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Federal Workers' Compensation

The Office of Workers' Compensation Programs administers four major disability compensation programs which provide wage replacement benefits, medical treatment, vocational rehabilitation and other benefits to certain workers or their dependents who experience work-related injury or occupational disease.

Here is a forum for members to share and exchange experiences regarding to workers' compensation related issues.


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ypiperpn  
#1 Posted : Sunday, July 4, 2021 8:35:43 PM(UTC)
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Good evening, I applied for a scheduled award last yr in Feb this is for my left knee at 35%. Aug 2020 a OWCP caseworker called me and asked me if I wanted my SR, I explained to her that I was waiting on authorization to have right hip surgery which is on the same claim as my left knee. I chose not to take it because I was/am still getting benefits, so the caseworker asked me to writing a letter saying that I was temporarily withdrawing my request for the SR. Now I get a different caseworker, filled a ca-7 for my scheduled award in May only to get rejected saying I can’t get it because my hip is not at MMI, is this a written policy, and why now all of a sudden I can’t get my SR for my left knee which is at MMI and apply for my SR for my right hip when that’s at MMI. Please clarify this for me so when I apply again, I will do it the correct way.
Thank you
VW1  
#2 Posted : Friday, July 9, 2021 12:32:20 PM(UTC)
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Yes, there is a written policy regarding your injury having to be at MMI when making a claim for a schedule award. You are looking at the situation as claiming a schedule award for your knee and then another one for your hip. If you look at the list of scheduled members and organs the knee and hip are not listed body parts. Your claim for a schedule award is for the permanent partial impairment to your left leg. Since you have two different injuries to that leg that are causing your impairment, and OWCP is aware of both injuries, then both injuries need to be at MMI when making your claim for a schedule award. That is due to the fact that when a doctor examines you for the purpose of providing an impairment rating, they must include all injuries to the scheduled member that cause permanent impairment.

If you look at the Federal (FECA) Procedure Manual, Part 2--Claims, Schedule Awards and Permanent Disability Claims, Chapter 2-808.5(b)(1) it states:

b. Evidence Required. To support a schedule award, the file must contain competent medical evidence which:

(1) Shows that the impairment has reached a permanent and fixed state and indicates the date on which this occurred ("date of maximum medical improvement" or MMI);

If you look at the Federal (FECA) Procedure Manual, Part 2--Claims, Schedule Awards and Permanent Disability Claims, Chapter 2-808.5(d) it states:

Rated impairment should reflect the total loss as evaluated for the scheduled member (i.e. arm, leg, etc.) at the time of the rating examination. See Raymond E. Gwynn, 35 ECAB 247, 253 (1983). There are no provisions for apportionment under the FECA. As such, schedule awards include permanent impairment resulting from conditions accepted by the OWCP as job-related as well as and any non-industrial permanent impairment present in the same scheduled member at the time of the rating examination.

If you look at the Federal (FECA) Procedure Manual, Part 2--Claims, Schedule Awards and Permanent Disability Claims, Chapter 2-808.6(b) it states:

If the claimant has not reached MMI, but evidence establishes that there may be impairment, the CE should advise the claimant in writing that once MMI is established he/she should submit the medical evidence establishing MMI and request that the claim for the schedule award be re-reviewed.

Hope this information was helpful to you.
ypiperpn  
#3 Posted : Saturday, July 10, 2021 10:03:55 AM(UTC)
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yes this is mostly helpful, but what I’m trying to understand is, I already had a 35% rating for my Left knee which was my initial injury then 2yrs later my right hip was added so now I have to wait until I reach MMI for my right hip because they’re under the same claim, also I have two different speciality ortho Drs. that’s treating me?
VW1  
#4 Posted : Wednesday, July 14, 2021 12:49:58 PM(UTC)
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Yes, you will have to wait until your hip injury reaches MMI. If you filed your claim for a SA based on the impairment to your extremity caused by the knee injury and they denied your claim, you can appeal that decision. This is just going to be additional and unnecessary work on your part because ECAB has stated that a SA cannot be paid unless the injury has reached a static and well stabilized state (MMI).

If you were my client, I would advise you to wait until the hip injury reaches MMI because this will most likely increase your percentage of impairment to your left lower extremity. When calculating your percentage of impairment, the rating physician must include all injuries to that extremity that are causing or contributing to your impairment. You might also find that the impairment caused by the knee injury will also increase since it has been 2 or more years since it was last evaluated.
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