Visit my website:

Wednesday, April 1, 2009

Beware of Biased Claims Examiners

FECA is considered a “non adversarial” system. Therefore, you would expect the program administrators to be helpful rather than hostile to the injured workers they are obligated to protect. My experience has been just the opposite. Here are some examples:
  • I have one client who was serving in a civilian capacity at a military base high in the mountains of Afghanistan when he suffered a fall and ended up needing a hernia repair, hip replacement, and knee surgery. It is almost four years later, and the claim was again denied by the same claims examiner for the third time. Hearings and Review keeps remanding the case, telling the examiner that he has adjudicated the case in error. The examiner then sits on the case for nine months to a year, and denies it again disregarding the remand instructions.
  • Some time ago, a claims examiner in the Philadelphia district office told me that all of my clients are liars, and the only reason they need to have a lawyer is because they are dishonest. This same examiner telephones injured workers and uses various scare tactics to make them think their cases will go badly because they have a lawyer representing them. Telling them the only reason they need a lawyer is because they are frauds. Workers that rebuff his threats have received unfavorable decisions and written accusations of fraud. When these wrongful actions are brought to the attention of the Philadelphia district office and the National office, the decisions are vacated, but this examiner continues his job without recrimination. He recently sent one of my clients (a decorated and disabled veteran) a letter terminating his benefits for allegedly committing fraud, without any basis for doing so. That decision was quickly vacated by his superiors who blandly dismissed the entire episode as a routine error. This is a system that is run by people who think are obsessed with outsourcing to the private sector, think that workers are frauds, and view this entire process as one that ought to be abolished.
Thankfully, not all claims examiners act or feel this way. But always be on your guard. You may find that the person whose job is to help you is actually completely insensitive to your plight as an injured worker.