As you know, navigating the OWCP maze is a challenge. You and your patients may have discovered that there are not many lawyers who accept cases involving injured federal workers.
You may have wondered why there are so few lawyers who represent injured workers? In a state workers’ compensation case, the lawyer takes a percentage of the recovery for the injured worker. That’s how they get paid and it is called a contingency fee. Contingency fees are expressly prohibited under federal law. Because of this, federal workers’ compensation lawyers, like ourselves, must charge an hourly rate for our time. Furthermore, federal workers’ compensation lawyers must charge a retainer before representing a client. Because of the prohibition of contingency fees and the requirement of a retainer, there are not many lawyers who handle these cases.
You may also be wondering how a lawyer in Chicago can represent your patient? Our federal workers’ compensation practice is national in scope. All proceedings before the OWCP are done electronically and telephonically. Because of this, we are able to help clients all over the country. We upload our legal papers directly to the OWCP and conference call our clients for all hearings. We communicate with our clients by telephone and e-mail. It works very effectively.
If working conditions in any way cause or contribute to an injury or medical condition, there is compensation coverage. The working condition need not be the only cause nor even the predominate cause. But, the medical records must clearly state the exact working condition and the exact mechanism which caused or contributed to the medical condition.
If there is an aggravation of a pre-existing injury by the job to any degree, there is workers= compensation coverage. A pre-existing condition or a condition which makes a worker more susceptible to injury does not disqualify the worker from workers’ compensation coverage. The question is whether the aggravation is temporary or permanent. (See below).
An acceleration is a documented physiological process by which an occupational act, or series of acts, can be shown to have increased the expected speed of progression in a pre-existing condition documented to be progressive in nature. A medical record must address each of these factors in detail for there to be workers’ compensation coverage. (See below).
To have medical treatment approved by OWCP, there must be adequate medical documentation. OWCP considers a medical record adequate when it address a number of factors deemed important for determining eligibility for workers’ compensation.
A report must describe in detail the employment incident or circumstance that resulted in the injury, whether traumatic or occupational. Generalizations such as, ”hurt at work” are inadequate.
A report must provide a firm diagnosis of the injury: a herniated C5-C6 disc, a torn knee ligament, asthma, etc.
A report must offer an opinion on the causal relationship between the injury and the disability or need for medical treatment. Although not necessary for medical treatment, a medical record must clearly indicate the doctor’s opinion as to the relationship between the injury and the medical treatment in order to be approved by OWCP.
A report’s opinions and conclusions on a causal relationship must be supported with reasoned analysis and objective findings. Once again, not typically included in a doctor’s medical records, but for treatment to be approved by OWCP, a doctor must justify his or her opinions in the medical records.
A doctor must conclude that his or her opinions are on a “more probable than not” basis. A more probable than not basis is over 50%. This is a legal standard, not a medical standard. A doctor does not need to know definitively that a medical condition was related to work, just that it is more likely than not the result of a work related injury or condition.
A doctor’s opinion should never be equivocal. He or she should not use terms such as appears or might be or likely. These words do not meet the more probable than not basis and will likely result in a denial for your patient. Stick to the magic words, “it is my opinion that it is more probable than not that the (describe medical condition) was caused/aggravated/accelerated by the (describe work injury).”
There are several types of causes of medical conditions which can be covered under federal workers’ compensation coverage.
This type of relationship is demonstrated when the injury or factors of employment, through a natural and unbroken sequence, result in the condition claimed. This is the simplest causation and usually results from one, single traumatic event.
This kind of relationship occurs if a pre-existing condition worsens, either temporarily or permanently, by an injury arising in the course of employment. A new trauma or employment related injury may aggravate a pre-existing degenerative process, and coverage by OWCP would last for the duration of the aggravation as medically determined. A temporary aggravation involves a limited period of medical treatment and/or disability, after which the employee returns to his previous physical or mental status. Compensation from OWCP is payable only for the period of aggravation established by the weight of medical evidence and not for any disability caused by the underlying disease. This is true even if the patient cannot return to the job held at the time of the injury because the pre-existing condition may worsen if he does return. A permanent aggravation occurs when a condition will persist indefinitely due to the effects of employment related injury or when a condition is materially worsened such that it will not revert to its previous level of severity.
An employment related injury or disease may hasten the development of an underlying condition, and acceleration is said to occur when the ordinary course of the disease does not account for the speed with which a condition develops. Precipitation A latent condition that would not have manifested itself but for the employment is said to have been precipitated by the factors of employment.
Source: OWCP Publication
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