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Tmilwaukee  
#1 Posted : Sunday, January 23, 2011 8:50:03 AM(UTC)
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I slipped on ice & tore up my shoulder about a year ago. I had rotator cuff surgery in March & was off for 3 months, collecting workman's comp. I've been told that I'm also entitled to a scheduled award. I have a doctor appointment tomorrow to get things rolling & also filled out the CA-7 form.

Any advice from anyone on proceeding with this? Anything I should know before seeing the doctor? I'm new to this procedure & wasn't even aware of it until someone at work told me about it.

NECArrier  
#2 Posted : Sunday, January 23, 2011 9:47:01 AM(UTC)
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Its called a schedule award, because the list of amounts to be paid for various disabilities or losses (loss of finger, toe, arm, etc) is called a schedule, so when you get paid the amount off the schedule, it is a "schedule award".

You might want to investigate this thoroughly. Does getting the schedule payment mean that the USPS is done with liability for that body part? Shoulders are notoriously tricky and yours might need further surgery down the line. If you get a schedule award, you might not be able to get the USPS to accept any further claims for that same shoulder. Worth checking out. I don't know the answers.
Nostradamus  
#3 Posted : Sunday, January 23, 2011 9:55:43 AM(UTC)
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How to Fight for a Schedule Award
By Brad Harris, Attorney at Law

One
important federal workers compensation benefit is the schedule award. It is
payment for the permanent impairment of an extremity as the result of a
work-related injury.  Eligible applicants can elect to have it paid over a
period of time or in a present value lump sum payment. When it comes to
filing for schedule award one of the most important aspects of the claim has nothing to do with you, but your doctor.


First, although it may be obvious to you that you are injured, the award is
not available for impairment of the back (spine), heart or brain.  However,
you may still qualify if impairment develops at other parts of your body as
a result of the injury to the ineligible part.  For example, nerve root
restriction at the portion of your spine that is injured often develops
impairment at the part of the body serviced by the nerve: lumbar problems lead to leg problems or neck problems lead to hand problems.


Of course, a person cannot get a scheduled award if they do not have an
accepted workers' compensation claim. For the claim to be accepted, the
employer must agree, or the Office of Workers' Compensation Programs (OWCP) must decide, that the injury was work related.


This is often an area of hot dispute. It is not unusual for the employer to
hire a consulting doctor for an agency medical exam.  Quite often, he
provides the basis for the denial of the worker's claim because his opinion
is that the injury did not really occur at work or that it is "pre-existing"
or merely a "degenerative" condition.  Injured workers are sometimes shocked
to find that in their time of need, it seems to them, that this doctor is
not being fair. A lot of people just don't normally attribute the negative aspects of advocacy to doctors.


Unfortunately, you will need your doctor in your corner during this boxing
match. Most doctors who actually try to help patients are unaware of just
how specific you will need for his or her written opinion to be when
attributing the injury to your work activity. Many treating physicians don't
like having to deal with all of the paperwork and delays required by the workers compensation laws just for one patient. 

When it comes to
debating a consulting doctor's opinion there are few things you need to make
sure to have. First, a detailed responsive report should be obtained and
filed in the record to contradict the agency medical examiner's opinions.
Your doctor is probably not accustomed to having his opinions challenged or
otherwise questioned by a consulting doctor hired by your employer. Treating
doctors can often be uncomfortable in the role of having to become your
advocate. It is easier for them to resort to ambiguous or vague statements
regarding their diagnosis and the cause of your problem. This can have the
effect of decreasing the strength of evidence in your favor when compared to the certainty expressed by the employer's consulting doctor.


I suggest that you that you take the time and money to obtain a good
responsive report from your treating physician. In doing this, it is
extremely important to get organized. For example, you should put together
all of your medical records in a three ring notebook with tabs, a table of
contents and summaries for your doctor. You may consider hiring a nurse to
be your helper in this. The goal is to make it easier for your treating
physician to review the opinions of the opposing doctors, as well as your
other doctors, in order to incorporate those things into an overall responsive report.

Of course one of
the primary things upon which he needs to focus is that you were not
experiencing any symptoms in this portion of your body prior to the work
related injury. Your doctor also needs to write about how there is nothing
uncommon about a person already having a weakened "degenerative" condition
without suffering any problems and then, as the result of a particular work
incident, the condition becomes painful or otherwise symptomatic. It can be
the case that a pre-existing, weakened condition can make people more likely to suffer injury than someone without the pre-existing condition.


Making a statement like this allows your doctor to help you turn what looked
liked a weak case into a stronger case when they attribute your impairments
and restrictions to the work incident. This can be further substantiated by
the fact that your records may clearly reflect that you were not receiving
any medical treatment for those portions of your body during the 12 months preceding the incident.


In order to get your workers compensation scheduled award, you should make
sure your OWCP scheduled award request file is complete.  The most important
document to be put in your file is a rating of your impairment by a physician.


Generally speaking, the amount of the award is dictated by the extent of
impairment and which body extremity is impaired. For example each limb is
assigned a number of weeks of compensation for its "loss of use".  If the
doctor determines you have a 25% impairment of that limb, your award is 25%
of what your workers compensation wage loss benefit would be for those
weeks.  Eligible applicants can elect to have it paid over a period of time or in a present value lump sum payment.


You need your impairment rating to be conducted in accordance with the
strict guidelines required by the federal government. Many doctors are
simply inexperienced in rating impairments in accordance with those
guidelines. Some think they are experienced because they may have done
something similar for a non- federal workers compensation patient in the
past - but they are wrong... the way of calculating the impairment for a federal employee is not the same as for a non-federal employee.


Unfortunately, some surgeons are very hesitant to help you substantiate the
residual impairment problem because that is like saying that their operation
was not successful. They mistakenly fear that somehow it is like admitting
malpractice. I sometimes think they must be taught to describe every
surgical procedure as a complete success. Fortunately, the rating does not have to be provided by your treating surgeon.


You should check with the doctor, his staff and other personnel in his
office to make sure that the work is done correctly. They might not be
experienced in this, they might not want to admit it, but you can't afford
to lose a very important benefit because of the possible discomfort of addressing their experience in the rating process.  Good luck!

Brad Harris can be
contacted at (877) 226 -2723 or at hbharris@iglou.com or at his website www.**********


Nostradamus2011-01-23 18:01:37
Nostradamus  
#4 Posted : Sunday, January 23, 2011 10:09:17 AM(UTC)
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I received a schedule award for a foot injury. I was injured on the job, treated at a hospital, filled out the CA-1 and was sent home.
It happens to be I have a family member that is a lawyer. So I called her to ask what to do. She was ADAMANT. "GET A LAWYER THAT SPECIALIZES IN FEDERAL WORKERS COMP, THEN GO TO THE DOCTOR HE/SHE RECOMMENDS."
That way all your players are singing from the same sheet of music. The Lawyer fills out the paperwork for the claim CORRECTLY, THE FIRST TIME IT IS SUBMITTED and the doctor WRITES A NARRATIVE THAT SUPPORTS THE INFO CONTAINED IN THE LAWYERS CLAIM DOCUMENTS.
My claim was never disputed. (They won't touch you if they're dealing with a lawyer that THEY KNOW knows what he's doing. Trust me).
I got 44% permanent disability schedule award, so I got 44% of 205 weeks of pay. (Over $100,000). The lawyer got 12.5% of that. Money well spent.
And most of all, no supervisor can ever say "I didn't go fast enough" again. I have a permanent disability, DOCUMENTED. The pace I choose is the pace I go, so "deal with it baby sup."

Read next post.

Nostradamus  
#5 Posted : Sunday, January 23, 2011 10:10:20 AM(UTC)
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The FECA provides for the payment of a Schedule Award. Schedule Awards
are defined as an award of compensation payable for a set number of weeks
for the loss or loss of use of a part of the body, whether total or partial.

The degree of impairment is established by medical evidence and expressed
as a percentage loss of the member involved. Permanent impairment may
originate either within the affected member (i.e., loss of use of your arm
in a Carpal Tunnel Syndrome claim) or another part of the body (i.e., a back
injury may result in impairment to a leg) for which a Schedule Award would be payable.

A claimant may also receive an Award for more than one part of the body
concerning a single injury (i.e., a back injury may result in impairment to a leg and an arm).

The body members covered by the Schedule Award and the compensation schedule include:

Arm 312 weeks
Fourth Finger 15 weeks
Leg 288 weeks
Hearing (1 ear) 52 weeks
Hand 244 weeks
Hearing (both) 200 weeks
Foot 205 weeks
Breast 52 weeks
Eye 160 weeks
Kidney (1) 156 weeks
Thumb 75 weeks
Larynx 160 weeks
First Finger 46 weeks
Lung (1) 156 weeks
Great Toe 38 weeks
Penis/Female Sex Organs 205 weeks
Second Finger 30 weeks
Testicle/Ovary (1) 52 weeks
Third Finger 25 weeks
Tongue 160 weeks
Toe (other) 16 weeks

Note: The above figures represent total loss of use.

An injured worker should only apply for a Schedule Award after having
reached maximum medical improvement (MMI) and are back to work full time
(even in a limited duty capacity) or retiring. The OWCP will not pay
compensation for wage loss (i.e., time in LWOP-IOD being paid by OWCP) and a
Schedule Award at the same time; however, if the injury occurred on or after
September 13, 1957, the Schedule Award may be paid concurrently with
benefits under the U.S. Civil Service Retirement Act (OPM). In order to apply for a Schedule Award, you need to submit a CA-7.

The treating physician should be advised to use the American Medical
Association's Guides to the Evaluation of Permanent Impairment, Fifth
Edition, and to report findings in accordance with those guidelines. Injures
sometimes leave objective or subjective impairment that cannot easily be
measured by the AMA Guides. Some examples are: pain, atrophy, deformity,
loss of sensation, loss of strength, marked sensitivity to heat or cold, and
soft tissue damage such as scarring and discoloration. The effects of such
factors should be explicitly considered along with the impairment measurable by the AMA Guides (5th Edition).

To support a Schedule Award, the file must contain competent medical evidence which:

  • Shows that the impairment has reached a permanent and fixed state (MMI)
    and indicates the date on which this occurred (date of maximum medical improvement).
  • Describes the impairment in sufficient detail for the Claims Examiner to visualize the character and degree of disability; and
  • Gives a percentage evaluation of the impairment (in terms of the
    affected member or function, not the body as a whole, except for impairment to the lungs).

The treating physician should also provide a detailed description of the
impairment which includes, where applicable, the loss in degree of active
and passive motion of the affected member or function, the amount of any
atrophy or deformity, decreases in strength or disturbances of sensation, or other pertinent description of impairment.

Once all of the medical evidence has been submitted to OWCP, the Claims
Examiner will review the file for completeness and forward the entire case
file to the District Medical Advisor (DMA) for verification. If there is no
conflict in medical option, you will be notified of the details concerning
your Schedule Award. If there is a conflict, the Claims Examiner will schedule a second opinion or contact the physician for clarification.

Schedule Award--FECA Procedure Manual Chapters
Information on schedule awards can be found at the following:

* 5 USC 8107 * 20 CFR Part 10, Section 10.404 * 20 CFR Part 10, Section
10.422 * FECA Procedure Manual Part 2, Claims, Chapter 2-808 * FECA
Procedure Manual Part 2, Claims, Chapter 2-901, Section 14 * FECA Procedure Manual Part 3, Medical, Chapter 3-700

More About a Schedule Award Payment

  • A claimant CAN NOT collect compensation for lost wages and a schedule award at the same time.
  • One exception: If the schedule award is payable due to a compensable
    injury that is not the one they are collecting compensation for lost wages for [2 separate claims].
  • Normally, schedule award will be paid in a lump sum if the claimant has returned to full duty [8 hours per day] or is collecting OPM.
  • In the event claimant is collecting FULL compensation for lost wages,
    such compensation will be suspended until the schedule award is paid in
    full. When schedule award is paid in full, compensation for lost wages
    will resume. Payment of schedule award will be in the same manner as compensation for lost wages, using the 28 day or so cycle.
  • In the event claimant is collecting PARTIAL compensation for lost
    wages [example 4 hour per day], such compensation will be suspended until
    the schedule award is paid in full. When schedule award is paid in full,
    partial compensation for lost wages will resume. Payment of schedule award
    will be in the same manner as compensation for lost wages, using the 28 day or so cycle.

For further information on payment of schedule award, see:

* 20 CFR Part 10, Section 10.404 * 20 CFR Part 10, Section 10.422 * FECA
Procedure Manual Part 2, Claims, Chapter 2-808 * FECA Procedure Manual Part 3, Medical, Chapter 3-700


nathaniel1fun  
#6 Posted : Sunday, January 23, 2011 12:50:32 PM(UTC)
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Nostradamus
 
Great info posted.  Was your impairment rating done under the AMA 6th Edition?
Nostradamus  
#7 Posted : Sunday, January 23, 2011 6:55:43 PM(UTC)
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I thought it was 5th, but I could be wrong. I remember the doctor saying something like "The guidelines recently changed but I know we recieved the latest issue" or something like that to one of his staff.
My injury happened about 8 years ago so I would not be surprised if they've changed, and change often.
As an example of the games they play (Not related to the schedule award process): My wife is a nurse and also handles some billing in her doctors office where she works. Well, when billing for a treatment provided, every procedure has a "code" that has to accompany the bill sent to an insurance provider. They change the codes every year. Why? So claims will be denied. Patients will get bills marked "The following claims are not covered" or such. It's also frequent to see, for instance, last years code for Tylenol is this years code for Tylenol with Codeine. One is 80-cents a pill and the other is $6/pill.
Bottom line: You need to deal with people who know what they're doing. Yes, they get paid. But it's like you suing somebody and getting $2000 or you having a lawyer do it and getting $10,000 with the lawyer getting $3,300. You still get 3-times as much. Remember, you don't NEED a lawyer but I think it was great advice to retain one. It was done right the first time and quickly completed without the back-and-forth hassles.
My lawyer took 12.5% but paid the doctor who did the examination and prepared the all-important  narrative.
It took about 3 months to get the check and I did not Know how much it would be (exact amount--because nothing was approved he couldn't tell me an exact amount, just what "it might be").
I was not expecting the check and was floored by the amount. Pleasantly. (It's a government Treasury check just like an income tax refund).

Nostradamus2011-01-24 03:03:27
clogsgalore  
#8 Posted : Monday, January 24, 2011 4:14:52 AM(UTC)
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If you are still on OWCP you cannot get a scheduled award.  If you are NOT collecting OWCP, your physician has a book, (AMA Guidelines for Disability and Impairment) that he/she will consult to determine the percentage of loss of use or impairment to you from your injury.  This will determine the amount of your scheduled award.
jesse slade  
#9 Posted : Monday, January 24, 2011 4:51:41 AM(UTC)
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Was thanked: 1 time(s) in 1 post(s)
Nostradamus: Some of the information you provided above is not accurate. For example, an employer can controvert an employee's work comp claim, but the employer does not play a role in the decision...that is the sole responsibility of OWCP.
 
Although an employer can send you to one of their doctors, an employer's physician's opinion is of no value to the OWCP.
 
Simply being asymptomatic is not enough for OWCP to determine you suffered a work related injury. The  doctor must provide a nexus between the work and the injury. Simply saying that the condition was asymptomatic prior to the accident or whatever does not prove causation. The doctor must provide casual relationship between the work, the event that caused the injuries and the conditions the employee suffers now.
maddog  
#10 Posted : Monday, January 24, 2011 5:11:47 AM(UTC)
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Nostradamus - I notice on your 1st Post that you appear to attribute the column to Bo Harris.  He as other may know is working himself into the "OWCP Attorney Area"  So is this really a claimant or Bo Harris.
 
One comment for all claimants.  Taking a lump sum payment is a gamble.  First of all you cannot receive any other compensation even if you have a recurrence of injury and are out of work.  Also you lose 4% of the total amount payable to you.  If you have the type of injury that could most definitely be re-injured, mu advice is do not take a lump sum.
branch  
#11 Posted : Monday, June 18, 2012 11:23:17 AM(UTC)
branch

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what does this mean


2011-08-19 84 - 2011-10-07 Not Payable - SA 2011-08-08

NECArrier  
#12 Posted : Monday, June 18, 2012 6:06:29 PM(UTC)
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did you already get a schedule award for an injury that you are now asking workman's comp for?
branch  
#13 Posted : Tuesday, June 19, 2012 11:48:46 AM(UTC)
branch

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I haven't received anything from these people.
NECArrier  
#14 Posted : Tuesday, June 19, 2012 7:06:31 PM(UTC)
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Do you have the number for the Injury Compensation specialist for your district? They are supposed to act as a liason between the injured employee and the OWCP. You could call them with your question.
You could also call your claims examiner @ OWCO and ask them the status of your claim. I've had good luck with both paths.
You could also ask your steward for the phone number of the guy in your business agent's office who handles OWCP issues, he might be able to tell you.
branch  
#15 Posted : Wednesday, June 20, 2012 12:32:40 PM(UTC)
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No I haven't received anything yet.
branch  
#16 Posted : Wednesday, June 20, 2012 12:47:27 PM(UTC)
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No I don't have that information.  I just have the CE and she can't tell me anything more than what is on the CQS.  I'm new with this.  It's been a year since I've filed and the only way I found out about the scheduled award was to read it in a letter I had received.  The doctor has just entered my MMI date.  Do you think I should contact a lawyer and do you know of anyone?  I broke my ankle, compound fracture, May 17, 2010 and my ankle is still broken and it has reached is max according to my doctor.  I could have bone graft but the doctor says I could lose my foot. I broke my ankle at work. This has changed my life for good.  I'm in pain and in wheelchair and I wear a boot because it's not healed completely and also I could break my ankle very easy. I would appreciate any help you can and have given me.  My email address is:  branchm69@yahoo.com  Thank you so much.  My job was with Department of Homeland Security in Human Resources. 
Whale wall  
#17 Posted : Monday, July 01, 2013 4:20:34 PM(UTC)
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In regards to Schedule awards, if I have a rotator cuff tear and decided not to get surgery on it. It has been going on three years since the incident happened, had injections but no surgery. Could I still qualify for a schedule award since it is not going to get any better. How do I proceed.
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