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Wednesday, April 27, 2011

Be Prepared for Your Periodic Roll Review

The Federal Employees' Compensation Procedure Manual indicates at 2-0700-17, Periodic Roll Review, that the Claims Examiner should review each case at least once a year to verify continuing entitlement to benefits, ensure that benefits are being paid at the “proper” level, resolve third party issues, and discontinue benefits when warranted. The annual review of a case often begins during the month prior to an injured worker’s birthday when form letters are mailed requesting information about entitlement to other government benefits, status of dependents, third party settlements, and possible work activity. Simultaneously, a request for medical evidence is made seeking to verify continuing presence of objective findings, an ongoing relationship of the accepted condition to the work injury, and the extent of disability.

Like a series of forks in the road, what happens next depends on many factors, some of which pertain to the specifics of your case, and some of which are the programmatic emphases of the day, the workload, or most anything else. As the Scout motto says, your best move is always to “Be prepared.” Regular medical care and timely comprehensive reports, medical testing as needed, surgery when prudent, are all obviously required. If you have moved, been divorced, or had any other change in your situation, don’t wait for the review to report it.

If you know that you are not totally disabled from the work injury, but have preexisting conditions that are also disabling, or another condition that has not yet been accepted as compensable, ensure that you have complete medical records available to prove it.

Finally, if you suspect that the axe may soon fall, the best time to seek help from a knowledgeable source is before that actually occurs in order to have the best chance of preserving benefits before you open the Notice of Decision reducing or terminating your benefits. Declining workloads at OWCP coupled with today’s economic environment and budgetary issues all mean that your number may come up sooner rather than later. Be prepared!