Shoulder Surgeries for Injured Federal Workers

Getting shoulder surgery approved under the Department of Labor’s Office of Workers’ Compensation Programs (DOL-OWCP) involves several detailed steps. Here’s a guide to help you through the process:

1. Report the Injury

Immediate Notification: Inform your employer about the shoulder injury as soon as possible.
Form CA-1 or CA-2: Depending on the nature of the injury, fill out and submit either Form CA-1 (Federal Employee’s Notice of Traumatic Injury and Claim for Continuation of Pay/Compensation) or Form CA-2 (Notice of Occupational Disease and Claim for Compensation).

2. Seek Medical Attention

Initial Medical Treatment: Get treatment from a healthcare provider familiar with DOL-OWCP procedures.
Medical Documentation: Ensure your treating physician documents the injury and provides a detailed report linking the shoulder injury to your work duties.

3. File a Workers’ Compensation Claim

Form CA-7: If you require wage-loss compensation, complete and submit Form CA-7 (Claim for Compensation).
Additional Documentation: Include necessary medical reports, diagnostic tests, and other supporting documents.

4. Obtain a Medical Authorization

Form CA-16: Your employer can authorize treatment using Form CA-16 (Authorization for Examination and/or Treatment), which ensures payment for treatment up to 60 days following the injury.
Medical Necessity: Your physician must provide evidence that the surgery is medically necessary and related to the work injury.

5. Submit a Surgery Request

Pre-Authorization: For non-emergency surgery, pre-authorization from OWCP is required. Your healthcare provider must submit a detailed surgery request.
Medical Justification: The request should include a comprehensive medical report with the diagnosis, recommended treatment plan, and justification for surgery.

6. Review and Approval Process

OWCP Review: OWCP will review the request, medical records, and supporting documentation. They may ask for additional information or an independent medical examination (IME).
Decision: OWCP will determine if the surgery is approved or denied. If approved, they will authorize the surgery. If denied, you will receive a written explanation and may need to appeal.

7. Post-Surgery Process

Follow-Up Care: Keep thorough documentation of your medical condition and progress after surgery.
Form CA-7 for Wage Loss: If additional time off work is needed for recovery, submit further Form CA-7s for wage-loss compensation.
Rehabilitation and Recovery: Participate in any required rehabilitation programs and follow your doctor’s recovery plan to ensure a successful return to work.

Tips for Success

  • Detailed Documentation: Ensure all medical records are thorough and directly link the injury to your work duties.
  • Timely Submission: Submit all forms and documentation promptly to avoid delays.
  • Consult an Expert: Consider consulting a workers’ compensation attorney or specialist if you encounter difficulties. They can provide guidance and assistance in navigating the system.

By following these steps and ensuring all necessary documentation is submitted promptly and thoroughly, you increase your chances of getting shoulder surgery approved under the DOL-OWCP workers’ compensation program.