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attyadvisor, Attorney
Category: Employment Law
Satisfied Customers: 6895
Experience:  29 years in Employment Law
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I appealed DOL termination of my claim after being evaluated

Customer Question

I appealed DOL termination of my claim after being evaluated by a Referee Dr, assigned by DOL. DOL stated "you no longer have any residuals related to your accepted work related medical conditions or continued disability from work as a result of the 9/12/2011 work injury or illness." I appealed because the DOL statement was wrong. The Referee Dr. ended his report by saying "Even though the patient has reached maximum medical improvement and does not require future treatment, she does suffer with mild residuals of her lumbar strain sustained on 9/12/2011. The medical reasoning for this is that from a clinical standpoint her lumbar strain mechanically and traumatically worsened her preexisting degenerative condition in her lumbar spine." I requested a diagnosis change that was given by my Dr. in 2011 after my injury and continued treatment because of continued discomfort. Several months after my appeal I received a determination that the decision to terminate claim "must be AFFIRMED, but MODIFIED, to reflect denial of ongoing medical care based upon lack of need rather than the employment injuries having resolved." I am concern that still I suffer with symptoms from my fall and their Referee Dr. states it as well, that someone other than myself determines I no longer need pain management. My symptoms are subjective and I still need treatment. What should I do - request a reconsideration. Is it legal to discontinue treatment though I still am symptomatic but someone else states I no longer need treatment? Or, do I bypass the reconsideration and file to ECAB for an appeal?
JA: Have you documented this or discussed it with HR?
Customer: This is an Workers Compensation Claim. HR not involved.
JA: Is the employment agreement "at will," union, full time or part time?
Customer: I am not sure we are addressing the same concern.
JA: Anything else you want the lawyer to know before I connect you?
Customer: NO
Submitted: 10 months ago.
Category: Employment Law
Expert:  Phillips Esq. replied 10 months ago.

Hello: This is Phillipsesq. Welcome to JustAnswer! I am reviewing your post, and I will post my response very shortly. Thank you for your patience.

Expert:  Phillips Esq. replied 10 months ago.

I am sorry to read about your difficulties.

If your agency's decision is final, then you need to file an appeal to the ECAB, the Employees’ Compensation Appeals Board. You can only appeal from a final decision. Otherwise, you need to file for reconsideration. The appeal must be filed within 180 days of the date of the final decision.

Goodluck with your case,

Customer: replied 10 months ago.
I understand the process. Is there legal grounds for OWCP to terminate my care if I am still symptomatic?Even if I don't require frequent care. If so, site the OWCP law. I don't know if
Expert:  Phillips Esq. replied 10 months ago.

I do not have a case law to cite. So, I will opt out and give another Attorney the opportunity to further assist you.

Customer: replied 10 months ago.
I don't know if their decision is final. I didn't ask for reconsideration.
Expert:  attyadvisor replied 10 months ago.

I am a different Attorney and it will be my pleasure to assist you. Do you have a copy of the decision? We may be able to tell if it is final.

Expert:  attyadvisor replied 10 months ago.

Cheryl did you want to continue with this question?