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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.