Wednesday, April 6, 2016

The CA-20 Trap

When you first file an OWCP claim a lot of times your employer will give you a CA-20 (Attending Physician’s Report) form and tell you to have your doctor complete the form.

Sometimes it’s not just the employer but OWCP might also tell you to have a CA-20 completed and even the FECA Manual says a CA-20 can be used as a medical report. Everyone makes it seem as if this is what you need from your doctor to get your claim accepted…but it’s not.

The CA-20 is an official OWCP form, but it’s a trap and not actually considered a medical report that can or will get your claim accepted. While everyone might tell you that it’s all you need from your physician, it isn’t.

This is because the CA-20 does not constitute a rationalized medical opinion on causal relationship; simply checking the box that indicates the injuries are work-related and writing a brief description isn’t enough and can actually cause the claim to be denied. If you submit a CA-20 you can expect OWCP to either ask for more information or use the CA-20 to deny your claim.

Once your claim is accepted you can use a CA-20 in between yearly medical narratives but a CA-20 will not be considered rationalized medical evidence and will never be considered a medical report that will get your claim accepted.

In order to get your claim accepted, your doctor must write a complete medical narrative. This is the only medical evidence that will get the claim accepted. Until your claim is accepted, avoid the frustration and skip the CA-20 and have your doctor write a complete medical narrative as required by OWCP.

For more information on medical narratives see these articles:


Friday, February 19, 2016

OWCP Attorney-The Best Choice?

The ECAB decisions for January 2016 show that 33 appeals were filed through attorneys. Of these 33 appeals, 26 of them were affirmed, meaning the claimant lost. 26 out of 33 attorney filed appeals lost, the other seven were remanded back to OWCP. None of them were reversed. One attorney had eight appeals decided in January and lost all eight.

I have a problem with this. Yes, it’s true that there are some issues that are difficult to get accepted. I’m not talking about the difficult, complicated issues. I’m talking about basic issues of getting a claim or disability accepted.

If you are in the business of helping OWCP claimants with their claims, there are things you know or should know. If you don’t know the basics about OWCP, you have no business taking on an OWCP claim. More importantly, in my opinion you have no business taking a claimant’s money.

The most basic of things with OWCP is that ALL claims hinge on medical evidence. We all know this. Claimants learn this pretty quickly so attorneys and non-attorney representatives who do OWCP claims for a living should know it better.

Whenever a claimant comes to me for help in getting a claim accepted, one of the first things I do is look at the medical evidence. If the medical evidence is lacking, there’s no point in charging the claimant to appeal a decision until the medical evidence is up to OWCP’s standards and if you’re helping claimants for a living, you should be able to easily tell whether or not the medical evidence is sufficient. If the medical evidence isn’t sufficient, you shouldn’t be taking the claimant’s money to appeal when you know they’re going to be denied again for insufficient medical evidence.

We all know OWCP doesn’t play fair. Even when the medical evidence is sufficient, OWCP likes to deny a claim. But it seems to me that the attorneys aren’t playing fair either. In all the cases at the ECAB level that were denied based on a lack of medical evidence, how many previous appeals were done? How much did it cost the claimant to get to the ECAB level only to lose again on a lack of proper medical evidence?

The ECAB is the top of the OWCP food chain. A claimant shouldn't go to the ECAB unless or until all of the evidence to overturn the decision has been submitted. So why go to the ECAB if the claimant is still missing the evidence to overturn the decision?

One case in particular is: 

In this case, in addition to lacking and contradictory medical evidence, nurse’s notes and a physician's assistant reports were submitted. A nurse and a physician’s assistant are not considered physicians under the Act so this does not constitute medical evidence and it’s confusing to me why these reports would be submitted in support of the claim when this isn’t even considered medical evidence by OWCP.

Twenty six claimants who had an attorney lost their ECAB appeals in January. It’s true that I don’t know the details of these cases, but the numbers don’t lie.

It’s no secret I’m not a fan of the OWCP attorneys. I personally think a lot of non-attorney representatives and advocates do a better job and most charge less and I'm not saying all the attorneys that handle OWCP are bad at their job.

Five appeals were decided in January where the claimant had a non-attorney representative. Two of those were reversed, meaning a full-blown win for the claimant. The high-priced attorneys had no reversals out of 33 appeals that were submitted, but the non-attorney representatives had two out of the five appeals they submitted.

Don’t get me wrong, I have no problem with anyone making a living. But if you’re charging a claimant, the very least you should be able to do is recognize the medical evidence is insufficient BEFORE you file an appeal and most especially before you get to the ECAB level.

An attorney or non-attorney representative is supposed to help the claimant. Whatever the issue is, the job is to get the issue resolved so that the claimant gets the benefits they’re entitled to. All attorney and non-attorney representatives charge for their services. A claimant is paying for the expertise and knowledge. So at the very least, shouldn’t an attorney or non-attorney representative tell a claimant where their evidence is lacking before charging them for an appeal or multiple appeals they know are going to lose?

Most people hire an attorney under the belief the attorney can get things done. They charge a lot of money for their knowledge and expertise in their field of practice. But more and more I'm noticing that when it comes to OWCP, having an attorney doesn't necessarily increase your chances of winning. 26 people learned that the hard way in January. 

Friday, November 13, 2015

October ECAB Decisions

The ECAB decisions for the month of October have been posted and I noticed something of concern.

Not all that long ago, some of the judges at the ECAB changed.

When the ECAB issues a decision they either affirm OWCP's decision which means they agree with OWCP and agree that the decision OWCP issued was correct. In other words, the claimant has lost their ECAB appeal.

They can remand OWCP's decision which means that something was wrong with OWCP's decision and the Board is sending it back to OWCP to correct whatever it is that the Board determined was wrong. Once OWCP has done that, OWCP issues a new decision.

A case can be remanded back to OWCP for a lot of different reasons such as OWCP didn't consider all the evidence, there's an outstanding medical conflict, a claimant has multiple claims that weren't combined, the case requires further development, etc... With a remand, the claimant hasn't lost, but hasn't won yet either because OWCP will be issuing a new decision.

Or the ECAB can reverse OWCP's decision. This means OWCP's decision was not correct or was inaccurate and the Board reverses it. This is a full-blown win for the claimant.

138 decisions are posted for October 2015. Of those, 27 were remanded back to OWCP. 111 were affirmed and ZERO were reversed.

Only 27 of the 138 were remanded and none were reversed. 111 were affirmed which is a pretty high percentage. Not a single claimant won their appeal in front of the ECAB in October. Not one.

I've been doing this a long time and I have never seen a month of ECAB decisions where there wasn't at least one reversal. I find this extremely concerning since this means the ECAB didn't find a single case where OWCP issued an inaccurate decision and I find that very hard to believe.


Wednesday, November 4, 2015

Schedule Awards-New Lie

In the latest liar, liar pants on fire files, OWCP is telling claimants in certain situations that they have no claim to a schedule award. I’ve been hearing this story more and more lately.

Claimants entitled to a schedule award are filing their CA-7’s and impairment ratings only to get a letter from OWCP which states the claimant is not entitled to a schedule award because they have not reached Maximum Medical Improvement, (MMI) because they are not working and they are receiving OWCP wage-loss compensation.

This letter states that a schedule award cannot be paid concurrently with wage-loss compensation or if the claimant is still receiving treatment. The letter ends by telling the claimant no further action will be taken to process their schedule award.

While it is true that a claimant cannot receive payment for wage-loss compensation and a schedule award at the same time (concurrently), a claimant can be at MMI and file for and receive a schedule award if they are not working and are still receiving treatment.

OWCP regulations indicate that if a claimant is not working and is receiving wage-loss compensation, the wage-loss compensation will be suspended while the schedule award pays out and when the schedule award is paid, the wage-loss compensation will be resumed.

Personally, I believe this is just the latest tactic of lying to claimants so that claimants will give up on their schedule awards. If you receive this letter, know that this information is not true.

These are the regulations that should be brought to OWCP’s attention should you receive this letter. I’ve written them below in letter form so that if necessary, you can copy and paste into your letter to OWCP.

If you have to write this letter to OWCP bringing the regulations to their attention, you should also ask for written confirmation that OWCP is in fact going to properly process your schedule award.

These are the regulations that apply:

There is no provision under the Act that hinders a claim for a schedule award if a claimant still requires treatment for their injuries. A claimant can be rated for permanent impairment on the current findings. The FECA manual states:

“A schedule award may be payable based on contemporaneous medical evidence of record showing a peak or plateau in the claimant's recovery status, even if the claimant's condition is likely to deteriorate. Payment of an increased award based on additional impairment may be considered at a later date.” See FECA manual part three at 3-0700-3(b).

There is no provision under the Act that indicates a claimant is required to be released back to work in order to claim a schedule award. In point of fact, the FECA manual states:
“If payment for TTD is interrupted to pay a schedule award, such TTD payments must be resumed at the end of the schedule if the claimant has not been reemployed or rated for LWEC at the time the award ends. See FECA manual part two at 2-0808-7(5) and Goldie Washington, 31 ECAB 239 (1979).

A schedule award is not payable concurrently with wage-loss compensation, however a schedule award is payable consecutively with wage-loss compensation. The FECA manual states:

“A schedule award is payable consecutively but not concurrently with an award for wage loss for disability for the same injury. See FECA manual part two at 2-0808-4(3). 


Tuesday, October 6, 2015

Filing A Schedule Award

I get contacted a lot by claimants who want information about how to file for a schedule award.

Most of these claimants have already hired someone who is going to take a percentage of the schedule award to “help” them but even after hiring them, they’re having trouble getting the answers they need.

Anyone who has read me, emailed me or talked to me knows how much I hate this practice. So once again let me stress the fact that an attorney or representative is not allowed under the Act to take a percentage of a schedule award or a percentage of anything related to your OWCP claim.

A contingency fee or a percentage is not allowed under OWCP for any reason.

Should you be looking for an attorney or representative to hire for any reason and they offer to relieve you of a percentage of your compensation or schedule award-that’s a clue that the attorney or representative isn’t on the up and up and doesn’t play by the rules. That might be a clue that maybe they’re not the right attorney or representative for you.

Even if you’ve signed a contract agreeing to a percentage, you do not have to abide by that contract since a percentage is not allowed under the Act.

Another thing that really bothers me about this is that the attorney or representative who is taking a percentage of a schedule award isn’t doing any work to receive that percentage.

It is actually simple to file for a schedule award by yourself. You only need two things:

One is an impairment rating under the 6th Edition of the Guides to Permanent Impairment.

A physician does this, so the attorney or representative has nothing to do with the impairment rating. They don’t do ANY work on the impairment rating…the physician does.

The second thing you need is a CA-7 with the portions relating to a schedule award completed.

Again, an attorney or representative doesn’t do ANY work for this. You can easily complete your name, address, claim number, date of injury, etc…You don’t need to pay someone thousands, sometimes tens of thousands of dollars to complete a few sections of a CA-7.

If you are still employed by your agency, you submit the CA-7 to your agency and the employer’s section is completed by the agency (remember to get a signed copy).

If you are not employed by your agency, you send the completed CA-7 to OWCP along with your impairment rating.

That’s it! That’s all there is to filing for a schedule award.

I get contacted all the time if a claimant has a question about completing the CA-7. I’m sure some of those people are reading this now. I’ve never charged anyone to help them complete a CA-7 for a schedule award. That’s because it only takes about five minutes of my time.

Obviously, I’m not against being paid for the work we do, but I am against those who illegally take a percentage of a claimant’s schedule award and/or compensation and make a really good living at it while claimants struggle with financial hardship.

If OWCP denies the schedule award or reduces the percentage, there are options and even if you need or want to hire help, you still should not pay a percentage of your schedule award.

I would love to see a trend where claimants file their own schedule award paperwork and keep the payout for themselves. After all, the claimant is the one with the permanent impairment they’ll have to live with, why should attorneys or representatives get a percentage of what is rightfully the claimant’s especially when they do nothing to ‘earn’ that illegal percentage?

Jesse Slade: owcpslayer@gmail.com

Wednesday, September 30, 2015

ICD-10 Codes

ICD-10 codes go into effect on 10/01/2015. OWCP will no longer accept ICD-9 codes for diagnoses. All diagnoses now need to include an ICD-10 code.

Monday, September 21, 2015

Team Work Ready

According to the Department of Justice, after an investigation by the USPS Office of Inspector General, The Department of Labor Office of Inspector General, Department of Veterans Affairs Office of Inspector General, Department of Homeland Security Office of Inspector General and IRS Criminal Investigations, Team Work Ready, a Houston, TX based company is the latest to be charged in a conspiracy involving health care fraud, money laundering and OWCP.
On June 30, 2015 a 20-count indictment was unsealed alleging that between January 2011 and June 2015, Team Work Ready submitted at least $6,787,058.00 in false and fraudulent claims to OWCP and received $5,656,778.00 in payment for those claims.
The indictment also alleges that Jeffrey Rose the CEO and Pamela Rose the CFO conspired to conceal approximately $700,000.00 in payments from OWCP when federal search warrants were executed on Team Work Ready clinics in July 2013.
Those indicted allegedly submitted claims for one-on-one physical therapy when patients were playing Nintendo Wii™, sitting in electronic massage chairs, playing water volleyball and/or watching television. 
While Team Work Ready advertises their facilities provide treatment rooms with state-of-the-art equipment designed for effective results with all therapeutic services performed and supervised on site by certified and licensed medical professionals, it would appear by this indictment that wasn't the case. 
The indictment also alleges the defendants received payments for sending patients to physicians and providers of diagnostic services.
Those currently indicted include Jeffrey Rose the CEO, Pamela Rose the CFO, Hugo Jaime the rehabilitation director and Frankie Sanders the vice president of operations.
Team Work Ready claimed it was a full-service clinic specializing in work-related injuries with 10 locations in five States including Texas and New Orleans and advertised they are a full-service multi-specialty clinic specializing in work-related injury, rehabilitation and therapeutic services for injured state and federal employees.
Team Work Ready continues to have an active Facebook page, but it appears their website has gone off line.
Once again, those that take advantage of injured workers are being paid exorbitant amounts of money while claimants suffer the consequences of being under the stigma of providers who allegedly falsified their bills.

Jesse can be reached at: owcpslayer@gmail.com