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Monday, December 19, 2016

Disturbing Trend of Claims Examiners trying to invent reasons not to pay benefits

In a number of recent claims that OWCP has approved, after protracted fights (2-7 years), I have found claims examiners refusing to commence payment of wage loss benefits. In what is perhaps the most egregious recent example, a USPS employee who suffered an emotional injury during Hurricane Katrina finally underwent a referee examination and received a notice that the claim was approved based upon the referee agreeing that compensable factors caused the injury and also caused total disability. Upon receiving the notices from OWCP, we submitted the necessary paperwork to switch the claimant from an approved disability retirement pension to receiving FECA benefits.

The next thing that happened is that OWCP reassigned the case to a new claims examiner named Rowena Daniels. Ms. Daniels looked at the paperwork we had submitted to start the process of paying wage loss benefits and decided to call the claimant to berate her that she was not entitled to wage loss benefits since she was receiving her pension. However, Ms. Daniels made a major mistake. She dialed my number, not the claimant's. You can imagine my surprise when I answered my phone and was met by a barrage of anger from Ms. Daniels who was screaming at me that I was not entitled to wage loss benefits since I was receiving my pension.

Eventually, when I could get a word in, I brought to her attention that she was speaking to me, not my client, and I then advised her that she was wrong. She angrily stated that I would get a letter from her and hung up. Needless to say, her letter advised that my client needed to prove she was disabled in order to get benefits, that there was no medical evidence, and giving us 30 days to submit that information. Even though the referee examiner's report was the weight of medical evidence.

This situation was brought to the attention of OWCP management, and my client quickly received her wage retroactive loss benefits. OWCP apologized for the letter saying that the client needed to prove her entitlement to benefits. They made no mention of the call I documented from Ms. Daniels.

Thursday, November 10, 2016

Open Season starts next week: November 14 - December 12, 2016

Its that time of year, if you need to make a change on 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:
Note that if your employing agency transferred your health insurance enrollment responsibility to OWCP,  you must send your completed SF2809 to 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:

Tuesday, May 17, 2016

What does it mean that OWCP sent me a letter from a Quality Assurance Specialist ("QAS")?

When you are receiving FECA benefits you are going to be regularly scrutinized. Your employing agency may do surveillance and OWCP will also periodically require all sorts of information from you. I was recently shown a letter signed by the district director of an OWCP office asking the claimant to contact an individual who was identified as a Quality Assurance Specialist (QAS). The person identified on the letter as the QAS is actually a criminal investigator from the USDOL. Its not clear whether the target here is the claimant or the claimant's physician. Or perhaps this is just the usual routine over the top OWCP bullying techniques.

When OWCP sends you a letter telling you to do something, if there is an explicity threat that if you don't cooperate your benefits will be sanctioned, then you cannot ignore the letter. However, if the letter does not give you notice that there is a penalty for not responding, then you may want to consider whether or not you respond. The fact that this letter was signed by the district director, provided the name of an OWCP claims supervisor and a direct dial number for him (OWCP employees typically make it impossible to find their direct dial info), and lastly the person identified benignly as a "QAS" is in reality a criminal investigator, makes me concerned that this person may have a serious problem. This person should perhaps have a lawyer contact the QAS on their behalf to find out what is going on and act as an intermediary.