There are a number of reasons why OWCP may terminate your monthly wage loss compensation benefits.
For federal workers who rely on Office of Workers’ Compensation Programs (OWCP) benefits to support them during their recovery from work-related injuries or illnesses, a termination of benefits can be distressing. If this happens to you, it is essential you understand your legal rights and the steps you can take to address the termination. This article will guide you through the options available to you if OWCP terminates your compensation and/or medical benefits.
Understand the reason for the termination
When OWCP terminates your benefits, it’s important to understand the reason behind their decision. To do so, you should carefully review any OWCP correspondence you receive on your claim regarding the termination decision. To summarize, the most common reasons include:
Medical Improvement: OWCP may terminate your wage-loss benefits if they feel your accepted condition improves and allows you to work. Additionally, OWCP may terminate your medical benefits if it determines that you no longer need treatment for your accepted condition.
Lack of Medical Evidence: If OWCP believes the medical evidence is insufficient to support your continuing benefits, they may also terminate those benefits. It’s crucial that your medical records and documentation accurately reflect the ongoing impact of your work-related injury or illness.
OWCP-Directed Examinations: If OWCP sends you to a second opinion or referee examination, they may also use that medical examiner’s opinions to terminate your benefits. Specifically, if the second opinion or referee examiner finds that you are able to work or that your accepted medical condition has resolved, OWCP may side with that medical examiner over your own treating medical provider.
Failure to Comply: If you fail to comply with OWCP requirements, such as attending scheduled second opinion or referee examinations or providing information OWCP requests, OWCP may terminate your benefits. You should ensure you understand and adhere to all the necessary obligations.
Steps you can take
If you disagree with OWCP’s decision to terminate your benefits, you can:
Contact OWCP: You may reach out to your assigned claims examiner to express your disagreement with the decision. You should prepare to provide any additional evidence or documentation that supports your disagreement. If OWCP believes they should terminate your benefits based on a second opinion exam, you can further request that OWCP conduct a referee examination.
Prepare a Written Statement: You can prepare a detailed written statement explaining why you believe the termination decision is incorrect. In it, you should clearly outline the reasons why you believe OWCP should reinstate your benefits.
Gather Supporting Evidence: You should collect any additional medical records, test results, diagnostics, or letters from medical providers that support your claim for continuing benefits. These pieces of evidence can strengthen your arguments that OWCP should reinstate your benefits.
Seek Legal Representation: We highly recommend that you engage the services of an experienced OWCP attorney. Doing so can significantly increase your chances of success. They can guide you through the process, ensure your rights are protected, and help you argue a strong case.
File an Appeal: Once you take the above steps, you can file an appeal on the termination decision. Before you do, you should review the OWCP’s correspondence to familiarize yourself with the different types of appeals and understand their deadlines. Additionally, you should carefully follow the OWCP’s specific instructions for submitting your appeal. Finally, you must meet any filing deadlines and submit your statement and supporting evidence. If you don’t know what to do, consult with an attorney. An attorney can help you gather all relevant evidence and construct a persuasive argument for why the termination decision was incorrect or unjustified.
Stay Informed and Seek Assistance
Throughout the process of addressing the termination, it’s essential that you stay informed and seek assistance when needed. Consider the following:
Keep Records: You should maintain a comprehensive record of all communications, documents, and deadlines related to your case. This will help you stay organized and provide evidence, if needed.
Consult with an Attorney: An experienced attorney can guide you through the complex appeal process, ensure your rights are protected, and advocate for your best interests.
Conclusion
If OWCP terminates your wage-loss and/or medical benefits, it’s essential that you promptly address this situation. It is key that you understand the reason for the termination and file an appeal to potentially reinstate your benefits. Remember to stay informed, seek assistance when needed, and consider engaging an attorney to navigate the process effectively.
*** This article is meant to be a general guide and is not a substitute for the advice of an attorney regarding your particular case. The steps you should take on your claim may vary depending on the circumstances. Should you wish to speak with an experienced attorney, please contact our law firm.