Failure to Attend OWCP Medical Exam Results in Loss of Compensation

In this federal workers' compensation claim, the claimant had already successfully proven that she had suffered an on the job injury. The Office of Workers' Compensation Programs (OWCP) continued to pay her compensation benefits for her injury. The OWCP then referred the claimant to an orthopedic surgeon for a second opinion as to her capacity to return to work. The claimant's own treating doctor, however, said that there was no useful information to be gained by going to the second opinion exam and that the claimant's injury could be worsened during the second opinion examination.
Based on her doctor's advice, the claimant did not attend the OWCP medical exam.
The OWCP proceeded to terminate her compensation benefits as a result.
On appeal, the claimant argued that she did not attend the OWCP exam per her doctors' own medical advice.
The Appeals Board said...not good enough. 
The OWCP Appeals Board said that the claimant's treating has no authority to make such a determination that the OWCP exam is not needed.
The choice of location and the choice of who, what and when the second opinion exam occurs is solely within the the discretion of the OWCP. The failure of the claimant to attend the OWCP exam, despite her own doctor's advice to the contrary, is sufficient grounds for OWCP to terminate the claimant's compensation and benefits.

Lesson: Attendance at an OWCP medical examination is all but mandatory. Failure to do so could result in permanent loss of benefits.

C.S. v. Department of Homeland Security (02/04/2010)

 

In 1997 Dipple was working as a highway traffic flagger when she was struck by a car and thrown a considerable distance.  She was later unable to return to her job for what she said were back and neck injuries and memory loss.  She then filed for her SSA disability benefits.
At the SSA hearing Dipple told the Judge that she had a fairly normal daily routine including basic household tasks and playing cards with her neighbors.
As result the Judge found that "These are not the actions of an individual who has "marked" limitations in the ability to perform simple, repetitive tasks" and denied disability benefits.
On appeal to federal court, the court upheld the SSA Judge's decision.  The court found that the social interaction, playing cards with neighbors, was sufficient enough to show that Dipple had no more than "slight" limitations in her social functioning and that Dipple's arguments to the contrary were not credible.
Benefits denied.

Lesson: Knowing what questions will be asked and what your answers will be at a SSA hearing will be vital to whether or not you are deemed "credible" for social security disability purposes.

Dipple v Astrue 8th CCA, (04/14/2010)

In this veterans disability claim, the veteran was sent to two medical examinations by the VA. The purpose of those exams was to determine whether or not the veteran's claimed injuries were related to his military service.
The VA doctors reported that they were unable to state any linkage to military service "without resorting to mere speculation."
Based on their own doctor's inability to come up with a conclusion, the VA denied the veteran's disability compensation as not related to military service.
On appeal the veteran argued that the VA failed in its duty to assist when their own doctors failed to provided a conclusion on their medical exams.
The Court agreed with the veteran and sent the claim back for another review. The Court found that the duty to assist requires that the VA obtain all relevant evidence that may reasonably be obtained before the VA may rely on a VA medical exam report to deny a claim.
If the VA doctor's conclusion is not possible without resort to speculation, that is still a medical conclusion. However before the VA may rely on such a report the VA doctor must explain in detail the basis for such an opinion. For example, whether or not additional testing is needed, or whether or not the doctor himself lacks the expertise. Furthermore the phrase "without resort to speculation" must reflect the knowledge of the medical community at large and not just that of the particular examining doctor.