OPM DISABILITY RETIREMENT
Federal employees do not to be totally disabled to receive OPM disability retirement benefits. If you are disabled from performing one or more of the essential elements of your job you may be entitled to benefits. Here are the usual requirements for OPM Disability Retirement:
- 18 months of service under FERS or
- 5 years of service under CSRS
- disabled by a medical condition
- the condition is expected to last at least one year
- the employer cannot accommodate the disabling medical condition
- claimant did not decline reasonable offer of reassignment
If you receive OPM disability retirement you can earn up to 80% of what your former position currently pays and continue to receive your disability benefits.
For example, you can earn up to $40,000 per year and continue to receive OPM disability retirement if your former position currently pays $50,000 per year.
OPM benefits are paid at 60% of your wages the first year and at 40% for each year thereafter. The rate of pay is based on the average of your “high three” years of wages. FERS recipients must also apply for Social Security Disability since they paid into the system and may be entitled to draw from the Social Security system as well.
In order to receive OPM disability retirement, you must effectively present the following to the Office of Personnel Management (OPM) for consideration:
- Your statement of disability
- Your supervisor’s statement
- Your physician’s statement explaining your disability
- Your agency’s statement regarding reassignment or accommodation
- The completed disability retirement application checklist
You have 1 year from the date of your termination or separation from federal service to apply for OPM disability retirement.
If you do not to apply for OPM Disability Retirement within one year you will be forever precluded from receiving OPM disability retirement benefits.
Some Handy Information Regarding OPM Disability Retirement
- you can include all work-related and non-work-related conditions for consideration by OPM
- you can be working when you apply for OPM disability retirement
- you don’t have to be totally disabled to receive OPM disability retirement
- you can receive OPM disability retirement and a scheduled award from OWCP at the same time
COMMON PROBLEMS WITH OPM DISABILITY RETIREMENT APPLICATIONS
Federal employees are routinely denied OPM Disability Retirement for many reasons. The following is a brief list of some of the usual problems:
- the doctor’s narrative does not delineate an accurate, detailed, medical history
- the doctor’s narrative does not fully explain your previous and present medical findings
- the doctor fails to provide a specific diagnosis of your current disabling condition/s
- the doctor does not provide a clear explanation of why you are unable to perform your specific job duties
- the doctor fails to provide OPM with detailed restrictions and limitations and fails to delineate how they apply to your inability to perform your job duties
- the employing agency fails to provide OPM with the required documents
- the employing agency fails to properly complete the required documents
- the employing agency falsely states to OPM that a job position was open, available and within your medical restrictions and limitations
- the employing agency falsely states to OPM that you refused to accept a reassignment within your medical restrictions and limitations
THE INFORMATION CONTAINED IN THIS WEB SITE IS PROVIDED FOR INFORMATIONAL, ILLUSTRATIVE, AND ADVERTISEMENT PURPOSES ONLY. IT IS NOT LEGAL ADVICE. IT SHOULD NOT BE RELIED UPON IN MAKING LEGAL DECISIONS OR IN PLACE OF A CONSULTATION WITH AN EXPERIENCED AND KNOWLEDGEABLE ATTORNEY OR LAWYER REGARDING A SPECIFIC MATTER. READING THIS SITE, SENDING US INFORMATION, OR RECEIVING INFORMATION FROM US DOES NOT ESTABLISH AN ATTORNEY-CLIENT RELATIONSHIP. OUR RESPONSE DOES NOT MEAN THAT WE ARE REPRESENTING YOU OR THAT WE ARE YOUR ATTORNEYS OR LAWYERS. STATEMENTS, TESTIMONIALS, AND ENDORSEMENTS CONTAINED HEREIN DO NOT CONSTITUTE A GUARANTEE, WARRANTY, OR PREDICTION REGARDING THE ULTIMATE RESULT OR OUTCOME OF YOUR LEGAL MATTER.
APPEALS TO REPRESENTATIVES & SENATORS
Is there bias against claimants at OWCP?
You can draw your own conclusions. I have had even those claims examiners who described themselves as “hard nuts to crack” approve well-developed claims. I have found claims examiners, senior claims examiners and supervisors with great variations in how they handle claims. Some have been as straightforward and candid as anyone you could want to work with. And if I did receive a denial from that claims examiner, her decision always stated what evidence was lacking – if you know how to read the decision denying the claim. In turn, our appeal needed to address that missing or weak evidence. In short, a good claim examiner’s denial will tell you what you need to fix for your appeal to prevail.
In fact, the man who first explained this system to me, who was above the supervisory level, once said that he sometimes looked for the intent of the claimant when deciding a case. When I pointed out to him that there was no intent standard in this system (intent only applies to criminal law, not to workers’ compensation law), he replied that no attorney had ever taken the time to have such a conversation with him, and that he would re-think his viewpoint on looking to the intent of the claimant.
On the other hand, I have found others who, before they viewed the witness statements and/or doctor statements I was handing them, told me I could bring that evidence up on appeal, and kept repeating that I could bring my arguments up on appeal, over and over again – meaning she was going to deny the claim no matter what I evidence I was providing.
In that case, I went straight back to my office and drafted a letter to that office’s director, which I hand delivered the next morning, and the case was quietly transferred to a senior claims examiner. This was an extraordinary result in an extraordinary set of circumstances. Do not try this argument unless you have a very strong set of circumstances, and a witness or two would not hurt.
To learn about a claims examiner who went completely off the chessboard, see the following.
POSTED AT: http://bighollywood.breitbart.com
Priceless – great article! Too bad most of the wimps who hold high level executive jobs in the government are democrats, the Entitlement Bunch. I work for the Dept of Labor, Federal Workers Compensation claims. some of these people (mostly men) haven’t worked in over 10 years because “they turned suddenly and felt a pop in their backs”. Study the entire case, and most of them were either A. one day away from being fired anyway for insubordination/attendance problems or B. Are 5th generation welfare mentality people who got lucky enough to be hired when there were plenty of federal jobs (usually during a Dem administration). Baggage Screeners at airports were converted to federal employees from state employees, falling under the Dept of Homeland Security in the fall of 2003. My district consists of 5 states – TX, NM, OK, LA, AR. Think about how many airports are in these states. Within a year, we had at least 10% of these screeners filing b.s. claims about how they “lifted a bag and their back hurt”. Liberal regulations allow them to live off compensation forever, if you are smart enough to go to a hack doctor who will keep you off work just to charge the government 150.00 for a medical report. Multiply this by hundreds – great little practice they have, and they are guaranteed patients for life. Sickened yet? Yeah me too – but I live with the system, and fight every day to do my utmost to get these slackers back to work. In all fairness, maybe 2% of the thousands of people on the rolls are there for legitimate work injuries. The rest are no better than the welfare queens you see on talk shows. Oh, the best part? These benefits are tax free. So your tax dollars are paying for these people to be professional vacation takers. Makes you feel all warm and fuzzy inside doesn’t it?
END OF POST:
(This may also be posted on other web-sites.)
What do you do if you think you are subject to a biased claims examiner?
WIN THE CASE.
- Get the medical tests you need.
- Get your medical reports squared away.
- Get the witness statements you need.
- Hire your own doctor to go to second opinion examinations.
- Have your doctor draft rebuttals to poorly written, dismissive and circumspect medical reports.
APPEALS TO CONGRESSMAN AND SENATORS
Appeals to Congressman or Senators usually result in little being done, other than your file may be reviewed by a Senior Claims Examiner on a more expedited basis.
But you still need to win your case on its merits.
No Congressman or Senator is going to twist OWCP’s arm to accept a claim that does not meet the criteria for acceptance – it’s simply not going to happen.
Your efforts may be better spent on laying out your case so simply and directly that anyone can understand it.
What seems obvious to you may not be so obvious to everyone else.
You lived your case; you probably have every document, medical exam and telephone contact memorized.
Remember, others cannot fill in between the lines as you.
REPRESENTATIVES AND SENATORS
LINKS FOR OWCP FORMS ( http://www.owcp.com/owcp.html )
CA-5B-Claim for Compensation by Parents, Brothers, Sisters, GrandParents, or GrandChildren
CA-6-Official Superior’s Report of Employee’s Death
CA-7-Claim for Compensation
CA-7A-Time Analysis Form, used for claiming compensation, including repurchase of paid leave
CA-7b-Leave Buy Back (LBB) Worksheet/Certification and Election
CA-10-What A Federal Employee Should Do When Injured At Work
CA-12-Claim For Continuance of Compensation Under the Federal Employees’ Compensation Act
CA-17-Duty Status Report CA-20-Attending Physician’s Report
CA-35-Evidence Required in Support of a Claim for Occupational Disease
CA-721-Notice of Law Enforcement Officer’s Injury Or Occupational Disease
CA-722-Notice of Law Enforcement Officer’s Death
CA-915-Claimant Medical Reimbursement Form
CA-1108-Statement of Recovery Letter with Long Form
CA-1122-Statement of Recovery Letter with Short Form
CA-2231-Claim for Reimbursement Assisted Reemployment
OWCP-1-Agreement and Undertaking
OWCP-5A-Work Capacity Evaluation Psychiatric/ Psychological Conditions
OWCP-5B-Work Capacity Evaluation Cardiovascular/ Pulmonary Conditions
OWCP-5C-Work Capacity Evaluation for Musculoskeletal Conditions
OWCP-16-Rehabilitation Plan And Award
OWCP-17-Rehabilitation Maintenance Certificate
OWCP-44-Rehabilitation Action Report
OWCP-957-Medical Travel Refund Request
OWCP-1500-Health Insurance Claim Form
UB-92-Uniform Health Insurance Claim Form
USEFUL LINKS & INFORMATION
Here are some links to other resources that may be helpful in working with the OWCP process – (I THINK THE CURRENT SITE HAS A FEW MORE LINKS TO ADD TO THIS.)
Federal Employees’ Compensation Homepage: http://www.dol.gov/owcp/dfec/index.htm
Comments Regarding Living With a Long-Term OWCP Claim: http://www.fedworkerscomp.net/zeelander.htm
OWCP Forms: http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm
Information for Medical Providers (print out and provide this information to your
Federal Employees’ Compensation Act (FECA) Q&A’s: http://www.oig.dol.gov/public/feca/questionsandanswers.pdf
ACS/CQS: https://owcp.dol.acs-inc.com/portal/ This is OWCP’s site, very useful to track information about your claim(s).
AMA (American Medical Association): http://www.ama-assn.org/
Code of Federal Regulations: www.gpoaccess.gov/cfr/
Title 20 Chapter VII; Benefits Review Board, Department of Labor. Includes Part 802; Rules of Practice and Procedure: http://www.access.gpo.gov/nara/cfr/waisidx_11/20cfr802_11.html
ECAB Decisions by month and year: http://www.dol.gov/ecab/decisions/main.htm
Use this site if you know the ECAB appeal number and date of the decision.
ECAB Decisions search by topic: http://www.dol.gov/appeals/search/search.htm
Use this site to search ECAB decisions by topic. Type in your search terms on the left and check the box for Federal Employee’s Compensation Act on the right. You can also use this site to check for decisions involving specific names such as physicians and/or nurses.
FECA Manual part 2: http://www.dol.gov/owcp/dfec/regs/compliance/DFECFolio/FECA-PT2.pdf
FECA Manual part 3: http://www.dol.gov/owcp/dfec/regs/compliance/DFECFolio/FECA-PT3.pdf
FECA Manual part 5: http://www.dol.gov/owcp/dfec/regs/compliance/DFECFolio/FECA-PT5.pdf
A must read for any claimant. These are the ‘rules’ OWCP must abide by. These Manuals are some of the best knowledge a claimant can have. Parts one and two are the basic FECA Manuals, part 5 covers Benefit payments including schedule awards, health benefits, etc…
FEDERAL REHABILITATION ACT OF 1973: http://www.eeoc.gov/laws/statutes/rehab.cfm FORMS:
http://owcp.dol.acs-inc.com/portal/formsAndLinks.do ICD-9 CODES:
http://www.icd9data.com/2011/Volume1/default.htm Medical Dictionary:
Merck Manuals: http://www.merckmanuals.com/home/index.html
These are medical manuals. Every district Office of OWCP is required to have the Merck Manuals in their library for reference. Go to this site and look up your medical condition(s), you may find useful information. You can print out what you need and use it with OWCP. Your physician can also refer to the Merck Manuals or quote them in a narrative report making it harder for OWCP to say no.
Occupational Information: http://www.occupationalinfo.org/onet/ This is part of the O*NET site. This site allows you to search employment projections by occupation and also contains an alphabetical index. O*NET (formally DOT): http://online.onetcenter.org/ Anyone in Vocational Rehabilitation should be aware of O*NET. Once your rehab counselor identifies a job for you, they must attach a O*NET (or DOT) number to the job. This is the site OWCP uses for job descriptions and physical requirements. Use this site to see what the requirements are and if they match your restrictions. Useful on appeal as well.
Research; Physicians: SEAK National Directory of IME’s: http://www.imenet.com/
American Board of IME’s: http://www.abime.org/node/19
Juris Pro Expert Witness Directory: http://www.jurispro.com/category/independent-medical-examinations-i-m-e–s-465/
Verdict Search: http://www.verdictsearch.com/
ALM Experts: http://www.almexperts.com/category/Medical-&-Health/MedExpert/1125838
IME Directory: http://www.independentmedicalexaminer.com/search.asp
IME Directory Resource: http://www.independentmedicalexaminers.com/imedirectory/
Second Opinion Services (MRI, X-Ray, CT scan, Ultra Sound):http://www.radiia.com/about-us.php
United States Code, (U.S.C.): http://www.gpoaccess.gov/uscode/
USPS Track and Confirm:http://www.usps.com/shipping/trackandconfirm.htm
Vocational Rehabilitation Procedure Manual: http://www.dol.gov/owcp/procedure-manual/rehab.pdf
A must read for anyone in Vocational Rehab, OWCP’s ‘rules’ on the subject.