Latest / Breaking OWCP with Chris & Gini / Chats (9-23-26) Breaking OWCP: What an Approved or Denied Claim Actually Means

Transcript

Chats (9-23-26) Breaking OWCP: What an Approved or Denied Claim Actually Means · Breaking OWCP with Chris & Gini

0:03
SPEAKER_00: Welcome back to the Breaking O WC Podcast.
0:08
SPEAKER_00: Join Chris and Jeannie as they bring you expert advice on Federal Workers Comp, guiding you step by step to get back to work the right way.
0:16
SPEAKER_00: Let's break down the barriers and get you the help you deserve.
0:21
SPEAKER_03: Welcome back.
0:24
SPEAKER_03: I sound like a Halloween character.
0:28
SPEAKER_03: Everybody, welcome back to Wednesday night OWCP chats with Chris and Jeannie.
0:34
SPEAKER_01: I am not Jeannie.
0:36
SPEAKER_03: We're feeling a little bit under the weather still.
0:40
SPEAKER_01: Yeah, I mean, if you saw us last week.
0:42
SPEAKER_03: We were dying like in our death chairs here.
0:45
SPEAKER_01: Yeah, and it just hasn't it hasn't gotten a lot better.
0:48
SPEAKER_03: And it's we know it's not flu or COVID, so it's just like sore throat, ear infection, sinus.
0:54
SPEAKER_03: It's just going around since we traveled from Vegas back to, I don't know why I was gonna say LA, back to Florida, the weather changed and it's still like so.
1:05
SPEAKER_01: She went from Vegas to Florida.
1:07
SPEAKER_01: I went to Vegas where it's just like dry, hot heat.
1:10
SPEAKER_01: It wasn't actually that bad, but the hotels are cigarettes.
1:14
SPEAKER_01: And because Dave Dorfman of Melbourne and Orlando, Florida got married to Mercedes.
1:20
SPEAKER_01: Congratulations, Dave Mercedes.
1:22
SPEAKER_01: Um, Dave wanted to go to a cigar bar.
1:25
SPEAKER_01: So I had a cigar in a smoky hotel.
1:28
SPEAKER_01: And then from there, we went, or I met my son in Texas in Milky, not Milwaukee, Wisconsin at Green Bay.
1:37
SPEAKER_01: And we watched Notre Dame beat Wisconsin, and it was a moist, cool night, a beautiful night, but way different than the environment in Vegas and Florida.
1:48
SPEAKER_01: And um, so it's an outdoor stadium at Lambeauville, which is awesome.
1:53
SPEAKER_01: And then came back home to Florida where it's you know hot and humid, and now this.
1:58
SPEAKER_01: So three different environments in like three different days, basically.
2:02
SPEAKER_01: Maybe four.
2:04
SPEAKER_01: And uh, so that's what happens.
2:05
SPEAKER_01: But anyways, glad to be back.
2:07
SPEAKER_01: We have a good topic for you tonight.
2:09
SPEAKER_03: Yeah, this topic, I'm reading your messages.
2:13
SPEAKER_03: I know there was like 524 of you that just were liking this last reel that you guys saw, Chris, talk about the OWCP 915 form.
2:24
SPEAKER_01: Hold on, 524, not 525, not 520, 524.
2:28
SPEAKER_03: Yes.
2:29
SPEAKER_03: And you guys, I remember one person said they've been with the post office for 20 years and they never heard about these forms and thinking, where are we making this stuff up?
2:42
SPEAKER_03: Yeah, we're not making this stuff up.
2:44
SPEAKER_03: These forms have been around longer than we've been doing OWCP.
2:48
SPEAKER_01: Yeah, and so as a result of hearing things like that, like I never heard of a 915 and 957, I don't know how to get paid.
2:54
SPEAKER_01: What's a CA 16?
2:55
SPEAKER_01: I'm like, oh my gosh, I've been doing this for 10, 11 years, and we still get these questions.
2:59
SPEAKER_01: Yes.
3:00
SPEAKER_01: So today I created a new training document for all of our franchisees just to make sure our case managers are really hitting home these documents, these forms, and you know what your rights are when they talk to you on the phone.
3:13
SPEAKER_01: Yep.
3:14
SPEAKER_01: Because it can't just be me teaching you, it's gotta be all of my people teaching as they go.
3:20
SPEAKER_03: And we keep telling you guys, come here.
3:22
SPEAKER_03: Those of you that are commenting and you say you never heard of this stuff, and I'm looking at some of these names.
3:27
SPEAKER_03: You guys have never came on here, I've never seen you on here, your name show up.
3:32
SPEAKER_03: You're probably watching the replay, which is fine.
3:34
SPEAKER_03: And we're glad to have you.
3:35
SPEAKER_03: But you guys gotta hit the follow button on Facebook, or if you're watching us on YouTube, you gotta click the subscribe.
3:41
SPEAKER_03: That's the only way you're gonna get the notification that we're going live.
3:45
SPEAKER_01: Yeah, so to my knowledge, I'm the only person that does this, and if anybody else ever does it, it won't be as good.
3:51
SPEAKER_01: They probably won't know.
3:53
SPEAKER_01: Maybe, I don't know.
3:54
SPEAKER_01: But you know, you need the information, and um, the only place you're really gonna get it, like the way I do it, is here.
4:01
SPEAKER_01: So tell your friends to follow us.
4:04
SPEAKER_01: There's no fee for being here.
4:06
SPEAKER_01: No, if we're not here selling swipe your credit card on the TV.
4:10
SPEAKER_01: Swipe a credit card.
4:11
SPEAKER_01: You don't have to go to any federal injury center's offices because you're here.
4:15
SPEAKER_01: There's no obligation.
4:16
SPEAKER_01: The only thing you're obligated to do is learn so you don't have the problems that other people have when they have an injury.
4:21
SPEAKER_01: Correct.
4:22
SPEAKER_01: And um, you know, it's really sad for me that the things I've been teaching for the last decade, there's still so many people that don't know about it.
4:29
SPEAKER_01: And that I've been in union groups of hundreds of people for the last decade, and still two-thirds of the people have never heard of me.
4:37
SPEAKER_01: I'm not anxious to be famous.
4:38
SPEAKER_01: I don't need to be or want to be.
4:41
SPEAKER_01: But the fact that you've never heard of me means that there's probably a good chance you never heard of a CA 16, for example.
4:47
SPEAKER_01: And that's a real problem, and we want to solve it.
4:50
SPEAKER_01: So get your friends here.
4:51
SPEAKER_01: You can put in the comments section here at in your friend's name, and that way they'll see it.
4:56
SPEAKER_01: You can also just share it with your friend, but if you do, come back because we have a good topic tonight that's gonna be helpful to you.
5:01
SPEAKER_01: Yep.
5:02
SPEAKER_01: We're gonna talk about approved versus denied claims, what it means and what you do about it.
5:07
SPEAKER_03: Yeah, because a lot of you are not understanding, and a lot of you are like missing deadlines, and we've done deadlines at the more when springtime was here about deadlines, and a lot of you are not understanding, and then about what do you do when your claim gets approved, and then a lot of you are telling me, well, once I get a denial, I just I don't do anything about it.
5:30
SPEAKER_03: No, that's not what you do when you get a denial.
5:32
SPEAKER_03: No, there's still some to come.
5:34
SPEAKER_03: Don't think that's the end just because you got a denial.
5:37
SPEAKER_03: Whether it's our office or another doctor, that's not the end of your case.
5:41
SPEAKER_01: And everyone gets denials.
5:42
SPEAKER_01: Every doctor gets denials.
5:44
SPEAKER_01: You know, you've all, if you've been with me for the last decade, you've heard me say that every denial is the fault of the doctor.
5:49
SPEAKER_01: I stand by that.
5:50
SPEAKER_01: Yep.
5:50
SPEAKER_01: But the difference between a doctor that understands the system and doctors that don't is the ones that understand it, they keep going.
5:56
SPEAKER_04: Yep.
5:57
SPEAKER_01: Because they understand the system.
5:58
SPEAKER_01: So we're gonna discuss that a little bit tonight too when we go through denials.
6:03
SPEAKER_01: But it's, you know, it's sad for me when I hear people say, Oh, you know, I got a denial, the end of the world is here.
6:09
SPEAKER_01: No, it's not.
6:10
SPEAKER_01: Or um, I got an approval, my claim's approved, everything's gonna be good.
6:14
SPEAKER_01: Not necessarily.
6:15
SPEAKER_01: Okay, it depends on what you do next.
6:17
SPEAKER_01: So we're gonna talk a lot about that tonight, and um, I'm gonna answer all of your questions.
6:21
SPEAKER_01: I told her to interrupt me, even in mid-sentence, if someone has a question.
6:25
SPEAKER_01: We're gonna be here until nine o'clock.
6:27
SPEAKER_01: We are notorious for going late.
6:29
SPEAKER_01: If you go late, asking questions.
6:31
SPEAKER_01: But the best thing you can do is ask them now, tell your friends because they're not gonna hear it if they don't hear me, um, unless you think you're gonna have a photographic memory and go back to work and tell your friends, which I hope you can.
6:43
SPEAKER_03: Victor.
6:44
SPEAKER_03: Victor is on Linda, my favorite friend, Linda.
6:47
SPEAKER_03: Hello, Jeannie and Chris.
6:49
SPEAKER_03: Tony Tony, thank you for all the great info.
6:52
SPEAKER_03: Very welcome, Jesse.
6:53
SPEAKER_03: Hello, guys.
6:54
SPEAKER_03: Good evening, good evening, good evening.
6:56
SPEAKER_03: We really don't have any housekeeping right now.
6:59
SPEAKER_01: Because we haven't done anything.
7:00
SPEAKER_03: We haven't done anything until we'll probably get to you guys with some housekeeping at the end of the month, but planning if you want to talk about the University of Notre Dame.
7:08
SPEAKER_03: No, we're not talking about that.
7:09
SPEAKER_03: But if you want to talk about the University of Utah or BYU, we can.
7:14
SPEAKER_01: We can, but Notre Dame would be better to talk about.
7:17
SPEAKER_03: We are planning on being here every Wednesday for this month, so which is a great treat.
7:22
SPEAKER_01: That means we're home.
7:23
SPEAKER_01: Yes.
7:23
SPEAKER_01: My dog doesn't forget who I am, and uh our kids get fed.
7:28
SPEAKER_03: All right, let's get started.
7:29
SPEAKER_03: Let me ask you guys something.
7:31
SPEAKER_03: I want to see, I want to see you guys drop your comments below.
7:34
SPEAKER_03: How many years do you have to file your OWCP injury claim?
7:41
SPEAKER_01: Okay, somebody that's heard me teach is gonna answer.
7:43
SPEAKER_03: Yeah, come on, guys, let's see.
7:44
SPEAKER_03: How many years?
7:45
SPEAKER_03: What have you heard before we start our topic?
7:48
SPEAKER_03: Because this is a part of this.
7:49
SPEAKER_01: Yeah, look, if you know the right answer, don't give the right answer.
7:51
SPEAKER_01: What have you heard?
7:52
SPEAKER_03: Yeah.
7:52
SPEAKER_03: What have you heard?
7:53
SPEAKER_01: You've been told by management and by your fellow co-workers, you have how many weeks, days, months, or years to follow a work entry claim?
8:04
SPEAKER_03: Lewis, hello, Jeannie and Chris.
8:06
SPEAKER_03: It's your number one fan.
8:07
SPEAKER_03: It's that time of the year, buddy.
8:09
SPEAKER_03: What's up?
8:11
SPEAKER_03: Linda, three years.
8:12
SPEAKER_03: Weldon, three years.
8:14
SPEAKER_03: How the heck did you know that?
8:15
SPEAKER_03: So I was supposed to say that.
8:17
SPEAKER_03: Well, they do know it.
8:18
SPEAKER_03: Well, we have to give other people a chance.
8:19
SPEAKER_01: Okay, if you heard seven days, three days, two weeks, three months, it's all wrong.
8:23
SPEAKER_01: 30 days.
8:24
SPEAKER_01: It is three years.
8:25
SPEAKER_01: We've heard where people Linda and Weldon.
8:29
SPEAKER_01: I think you cheated.
8:32
SPEAKER_03: So, all right.
8:34
SPEAKER_03: It is three years.
8:36
SPEAKER_03: We've heard so many people message us, and I won't forget this one where they message us and said, My super my supervisor said, I have 30 days.
8:46
SPEAKER_03: Then she calls, you know, she calls me and she says, My supervisor said I have 30 days.
8:51
SPEAKER_03: And I said, No, it's actually three years.
8:54
SPEAKER_03: And she's like, No, that's not what my supervisor said.
8:56
SPEAKER_03: And then, you know, she's just like, well, thanks for the info.
8:59
SPEAKER_03: The end.
9:00
SPEAKER_03: And that was it.
9:00
SPEAKER_03: And then what happens?
9:02
SPEAKER_03: Two months later, she calls me back.
9:04
SPEAKER_01: Let me pause to say hello, Tammy.
9:06
SPEAKER_01: We love you too.
9:07
SPEAKER_01: We love you so much.
9:08
SPEAKER_01: Yeah, she's turned the fan on.
9:10
SPEAKER_01: Let's go.
9:12
SPEAKER_01: This woman likes to smoke me out of the room.
9:14
SPEAKER_01: She's got a we're in Florida.
9:16
SPEAKER_01: It's not cold, and she's wearing a hoodie.
9:18
SPEAKER_03: It's because I don't feel good.
9:19
SPEAKER_03: Can't uh, Linda.
9:20
SPEAKER_03: I listen and follow you guys for a long time.
9:22
SPEAKER_03: Yes.
9:23
SPEAKER_01: Dina, what's up?
9:24
SPEAKER_01: What's up, Dina?
9:25
SPEAKER_03: Chris, please don't talk about the Cowboys first game.
9:30
SPEAKER_03: Who said that?
9:31
SPEAKER_03: Victor.
9:32
SPEAKER_01: I know.
9:32
SPEAKER_01: Believe me, Victor.
9:33
SPEAKER_01: Believe me, I'm not.
9:35
SPEAKER_01: Melissa said it's also three years to file an expansion on your approved claim.
9:39
SPEAKER_01: I don't believe that's true, Melissa.
9:41
SPEAKER_03: Misty, Misty's on.
9:43
SPEAKER_03: How are you doing, girl?
9:45
SPEAKER_03: All right, guys.
9:46
SPEAKER_03: What does it mean to get your claim approved versus denied?
9:52
SPEAKER_01: I'm sorry.
9:53
SPEAKER_01: Remember that question, Melissa.
9:55
SPEAKER_01: I didn't want to just leave you hanging there.
9:56
SPEAKER_01: Melissa said it's also three years to file an expansion on your approved claim.
9:59
SPEAKER_01: Question mark.
10:00
SPEAKER_01: I have great experience, Tammy Newman can answer this or contest to this or attest to it, that after 11 or 8 or 10 years, I can still get an expansion approved.
10:11
SPEAKER_04: Yeah.
10:12
SPEAKER_01: Okay, so I just want to be very clear.
10:14
SPEAKER_01: It's very important.
10:14
SPEAKER_01: I'm glad you asked the question, but we're here for information.
10:17
SPEAKER_01: And the actual information is no.
10:20
SPEAKER_01: I can get an expansion approved whenever the heck I want to.
10:24
SPEAKER_01: So as long as there's already an improved claim.
10:26
SPEAKER_03: We miss you too, Miss D.
10:27
SPEAKER_01: Yeah, for sure.
10:28
SPEAKER_01: Hi, Emmy.
10:30
SPEAKER_03: All right.
10:30
SPEAKER_03: All right.
10:31
SPEAKER_03: So getting your claim approved, you guys have to make sure you do have three years to file your claim.
10:37
SPEAKER_03: I don't care what anybody says, what a steward says, what a supervisor says, what the local president says.
10:44
SPEAKER_03: It is three years, whether it's a CA1 or a CA2.
10:48
SPEAKER_03: You have three years to file your claim from the date of your injury.
10:52
SPEAKER_03: Except for a CA2.
10:53
SPEAKER_01: It's actually three years from the date you were that you reasonably were aware that it's a work-related injury, which basically is usually when the doctor said so.
11:03
SPEAKER_01: Unless you yourself have a medical license.
11:06
SPEAKER_03: Three years.
11:07
SPEAKER_03: Not 30 days, not three weeks, not anything else.
11:10
SPEAKER_03: Three years.
11:11
SPEAKER_03: Tell your friends.
11:12
SPEAKER_01: Right, exactly.
11:13
SPEAKER_01: Tell your friends.
11:13
SPEAKER_01: Why is that important?
11:15
SPEAKER_01: You are working around people right now who think that the time ran out because somebody told them three days, two weeks, 30 days, 45 days, whatever.
11:22
SPEAKER_01: But it's three years.
11:23
SPEAKER_01: And so they're limping around, they're struggling to do their job, and they're worried about getting fired because they're not working fast enough, right?
11:31
SPEAKER_02: Yeah.
11:31
SPEAKER_01: And um it is now your job to tell them you have three years, go report and file.
11:37
SPEAKER_01: Now, someone in management is going to be a jerk and say, What took you so long to report?
11:42
SPEAKER_01: And um, the answer doesn't matter, okay, because your union can fight that, don't worry about it, okay?
11:48
SPEAKER_01: But the key is that you have by law three years.
11:51
SPEAKER_01: And so let your friends know that it's not too late.
11:54
SPEAKER_01: They can get help.
11:55
SPEAKER_01: So many people are worried about how to make it to retirement, but they're unsure how they're gonna make it through tomorrow's shift.
12:03
SPEAKER_03: Correct.
12:04
SPEAKER_01: And that sounds like a saying, and it's because I made it up myself, but it's because I think it all the time.
12:09
SPEAKER_01: How do you make it to retirement if you can't make it through tomorrow?
12:12
SPEAKER_02: Correct.
12:13
SPEAKER_01: And that's what they're going through every single day when they have an injury and they think it's too late.
12:18
SPEAKER_01: So let people know it's not too late.
12:20
SPEAKER_01: All right, seriously.
12:20
SPEAKER_01: And just a side note, when your coworkers go out on OWCP, don't give them a hard time.
12:26
SPEAKER_01: I keep hearing people say that their co-workers are mad at them, you know, they're having to take up the slack.
12:31
SPEAKER_01: I promise you, when it's your when it's you that's hurt, and one day, I pray to God it's not, but one day it's likely to be.
12:38
SPEAKER_01: You're gonna want people to take it easy on you.
12:40
SPEAKER_01: Because it's hard.
12:41
SPEAKER_01: It's so hard to have a back injury, a knee injury, a shoulder injury, and do the jobs you do.
12:47
SPEAKER_01: It's awful.
12:48
SPEAKER_01: So we at federal injury centers and OWCP chats want you to go to work as soon as humanly possible.
12:53
SPEAKER_01: Yeah, because the surest way to get paid is to clock in.
12:56
SPEAKER_01: But sometimes medically, the doctors need you to be off so you can actually get better.
13:00
SPEAKER_01: So take it easy.
13:01
SPEAKER_01: And if you're somebody who is injured and you're worried about what your coworkers think, remember, how do you make it to retirement if you can't make it through tomorrow's shift?
13:10
SPEAKER_03: And remember, for your supervisors or the stewards that are not so nice, you're not a medical doctor.
13:17
SPEAKER_03: So if somebody gets injured, you don't have x-ray vision.
13:20
SPEAKER_03: You do not have a medical license to tell them they are not injured.
13:24
SPEAKER_03: You do not have that right.
13:25
SPEAKER_01: And supervisors.
13:26
SPEAKER_03: Yes.
13:27
SPEAKER_01: We've helped some of you too.
13:28
SPEAKER_01: Yes, we have.
13:29
SPEAKER_01: It's all fun and games until it's you getting hurt.
13:31
SPEAKER_01: Yep.
13:31
SPEAKER_01: So take it easy.
13:32
SPEAKER_03: All right.
13:33
SPEAKER_03: So those of you that are hopping on tonight, we're saying we're going over, we're educating on approved claims versus denied.
13:40
SPEAKER_03: What do you do when your claim gets approved?
13:42
SPEAKER_03: And what do you do when your claim gets denied?
13:45
SPEAKER_01: Hit it, Chris.
13:46
SPEAKER_01: So you can all see.
13:48
SPEAKER_01: I can see what you see.
13:49
SPEAKER_01: I got paper in front of me.
13:51
SPEAKER_01: Lately, I've decided that I'm gonna make notes because I'm stepping up my game.
13:54
SPEAKER_01: I'm gonna make sure it's not just my brain working, it's my brain on overtime.
13:58
SPEAKER_02: I think getting, I think he's getting old.
14:01
SPEAKER_02: I'm not that old.
14:02
SPEAKER_02: 51.
14:03
SPEAKER_01: That's not that old.
14:05
unknown: Sorry.
14:05
SPEAKER_01: It's really not.
14:06
SPEAKER_01: You know, people in the Bible live to like 120.
14:09
SPEAKER_01: I'm pretty young.
14:11
SPEAKER_01: Okay, so I made some notes here, and I'm just gonna read through them and talk about them, and then you're gonna ask questions, and I'm gonna tell you more stuff that's not on this page, and then I'm gonna say other things that I just think about all the time.
14:23
SPEAKER_01: Yep.
14:23
SPEAKER_01: And here's the first thing on an approved claim.
14:26
SPEAKER_01: An approval means that OWCP accepted a specific condition, not everything that's wrong with you.
14:33
SPEAKER_01: And that's important to understand because say you're somebody that got a car wreck, you know, you're driving your LLV and your LLV rolled over, which is awful, right?
14:41
SPEAKER_01: And you got hit in an intersection.
14:42
SPEAKER_01: I mean, the worst thing I can think of, right?
14:45
SPEAKER_01: And your shoulders hurt, your backs hurt, your knees hurt, and your necks hurt.
14:49
SPEAKER_01: All this stuff is happening.
14:50
SPEAKER_04: Yeah.
14:50
SPEAKER_01: And your doctor gets your shoulder approved, shoulder sprain, approved.
14:55
SPEAKER_01: And uh, you're like, oh, thank God, my claim's approved.
14:59
SPEAKER_01: Not really.
15:00
SPEAKER_03: Can I do a timeout?
15:01
SPEAKER_01: Okay.
15:02
SPEAKER_03: Okay, a lot of you, and this happens to so many of you, and it's because you just don't know or you don't understand.
15:09
SPEAKER_03: When you submit your CA1 or CA2s, and Department of Labor sends you a letter and it gives you a claim number, that does not mean your case is approved because you haven't even seen a doctor.
15:22
SPEAKER_03: That is just saying, okay, we got your info, you are number, whatever it is the claim number states.
15:29
SPEAKER_03: So that is not an approval because a lot of you have put that down in one of our reels.
15:34
SPEAKER_03: That is not an approval.
15:35
SPEAKER_03: That's why all the benefits that you are asking about, you have not gotten them.
15:40
SPEAKER_01: Who here has seen Pulp Fiction?
15:44
SPEAKER_01: Look at Genie with the big brain, Samuel L.
15:47
SPEAKER_01: Jackson said.
15:47
SPEAKER_04: Oh my gosh.
15:49
SPEAKER_01: Right after he shot the guy.
15:50
SPEAKER_01: So uh, I'm not gonna shoot you.
15:53
SPEAKER_01: That was pretty good though.
15:54
SPEAKER_01: But that's exactly right.
15:55
SPEAKER_02: Yeah.
15:55
SPEAKER_01: The claim number, that nine-digit number, does not mean approved.
15:58
SPEAKER_02: Correct.
15:59
SPEAKER_01: But an approval doesn't mean everything's approved.
16:02
SPEAKER_01: That's very, very, very, very important.
16:05
SPEAKER_01: You know, if you've got multiple injuries, they approve one thing, and even the diagnosis probably weak.
16:10
SPEAKER_01: And um said me, exactly.
16:14
SPEAKER_01: And so you're like, my claim's approved.
16:17
SPEAKER_01: Yeah, for a shoulder sprain, they're gonna expect you to be back to work in a few weeks because the sprain subsides pretty quickly.
16:23
SPEAKER_01: Usually, I'm not a doctor.
16:24
SPEAKER_01: Everyone that's never seen me before, not a doctor.
16:27
SPEAKER_01: Okay, so anything I say, don't take it as medical advice.
16:30
SPEAKER_01: But I've seen this stuff a long time.
16:32
SPEAKER_01: You know, I've been doing it forever.
16:34
SPEAKER_01: So your approved claim just means a specific diagnosis is approved.
16:39
SPEAKER_01: You need to read your documentation.
16:41
SPEAKER_01: DOL is gonna send you a letter that says, Congratulations, your claims approved for the following conditions.
16:46
SPEAKER_01: And you're gonna look at it and go, shoulder sprain, what about my knee, neck, sh, and my uh back, and I've got a rotator cuff.
16:54
SPEAKER_01: So now you have a problem.
16:55
SPEAKER_01: So remember that you have to have everything that's wrong with you from the injury accepted for them to be able to take care of any of it.
17:03
SPEAKER_03: But the way you get accepted is you go to a DOL doctor and the doctor sees you and writes a narrative.
17:10
SPEAKER_01: Yeah, what's a DOL doctor?
17:12
SPEAKER_01: I'll get to that at the end.
17:13
SPEAKER_01: Yeah.
17:13
SPEAKER_01: Um, and for those of you that are new, this is not a sales platform.
17:19
SPEAKER_01: Yes, we have federal injury centers.
17:21
SPEAKER_01: It probably says it here.
17:22
SPEAKER_01: No, it doesn't.
17:24
SPEAKER_01: Because it's not a sales platform.
17:25
SPEAKER_03: Right.
17:25
SPEAKER_03: If you go to a uh walk-in clinic or an emergency room and you get those little consultation notes, that is not a narrative.
17:33
SPEAKER_03: DOL will totally deny that.
17:35
SPEAKER_03: So remember that you have to submit your paperwork, get that cake, that claim number, go see a DOL doctor.
17:44
SPEAKER_01: All right, so I've got five of these approval things.
17:47
SPEAKER_01: I'm gonna read all five, then we're gonna stop and read all your questions.
17:50
SPEAKER_01: So hang around, okay?
17:52
SPEAKER_01: I'm gonna answer all your questions.
17:54
SPEAKER_01: So, next thing, approval is the beginning of the case, not the end.
17:57
SPEAKER_01: So, this is very important for you.
17:59
SPEAKER_01: My claims approved.
18:00
SPEAKER_01: Oh, good, I can relax.
18:02
SPEAKER_01: Wrong.
18:03
SPEAKER_01: You cannot relax.
18:04
SPEAKER_02: Don't relax.
18:05
SPEAKER_01: Now you got to make sure that all the medical documentation's in, that you attend all your doctor's visits that he says you need to do, that you follow the CA 17, that you communicate with management, that you make an effort to go back to work.
18:18
SPEAKER_01: All these things matter because if at any point along the way you don't do what you're supposed to do, then it'll feel like all hell is raining down on you.
18:28
SPEAKER_01: Yep.
18:28
SPEAKER_01: They'll send you to second opinion visits, they'll close your claim, they'll, you know, the second opinion may retroactively close and say, Oh, never mind, it's not denied, you were never hurt.
18:39
SPEAKER_01: So you must remain actively involved, follow medical instructions, attend appointments, meet deadlines.
18:46
SPEAKER_01: Deadlines are really important.
18:48
SPEAKER_01: I'll go, I have a whole episode that I do on deadlines, and monitor your e-comp.
18:54
SPEAKER_01: Everything that happens and is said about you is in your e-comp case file.
18:59
SPEAKER_01: So approval is the beginning of the case, not the end, but thank God it's approved because only 14% of federal employees have an approved claim.
19:07
SPEAKER_03: Correct.
19:08
SPEAKER_01: Except last time I checked, it was actually down to almost seven.
19:11
SPEAKER_03: Yep.
19:12
SPEAKER_01: Which is really sad.
19:14
SPEAKER_01: Okay, so almost nobody has an approved claim.
19:18
SPEAKER_01: But at federal injury centers, which is not a sales thing, it's just the truth.
19:22
SPEAKER_01: Because you have to know that a doctor trained in OWCP can get this done.
19:26
SPEAKER_01: Our claims acceptance rate is over 90%.
19:30
SPEAKER_01: In many cases, over 95%, compared to a national average of 7 to 14.
19:35
SPEAKER_01: So you have to choose your doctor carefully.
19:38
SPEAKER_03: Yeah, you do.
19:39
SPEAKER_01: It doesn't have to be us, but you gotta know that when you go to a doctor, they may not know what they're doing.
19:45
SPEAKER_03: Correct.
19:46
SPEAKER_01: All right, the next thing medical treatment may still require authorization.
19:50
SPEAKER_01: So you're somebody with a shoulder injury that's been approved, and you're like, why won't they approve surgery?
19:55
SPEAKER_01: Well, guess what?
19:56
SPEAKER_01: Your approved condition is a shoulder sprain, even though later on you got an MRI that showed a rotator cuff tear.
20:03
SPEAKER_04: Yep.
20:04
SPEAKER_01: Rotator cuff tear, as far as I understand, is surgical, right?
20:08
SPEAKER_01: But a sprain is not.
20:10
SPEAKER_01: Why can't I get my surgery approved?
20:13
SPEAKER_01: DOL hates me.
20:14
SPEAKER_01: OWCP is against me, the world is after me.
20:17
SPEAKER_01: Nope, your doctor did a bad job.
20:19
SPEAKER_01: He did.
20:19
SPEAKER_01: So you gotta make sure that your correct conditions are approved, and then your doctor knows how to get authorization for the treatment needed.
20:29
SPEAKER_01: All treatment after 120 days for sure requires authorization from the claims examiner.
20:35
SPEAKER_01: And all authorization is gonna be based on the diagnosis.
20:39
SPEAKER_01: So your diagnosis has to be correct.
20:41
SPEAKER_01: Some doctors, and some of mine have been guilty of this, want to just get the sprain approved because it's easy and we get your claim approved and you can start getting help.
20:48
SPEAKER_01: And I like that.
20:50
SPEAKER_01: I like it right until you need something serious and you have the wrong diagnosis.
20:54
SPEAKER_01: Correct.
20:54
SPEAKER_01: So you gotta keep track of that.
20:57
SPEAKER_01: Next, approval does not automatically produce wage loss compensation.
21:02
SPEAKER_01: I hear this all the time.
21:03
SPEAKER_01: My claims approved.
21:05
SPEAKER_01: Why am I not getting paid?
21:07
SPEAKER_01: Well, it's because your doctor has not written a disability narrative explaining why you need to be off of work.
21:14
SPEAKER_01: See, you have a CA 17, a duty status report.
21:17
SPEAKER_01: Hopefully, the doctor fills out and says, here's your restrictions, or you can't work.
21:22
SPEAKER_01: But then they have to write a letter explaining why you can't work medically.
21:26
SPEAKER_01: That because this person stepped off of a curb and twisted their knee and blew out their ACL, they're not able to bend and squat and I don't know what.
21:37
SPEAKER_01: Like whatever.
21:38
SPEAKER_01: I'm not a doctor.
21:39
SPEAKER_01: But they're not able to do it because of this ligament tear that causes the following symptoms when they do it.
21:44
SPEAKER_01: They need this documented medically.
21:47
SPEAKER_01: So approval does not automatically produce wage loss compensation.
21:51
SPEAKER_01: Your doctor's got to take one extra step to write a narrative report that helps you get paid for your time off.
21:58
SPEAKER_01: See, the doctor can write it.
22:00
SPEAKER_01: SCA 17.
22:01
SPEAKER_01: They can write restrictions, they can take you off of work.
22:04
SPEAKER_01: But if they don't write a narrative that explains why medically you're off of work, you're not getting paid.
22:10
SPEAKER_01: And you're never going to be approved for compensation to be off of work.
22:14
SPEAKER_01: So it's very, very important.
22:16
SPEAKER_01: You're approved, but you're not paid.
22:19
SPEAKER_01: It's not good enough yet.
22:21
SPEAKER_01: And finally, approve claims.
22:25
SPEAKER_01: Work restrictions must be specific and medically supported.
22:30
SPEAKER_01: So back to that CA17.
22:32
SPEAKER_01: We want to get you back to work.
22:33
SPEAKER_01: I told you in the beginning, the surest way to get paid is to clock in.
22:37
SPEAKER_01: We want you back to work.
22:38
SPEAKER_01: And not to mention that if you're, say, a postal employee, you're out of work for a year, you run the risk of losing your position.
22:45
SPEAKER_01: A role carrier, two years.
22:47
SPEAKER_01: Any other federal agency, one year.
22:50
SPEAKER_01: Like you can lose your job and be forced to retrain or take a different position if you're out of work for too long.
22:57
SPEAKER_01: We want to get you back to work as soon as possible to prevent that problem.
23:02
SPEAKER_01: And the way to do that is to make sure that you have the right restrictions and that they're medically supported.
23:07
SPEAKER_01: So I said that disability narrative.
23:09
SPEAKER_01: We want to get you back to work so you don't lose your position, so you keep your benefits and you make it to retirement.
23:16
SPEAKER_01: You can't make it to retirement if you can't make it to the next shift, but you're not going to make it to retirement if your doctor writes bad reports.
23:23
SPEAKER_01: Correct.
23:24
SPEAKER_01: So I'm going to pause.
23:25
SPEAKER_03: All right, so let's recap.
23:28
SPEAKER_03: File your CA1 or CA2.
23:31
SPEAKER_03: OWCP is going to send you a letter with a claim number.
23:35
SPEAKER_03: Remember, that is not your approval that your claim's been accepted.
23:40
SPEAKER_03: Find yourself a trained DOL doctor.
23:45
SPEAKER_03: The doctor's going to write you a narrative.
23:47
SPEAKER_03: That's what gets submitted to see if your claim is going to get approved or denied.
23:53
SPEAKER_03: Don't forget.
23:54
SPEAKER_03: All right.
23:56
SPEAKER_03: Jessica, that's what happened to me.
23:58
SPEAKER_03: They approved the worst injury, but not all of me that was hurt.
24:03
SPEAKER_03: So you only got a part of your claim accepted or of your body parts.
24:08
SPEAKER_03: Maria, hello.
24:10
SPEAKER_03: Becky Bridges.
24:12
SPEAKER_03: My request to expand my claim to include cervical ridiciopathy.
24:17
SPEAKER_03: I received a denial.
24:19
SPEAKER_03: But when I went to eComp, saw where it was it has been given to a DMO, district medical.
24:25
SPEAKER_01: Right.
24:26
SPEAKER_03: I chose an oral hearing off the denial packet.
24:30
SPEAKER_03: What's next?
24:31
SPEAKER_03: Oral hearing or DMO or both?
24:34
SPEAKER_01: The DMO is not an appeal.
24:37
SPEAKER_01: That's just a person looking at it, a district medical officer.
24:40
SPEAKER_01: The oral hearing is an appeal, and that can work.
24:43
SPEAKER_01: And I'm glad you filed it on time.
24:45
SPEAKER_01: I think you have like 30 days to file it.
24:47
SPEAKER_01: If it's denied, you can still do reconsideration.
24:49
SPEAKER_01: Every denial has an appeal.
24:52
SPEAKER_01: So you can still reconsider it.
24:54
SPEAKER_01: So ultimately, if it's denied during oral hearing, you will need a medical report that substantiates your appeal.
25:01
SPEAKER_02: Yeah.
25:02
SPEAKER_01: And you'll do another one.
25:03
SPEAKER_01: You'll have 12 months to appeal from the next denial to reconsideration.
25:08
SPEAKER_03: If we always tell people, I mean, there's like what four or five choices.
25:12
SPEAKER_03: We always say the best one is the reconsideration instead of the other one.
25:16
SPEAKER_01: So that's that's our thing.
25:19
SPEAKER_01: She's exactly right.
25:19
SPEAKER_01: But let me clarify that for those of you letter carriers out there who hate that I say that.
25:24
SPEAKER_01: Oral hearings are cool when you have a union store that helps you.
25:27
SPEAKER_01: I think it's in it's freaking amazing, actually.
25:30
SPEAKER_01: But not everybody has a steward to help.
25:32
SPEAKER_01: You can't afford a lawyer to do it.
25:34
SPEAKER_01: You need your steward.
25:35
SPEAKER_01: So when you have that, I think it's an amazing thing.
25:37
SPEAKER_01: A review of the written record, I don't like.
25:40
SPEAKER_01: It's just my personal thing because they're reviewing the record they use to deny you already.
25:44
SPEAKER_04: Yeah.
25:45
SPEAKER_01: ECAB is more like a uh it's an appeal that's based on fact and law and statutes.
25:52
SPEAKER_01: And it's a little intimidating and without representation, I don't like it.
25:56
SPEAKER_04: Yeah.
25:57
SPEAKER_01: But the reconsideration gives you 12 months to appeal, and the doctor can write new medical information that the claims examiner must consider.
26:06
SPEAKER_01: Correct.
26:06
SPEAKER_01: And we have a very high approval rate on reconsiderations.
26:11
SPEAKER_03: Linda, I just went through this on a shoulder sprain just to get accepted.
26:16
SPEAKER_03: I had an MRI and expansion with my entire case.
26:20
SPEAKER_01: That's awesome.
26:21
SPEAKER_01: That you got to accept it is incredible.
26:22
SPEAKER_01: I love that.
26:23
SPEAKER_01: That's what I live for.
26:24
SPEAKER_03: Matt, my denial was overturned today, March 10th to September 4th.
26:30
SPEAKER_03: I need to shout out to my case manager at FIC Richmond and the staff and all my and my doctors and all the staff.
26:38
SPEAKER_03: Well, thanks, Matt.
26:39
SPEAKER_01: That's awesome.
26:40
SPEAKER_01: You know, the thing with us, and again, not a sales presentation.
26:43
SPEAKER_01: Do go where you want to go, see who you want to see, go to Google and search worst doctor ever if you want to.
26:49
SPEAKER_01: But the way we do it is we have a case manager at every office that is expected to be trained like I am.
26:55
SPEAKER_01: And you know what?
26:57
SPEAKER_01: That is a difference maker between other offices and ours because our people can help navigate the system.
27:03
SPEAKER_01: And I really love that, and I'm glad that it worked out for you.
27:07
SPEAKER_03: Jessica, I am the cash cow at my FIC, and they aren't even doing all they could charge.
27:14
SPEAKER_01: I don't even know what that means, but we don't do things based on money.
27:18
SPEAKER_01: We do things based on medical necessity.
27:20
SPEAKER_01: So um I hope you're getting better, but all we care about is you're getting better, not based on money.
27:27
SPEAKER_03: And we're only speaking for our offices.
27:30
SPEAKER_03: If they're asking for any money, you need to contact Chris or I immediately, please.
27:35
SPEAKER_01: Yeah, we don't put money first.
27:36
SPEAKER_01: We put people first, we put results first.
27:39
SPEAKER_01: You wouldn't believe the number of things I do for no money, and I'm happy to do it.
27:42
SPEAKER_01: I don't care.
27:43
SPEAKER_03: None of our offices should be asking you for money.
27:45
SPEAKER_01: I'm sure nobody is, but we don't do it for money.
27:48
SPEAKER_01: We just want you to get better and back to work.
27:49
SPEAKER_03: Matt said also my state senator office helped expedite the claim.
27:53
SPEAKER_01: Matt, you know what?
27:54
SPEAKER_01: I've got so many examples where when you write to your congressperson, it works, and it's amazing.
27:59
SPEAKER_01: So I'm happy that that worked for you, Matt.
28:02
SPEAKER_03: Norax! What are you doing?
28:05
SPEAKER_03: Maria, I filed a congressional a while back.
28:08
SPEAKER_03: I called in about travel, denied.
28:10
SPEAKER_03: Sabrina was kind enough to point out she looked at my file and that I can get more with honey.
28:16
unknown: Oh.
28:16
SPEAKER_01: Well, I think that's true.
28:18
SPEAKER_01: What is it?
28:19
SPEAKER_01: The you attract it's like a honey and bees and flies thing.
28:24
SPEAKER_01: Whatever.
28:24
SPEAKER_01: Yeah, being nice.
28:25
SPEAKER_01: I was just telling her, everyone, if they were just nice, especially management, the system would work so much better.
28:32
SPEAKER_01: I like being nice.
28:33
SPEAKER_01: I think it's the right thing to do.
28:37
SPEAKER_01: We're making sure we didn't miss anything, so stand by.
28:40
SPEAKER_03: Okay, Lewis, I knew I was missing yours.
28:43
SPEAKER_03: For anything that is approved, is it for the rest of my life, even after retirement?
28:47
SPEAKER_01: Yes.
28:48
SPEAKER_01: Yeah, so here's the deal: your claim, your condition is approved forever.
28:53
SPEAKER_01: Your treatment is not approved forever, but it's always able to be reopened based on medical necessity.
29:02
SPEAKER_01: So technically, you have lifetime medical based on medical necessity for the condition that happened at work.
29:09
SPEAKER_03: Yeah.
29:10
SPEAKER_03: Chris, thank you.
29:11
SPEAKER_03: Oh, you guys are amazing for that.
29:13
SPEAKER_03: Thank you.
29:14
SPEAKER_03: You're welcome.
29:15
SPEAKER_03: Weldon, I have had over 20 CE with considerations as an option, but my claim was remanded back to the C C E five times by ECAB.
29:27
SPEAKER_03: Finally approved for I don't know, something work-related injury medically only.
29:34
SPEAKER_03: Medical only, yeah.
29:35
SPEAKER_01: Well, I mean, look.
29:36
SPEAKER_03: Oh, he meant claims examiner.
29:37
SPEAKER_01: Yeah, so well then basically you've been through it, but it ended up, it seems like it worked out for you.
29:43
SPEAKER_04: Yeah.
29:43
SPEAKER_01: And that's frustrating, but that's the system.
29:46
SPEAKER_01: I always say OWCP is not spelled F-A-I-R.
29:51
SPEAKER_03: Nancy.
29:53
SPEAKER_03: A friend opened a CA1 for physical and mental case, harassment and bullying, physical aggression by my supervisor.
30:01
SPEAKER_03: She got with the union, but she doesn't know what to do next.
30:04
SPEAKER_03: She got a CA20 disability letter, CA17, but the supervisor is not releasing the CA1 online.
30:11
SPEAKER_03: What can she do?
30:12
SPEAKER_01: She can file a grievance.
30:14
SPEAKER_01: She can contact OSHA because the supervisor is required to release a CA1 within seven days.
30:20
SPEAKER_01: That's a law.
30:21
SPEAKER_01: And if he doesn't or she doesn't do that, then they are preventing you from getting help, which sounds like a safety issue.
30:27
SPEAKER_01: So I would ask OSHA if it is a safety issue.
30:31
SPEAKER_01: The phone number to OSHA is 1-800-321-OSHA.
30:34
SPEAKER_01: I would also contact your agency's OIG because they don't just investigate you, they also investigate management.
30:43
SPEAKER_01: And I would contact my congressperson because it's my life, and the uh OWCB does not want to deal with Congress.
30:51
SPEAKER_01: I'm telling you, when this happens, they just start like getting in line.
30:55
SPEAKER_01: I doubt the agency wants to deal with that either.
30:58
SPEAKER_01: But you have or your friend has every right to have their claim at least heard, and it can't be heard until the supervisor sends in the documentation.
31:07
SPEAKER_01: Don't let that happen.
31:09
SPEAKER_03: Mary, when you got injured at rate job 96,000, then you suddenly receive it, went down to 80,000.
31:18
SPEAKER_03: Which is which is true for you?
31:22
SPEAKER_01: So it sounds like what you're asking me is you got hurt and you were getting paid a certain amount, and then after your injury, you're getting paid a different amount.
31:28
SPEAKER_03: Yeah.
31:28
SPEAKER_03: So there's a couple of things there.
31:30
SPEAKER_03: Oh, wait, hold on.
31:31
SPEAKER_03: Or went up your yearly income.
31:33
SPEAKER_03: What will you follow?
31:34
SPEAKER_03: Right.
31:34
SPEAKER_01: Okay, so there's a couple of things there that I'm just gonna tell you that you're gonna have to research yourself because I can't possibly know.
31:40
SPEAKER_01: But one, um, are they calculating your compensation correctly based on pay and hours?
31:49
SPEAKER_01: That's number one.
31:50
SPEAKER_01: Um, two, Jesus, number one is actually the biggest one.
31:57
SPEAKER_01: Huh.
31:58
SPEAKER_01: That's the one I'd look at.
31:59
SPEAKER_01: I think that's what's happening.
32:00
SPEAKER_01: I think they're miscalculating your pay.
32:03
SPEAKER_01: They're if you were out of work a long time, uh, not back at work, you may still be getting paid from the old salary, even though everyone else is at the new salary.
32:12
SPEAKER_01: I would recommend that you talk to your union because they know how to help you for sure.
32:18
SPEAKER_01: I'm gonna read this again because I think I have something else.
32:20
SPEAKER_03: Okay.
32:23
SPEAKER_01: I see it.
32:23
SPEAKER_03: Right back at you, Nancy.
32:28
SPEAKER_01: Make sure they're not make sure they're paying you for all of your extra hours.
32:31
SPEAKER_01: Like some people are working more than 40, and that's irregular hours, and they're not getting paid for that either.
32:36
SPEAKER_01: Also, the last thing is it could be based on your compensation rate, based on dependence.
32:42
SPEAKER_01: No dependence, 75%, multiple dependence, 66 and a third, or something like that.
32:48
SPEAKER_01: So just check on those things, those are really important.
32:51
SPEAKER_01: And I know I said it fast.
32:52
SPEAKER_01: Feel free and go back and rewind, play it, rewind, play it.
32:56
SPEAKER_01: But it's maybe something like that.
32:57
SPEAKER_01: But I think ultimately your best bet is to go to your union, who's probably strong, and ask them to help you.
33:03
SPEAKER_03: Yeah.
33:04
SPEAKER_03: Just take a picture of that.
33:06
SPEAKER_03: All right, Jessica.
33:07
SPEAKER_03: Someone pays the DOL doctor.
33:09
SPEAKER_03: Yes, Department of Labor pays the doctors.
33:12
SPEAKER_03: That's correct.
33:13
SPEAKER_03: Whether it's our doctor or other doctors that do workers' comp, Department of Labor pays them.
33:19
SPEAKER_03: When I'm on the schedule, they argue about what part of me they can treat.
33:22
SPEAKER_03: They talk about billing all the time.
33:25
SPEAKER_03: They don't bill me, but the reserve treatment based on being paid.
33:29
SPEAKER_01: Ah, I get you now.
33:30
SPEAKER_01: So, Jessica, the way this works is OWCP will only cover.
33:34
SPEAKER_01: I'm trying, I don't like to use money because I hate that.
33:36
SPEAKER_01: But they'll only pay doctors for accepted additions.
33:40
SPEAKER_01: So let's say you have a knee and you think your shoulders hurt too, and I'm not saying it's not.
33:44
SPEAKER_01: That's not the point.
33:45
SPEAKER_01: They'll treat your knee, but they won't be able to treat your shoulder until OWCP approves it.
33:50
SPEAKER_01: If your shoulder is a should be accepted, they can do a diagnosis expansion, or you can do a new claim.
33:58
SPEAKER_01: But doctors are very, very cautious about treating something that's not covered.
34:02
SPEAKER_01: They do like to get paid for the work they do.
34:05
SPEAKER_01: I hate that money sometimes is number one to doctors, but um, it's like if you go to your family doctor for the flu, um, you're probably not gonna get treated for, I don't know, a bug bite.
34:17
SPEAKER_01: I don't know.
34:17
SPEAKER_01: It's like doctors just work this way.
34:19
SPEAKER_01: Yeah.
34:19
SPEAKER_01: So you gotta make sure all of your conditions that you have are accepted, and then they'll be able to help you with all of them.
34:25
SPEAKER_03: Yeah, exactly what he said.
34:27
SPEAKER_03: It is just like if you're going to your primary care doctor, you go in for your three-month visit.
34:31
SPEAKER_03: Well, now you you know you're sick, and they're gonna be like, uh, okay.
34:35
SPEAKER_03: Yeah, and I need you to come in for separate visits.
34:38
SPEAKER_01: I just went for a follow-up a couple of weeks ago and said, I need an EKG.
34:41
SPEAKER_01: Don't worry about it, I'm not gonna die.
34:43
SPEAKER_01: And they didn't do it because that wasn't the reason for the visit.
34:46
SPEAKER_01: This is very common in healthcare.
34:48
SPEAKER_04: Yep.
34:49
SPEAKER_03: All right, let's move on.
34:51
SPEAKER_03: Now that was everything about what you do when your case gets approved, how it gets approved, and what to do when it gets approved.
34:59
SPEAKER_03: And yes, all you get all your benefits, like Lewis was saying, all your benefits come after your case is approved.
35:06
SPEAKER_03: Now let's talk about denials.
35:08
SPEAKER_03: A lot of you, a lot of you, I mean, my inbox gets blown up with this.
35:14
SPEAKER_03: Oh, you guys said this and this, but my claim got denied.
35:18
SPEAKER_03: And it's like you guys reach out to me two months later.
35:22
SPEAKER_03: No, reach out to me right away.
35:24
SPEAKER_03: If you get a denied claim and you don't understand, reach out to me as soon as you get that DOL letter.
35:28
SPEAKER_03: I will tell you what to do.
35:30
SPEAKER_03: But just because it's denied, that doesn't mean your case is over.
35:34
SPEAKER_03: And that's what happens.
35:35
SPEAKER_03: You guys get that denial letter, and you're like, oh, screw that, federal injury centers, whatever it is, they didn't do a great job, whatever, whatever.
35:43
SPEAKER_03: It is not over.
35:44
SPEAKER_03: Whether it's federal injury centers or another doctor's office, it's not over.
35:48
SPEAKER_01: Right.
35:49
SPEAKER_01: And that's perfect.
35:51
SPEAKER_01: She hasn't seen my notes, but that leads right into thing number one on denials.
35:55
SPEAKER_01: When a claim is denied, read, respond, meet the deadline.
35:59
SPEAKER_01: So read your done.
36:00
SPEAKER_01: All denials.
36:02
SPEAKER_01: Read denials.
36:03
SPEAKER_01: So many people get their letters from the United States Department of Labor and don't read them.
36:08
SPEAKER_01: It's not junk mail, people.
36:09
SPEAKER_01: You gotta read these things because they say things.
36:12
SPEAKER_03: Yeah, and keep all these letters and give them to the case manager in whatever office you go to, keep them.
36:18
SPEAKER_01: I don't care if DOL is sending you a birthday letter saying happy birthday, give it to your case manager.
36:22
SPEAKER_01: Yeah, they're not gonna send that.
36:23
SPEAKER_01: But if they did, give it to the case manager at the doctor's office.
36:26
SPEAKER_01: And if you're in an office that's not federal injury centers, they probably won't have a case manager.
36:30
SPEAKER_01: Give it to the doctor.
36:31
SPEAKER_01: Hold on.
36:32
SPEAKER_01: Weldon.
36:33
SPEAKER_03: Is an expansion the same as a reoccurrence of an injury?
36:38
SPEAKER_01: No.
36:38
SPEAKER_01: An expansion is adding a diagnosis to an accepted claim.
36:42
SPEAKER_01: A recurrence is an accepted claim that came back later on.
36:46
SPEAKER_01: Two different things.
36:47
SPEAKER_01: All right, so here's the here's the thing you're gonna do with denials.
36:50
SPEAKER_01: Number one, it's not the end of the world.
36:54
SPEAKER_01: No, we get and I understand why people think it because I did all this work and I got hurt, and why won't the why won't they take care of me?
37:02
SPEAKER_01: They're out to get me, my supervisors are out to get me, the claim desemper doesn't care about me, the nurse case manager is against me.
37:08
SPEAKER_01: None of that is really true most of the time, sometimes, but not most of the time.
37:12
SPEAKER_01: A denial letter is a roadmap.
37:15
SPEAKER_01: It is okay, it is not the end of the world.
37:18
SPEAKER_01: Every denial letter has a paragraph in it that says specifically your claim is denied because, and your doctor can go back and address that denial.
37:29
SPEAKER_01: You get to appeal.
37:30
SPEAKER_01: The last page of every denial letter is an appeal request form.
37:34
SPEAKER_01: The doctor can say, do reconsideration, and I'll address this denial.
37:39
SPEAKER_01: And then you have a chance to win.
37:41
SPEAKER_01: You can do an infinite number of denials.
37:44
SPEAKER_01: As long as the doctor has new medical information, each denial, you can do a new new reconsideration.
37:49
SPEAKER_01: It's not over until you give up.
37:51
SPEAKER_03: Now we understand you don't want that because now you're still waiting for all of these benefits, especially your pay.
37:57
SPEAKER_01: Ask Gilbert, ask Tammy, ask Scott.
38:00
SPEAKER_01: It's not over unless you give up.
38:02
SPEAKER_01: It's not over until the fat lady sings.
38:04
SPEAKER_01: And I'm not a fat lady and I'm not singing, okay?
38:08
SPEAKER_01: And I like to say this: it's not over until I say it is, but if you give up, it's over.
38:12
SPEAKER_01: Yes.
38:13
SPEAKER_01: You know, but typically, if I say I'm gonna take on this case, we're gonna win it, or I'm gonna die.
38:20
SPEAKER_01: I'm gonna take it to death.
38:22
SPEAKER_02: Yeah.
38:22
SPEAKER_01: Because you can always win a case if it's legit.
38:26
SPEAKER_01: Every legitimate case should be won.
38:28
SPEAKER_01: Okay, you just need the right doctrine to write the right report.
38:31
SPEAKER_01: So a denial letter is a roadmap, not the end of the world.
38:34
SPEAKER_01: Don't forget that.
38:36
SPEAKER_01: Most denials involve one of five basic elements.
38:40
SPEAKER_01: Most people don't even know what is included in an accepted claim.
38:44
SPEAKER_01: Like what has to go in the narrative?
38:46
SPEAKER_01: Correct.
38:47
SPEAKER_01: And I'm not gonna say what the five things are because it's freaking boring.
38:50
SPEAKER_01: But the point is that there is a way, there's a roadmap to write a narrative.
38:55
SPEAKER_04: Yep.
38:56
SPEAKER_01: And if your doctor writes a really crappy narrative, it's going to be denied.
39:00
SPEAKER_01: And if you stay with that doctor and he writes another bad narrative, it's gonna get denied again and again.
39:04
SPEAKER_01: But guess what?
39:06
SPEAKER_01: The wrong doctor will not write more than one or two narratives.
39:09
SPEAKER_01: Correct.
39:09
SPEAKER_01: Because they're not getting paid because your claim's not approved.
39:12
SPEAKER_01: So when a claim's not approved, the doctor doesn't get paid, they're gonna drop you.
39:17
SPEAKER_01: So choose the right doctor.
39:20
SPEAKER_01: Make the extra effort in the little time you have to find somebody who understands OWCP.
39:25
SPEAKER_01: And again, I didn't say choose federal injury centers.
39:28
SPEAKER_01: Somebody who understands OWCP, that will fight the claim, that will not give up.
39:34
SPEAKER_04: Correct.
39:34
SPEAKER_01: That'll be a gladiator.
39:36
SPEAKER_01: That's what you need.
39:38
SPEAKER_01: So they have to uh most denials involve one, not more than one, of the five basic elements.
39:44
SPEAKER_01: And the next thing is usually it's causal relationship.
39:48
SPEAKER_01: It's usually the thing that most doctors screw up because it's hard.
39:52
SPEAKER_01: You know, you stepped off a curve, you felt a pop in your knee, and that pop in the knee was an ACL, and the the reason the ACL tore was some torque that went to the other side, and that caused blah, blah, blah, blah, blah.
40:03
SPEAKER_01: And I'm not a doctor.
40:04
SPEAKER_01: But that's what has to be written in there to explain what happened while you were delivering the mail and you stepped off a curb and you tore your knee.
40:12
SPEAKER_01: Yep.
40:13
SPEAKER_01: And they have a hard time writing that.
40:15
SPEAKER_01: Most doctors will just say, delivering the mail, stepped off a curb, felt a pop in the knee.
40:19
SPEAKER_01: I can't laugh right now.
40:20
SPEAKER_01: This is too serious.
40:21
SPEAKER_01: Sorry.
40:22
SPEAKER_01: And delivering the mail, stepped off the curve, felt a pop in the knee is denied.
40:27
SPEAKER_01: Period.
40:28
SPEAKER_01: It's not good enough.
40:29
SPEAKER_01: So they have to be able to get causation.
40:32
SPEAKER_01: The fourth thing is denied does not mean finished, okay?
40:36
SPEAKER_01: But check this out.
40:37
SPEAKER_01: Deadlines definitely matter.
40:38
SPEAKER_01: You have to understand the deadlines for your appeals.
40:41
SPEAKER_01: 30 days, 30 days, 30 days, 12 months.
40:46
SPEAKER_01: That's why we like reconsiderations because you get 12 months.
40:50
SPEAKER_01: I've told this story lots of times, but she and I were sitting on the couch one night watching TV at 11:40 something at night.
40:56
SPEAKER_01: She was on Facebook on her phone, like always.
41:01
SPEAKER_01: I like to let that set for a second.
41:04
SPEAKER_01: And somebody messaged her on Facebook.
41:06
SPEAKER_03: Lucky thing I was.
41:07
SPEAKER_01: They weren't lucky.
41:08
SPEAKER_01: She's she's only doing it if she's awake.
41:10
SPEAKER_01: And then um they said, Hey, I think I'm gonna miss my deadline.
41:14
SPEAKER_01: And they told her and she told me.
41:15
SPEAKER_01: I was like, Oh man, they're so I sent her a pill request form.
41:19
SPEAKER_01: I said, give it to them.
41:20
SPEAKER_01: And this person got their appeal request form in within three minutes of the deadline of missing their 12-month deadline.
41:27
SPEAKER_01: Yep.
41:28
SPEAKER_01: Three minutes, literally.
41:29
SPEAKER_01: Denied does not mean finished, but it's finished if you miss deadlines.
41:33
SPEAKER_01: So don't miss deadlines.
41:35
SPEAKER_01: And finally, and then we'll go to more questions.
41:37
SPEAKER_01: Whether approved or denied, document everything.
41:41
SPEAKER_01: When you're getting uh when you first get injured, write your personal statement.
41:45
SPEAKER_01: Write everything that happened.
41:46
SPEAKER_01: I always say if you saw butterflies flying and you heard birds chirping, write it down.
41:50
SPEAKER_01: Write everything because that goes to the doctor, and the doctor can put that in their narrative report.
41:55
SPEAKER_01: Document everything that happens.
41:56
SPEAKER_01: If your supervisor gives you a hard time, document it.
42:00
SPEAKER_01: If they don't turn your CA1 in and CA2 in, CA7 in within seven days, five days, document it.
42:07
SPEAKER_01: If you go to a second opinion visit and they spend two minutes with you, document it.
42:11
SPEAKER_01: Document everything because that's how you protect yourself.
42:15
SPEAKER_01: People will just go around going, well, the system will take care of me.
42:19
SPEAKER_01: It will not.
42:20
SPEAKER_01: The system will swallow you up.
42:22
SPEAKER_01: Yep.
42:23
SPEAKER_01: Do not take it for granted.
42:26
SPEAKER_01: Document everything.
42:28
SPEAKER_01: And with that, I'm gonna answer some more questions.
42:32
SPEAKER_03: Okay, so you guys understand if you get a denial, it's not the end.
42:37
SPEAKER_03: Don't give up.
42:38
SPEAKER_03: Don't stop going to your treatment to whatever doctor.
42:42
SPEAKER_03: Keep that denial letter.
42:43
SPEAKER_03: Like Chris said, it has information that the doctor will see on why it got denied.
42:49
SPEAKER_03: And take it to the doctor.
42:50
SPEAKER_03: Whatever doctor you're seeing, take these letters to your doctor, give it to the case managers, call them, tell them you got a denial, so they bring you in.
42:59
SPEAKER_03: Victor's there's a lot here.
43:01
SPEAKER_01: Let's not miss any.
43:02
SPEAKER_03: I have them here.
43:03
SPEAKER_03: Victor said, but Chris Helms looks like the fat lady.
43:06
SPEAKER_01: Boy, please.
43:07
SPEAKER_03: He said, just kidding.
43:09
SPEAKER_01: I'm down at my lowest weight ever.
43:11
SPEAKER_03: And Sean Dill said, Hi guys, I'm working on Claude.
43:14
SPEAKER_01: Okay.
43:16
SPEAKER_03: All right.
43:17
SPEAKER_03: Maria, doctors charge you extra if you talk about anything outside of your reason, your reason there.
43:25
SPEAKER_03: So it's two office visits, so you get charged as such.
43:29
SPEAKER_03: Yes, that's how primary care offices work.
43:31
SPEAKER_03: It does suck.
43:32
SPEAKER_01: I actually hate it, but actually, they can do like a modifier and say there's a different thing, but that's really, really high-level stuff.
43:38
SPEAKER_01: The bottom line is you're not wrong.
43:40
SPEAKER_03: Yeah.
43:41
SPEAKER_03: Uh Jessica, my FIC needs a refresh.
43:44
SPEAKER_03: They're jeopardizing deadlines.
43:46
SPEAKER_03: I'm on the fourth doctor trying to get an expansion consequential.
43:52
SPEAKER_01: I like to know where you're located.
43:55
SPEAKER_03: Tenora, hello from Federal Injury Centers of Portland.
43:59
SPEAKER_03: What's up?
44:00
SPEAKER_03: Well then, after my asthma approval, I have new medical injury occurring.
44:04
SPEAKER_03: How do I request compensation?
44:07
SPEAKER_01: Yeah, so unless the new injury is part of the asthma, it's a new claim.
44:12
SPEAKER_01: So you have to decide did it happen in one shift or multiple shifts that would make it a CA1 or a CA2.
44:18
SPEAKER_01: It is not uncommon.
44:19
SPEAKER_01: You should not feel bad about it.
44:20
SPEAKER_01: You shouldn't feel weird at all about it to have multiple claims at the same time.
44:26
SPEAKER_01: It's one of the most common things we see.
44:28
SPEAKER_01: So if you have other conditions that aren't related to diasma, then you file new claims.
44:34
SPEAKER_01: Single shift, CA1, multiple shifts, CA2, and then act accordingly.
44:39
SPEAKER_03: Trudy.
44:41
SPEAKER_03: Okay.
44:41
SPEAKER_03: Maybe you didn't we weren't on at the very beginning.
44:44
SPEAKER_03: She said, I filed a claim three months ago and still haven't heard a word.
44:47
SPEAKER_03: What can I do?
44:48
SPEAKER_03: Are you saying you haven't heard a word from Department of Labor or getting your claim accepted?
44:54
SPEAKER_03: So that's the question, that's the answer we need from you.
44:57
SPEAKER_01: Department of Labor is who accepts the claim.
44:59
SPEAKER_01: So what I would say to you is call your claim examiner, who probably won't answer because they're overwhelmed.
45:04
SPEAKER_01: Don't be mad at them.
45:05
SPEAKER_01: Leave a voicemail and just ask what is the status of my claim.
45:09
SPEAKER_01: They will transcribe the voicemail and all documents, a transcribed voicemail is a document, have to be responded to.
45:17
SPEAKER_01: So they'll get back to you.
45:20
SPEAKER_03: Oh, she said yes to both.
45:23
SPEAKER_01: Okay.
45:25
SPEAKER_03: After after the chat, go ahead and message me.
45:28
SPEAKER_03: After the chat, click the message and message me.
45:32
SPEAKER_03: Jessica, I'm grateful.
45:33
SPEAKER_03: My FIC in Phoenix City has kept me alive while I'm busted into pieces.
45:38
SPEAKER_03: That's good to know.
45:39
SPEAKER_01: Well, I'm sorry you're busted to pieces, but I'm really happy the office is helping you out.
45:44
SPEAKER_01: I'm so happy for that.
45:45
SPEAKER_03: Alright, what other questions?
45:46
SPEAKER_03: What are we at?
45:47
SPEAKER_03: We have 16 minutes.
45:50
SPEAKER_03: 14.
45:50
SPEAKER_03: 14.
45:51
SPEAKER_03: So is it?
45:52
SPEAKER_03: Yeah.
45:52
SPEAKER_01: I just did basic math.
45:54
SPEAKER_03: We talked about approvals and denials.
45:58
SPEAKER_03: Approvals and denials.
46:01
SPEAKER_01: And I wrote this last statement down.
46:02
SPEAKER_01: I just wanted to end with it, but since there's no more.
46:07
SPEAKER_01: I was gonna say no more questions, but Lewis Notre Dame at BYU.
46:10
SPEAKER_03: Yay, BYU! Yes, we are actually going to the game.
46:13
SPEAKER_01: Yeah.
46:15
SPEAKER_03: Obviously, I'm rooting for BYU, even though I love you.
46:20
SPEAKER_03: But I'm I'm gonna cheer for BYU no matter what.
46:23
SPEAKER_01: Alright, let me just I'm just going off track just for a second, okay?
46:27
SPEAKER_01: Just for a second.
46:28
SPEAKER_01: Regarding football.
46:29
SPEAKER_01: And I want to get back on OWCB fast, but Lewis did this to me, so it's his fault.
46:34
SPEAKER_01: So everybody just give him like thumbs down.
46:37
SPEAKER_01: But I have this thing that I do.
46:38
SPEAKER_01: I say I don't sing the hey hey goodbye song, but until the clock shows zero, zero, zero.
46:43
SPEAKER_01: So I'm not gonna say Notre Dame's gonna beat BYU.
46:46
SPEAKER_01: I'm not saying that.
46:47
SPEAKER_01: I'm not saying they're gonna win this week against Michigan State, although they're picked by almost 30.
46:52
SPEAKER_01: I'm just saying that we'll see what happens and I'll be there.
46:56
SPEAKER_01: There's more stuff.
46:57
SPEAKER_01: I won't read my closing message yet.
46:59
SPEAKER_03: So before I say this, I have to give him a heart because I love him so much.
47:04
SPEAKER_03: Juan said, Chris and Jeannie on Wednesday nights, kicking ass on OWCB and doing it right.
47:11
SPEAKER_03: Love and miss you guys always.
47:14
SPEAKER_03: I love you, Juan.
47:15
SPEAKER_03: You know that.
47:16
SPEAKER_01: Juan.
47:17
SPEAKER_01: Okay, seriously, we love you.
47:18
SPEAKER_01: And for all of you out there that don't know him, I'm fairly sure he could kill you with a pencil.
47:23
unknown: Yes.
47:25
SPEAKER_01: But that's not why I love him, but is one of the reasons I like him a lot.
47:29
SPEAKER_03: All right.
47:30
SPEAKER_03: Matt, oh, see you in Orlando for APGBU fall.
47:33
SPEAKER_03: Yep, we're already there.
47:34
SPEAKER_03: We're there.
47:35
SPEAKER_03: We're already there, Victor.
47:37
SPEAKER_01: All right, so we got a lot of long things here.
47:39
SPEAKER_01: Let's Matt.
47:40
SPEAKER_03: Also regarding 30-day suitable job offers, the letter normally says we concur with the employing agency.
47:48
SPEAKER_03: It actually means you have 30 days to rebute the job offer before a suitable determination.
47:54
SPEAKER_03: Don't let your union specialist make you think you have 30 days to accept the offer.
47:59
SPEAKER_03: Those are mandated letters automatically generated.
48:03
SPEAKER_03: All right, pause.
48:04
SPEAKER_01: So here's the rule.
48:05
SPEAKER_01: He's talking about limited duty offers.
48:08
SPEAKER_01: What happens is your doctor fills out a CA 17.
48:11
SPEAKER_01: And if any of this, Matt, contradicts you, I don't mean to do it on purpose, but I'm gonna tell the rule.
48:16
SPEAKER_01: I don't think it did, but we'll see.
48:18
SPEAKER_01: So doctor fills out a CA 17 duty status report.
48:21
SPEAKER_01: It goes to supervisor agency, um, does their effort and finds a limited duty offer.
48:28
SPEAKER_01: They give you the offer in writing, but they have to also give it to the claims examiner.
48:31
SPEAKER_01: So you don't have to sign it now.
48:33
SPEAKER_04: Correct.
48:34
SPEAKER_01: You don't have to sign it under duress or protest or any of that crap.
48:36
SPEAKER_01: It's not written in the rules, duress or protest at all.
48:40
SPEAKER_01: The claims examiner gets it, they review it, and they're like, the CA 17 says this, the offer says this, we think it's a valid offer.
48:47
SPEAKER_01: Cool.
48:48
SPEAKER_01: So now you have an opportunity to give it to your doctor.
48:51
SPEAKER_01: Your doctor has 30 days to review it.
48:53
SPEAKER_01: I recommend reviewing it in 30 minutes, 30 seconds if possible, but as soon as possible, because you want to get back on the clock and get paid.
49:00
SPEAKER_01: The surest way to get paid is to clock in.
49:03
SPEAKER_01: Now, if your doctor disagrees, they can disagree.
49:06
SPEAKER_01: If the claims examiner comes back and says, nah, I still disagree, the doctor has another two weeks to figure it out.
49:12
SPEAKER_01: So ultimately, you do have to accept an offer that the agency and the claims examiner ultimately find to be valid.
49:22
SPEAKER_01: And if you don't, they will cut all your benefits off.
49:24
SPEAKER_01: It's very important to understand that.
49:26
SPEAKER_02: Yeah.
49:27
SPEAKER_01: And that was complicated, and some put somebody's gonna be confused right now.
49:30
SPEAKER_01: But I occasionally do an entire episode on this, and so you can go back and find past ones, and there'll be one in the future.
49:37
SPEAKER_03: Maria, any FIC expansion into Kentucky, our partner that does that is looking.
49:44
SPEAKER_03: We're talking to doctors.
49:45
SPEAKER_03: We are talking to doctors everywhere.
49:47
SPEAKER_03: That's Joe's job, our partner Joe.
49:49
SPEAKER_03: That's his job, and he's working hard at it.
49:51
SPEAKER_03: This is not an easy system, so it's hard when we explain how this what the system entails.
49:57
SPEAKER_03: So we are looking everywhere that we still don't have locations.
50:01
SPEAKER_01: And I'll say this when I created this company and I we actually shut it down like four times because I thought there's a better way to do this.
50:09
SPEAKER_01: We are at what I think is the best way to do it, franchise.
50:12
SPEAKER_01: And um, our goal is to have an office within 50 miles of every federal employee in all 50 states, including Hawaii and Alaska.
50:19
SPEAKER_04: Yep.
50:19
SPEAKER_01: So are we trying to go to Kentucky?
50:21
SPEAKER_01: Absolutely.
50:23
SPEAKER_01: Alaska and Hawaii too.
50:24
SPEAKER_01: I mean, we want to be everywhere.
50:25
SPEAKER_04: Yeah.
50:26
SPEAKER_01: Because I know wherever I'm not at, you're struggling.
50:28
SPEAKER_01: And that's why we do what we do.
50:30
SPEAKER_01: There's a reason we expand to the areas we're in because we know you don't have other options otherwise.
50:36
SPEAKER_01: So, yes, we're trying to get to Kentucky.
50:38
SPEAKER_01: Yes.
50:38
SPEAKER_01: It's a passion of mine and we're we're working on it.
50:42
SPEAKER_03: Bobby Sloan.
50:44
SPEAKER_03: It's been four years since I hurt my knee, and I've had a knee replacement because of it, or I'm still having issues with the outer side of the left knee.
50:53
SPEAKER_03: Am I allowed to go to a different doctor out of our area without a referral?
50:58
SPEAKER_01: So you said allowed, which means probably not.
51:00
SPEAKER_01: If you said can, I would have said yes.
51:02
SPEAKER_01: What I would say is get a referral because OWCP honors referrals.
51:06
SPEAKER_01: So just get a referral.
51:07
SPEAKER_01: Yeah.
51:08
SPEAKER_01: You don't want more problems than are necessary.
51:11
SPEAKER_01: Just get a referral.
51:13
SPEAKER_03: Victor, we're not ending yet.
51:14
SPEAKER_03: You hold yourself.
51:15
SPEAKER_03: Hold on.
51:16
SPEAKER_01: Please, just hang on there.
51:17
SPEAKER_03: Jesse, what happens once your doctor has stopped PT and gives you your long-term limitations for going back to work?
51:26
SPEAKER_03: He has stated I'm 50% disabled and I don't see him again until January.
51:31
SPEAKER_03: I'm an RCA in New York.
51:33
SPEAKER_01: It's hard for me to answer that because I'm not a doctor and I don't know what doctors think of to make medical decisions.
51:39
SPEAKER_01: But the best thing I can tell you is go talk to the doctor.
51:42
SPEAKER_01: If you don't like it, you can ask for a referral.
51:45
SPEAKER_01: Uh, you can change treating doctors.
51:47
SPEAKER_01: It's hard for me to answer that because doctors know better than I do about what's going on medically.
51:52
SPEAKER_02: Yeah.
51:52
SPEAKER_01: So medical questions I'm going to struggle with, and I don't mean to because I don't like to be stomped, but I'm not a doctor.
51:59
SPEAKER_03: Jerry.
52:02
SPEAKER_03: Our Jerry?
52:03
SPEAKER_03: Yes.
52:03
SPEAKER_01: Oh, hello.
52:04
SPEAKER_03: Can you reiterate about how you can have an accepted claim but still have a denial of compensation being approved for medical only?
52:12
SPEAKER_03: And what advice can you give them besides running to an FIC office for proper narrative?
52:18
SPEAKER_03: Want our friend to hear from you.
52:20
SPEAKER_01: So you don't have to run to an FIC office, but what you do have to know is that just because your condition is accepted, that means they'll pay for the medical, right?
52:29
SPEAKER_01: With pre-authorization.
52:31
SPEAKER_01: They still have to approve the treatment.
52:32
SPEAKER_01: But they're not going to approve payment if you're off of work unless the doctor explains medically why you need to be off of work.
52:40
SPEAKER_01: So we created a document called a disability narrative where the doctor explains medically why someone has to be off.
52:47
SPEAKER_01: We fill out the CA 17.
52:48
SPEAKER_01: I say we, the doctor.
52:50
SPEAKER_01: It's a medical form.
52:51
SPEAKER_01: But the doctor fills out a CA 17 explaining the deficits, right?
52:55
SPEAKER_01: And then they write a medical narrative explaining why they made that decision.
52:59
SPEAKER_01: And when that goes in, that's how somebody starts to get paid.
53:03
SPEAKER_04: Yeah.
53:03
SPEAKER_01: So it requires a doctor to write an extra report.
53:06
SPEAKER_01: And look, OWCP requires doctors to jump through hoops to help you.
53:10
SPEAKER_01: That's probably by design.
53:11
SPEAKER_02: Yeah.
53:12
SPEAKER_01: But a good doctor will jump through all the hoops they need to because they care about you.
53:16
SPEAKER_03: John Reverend, how are you?
53:19
SPEAKER_03: I hope you're feeling and doing much better, my friend.
53:22
SPEAKER_03: What's up, John?
53:23
SPEAKER_03: And can DOL expand the claim internally after results of their requested second opinion?
53:30
SPEAKER_01: So they can.
53:32
SPEAKER_01: I love can questions because the answer to can is almost always yes, but they don't.
53:37
SPEAKER_01: Your doctor will have to do a diagnosis expansion.
53:40
SPEAKER_03: Jesse, I go back in January for anticipated schedule loss, but he has me at 50% disabled now.
53:49
SPEAKER_01: I'm not sure what to say about that.
53:50
SPEAKER_01: It's a doctor thing.
53:51
SPEAKER_03: Yeah.
53:52
SPEAKER_03: Linda says Pittsburgh needs one, please.
53:55
SPEAKER_03: So we know, and we're working on it just like we are the last time.
53:57
SPEAKER_01: Pittsburgh definitely needs one.
53:59
SPEAKER_01: We are all over the map trying to figure this out.
54:02
SPEAKER_03: Matt Hayes, she said, the BS I went through, I have an axe to grind now.
54:07
SPEAKER_01: I know you do, Matt.
54:08
SPEAKER_03: I know you do.
54:09
SPEAKER_03: Yeah, I know.
54:10
SPEAKER_03: Maria, I'm from there and not thrilled with this Florida heat.
54:15
SPEAKER_03: Thank you.
54:16
SPEAKER_03: I hate the heat.
54:17
SPEAKER_03: This is why I'm I'm from here, Utah.
54:19
SPEAKER_01: Look, I'm from Texas, where it was like 110 for like six weeks in a row.
54:23
SPEAKER_01: So this was a this is winter.
54:26
SPEAKER_03: Maria, oh my heck, the FIC in Springfield is practically across the street from the mail processing plant.
54:33
SPEAKER_03: Perfect.
54:34
SPEAKER_03: Hey, walk across the street, Maria.
54:37
SPEAKER_01: So we have a a Maria also who owns that office.
54:40
SPEAKER_01: She just happened to find office space for rent that happened to be there.
54:44
SPEAKER_01: And that was a smart decision because you guys need the help.
54:48
SPEAKER_03: Dr.
54:49
SPEAKER_03: Steffick.
54:50
SPEAKER_03: Great to see you guys again.
54:52
SPEAKER_03: Not a fan of Jeannie's hat, but I will have the right hat when I go to the BYU Notre Dame game because I will be a BYU fan that day.
55:00
SPEAKER_01: So the reason Tim's not a fan of your hat is he's actually a Notre Dame fan.
55:04
SPEAKER_03: No, he's actually a BYU fan.
55:06
SPEAKER_01: He's a closet Irish fan.
55:09
SPEAKER_01: But Dr.
55:10
SPEAKER_01: Stef has offices in Daytona, Jacksonville, Tallahassee, and another office coming soon.
55:19
SPEAKER_03: Maria, you're getting closer to Hartford.
55:22
SPEAKER_03: Aww.
55:22
SPEAKER_03: We need an FIC in Hartford, Connecticut.
55:25
SPEAKER_03: Oh, we know.
55:26
SPEAKER_01: Yeah.
55:26
SPEAKER_01: We know.
55:27
SPEAKER_03: Tenora, I love helping fellow rural carriers navigate this process, and thank you for allowing me this opportunity.
55:33
SPEAKER_01: I'm really glad you're here, Tenora.
55:34
SPEAKER_01: I mean, seriously, take what I'm giving you and give it to someone else.
55:38
SPEAKER_01: I really need that.
55:39
SPEAKER_01: Give it to them.
55:40
SPEAKER_01: Don't tell them it even came from me.
55:41
SPEAKER_01: Take all the credit, but just give it to somebody.
55:44
SPEAKER_03: Yeah.
55:45
SPEAKER_03: Dina.
55:46
SPEAKER_03: Oh boy.
55:47
SPEAKER_01: I see it.
55:48
SPEAKER_03: Go cow Dallas Cowboys.
55:51
SPEAKER_03: Wow.
55:54
SPEAKER_01: So, for all of you there that are just new here or didn't know, I am originally from Dallas.
56:00
SPEAKER_01: I lived in Texas 41 years.
56:02
SPEAKER_01: My entire family tree is planted in Texas.
56:05
SPEAKER_01: I moved to Florida because she wouldn't marry me if she had to go to Texas.
56:09
SPEAKER_01: So I decided to marry her and come here.
56:11
SPEAKER_01: It's cool because palm trees and beaches are nice.
56:15
SPEAKER_01: And the Dallas Cowboys haven't won a Super Bowl since 1995.
56:19
SPEAKER_01: And so, Dina, I'm very sorry for you.
56:23
SPEAKER_01: As I'm sorry for myself.
56:25
SPEAKER_03: Tenora said all day, every day, keep to the credit.
56:29
SPEAKER_01: Keep no credit.
56:30
SPEAKER_03: Oh, sorry, I don't have my glasses.
56:31
SPEAKER_03: Keep no credit.
56:32
SPEAKER_01: No to the, they all look the same when you're blind.
56:35
SPEAKER_03: All right, as we wrap up, so we discussed what it means to get your claim approved, the process to get your claim approved, and then we explain what happens if you get a denial and the process of getting a denial and what to do if you get a denial.
56:54
SPEAKER_03: Remember, please don't throw away these letters that OWCP sends you.
56:58
SPEAKER_03: Do not throw away any of them.
57:00
SPEAKER_03: Even it has a blank piece of paper.
57:03
SPEAKER_03: Chris had to read, I think, over 3,000 pages one day on a patient, a really sweet patient that we know very dearly.
57:10
SPEAKER_03: And he read all 3,000 plus pages.
57:13
SPEAKER_03: And there was a few blanks, but you know what?
57:15
SPEAKER_03: She kept everything in order.
57:17
SPEAKER_03: So it was easy for him to go through 3,000 pages.
57:20
SPEAKER_03: Save everything.
57:21
SPEAKER_03: Yes.
57:22
SPEAKER_01: I've read thousands of pages, hundreds of pages.
57:25
SPEAKER_01: All of my staff does the same thing.
57:26
SPEAKER_01: All the case managers and all the offices do the same thing.
57:30
SPEAKER_01: We are committed to getting your claims approved, getting you better, getting you back to work.
57:34
SPEAKER_01: I have something I want to say.
57:35
SPEAKER_01: And Jerry said, love you guys.
57:37
SPEAKER_02: I have no questions.
57:38
SPEAKER_01: I love her too.
57:40
SPEAKER_01: You know what?
57:41
SPEAKER_01: I remember the first time I met Jerry.
57:43
SPEAKER_01: I was in Maryland.
57:44
SPEAKER_01: Maryland?
57:46
SPEAKER_01: Virginia.
57:46
SPEAKER_01: No, I was in Virginia.
57:47
SPEAKER_03: I saw her.
57:48
SPEAKER_03: And um or she drove two hours to come see you?
57:51
SPEAKER_01: She stole my heart.
57:52
SPEAKER_01: Yeah, I know.
57:53
SPEAKER_01: I've never met somebody sweeter than her at that time.
57:55
SPEAKER_01: It's just incredible.
57:56
SPEAKER_03: She has we love her so much.
57:57
SPEAKER_03: Jesse, okay, maybe you can answer this one.
58:00
SPEAKER_03: What happens once your doctor has given you the anticipated schedule loss?
58:05
SPEAKER_03: What is the process with OWCP going forward and going back to work?
58:10
SPEAKER_03: He has stated I would require a new position because of my limitations and suggested vocational training for a new position.
58:18
SPEAKER_03: I just want to know what happens next with OWCP.
58:21
SPEAKER_01: Thank you so much for your help.
58:23
SPEAKER_03: You're welcome.
58:23
SPEAKER_01: So that's a couple of things rolled up into one.
58:25
SPEAKER_01: I mean, we're talking about vocational rehab and we're talking about schedule awards that don't necessarily for all of you out there don't have to go together.
58:33
SPEAKER_01: You can get a scheduled award without vocational rehab and vice versa.
58:36
SPEAKER_01: The schedule award has got to be approved by OWCP.
58:39
SPEAKER_01: You're likely going to go to a second opinion doctor, maybe even a referee doctor, and then you'll you'll figure it out.
58:44
SPEAKER_01: They'll pay you on that.
58:46
SPEAKER_01: Um, vocational rehab is just because they don't want you to be sitting at home for the rest of your life, they want you to be able to be productive the way you want to be.
58:52
SPEAKER_01: And so sometimes you can't do your same job.
58:55
SPEAKER_01: I just did a vocational rehab training a few weeks ago.
58:58
SPEAKER_01: You should go take a look at it.
58:59
SPEAKER_01: But what they're trying to do is get you back to work with the idea that that's probably best for you.
59:04
SPEAKER_01: And I don't know what's best for you.
59:05
SPEAKER_01: I'm just saying what they're doing.
59:06
SPEAKER_01: So they're not necessarily the same thing.
59:08
SPEAKER_03: John Reverend gave the big eyes and said that one time in Bandcamp.
59:15
SPEAKER_01: Look, I saw American Pie, John.
59:17
SPEAKER_01: You cannot stump me with a movie reference.
59:20
SPEAKER_03: Becky, I've never heard of a CA 17.
59:23
SPEAKER_03: When do you submit?
59:24
SPEAKER_01: Oh, goodness gracious, Becky.
59:26
SPEAKER_01: You have to get that from your supervisor.
59:28
SPEAKER_03: Yes.
59:29
SPEAKER_01: Side A says supervisor, side B says physician.
59:32
SPEAKER_01: Supervisor fills out side A.
59:34
SPEAKER_01: You take it to your doctor, they fill out side B, and then you take it back to your supervisor.
59:39
SPEAKER_01: That's how they write restrictions, take you off of work and put you back to work.
59:43
SPEAKER_03: Yeah.
59:44
SPEAKER_03: Uh Matt Hayes said Colts.
59:47
SPEAKER_03: Who are they?
59:48
SPEAKER_03: Who are the Colts?
59:48
SPEAKER_03: Indianapolis Colts.
59:49
SPEAKER_03: I don't follow NFL, so I don't know.
59:51
SPEAKER_03: Who is it?
59:52
SPEAKER_03: Indianapolis Colts.
59:53
SPEAKER_03: Oh, okay.
59:54
SPEAKER_03: Yeah.
59:54
SPEAKER_03: Jerry, love you guys.
59:55
SPEAKER_03: Keep up the good work.
59:56
SPEAKER_03: Big hugs.
59:57
SPEAKER_03: We love you too, Jerry.
59:59
SPEAKER_01: Love you too.
59:59
SPEAKER_03: Linda, good night, guys.
1:00:00
SPEAKER_03: See you next week.
1:00:02
SPEAKER_03: Tenora.
1:00:02
SPEAKER_01: No, nobody leave yet.
1:00:04
SPEAKER_01: I have something else to say.
1:00:04
SPEAKER_03: Yeah, I have something funny to say to end.
1:00:06
SPEAKER_03: Tenora, Jesse, message me if you want to hear my story.
1:00:09
SPEAKER_03: Matt, me too.
1:00:10
SPEAKER_03: I just love me some Jerry Mike Michelle Gatewood.
1:00:14
SPEAKER_01: Oh, he's smart.
1:00:14
SPEAKER_01: All right, this is my last thing.
1:00:16
SPEAKER_03: And then I have a last thing.
1:00:17
SPEAKER_01: An approval.
1:00:19
SPEAKER_01: Like everybody, just please laser focus in on me.
1:00:23
SPEAKER_01: And approval is not permission to stop paying attention.
1:00:27
SPEAKER_01: You're approved.
1:00:28
SPEAKER_01: Now laser focus in.
1:00:30
SPEAKER_01: Okay, because lots of bad things can happen next.
1:00:33
SPEAKER_01: You're approved.
1:00:34
SPEAKER_01: Now really focus in.
1:00:36
SPEAKER_01: Alright, because it's not the end, that's a beginning.
1:00:39
SPEAKER_01: And a denial is not permission to give up.
1:00:43
SPEAKER_01: I'm telling you.
1:00:44
SPEAKER_02: Yeah.
1:00:45
SPEAKER_01: I'm telling you, the world is caving in.
1:00:46
SPEAKER_01: The sky is falling.
1:00:47
SPEAKER_01: It's not.
1:00:48
SPEAKER_01: They gave you a roadmap to fix it.
1:00:51
SPEAKER_01: So don't get too high on the approval and don't get down on the denial.
1:00:56
SPEAKER_01: If you have a legitimate case, you should get approved.
1:00:59
SPEAKER_01: A legit injury gets approved if it's filed timely.
1:01:04
SPEAKER_01: That's the one thing I know.
1:01:05
SPEAKER_01: That's why I'm so confident that I can get any legitimate timely filed claim approved.
1:01:11
SPEAKER_02: Yeah.
1:01:11
SPEAKER_01: I would bet my life on it.
1:01:13
SPEAKER_01: Any legitimate timely filed claim, I could get approved.
1:01:18
SPEAKER_01: So don't get too high on the approvals and don't get too low on the denials.
1:01:21
SPEAKER_01: Yeah.
1:01:22
SPEAKER_01: It's all gonna be okay.
1:01:24
SPEAKER_03: Lewis said, just saying Princeton has disowned the Notre Dame fan over there.
1:01:30
SPEAKER_01: Okay, so Princeton's not the Princeton I grew up in.
1:01:34
SPEAKER_01: I drive through it and I don't stay in it.
1:01:38
SPEAKER_03: Alright, guys, I just before we come to an end here.
1:01:43
SPEAKER_03: Follow me or your friends with me on my purse.
1:01:47
SPEAKER_03: They want you to quit.
1:01:48
SPEAKER_03: Don't quit.
1:01:49
SPEAKER_03: No, she's right.
1:01:50
SPEAKER_03: If you get a denial, that's exactly what Maria said.
1:01:54
SPEAKER_01: You know what?
1:01:55
SPEAKER_01: I do this all the time.
1:01:56
SPEAKER_01: Wolf of Wall Street.
1:01:57
SPEAKER_01: There's a scene at the end, and I'm not making a joke now.
1:02:00
SPEAKER_01: The scene at the end where Leonardo DiCaprio has been like shut down.
1:02:03
SPEAKER_01: They said he's gotta quit, and he's gotta divest his interest in this illegal thing he's been doing, but he's so passionate about it.
1:02:10
SPEAKER_01: He starts hitting himself on the head with his microphone.
1:02:12
SPEAKER_01: He says, I'm not leaving.
1:02:14
SPEAKER_01: I'm not leaving, right?
1:02:15
SPEAKER_01: And he says other words too.
1:02:16
SPEAKER_01: I feel that way all the time about you guys.
1:02:18
SPEAKER_01: Yeah, I think about it all.
1:02:20
SPEAKER_01: Don't I say it?
1:02:20
SPEAKER_01: Yeah.
1:02:21
SPEAKER_01: I see that scene in my head all the time when it comes to you.
1:02:25
SPEAKER_01: I'm not leaving.
1:02:26
SPEAKER_01: You shouldn't either.
1:02:27
SPEAKER_03: Yeah.
1:02:28
SPEAKER_03: Linda, surgery next Tuesday, pray for me.
1:02:31
SPEAKER_03: I will.
1:02:31
SPEAKER_03: I actually will.
1:02:32
SPEAKER_03: And I will reach out to you.
1:02:34
SPEAKER_03: Richard, how do I obtain disability rating more than three years from return to MMI?
1:02:41
SPEAKER_01: You can do an impairment rating anytime as long as you're alive.
1:02:46
SPEAKER_01: So rest assured, you have not missed a deadline.
1:02:48
SPEAKER_01: Just stay alive.
1:02:49
SPEAKER_03: Alright, I'm gonna end this and then we're gonna we're gonna get off.
1:02:52
SPEAKER_03: So those of you that follow me on my page, I didn't know this till today.
1:02:58
SPEAKER_03: That and please don't say the person's name because I don't want this person's name on the I didn't know that 60 minutes wasn't an hour.
1:03:11
SPEAKER_03: Till today I heard this, that one hour is one hour.
1:03:16
SPEAKER_03: 60 minutes is not one hour.
1:03:20
SPEAKER_03: But if you guys want to know what I'm talking about, watch 60 minutes on Sunday.
1:03:25
SPEAKER_01: Cheryl David said, Do you know if you're on OWCB, do they still consider you an active employee?
1:03:31
SPEAKER_01: Yes, you are, as long as you are an active employee.
1:03:34
SPEAKER_01: And Victor said, and I love Victor does this all the time.
1:03:39
SPEAKER_01: He's so fantastic about this.
1:03:40
SPEAKER_01: Now's the time.
1:03:41
SPEAKER_01: Always fight for your rights and never, never give up.
1:03:44
SPEAKER_01: I'm telling you right now, I promise you, if you don't give up, we won't give up ever.
1:03:51
SPEAKER_03: I'm telling you guys, 60 minutes is an hour.
1:03:54
SPEAKER_03: If it's not, they failed us in elementary school.
1:03:59
SPEAKER_01: See, I try to do this emotional end, and she goes back to 60 minutes.
1:04:04
SPEAKER_04: I'm sorry.
1:04:06
SPEAKER_01: I think if you're watching 60 minutes, you should give up.
1:04:09
SPEAKER_01: You should this time.
1:04:10
SPEAKER_01: Because I'm pretty sure they have football on.
1:04:12
unknown: Yeah.
1:04:13
SPEAKER_03: All right, guys, we will be back next Wednesday night.
1:04:16
SPEAKER_03: One said 100%.
1:04:18
unknown: Yeah.
1:04:19
SPEAKER_01: One, love you, miss you.
1:04:20
SPEAKER_01: Tell Larry I said hi, love you, miss him too.
1:04:22
SPEAKER_03: All right, guys, we will see you next Wednesday, 8 p.m.
1:04:25
SPEAKER_03: Follow us on Facebook, subscribe to us on YouTube at Wednesday night OWCP chats with.