Source: https://feddoctor.com/tag/causation-report/
Timestamp: 2019-11-18 08:28:21
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causation report | FedDoctor
Posts Tagged ‘causation report’
Getting an OWCP claim accepted
Getting a federal workers compensation claim accepted by the OWCP can be difficult. In order to have an accepted claim, you must prove that the injury occurred as a result of your employment.
It sounds simple and it should be, however, medical documentation is necessary to establish the cause of injury. Often, this evidence is hard to get right, even for doctors that typically deal with workers compensation issues.
Part of the reason OWCP can be difficult for physicians is that the rules are different for federal workers comp than most state comp laws. Many doctors that are used to state law comp (which is far more common) are not aware of how the OWCP claims examiners adjudicate claims. The cause of injury must be very clear if not exhaustive.
Normal logical thinking would lead one to understand that if a doctor indicates in medical notes that the injury is work related, that would be enough to conclude that a claim should be opened and approved. But OWCP often requires more. A more detailed causation report may be required to describe exactly what actions or movements caused the particular injury.
These reports require much more time than most doctors are used to giving in these matters. Generally, doctors want to get going on the treatment and help their patients heal and return to full capacity as soon as possible. But if the claim is not accepted, the treatments may never be authorized.
That is why selecting a physician for your federal workers compensation claim is so important to your benefits. Without good documentation, your claim may never get off the ground and could result in a long drawn out fight with OWCP to get any benefits at all.
FedDoctor is here to help you with this particular problem. You don’t have to switch all of your care to your federal doctor, but it can be beneficial to at least see them for your work injury. While many FedDoctors treat other injury and illness types, they all spend a significant portion of their time trying to stay on top of the federal comp rules and regulations to ensure that when you present in their office with a federal on-the-job injury, they can help you get the treatment you are entitled to.
Many federal employees unfortunately think that they will not get injured at work and that this information doesn’t apply to them. The numbers indicate differently. 1 in 17 federal employees files a claim every year. Many never file claims because they have heard horror stories from those that have.
This kind of action can lead to even bigger problems later on. If an initial injury is never accepted by OWCP, later injuries that stem from them won’t be covered either. If a minor injury now develops into a major problem later, the employee can have a hard time getting the federal workers compensation office to accept it later. Claims examiners can point the previous, unaccepted condition as a “preexisting condition” and deny coverage based on a lack of relevant causation.
Whether you have an ongoing claim, or you were just injured, or even if you have never had an injury, understanding the difficulties that federal employees face is important. Share this information with you union and and encourage your coworkers to be prepared in case an injury occurs.
FedDoctor wants all federal employees to find competent care for federal workers compensation injury claims. We are constantly looking to add more federal doctors in your area. We don’t accept just any doctors to be on the site. We seek doctors who have a specific interest in helping with federal comp claims. If you are seeing a good federal doctor now, let us know! We want to help them treat more federal employees!
Whether you need a causation report or an impairment rating for a schedule award, FedDoctor is here to help you. Start your search for quality care today.
Tags: causation report, federal doctor, federal workers comp doctor, federal workers compensation doctor, owcp doctor
Why is it hard to find a federal doctor? Part 5
So it seems that most doctors either don’t do federal workers compensation, or don’t understand it. They may be very compassionate, genuine, caring physicians who just can’t make heads or tails of the OWCP.
If your doctor is eager to help and willing to help you fight your way through the process, you may still be facing an uphill battle. The issue becomes that first visit to the ER or urgent care facility. Remember from Part 3 of this series when the doctor didn’t preform and MRI after your twisted knee injury. The emergency doctor was most likely not especially thorough with the documentation on cause of injury. The report may say ‘slipped on stairs’ when what you need to say is ‘slipped on stairs while working at their job for the federal government’.
I know it seems like a small difference, but the OWCP Claims Examiner will want all of the dots connected. It is not their job to make assumptions. It is their job to examine the evidence presented and make a determination. This case might be denied.
Or even more complicating, imagine the ER doctor did state it was a work injury and the claim is opened with the accepted condition of ‘Knee Sprain’. Now your own doctor is willing to give this a fighting chance and work with you on your federal workers comp claim. First, the doctor orders an MRI and discovers that your injury is more severe than originally thought. You have torn your meniscus and will require a knee operation to return to health. The doctor submits a request for pre-authorization from the ACS website and is flatly denied.
Frustrated, but maybe not yet willing to give up, the doctor writes a letter to the OWCP CE stating that the surgery is necessary for you to get better. Remember, the Examiner is simply evaluating the evidence presented, and so far, doesn’t think your work injury warrants an operation.
Tags: causation report, federal comp doctor, federal doctor, federal workers comp doctor, federal workers compensation doctor, owcp doctor, schedule award doctor
Why is it hard to find a federal doctor? Part 4
Now that the emergency has subsided and you begin the process of visiting your regular doctor, you begin to find that being a federal employee who is hurt on the job, can be a very difficult proposition.
Once you see your doctor and explain the situation, they may be genuinely concerned, but confused on how to proceed. Many doctors do not attempt to help with workers compensation claims at all. They are happy to provide treatment but they have built a practice that does not assist with paperwork. They are allowed to do this! It is your doctor’s business and he/she can run it any way they choose. If they choose to operate a treatment-only practice, that means you need to find a new doctor. Hopefully your doctor can recommend someone else…
Another scenario is that your doctor immediately recognizes your need for a local orthopedic specialist or surgeon and refers you out to their office for further evaluation. Again, you may show up for your appointment only to find that they do not accept work related injury claims and don’t fill out paperwork. You are back to square one.
Commonly, your doctor, or the referred specialist do help with workers compensation claims and are extremely well versed in the laws that govern the state in which you live. Unfortunately, the state laws are very different from the federal law, FECA.
Most doctors do not gear their practices to serve federal employees. And why should they? The federal government and OWCP make it more difficult than most private insurers or state law workers comp. It is also a very small percentage of the overall population. Less than 1 out of every 100 Americans is a federal employee.
A third variable is that a doctor may have had a federal workers compensation claim before. But, if the office staff had trouble with the billing process, or if a requested pre-authorization was denied, the office may have sworn off any future dealings with the OWCP.
Tags: causation report, federal doctor, federal workers comp doctor, local doctor, local orthopedic doctor, owcp doctor, schedule award doctor
Why is it hard to find a federal doctor? Part 3
Now that we have discussed the structure that the government uses to adjudicate work injury claims and the process of filing a new claim, we will begin to discuss why it is hard to find a doctor that is familiar with the federal system.
When the OWCP Claims Examiner opens (if they do not require additional evidence) a new federal workers compensation claim, they accept certain medical conditions as being work related. If you twist your knee and your doctor diagnoses a knee sprain, the claim will be opened and treatment that typically is prescribed is approved at the treating physician’s discretion.
The Claims Examiner notifies the ACS and all medical bills should be sent directly to the ACS through an online portal. If the treatment rendered and billed falls under the normal scope of treatment, it is approved. If not, the doctor’s bill will be rejected. It seems fairly reasonable on paper, doesn’t it?
Unfortunately, it can be much more cumbersome in real life.
If you were to twist your knee on the job and go to a hospital or urgent treatment center, they often will provide you with immediate and necessary care. Once the injury has been determined to be less than life threatening, a frequent recommendation is to ice, take some over-the-counter pain reliever and follow up with your regular doctor at your (or their) earliest convenience.
An MRI is rarely preformed. The rarity is due to many factors, one of which is often the amount of swelling that may be present in the knee. Doctors are often (and rightly so) conservative with these types of treatment plans. No one wants some doctor they barely know to rush them to surgery only to find once they are in the middle of a procedure that it was less than necessary. Most patients, and certainly the insurance company or federal workers compensation office, would be unhappy, to say the least.
Tags: causation report, federal comp doctor, federal doctor, federal workers compensation doctor, local doctor, owcp doctor, postal doctor
Why is it hard to find a federal doctor? Part 2
To understand the way the OWCP operates, you must first understand mechanism of injury, or causation.
For the purposes of the federal workers compensation system, there are two different types of cause; traumatic and occupational (Read about Traumatic here, Occupational here).
A traumatic injury occurs at a given time. For instance, an automobile accident. An occupational injury occurs due to a repetitive hazard or peril such as carpal tunnel syndrome or chemical inhalation.
Both are legitimate injury types and can be caused at the work place or while in the performance of duty. Federal employees are often exposed to these risks on a daily basis. CA-1 and CA-2 forms can be filed based on the type of injury that has occurred.
Once a claim form has been submitted to the agency, it must forward the claim information to the appropriate district office for adjudication. The case will be given a claim number and assigned to a claims examiner (CE). The claims examiner does not have formal legal or medical training. Rather, they work for the Department of Labor and spend the majority of their time looking over submitted evidence to determine whether a claim is legitimate, or not.
Like in any profession, there are some CE’s that are better than others. Essentially what they are looking for is the correct forms to be used by the claimant and for the supporting documentation from the treating physician to be thorough, clear, easy to understand to a lay person, and to clearly identify the cause of injury. Along with any diagnostic studies that could be provided, the CE will use that information to decide whether or not a claim should be opened for compensation, or closed due to lack of evidence.
That does not mean that the more information you send a claims examiner, the better. On the contrary, the CE has dozens, if not hundreds of files that they are responsible for. Your doctor needs to be clear and concise, yet build the cause of injury information and documentation from the ground up.
Tags: 6th edition ama guides, causation report, federal comp doctor, federal doctor, federal workers comp doctor, federal workers compensation doctor, owcp doctor
Traumatic or Occupational Injury? Part 2
To continue our discussion about filing a new claim with the Office of Workers Compensation Programs, let’s look at the CA-2 form:
A CA-2 is a Notice of Occupational Disease form. These are used when your injury occurred over a period of time due to repetitive motion or exposure. A good example of an occupational injury is Carpal Tunnel Syndrome or CTS.
Again, it is imperative that your doctor understand the importance of a good causation report. Any objective test findings should accompany his detailed narrative explaining the history of the injury. This is where having a physician that is familiar with the OWCP can really pay off.
Many doctors are never questioned on their opinions, but the federal workers compensation system is deferent. They make a habit of requiring doctors to go above and beyond their normal practice scope to prove that the injury occurred as a result of performing the federal service.
Using FedDoctor.com can be helpful when trying to locate a local doctor who understands what the OWCP is asking for. Federal doctors are hard to find, but having one can be the difference in your claim.
Tags: 6th edition ama guides, causation report, federal doctor, federal workers comp doctor, federal workers compensation doctor, owcp doctor, schedule award doctor
Traumatic or Occupational Injury? Part 1
Many federal employees that are injured on the job are bombarded with federal claim forms. When filing for a new workers compensation claim, the most common are the CA-1 and CA-2.
The CA-1 is a new claim for traumatic injury. A traumatic injury is when something outside of the patient causes sudden injury. A good example would be twisting a knee while climbing steps, or slipping and falling on a sheet of ice while performing your job. Many traumatic injury are dismissed by the injured employee as minor. This can lead to problems down the road.
If the injured federal employee doesn’t seek medical care, it is hard to establish that the events at work are what actually caused the subsequent injuries. Always report injuries to supervisors and fill our incident reports whenever possible. If you do carry on with the day or even go home before realizing that the injury is severe, report how the event happened whenever you do make it to your doctor.
The OWCP wants for your care provider to explain to them how you were injured. the more detail you can provide the better. It also significantly helps if your doctor is familiar with federal workers compensation rules. Many doctors are familiar with state law workers comp, but few know the federal.
In order to have a good chance at an accepted OWCP claim, your doctor will need to provide the OWCP with documentation concerning his or her opinion regarding the events that caused the injury itself. It doesn’t matter if your knee was hurt previously, if your job made it worse, your doctor will need to outline how the incident on the job worsened your condition.
The more objective findings and diagnostic studies your physician can provide along with their detailed medical narrative and opinion, the higher your chances are of having an accepted federal workers compensation claim.
Use FedDoctor to find a local federal doctor to help you get treatment and documentation for your file.
Tags: 6th edition ama guides, causation report, federal doctor, federal workers comp doctor, federal workers compensation doctor, owcp doctor