(Chats 5-1-19) Secrets of the Claims Examiner: Expert Strategies for Approval

Chris and Gini discuss the internal "reprogramming" of their new expert staff to help listeners understand what CEs look for in a narrative. The episode covers the "Five Pillars of a Narrative Report," the rules for travel reimbursement, and a checklist for protecting your job using the CA-17 instead of FMLA.Key Takeaways & Show Notes1. The Five Pillars of a Winning Narrative ReportChris explains that because every injury is unique, there is no "template," but every successful report must include:Detailed Job Description: Beyond just a job title; it must list physical demands (e.g., "walking 10 miles," "lifting 70 lbs").Detailed Injury Description: A step-by-step account of the incident (e.g., "stepped into a hole while exiting the LLV").Direct Link (Causation): A clear explanation of how the specific job duties caused the specific medical condition.Medical Rationale: The doctor's professional reasoning connecting the diagnosis to the mechanics of the injury.Specific Diagnosis: A valid medical diagnosis (not just "pain").2. Travel Reimbursement (Form OWCP-957)Round Trip Rule: You are entitled to reimbursement for travel to doctors and physical therapy for up to 100 miles round trip.Pre-Authorization: If you must travel more than 100 miles, you must get pre-approval from your Claims Examiner.Documentation: Use Google Maps to verify mileage and submit the form for every three trips.3. Protecting Your Job: CA-17 vs. FMLAChris provides a strategy for "preserving" FMLA:If your claim is accepted, your CA-17 (Duty Status Report) protects your job because management must follow medical restrictions.Preserve FMLA: Save your FMLA hours for non-work-related illnesses or family emergencies. Use the CA-17 as your primary job protection for work injuries.The "Shall" Requirement: Management is legally required to fill out Side A of the CA-17 before the doctor fills out Side B.4. Fighting Back Against "Accident Write-Ups"If management attempts to put an "accident write-up" in your file:This is often a tactic to claim willful misconduct.Action: Immediately contact your union and file a grievance. Use your right to a copy of the front and back of your CA-1/CA-2 to see exactly what management wrote in the "supervisor" portions.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