| Further issues to
investigate |
OWCP admits injured
workers aren't told how to satisfy their burden of proof, in their Customer Service
Plan: ". . . we need to do a much better job of informing injured workers
what the adjudication process entails, the type of evidence they need to supply, and the
target timeframes we strive to meet in adjudicating their claims. Goal: We will begin to
notify employees filing occupational illness claims of these evidentiary requirements,
what they can do to speed the process . . .". This is found in the Customer
Service Plan. No further proof of the adversarial nature of the process can be
required, by their own admission.
We would all like to know how many doctors' entire practice
consist of sending people back to work with opinions of no injury or no disability, and
who they are. We would also like to know how much OWCP uses the same small physician
pools around the country to do their second opinions, and why the pool of
"available" secop doctors is not much larger than it seems to be. The
practice of using cursory hands-off secops to create medical conflicts to deny claims or
terminate benefits should be investigated in detail. We believe that statistical
studies of these issues would reveal the most serious abuses by OWCP.
They don't tell injured workers or their doctors what is actually
needed to accept a claim , but play guessing games with the wording on causal relationship
and medical evidence. They offer easy access to case files for the agencies, but claimants
continually report they can't even get copies of their own files and medical reports in a
timely manner. Many cannot even find out what doctors said to cut off their benefits
without having to involve their Congressmen. The way they interpret "burden of
proof" is to expect injured workers and their doctors to dig out all the obscure
rugulations and case law that OWCP or ECAB might feel is applicable to their case.
This is an obvious impossibility without being able to routinely afford and use lawners,
yet many thousands of claims depend on being able to do this expertly.
Doctors everywhere hate to take federal injury cases. Our members
report that many times it's hard for treating physicians to get paid, and they are
routinely insulted, ignored, and pressured by agencies and "rehab" nurses.
Once a claim has been denied, claimants find it difficult to get doctors to continue
treatment or fill out the needed paperwork to rebut OWCP's own doctors regardless of how
unqualified or incompetent OWCP doctors may be. They get harassed by agencies and by OWCP
to return claimants to work, regardless of their own firsthand medical evidence and
knowledge.
Agencies commonly make verbal accommodations to light duty needs,
and then force returning workers to aggravate the original injury or lose their job, then
lose their claims, and lose their health insurance and family security with it. They wait
months or years for treatment and income replacement, only to have OWCP finally approve it
as it should have done long before. Due to OWCP delays, medical conditions get worse and
the final cost goes up out of control. The worker sometimes ends up totally disabled for
lack of treatment.
One of the most obvious abuses is cutting off compensation and
treatment without sufficient warning, without time for them to revisit their treating
physicians for more specific examinations and reports for OWCP, and without understanding
why claims are cut off. If any warning is given, the time frame is too short to respond
with needed medical evidence in most cases, and in any event, the only recourse is to do
without and appeal for a hearing to be held months in the future. Time limits for
injured workers to respond should be from the date received, not from any old date that
OWCP puts on their letters.
Many of the injured report agency intimidation and retaliation.
We don't know how many legitimate claims are never even filed because they make examples
of those who do. But they can't sue; they can only try EEOC and wait years for justice. By
then, their careers, homes, and families may be history. This happens far too often.
Our reports from claimants indicate that the whole OWCP system
with its paperwork, red tape, and obscure regulations is simply too complicated for many
of the injured (and their doctors) to make effective use of the system and get the
protections that Congress intended. In most cases there is no realistic guidance for
the claimant to cope with the red tape and requirements. This makes the process
especially adversarial when people are in pain with attendant difficulty in coping with
the injury or disease itself and the frequent emotional damage or clinical depression that
may arise from it. Such collateral difficulties are well documented in medical
literature. But nowhere does the process take this into account.
Meanwhile, the claimant is up against an army of red tape experts in OWCP and the
agencies.
There is no ombudsman looking out for the rights of the injured
worker. How can we have an impartial and nonadversarial system without independent
assistance to those injured and disabled? OWCP has long demonstrated that their
primary allegiance is to the employing agencies, fostering widespread allegations of
collusion and unethical conduct.
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