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

Wednesday, September 16, 2015

Tuesday, September 1, 2015

Lenin "Lenny" Perez

It never seems to end...

As if being harassed by OWCP or the agency you worked for, as if being hurt on the job or having to constantly prove your injuries wasn’t enough to deal with, now the people who claim to be on your side to help you are also taking advantage.

It’s no secret how I feel about attorneys and representatives who advertise their willingness to help claimants, but actually don't. Sure, there are some good ones out there, but more and more I’m hearing about how these same people are abusing claimants too.

It’s becoming common for attorneys and representatives to charge a claimant a percentage of their schedule award, even though OWCP does not allow that. They get away with it because claimants don’t know it’s not allowed.

This bothers me. First because it’s the claimant that was hurt, it’s the claimant that has a permanent impairment they have to live with and it’s the claimant that’s entitled to their schedule award money. For an attorney or representative to take a chunk of that just seems wrong to me.

Second, schedule awards aren’t that hard. The doctor does the impairment rating, so an attorney or representative doesn’t have to do any work there-the doctor does. The CA-7 is easy enough to complete. For a schedule award, the CA-7 is just a couple of sections. The attorney or representative isn’t working hard on that either. If they complete it for a claimant, it shouldn’t take more than 10 minutes of their day.

OWCP could deny the schedule award and the attorney or representative may have to appeal. Yes, this would make them have to work. But other claimant’s without schedule awards require appeals too, do the attorneys and representatives charge tens of thousands of dollars for those appeals? No. If they did, they’d be out of business.

So what justifies taking a percentage from 10%-30% of a claimant’s schedule award that can end up to be tens of thousands of dollars in the attorney’s or representative’s pocket for the same appeal? Why should a claimant with a schedule award have to pay so much more?

If you’re reading this, please understand that there are other attorneys, representatives and advocates that can help you without taking a percentage of your schedule award.

Which brings me to Lenin "Lenny" Perez. Mr. Perez and his company claim they are advocates for injured employees. Which would lead a person to believe they’re on the injured worker’s side. It’s true they charge a reasonable monthly fee, but they also take a percentage (10%) of a claimant’s schedule award.

In addition, Mr. Perez has now been arrested for a SECOND time for allegedly taking 15%-20% kickbacks for his referrals of injured workers to specific doctors/clinics. This time it’s being reported that Mr. Perez made more than $250,000.00 from these kickbacks.

Their website claims Mr. Perez is the leading consultant/advocate in the field. You’d think the leading consultant/advocate would at least know what is and isn’t legal especially when he was arrested for the same thing, plead guilty in 2006 and did jail time.

You’d think the leading consultant/advocate would know OWCP doesn’t allow him or his firm to take a percentage of a claimant’s schedule award.

You'd think the leading consultant/advocate would have a better win record.

You'd think the leading consultant/advocate wouldn't risk tarnishing claimants by association.

Sometimes a claimant needs help with their claim. If you do, my advice is to make sure the person you hire is not only on YOUR side but conducts their business in an ethical way. To know that they will fight for you and not just cash your checks.

And anyone who wants a percentage of your schedule award is outside the regulations of OWCP. If they’re willing to go outside the regulations on your schedule award, what else might they do that isn’t in your best interest?

From the Tampa Tribune:

Appeal of Mr. Perez’ first sentence:

Jesse can be reached at: owcpslayer@gmail.com