ligament or broken bone, your case will be denied. Pain diagnosis is not compensable under the FECA for federal workers. All CA forms to establish claims must be signed by an MD/DO or co-signed by an MD/DO, if you see a PA or NP.
Your medical provider should also explicitly describe how your medical condition was caused by a work-related event or exposure. This is called the doctor’s “causation opinion”. ‘Causation” needs to be written in explanatory terms as opposed to a conclusion statement. The causation statement requires the doctor to provide rationale with a description of a definitive link between the work-related incident and your medical condition. This is a story of an injured worker who had his work-related injury denied for a year and a half due to the wrong provider signing his document and receiving a diagnosis of “pain,’ along with his second doctor using one wrong word…“probably.” Welcome to a story time version of the podcast!

You can find the DFEC procedure manual that explains these requirements at the following link: https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECA-PT2/group1#208053

https://www.buzzsprout.com/1902653/10028983-episode-10-federal-workers-compensation-coffee-break-podcast-dol-owcp-form-ca7a-form-ca7b

Episode 10- Explanation of the the CA-7 form types.

This is part two of a two part DOL – OWCP injured worker compensation scenarios that include leave buy back, time off of work, time off for medical appointments during a shift, scheduled awards, adjudication, benefit types and wage loss. There are three versions of the DOL form CA-7. We will review all three with most of the emphasize on the Form CA-7a and CA7b.

First the CA-7a = Time Analysis form:

•Supplements Form CA-7 when disability/time loss from work is intermittent or for partial days.
•Allows for individual hours to be claimed on specific days in a claimed period, rather than full days.
•Is used to document and claim time lost due to OWCP related medical appointments and treatments.
•Compensation payments for medical appointments must be supported by attendance records or medical evidence in file.

DOL – OWCP Form CA-7 B — Leave Buy Back (LBB) Worksheet/Certification and Election

•Leave Buy Back: When an Injured Worker elects to use accrued sick or annual leave during a period of disability, he or she may later, with the concurrence of your Employer Agency, claim compensation for the period of disability and “buy back” the leave used…. this can be found in DFEC procedure manual and in the federal registry at (20 C.F.R. § 10.425). The FECA does not govern whether a claimant may or may not buy back leave from an EA, and any decision by EA to disallow leave buy back is not a decision of OWCP over which the Employees’ Compensation Appeals Board may exercise jurisdiction. So I direct you to HR and your employee contract agreement.

Leave Buy Back (LBB):
•Employing Agency and Injured Worker must complete Form CA-7b. Form CA-7b provides an estimate of the cost to the you the injured worker to reinstate the used leave.
•Your District Office makes the determination on whether or not the medical evidence is sufficient to support all of the hours claimed.
•If there is medical evidence for all hours claimed but Employing Agency’s estimate of FECA entitlement is off by more than 10 percent, then the claims examiner will advise you and ask if he/she wishes to continue with the leave repurchase.
•OWCP makes payment directly to Employing Agency the (address is provided on Form CA-7b).

DOL – OWCP form CA-7 link: https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7.pdf
DOL – OWCP form CA-7a link: https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7a.pdf
DOL – OWCP form CA-7b link: https://www.dol.gov/sites/dolgov/files/owcp/regs/compliance/ca-7a.pdf

https://www.buzzsprout.com/1902653/10114678-episode-11-federal-workers-compensation-coffee-break-podcast-5-basic-elements-of-establishing-a-dol-claim

Episode 11- ESTABLISHING A DOL CLAIM FOR FEDERAL WORKERS COMPENSATION

When filing a workers’ compensation claim, the burden of proof is on the employee. Therefore, it is the employee’s responsibility to show a causal relationship between his or her disability and an on-the-job injury, or his or her claimed occupational disease and conditions of employment.

Burden of Proof

•It is the claimant’s responsibility to establish the five basic requirements of a claim, which is known as the “burden of proof.”

•It is OWCP’s responsibility to establish willful misconduct, injury caused by intoxication, or intent to cause an injury (Statutory Exclusions) during the adjudication phase of the claim.

Burden of Proof – Employee Responsibilities:

•The burden of proof to establish the essential elements of the claim

•Submit factual evidence as required by OWCP

•Provide medical evidence as requested

•Keep supervisor informed of condition

•Return to work as soon as medically able

Only OWCP has the authority to approve/disapprove a claim.

ELEMENTS OF A CLAIM:

•Time

•Civil employee

•Fact of injury

•Performance of duty

•Causal relationship |

ALL 5 ELEMENTS MUST BE MET BEFORE BENEFITS CAN BE AWARDED

https://www.buzzsprout.com/1902653/10205810-episode-12-federal-workers-compensation-coffee-break-podcast-continuation-of-pay-cop

Episode 12 – Continuation of Pay (COP) Part 1

COP stands for Continuation of Pay & is the continuance of a federal employee’s regular pay for a period not to exceed 45 calendar days of disability for a federal worker who is injured on the job.

COP is the continuation of your regular pay check uninterrupted for 45 days rather than being paid for time off of work through OWCP. This entire podcast 1 of a 2 part COP series is about being paid while off of work for the first 45 days rather than your employer wrongly using and not reimbursing YOU the injured worker for your LEAVE!

Continuation of Pay (COP)
•Applies to traumatic cases only
•Intent is to avoid interruption of pay while the claim is adjudicated.

•COP can be paid for the following:

•Disability – Total or Partial

•Lost elements of pay – (e.g. night differential, holiday pay)

•Lost time for medical appointments

•After entitlement to COP ends, the employee may apply for compensation or use leave

We will cover these 7 bulletin points in detail in this podcast and then we will cover other important factors of COP to include common scenarios of how to calculate and/or apply or qualify correctly for FACTORS that COP can be applied to….in the 2nd podcast in this two part series.

https://www.buzzsprout.com/1902653/10205906-episode-13-federal-workers-compensation-coffee-break-podcast-continuation-of-pay-cop-part-2

Episode 13 – Continuation of Pay (COP) Part 2

This entire podcast 2 part COP series is about being paid while off of work for the first 45 days rather than your employer wrongly using and not reimbursing YOU the injured worker for your LEAVE!

In the second part of our COP series wee address the COP rules for Postal workers, discuss termination of COP and practicing some COP scenarios and practice questions.
1 Continuation of Pay (COP) is the continuance of the employee’s regular pay for a period not to exceed 45 calendar days of disability
2. Employee must begin losing time from work due to traumatic injury within 45 days of the injury to be eligible for COP.
3. COP should be charged for weekends and holidays if the medical evidence shows the employee was disabled on the days in question – calendar days are counted, not just work days.
4. If an employee returns to work following a work stoppage without using all 45 days of COP and then suffers a recurrence of disability within 45 days from the first Return To
Work date, the employee is entitled to use the remainder of the 45 days.
5. To controvert the claim, the agency must complete the indicated portion of Form CA-1 and submit detailed information in support of the controversion to the OWCP.
6. An YOUR EMPLOYER’s objection to paying COP for one of nine reasons provided by regulation is called “controversion”. COP may be controverted only if one of the nine reasons apply.
7. When YOUR EMPLOYER has paid COP, it may be stopped only in certain instances. Please see Continuation of Pay presentation for those instances.

https://www.buzzsprout.com/1902653/10232824-episode-14-federal-workers-compensation-coffee-break-podcast-scheduled-awards-part-1-of-2

Episode 14 – Scheduled Awards Part 1 of 2

Schedule Awards are monetary payments for a prescribed number of weeks to federal employees who suffer the permanent total or partial loss of use of those anatomical members, functions or organs of the body that are listed on the OWCP website. There are many body parts that are covered and some that are excluded. I would suggest you go over the body part list on the OWCP website. For the sake of brevity we will not cover each body part. This is 2 part podcast series. The first podcast is me narrating the exact wording of the DFEC procedure manual on all of the legislated rules and provision of impairment rating and scheduled awards.

The schedule award is payable whether the employee is working, sick or on annual leave, receiving retirement benefits, or is no longer employed by the federal government. However, an employee cannot receive a schedule award while receiving compensation for wage loss at the same time they receive the schedule award.

DFEC Procedure Manual Part 2 Scheduled AWARDS

Entitlement to Schedule Awards. Permanent impairment to certain parts of the body will entitle the claimant to an award of compensation payable for a set number of weeks. The Claims Examiner (CE) should monitor medical reports for the possibility of eventual impairment to a schedule member and the date by which maximum medical improvement (MMI) is expected. If it appears that a schedule award may be payable, the CE should advise the claimant via Form CA-1053, or the equivalent, of his or her possible entitlement to such an award.
Here is the link to the DFEC Procedure Manual portion addressing the federal rules associated with Scheduled Awards, MMI, and Impairment Ratings:
https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECA-PT2/group2#20808

https://www.buzzsprout.com/1902653/10232886-episode-15-federal-workers-compensation-coffee-break-podcast-part-two-of-two-scheduled-awards-impairment-ratings-and-disability

Episode 15 – Scheduled Awards, Impairment Ratings and Disability Payments Part two

In order to receive a Schedule Award, the person must be rated by a physician, using the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, otherwise known as the AMA GUIDE 6th Edition. Prior to receiving the rating, the person has to have reached Maximum Medical Improvement, which is referred to as MMI. This rating should not be for the whole body, but for the injured body area or body part, such as 25% of the right lower extremity. When the physician rates the injured employee, YOUR physician is required to reference the page number and paragraph of the sixth edition guides to the evaluation of permanent impairment that relates to the employee’s ratings.

Please be aware that one does not have to accept surgery before receiving a Schedule Award. No invasive procedure can be performed on the claimant if he or she objects to it. Invasive procedures are considered anytime you penetrate the skin, such as injections or other procedures such as surgeries.

What should the employer do when an employee files an initial claim for compensation due to disability or permanent impairment ?
Upon receipt of Form CA-7 from the employee, the employer shall complete the appropriate portions of the form. As soon as possible, but no more than five (5) working days after receipt from the employee, the employer shall forward the completed Form CA-7 and accompanying medical report to OWCP. OWCP clarifies schedule award procedures, including how pre-existing or ,nonindustrial medical conditions affect these important permanent disability awards.

I want to talk about a common misunderstood and misused category that claims examiners and second opinion doctors attempt to utilize that is not included in the DFEC procedure manual or Code of Federal Regulations. The word that I am referring to is called apportionment.

Under federal law, there is no “apportionment” – that is, if your employment contributed to any degree to the medical condition causing the disability, the entire disability is covered in full.
Link to the DFEC Procedure Manual portion:
https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECA-PT2/group2#20808

https://www.buzzsprout.com/1902653/10248337-episode-16-federal-workers-compensation-coffee-break-podcast-owcp-initial-claim-development

Episode 16 – Initial Claim Development

Upon initial receipt of an Office of Workers’ Compensation Programs (OWCP) claim form (CA-1, CA-2, CA-2a, CA-5, etc.), the responsible claims examiner (CE) will determine if the initial claim and supplemental documentation is sufficient to meet the following five basic criteria for OWCP claims.

Five Basic Criteria
The Federal Employees’ Compensation Act (FECA) five basic criteria:
(1) Be timely filed.
(2) Be made by a Federal Civil Employee.
(3) Establish Fact of Injury, which has both a factual and medical component. Factually, the injury, accident or employment factor alleged must have actually occurred. Medically, a medical condition must be diagnosed in connection with the injury or event.
(4) Establish Performance of Duty. The injury and/or medical condition must have arisen during the course of employment and within the scope of compensable work factors.
(5) Establish Causal Relationship, which means the medical evidence establishes that the diagnosed condition is causally related to the injury or event. These criteria must be satisfied in the order listed above.
|
Development and Adjudication
|•CE will allow at least 30 days for response from the claimant.
•Failure to allow at least 30 days before making an adverse decision is reversible error.
•CE must explain deficiencies in initial evidence – which of the five basics are not established.

https://www.buzzsprout.com/1902653/10346918-episode-17-federal-workers-compensation-coffee-break-podcast-third-party-liability

Episode 17 – Third Party Liability for DOL & OWCP Federal Workers Compensation Claimants

Importance to OWCP

These are the important topics that we are going to cover today that YOU MUST KNOW…it can and will effect your case to the point of denial of your entire claim…so pay close attention to the next 4 statements…Ready Pins out …here we go… First…

•The claimant (that is You) is required to pursue damages.

•Injured workers (IW) are required to report any settlements obtained from the third party.

•Benefits can be suspended if claimant does not pursue damages or fails to report them.

•A portion of any settlement obtained must be refunded to OWCP.

Here is the link with the entire podcast information included: https://www.dol.gov/sites/dolgov/files/owcp/dfec/icstraining/thirdpartyliability/thirdpartyliability.pdf

https://www.buzzsprout.com/1902653/10374347-episode-18-federal-workers-compensation-coffee-break-podcast-va-disability-claims

Episode 18 – Starting VA Disability Claim

How do I prepare before starting my VA Disability application?
Find out if you’re eligible for VA disability compensation
What evidence will I need to provide to support my VA Disability claim?
There are four key things you need to do:
(1) Determine if you are eligible for VA Disability Compensation
(2) Gather sufficient proof to support your disability claim
(3) Fill out all the necessary VA disability claim forms to complete your claim
(4) File your claim through one of the three approaches: mail, in person, online

You can help to support your VA disability claim by providing documents such as:

VA medical records and hospital records that relate to your claimed illnesses or injuries or that show your rated disability has gotten worse
Private medical records and hospital reports that relate to your claimed illnesses or injuries or that show your disability has gotten worse
Supporting statements you’d like to provide from family members, friends, clergy members, law enforcement personnel, or those you served with that can tell us more about your claimed condition and how and when it happened or how it got worse

Depending on the type of claim you file, you may gather supporting documents yourself, or you can ask for our help to gather evidence.
How do I file my claim? You can file your disability compensation claim online right now by clicking the link below.

File a disability compensation claim

You can also file a disability claim: By mail, in person or online or with the help of a trained professional.
VA Forms 21-4142 and 21-4142a: https://www.vba.va.gov/pubs/forms/VBA-21-4142-ARE.pdf

(VSO)Veterans Service Office assistance list link:
https://www.va.gov/ogc/apps/accreditation/index.asp

Tampa Bay OWCP/ DOL Doctors – M&R Therapy Center

https://www.buzzsprout.com/1902653/10407862-episode-19-federal-workers-compensation-coffee-break-podcast-owcp-dol-denials-appeals

Episode 19 – OWCP Denials & Appeals

•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

https://www.buzzsprout.com/1902653/10524244-episode-20-federal-workers-compensation-coffee-break-podcast-scheduled-awards-disability

Episode 20 -Scheduled Awards & Disability

The FECA provides that loss of both hands, arms, feet, or legs, or the loss of sight of both eyes is prima facie evidence of permanent total disability. See 5 U.S.C. 8105(b). It does not mean, however, that a claimant in this medical condition should be automatically declared permanently and totally disabled.
Compensation is provided for specified periods of time for the permanent loss or loss of use of certain members, organs and functions of the body. Such loss or loss of use is known as permanent impairment. Compensation for proportionate periods of time is payable for partial loss or loss of use of each member, organ or function. 5 U.S.C. 8107(b)(19).

Employees covered under the Federal Employees’ Retirement System (FERS) are required to apply for Social Security disability benefits in order to obtain FERS disability retirement. Social Security regulations provide for dollar-for-dollar offset of Social Security disability benefits if an employee receives workers’ compensation disability benefits.

Social Security Disability: Social Security considers OWCP Schedule Awards as disability benefits, and will deduct the full amount from any Social Security disability benefits due. Moreover, Social Security will report the full amount of the deduction to the IRS as taxable income, even though it never was paid to the injured worker.

VA Disability: Under FECA, an injured federal worker whose claim is accepted is entitled to medical benefits and wage loss compensation. For federal worker with DVA disability ratings, applying for some FECA benefits may require an election between the DVA benefits and FECA benefits. An injured worker with a DVA disability rating for the same injury will often receive more from an increase of their DVA disability rating than from a schedule award. Injured workers with DVA disability ratings should contact their National Business Agent’s office for guidance.

To receive a Schedule Award, the person must be rated by a physician, using the AMA Guides to the Evaluation of Permanent Impairment, Sixth Edition, g, the person has to have reached Maximum Medical Improvement, which is referred to as MMI.

Schedule Award is paid using the formula:

(OWCP Compensation Rate) x (Number of weeks allowed on the Schedule for the injured body part) x (% of Impairment) = $Schedule Award

Office Location & Hours

4150 N Armenia Ave #102, Tampa, FL 33607

(813) 877-6900

Monday through Friday,
8:00 am - 7:00 pm

Episode 12 – Continuation of Pay (COP) Part 1

Episode 13 – Continuation of Pay (COP) Part 2

Episode 16 – Initial Claim Development

Episode 18 – Starting VA Disability Claim

Episode 20 -Scheduled Awards & Disability