(Chats 5-15-19) The Specialist Trap: Why Your Orthopedic Surgeon is Getting You Denied

Chris and Gini explain the "nearly impossible" challenge of changing doctors once a specialist is chosen and why an OWCP-trained doctor should always be your first call. They also discuss how to handle auto accidents in government vehicles (LLVs) and the strategy of using third-party lawsuits to secure extra compensation.Key Takeaways & Show Notes1. The Specialist TrapOne of the most common mistakes is going to an Orthopedic Surgeon or a Specialist as your first treating doctor.The Problem: Specialists are trained for surgery, not for writing the multi-page medical narratives required by the DOL.The Trap: Once you designate a specialist as your "Physician of Record," the DOL often denies requests to switch to a general practitioner or an OWCP specialist later, labeling it a "move to a lower level of care."The Solution: Choose an OWCP-trained treating doctor first. They will get the claim accepted and then refer you to a surgeon if medically necessary.2. Auto Accidents & Third-Party ClaimsFor letter carriers and rural carriers who are hit by other drivers:Dual Filing: This is both an OWCP claim (CA-1) and a Personal Injury case.The 20/80 Rule: If you sue the at-fault driver and win a settlement, federal law generally allows you to keep 20% of the settlement (after expenses) as a "guaranteed share," while the other 80% is used to reimburse the DOL for medical bills they paid.Legal Tip: You need a lawyer who understands both personal injury and the "FECA" (Federal Employees' Compensation Act) lien process so you don't lose your settlement to the government.3. Adhering to the CA-17 (Duty Status Report)Chris introduces a new mantra: #FileAGrievance.If your doctor provides a CA-17 with restrictions (e.g., "4 hours of work" or "20 lb lifting limit") and management ignores it, it is a violation.The "As Tolerated" Warning: Never let a doctor write "as tolerated" on your restrictions. Management will interpret this as "full duty." Ensure your doctor lists specific, numbered limitations.4. Reopening Closed ClaimsA common myth is that once a case is closed, it's gone forever.The Reality: Claims can be reopened via a CA-2a (Notice of Recurrence) or by providing new medical evidence that the condition has worsened.Timeline: Reopening a claim typically takes 4 to 6 weeks for processing.Actionable AdviceTravel Reimbursement: If your case is accepted, use Form OWCP-957 to backdate and claim mileage for all doctor visits.Avoid Kaiser/Urgent Care: While good for emergencies, these facilities rarely have the administrative staff to handle the long-term paperwork required to keep a federal claim active.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