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Tuesday, October 10, 2017

ECAB Decision Search

Several months ago the ability to search ECAB decisions suddenly disappeared.

Personally, I figured they did that on purpose so that claimants and those that represent them no longer had access to decisions on which valid arguments could be made. Hard to cite a decision when you don't have access to the decisions.

Plus, it made it impossible to look up doctors to see how often they went against a claimant or to look up representatives to search their win/loss records.

Since this ability to search decisions disappeared into a puff of smoke, I've been checking to see if it would come back. Giving them the benefit of the doubt, I did wonder if they were making updates to the site, but with each passing day, that seemed less likely.

So I moved on to find another way to access Board decisions and today I found it!

It's a bit different than the old way, but it does work!

Here is the link:

Thursday, October 5, 2017

I Thought My CA-1 Claim Was Accepted

A CA-1 or traumatic injury claim works differently than all other OWCP claims and these differences can be confusing.

A CA-1 is filed when injuries occur in one day or during one shift and are identifiable to specific events such as a car accident, a dog bite, a broken bone, etc...Any injury that happens suddenly in a single day or during a single shift.

When a traumatic injury claim is filed, you have the option of taking your leave or taking Continuation of Pay, (COP) if you cannot work. These options are on the claim form.

COP pays your wages for the first 45 days of a claim. The COP option means the agency is paying you. Most agencies will try to get you to use your leave but you shouldn't have to use up your leave because you were injured at work.

*For postal workers and only for postal workers, the first three days of a claim are on the injured employee. You can use leave or Leave Without Pay, (LWOP) for those first three days if you can't work. If there's disability (you can't work) for more than 14 days, then the leave a postal worker uses for those first three days should be restored (returned to the employee).

If you cannot work due to your injuries, then the COP pays you for those first 45 days while you're not working. Once the 45 day period ends, if you're still unable to work, you would file CA-7's for compensation.

In order for OWCP to pay compensation, your doctor needs to write something for OWCP that specifically addresses the dates of disability, why you cannot work, what job duties you cannot perform and connect these reasons to the work-related injuries.

COP is charged if you're able to work but require medical treatment. For instance, if you have a medical appointment, physical therapy, testing, etc...during the first 45 days after the injury COP covers your time away from work.

COP is charged by the day, so if you have a medical appointment that takes three hours, one full day of COP is charged.

Another way a CA-1 is different is that when there's a traumatic injury your agency should give you a CA-16 within four hours of being notified of the injuries. A CA-16 guarantees payment to the first physician that treats you for non-surgical treatment.

Because the CA-16 guarantees payment, it is not available online and must be given to you by your agency. The CA-16 will indicate the name of the physician. The physician you see is your choice. If the agency writes in a physicians name, it should be changed to reflect the physician you choose.

When you choose the physician, your agency should also give you an OWCP-1500 form as well. This isn't necessary if the agency chooses the physician because those physicians normally have contracts with the agency.

Once you're injured and your agency is notified, you should seek medical treatment as soon as possible but the CA-16 is valid for up to 60 days from the date of injury.

Even if your agency does not give you a CA-16, OWCP should pay for the physician but the CA-16 is a guarantee of payment.

As with any OWCP claim, the employee has the choice of the first physician they see. The agency may want you to go to 'their' doctor, but you have the choice of the physician and let's face it, the agency's doctor is on the agency's side not yours.

If the agency insists on taking you to the doctor, then you should insist that they take you to your doctor. Unless there's a valid reason, such as your doctor is more than 25 miles from the place of injury (or the employee's home), the agency needs to take you to your doctor.

If the agency refuses, then you should make other arrangements for transportation so that the first medical report isn't coming from an agency doctor on the agency's payroll that probably won't accurately diagnose you.

If you have a doctor in your area that is knowledgeable with the ways of OWCPland, it's in your best interest to see that doctor first.

A lot of people who file a CA-1 claim are confused when suddenly it appears that OWCP has changed their mind about accepting the claim. This is another difference between a CA-1 claim and all other claims.

With a CA-1 claim, OWCP authorizes up to $1,500.00 in payments to medical providers without question. Once the claim reaches that $1,500.00 mark, OWCP sends a development letter and the claim has to be proven with evidence just like any other claim.

The development letter will require that you provide OWCP with a medical narrative and often the letter also contains a questionnaire that you must complete. The development letter will give you thirty days to provide the evidence.

A CA-20 is not enough to get any claim accepted, a physician must write a medical narrative.

If you miss that deadline or don't submit what OWCP is asking for, OWCP will deny the claim and you'd have to appeal that decision. If this happens and COP was used, then the COP is converted to your leave.

This can cause confusion because the bills are being paid and the injured employee believes the claim is accepted when it is not and can cause complications because the COP is reversed and your doctors will no longer be paid.

So if you file a CA-1 claim, be aware that unless the injury is minor with less than $1,500.00 in medical bills, you will be expected to prove your claim once you exceed the $1,500.00 allotment. If you're sent a development letter make sure you give OWCP everything they need so that you don't have the complication and delay of having to appeal.

You can check bill status on the ACS site. I've included the link below. When you see that you're getting close to the $1,500.00 mark, it's in your best interest to get a proper medical narrative so you don't miss OWCP's thirty day deadline.

Until you receive a letter from OWCP that indicates the claim has been accepted and what conditions are accepted, your CA-1 claim is not officially accepted.


                                                    MORE INFORMATION:

Choice of physician:
Information about choice of physician is listed on the CA-16 form

20 C.F.R. 702.403:
https://www.gpo.gov/fdsys/pkg/CFR-1998-title20-vol3/pdf/CFR-1998-title20-vol3-part702.pdf

Publication 810 (chapter 6):
https://www.dol.gov/owcp/dfec/regs/compliance/DFECFolio/agencyhb.pdf

Bill Status:
https://owcp.dol.acs-inc.com/

Other Relevant Articles:
Disability: http://theowcpclassroom.blogspot.com/2017/09/my-claim-was-accepted-but-im-not.html

CA-20's: http://theowcpclassroom.blogspot.com/2016/04/the-ca-20-trap.html

Medical Narratives:
http://theowcpclassroom.blogspot.com/2011/03/narrative-reports-your-physician.html

http://theowcpclassroom.blogspot.com/2011/07/more-on-medical-narratives.html

http://theowcpclassroom.blogspot.com/2015/03/painin-your-report.html

Doctors That Accept OWCP Claimants:
http://theowcpclassroom.blogspot.com/p/doctors-that-accept-owcp-claimants.html





Wednesday, September 27, 2017

My Claim Was Accepted But I'm Not Receiving Compensation

I often hear from claimants that their claim was accepted but they're confused why OWCP isn't paying compensation. This is because there are two sides to every OWCP claim...the medical side and the compensation side and each side must be proven separately.

Every OWCP claim covers medical conditions. When your claim is accepted, specific medical conditions are accepted as work-related and this allows you to receive treatment for those medical conditions that OWCP pays for.

But just because your claim is accepted for medical conditions it does not mean you're also approved for compensation.

Compensation is paid for disability, an inability to perform your job (or any job) and the disability must be proven to OWCP before OWCP will pay compensation.

To receive compensation you need two things....first you have to file CA-7's and second, your doctor must provide medical rationale that explains the disability and the reasons you cannot work.

To avoid delays, your doctor should address the disability in his/her medical narrative that's submitted to get your claim accepted. If this isn't done in the original narrative, the doctor will have to write something specific about the disability.

If you supply OWCP with a completed CA-17 or OWCP-5, this will not be enough for OWCP to pay compensation.

The doctor needs to specifically address the dates of disability. So if your date of injury is 09/01/2017 and you've been unable to work since, the doctor has to specifically state from 09/01/2017 and continuing, you have not been able to perform your job duties. If the doctor doesn't specifically indicate the dates of disability, OWCP won't pay compensation until they receive that information.

Your doctor needs to explain the physical requirements of your normal job duties. This is so it's clear to OWCP that your doctor understands what your job entails.

The doctor needs to explain what job duties you cannot perform and why you cannot perform them. As always, the reason cannot be due to pain as OWCP has determined pain is a symptom. To OWCP, your pain is your problem and not a reason not to work.

So the doctor cannot say you can't work because you're in pain. If the doctor discusses pain, the doctor must explain where the pain is coming from, what is causing the pain and how it affects your ability to work and this must be related to the accepted (or claimed) conditions.

The doctor should explain your symptoms, any loss of range of motion, etc...

Any side effects of medication that's prescribed for your work-related conditions should be explained. This should not be the general side effects of a medication, but how the medication specifically affects you.

Any driving restrictions should be explained.

If your job is repetitive in nature, that should be explained. For instance, postal workers whose jobs tend to be highly repetitive.

As an example, if you have a knee condition and your job entails walking, standing, climbing stairs, kneeling etc...the doctor needs to explain that because of the knee condition, loss of range of motion in the knee, swelling of the knee, etc...you cannot perform the job duties of walking, standing, kneeling or climbing stairs.

If you have to elevate your knee repeatedly during the day due to swelling or if you have to wear a brace, that should be explained and connected to why you can't perform specific job duties like walking or climbing stairs, kneeling or driving.

If you have a spinal condition and your job entails sitting and/or sitting while driving, the doctor needs to explain how sitting further compresses your spine and that you cannot perform the job duties of sitting and/or sitting while driving. If there's a loss of range of motion it should be explained that you cannot bend or twist or turn your head.

If you cannot lift the weight you're required to lift for your job because of your conditions, the doctor needs to explain that you cannot lift as required for your job.

If you need to lay down during the day to take the pressure off your spine and relieve your symptoms, that should be explained.

If you have shoulder conditions and your job entails reaching or reaching above the shoulder and/or lifting, the doctor needs to explain why you cannot reach or reach above your shoulder or lift.

The doctor can't say you 'shouldn't' do a specific job duty or that a specific job duty 'might' harm you.  OWCP doesn't pay compensation for what they call "fear of future injury" so the doctor can't say if you perform these job duties you could be injured further, or it might injury you further. The doctor has to state in definitive terms the job duties you cannot perform and any other reasons you cannot work such as medication.

As with everything in OWCPland, the disability has to be explained to them in specific detail before they will approve and pay compensation. Because OWCP doesn't explain these requirements, it's often the reason that compensation is delayed.


Monday, September 18, 2017

New CQS Website-OWCP Connect


OWCP has created a new website called OWCP Connect. This site is the new 
CQS system that was removed from ACS a few years ago.

At this time, the system is only available to claimants with existing claims. 

It is not available to survivors receiving death benefits and is not available 
to representatives or other parties.

If you have multiple cases, after your account is validated, only one 
account is needed and you will be able to view all your claims unless the 
claim has been retired.
Using the site, you will be able to see your case status, compensation 
payments and compensation tracking.
Here is the link:
https://owcpconnect.dol.gov/



Tuesday, May 9, 2017

Agency Contractor Improperly Inserting Themselves Into Claims

It has come to my attention that there is a third party contractor called Managed Care Advisors, (MCA) agencies are using to monitor/manage OWCP claims.

MCA employs physicians and nurses that are improperly inserting themselves into claims and contact is being made with your providers (physicians, physical therapists, etc…) in varying ways including by letter. 

I wrote about this issue in a previous article but at that time did not know the contractor was MCA.

The letters I've seen that are being sent to your providers are written not on MCA letterhead, but on what seems to be Homeland Security letterhead so it appears these are official requests by the agencies under DHS. MCA may also be using letterhead of other agencies as well but as of today, I haven't seen those. 

One such letter was sent by an MCA physician to an employee’s physician and completely and totally misrepresented the facts. Let me put it this way, very little of this letter was actually true, most of it is fabricated and is about as unprofessional and outside the bounds of OWCP as I've ever seen. 

The employee had been medically disqualified and retired for some time but MCA's physician stated in the letter to her doctor the employee was "NOT" retired (yes, he used all caps). 

As if that wasn't inappropriate enough, MCA's physician then states, "The American taxpayers are paying for her medical care and salary compensation via federal workers' compensation (FECA)."

It went on to say a "recent" second opinion indicated the employee had "NO residuals" of the accepted injuries, had minimal objective findings on examination and that all the accepted conditions "had resolved". The letter stated the second opinion indicated the employee could "return to her date of injury job without restrictions".

The letter stated the employee's doctor could request a copy of this second opinion from the CE which is completely false as well and alluded that the employee worked for Border Protection when, in fact she worked for another agency. 

It's unknown where MCA's physician got his information since the employee did not have a recent second opinion and is in fact retired. Was he using an old second opinion and stating it was recent or did he just make it all up...we don't know yet.

The letter ended by inappropriately asking the physician to release the employee to return to work and instructed the employee's physician to FAX this release to MCA. It also stated the employee's physician could set up an appointment with MCA's physician to "discuss this case with me" which again is highly inappropriate. 

Had the employee's physician complied or responded without discussing the letter with the employee, this would have resulted in the employee’s compensation and medical benefits being terminated by OWCP, effectively ending her legitimate claim. 

Another letter to an employee's physician from an MCA nurse misrepresented a C.F.R. and the FECA stating this C.F.R. permitted the physician to disclose information under FECA without a release form. This made it appear it would be legal for the provider to release information without a medical release because the employee had a workers' compensation claim.

However, this information isn't true if you actually read the C.F.R.s or the parts of the FECA Manuals that apply.

This letter was an obvious attempt to obtain medical records under false pretenses without the employee's knowledge or authorization and once again, the employee had no idea the letter had been sent. 

I can't say this enough...Your agency and/or contractors like MCA CANNOT attend medical appointments, CANNOT participate in your treatment, CANNOT make treatment recommendations, CANNOT schedule appointments, CANNOT discuss your claim or your injuries with your medical providers and they CANNOT attempt to change your physician’s opinion.

What they are allowed to do is ask your provider about work limitations and possible job assignments…nothing more.

The agency and/or its contractors CANNOT contact your medical providers in person or by telephone.

Your agency or its contractors can contact your providers in writing. If the agency or its contractors is contacting a provider, it MUST be in writing and a copy of the letter MUST be sent to both you and OWCP at the same time it's sent to your provider. If the provier responds, a copy of that response MUST be sent to you.

However, MCA employees are not copying the employee or OWCP so the employee does not know this is happening unless a provider alerts them. As you can see from the cases above, this behavior could be VERY detrimental to you and your claim.

Your providers have no responsibility to respond to ANY agency request for medical information. Even if asked by the agency about your work ability, the provider does not have to respond. Your providers are only obligated to send medical information to OWCP. 

If you have an accepted OWCP claim, I strongly urge you to contact your providers and inquire if they have received a letter or had other contact by either a nurse or physician who appears to be working for the agency. In some cases, they inappropriately represent themselves as OWCP nurses.

I would also urge you to tell anyone else you know who has an OWCP claim. The word needs to get out about this. 

The bottom line is, you have NO obligation to allow the employer's nurse or physician access to you, your claim or your providers. But if they do contact your providers, again...it MUST be in writing and you MUST get a copy of the letter and it can only discuss your work limitations. If they don't adhere to this, they're violating 20 C.F.R. 10.506.

We are working on addressing this issue legally, but need your help. If such a letter has been received by one of your providers, please forward a copy to me at owcpslayer@gmail.com

The more proof we have, the more likely we are to resolve this issue and end MCA's inappropriate actions and involvement in claims.   

In addition, I have created two templates you can cut and paste to protect yourself; one to give to your providers so that your medical documents are not being inadvertently released and the other which you can use if you previously signed an agency medical release and want to revoke that release.

You can find these templates on the How To page: http://theowcpclassroom.blogspot.com/p/letter-templates.html

Related article: http://theowcpclassroom.blogspot.com/2016/05/field-nurse-is-yours-legit.html

Friday, May 5, 2017

Wall of Shame-Dr. Alexander Doman

Many of you have had experience with Dr. Alexander Doman, one of OWCP's best 'hit men' who, in my opinion deserves his place on my wall of shame.

I have written and submitted a formal complaint to OWCP in regard to Dr. Doman on behalf of all claimants who have experienced one of his "examinations".

If you have been directed by OWCP to attend an exam with Dr. Doman and his report indicates you exaggerated or magnified your symptoms, intentionally deceived him or were malingering, I highly recommend that you include your information in the complaint and submit it to OWCP as well.

OWCP will not stop using physicians like Dr. Doman unless or until the evidence against THEM is overwhelming and can no longer be ignored.

In addition, claimants can get copies of all the complaints against a physician by doing a FOIA request (see the How To section). By receiving the complaints, you have an argument against a physician.

For instance, if just ten of you insert your information and send your complaints to OWCP then these complaints should remain on file. Through a FOIA request other claimants can get redacted copies of the complaints. Those ten complaints can be used as an argument that Dr. Doman is biased and his report is not valid.

After OWCP receives three complaints against a doctor they're supposed to investigate.

Multiple complaints have the power to make OWCP and/or the ECAB take notice or at the very least provide an argument that can overturn OWCP's decision to give Dr. Doman's report weight of medical evidence in your claim. But imagine what twenty or thirty or fifty complaints would do.

Unless claimants band together and file complaints against these physicians, nothing is going to change. In the case of Dr. Doman, I've made it really easy to get these complaints filed.

A copy of the complaint is below which you can cut and paste and insert your information I've indicated in Red.

 Here is a copy of the complaint:


Date: Insert Date


Office of Workers’ Compensation Programs
P.O. Box 8300
London, KY 40742

Insert your name

OWCP Claim Number: Insert your claim number
Date of Injury: Insert your date of injury


To Whom It May Concern:

Consider this my formal complaint of bias against Office physician, Dr. Alexander N. Doman.

Dr. Doman has performed second opinion and Referee examinations for the Office for at least twenty (20) years in at least eight (8) states (GA, MA, WI, NY, NC, VA, TX and TN) although a valid medical license could only be found in the state of GA (license #033313).

In addition, Dr. Doman was the Office referral physician in ECAB docket number 15-0640 issued 06/11/2015 in Guam.

Physicians do not normally practice medicine in multiple states especially without being licensed in the state(s) in which they practice. This leads one to believe Dr. Doman isn’t practicing medicine in multiple states, but performing examinations in multiple states for the Offices’ purposes.

It is unreasonable to think that the Office could not find a qualified second opinion or referral physician in the state in which the claimant lives and had to fly Dr. Doman in at great expense to examine claimants. This would give the appearance of bias as Dr. Doman consistently provides opinions against a claimant.

During an Office-directed second opinion examination of December 11, 2014 under claim number 062216370 Dr. Doman stated;

“There is also evidence of both symptom exaggeration during the examination.” [sic]
“It is again noted that there is strong evidence from the examination today of significant symptom magnification”

Dr. Doman provides the Office no rationale on how he arrived at this opinion. Nor does Dr. Doman provide or discuss the “strong evidence” he refers to in his December 11, 2014 second opinion report.

During an Office-directed second opinion examination of June 06, 2015 under claim number 142007938 Dr. Doman stated;

“This lady’s subjective complaints do grossly outweigh and do not correspond to the objective findings. The findings on examination indicate gross and intentional symptom exaggeration.”

Dr. Doman did not provide the Office any medical rationale as to how he came to this conclusion.

During an Office-directed second opinion examination of March 29, 2016 under claim number 140266302 Dr. Doman stated;

“The rationale for this is because this claimant’s physical examination clearly indicates that this claimant is exhibiting gross and extreme symptom magnification for the purposes of deceiving this examiner.”

During an Office-directed referee examination of August 02, 2016 under claim number 062353031 Dr. Doman stated;

“Gross and intentional symptom magnification for purposes of deceiving this examiner with complaints of severe back pain while in the prone position with simple attempts to flex her knees while in this position.”

During an Office–directed second opinion examination of 03/14/2017 under claim number 060661746 Dr. Doman stated;

“This gentleman has traumatic findings of intentional symptom magnification with complaints of severe back pain with simple attempts to flex both his left and the right knee while in the prone position on a nonphysiologic and nonanatomic basis.”

Additionally, Dr. Doman indicated “Malingering” as a diagnosis in this report. Malingering is considered conscious and willful with intent, the deliberate and fraudulent feigning of symptoms for which a person can be prosecuted for fraud. This is a serious allegation which Dr. Doman indicated was a “Diagnosis”, yet Dr. Doman provides no explanation as to how he arrived at the intent of this claimant’s alleged malingering.

Insert information from your Dr. Doman report here

There are a limited number of Dr. Doman’s opinions available to me, however in eighteen (18) cases in front of the Employees Compensation Appeals Board, (ECAB or the Board) Dr. Doman stated various ways he believed claimants were falsifying their symptoms, using very similar terms and phrases in each of his reports;

Docket #
Issued
Dr. Doman’s report stated
99-1502
06/27/2000
Appellant displayed markedly inappropriate behavior that was psychogenic in nature.
03-2278
01/21/2004
“Subjective complaints of pain [did] not correspond with the objective findings.”
07-0102
10/02/2007
A self-limited disorder
08-2271
08/06/2009
Intentional symptom exaggeration. Diagnosis is that of a malingering patient. Purposely exaggerating her complaints, in the opinion of this examiner, for purposes of secondary gain.
09-1388
03/19/2010
Intentionally exaggerating her complaints for purposes of secondary gain. Stated appellant was malingering.
10-0455
09/15/2010
“Gross signs of intentional symptom magnification....” Stated appellant was malingering.
10-1197
02/14/2011
Subjective complaints outweighed the objective findings.
11-0690
10/13/2011
He opined that appellant was malingering.
11-0379
10/17/2011
Obvious signs of symptom exaggeration.
11-1840
04/09/2012
Symptom magnification.
12-0123
06/12/2012
Malingering based on his normal orthopedic examination findings.
12-0458
09/13/2012
“Obvious signs of symptom exaggeration. Grossly exaggerated and in fact suggestive of a patient who is malingering.” 
12-1128
12/14/2012
Malingering for purposes of secondary gain.
12-0167
05/17/2012
Subjective complaints of pain grossly outweighed the objective medical findings.
13-0159
05/14/2013
Subjective complaints grossly outweighed her objective findings.
15-0836
07/24/2015
Subjective complaints grossly exaggerated for purposes of deceiving him
16-0095
05/20/2016
Malingering on either conscious or unconscious basis. Obvious signs of intentional efforts to deceive the examiner. Pain is psychogenic in origin.
16-1084
10/21/2016
Obvious signs of symptom exaggeration.

In none of the above cases did the Board indicate that Dr. Doman provided pervasive evidence as to how he arrived at his opinions on symptom magnification, symptom exaggeration and/or malingering.

Symptom magnification and/or symptom exaggeration are a psychiatric diagnosis. Dr. Doman does not explain how, as an orthopedist, he is qualified to make such a psychiatric diagnosis.

In addition, Dr. Doman often states the claimant has behavior that is psychogenic in nature. This indicates that each of the claimant’s he examines has a psychological condition. Yet Dr. Doman provides no referral to a psychologist/psychiatrist and provides no credentials that would qualify him to make such a diagnosis. 

Dr. Doman consistently suggests symptom magnification, exaggeration and/or malingering when bending the knees while in a prone position, yet I could not find a single case where Dr. Doman explained how flexing the knees while the claimant was in a prone position could not cause pain in the spine or how this one test result evidenced the claimant was exaggerating, malingering or attempting to deceive him.

In point of fact, there is no evidence based examination technique to determine a patient is malingering; there is no physical examination maneuver that can determine a patient’s external incentives. Yet Dr. Doman consistently uses this same examination maneuver to determine claimants are deceiving him, exaggerating their symptoms, magnifying their symptoms or malingering and the Office has accepted these opinions as factual to the detriment of claimants.

Dr. Doman simply makes offending allegations of symptom magnification, intentional deception, symptom exaggeration and malingering without providing the Office the medical rationale that formed his conclusions. Nor does Dr. Doman provide how he measured these intentional fraudulent behaviors. 

The Office then accepts these offending allegations as fact and issues negative decisions based on Dr. Doman's unproven allegations.

Dr. Doman has a propensity to opine claimants falsify their symptoms, yet I could find no case where Dr. Doman provided a discussion of the objective evidence he relied on that forms his opinions.

In addition to my claim, I am providing the Office twenty three (23) cases as cited above wherein Dr. Doman indicated a claimant was exhibiting symptom exaggeration, symptom magnification, malingering or other unsubstantiated negative comments in his reports while providing no medical rationale, evidence or criteria in how he arrived at these opinions.

Dr. Doman consistently uses the same phrasing no matter the claimant’s examination, medical record, test results, etc…It is suspicious that Dr. Doman uses these similar terms and phrases on a regular basis. The consistency in which Dr. Doman uses these derogatory phrases can only lead one to believe Dr. Doman is biased against the claimants he examines for his own secondary gain.

In addition, I have learned that Dr. Doman acting as the Office second opinion examiner has been paired with Dr. Harold H. Alexander acting as the Office referee examiner on at least four (4) separate occasions (docket number 10-0878 issued 12/17/2010, docket number 11-0931 issued 11/09/2011 and docket number 13-0159 issued 05/14/2013, docket number 14-1676 issued 11/2014.

Dr. Doman acting as the second opinion examiner has been paired with Dr. Charles Thomas Hopkins, Jr. acting as the Office referee examiner on at least five (5) separate occasions (docket number 10-0455 issued 09/15/2010, docket number 10-0981 12/09/2010, docket number 10-2372 issued 09/30/2011, docket number 11-1205 issued 02/24/2012 and docket number 13-1650 issued 02/10/2014).

As referee physicians are to be chosen on a random basis, it is highly suspicious that Dr. Doman has been paired with the same referee physicians on multiple occasions.

FECA Circular 00-08 (2007) states in part;

"Credible, reliable medical evidence is vital to the claims process and it is particularly important that OWCP-directed medical examinations are not compromised in any way. Where a complaint is received concerning a physician and/or challenging a medical report, the claims examiner should, [g]enerally, address the complaint in the context of the specific FECA case. The CE should first evaluate the charge and supporting evidence to determine how to proceed.”

"If OWCP receives a written complaint concerning a physician's professional conduct (which includes allegations concerning veracity, discrimination or bias) before or following an OWCP-directed medical examination, and that complaint is supported by credible evidence of the type detailed in the procedure manual, the CE may ask the DO manager or district medical director to help develop the evidence."

Dr. Doman is a less than reputable physician which is used by the Office to receive a guaranteed negative result against the claimant. As his bias is obvious, the Office has a duty to immediately remove him. 


Respectfully submitted,


_____________________________
Insert your name
Insert your address

Sunday, April 30, 2017

Schedule Awards-Revisions to FECA Manual

There have been some new revisions to the FECA Manual part two at 2-0808 that may have a positive result for schedule awards.

The first change has to do with the District Medical Adviser, (DMA). In the past, when OWCP sent you to a second opinion about your schedule award and the DMA did not agree with the second opinion this created a conflict in medical opinion that resulted in being sent to a referee physician.

The new change indicates that the DMA cannot create a conflict in medical opinion with a second opinion physician because both the DMA and the second opinion work for OWCP. A conflict in medical opinion occurs when a doctor on your side disagrees with a doctor on OWCP's side. Since both the DMA and the second opinion are on OWCP's side, there cannot be a conflict.

Instead, the DMA must provide a medical report with medical rationale stating why they don't agree with the second opinion and the CE is to ask for a clarification report from the second opinion if the DMA does not agree with the impairment rating.

After receiving the clarification from the second opinion, the Claims Examiner, (CE) must then weigh the medical evidence to see if there is a conflict in medical opinion between your doctor's rating and one of OWCP's physicians. There can no longer be a conflict in medical opinion between two of OWCP's doctors.

The next change concerns the referee physician. In the past, OWCP would send the referee report to the DMA for review. The new change indicates that if the referee's report resolves the conflict and provides a thorough explanation of the impairment and cites the proper tables and charts, then the referee opinion is determined to be accurate and review by the DMA is no longer necessary.

The CE may send the referee report to the DMA but this is no longer automatic. Instead, the CE only has the DMA review a referee opinion if there is an issue with the referee's report.

Also, if there is an issue with the referee report, the CE should ask for clarification from the referee and not send it to the DMA to clarify. Only the doctor who wrote the report can clarify their own opinion.

The last change is a big one for some claimants. In the past, OWCP only allowed ratings only for accepted conditions even though this is not how the law is written.

The new change indicates that OWCP MUST follow the law and impairment ratings should include both work-related and non-work-related conditions to the same covered body part (arm, leg, etc).

For instance let's say that OWCP has accepted a specific condition in your shoulder and OWCP approved surgery on the shoulder but that same shoulder has pre-existing arthritis that is not accepted.

In the past OWCP would only accept ratings that included the impairment due to the accepted conditions and not the pre-existing arthritis. Now OWCP has to accept the impairment rating that includes the pre-existing arthritis even though it isn't accepted by OWCP.

Or say you have a left knee condition that is not work-related but you also have an accepted left ankle condition and both of these conditions affect your left leg and cause an impairment. OWCP must accept the impairment to the left knee which is not accepted as well as the left ankle which is accepted.

Or say that OWCP did not accept all the conditions to a body part when the claim was accepted. The conditions OWCP did not accept must now be included in the impairment rating if they result in a loss of use.

In other words, OWCP has to accept the Total loss of the covered body part at the time of the rating and OWCP can no longer 'portion' out your rating, they must accept and pay for a rating that includes ALL conditions that affect the covered body part whether the conditions are accepted or not.

This could result in higher impairment ratings for people who have conditions to the same body part that are not accepted by OWCP or that pre-existed the work-related injuries.

The FECA Manual part two at 2-0808-5(d) has been changed to read:

"Rated impairment should reflect the total loss as evaluated for the scheduled member (i.e. arm, leg, etc.) at the time of the rating examination. See Raymond E. Gwynn, 35 ECAB 247, 253 (1983). There are no provisions for apportionment under the FECA. As such, schedule awards include permanent impairment resulting from conditions accepted by the OWCP as job-related as well as and any non-industrial permanent impairment present in the same scheduled member at the time of the rating examination.

As long as the work-related injury has affected any residual usefulness, in whole or in part, of a scheduled member, a schedule award may be appropriate. Similarly, an increase in schedule award may be appropriate as long as a material change in the work-related injury is at least in part contributory to an increase in impairment of the scheduled member.


For example, if an aggravation of left hip osteoarthritis is accepted as work-related but the claimant also suffers from non-industrial left knee osteoarthritis, both of which have resulted in permanent impairment, an  assessment of impairment should reflect the total loss of the left leg, to include both the industrial and non- industrial injuries."

Hopefully this will force OWCP to follow regulations. 

These changes should mean a faster turnaround time for schedule awards because less time is wasted on the DMA and there cannot be a conflict in medical opinion between the DMA and one of OWCP's physicians. 

It should also result in higher impairment ratings for some claimants because OWCP has to accept impairment ratings that include all conditions that impair the covered body part.

Link to FECA Manual: https://www.dol.gov/owcp/dfec/regs/compliance/DFECfolio/FECA-PT2/group2.htm#20808