OWCP Periodic Roll payment schedule for 2019 has been published

OWCP's 2019 payment schedule for FECA claimants receiving periodic wage loss and schedule award payments is now accessible on the web. It can become confusing to understand what date the next payment is due from OWCP as they issue payments on a 28 day cycle, 13 times a year. Here is a link to the 2019 payment schedule:
https://www.dol.gov/owcp/dfec/regs/compliance/Periodic-Roll-Payment-Schedule.htm

December 7, 2018 Periodic Roll payment delays

I have been fielding a lot of calls this morning from FECA claimants who should have received their direct deposit periodic roll payment this morning. I am advised by various persons at OWCP that there was a problem with the transfer of payment data from OWCP to Treasury this week and payments are delayed. Many claimants should expect to have their direct deposit tomorrow, but apparently some smaller banking institutions may not post receipt of the payment until Monday morning.

Its Open Season, be sure to make necessary changes to health insurance by the December 10, 2018 deadline

Its that time of year, if you need to make a change to your health benefit enrollment, or just want to explore your options, remember that you need to do this over the web since OWCP no longer mails out brochures. A good place to start is here:

https://www.opm.gov/healthcare-insurance/open-season

Note that if your employing agency transferred your health insurance enrollment responsibility to OWCP,  you must make sure your completed SF2809 is received by the OWCP District Office handling your case. If you are not sure, send it to both your agency and OWCP.

Be sure to go to the OPM website to get started:

https://www.opm.gov/healthcare-insurance/open-season/

OWCP no longer putting claims personnel names on correspondence

If you have gotten mail from OWCP since late August, you may have noticed that OWCP claims personnel names no longer appear on most documents. Instead, on the page that should have a signature line, you will see what is called a QR code at the bottom left, it sort of resembles a square bar code. That code contains various information including the name of the author in the format of their first name and last initial, ie "Jeff Z". OWCP explained in FECA Bulletin No 18-07 that "[e]mployees have expressed security and safety concerns regarding use of names in ... communications" as the reasoning for making this change.

This policy is being implemented in slightly different ways by each district office, so depending on the office you are assigned to, you may see some variations.

In order to know the name of the person who sent you correspondence from OWCP, you will need to download a free "QR reader" app. Go to the app store where you download apps for your device and search for a "QR Code Reader" which you should be able to download for free and then use the camera on your device to read the QR Code.

If you are interested in more information on QR codes here is a link to the wiki:

https://en.wikipedia.org/wiki/QR_code


Following is the full text of FECA Bulletin No. 18-07:


FECA BULLETIN NO. 18-07
Issue Date: August 17, 2018

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Subject: Protecting the Identity of Employees in Written and Oral Correspondence
Background: Division of Federal Employees' Compensation (DFEC) employees routinely respond to a myriad of written and telephonic inquiries, and issue written correspondence when developing and adjudicating a claim, and when terminating, reducing or suspending medical and/or compensation entitlement. Employees have expressed security and safety concerns regarding use of names in these communications.
DFEC recognizes the importance of the safety and welfare of its employees in its mandate to fulfill the requirements of the FECA, 5 U.S.C. 8101 et. seq. As a result, DFEC has changed its longstanding procedure of placing employee names on written correspondence, including all formal decisions. A similar change will also apply to oral communication.
Notice regarding this change was published in the Federal Register on April 18, 2018. See Federal Register / Vol. 83, No. 75, page 17196.
Purpose: To provide guidance on the format by which DFEC employees should identify themselves on written and oral communication/correspondence.
Applicability: All National Office and District Office personnel.
Action: Balancing the safety of our employees and the communication needs of our stakeholders, DFEC will use the below methods in identifying the authors of its written and telephonic communications:

1. All signatures and names currently appearing on outgoing correspondence will be replaced with "Division of Federal Employees' Compensation," and the author of the document will be captured in the case management system.
2. To preserve the Employees' Compensation Appeals Board's (ECAB) ability to identify the adjudicator of certain decisions such as reconsideration decisions, DFEC will use a Quick Response (QR) Code to identify decision authors.
3. A naming convention for the staff will be used to provide every employee with a pseudonym for use in telephonic and other oral communications. The naming convention to create the pseudonym will be the employee's first name and last name initial. If more than one individual within an office has the same combination (e.g. two Thomas J.'s) then their middle initials will be added.
4. Outgoing correspondence (including decisions) will not contain or otherwise reveal the pseudonym when printed. Instead the pseudonym will be embedded into a QR Code on the letter, allowing a QR scanner device to reveal the pseudonym.

Disposition: This Bulletin is to be retained until incorporated unto the DFEC Procedure Manual.

ANTONIO RIOS
Director for
Federal Employees' Compensation
Distribution: All DFEC staff

Sometimes you can get reimbursed for legal fees and other expenses related to your OWCP claim

This is a topic I have previously posted, but its important and bears repeating. If you are receiving a check from OWCP and are also entitled to Social Security Disability payments from SSA, you may be able to recover legal fees and other unreimbursed expenses through your Social Security disability claim. If SSA is reducing your check, they are taking an "offset" because you are receiving a check from OWCP, you can recover your unreimbursed expenses from SSA. This also applies to other expenses related to your workers compensation, for instance paying for medical a report.

SSA has a document available online explaining how to report expenses such as attorney fees paid in connection with receiving benefits from OWCP. The attorney fees (and other qualifying expenses) will be used to reduce the offset amount. Please click on the link below to SSA POMS - DI 52150.050 - Excludable Expenses, and carefully follow SSA's instructions:

https://secure.ssa.gov/poms.nsf/lnx/0452150050
If this link does not work, do a google search for the document number  "POMS 0452150050"

Submitting FECA medical bills and reimbursement requests to OWCP

Recently, a client was complaining that nothing had happened with her request for reimbursement for traveling to an OWCP directed medical exam. After spending more time on this than seemed reasonable, I was able to determine that the problem was that she uploaded the reimbursement through the ECOMP interface. The problem is that reimbursement and bills must be mailed to the DFEC Mailbox address:

This is a reminder that when dealing with OWCP, one must always remember that everything this program does is designed for the convenience of OWCP and employing agencies. While employing agencies are given unfettered access to your file, and extensive ability to upload and characterize all sorts of documents through ECOMP, a claimant must send in a written request for access to their file, and, if you're lucky, an updated copy will be sent out after 30 days, and typically, that copy was made shortly after it was requested, and then held until the end of the thirty days.

Requesting copies of medical records from medical providers

I frequently hear from injured workers that they have difficulty requesting copies of their records, either being told they are not allowed to have a copy or being charged exorbitant fees. The following article lays out some very good tips and instructions on how to request a copy of your records, and how to do so in ways that minimize the cost. Keep in mind that for many medical providers, sending out copies of your records has been turned into another profit center. By understanding your rights, you can avoid improper charges and obstacles to getting a copy of your medical records:

https://www.theexpertinstitute.com/top-ten-rules-for-requesting-low-cost-medical-records-under-hitech-hipaa/

OWCP Provider Number

In order for a medical provider to bill OWCP for medical care, the provider needs to register through OWCP's contractor to get a provider number. I have found that sometimes the process of registering for a provider number or straightening out problems with a provider number can become an obstacle to a physician's office being able to accept and treat federal workers compensation claimants. If your physician's office is having problems registering for their provider number or renewing their provider number, please ask whomever at the physician's office is having a problem with this process to call me directly. Here is a link to useful information on this program to share with your physician's office:

https://www.dol.gov/owcp/dfec/medicalprovider.htm

OWCP allowing federal employee workers compensation paper files to be destroyed

Beginning in 2003, OWCP migrated from maintaining federal employees' workers compensation claims as paper files to an imaged system. When there is no activity for an extended period, paper files are shipped off to the federal record center. The federal record center destroys files after 15 years. If you had a pre 2003 paper file that is now considered a "retired" file, meaning it has been shipped off to the federal record center, you are at risk of your paper file being destroyed. This recently arose for a new client of mine who sustained an ACL injury in the early 1990s, underwent surgical repair, recuperated, and returned to work. Now he is being told he needs to consider a knee replacement procedure, but OWCP reports that they cannot retrieve his file. It was shipped off to the federal record center in 2003, and the federal record center routinely destroyed the file in 2016.

If you have an old injury and OWCP sent the file to the federal record center, if you do not have a completed copy of your file, you should make OWCP send you a copy before its too late.

This is an interesting article for federal employees regarding offsets between FERS pensions and SSA benefits

This is a little off topic from my usual OWCP related post, but federal employees should find this article interesting as it provides some accessible information explaining the interplay between your FERS and SSA benefits:

https://www.fool.com/retirement/2018/06/19/can-my-pension-lower-my-social-security-benefits.aspx

OWCP fax numbers

I am frequently surprised that claimants are unaware that they can fax documents to their OWCP office. The contact information for each district office, including the official fax number, is found on the web at this link:

https://www.dol.gov/owcp/contacts/fecacont.htm

If you have a new injury, it is critical that your claims examiner receive all of the records being generated by your doctors. Be sure to mark your claim number on each pieces of paper and fax, mail, or upload that to your file. Do not rely on other people. If you want your claim to get approved, YOU should gather all records and send them to OWCP. Mailing to the PO Box in London Kentucky can be very slow, you should either upload documents using ECOMP or fax things. Anything that you mail or fax MUST have your OWCP claim number clearly marked on the top right. During the time that your claim is pending approval, you need to be on top of this. Once the claim is approved, the doctors will send in the paperwork when they send in bills. But prior to the approval, you need to make sure that everything is getting in the file by taking care of it yourself.

If the claims examiner ends up with two copies, so what, if they do not get something critical, your claim could get denied.

OWCP Publishes New Opioid Prescribing Guidelines for FECA cases

The Federal Employee Compensation program has been slowly dealing with the opioid crisis and has published guidance on changes to the program regarding opioids. The new guidance is in the form of a FECA Bulletin which provides:

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Subject: Opioid Prescribing Guidelines, Short-Term, Long-Term and High Dose Opioid Use
Background: Under the Federal Employees' Compensation Act (FECA), the Department of Labor's (DOL) Office of Workers' Compensation Programs (OWCP) may provide to an employee injured while in the performance of duty, the services, appliances, and supplies prescribed or recommended by a qualified physician, which OWCP considers "likely to cure, give relief, reduce the degree or the period of disability, or aid in lessening the amount of the monthly compensation." See 5 U.S.C. 8103.
In accordance with the discretion granted to DOL and delegated to OWCP, OWCP's Division of Federal Employees' Compensation (DFEC) implemented a policy applicable to newly prescribed opioid users (i.e. where an opioid has not been prescribed within the past 180 days, if ever) in FECA Bulletin 17-07, issued on June 6, 2017
DFEC is now instituting a new supplemental policy to address long-term and high dose opioid therapy. While FECA Bulletin 17-07 applies to newly prescribed opioid users, and requires their treating physician to complete a Certification/Letter of Medical Necessity, Form CA-27 (LMN), after an initial 60-day period, this policy focuses on the effects of opioid therapy for all users. For long-term and/or high dose users where the prescribed opioid therapy is deemed to require further management, completion of Form CA-27 will now be required upon DFEC's request¹. Claims staff will review factors such as the claimant's morphine-equivalent dose (MED), recent surgeries and the cumulative, continuous length of treatment in assessing the most appropriate action to take in each particular case.
In order to effectively and efficiently manage opioid prescriptions, DFEC has created Prescription Management units within DFEC's Branch of Program Integrity, Fraud Prevention and Prescription Management. DFEC currently has four Prescription Management Units located throughout the country (Jacksonville, Seattle, New Orleans and Chicago), and these units are staffed with Medical Benefits Claims Examiners (MBE). The MBEs are assigned cases based on claimant information (as opposed to OWCP case file number), so an MBE will be assigned cases throughout the country, rather than based on geographic jurisdictional lines (traditional district office assignments).
This means that DFEC has two types of claims examiners involved in medical case management. MBEs are responsible for reviewing and evaluating entitlement to compounded drug and opioid prescription medications and any related requests. They are also involved in ancillary duties that may arise during such medical case evaluation, to include claim expansion (inclusion of new, additional conditions based on medical evidence; approval and denial of treatment regimens; and/or issuance of decisions regarding entitlement to medical care).
Responsible Claims Examiners (RCE), located within each District Office, will continue to serve as the primary point of contact for the claimant for handling all other aspects of the case, to include initial and recurrence adjudications, payment of compensation, periodic entitlement reviews, job offers (temporary and permanent), loss of wage earning capacity determinations and disability management.
Purpose: To provide supplemental guidance to MBEs and RCEs on the management of cases and the authorization of opioid prescriptions where a claimant is receiving opioids for a work-related condition (other than cancer).
Action: For opioid prescriptions for any work-related condition other than cancer:²

1. Upon review of an opioid recipient's MED and/or length of opioid treatment, the MBE may determine that further medical development is necessary. If so, the MBE should issue a letter to the attending physician. The letter should (1) address opioid-specific issues, (2) address other medical case management/entitlement issues, if applicable, and (3) request that the physician complete the LMN for consideration of further opioid authorization. The MBE should afford a reasonable period of time (generally 30 days unless there is an urgent concern for safety/health in which case 14 days' notice will suffice) for the submission of such documentation, depending on the nature of the inquiry.
   
2. Following the expiration of the afforded time to respond, the MBE should review the medical evidence of record, to include the justification provided on the LMN and/or the supporting medical documentation. In evaluating whether further development is necessary, the MBE should assess factors including, but not limited to, (1) whether the physician has demonstrated enough knowledge regarding the claimant's medical condition to arrive at a sound medical opinion, (2) the level of medical rationale provided by the physician, and (3) whether the necessity is based upon objective clinical findings versus subjective complaints. See FECA Procedure Manual 2-810.6 for additional discussion on weighing and evaluating medical evidence.
   
3. Should the MBE determine additional development is needed, he or she may again contact the claimant's physician for clarification. Depending on the sufficiency of the file describing the medical necessity for opioid usage, the District Medical Advisor (DMA) may also be consulted to determine the appropriateness of the opioid prescription and pain management plan, including requests for treatment/rehabilitation plans to treat dependence on opioids resulting from prescriptions for an employment-related condition. See FECA Procedure Manual 3-900.4 regarding the handling of concerns about medical treatment. The MBE may also choose to send the claimant for a second opinion (SECOP) examination if warranted based on the evidence of record. If a Field Nurse (FN) has been assigned to the case, the MBE may also direct the FN to address the issue of ongoing opioid usage with the treating physician. If a FN is not currently assigned, the MBE may make a task-based nurse referral to assist with opioid prescription management issues.
   
4. If a conflict in medical opinion arises between the claimant's attending physician and either a SECOP examiner or DMA, the MBE should refer the claimant for a referee medical examination (RME) to resolve the conflict.
   
   
5. Following appropriate development, if the medical evidence establishes that the opioid treatment is warranted, the MBE should notate the case record and review the case again at a reasonable interval.
   
6. Following appropriate development, if the medical evidence establishes that the current opioid treatment is not warranted for the work-related condition(s), the MBE should review the medical evidence to determine whether any physician that has reviewed the case opines that the claimant would benefit from medication assisted treatment (MAT) or other treatment for opioid use disorder. If no such evidence exists, the MBE should proceed with the issuance of a proposed termination of entitlement to opioid medications. A period of 30 days should be provided for a response. After 30 days, the MBE should again review the case and any response, and either issue a final termination denying opioid entitlement or take additional development action as needed.
   
7. If one of the physicians evaluating the claimant states that he or she would benefit from MAT or other treatment for opioid use disorder, the MBE should advise the claimant and the attending physician of such recommendation. If the attending physician disagrees or fails to respond, the MBE may explore (along with the claimant) information about appropriate treatment centers and may authorize a change of physician if the claimant wishes to seek treatment with another physician. If the claimant and attending physician support an alternative treatment plan, the MBE should authorize treatment and monitor progress as appropriate. A task-based nurse may be assigned to assist in facilitating this process. If the claimant and/or treating physician are ultimately unresponsive and/or not interested in pursuing any change in treatment plan, the MBE should proceed with the issuance of a proposed termination of entitlement to opioid medications (if the weight of the medical evidence continues to establish that the current opioid treatment is not warranted).
   
   
8. In some instances, the weight of the medical evidence may establish that entitlement to opioid medication should be reduced instead of terminated. In such cases, the MBE should advise the claimant and attending physician of the availability of MAT or other treatment for opioid use disorder if recommended by a physician. The MBE should subsequently follow the guidance provided in item 6 or 7 above, except that a proposed reduction of opioid medication should be issued.
   
9. A period of 30 days should be provided for a response to any proposed termination of, or reduction in, opioid medication. Following that period, the MBE should again review the case and any response, and either issue a final termination denying opioid entitlement or take additional development action as needed.³
   
10. In addition to addressing the opioid issue, the MBE may also address other aspects of the claimant's medical condition that may have impact on the management of the case. The MBE will be able to take actions necessary to resolve the opioid issue and to address necessity of medical treatment, including issuing letters to accept additional medical conditions, issuing decisions to deny entitlement to medical treatment, and proposed terminations of medical and/or benefits. In such cases, the MBE should communicate with the RCE concerning actions that may impact the overall management of the claim. These communications may be documented through a CA-110 or memo to the file.
    
11. Only the RCE will be responsible for taking actions involving disability or schedule award compensation. In addition, the RCE will still be responsible for periodic entitlement reviews, disability management and vocational rehabilitation efforts. The RCE will also issue decisions regarding termination of entitlement to benefits, even if the determination is based upon medical evidence received as a result of the MBE's actions or if the proposed termination was issued by the MBE. Additionally, in cases where a claimant may have entitlement to compensation as a result of an action taken by the MBE (i.e., stopping work for an in-patient treatment, etc.) the RCE will be responsible for making the compensation payments.

Applicability: Appropriate National and District Office personnel.
Disposition: This Bulletin is to be retained until incorporated into the Procedure Manual.

ANTONIO RIOS
Director for
Federal Employees' Compensation
Distribution: All DFEC Staff
¹ The issuance of this bulletin does not supersede or otherwise modify existing guidance on opioid prescribing guidelines provided in FECA Bulletin No. 17-07 (issued June 6, 2017).
² The issuance of this Bulletin does not supersede or otherwise modify existing guidance on Fentanyl. See FECA Bulletin No. 11-05 (issued May 3, 2011).
³ If the proposed termination addresses issues other than opioid medication (i.e. termination of all medical benefits), the final termination should be issued by the RCE and not the MBE. See items 10 and 11. Also note that a termination of entitlement to opioid medication alone does not terminate entitlement to MAT or other treatment for opioid use disorder.

FECA BULLETIN NO. 18-04 Issue Date: June 15, 2018

You can find the text of the rule here:

https://www.dol.gov/owcp/dfec/regs/compliance/DFECfolio/FECABulletins/FY2016-2020.htm#FECAB1804

William Bauer MD Otolaryngologist and OWCP hearing loss cases

If OWCP denied your hearing loss claim based upon a report by ENT William Bauer MD, please give me a call as the denial may have nothing to do with whether or not you actually have noise related hearing loss, it would appear that this physician specializes in writing reports that are calculated to get your claim denied. Just as a broken clock will be correct twice a day, it might be that you don't have noise related hearing loss, but in my client's circumstances this doctor's opinion had nothing to do with the merits of the case and appeared to only relate solely to a desire to get OWCP to send more business by writing unfavorable reports. If your hearing loss claim was denied based upon a report by William Bauer MD don't give up!

Postal Worker Loses $37K in SSDI Benefits for Failure to Advise of OWCP workers comp payments

There are offsets between your federal workers comp benefits paid by OWCP and benefits you receive from SSA. When you are receiving monetary benefits from OWCP and you receive disability benefits from SSA, you must notify SSA, as there may be a reduction of your SSD benefit and if you don't stay on top of this you will ultimately have a significant overpayment that you are required to repay. Similarly, an OWCP recipient who is in the FERS retirement system and begins receiving SSA retirement benefits must notify OWCP immediately of this as there is an offset that runs the other way; OWCP gets a credit for the portion of your SSA retirement annuity that arises from your federal employment. Just because you tell OWCP that you have started receiving the SSA retirement does not mean you are ok, you need to follow up and make sure your claims examiner has requested the necessary information from SSA. If OWCP fails to follow up, you will still have an overpayment and likely be required to repay it.

Here is a link to a story about a USPS employee who received an overpayment from SSA due to failing to notify SSA of receipt of OWCP benefits:

https://www.lexisnexis.com/legalnewsroom/workers-compensation/b/recent-cases-news-trends-developments/archive/2018/05/11/united-states-postal-worker-loses-37k-in-ssdi-benefits-for-failure-to-advise-of-workers-comp-awards.aspx

OWCP Launches Initiative To Assist With Claims Arising From The September 11th Terrorist Attacks

In a recent "news" item, OWCP announced a new initiative to assist federal employees with FECA claims arising from the September 11th Terrorist Attacks. Information about this can be found on the OWCP website at:

https://www.dol.gov/owcp/dfec/FECAClaimsSeptember11.htm

However, the biggest issue with these cases, which is NOT addressed in the announcement and guidance offered by OWCP, is the severe and unreasonable approach taken by OWCP in approaching timeliness. The biggest obstacle to 9/11 claims at this point in time is making sure that a claim is explained in a manner that does not allow OWCP to deny the claim on the basis that allows OWCP to unreasonably determine that the claimant should have known they had an injury and missed their time limitation for filing the claim within three years of when they knew or should have known of their injury.

If you are contemplating filing a claim for a medical condition arising from 9/11, or your presence at Ground Zero, or work related to that event, please realize that you must either explain that you have still been exposed to work factors contributing to your condition within three years of the date of filing your claim, or you must have a medical condition that was "latent" meaning it did not arise until more recently (such as cancer) and you must file your claim within three years of when you knew or should have known that your condition arose from that exposure. You can also show that you gave your supervisor written notice of your injury at the time the injury occurred.

This can be particularly complex in a claim for PTSD or other mental health condition arising from exposure. There are many cases in which OWCP essentially says, you should have known you have PTSD if you were there and if you file your claim more than three years after that exposure they will deny your claim on timeliness. There are sometimes ways to work around this issue, but it is critical that if you are filing a claim now, for a condition that you relate to exposure that occurred more than three years ago, you stand a very good chance of getting a denial unless your claim can be explained in a way that allows you to meet the three year time limitation.

OWCP Periodic Roll payment schedule 2018

OWCP's 2018 payment schedule is now accessible on the web. It can become confusing to understand what date the next payment is due from OWCP as they issue payments on a 28 day cycle, 13 times a year. Here is a link to the 2018 payment schedule:

https://www.dol.gov/owcp/dfec/regs/compliance/Periodic-Roll-Payment-Schedule.htm