Getting Shoulder Surgery Approved Under the DOL-OWCP

Getting shoulder surgery approved under the Department of Labor’s Office of Workers’ Compensation Programs (DOL-OWCP) can be a detailed process. Here are the steps you typically need to follow:

1. Report the Injury

  • Immediate Notification: Notify your employer about the shoulder injury as soon as possible.
  • Form CA-1 or CA-2: Depending on whether the injury is traumatic or occupational, complete 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: Obtain medical treatment from a healthcare provider. Ensure they are familiar with DOL-OWCP procedures.
  • Medical Documentation: Your treating physician must document the injury and provide a detailed medical report linking the shoulder injury to your work duties.

3. File a Workers’ Compensation Claim

  • Form CA-7: If you need wage-loss compensation due to your injury, complete and submit Form CA-7 (Claim for Compensation).
  • Additional Documentation: Include any necessary medical reports, diagnostic tests, and other supporting documentation.

4. Obtain a Medical Authorization

  • Form CA-16: Your employer can authorize medical treatment with Form CA-16 (Authorization for Examination and/or Treatment), which guarantees payment for treatment for up to 60 days following the injury.
  • Medical Necessity: The treating physician must provide evidence that the shoulder 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 must include a comprehensive medical report, including the diagnosis, recommended treatment plan, and why surgery is necessary.

6. Review and Approval Process

  • OWCP Review: OWCP will review the request, medical records, and supporting documentation. They may request additional information or an independent medical examination (IME).
  • Decision: OWCP will make a determination based on the provided evidence. If approved, they will authorize the surgery. If denied, you will receive a written explanation and may need to appeal the decision.

7. Post-Surgery Process

  • Follow-Up Care: Ensure continuous documentation of your medical condition and progress post-surgery.
  • Form CA-7 for Wage Loss: If you need extended time off work for recovery, submit additional 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 documentation is thorough and directly links the injury to your work duties.
  • Timely Submission: Submit all forms and documentation promptly to avoid delays.
  • Consult an Expert: Consider consulting with a workers’ compensation attorney or specialist if you encounter difficulties in the approval process. They can provide guidance and assistance in navigating the system.

By following these steps and ensuring thorough and timely submission of all necessary documentation, you increase the likelihood of getting your shoulder surgery approved under the DOL-OWCP workers’ compensation program.