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Edward Daniel
05-25-2012
03:46 PM ET (US)
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You need to get the case out of the District Office. I would suggest that you contact the District Director or Regional Director, once again explaining the situation and request that a Compensation order denying benefits under the Act and Federal Register be issued with appeal rights. Then request an oral hearing with the Branch of Hearings and Review. At the hearing you will be allowed to present documentation as to actual mileage in order to seek and obtain medical care for your accepted work related condition(s).
Edward Daniel
FECA Claims Representative
133 Vista Dr
Willow Park, TX 76087
817-441-7247 Voice
817-441-9046 Fax
Web: http://www.feca-representative.com/
< replied-to message removed by QT >
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Wolfgang Holst
05-25-2012
02:29 PM ET (US)
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Dear Messr.'s Linehan and Daniel:
My message concerns issues raised in messages M904,M905,M912 and M913 that deal with medical travel reimbursement. I know full well that the CFR amendments that went into effect on August 31, 2011 limit such travel to 100 miles round trip. But the language of the appropriate section allows for special circumstances such as when an IW lives in a remote or rural area. I live at 7,200 feet up in the mountains and have to drive 52 miles just to get to the nearest freeway onramp. I have co-morbid medical conditions for which OWCP has approved multiple Board Certified Specialists as treating physicians. But, none practice within 50 miles of my residence, and in actuality, I must travel more like 200 miles round trip for each appointment. I've been with these physicians for years and it would be a significant loss to have to change them because of the mutual trust, respect and specific knowledge relative to my multiple condidtions.
Now getting to my question(s). As sure as the sun rises in the east, OWCP this past September stopped paying my mileage to my physicians and has been holding to the 100 rt mileage requirement. I've explained numerous times to them the problem of their being no adequate physicians up here and none up to and beyond the freeway onramp. With my pre-authorization requests I submit an unsworn declaration under penalty of perjury stating that I conducted a telephone book search in my local area for board certified specialists. I also swear that I have conducted a search for appropriate specialists on the ACS/USDOL Provider List for all populated areas in the mountains, in the cities below the mountains and in the cities in the Southern California desert area within 60 DRIVING miles from where I reside. The searches always come up negative when I input the city names and the area of specialty. Needless to say, OWCP still bounces me. So my questions are: Have I exhausted my obligation to find an appropriate medical specialist within the 50 mile one-way commute requirement for the conditions accepted by utilizing the ACS/DOL Provider List? Am I now justified to seek and in fact obtain mileage reimbursement for travel beyond 50 miles? Interestingly on this issue, along with a pre-auth denial, one of my claims examiners sent me a letter stating, "...the ACS website is not all inclusive and you are not prohibited from selecting a physician not currently selected on that website. You may select a physician who has enrolled or is willing to enroll with our central bill processing and medical authorization unit..." But, as we all know, who wants to do that? The CE went on further writing, "I am enclosing a list of endocrinologists within 50 miles of your residence to assist you in your search for a suitable physician." Well, the list that she provided was downloaded from the www.healthgrades.com/provider directory with 20 board certified endocrinologists listed. First off, the "within 50 miles" is as "the crow flies," and not as the road goes. In order for me to remain within the 50 mile limitation would require a Mercy Air Helicopter ride to the tune of $10,000 each way or a two day hike down the mountain, and be at risk for bear and/or mountain lion attacks. I don't think my diabetes or hypertension would survive such hikes up and down the mountain either. I also undertook to call some of the physicians on the list and one was at the VA Hospital and doesn't see private, paying patients. Many said no to OWCP patients. Some didn't know what OWCP, USDOL or FECA were, much less any type of job injury scheme. One was a medical group that sees an average 250 patients per day, which would not be ideal due to my reactive airways disease and environmental hypersenstivity. Question: What obligation do I have to seek a specialist from the woefully inadequate printout prepared by a commercial entity in which no attempt ever was made to ascertain the exact driving route(s) and the the actual driving mileage involved?
On a final note and something on which you, Mr. Linehan touched upon in one of your responses, OWCP has not hesitated sending me as much as 150 driving miles one-way to SECOPS - which would suggest that they themselves are unable to locate a suitable physician within 50 miles of my residence. Does this double-standard factor into the issue? What about the claim-reset concept? Does it have any effect? The claims examiners are relying on a letter sent to me by the SFO District Director in December 2011 which stated that my reimbursements over 100 miles rt would no longer be approved and are using it as grounds for a blanket denial.
Answers or guidance either of you gentlemen can provide me is sincerely appreciated. If you have any citations, department directives or memos that might help, don't hestiate to forward them!
Wolfgang Holst
Big Bear Lake, CA
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Edward Daniel
05-25-2012
11:47 AM ET (US)
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I have used eCOMP as method to get documents to the CE and/or the case the same day. A CE and I tested how fast the documents would reach the case file. I sent several documents via eCOMP to the case file and the CE called me about 10 minutes later to tell me she received the documents. There is a limit as to the size of the document or documents you are sending, but the system will let know if it is too big.
Edward Daniel
FECA Claims Representative
133 Vista Dr
Willow Park, TX 76087
817-441-7247 Voice
817-441-9046 Fax
Web: http://www.feca-representative.com/
< replied-to message removed by QT >
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linehanpc  05-25-2012
10:20 AM ET (US)
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ECOMP The website for injured federal employees
Federal Employees and Contractors: If you are a Federal employee or a contractor who has sustained a work-related injury or illness, you may use this portal to report the incident or illness to your supervisor using OSHA's Form 301 (Injury and Illness Incident Report).
Federal Employees Only: If you are a Federal employee you may also file a claim for benefits under the Federal Employees' Compensation Act (FECA). You may initiate a new claim by filing either form CA-1 (Federal Employee's Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation) or form CA-2 (Notice of Occupational Disease and Claim for Compensation). You may also file form CA-7 (Claim for Compensation) if you have an existing FECA case.
http://linehanpc.blogspot.com/2012/05/ecom...njured-federal.html
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Ed Daniel
05-22-2012
06:45 PM ET (US)
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gfro: Yes
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gfro
05-22-2012
03:13 PM ET (US)
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sorry I meant 972...
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gfro
05-22-2012
03:12 PM ET (US)
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I wondered if this would apply for post # 971 ? “ It is apparent that OWCP in its August 4, 2010 decision did not review the May 11, 2010 report from Dr. Sanders, as no reference was made to this evidence in the decision. For this reason, the case will be remanded to OWCP to enable it to properly consider all the evidence submitted prior to the issuance of the August 4, 2010 decision. Following such further development as OWCP deems necessary, it shall issue an appropriate decision on the merits. “
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Ed Daniel
05-12-2012
05:18 PM ET (US)
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test
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linehanpc 05-07-2012
08:41 PM ET (US)
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NOT OUR PROBLEM SAYS COURT TO DISABLED VETERANS
Federal court rules against veterans rights despite Department of Veterans Affairs documents showing that the system took an average of 4.4 years to review veterans' health care claims; that more than 1,400 veterans who had been denied coverage have now died in one six-month period while their appeals were pending; and that 18 veterans per day were committing suicide.
Federal court says disabled veterans claim that "they should be allowed to hire lawyers and obtain evidence when appealing the denial of disability benefits would contradict the "non-adversarial system" and denies veterans that right of representation.
In dissent, Judge Mary Schroeder said the court's refusal to consider claims of system-wide delays "leaves millions of veterans - past, present and future - without any available redress."
Read more: http://www.sfgate.com/cgi-bin/article.cgi?...8.DTL#ixzz1uEp0zkSa
Read more: http://www.sfgate.com/cgi-bin/article.cgi?...8.DTL#ixzz1uEogyeve
http://linehanpc.blogspot.com/2012/05/not-...deral-court-to.html
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neice 05-07-2012
08:07 PM ET (US)
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Mizel - Actually you shouldn't ask for the whole file again, just what was generated from the end date of the previous cd you got because they can charge you for giving you the same info again.
I kind of had the same problem as you. I ended up demanding my due process because the CE arbitrarily closed my new claim. I wrote to the District Director & the Regional Director. Finally I got my appeal rights. I just got the appeal back from the Hearing Representative and the claim was remanded.
You have to demand your rights, because some of the CE's don't want you to get your benefits.
Some of your appeal rights give you 30 days, like the Review of the Written Record, which is I think is the best one. I always send my appeals via Express Mail, it cost more but I know it gets there on time.
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Mizel 05-07-2012
06:52 PM ET (US)
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Thanks Snowed /m978: Question: If I request a copy of my case file, will they provide the complete file seeing as how I requested a copy last year and they provided it on CD? If I need the complete file on CD, how would I accomplish that?
Thanks...
It's Mizel... networking...
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Snowed 05-07-2012
06:22 PM ET (US)
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Mizel-
Before you send the appeal to the board, request a copy of your case file to see if the medical report is included.
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Edward Daniel
05-07-2012
05:38 PM ET (US)
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Mizel: again send the case to the Board.
Edward Daniel
FECA Claims Representative
133 Vista Dr
Willow Park, TX 76087
817-441-7247 Voice
817-441-9046 Fax
Web: http://www.feca-representative.com/
< replied-to message removed by QT >
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Edward Daniel
05-07-2012
05:37 PM ET (US)
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Traci; You need to send a written request for the SOAF and questions sent to the 2nd opinion doctor. Send it via three methods (1) USPS mail, (2) fax to the district office and (3)eCOMP. The letter needs to address to the District Director of the District Office handling your claim. Your letter should explain the date of the letter received, the date you received the letter and the date of the examination.
Edward Daniel
FECA Claims Representative
133 Vista Dr
Willow Park, TX 76087
817-441-7247 Voice
817-441-9046 Fax
Web: http://www.feca-representative.com/
< replied-to message removed by QT >
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Mizel 05-07-2012
04:18 PM ET (US)
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Hello Jim, /m973: Your point is noted and pretty much bottom-lines my whole ordeal. Appeal and move on. Thanks for the comment and insight.
It's Mizel... and I'm moving on...
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Traci
05-07-2012
03:54 PM ET (US)
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I got the dreaded second opinion appointment one week from today. I thought that I could request a SOAF but how do you get that in time for the appointment. I need all the advice I can get. Thanks
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