Multiple Cases OWCP 2nd Opinion/Referee Exam Ordered.

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Latest post 03-24-2010 4:59 PM by Gordon Reiselt. 6 replies.
  • 10-22-2009 4:23 PM

    • bopchris
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    • Joined on 10-22-2009
    • WI
    • Posts 2

    Multiple Cases OWCP 2nd Opinion/Referee Exam Ordered.

    Well let me start off by saying I have contacted 2 lawyers already; one of which returned my message and said I don't need his services; the other I am still waiting to hear back from.

    Basically here is my backround. I was assaulted and sustained a back injury at work back in 2000. I then returned to work light duty until 2002. I returned to full duty in 2002 with modifications until I re-injured(owcp calls it a new injury) my back at the end of 2003. I still worked for about 6 months and things progressively got worse. My doctor pulled me off work and my employer never let me return. In late 2004 they rushed me threw a fitness for duty examination and terminated me for being unfit for duty(I was a Federal Law Enforcement Officer in the Bureau of Prisons.) I was approved for Medical Retirement almost immediately due to being terminated; However I stayed on OWCP periodic rolls. I just recently this past summer won my Social Security Disability(SSD) appeals, and that is when OWCP problems started again. As soon as I notified OWCP that I got approved for SSD they immediately scheduled a Second Opinion evaluation with one of there paid doctors and gave me less than 10 days notice of the exam. I demanded a SOAF and a copy of all questions, and paperwork sent to there doctor but they arrived 6 days after I had the second opinion. I have requested a copy of the second opinion doctors findings but have yet to receive that also, but just got notice today that I am having a referee exam in 6 days(10 days from the date of the memo.)

    BTW the original SOAF is inaccurate and has stuff mission from it and false statements in it. The 2nd opinion doctor was also asked direct "leading" questions by my claims examiner and the doctor refused to discuss anything that wasn't listed on the SOAF or questioned by my examiner.

    Here is my problem though what do I do; I know for a fact my employing agency will not offer me a modified job, there own doctor states I can never fully meet the Law Enforcement Officer qualifications again due to my injuries.

    Social Security Disability has determined I am unemployable and there is no acceptable job "in this nations economy" or in my geographical area that I qualify for and/or have the ability to perform.

    Do I just ride this out and go to the referee examination; and see if OWCP ever offers me a job? Do they have to offer me a job or can they terminate me from the rolls just on medical evidence since I have been out of work and on there rolls for over 5 years?

    (The lawyer I talked to said they have to come back with a job offer if the referee examination agrees with there doctor and not mine, or the 6 other doctors the State of Wisconsin and the Social Security Administration has sent me 2; and based on being terminated by my agency he doesn't see them ever offering me a job; so I don't need his services.)

    Any and all advice is welcome and thanks for any assistance in advance.(I just want to make sure all my i's r dotted and t's are crossed; because if I get terminated from OWCP I will probably be without compensation for 90-180days while I fight OWCP and get my FECA disability and Social Security Disability payments started. And OWCP has killed all my monetary reserves over the years due to medical bills that aren't covered; or been delayed; or based on a secondary injury that I am still fighting for causal relationship to my primary injuries.

    Thanks Again.

  • 10-22-2009 4:33 PM In reply to

    • bopchris
      Consumer
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    • Joined on 10-22-2009
    • WI
    • Posts 2

    Re: Multiple Cases OWCP 2nd Opinion/Referee Exam Ordered.

    *Update*I just received my copy of the original 2nd opinion exam and its a sham, The SOAF lacks in information.  My CE selectively gave the 2nd opinion doctor medical records.  the doctors opinion is just about the last injury and makes no comment on my original injury or any residuals; just that there should be no restrictions from my last injury as of (get this) June 17, 2004. (so the 2nd opinion doctor is saying I fully recovered from my latest injury on June 17, 2004.)  I had a agency doctor do a fitness for duty exam on me in August of 2004 which was the basis of me being determined unfit for duty and terminated in November of 2004.

    the 2nd opinion doctor stated the following which is the basis for the referee exam: "In my opinion, he needs no physical limitations resulting from the workrelated condition of November 9, 2003. This was a temporary injury which did not cause any objective change that would warrant any restrictions."

    Please note I have been on perminent restrictions for my original injury prior to this injury.  I had a spinal stimulator implanted in December 2005 to help with pain as result of both injuries and to get me off the narcotics.  I have been on the periodic rolls since November 2004 when I was terminated.  And I am now receiving Social Security Disabiltiy as I have been determined perminently disabled due to my back injuries.

    What recourse do I have to fight this sham OWCP is trying to play?

  • 10-23-2009 3:39 PM In reply to

    Re: Multiple Cases OWCP 2nd Opinion/Referee Exam Ordered.

    The fact that you are eligible for disability retirement and social security disability has no bearing whatsoever on your eligibility for  workers compensation. They are different programs with different standards. Do not dwell on that aspect of your claim. They have been approved and there is nothing more to do there.


    So you have been to a second opinion but do not yet have the results. Wait for the result before taking any further steps. If the reprot from thr second opinion is favorable you do not want OWCP thrwoing it out because the SOAF is inaccurate, do you? If the second opinion is not favorable, then bring in the issues you have with the SOAF. OWCP will probably pay little or no attention, but make the object in writing.

    What OWCP should do if the second opinion is not favorable to you is to send a copy of the second opinion to your doctor and ask for his/her approval or disapproval. If your doctor concurs with the second opinion, you are screwed. If your doctor does not agree, OWCP should schedule a referee examination. Notice that I said should. That is, the right thing to so is schedule the referee- but OWCP doesn't always do the right thing as you are well aware.

    This is a brief outline of your options. I ma sure you may have more, but what I have wriiten is based only upon what you have decided to reveal. If you get an adverse decision, appeal, appeal and appeal again.

     

  • 12-11-2009 5:57 PM In reply to

    • tallkool1
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    • Joined on 12-11-2009
    • IL
    • Posts 4

    Re: Multiple Cases OWCP 2nd Opinion/Referee Exam Ordered.

    Your point about the AP and OWCP's 2nd opinion doc brings me to my question.  In my case, also a federal employee and also a back injury, both doctors are in agreement with the possiblity of my returning to the same position unlikely.  Now today I get a notice for DOL informing me of a Referee Examination because of conflict in medical evidence.....Where?

    Is this just something that DOL is doing to hopefully find a doctor that will side against me? Their 2nd opinion doc prior to my spinal fusion surgery ALSO agreed with my AP on necessity of surgery and so on.  I would think that when 2 of their own doctors are in agreement with the AP, that it would be fairly cut and dried.  But then there is that whole assume thing.....

    Also just found out the report of a 2nd FCE says I can lift up to 50lbs, but if my APis not comfortable with that does he HAVE to follow those conditions set forth from FCE? 

  • 12-21-2009 12:07 PM In reply to

    Re: Multiple Cases OWCP 2nd Opinion/Referee Exam Ordered.

    The only thing that can trigger a referee examination is a conflcit in the medical opinion between a attending doctor and a government second opinion doctor. If there is no conflcit and a referee examination is scheduled which is not in your favor and if OWCP uses that referee opinion against you, you will need to appeal and demonstrate that there was no conflcit and therefore the referee opinion is not necessary and should not be used against you.

  • 03-24-2010 4:30 PM In reply to

    • mem2008
      Consumer
    • Top 500 Contributor
    • Joined on 01-30-2008
    • AR
    • Posts 94

    Re: Multiple Cases OWCP 2nd Opinion/Referee Exam Ordered.

    OWCP used their DMA for a second opinion exam. I was not notified until after he submitted his report, disagreeing with my doctor, which created a conflict in medical opinion. OWCP has now scheduled a referee exam. Is there a basis to contest this as I was deprived of the opportunity to challege the selection of the examiner and to request a copy of the SOAF?  My doctor was not provided with a copy of the DMA report to review/rebut prior to the scheduling of a referee examination. 

  • 03-24-2010 4:59 PM In reply to

    Re: Multiple Cases OWCP 2nd Opinion/Referee Exam Ordered.

    The time to challange this would be when they enter an adverse decision based upon the referee opinion. At that time you should agrue that the second opinion examination was flawed and that the referee examination was really a second opinion. For this reason there is still a conflict in the medical opinion which requires resolution.

    Remember, it is OWCP burden of proof.

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