Training Resources
Training Resources
Doctor’s narrative reports are the most important aspect of an accepted OWCP work injury claim. Bad or insufficient reports always lead to denied claims. Therefor, doctors must be willing to do whatever it takes to write excellent, detailed reports that will lead to accepted claims. The best marketing plan is accepted OWCP claims.
When doctors write bad narrative reports, patients always get denied claims. The following list contains some of the worst problems that occur to patients after denied claims.
Patients lose all of their work injury benefits.Patients are not able to be paid for time away from work when they’re injured.Patients can’t be reimbursed for mileage and other travel expenses.Patients can’t be reimbursed for money they’ve paid out of their pocket for medical expenses.Patients have to make financial decisions on their health which makes it difficult to get better.Patients have to work with pain because they can’t afford to get better or be off work.Patients consider going on federal disability which pays just 40% of their income by year 2.Patients experience tragic events such as loss of home and bankruptcy when they can’t work.Patients’ jobs are not protected because the claim is not accepted, and their supervisors can fire them.Patients develop stress leading to depression and anxiety, which too often leads to suicidal thoughts.
Denied claims also have a negative effect on doctors.
Doctors bills are not paid until the claim is approved.Doctors who can’t get claims approved stop getting patients.Doctors who can’t get new patients and who can’t get paid for their work, drop out of the program.
However, accepted claims have an incredible positive effect on patients and doctors.
Patients can’t be fired for having an accepted work injury claim.Patients can be paid to be off work to go to the doctor.Patients can be reimbursed for expenses.Supervisors are required to give limited duty jobs to patients with accepted claims.Patients can avoid disability, loss of home, stress, anxiety, depression and all the terrible things that follow.Doctors can get paid (extraordinarily well).Doctors who get claims approved become superstars who can get every patient in their area to come to them for help.
The doctor’s narrative report always includes the following elements.
A thorough description of the patient, their job title and agency, and years on the job.A detailed description of the job and its physical requirements.A detailed description of the injury or the situation that lead to the condition.A detailed link between the job and the injury. This is called Causation.A thorough medical history and physical.A final summary restating the description of the injury and causation along with an unequivocal statement affirming that the diagnoses are directly related to the job. For example: “In my medical opinion, the following conditions are a direct result of the employee’s required job duties as a letter carrier on June 7, 2018.”
Important points to remember when writing narrative reports.
You can never use too much detail, but too little and you risk a denial.Job descriptions are the same for each job position in all federal agencies. Most of the time, these can be copied and pasted (templates) from past narrative reports.Many job descriptions can be found online. Patients often can bring written job descriptions with them to the office. The CA17 contains physical demands of the job. Finally, it’s very useful to interview the patient to ask them what they do in their job.The detailed description of the injury is very important. Simply stating that the patient bent down and felt pain in their back is not going to get the job done. What was the patient lifting? How many hours had the patient worked that shift? Approximately how much did the object weigh? How far was the object carried? How many miles had the patient walked that day? How many flights of stairs? How many hours at a computer typing? What was the temperature that day? Was the patient wearing required uniform? What was the pain level when the injury occurred? Who else saw the injury happen? What did the witness statement say? When writing the narrative, the doctor should think like a claims examiner and contemplate what would he/she need to see in order to say yes to opening the claim. Every injury is different. The specific details of each injury need to be written as a persuasive story that a claims examiner can’t say “no” to.Causation is critical. You may have very thoroughly detailed the injury or you may have excellent diagnostics (xrays, MRI, NCV, etc) that indicate structural damage, but did you clearly link the injury to the job? The patient has a herniated disk. So what? Torn ligament. So what? Injured rotator cuff. So what? Carpal Tunnel Syndrome. So what? How did the job cause those conditions? Causation links the job to the diagnosis in a clear and irrefutable way.The final summary contains 2 critical elements: diagnoses and the doctor’s medical opinion statement. Do not use any diagnosis that indicates pain: cervicalgia, lumbago, or any other ICD-10 code that is a symptom of another problem. Pain diagnoses always get denied. Do not diagnose pain under any circumstance. Instead, diagnose the condition that is causing the pain symptom. Example – a lumbar sprain or herniated disk may lead to pain. So, diagnose the sprain or herniation, but leave out the pain diagnosis.
Next is the doctor’s medical opinion statement: “In my medical opinion, the following conditions are a direct result of the employee’s required job duties . . .” Doctors that can’t write clear definitive statements cause claims to be denied. A statement like, “in all medical probability,” or “to a reasonable degree of medical certainty” will cause the claim to be denied. So be sure about your diagnosis and then say so.