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 Post subject: Impairment rating 26% upper extremity
PostPosted: Sat Jan 12, 2013 7:12 pm 
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Joined: Tue Mar 27, 2012 11:15 pm
Posts: 25
Finally the second opinion orthopedic doctor and the District Medical Advisor agree on 26% permanent impairment of the right upper extremity due to my RSD/CRPS. How do they calculate a Schedule Award for an entire upper extremity? Is that the same as just the arm or possibly hand and arm or do they have another category?

According to the DMA, he did not agree with my doctor's Range of Motion measurements because he did not do 3 measurements for each movement, only one, so he did not consider this in the point total used to compute the impairment level. The second opinion doctor did not take the time to do any ROM measurements at all and did not feel that they would change the impairment rating in his opinion.

At this point, I don't know if 26% is good or not? My Claims Examiner said she is going to work on a Schedule Award based on the information she has. I have obtained a CD of my file and read it carefully. I don't think I can prove any more physical injury, unless I reject the offer and set myself up for another exam and a lot more time.

It has been 2 years since my injury and I have been back to work for a year, with limitations but same salary. OWCP really tries to wear you down and also does not make information easily available.

Anyone have comparable experience? Anyone get a good schedule award and think OWCP was fair with them? Anyone on this forum have experience with chronic regional pain syndrome/ reflex dystrophy and loss of function of their dominant hand due to a work comp injury? Just reaching out. Love this forum because in sharing we can help each other deal with the problems and maybe make it easier for the newly injured Fed employees to navigate work comp. Thanks Jesse.


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 Post subject: Re: Impairment rating 26% upper extremity
PostPosted: Sun Jan 13, 2013 2:11 am 
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Joined: Sat Mar 19, 2011 7:57 pm
Posts: 178
I don't know if your rating was fair or not but I would just take the award and after it runs out, go for another rating. If your new rating is higher then the old one, you will be paid the difference.


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 Post subject: Re: Impairment rating 26% upper extremity
PostPosted: Sun Jan 13, 2013 4:18 pm 
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Joined: Tue Mar 27, 2012 11:15 pm
Posts: 25
I was thinking of that too. Thanks.


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 Post subject: Re: Impairment rating 26% upper extremity
PostPosted: Sat Jan 26, 2013 4:05 am 
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Joined: Tue Mar 27, 2012 11:15 pm
Posts: 25
Work comp mystifies me. I was just awarded a Schedule Award of 26% partial permanent impairment of the right upper extremity and simultaneously received a letter from them updating my accepted conditions. Does anyone understand the implication of adding another accepted condition?
I had three accepted conditions and now after two years and at the same time I get the SA, they add a "new condition" with a directive that says-"Please advise all medical providers who are treating you for this injury of the newly accepted condition(s) with the ICD-9 code(s). Accurate coding facilitates timely bill processing."
The announcement that comes with the schedule award describes a number of options for appeal by adding more medical information for review, reconsideration or ECAB. I do not feel that the decision of work comp was unfair, but there was information missing and I still feel that the severity of my permanent injury was underestimated. What does it take to submit a successful appeal or request for review or reconsideration?


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 Post subject: Re: Impairment rating 26% upper extremity
PostPosted: Sat Jan 26, 2013 6:03 am 
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Joined: Wed Mar 16, 2011 11:05 pm
Posts: 935
It takes evidence. It's an appeal. Evidence would be in the form of medical evidence, case law, policy, etc... discounting and proving OWCP got their decision wrong.

If you believe it's fair, why not take the 26%? You can apply for an additional SA in a year should your conditions worsen to an additional percentage. 26% for OWCP is pretty good. Appeal and you open the door again, you're saying you don't accept the 26%. Maybe new OWCP physicians are involved and they discount the 26%. On the other hand if the new condition adds to the SA and there was other information that would have contributed to a higher percentage, then it might be worth going after and doing an appeal. Any appeal is a gamble. Only you can make the decision since you're the one that it affects most and you have all the details.

How significant is the new condition to the impairment rating of 26%?


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 Post subject: Re: Impairment rating 26% upper extremity
PostPosted: Sat Jan 26, 2013 12:13 pm 
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Joined: Tue Mar 27, 2012 11:15 pm
Posts: 25
thanks Jesse. I am accepting the 26% schedule award. It pays me until May, 2014. I am not ungrateful for this, I think it is pretty good. I will continue to gather information and can submit later as you suggested. The new accepted condition was for RDS/chronic regional pain syndrome which is the main diagnosis for which the 26% impairment was awarded. The prior diagnoses were Causalgia of the right upper extremity (which is another way of saying CRPS with a different ICD-9 code) and distal radial fracture right wrist and adhesive capsulitis of the right shoulder. Now I have 4 accepted conditions instead of 3.
I was not given a paper to sign, I just started receiving the schedule award direct deposit.
As the injured party who cannot do certain things at all with my atrophied hand and fingers and can barely move my wrist or lift with my right hand, it is difficult for me (subjectively) to accept this loss as only 26% whole body impairment. But in reading others reports on their settlements, I could have done a lot worse too. I am working full-time, but have limitations due to the injury.
I wouldn't gamble dealing with another doctor at this point, but the district medical advisor seems reasonable. He is the one who increased my rating from 20 to 26% based on the second opinion doctors exam. At the end of the DMAs letter he says specifically that if there is additional data on my case in the future he would be glad to look at it, but I still have to go through Work Comp to send information to him, I cannot contact him directly as far as I am aware.
I hope at least my experience may be helpful to other members of this forum. Work Comp is a complicated system.


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 Post subject: Re: Impairment rating 26% upper extremity
PostPosted: Mon Jan 28, 2013 4:19 am 
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Joined: Sat Mar 19, 2011 7:57 pm
Posts: 178
Generally, OWCP does not accept whole person impairment ratings. The extremities can only be rated as impairments to the extremities not whole person. Other organs can be given a whole person impairment rating but then must be converted to the individual organ impairment.


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 Post subject: Re: Impairment rating 26% upper extremity
PostPosted: Tue Jan 29, 2013 1:58 am 
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Joined: Tue Mar 27, 2012 11:15 pm
Posts: 25
Snowed, you are correct. The rating is simply a 26% impairment of the right upper extremity. thanks.


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