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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 : Monday, June 29, 2020 7:56:43 PM(UTC)

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So here's a brief synopsis. I need help to ultimately get compensated for paying out of pocket. My claim has been open since 2004. I have had ongoing physical therapy that OWCP cuts in spurts and then restarts once my docs and/or theirs agree to the permanent damage in my tendons.

I have been with the same doc since 2015. He has followed the path of all of my previous docs including an orthopedic specialist I saw exclusively from 2010-2012. He has consistently recommended acupuncture, physical therapy and aquatherapy. OWCP was paying for and covering this with him from 2015- Nov 2018. At Nov 2018 they put a hold on everything with no medical evidence indicating they should do so. They claimed I shouldn't continue needing the treatment, my records show that the tendon injuries are permanent, starting with the Ortho in 2010. They failed to setup a SECOP until January 2020. I couldn't afford to fly to the other island (I'm in Hawaii) until they compensated me from a prior SECOP in 2017 (they ordered me to see a psychiatrist and an orthopedic specialist. I saw the psychiatrist first, and they kept refusing to compensate me for the flight and car travel expenses, which my family covered out of pocket. I told them I couldnt afford to fly back for the 2017 ortho appt and my family refused to cover it since OWCP failed to compensate me for the psych travel expenses. So OWCP cancelled the SECOP.) My medical expenses and Phys Therapy (PT) continued to get covered until Nov. 2018. When they halted it. They eventually compensated me for the 2017 psych travel expenses in mid 2019 if I remember correctly. Their in house SECOP ortho specialist that I flew to see in Jan 2020 concluded that I need continued treatment, palliative care, and that the tendonosis is PERMANENT and that status would never change and the tendonosis is already an accepted Dx by OWCP.

1) I filed for travel expenses with OWCP for the Jan 2020 trip and they received the filings on May 18, 2020 at london, ky. I have not had any responses or payments from them yet. How long should it take for a denial or payment? My sense of this is skewed since they played games and didn't pay my 2017 expenses until mid 2019. Please help give me a ball park idea?

2) The bigger issue. My attending phys. is a bit of a petty tyrant and he knew that the holds on medical treatment payments were in place (starting Nov. 2018), except for painkillers and other pills (go figure). From Nov 2018 to present he has written the same diagnoses as before Nov. 2018 and has recommended acupuncture, physical therapy, and aquatherapy. For part of the physical therapy I see a massage therapist who once worked under his medical corporation, but who left because he didn't like something she did (mention a chiro to some patients, and apparently chiro's can be primary providers in Hawaii which means people could completely change from him to the chiro, so he flipped out even though she mentioned it for treatment not for a physician change). So she stopped working under his corporation and set up as an enrolled independent medical treatment provider with OWCP. His staff told me they weren't working with her any more but I was set on using her as my treatment provider because she's never injured my tendons and I have the right to choose who I go to for treatment.

Well, as of Jan. 2020 the SECOP ortho agreed I needed the medications and the treatment and palliative care because of the permanent nature of the injuries. I've been trying to help make things happen to get reimbursed. The massage therapist submitted treatment plans to my attending phys. to have signed so she could submit them with payment requests to workers comp. The attend. phys. signed one from Oct. 2019 to March 2020 and another from March 2020 to Sept. 2020, but he refused to sign the prior two covering from Nov. 2018 to Sept. 2019 claiming that they were too old.

What can I do here? He's intentionally doing this to spite the massage therapist, but it's screwing me and my wife out of money we should be getting reimbursed since his records and the SECOP 2020 indicate that I needed that treatment during that time frame. I discussed this with him when OWCP had things on hold and the fact that we would need to come back to get covered what I was doing, under his recommendations, out of pocket (and what I could afford since aquatherapy, acupuncture, and the exercises at the PT place would have cost way more than the 1 manual tissue mobilization Tx / week my wife was covering).

This is literally a personal policy and he's doing this because of the provider. He has his own records indicating that he deemed I needed that Tx. This is stressing me out tremendously which makes my pain worse.

Can someone please provide guidance?
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