(Chats 4-17-19) - The Woodshed: Filing Claims Without Fear

1. Why Claims Get Denied: The Doctor ProblemChris identifies six categories of medical professionals who frequently (and often unintentionally) cause federal claims to be denied because they lack OWCP-specific training:Family Practice Doctors: Don't understand the complex narrative requirements.Chiropractors (Non-Specialized): Often miss the medical connection needed by DOL.Urgent Care Centers: Frequently use Nurse Practitioners; DOL requires an MD signature for forms to be valid.Specialists (Surgeons): Focused on surgery, not the administrative "medical rationale" required for claim acceptance.ER Doctors: Too busy for the multi-page narrative reports needed.VA Doctors: Excellent clinicians, but not trained in the specific "Fed Comp" system.2. The CA-10: Your Legal RoadmapThe CA-10 is the official instruction manual for what a federal employee should do when injured.The Legend of the Bulletin Board: By law, this form must be posted on the employee bulletin board, yet almost no one sees it.Immediate Action: You must report injuries immediately to secure benefits like COP (Continuation of Pay).3. The "Shall" Rule: CA-16 and Initial ChoiceChris highlights two powerful laws found in the Code of Federal Regulations (CFR):CA-16 (Authorization for Examination): If you have a traumatic injury (CA-1), management shall issue this form within 4 hours. It pays medical bills for 60 days even if the claim is eventually denied.Initial Choice of Physician: You have the legal right to choose your doctor. Management cannot force you to see "their" doctor or a contract facility like Concentra.4. Five Ways to Fight Back Against ManagementIf management "wrongfully impedes" a claim (which is a federal crime), Chris provides a five-point checklist for protection:File a Grievance: Build a "mountain of grievances" to force agency compliance.Contact EAP: Use Employee Assistance to mediate or document the stress of the situation.File an EEO: If you are being targeted or harassed, call an EEO expert to see if you have a claim.Call OSHA (1-800-321-OSHA): Employees have a right to report injuries. If a supervisor prevents you from filing or orders you into a dangerous situation, it is a safety violation.NLRB (National Labor Relations Board): File a complaint regarding labor board violations.Important StatisticsChris highlights the disparity between workers' perceived injury rates and official acceptance rates:The 1-out-of-19 Stat: In 2018, only 1 out of every 19 federal employees had an accepted claim (roughly 5.2%).Social Security Administration: Acceptance rates were as low as 1 out of 50.Perceived vs. Actual: While employees estimate that 50% to 90% of their coworkers have work-related conditions, the lack of training leads to an "underwhelming" number of attempted and accepted claims.Website for Locations. www.federalinjurycenters.comContact: 877-787-OWCP or message us FacebookTo Buy The Book: www.breakingowcp.comTo Email information: [email protected] Us on Facebook, YouTube, LinkedIn, Instagram @Wednesday Night OWCP Chats with Chris & Gini