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Wednesday, May 20, 2009

New OWCP Tactic

I have noticed a sneaky, new tactic being used by claims examiners to get rid of unwanted medical reports. It is based on a long-standing rule that when OWCP sends you to a directed medical examination (i.e., a second opinion or referee exam), and that doctor does not provide an adequate medical report, then OWCP is supposed to request an addendum from the doctor. If the doctor still does not give a good enough explanation, then that doctor's report is set aside and OWCP must send you to a new doctor. 

What seems to be happening with increasing frequency is that this rule is being used as a pretext for getting rid of doctors' reports that do not fit with the claims examiner's view of a case.

I have had several clients over the last few months who were sent out for directed exams. The doctors wrote reports that were no better or worse than other reports they'd written in dozens of other cases. EXCEPT this time their reports supported the injured workers' cases. The claims examiners proceeded to invent reasons why the reports were not good enough, requested clarifications, and then declared that the clarifications were not good enough either. In this way, they were able to send the claimants to new doctors hoping to get an opinion they liked.

This tactic also sends a message to physicians that if they want more patients sent to them for evaluation and reports, they better say what they think OWCP wants them to say!

Be on guard and don't let yourself fall victim to this new trick!