Occupational Disease or Illness

An occupational disease or illness is a condition produced by the work environment over a period longer than one work day or shift. The condition may result from infection, repeated stress or strain, or repeated exposure to toxins, poisons, fumes or other continuing conditions of the work environment.

The length of exposure, not the cause of the injury or the medical condition that results, determines whether an injury is occupational. For instance, if an employee is exposed to toxic fumes for one day, the incident is considered traumatic. If the employee is exposed to toxic fumes for two or more days, the incident is considered to be an occupational illness/disease. From OWCP Publication CA 550

What Do You Do?

What must an employee do when injured at work? -- adapted from CA 550 language

(1) Report the injury to the supervisor right away;

(2) Request Form CA-2 from your supervisor. There is a section for the claimant and supervisor to complete. Your supervisor is obligated to provide you with necessary forms if you choose to file a claim. S/he is also responsible for processing these forms in a timely manner;

(3) READ THE TOP OF PAGE FOUR OF THE CA 2 BEFORE DOING ANYTHING MORE. Using the instructions on page four of the CA 2 write an employee statement. click here for examples;

(4) Select your doctor of choice. Present your doctor with (1) employee statement, (2) copy of the appropriate duty assignment job description for visual aid and (3) page four of the CA 2 so s/he can prepare a medical narrative to support your claim of injury. Make sure s/he realizes how important the documentation is to the success of your claim. Emphasize the importance of addressing each topic found on page four of the CA 2.

Also, ask your doctor for copies of notes from each doctor visit, as well as all test results pertaining to the claimed condition;

(5) Once your doctor gives you the medical documentation (including visit notes and test results), compile everything you need to file the claim. KEEP ALL YOUR DOCUMENTS TOGETHER UNTIL YOU ARE PHYSICALLY READY TO HAND OVER THE ENTIRE CLAIM.

• CA 2 completed by you (keep reading for help with form CA 2).
  
• Employee statement.
  
• Medical Documentation, along with office notes and test results.
  

(7) Send the remaining documentation directly to the post office district injury compensation specialist.(see your steward for name and address);

The goal is to have all your documents sent to the Dept of Labor at the same time. This would be to your advantage because the claims examiner would be able to make a quicker ruling if all the evidence was submitted at the same time.

If you submit your CA-2 without supporting documentation, you will receive a letter asking for more information. This exchange of correspondence can become a lengthy process and your claim may be denied until additional documentation is provided.

Doctor of Choice

An injured worker is entitled to a first choice of physician or facility for treatment. The employee’s choice of physician must be honored and treatment should not be delayed. Once a choice has been established, you may switch doctors only with written permission from the Department of Labor.

If you require medical treatment due to a work-related occupational disease or illness, you should obtain care directly from your physician. If OWCP accepts your claim, it will pay for medical treatment required for the accepted condition(s). This includes treatment received before the claim was accepted.

You may have problems convincing your insurer to treat you while processing your claim. If this happens, firmly state that you DO NOT have a work-related occupational disease or illness until the Department of Labor accepts the claim. Until then, the injury must be treated like any other illness; bills are submitted through your health plan. Only the Department of Labor can say whether or not an injury is job related, not your health plan.

If, for any reason, you personally pay for medical treatment and then receive an accepted claim, you may be reimbursed for standard, valid charges.

Date of injury

KEEP IN MIND! YOU ONLY HAVE THREE YEARS TO FILE A CLAIM. On page 1 of form CA2, questions #11 & 12 ask for a date (see below). Normally, I advise employees to use the date he or she decided to make a doctor's appointment for question #11 and the actual date of the appointment for question #12. The date in question #11 becomes the official date of injujry for this claim.

Try to make these dates as close together as possible. If the date you first became aware of the illness or disease was January 1, 2008 and the doctor's appointment wasn't until October 1, 2008, the Dept of Labor will want a lengthy explanation as to why you waited so long. The fewer questions they ask, the better off you are...

Documentation

You need to substantiate your claim with rational medical documentation. The burden of proof is on you. You must effectively communicate your needs to your physician when asking for documentation. Doctors don’t like committing themselves to "positively" diagnosing an injury as work related. Your doctor doesn’t necessarily have to say that your injury was unquestionably "caused" by your work. However, your doctor does have to say s/he can reasonably conclude that your injury was "aggravated", "exacerbated" or "accelerated" by your duties.

Your doctor also needs to show causal relationship between your injury and your duties. Causal relationship is a "medical connection between the injury and the condition found", based entirely on medical evidence provided by physicians who have examined and treated the employee. Opinions of the employee, supervisor or witnesses are not considered.

FECA does cover pre-existing medical conditions that are aggravated, accelerated or precipitated by factors of employment. When a pre-existing condition involving the same part of the body is present, the physician must provide a medical opinion, which states both the effects of the work-related condition and those of the pre-existing conditions.

To get your claim approved, your physician will need to be thorough when providing documentation. Documentation received from your doctor is the single most important component in an occupational disease/illness claim. Don’t let the doctor take any short cuts; force her or him to be thorough.

The Department of Labor considers the factual and medical evidence sent by the employee and the employer. This evidence is VERY important when filing a CA-2. Refer to page 4 of the CA-2 for instructions on what is expected for the employee statement and the medical report (see below). Make sure your doctor has a copy of your employee statement (see below) before s/he generates the medical documentation to help get your claim approved.

I cannot stress enough that you and your physician play a big role in getting a positive result regarding your claim.

Statement from employee. (page 4 of CA-2 instructions)

                 click here to review sample employee statements