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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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djplourd  
#1 Posted : Monday, June 24, 2019 7:46:22 AM(UTC)
djplourd

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This could be a long story but I'll try to keep it brief.

My wife was injured in a car accident 2 1/2+ years ago. She was outside running during her authorized physical fitness (3 hours a week) and wa***** by a car while crossing the street in a crosswalk. So far she has had two neck surgeries, a shoulder surgery, and recently had a cervical spinal cord simulator implanted. So far the simulator isn't helping much, so there's a possibility of a third neck surgery or we just call it quits and pursue DR.

OWCP has inquired about repayment because of the 3rd party liability. I filled out a draft Form CA-1108 but I was just guessing at the settlement amount.
Questions:
1. Line 4 - LOSS OF CONSORTIUM - In a non-death case or a death case where no cause of action for wrongful death is asserted, a reasonable allocation for a spouse’s loss of consortium will be up to 25% of Line 3. How does OWCP determine the %?

2. OWCP is asking to include travel payments and case nurses salaries in the repayment. Our lawyer is disputing those as administrative costs but what is acceptable for them to request repayment for?

3. Most of her medical care has been through Tricare and not DOL. Assuming the settlement includes the Tricare costs, how do we show that on the form? The first line asks for Gross Recovery (Entire Amount of the Award). If any Tricare costs are included in the repayment calculations, then our repayment would be larger than it should be.

It is unlikely that she will regain full use of her arm. When should we pursue the schedule award? Or Disability retirement? Both? Right now she's still be covered for lost wages (except for the last several months because DOL is disputing approval of her shoulder surgery). Currently she's scheduled to return to work in about a month, but for only 3 hours a day and her activities are so limited she really can't do much of anything.


Daniel
frankgonzalez  
#2 Posted : Monday, June 24, 2019 10:10:59 AM(UTC)
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Originally Posted by: djplourd Go to Quoted Post
This could be a long story but I'll try to keep it brief.

My wife was injured in a car accident 2 1/2+ years ago. She was outside running during her authorized physical fitness (3 hours a week) and wa***** by a car while crossing the street in a crosswalk. So far she has had two neck surgeries, a shoulder surgery, and recently had a cervical spinal cord simulator implanted. So far the simulator isn't helping much, so there's a possibility of a third neck surgery or we just call it quits and pursue DR.

OWCP has inquired about repayment because of the 3rd party liability. I filled out a draft Form CA-1108 but I was just guessing at the settlement amount.
Questions:
1. Line 4 - LOSS OF CONSORTIUM - In a non-death case or a death case where no cause of action for wrongful death is asserted, a reasonable allocation for a spouse’s loss of consortium will be up to 25% of Line 3. How does OWCP determine the %?

2. OWCP is asking to include travel payments and case nurses salaries in the repayment. Our lawyer is disputing those as administrative costs but what is acceptable for them to request repayment for?

3. Most of her medical care has been through Tricare and not DOL. Assuming the settlement includes the Tricare costs, how do we show that on the form? The first line asks for Gross Recovery (Entire Amount of the Award). If any Tricare costs are included in the repayment calculations, then our repayment would be larger than it should be.

It is unlikely that she will regain full use of her arm. When should we pursue the schedule award? Or Disability retirement? Both? Right now she's still be covered for lost wages (except for the last several months because DOL is disputing approval of her shoulder surgery). Currently she's scheduled to return to work in about a month, but for only 3 hours a day and her activities are so limited she really can't do much of anything.


Daniel
Also remember Tricare will want part of any settlement you get form the driver with regard to medical payments...so you will need to factor that in as well.
You should have voted Cthulu...the greatest of all Evils
djplourd  
#3 Posted : Monday, June 24, 2019 11:55:29 AM(UTC)
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Originally Posted by: frankgonzalez Go to Quoted Post
Also remember Tricare will want part of any settlement you get form the driver with regard to medical payments...so you will need to factor that in as well.


The last time we checked with our lawyer Tricare still hasn't responded with their medical bills. There's no way the settlement will be large enough to cover all the Tricare bills. Each of the neck surgeries were $200K+. Somebody's coming up short between DOL, Tricare and us, but I'm not paying any shortage out of my pocket.

Let's say the total cost is $750,000 for medical and wages, but the settlement is only for $100,000 because that was the limit of the drivers insurance coverage. Of course we'd sue for at least the remaining $650,000 (which didn't even include pain and suffering). Who gets what $ out of the $100,000? And if we get a judgement against the driver for the difference, does a percentage go to DOL and Tricare? And teh lawyers get their cut as well.

The wages covered from DOL have already been more than $50,000, plus roughly $20,000 in medical and admin costs.
frankgonzalez  
#4 Posted : Tuesday, June 25, 2019 10:28:33 AM(UTC)
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You need to break out everything. You can't say "Wages and medical" cost $750K, so who gets how much?" Tricare isn't going to care about the amount for lost wages. They are solely concerned about the medical costs. DoL may be concerned about some medical costs (if they paid out anything in that realm), but are concerned about lost wages.

So who wants what will depend on how much was spent on what by each one. I'd call the local Tricare office to find out what they will be coming for, then call DoL and try to find someone who can answer the same question on their end.
You should have voted Cthulu...the greatest of all Evils
jesse slade  
#5 Posted : Tuesday, June 25, 2019 11:43:00 AM(UTC)

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With OWCP and a third party claim where the OWCP medical and compensation are significant, the settlement is often lower than the amount already paid by OWCP.

OWCP allows a claimant to keep a minimum of 20% of the settlement. Even if the costs already paid are less than the settlement, OWCP keeps the unused portion to apply toward the costs of the claim. If the claim is closed, all benefits are paid, and there's an excess of the settlement, that excess is returned to the claimant.

You should not be completing the statement of recovery if no settlement has been made. Instead, update OWCP of the progress of the case, i.e., by telling them it has not yet been settled. When settlement is expected (if known), the progress, etc...

If you complete the statement of recovery, you're telling OWCP recovery has been made and they'll expect their money. This is why you can't complete it accurately, because there has been no recovery.

You can guess all you want about what the settlement might be, you can notify OWCP of what you're guessing the settlement might be and you could be completely wrong. So best to not guess because you have no idea what the actual settlement is going to be.

Loss of consortium isn't automatically awarded. This would be part of the lawsuit. If loss of consortium is awarded to you, the amount awarded is usually based on your state's laws for loss of consortium. But you may not receive loss of consortium.

If her claim was accepted as work-related, the providers should have been billing OWCP not Tricare. If this is still occurring, every provider should be instructed to bill only OWCP for anything related to her accepted claim.

You cannot apply for a schedule award until she reaches Maximum Medical Improvement, (MMI). If she requires surgery, she has not reached MMI.
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