Communicating with your Attending Physician Part 2

ATTENTION ALL CARRIERS THAT HAVE FILED A CLAIM TO OWCP. Once you receive a Development Letter, YOU MUST CONTACT ME IMMEDIATELY. Call 631-789-1616 so we can review your claim to determine what you need to do in order to help get your case approved. Failure to contact me could result in your claim being denied.  

      Pre –Existing Conditions

     The Letter Carrier craft is an aging work force.  In fact, recently it was cited that the average age of a Letter Carrier is over 53 years old.  Many carriers suffer from long term chronic conditions.  These conditions may also be pre-existing conditions that have deteriorated by the work we perform.  Pre –existing conditions may even first manifest themselves as Letter Carriers perform their duties.

     Whether or not the Office of Workers Compensation (OWCP) accepts the claim for the worsening condition depends on whether a causal relationship has been established between work factors and the claimed condition. It is important to note that failure to establish causal relationship is the reason that most claims are denied.

     While this may be complicated to sort out, it should be remembered that OWCP does not apportion causality; OWCP will accept the claim if any part of the claimed condition can be attributed to work factors.  OWCP recognizes three kinds of causal relationship between work factors and the worsening of a pre –existing condition which are:

·       Aggravation

·       Acceleration

·       Precipitation

     If a pre-existing condition has worsened, either temporarily or permanently, by a work related injury, that condition is said to be aggravated. For instance, a traumatic back injury may aggravate a claimant’s pre – existing generative disc disease Compensation would be payable for the duration of the aggravation as medically determined.

     A work related injury or disease may accelerate the development of an underlying condition, and  acceleration is said to occur when the ordinary course of the disease does not account for the speed with which the condition develops.  An acceptance for acceleration of a condition carries the same force as an acceptance for direct causation.  That is, the condition has been accepted with no limitation on its duration or severity.

     Precipitation refers to a dormant condition which would not have manifested itself on this occasion but for the employment. An acceptance for precipitation would be limited to the period of the work – related manifestation of the latent condition. OWCP’s responsibility for the condition would cease once the carrier has recovered.

     There is not a dramatic difference that separates these three categories of causal relationship from each other. The definitions are not medical definitions, they derived either from the implementing regulations of the Federal Employees' Compensation Act (FECA) or from OWCP procedure. Unless physicians have experience with OWCP, they would not use these definitions in the ordinary course of their practice.  Most physicians focus on the therapeutic care of injury rather than the cause of the injury.

     OWCP, however, focuses almost entirely on the cause of the claimed injury. For OWCP to accept a claim, an injury has to be caused in some way by factors in the work environment.  Which causal category OWCP applies can have lasting effects on how the claim develops.

Real problems can occur when OWCP accepts a claim for the temporary worsening condition when that condition has, in fact, been permanently worsened by the exposure of work factors. 

     Due to this, it is crucial that your attending physician understand how OWCP defines and applies the different definitions of causation if you have a claim that involves a pre- existing condition.   Attending physicians should be prepared to employ these definitions as they use their best medical judgement to present and rationalize the medical evidence for the claimed injury.