Bernard: Hey, it’s Bernard Nomberg with the Nomberg Law Firm. We’re back on another Tuesday, talking about an area of the law. And I’ve got Jimmy Haggerty, a Vestavia-based attorney, here to talk with us. Jimmy, I appreciate you coming on this morning. And Jimmy’s going to talk to us about an area of the law that not a lot of folks know about, but it involves employees who are hired and work for the federal government, and they get hurt on the job. But before we get to the nuts and bolts about that. Jimmy, tell us a little bit about yourself, your background, and so forth.
Jimmy: I’ve been doing OWCP work, which is the Office of Workers’ Compensation Program through the Department of Labor, for a little over 15 years. Prior to that, I did a good deal of Insurance Defense work. I graduated here locally from law school and went to undergraduate school at the University of Alabama, Birmingham.
Bernard: Well, Jimmy, let’s get into this area about workers who are employed with the federal government and when they get hurt on the job. My firm handles worker comp cases, but it’s different from what you guys do. We handle state-side work comp for folks who are employed, maybe with private employers. There are also individuals who are State of Alabama employees. And that’s a whole different avenue of administrative tasks for folks who got hurt on the job. But what we’re talking about are people who are employed by the federal government. Give us an idea of what types of jobs those are and some of your clients.
Jimmy: FECA which is the Federal Employees Compensation Act, covers just about any and all federal employee that works for a federal agency. I’ve represented people at the post office, the IRS, the FBI, and a multitude of other agencies. And it’s basically similar to Alabama work comp law from a standpoint that if you’re injured in the course of your business, working for that particular agency, you will come under FECA and OWCP.
Bernard: And OWCP, again, stands for what?
Jimmy: OWCP is the Office of Workers’ Compensation Programs. It’s an agency under the umbrella of the Department of Labor, which is responsible for all federal employees injured in their work.
Bernard: Now, the types of claims and cases that you handle, are they largely administrative based? Are they litigation based? How are they typically handled?
Jimmy: They’re typically administrated based on the standpoint that you have a three-tiered level of appeals if your case is denied. For the first appeal, you can either request an oral argument or reconsideration. You have to do that within 30 days of your denial of your claim. The second one is a specialized reconsideration which has to be done within a year of the denial of the claim. And the third one is ECAB which is the Employees’ Compensation Appeals Board. Which is done in Washington, D.C., and you have to go up there and argue in person.
Bernard: Okay, we’ll go through a typical example in just a minute. But if somebody is denied initially and they appeal that first tier that you just referred to. Who are they appealing to?
Jimmy: They’re appealing to the Office of Workers Compensation Program in Jacksonville, Florida, or London, Kentucky. And the claims examiner is given the request on the appeal then it’s handed to another officer, who will view it with a new set of eyes, so to speak, and then they will render their opinion. But if you get an oral hearing, you get to give your side of the story, so to speak, or before that hearing officer, before they make a decision.
Bernard: And will that either be in Kentucky or Florida?
Jimmy: Those are done by telephone.
Bernard: Okay, well, let’s create a hypothetical and talk about it for a minute. Let’s say that you represent a postal worker. And the postal worker steps out of their truck to deliver the mail and breaks an ankle because they’ve stepped in a hole. And then they come to you three weeks later saying I got hurt, and right now they are covering my medical care. What are you telling those folks? What are their rights?
Jimmy: Well, first of all, they’re due to get all the medical help they need with respect to the work-related claim. Once they are rendered to be at MMI or Maximum Medical Improvement, they may be in a position to get some type of monetary settlement, depending on what’s involved with the injury. It’s a lot like Alabama workers’ compensation, from the standpoint of scheduled members award off, that type of thing.
Bernard: Who picks the doctors or the medical care providers?
Jimmy: That’s a bit of a problem from a standpoint. They get to pick their own. But a lot of times, particularly right here in Central Alabama, if you’re a federal employee and you’re injured on the job, and you have to say to the guy that I need knee surgery, his firm will not take federal employees because the Department of Labor is so difficult to deal with.
Bernard: Well, that’s what’s going to lead me to the next question, the logistics. Who’s actually paying for this, and how does it get paid?
Jimmy: The Department of Labor pays for the entire claim. Once it’s in the system, supposedly, and you get a claim number, from that point on, it’s a matter of going back and forth. It is kind of like a quasi Blue Cross Blue Shield; accept it. They’re very, very touchy about making sure the things are filed properly in order to get paid for them.
Bernard: Sure. I can see that with any work comp case, whether it’s a federal, state, or private employer. What about a situation when the employee first gets hurt? This postal worker we’re talking about; steps into a hole and breaks his ankle. Who’s he supposed to notify to say, ‘I got hurt. What do I do next?’
Jimmy: He is supposed to notify his supervisor within 30 days of the accident. And that is done through A form called CA-1. Whereby he fills out the front portion of this form, and the supervisor fills out the back portion. And the supervisor sends it off to London, Kentucky. And that’s when the claim number is set up.
Bernard: And our scenario, let’s say that we now have an emergency because he knows he’s hurt, and he just goes straight to the emergency room. How should he proceed or deal with that?
Jimmy: If it’s a life or death situation, I would tell them to proceed on. And if the emergency room says anything, all federal employees have Blue Cross Blue Shield.
Bernard: I see. And we can deal with the paperwork after the fact.
Jimmy: I’d rather seek forgiveness than ask permission if somebody’s at death’s door.
Bernard: Certainly. Let’s say that our guy had surgery, and he’s off work for six to eight weeks because he can’t walk at this point. Is he paid any compensation or his salary while he’s out?
Jimmy: Yes, again, similar to state workers comp. Plus, he gets a continuation of pay for 45 days until the workers’ comp sets in.
Bernard: And usually, how long does it take for that compensation to kick in when they’ve been off work?
Jimmy: I would say anywhere from 30 to 45 days.
Bernard: Is there an adjuster? Or is there a claims handler for these claims?
Jimmy: They have claim supervisors that are Department of Labor employees in London, Kentucky, and Jacksonville, Florida.
Bernard: It’s interesting. I guess that’s just our part of the country.
Jimmy: It’s this region.
Bernard: Okay. And our guy in this scenario, three months after he gets hurt and has his surgery, the doctor says from a medical standpoint, you’re as healed as you’re going to be. And he says you have an impairment rating of 8%. You’re eventually going to be able to walk on your foot normally, but you need to ramp up to get to that part. And let’s say that he does that, and we’re now six months after the original injury, and all the dust has settled on his medical care, and he’s done treatment. The doctor says just come back if you need me. At that point, what’s the next step for the employee?
Jimmy: After everything is said and done, accepted, and he’s reached MMI. As a general rule, you’ll get a letter from the Department of Labor saying you reached MMI on this date, your average weekly wage was this, we’ve determined that the benefits that they’ve been paid to date are that, and we’re going to give you some type of a scheduled member award for this amount of money. And it’s not done by any negotiation process. It’s like, here it is. If you don’t like it, you go through the same appeal process that you would follow if they had denied your claim from the get-go.
Bernard: I see. Let’s say that our postal worker doesn’t like what he’s being offered. He thinks that they’re just wrong in either the calculations or whatever it is. It’s not enough money in his mind. Then, what?
Jimmy: Then nothing. What I would like for y’all to do is take this back and check your math. All the math is done right there on the letter. And they spit those things out of the computer on a daily basis. And that’s just the way it is.
Bernard: So, where do you come in? I’m going to assume that you’re most needed if It’s a denied claim.
Jimmy: Correct. Well, also, my need comes in if there’s a third-party claim. In other words, in this scenario, if he was stepping out of the truck and the guy rear-ended him and caused the damage. Our guy would get a letter from the Department of Labor that said through our investigation, we have ascertained that a third party is responsible for your injuries. And what happens there is the same letter says, we’re putting the burden on you to go after the third party. So I also get involved with third-party claims. And once you get the third party involved, then me or whoever’s handling it, from a legal standpoint, is responsible for protecting the lane from the Department of Labor for benefits and medical. You don’t pay back a dollar on a dollar. It’s like Blue Cross. There’s a 20-item formula; you have to do all the calculations, where you include attorney fees, expenses, and whatnot. And at the end of the representation, the client gets money from the Department of Labor and the insurance company for the third party. And then the Department of Labor gets part of their money back.
Bernard: Right. We won’t get too deep into the subrogation today. And I appreciate all the information that you’re providing because most folks who are federal employees really just don’t have an idea of what they’re supposed to do and how they’re supposed to do it. So they’ve got a 30-day window to notify their supervisor to make sure the claim is proceeding.
Jimmy: Exactly. And the burden is always on them; I stress that all the time. Don’t even assume your supervisor’s going to turn it in.
Bernard: Well, Jimmy, I apologize for not asking you earlier. Folks who are watching this, whether it’s live or later on, if they’ve got a case like this or want to ask questions, how do they get in touch with you?
Jimmy: My number in Birmingham is 205-822-1223. I don’t have a problem with folks asking me general questions. I’d much rather answer a phone call and help somebody out than have somebody call me six months down the road, messed up eight ways to Sunday.
Bernard: Yeah, the earlier, the better. What if they want to email you instead?
Jimmy: Sure. My email address is firstname.lastname@example.org
Bernard: Okay. Just a couple of things before we wrap up today. Talk to us just briefly; if an oral argument is requested and granted, what kind of process is that?
Jimmy: The process sets up in such a way that you’re in the conference room with your attorney, and the hearing officer is up in DC with the court reporter. And I always suggest to people, even if you don’t hire me to do it, to ask for an oral argument of your own. Because this hearing officer, for lack of a better term, is, a lot of times, more qualified to understand the ins and out of legal and medical causation in those claims. And you get to give your side of the story, so to speak. And that the hearing officer will have a much better idea after hearing the claimant, as well as his or her attorney, in addition to the filings. Sometimes, it is voluminous filings of all the paperwork. You know you do have claims that go on for years.
Bernard: What’s the statute of limitations or the time period that a person has to make a claim?
Jimmy: Three years.
Bernard: So, three years from the date of the accident itself?
Jimmy: I generally tell people three years from the date of the accident.
Bernard: What about occupational exposures to chemicals and the like? Could those also be covered?
Jimmy: Those could also be covered. The only difference is you file a different form. If it’s a standard work comp injury, like a broken arm or cervical injury, that comes under a CA-1. If it’s an occupational disease, say exposure to chemicals or whatnot, that would be a CA-2.
Bernard: So it’s just different paperwork, different path but same ride.
Jimmy: Yes. Same thing with the death claim. There’s a different form for that as well.
Bernard: What’s the statute of limitations on the death claim?
Jimmy: The statute of limitations on the death claim is the same statute; 3 years.
Bernard: One last thing that just hit me. What are some typical reasons for denials that you’ve come across?
Jimmy: As a general rule, most of the denials I see are from a medical causation basis. Typically on the legal causation side, they have a witness or some civilian report what happened, that type of thing. But they expect very precise documentation from all healthcare providers. In other words, if you have a doctor that comes back and says, ‘Well, I looked at the history of the case, and based on what I know, it’s work-related,’ that’s not going to help. They’re not going to hook. What they want is the rationale used and everything else from the standpoint of how he got from point A to point Z and everything in between. Hence, that goes back to the problem that so many, typically specialists, will not deal with federal employees. It’s just not it’s not worth it for them.
Bernard: One of the things that we constantly communicate to our clients is that from the very beginning, the first time you see a doctor tell them where it hurts; every body part. Even if it’s just something that you’re not sure is going to be a long-term thing. Tell them the beginning, get it in documentation, and then that will be a basis of six months or a year from now when you’re still having those issues. Do you subscribe to that advice as well?
Jimmy: Yes, I do. And I also believe that once you start seeing a doctor, as we all know, you may hurt your knee, and during the process, particularly after an automobile accident, you may have some other issues that come up. And they may come back and say, ‘well, I only made a claim for the knee.’ So my philosophy is it’s your right to make a claim for everything that was involved in that accident. So, go ahead and file a new claim for the other problem you may have. The worst-case scenario is they’re going to say no. But if you wait now, and three years later, you say, now I’m thinking that it did involve.
Bernard: Yeah, that’s the biggest fight. Well, Jimmy, it’s all sound and excellent advice. We appreciate you sharing your expertise and your knowledge. Again, how can folks get in touch with you?
Jimmy: In Birmingham, 205-822-1223.
Bernard: Again, this is Bernard Nomberg with Nomberg Law Firm. You can always reach us at 205-930-6900. We’re in downtown Birmingham. nomberglaw.com is our website. And you can find us on Twitter and Facebook. We will be back again next Tuesday with another area of the law. Thank you for sticking with us for a little bit this morning. We hope you have a good rest of your week.
Disclaimer: Please note that this transcript has been generated automatically and may contain errors, inaccuracies or deviations from the original video. It is provided as a convenience and is not intended as an exact representation of the content.
When it comes to navigating your workers’ compensation claim, it may not even cross your mind to wonder how best to settle your claim.