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Wednesday, May 25, 2016

Field Nurse-Is Yours Legit?

As if there wasn’t enough to contend with, a new issue for claimants has come to my attention and it's getting more widespread. It is important that this information gets to ANY claimant who finds themselves with a nurse on their claim.

Agencies are assigning nurses to OWCP claims and in some cases, these nurses are misrepresenting to a claimant and/or their providers that they were assigned by OWCP or that they are contracted by OWCP.

In some cases, the agency nurses are misrepresenting that even though employed by the agency, they have the right to access your medical records and get involved with your providers because you were injured at work.

THIS IS NOT TRUE

In some cases, the agency and/or its nurses are preventing an injured worker from seeing a qualified physician by recommending a physician or telling the injured worker they have to see a particular physician. You do NOT have to have an agency-recommended physician as your treating physician.

In some cases, the agency and/or their nurses are directing claimants away from certain physicians, saying the physician is under investigation when they are not. This is currently most widespread in Arizona.

I’ve said it before and I’ll say it again, DO NOT believe your agency without proof what they’re saying is true. It’s hard enough to find a physician that will take an OWCP patient, now the agencies are trying to eliminate physicians, especially the good ones, that do accept OWCP claimants by telling lies about the physicians to scare claimants away.

For injured Border Patrol employees, there is at least one agency nurse in Arizona that is currently not licensed in the state of Arizona and is inappropriately inserting herself into claims as if she has a legitimate right.

In some cases, the agency and/or their nurses are inappropriately obtaining your medical records from your medical providers. When you’re injured, your agency does not receive or manage your medical records…OWCP does.

In some cases, the agency and/or their nurses are contacting your providers in person or by telephone. The agency and/or their nurse CANNOT contact your medical providers in person or by telephone.

However, your agency can contact your providers in writing. If any agency is contacting a provider, it MUST be in writing and a copy of the letter must be provided to both you and OWCP at the same time it’s sent to your provider. The agency can ask your provider about work limitations and possible job assignments.

If the agency writes your provider and the provider is going to respond, they should respond to OWCP. The doctor has no obligation to respond to the agency. Your agency is not involved in the decisions of your claim. Your agency doesn't review or weigh medical evidence. Your agency does not manage any part of your claim. Your obligation is to OWCP not your agency.

Your obligation to your agency is to notify them when you have been released to work and to provide any physical restrictions through a completed CA-17. 

If the agency needs information, they can contact OWCP and if they are legally entitled to the information, OWCP will give it to them. 

If your agency contacts you for medical reports, you should send the reports to OWCP and NOT the agency, but you can and should provide the agency a current CA-17.

The agencies and/or their nurses are inserting themselves into claims and asking providers for information such as billing codes. Legitimate OWCP Field Nurses don’t need to ask for billing codes. Since all your bills go through OWCP, they can easily find out what’s being billed. They don’t need ask your providers for billing codes.

Your agency and/or their nurses CANNOT attend medical appointments, CANNOT participate in your treatment, CANNOT make treatment recommendations, CANNOT schedule appointments and CANNOT discuss your claim or your injuries with your medical providers.

Because of these new agency tactics, ANY nurse assigned to your claim should be properly identified as an OWCP Field Nurse. 

When OWCP assigns a Field Nurse to your claim, you will be notified in writing. If you did not receive a letter from OWCP assigning a Field Nurse to your claim, there is a chance the nurse contacting you is not assigned by OWCP but is an agency nurse.

ALL claimants should ask their Field Nurse for the letter OWCP sent them and identification to confirm they are in fact the OWCP Field Nurse assigned and not an imposter sent by the agency to wrongfully obtain your medical information and documents.

Once you know the nurse's name, you should also confirm the nurse has a current and valid license in your state.

If an agency nurse inserts themselves into your claim, I suggest you contact OWCP in writing and let them know the agency is acting outside its bounds of the Act.  A copy should also be sent to your agency and the agency should be told to remove their nurse from your claim immediately. That the nurse is not to contact you or any of your providers again. And most important, your providers need to be notified in writing that the agency nurse has no legal right to any information involving your claim.

If an agency nurse is or has been assigned to your case and improperly obtained medical information, you can also file a complaint with your state’s nursing board for improperly inserting themselves into your claim and/or directing the course of medical treatment, possible Privacy Act and/or HIPAA violations and violating 20 CFR §10.506. You can also talk to your union about filing a grievance.

You do NOT have to interact in any way with an agency nurse or an OWCP Field Nurse for that matter. 

It is not in your best interest to allow your agency access to your medical records or your providers. They are not entitled to the information and if the agency requires information regarding your claim, they should be told to contact OWCP. 

A CA-17 indicating your physical restrictions is all the medical documentation your agency should require. If they need anything else, the agency should be told to contact OWCP. 

Your agency has NO authority to insert themselves into your claim. If the agency requires information about your claim, they should be told to contact OWCP. If the agency is legally entitled to the information, OWCP will provide it to the agency.

If I haven't said it enough: The agency should contact OWCP if they need information about your claim. 

Also something to remember, Field Nurses are Voluntary. Even if you’re assigned a Field Nurse by OWCP, you do not have to allow them access to you, your home, your providers or your medical records.

Claimants unfortunately have to protect themselves and the best way to do that is by knowing your rights. You are NOT required to cooperate with an agency nurse in any way, shape or form and if one has inserted themselves into your claim, you should immediately put a stop to it.

Policy and Law:

From the FECA Field Nurse Handbook Part Three:

6. EA (employing agency) Nurses: Several EAs have developed their own nurse intervention programs. Whereas the concept of early intervention is in keeping with current case management techniques, the activities of these EA nurse programs should be coordinated with the OWCP adjudicatory and case management activities.

a.      Specific guidelines established for EA Nurses and EA Nursing Programs include:

(1)  The IW's (injured worker's) participation in an EA nurse intervention program is voluntary;

(2)  An EA nurse intervention program is limited in its scope and authority, and has no jurisdiction over issues under the purview of OWCP;

(3) OWCP FN (Field Nurse) intervention activities/actions supersede the EA actions and the EA nurse should suspend any independent actions during the course of OWCP nurse intervention; and

(4) OWCP officially recognizes only one EA point of contact responsible for coordinating compensation and RTW (Return to Work) efforts (e.g. the EA ICS (injury compensation specialist) or EA duty station supervisor).

b.     Communicating with EA Nurses. As noted above in 6a(4), the FN should only be communicating directly with the identified EA point of contact. The EA nurse is not recognized as a point of contact for case-related communications, however, the EA nurse can act as an EA resource during RTW conferences. The EA nurse may assist the EA and FN with issues related specifically to the RTW effort and identification of light duty work (as well as identification of any barriers the IW may encounter upon RTW). The FN may recommend to the EA point of contact that the EA nurse be made available to participate in RTW discussions and work site evaluations; however, such RTW discussions and work site evaluations should not be delayed in order to accommodate the EA nurse's schedule.


The agency may monitor the employee's medical care through requests to the employee, or his or her physician, within certain guidelines contained in the FECA's regulations, specifically 20 CFR §10.506. This section says:

"The employer may monitor the employee's medical progress and duty status by obtaining periodic medical reports. Form CA-17 is usually adequate for this purpose. To aid in returning an injured employee to suitable employment, the employer may also contact the employee's physician in writing concerning the work limitations imposed by the effects of the injury and possible job assignments. (However, the employer shall not contact the physician by telephone or through personal visit.) When such contact is made, the employer shall send a copy of any such correspondence to OWCP and the employee, as well as a copy of the physician's response when received. The employer may also contact the employee at reasonable intervals to request periodic medical reports addressing his or her ability to return to work."


The Border Patrol's union has noticed the problem and have written this article:


Related article on OWCP’s Field Nurse program: http://theowcpclassroom.blogspot.com/2011/03/field-nurse.html




owcpslayer@gmail.com

Monday, May 23, 2016

Lenin "Lenny" Perez and AmeriMed Diagnostic Services-Update

See original article at: 
http://theowcpclassroom.blogspot.com/2015/09/lenin-lenny-perez.html 


03/31/2016 Lenin "Lenny" Perez whose company claimed they were advocates for injured federal employees pleaded guilty to conspiracy and receiving illegal remuneration (kickbacks), charges which each carry up to five years in federal prison. 

The amount of the kickbacks exceeded $1,000,000.00 with approximately $250,000.00 paid to his daughter.


Mr. Perez' daughter, Liane Perez-Rodriguez pleaded guilty to making a false statement and faces up to five years in federal prison. By pleading guilty, Ms. Perez-Rodriguez admitted lying to investigators.


Ms. Perez-Rodriguez had a "no-show" job at AmeriMed Diagnostic Services in Florida which according to documents, was created to funnel AmeriMed clinic money to her father, Mr. Perez. 


Ironically, Ms. Perez-Rodriguez's real job was as a legal secretary in the Public Defender's office. 


Lois Luis who helped run AmeriMed also pleaded guilty to conspiracy and receiving illegal remuneration (kickbacks) and also faces up to five years in federal prison for each charge. 


Mary K. Manso, chief executive officer at AmeriMed pleaded guilty to obstructing a health care investigation and also faces up to five years in federal prison. According to her plea agreement, Ms. Manso lied to federal investigators about kickbacks at AmeriMed and helped AmeriMed launder $2,500,000.00 obtained through fraudulent billing practices. 


Department of Justice news release:https://www.justice.gov/usao-mdfl/pr/federal-workers-compensation-kickback-conspirators-plead-guilty-0



owcpslayer@gmail.com



Friday, May 20, 2016

OWCP Second Opinions and Their Test Results

Often when you're sent to an OWCP-directed second opinion examination, the physician will take X-Rays as part of that examination.

Normally, when you have diagnostic tests performed, they are performed by providers or facilities that are not involved in your claim and only provide a report of the results of the test. In other words, an unbiased third party.

The second opinion will include in the report their interpretation of what the X-Rays they performed indicate. Often, OWCP's physicians report that the X-Rays they took on the date of your examination show no or minimal abnormalities.

As we all know, OWCP's physicians do not always report their findings accurately and often the findings of the second opinion's X-Rays differ from every other test result you've had.

If the second opinion reports that the X-Rays show no or minimal abnormalities or their findings differ from other test results, such as an MRI, you should request from OWCP the actual X-Ray films the second opinion performed so that your physician or an independent radiologist can look at the films and determine if they see anything that differs from the second opinion.

If OWCP will not provide those actual films, you can argue that without the actual films, OWCP is taking only their physician's opinion of what those test results indicate which may or may not be accurate.

You can argue that OWCP's physician has access to medical evidence that OWCP is refusing to provide to your physician, which appears biased in this "non-adversarial" system.

You can argue that if OWCP will not provide your physician the actual films, the findings by their physician cannot be used as no one but their second opinion has seen the films and reported on them.

You can argue that your physician cannot provide a rebuttal to test results they've never seen.

You can argue that it is reasonable that your physician be provided the actual films that helped form their physician's opinion.

As your physician should provide a rebuttal to a negative second opinion, that rebuttal cannot be complete without seeing the actual films OWCP's second opinion reported on and confirming that the test results were in fact, accurately reported.

If OWCP does provide the films and your physician notices more than what the second opinion reported, your physician should include those differences in their report.

This is another way claimants can help themselves fight negative second opinions.





owcpslayer@gmail.com






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:



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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.





owcpslayer@gmail.com






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). 






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