Thursday, September 9, 2010

Reconsideration- OWCP

In the 1980's when laws were passed putting all Federal employees under Social Security and Medicare, I opted to stay with the Civil service Retirement plan and not go under FERS, but did begin paying Medicare tax. There are some differences in the rules, apparently, with regard to Federal Workers Compensation. When one is injured on the job, there is no way to have a final retirement until Federal workers Comp is finally settled. Laws were also passed that when one has a life sustaining medical needs such as home oxygen, then permanent medical benefits are awarded as soon as the claim is accepted. And before any decision is made as to whether one can work, etc. Many current employees and contractors of the agencies apparently are unaware of the rules that pertain to me. There has been no settlement although a schedule award was filed for in 1996. Extensive medical documentation has been submitted over the years and multiple doctors have signed for permanent disability. With much of the files going missing at times, a claims examiner in the Dallas OWCP office in 2007 mistakenly decided I'd refused to return to work in 7/1990, although the files clearly showed that I did and suffered physically with no reasonable accommodation which had been promised to me.
In 2/09, the Claims Authorization Board set aside that final excuse to not reinstate temporary wage loss and any other benefits being withheld. They also remanded the case and stated that i was to be asked for the facts of the case, since destruction of records by OWCP and contractors meant they didn't have a clue what was occurring in my file. They also stated that they can't review and issue that has never had an initial decision.
I waited and in 10/09 a check was sent me and a letter to start the permanent disability process. The claims examiner admitted that my leave records couldn't quite be understood. Also, there are CA1's & CA 2's in file on secondary and tertiary medical issues that have yet to be reviewed for acceptance along with the extensive medical documentation on those physical conditions. So, neither my claims examiner nor I have any idea exactly what medical issues will be negotiated for a schedule award , yet . Prior remands referred to these pending claims with no decision. Since we are dealing with, for the most part, internal organs that interact and cause harm to each other, these need to be decided as future medical care and who will pay for it should not be left to constant appeals and hassles.
Social Security, my employer, made decision on various Contending of Pay periods of time that i had filed for since 1/10/89, some I agreed with some i didn't. They have agreed to do the leave buy back, but need OWCP to make a formal decision as exactly what different periods of time should be; continuation of pay or wage loss under OWCP. There are numerous CA1's. CA2's and CA2A's filed since 1/10/89 and only most have never been ruled on.
There were numerous claim numbers placed on many of the claims, but in 1995, these were all consolidated under the original claims number by the Philadelphia OWCP office.
I'm aware and so were the Judges in 2/09, that you did not have all the information yet in the files to make the needed decisions. Also, there are out - of pocket expenses that have never had an initial processing and payment going back to 1989 despite numerous remands over the years for this to be done. Many medical providers have not been fully paid. Various insurance and other health plans such as Medicare have not been reimbursed either. Most critical is that Lincare is now the monopoly service provider of home compressed oxygen (liquid) in my area. They bought out health Connections which was being paid monthly by OWCP. No transfer ever took place. Federal Blues and medicare had paid for part of the time, but was stopped, allegedly by a past Director of OPM.
When ACS took over the processing of all paper files and claims for payment in /02, my reconstructed file of @35,000 pages was at the appeals board in Washington, D.C. It arrived in London, KY in 6/04 to be scanned in and worked and the entire file 'disappeared' out of their office and only pieces survived and misled the Dallas OWCP office as to what was occurring on my case. In 1/06, when Lincare called OWCP-they were told case closed and left the impression that I'd received a large settlement that included monies to repay them and other medical providers. Did not occur. When my new oxygen provider billed OWCP, the claims were not input by ACS because: the computer will pay them. I now understand that ACS's computer is still 'offline' of the official US DEPT of Labor computer that posts bi weekly to Medicare showing permanent medical benefits and Federal Blue Cross Blew Shield as my 2 primary payers since no schedule award has yet been done. Currently, our son is hauling tanks and paying out of pocket for me to stay alive and its a terrible financial hardship for the entire family. Lincare's headquarters won't budge without full payment and assurances form OWCP. Due to my occupational asthma, I'm approved for compressed air ( liquid) oxygen due to the ozone emission causing grave inflammation from concentrators. I've submitted all the invoices, etc from Lincare multiple times and those are still not processed.
Bills, and other issues not paid have appeals pending on them some for over a decade. To compound the problem is that prior to ACS taking over, the Dallas OWCP office was not itemizing what was or was not paid on out of pocket expenses. of curse I filed timely appeals and asked for an itemization so that the medical records could be associated with the items not paid. To date none of these appeals have been answered. Apparently, ACS, never forwards them to you either.
Further obstruction of medical care is that providers.suppliers have no idea whom to bill as when they cal ACS, they keep being erroneously told that my case is closed and some 'unknown' third party is to be billed. They wont tell me who that is either as its non-existent.
In 2005, I received permission from the Secretary of labor's office to reconstruct the file which was now @40,000 pages with new expenses and appeals, etc, Due to financial hardship caused by the 'disappearance of my file,' I was given permission to use the 1-800-215-4901 in Tallahassee, Fla. ACS and some very nice ladies boxed up the files and sent them to London, KY to be scanned and they 'disappeared' without being scanned in. Now the file is @ 50,000 pages and all the hard work by my family and I of putting my claim # on every page,etc is missing.
This time we need an agreement as to where the files can be faxed to and that they will be processed, scanned in, etc. and never disappear again. I do have a 'flat rate' long distance carrier now, and so it can be a fax number most convenient for you.
There are probably other legal paper work that needs to be done and this should be worked through also. I've suggested multiple times to start with 1989 and work forward completely each year 'building year by year.' This also resolves some issues of filing dates as it shows when different issues were 'discovered; and doctors made medical reference to the discoveries. Everything has been timely filed and refiled at great personal and financial expense.
OWCP temporary wage loss needs to be reinstated as of 1/3/99 and medical bills related the medical conditions already accepted need to be paid as they come in. Plus reprocessing the back log. In 2005, I'd submitted the medical bills from each provider with receipts and the medicals from each in an organized manner. Due to other matters that have occurred as a result of this not being taken care of , much of these files were pulled apart to submit to other health care appeals, etc. Which can be read about online in many blog comments by me.
Some of the medical conditions in the secondary and tertiary claims are for nerve damage in hands, etc. due to ABG needle sticks, heart, kidney, diabetes, gastrointestonal, etc. 50% vision loss due to cataracts, etc. mucousal membrane damage that never recovered, etc. All medically documented and filed over the last 21 years and claims 'disappeared'. Its physically harmful for me to have to get into all the ink and paper and hopefully, we can work through this to a final conclusion this time with out files constantly going 'missing.' Once all the back log is worked through, then I personally believe a fair and equitable settlement can be reached on the schedule awards and then I'll be in a better position to decide about taking a buy out of future OWCP payments and monies placed in escrow for future medical care to be paid by my FEHB health insurer OR; just receive ongoing monthly wage loss and have the covered medical bills paid by OWCP or my insurance health plan(s) reimbursed if they pay the bills first.
P.S. There has been no settlement of any third party law suits to date as OWCP has not yet determined what the 'damages' are. This has greatly hurt the taxpayer getting reimbursed if an out of court settlement agreement is not agreed to and the US Dept Of Labor and I must go to court after all this time to obtain reimbursement for the taxpayers. Compounding this is CNA 'wanting' to consolidate a 'slip and fall' case with the OWCP case since before I understood and was told the true nature of my injuries and that they were permanent and progressive, I'd gone back to school to train for another career and even though I didn't consider the 'cause' as related, I'm now aware of some other on-going 'shenanigans' that were occurring that may have led to why I was on the stairs at the point in time.
P.S.S. In the paper OWCP file is another accepted condition: pneumonitis; its on your internal cover sheet chart. But there are a lot of various medical problems commonly associated with this kind of traumatic injury. Its a miracle along with the medical of many good doctors that have continued to provide treatment with horrific billing problems that have allowed me to be here today. I've lost good doctors because they just couldn't go through the billing hassles anymore and needed to be paid fully and timely.
Linda Joy Adams

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