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Wednesday, March 23, 2011

Narrative Reports; Your Physician

At some point during your OWCP claims process, you're going to need a narrative medical report from your physician. Your claim won't be accepted without a proper narrative.  Physician's who don't regularly write reports for OWCP have little or no idea what OWCP requires in a narrative report. Today, we're going to learn about the requirements of a proper narrative report.

A detailed narrative report is time consuming for your physician. You should make your physician aware that s/he can charge more for the detailed narrative due to the extensive nature of the report.

Everything that goes to OWCP must have Your Name, Claim Number(s) and Date(s) of Injury, including anything submitted from your physician. You will need to supply your physician with this information so it can be included in their report.

The FECA Manual part 2 at 2-812-6(a) Content of Medical Reports states:
"Regardless of whether the CE contacts the physician or the claimant, the medical report should include:
(1) The date of most recent examination.
(2) Results of recent objective testing.
(3) Physical examination findings.
(4) The diagnosis of any conditions present.
(5) A well reasoned medical opinion supported by the physical findings and objective testing as to whether the current condition(s) is related to the employment.
(6) The claimants work restrictions, including a completed Form OWCP-5 if applicable.
(7) The type and frequency of medical treatment being provided or recommended."
You can find part 2 of the FECA on the "Links" page.

Let's take these requirements one by one:

(1) The date of most recent examination.

This is self-explanatory, it's the most recent date your doctor examined you;
(2) Results of recent objective testing.
This includes MRI-s, X-Rays, EMG's, EKG's, EEG's, Blood tests, etc... In other words, any diagnostic test that confirms your diagnosis. Objective testing is any test you can't fake. Your doctor also needs to state what abnormal findings came from the results of your test. For example, your MRI shows a herniated disc at C4-5, your X-Ray showed your Right thumb was broken in two places, one break being a compound fracture. 
Your physician should be specific about the test results. If the test results show multiple issues, your physician can state that the test showed multiple abnormalities and s/he has attached a copy of the test results with his/her report. If your physician is going to attach the test results (and s/he should) it must be mentioned in your physician's report that a copy is attached.
If the test results confirm the reason the physician sent you for the test, this should also be stated. For example, The abnormal results of the 00/00/0000 MRI of the Right knee confirm the diagnosis of Lateral Meniscus tear and ACL tear of the Right knee.
If it applies to your condition(s), your physician should be specific about the LEFT, RIGHT or BILATERAL body part EVERY time that body part is mentioned in their reports.
If you've had multiple tests, you can make it easier and help your physician by listing the dates and facilities you had your test(s) and provide a copy of the test results for easy reference or to attach to your report. You should list them in dated order beginning with the most recent test results;
(3) Physical examination findings.

This is Range of Motion, (ROM), Reflexes, Grip/Pinch strength, Straight Leg Raises, Gait derangement, Palpitations, Limb length discrepancy, Swelling, Bruising, Muscle Atrophy, etc...The type of tests your physician performs depends on the type of physician you're seeing and your specific condition(s).
Your physician should list out his/her findings in specific detail. For example, if the test is negative or positive. If the physician finds spasms, tenderness, firmness, weakness, etc...these results should be listed. If measurements are taken, the measurement results.
Any test performed on your upper (arms) or lower (legs) extremities, ears or eyes should be identified by either Right, Left or Bilateral. If Range of Motion is diminished, your physician should list those findings as specifically as possible;
(4) The diagnosis of any conditions present.

The diagnosis must also include the corresponding ICD-10 code. Your physician will be very familiar with ICD-10 codes. The ICD-10 code is the medical diagnosis code (a number)that identifies your medical condition. 
Once your claim is accepted by OWCP, your accepted condition(s) will be identified by ICD-10 codes. You can locate your OWCP accepted ICD-10 codes on the ACS site. Once you log in, click on CQS (Customer Query System) on the left side of the screen. Enter your claim number when the CQS screen comes up. Your accepted conditions will be listed in the upper right hand corner of the page. You can find the ACS and ICD-10 web sites on the "Links" page;
(5) A well reasoned medical opinion supported by physical findings and objective testing as to whether the current condition(s) is related to the employment.

A well reasoned medical opinion is the most important part of your medical narrative, especially if your claim has not yet been accepted. Your physician must state how s/he came to his/her medical opinion regarding your medical conditions. You physician must be as specific as possible. This part of your report is crucial and I've included more information about it later in this post;
(6) The claimant's work restrictions, including a completed Form OWCP-5 if applicable.
OWCP sends every second opinion or IME physician a Form OWCP-5, but very rarely sends your physician an OWCP-5 to complete. However, there is no 'rule' that says your physician cannot complete an OWCP-5. You can print out an OWCP-5 and bring it with you for your physician to complete and attach to his/her report. If your physician is attaching an OWCP-5 to his/her report, s/he should state it in the report. For example, your physician should state, they've attached a completed OWCP-5 which indicates your physical restrictions.
An OWCP-5 lists your physical restrictions and are by type of condition. For example, an OWCP-5c is for musculoskeletal conditions, an OWCP-5a is for emotional/mental conditions. So, make sure you print out the proper form for your condition(s). You can find OWCP-5 forms under Forms on the "Links" page.
(7) The type and frequency of the medical treatment being provided or recommended.
Treatment being provided is any treatment you've already received or are receiving, such as Physical Therapy, Medications, Braces, Nerve Blocks or other Injections, etc...
Your physician should not only list the treatment(s), but also the details of the treatment. For instance, the name of the physical therapy facility and the frequency you attend and why you're attending. For example, Ms. Doe attending physical therapy at XYZ Physical Therapy twice per week beginning 00/00/0000 to maintain range of motion in the Left shoulder. 
If you're receiving medication, your physician should list every medication by name, the dosage, frequency and why it's prescribed. For example, Mr. Doe is prescribed Diazepam 5mg 3 times per day for pain and spasms. If there were outpatient procedures, your physician should state the name of the facility which performed the procedure, what the procedure was and the results of the procedure. If there is a report of the out patient procedure, a copy should be provided to your physician.
If you've had multiple treatments, you can help your physician by providing them with a list of the treatment you've received to date to make it easy to incorporate into their report. A copy of the report should also be attached to your physician's report and again, your physician must state a copy is attached.
If your physician is recommending treatment, then s/he should state not just what treatment you require, but the name of the facility in which it will be performed (if known), how often s/he recommends the treatment and why the physician believes the treatment may help you. For example, Mr. Doe requires physical therapy at XYZ Physical Therapy 3 times per week to maintain range of motion in the Left knee.
A well reasoned medical opinion is crucial to your narrative report. What the above section of the FECA Manual doesn't state is that your physician needs to state what Agency you work for, what your start date was, what position you held on the date of your injury and the physical requirements of your job. You should provide a description of the physical requirements of your job so your physician can refer to it in his/her report. Your physician should attach a copy of the job description and needs to state s/he is attaching a copy of the job description.

You should bring your physician a copy of your job description. If you don't have an official job description, your Agency may be able to provide one to you. If not, you can get your official job description and physical requirements from O*NET the link for O*NET is on the "Links" page.

If you filed a traumatic injury claim, your physician must be specific how you were injured. S/he must state you were in performance of your regularly or specially assigned duties and what Agency you were working for when the injury occurred. For example, On 00/00/0000 Ms. Doe was in performance of her regularly assigned duties as a clerk with the U.S. Postal Service during an 8 hour shift while having no medical problems when she fell off a ladder onto a concrete floor. Ms. Doe fell approximately 4 feet landing on her Right side, breaking her Right femur, shattering her Right knee cap and bruising her Right shoulder. The 4 foot fall and resulting impact of landing on the concrete floor is what caused the Right femur to break, shattered the Right knee cap and bruised the Right shoulder. Prior to the 4 foot fall off the ladder, Ms. Doe's Right femur, Right knee cap and Right shoulder were not injured, broken or fractured and she was not seeking medical treatment or taking any medication for any of these conditions. It is reasonable the 4 foot fall off the ladder landing on the concrete floor is what caused the diagnosed injuries to Ms. Doe's Right femur, Right knee cap and Right shoulder.

Your physician cannot be too specific in narrative reports to OWCP.

It seems obvious to all of us that falling 4 feet off a ladder will injure you, but if your physician isn't extremely specific about who you were working for and exactly how your injuries occurred, OWCP will more than likely reject the report and your claim forcing you to go back to your physician to try again.

If you've filed an occupational injury claim (CA-2), then your doctor needs to specifically state how the injury occurred. For example, your job requires you to repetitiously use the injured body part throughout the day and you've been performing the job tasks for 15 years. The 15 years of repetitively using the specific body part contributed to the acceleration of a degenerative condition. Just as with a traumatic injury, your physician must be specific how the injury was worsened by your employment.

When your physician writes a medical narrative for OWCP it's about the WHO, WHAT, WHEN, WHERE, WHY and HOW in specific detail. Your physician must report with certainty. OWCP will reject any reports stating your condition(s) "Might be" "Could be" "Maybe" related to your employment. Your doctor can use terms such as "More probable than not" "More likely than not" "With a reasonable medical certainty" "It's reasonable to conclude", etc...

Your physician should sign and date the report. OWCP will not give any weight to a report that is not signed by a physician. A physician's assistant is not a doctor under the Act and will be given no weight whatsoever no matter how detailed the report is.

Once you have a narrative report from your physician, you should send a copy of the report, test results, job description, any forms such as a completed and signed OWCP-5 with a letter to your CE. I recommend you send this delivery confirmation, certified mail or other trackable delivery system so that you have proof OWCP received the report and the documents that go with it. Your letter should state each item you're sending and the date of the item. This way you can be sure OWCP received the narrative and all the documents that were attached to the report.

15 comments:

  1. so should a referee doctors report also have to include the claim #? all medications you are taking? what agency you worked for? all icd codes you are being treated and have been treated for? if you are left or right handed?

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  2. Yes. This information should be in the Statement of Accepted Facts, (SOAF) which goes to the physician.

    The Agency part is crucial since this is where and how you were injured. The report should contain a job description and how the injuries occurred in relation to the job.

    The ICD-9 codes/conditions that are accepted should be listed so that the physician makes it clear they understand the conditions. If there are any concurrent conditions, then those should be listed as well.

    They may not use the ICD-9 codes, but the conditions should be listed.

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  3. Does it have to be the doctor that put me on light duty. Can it be a doctor in the same clinic? Am I allowed to have more than one physician?

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  5. No it does not have to be the same physician. You can have a need for multiple physicians. You may require a neurologist, an orthopedist, etc...depending on your medical conditions. Any physician can write a medical report for your claim.

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  6. I am waiting for a reconsideration on my owcp claim and don't think my doctor understands how my medical reports need to be written. he as wrote MRI of the right knee was finally obtaine. this d which revealed a torn medial meniscus. He continued to have pain in the right knee with tenderness to the medial and posterior medial joint line. This is flet to be related to the injury which place at work at the post office on February 3 2014. at this time he had a twisting injury to his knee, findings consistent with internal derangement, exam consistent with meniscus tear and MRI finding were also consistent with torn medial meniscus of the right knee. again the accident February 3 caused the injury to his right knee which again as he worked continued to bother him. HELP WHAT IS MISSING TO HAVE MY CLAIM ACCEPTED.? THANKS

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  7. Contact me at jesseslade@frontier.com if you want to discuss. Or you can post questions at http://theowcpclassroom.freeforums.org

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  8. Who pays for the narrative

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  9. OWCP pays for the narrative reports your doctor submits.

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  10. Miss Slade,
    As a Union representative who assists our local's dues-paying members with their WC claims, I have never found it to be the case that OWCP pays for a claimant's PCP to provide a narrative report, nor have I heard of OWCP reimbursing a claimant who has paid their PCP to provide a narrative report out of their own pocket. DOL/OWCP does, however, pay their SecOp and Referee physicians to perform independent exams and supply OWCP with narrative reports.

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  11. Katy: OWCP pays for any report a claimant's physician provides just like they pay for a secop of referee report.

    OWCP will also pay for the report of a physician hired by the claimant to provide an impairment rating.

    Often when OWCP requests a report from a claimant's physician, the letter the doctor receives will state OWCP will pay for the report.

    The difference is OWCP pays their own secop's and referee's a lot more money.

    A report that comes with an examination is payable by OWCP.

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  12. Is there a company that will review the medical narrative before submitting to OWCP?

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  13. Contact me at owcpslayer@gmail.com and I'll look at your medical narrative.

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  14. Jesse. I think I'm going to need help. I am picking up my doctors narrative tomorrow to express mail to Kentucky and I'm not sure what will happen with it all. Are you still around to help me if I need it?

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