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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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gringobonk  
#1 Posted : Wednesday, January 23, 2019 1:48:01 AM(UTC)

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So I got a letter from OWCP denying ongoing physical therapy (I know, such a shocker right folks?). But here's the curious thing, based on the letter head and some quick googling, it looks like the Regional Medical Advisor outsourced the review of my case and as far as I know their own code does not indicate that this is within protocol or okay.

First and foremost, does any one know the name of District 13 RMA? Is it Tony Villa?

I have a letter from my claims examiner, Airiel Quintana that poses the questions about medical necessity and causal relationship of the diagnoses to the "District Medical Advisor".

Then I got a letter from OWCP denying medical treatment with the "District Medical Advisor Review" attached. There are problems with it, including the idiot answering one question with both, yes for treatment is required, and then an explanation for why it isn't required.

But the doctor who did the write up, Todd Fellars, put in the heading "attn: Tony Villa". And the way the doctor signs off, it comes across as a SECOP write up.

Am I mistaken in thinking that the District Medical Advisor is the actual title of ONE individual within OWCP who is supposed to review these things and provide feedback?

I have to find out who Tony Villa is, and more details to make sure OWCP followed protocol because if they didn't it's something I will obviously use to shoot these jerks down.

Some one please chime in and help clear up what ever you can!

Thanks!
jesse slade  
#2 Posted : Thursday, January 31, 2019 8:54:27 PM(UTC)

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According to his LinkedIn page, he's a "workers' compensation specialist" in San Francisco (District 13).

He is not a doctor.

There's a Regional Director, District Medical Director and District Medical Adviser, but no regional medical adviser that I'm aware of.

Claims Examiners are not physicians, so when they have medical questions (among other things), they refer the file and questions to the DMA who is a physician. The DMA then provides OWCP a report.
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gringobonk on 2/2/2019(UTC)
gringobonk  
#3 Posted : Saturday, February 02, 2019 2:28:32 AM(UTC)

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Originally Posted by: jesse slade Go to Quoted Post
According to his LinkedIn page, he's a "workers' compensation specialist" in San Francisco (District 13).

He is not a doctor.

There's a Regional Director, District Medical Director and District Medical Adviser, but no regional medical adviser that I'm aware of.

Claims Examiners are not physicians, so when they have medical questions (among other things), they refer the file and questions to the DMA who is a physician. The DMA then provides OWCP a report.



Okay, so is this District Medical Adviser, who is a doctor, allowed to outsource his report because that looks exactly like what happened?

Based on your response it sounds like somehow this Tony Villa was an intermediary outside of OWCP, who forwarded the CEs inquiry to Todd Fellars, MD.

I was pretty sure that the 3 positions you mentioned were actual titled positions and not some label akin to "Second Opinion" doctors, which is why I asked.

If the DMA outsourced this when they are supposed to be the one providing the analysis and answering of the CEs inquiry then this sounds like a huge breech of protocol. It sounds like patient confidentiality is also being breeched as protocol doesn't authorize outside contractors access to the records nor these outside doctors who provide this function.

I have to finish putting together an attack on the Fellars report and if he's not even authorized to be submitting reports that would allow me to attack the entire report as invalid.

I need to get a response in before Feb 10th so if you could clarify regarding my questions about outsourcing I would greatly appreciate it. I can't find any thing in their manual indicating this is remotely okay.
jesse slade  
#4 Posted : Saturday, February 02, 2019 9:50:20 AM(UTC)

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Villa is more likely a CE in District 13 calling himself an OWCP specialist.

The functions of the DMA include interpretation of medical reports; rendering medical evaluations in his or her own right; and providing guidance or instruction to claims staff regarding general medical issues which are in compensation claims.

It's not a breach of protocol or regulations to use a DMA, it's part of the system.

The role of the DMA is covered in part 3 of the FECA Manual at 3-0200-4.

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gringobonk on 2/7/2019(UTC)
gringobonk  
#5 Posted : Sunday, February 03, 2019 4:42:07 AM(UTC)

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Originally Posted by: jesse slade Go to Quoted Post
Villa is more likely a CE in District 13 calling himself an OWCP specialist.

The functions of the DMA include interpretation of medical reports; rendering medical evaluations in his or her own right; and providing guidance or instruction to claims staff regarding general medical issues which are in compensation claims.

It's not a breach of protocol or regulations to use a DMA, it's part of the system.

The role of the DMA is covered in part 3 of the FECA Manual at 3-0200-4.



I've read the manual. I know the DMA is part of the system. I didn't make myself clear.

This individual, Todd Fellars, MD has a practice in San Diego. He wrote the report.

I was under the impression that the DMA would be a full time employed position with the OWCP and that they wouldn't have a practice outside of the OWCP. I didn't expect a report by the DMA to close with a line such as, "Thank you for asking me to review this file in consultation."

This sounds like a line from my attending physician reports, or SECOP reports.

I'm trying to figure out if this guy is the DMA, or if the task was outsourced to him.

I'm sorry for not making myself clear and being difficult. If you can help understand this better I would appreciate it. I don't see any thing clarifying the issue of DMA full time employment, like the CE so that's why I'm horribly confused right now.
jesse slade  
#6 Posted : Sunday, February 03, 2019 12:00:37 PM(UTC)

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DMAs are contracted. They're not full-time employees. There may be one or more contracted for any District.
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gringobonk on 2/7/2019(UTC)
gringobonk  
#7 Posted : Thursday, February 07, 2019 10:30:00 PM(UTC)

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Originally Posted by: jesse slade Go to Quoted Post
DMAs are contracted. They're not full-time employees. There may be one or more contracted for any District.


This helps clarify things tremendously, thank you.

I could have sworn they were a full time, titled position, but given how the letter was written and what you've said it makes sense. On to attacking his errors.

And do you know the due date for a response? Is it the day the CEs letter is dated to me, or the day they mailed it to me, because they mailed it 3 days after the letter is dated which cuts into my time to respond otherwise....? I'm going to try digging this up in the FECA manual again. I used to have this memorized but it's been a while since they had a go at me.
jesse slade  
#8 Posted : Friday, February 08, 2019 8:07:37 PM(UTC)

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If you were provided a 30 day response window, that clock starts from the date of the letter.
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