Federal employees’ workers’ compensation is intended to be a temporary benefit. It’s expensive to maintain, so both the injured worker’s employing agency and the Office of Workers’ Compensation Programs (the OWCP) are determined to return the worker to meaningful work as soon as possible. They also may terminate the benefits at any time, if the employee is arguably no longer eligible.
With this in mind, it’s incredibly important for federal workers to become familiar with the rules, understand the reasons the OWCP may cancel their workers’ compensation payments, and be prepared with a backup financial strategy.
The following is a list of the five most common reasons a federal worker may lose his or her workers’ compensation benefits:
1. The Federal Worker Provides an Insufficient Doctor Report
If you’re an injured worker applying for workers’ compensation benefits, your doctor must provide a diagnosis sufficient to warrant all medical services you may need. For example, if you are initially diagnosed only with “sprain”, and subsequently an MRI proves you need surgery, it will be difficult to get a necessary surgery approved.
When discussing your work-related injury with your doctor, be sure to emphasize the importance of the doctor giving a good initial diagnosis as well as providing updates as the condition may progress. The doctor should also explicitly link your medical condition to the work event. This is called the doctor’s “causation opinion”. It needs to be written in explanatory terms as opposed to conclusory statements. If the doctor doesn’t provide rationale for a definitive link between the work incident and medical condition, the workers’ compensation claim will not likely be approved. If the diagnosis never expands beyond preliminary, future services for the developed condition will not likely be approved.
2. The Federal Worker Refuses to Accept a Suitable Job Placement
An injured employee who cannot return to his position held at the time of injury, but who is not totally disabled for all gainful employment, is considered to be partially disabled – the employing agency has the right to offer him a different, but “suitable” position which the employee is obliged to accept.
Therefore, the employing agency tries to find the injured worker a new position, located in the same commuting area, which fits within the employee’s reported medical restrictions. Generally, the new position must fit the following requirements to be considered suitable:
- The employee can perform the physical requirements of the position in relation to the medical evidence
- The tenure type (permanent or temporary) must be the same as the employee’s former position
- The new position must fit within the federal employee’s skill set (vocationally, educationally, etc.)
If the federal employee refuses to seek suitable work, or refuses/neglects to work after a suitable job is secured for him or her, then the federal employee is not entitled to continued compensation.
You only have thirty days to provide reasons for refusing the position. Job offers are often incorrect for specific, unexpected reasons. For example, it must take into account ALL of your medical issues, regardless if they are work-related.
As soon as you receive the job offer, confirm the position’s description specifically notes the physical requirements, and discuss it with your doctor. Ask the treating physician to be certain you can sufficiently complete the proposed work activities. If you are offered a new position, which you do not believe to be suitable, explain why (in writing) to your employer.
3. An Employee (Without Good Cause) Does Not Participate in a Vocational Rehabilitation Program
The OWCP has the right to direct a permanently disabled federal employee to undergo vocational rehabilitation. This program supposedly is meant to “retrain” a federal worker for a new position that meets her new medical requirements. Unfortunately, this process is often used more as a way to reduce an employee’s workers’ compensation wage loss benefit. If the rehabilitation counselor deems the employee capable of working any job, the OWCP will accordingly reduce the employee’s workers’ compensation wage loss benefit.
If you are instructed to participate in the OWCP vocational rehabilitation program, you must participate or the OWCP has the right to completely terminate your wage-loss benefit. You can fight the OWCP’s post-vocational rehabilitation defined wage-earning capacity, but I strongly encourage you to seek legal counsel to build an effective case.
4. Employee with Inconsistent Medical Records Accused of Fraud
Most patients have no idea what information their medical records contain. If you have filed a workers’ compensation claim, your employing agency has the right to monitor your medical records to look for inconsistencies, which may be used to argue the indication of fraud.
Your employing agency has the right to contract their own private investigators or request the OIG (Office of Inspector General) investigate workers’ compensation cases. Their powers extend beyond what is even police permitted.
For example, they are not required to prove probable cause to a judge in order to obtain a subpoena. They simply type up their own subpoena, and present it as if it were a regularly obtained subpoena. They can even request your doctor not reveal the fact that they have visited with them and discussed your medical conditions.
If there is an indication of fraud, a federal employee will not only lose all compensation benefits, but he may also be subjected to a criminal investigation. The moment the OIG becomes involved in your case, you should contact a lawyer!
5. The Employee Fails to Cooperate with Required Additional Examinations
Your claims examiner can send your medical records to a new doctor for a second opinion. If the doctor disagrees with anything your personal physician has stated, there is now a “conflict” in the medical evidence, which serves as a justification for your claims examiner to schedule you to meet with a “second opinion” doctor of their choosing to resolve the conflict.
Because your claims examiner will not allow you to audiotape nor videotape your examination with the second opinion doctor, you may feel anxious about the process. For example, most second opinion examiners are retired and typically only spend a few minutes of examination time. You also don’t have some rights that state law workers’ compensation claimants have. For example, you don’t have the right to take a deposition of this doctor, nor even to send them written questions to answer.
You cannot refuse to meet with the chosen second opinion physician. If you do not cooperate, your workers’ compensation benefits will be terminated for failure to cooperate with the development of your claim.
Bo’s tip: The U.S. government provides worker compensation benefits to civilian federal workers who become injured or ill because of their job duties. Depending on the individual’s case, a worker may be entitled to lost wages, medical benefits, and/or a schedule award… but compliance with his or her requirements is mandatory. Don’t assume you know what’s going on in your claim without professional assistance.
To learn more about OWCP federal workers’ compensation, review this article I wrote for FedSmith.