Under limited circumstances you can get reimbursed for attorney fees and other unreimbursed expenses related to your OWCP claim

This is a topic I posted some years ago, 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 your attorney fees from SSA if your Social Security disability check is being offset (reduced) because you are receiving a check from OWCP. This also applies to other expenses related to your workers compensation such as paying for medical reports.

SSA has a document available online explaining how to report attorney fees paid in connection with receiving wage loss 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"

How do I find out the injury codes that OWCP has approved on my federal workers compensation case?

I frequently speak to OWCP claimants who do not know what specific medical conditions their case is approved for. This can lead to problems when it turns out your case was only approved for a minor condition or aspects of your injuries were never accepted. This is also important information to share with your doctors as bills will not get paid, surgery will not get authorized, and a multitude of other problems can arise if your doctors are not using the codes your case is approved for or explaining in reports why the coding needs to be corrected.

If you are not sure what medical conditions your case is approved for, you can now view that information through OWCP's Claimant Query System (CQS) system. Many current federal employees are able to access CQS through the National Finance Center (NFC) website:

https://www.nfc.usda.gov/index.php


However, if you do not have NFC access, such as anyone who is no longer a federal employee, you can log in directly to the CQS system by following this link:

https://owcpconnect.dol.gov/owcplogin/?site=cqs

It is important to make sure that your doctors are aware of the exact accepted medical conditions from your case and that you make sure that if conditions need to be upgraded or added to your case, that you arrange for your doctor to provide a good narrative report explaining how the additional condition(s) relate to the mechanism of how you were injured.

Claimant Query System (CQS) Update

Several years ago OWCP cut off direct claimant access to the Claimant Query System (CQS) due to massive amounts of medical billing fraud due to the very weak log in authentication utilized at that time. Subsequently, OWCP claimants were only able to access CQS information if they remained active federal employees through the National Finance Center (NFC) web interface. However, claimants who were no longer federal employees and their representatives have had no online access over the last several years.

OWCP has been working on restoring a standalone CQS access and has now launched a new portal. CQS is a secure site where injured workers may log in to view information on their case status, compensation payments and compensation claim tracking. Access to CQS is now available through a new site called OWCP Connect, which allows individuals with existing claims under the Federal Employees’ Compensation Act (FECA), to register for an account and log in after authenticating their credentials.  Claimants may navigate to OWCP Connect by clicking here. If that link does not work for you paste the following into your browser https://owcpconnect.dol.gov/owcplogin/?site=cqs

 

During the account registration process, claimants must prove their identity by validating information entered against secure Credit Bureau data. Claimants will need to successfully answer questions posed by the Credit Bureau about their credit history in order to verify their identity. Information available to the credit bureau about an injured worker’s credit history will be used for identity verification only, and this information will not be saved or stored in OWCP records.

After a claimant’s identity has been authenticated, they will create a password, security image, key phrase and security questions for the account. Once an account has been created, the claimant may log into OWCP Connect and access CQS by entering their OWCP case file number. A case may only be accessed if the personal information associated with the OWCP Connect account matches the information associated with the OWCP case file. Please note that for federal agencies serviced by the National Finance Center (NFC), access to CQS will continue to be available to injured workers by logging into NFC’s Employee Personal Page.

A question that FECA claimants sometimes ask is OWCP reduced my check saying I can work, now my condition is worse, can my check be reinstated?

In a FECA claim, OWCP will sometimes determine that you have the ability to earn wages and reduce your check. Sometimes the person is actually working, other times, they send you a notice that they have selected a make believe job, and reduced your check based upon the amount of make believe money you supposedly can earn in that make believe job. If later your condition worsens, for instance you need a surgery or your doctors are explaining that your condition is worse, you may be able to prove to OWCP that you are no longer employable and get your full wage loss benefits reinstated. Recently, a person came to me whose check was reduced in 2006. In 2009 OWCP sent this person to their selected doctor who advised that the person was unemployable and needed surgery. Since that time the person has undergone four more surgeries. Yet OWCP claims examiners never informed the person that due to the OWCP selected doctor saying that the work injury had worsened that she could request modification, nor did OWCP inform the person when the four surgeries were approved over the last eight years that each of those events should have triggered the person's wages being restored. When I became involved in the case, OWCP claims examiners continued to resist reinstating the full wage loss for many months, but finally agreed to reinstate full lost wages retroactive to 2009. If your check has been reduced by way of a decision in which OWCP claimed you were able to have earnings, and your condition has worsened to the point that you are no longer employable, that decision can most certainly be modified and your full wage loss benefit can be reinstated.

OWCP has created a new prior authorization policy opioid medication prescriptions for claimants who are identified as newly receiving these medications

OWCP’s Division of Federal Employees’ Compensation (DFEC) has implemented a new prior authorization policy for some opioid medication prescriptions for claimants who are identified as newly receiving these medications under the Federal Employees’ Compensation Act (FECA) Program. Injured workers with accepted FECA claims will, after an initial 60 day period of opioid medication, be required to have a physician-completed Letter of Medical Necessity (also referred to as LMN or Form CA-27) fully completed by an enrolled provider prior to authorization of continued opioid medication by DFEC.  Incomplete CA-27s will be returned to the provider without further processing.  Authorizations for opioid prescriptions will be limited to a maximum of 60 days, with initial fills and refills to be issued in no more than 30-day supplies. Providers should only offer the patient the amount that the physician believes the patient will need.  Providers should utilize “partial fills” for schedule II and schedule III opioids.  As part of the new opioid policy, no more than two opioids will be permitted for a single case.  Additionally, compounded medications containing opioids will require a completed and approved LMN prior to dispensing, effective June 26, 2017.

The Letter of Medical Necessity (LMN/Form CA-27) is accessible to OWCP-registered providers on the ACS website (http://owcp.dol.acs-inc.com/portal/main.do)  and must be completed by the treating physician and submitted electronically. Instructions on how to submit the LMN are available on the Latest Developments section of the ACS website.

Additionally, DFEC recently issued FECA Bulletin No. 17-07 which provides further information on the new policy. This Bulletin can be found at https://www.dol.gov/owcp/dfec/regs/compliance/DFECfolio/FECABulletins/FY2016-2020.htm#FECAB1707

Keep this in mind when you stop work for an approved surgery

When a FECA claimant stops work to undergo an approved surgery, your OWCP claims examiner cannot start your check for lost wages without proof that you actually had the surgery. This frequently causes workers' comp payment to be delayed because medical providers can be quite slow in submitting bills and treatment records. It is a good practice to get a copy of the operative report as soon as possible or even a note signed by the doctor confirming that you had the surgery. Make sure you mark your file number on it and fax or upload it to your OWCP file. That way your claims examiner can document that you had the surgery and start paying you. Your claims examiner is concerned that that if, for some reason, your scheduled surgery is delayed or canceled at the last minute, they do not want to have paid you when in fact you are back to work or off work for a reason unrelated to your work injury. 

What happens to OWCP claims if there is another government shutdown?

I am getting asked this question once again as it looks like there is a possibility of another shutdown due to a budget impasse. In the past, OWCP district offices have continued to operate as an essential function, but the Branch of Hearings and Review has been shutdown. We will wait and see what happens.

Here my post from the last shutdown in 2013:
http://owcplawyer.blogspot.com/2013/10/the-government-shutdown-and-owcp.html

This link is from APWU regarding the 2013 shutdown:
http://www.apwu.org/news/web-news-article/how-does-shutdown-affect-owcp-claims