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<< Back to "Federal Workers Comp-OWCP Monthly Topic" index Letter to OWCP Director Shelby Hallmark about doctors not treating federal workers' compensation claimantsSeptember 2009Below is the text of letter I recently send the director or OWCP. I’ll report if I receive a response. August 24, 2009 Dear Mr. Hallmark: Subject: Medical treatment for injured workers I am writing to you with two concerns. First, I’m finding federal employees are increasing unable to obtain treatment from doctors for their work-related injuries because physicians are reluctant to see injured federal workers. Secondly, I find claims examiners do not routinely contact attending physicians for supplemental reports if a medical opinion lacks needed information. I am a private attorney and have been assisting federal employees with OWCP claims since 1994. I have handled hundreds of federal workers’ compensation cases and represented claimants in a significant number of hearings before the Branch of Hearings and Review. I’ve also submitted appeals to ECAB. Claimants, fearing possible rejection as a patient, may keep from doctors the fact their injuries are work-related and covered under federal workers’ compensation. In fact, I have seen people resort to lying to doctors regarding their injuries, so the doctor can treat them and bill private insurance. Of course, that fib causes problems when the injured worker submits a claim for compensation and needs to submit medical evidence to document the injury. To illustrate the difficulty, one of my clients had trouble finding in her area a doctor whose office would bill OWCP for treatment. To find a doctor, she moved to a larger community, but even in her new location she had trouble obtaining treatment. Her move required relocating 600 miles from her place of employment. A hearing decision found her difficulties in finding a physician were “unsubstantiated”—but her difficulties were real: she could not find a willing medical clinic. The problem is so real for so many that a doctor in Oklahoma takes patients from all over the country. Some of my clients have traveled there for evaluation and treatment. There must be many reasons for this lack of doctors. Medical offices may avoid OWCP red tape or reject the amount of reimbursement. However, one reason might be that doctors, especially specialists, simply dislike dealing with District Office claims examiners. OWCP has rigid rules concerning the content of medical reports, and doctors frequently see their reports rejected by claims examiners without explanation. Doctors may write two or three reports in a case and still find their opinions rejected. This may lead doctors to become discouraged with the system and to tell injured federal to find care elsewhere. To illustrate the frustration some doctors feel, the following is a quote from a 2008 letter from the claims examiner to a doctor. The claims examiner, in trying to allay the doctor’s concerns, quotes what the doctor wrote to him earlier: “[I] have a strong suspicion that your background and training as a claims examiner in no way qualifies you to evaluate the objective medical information that supports my opinion.” The claims examiner’s solution was to send the claimant to a second-opinion physician. When doctors must engage in such exchanges with OWCP, it doesn’t create a climate that encourages medical offices to accept federal workers’ compensation patients. In fact, OWCP rules recognize that doctors may have trouble writing reports that satisfy the requirements of claims examiners. That is why the rules say a claims examiner must “always” write a treating doctor for a supplemental report if his or her report lacks needed detail or opinion.[1] In my experience, that requirement is rarely followed. I see people with meritorious claims denied simply because claims examiners never explained to their doctors the elements of a well-rationalized report. I’ve read a large number of ECAB opinions that denied claims based on the inadequacy of the medical reports, and I’ve wondered what efforts the District Offices made to contact the attending physicians for supplemental reports. A claims examiner is the one person in the system who knows what is needed to approve a claim. He or she is the official adjudicator of a claim. That is why the claim examiner should write a doctor directly and ask for a supplemental report if the initial report is inadequate. Also, a doctor may be more likely to respond in a satisfactory manner to an official request from a claims examiner for additional opinion than to a request from a claimant. In summary, something needs to be done to make doctors more readily available to injured federal workers. Also, claims examiners need to be instructed to actually follow the requirements regarding doctor’s reports. Sincerely, Norman R. McNulty, Jr. [1] See John J. Carlone, 41 ECAB 354, one of my favorite ECAB decisions. I am not sure its teachings are followed by District Offices. << Back to "Federal Workers Comp-OWCP Monthly Topic" index 
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