Employees who have worked overseas for government contractors such as FLUOR, KBR, Dyncorp, Mission Essential Personnel, Janus and others, find it difficult to navigate the complex world of Office of Workers Compensation program once they complete their contract and return home.
Sometimes, certain illnesses or injuries appear several years after employees come back home from war zones. Let’s look at PTSD for example: employee visits his physician several years after his contract is ended, and ends up with a diagnosis from Anxiety spectrum disorders. Employee is unsure if he should reports this to his former employer or just let it go. In this scenario, it is important for employee to report injury/illness to former employer, who will in return file LS-202 form and put OWCP office on notice along with their insurance carrier. Another way is to have employee file form LS-203 and send it over to OWCP office, which will notify employer and insurance carrier.
Once insurance was notified that a work comp claim has been filed, they have a limited time frame in which they must either accept the claim and start paying benefits to the employee or deny the claim and issue form LS-207 to the employee.
Let’s stop for a moment and look at above scenario from dual perspective. Claimant just got a diagnosis and is eager to continue medical treatment and receive monetary compensation for illness/injury he suffered while working for employer. From insurance point of view, they have a Claimant who completed his contract some years ago and filed insurance claim asking for benefits for injury/illness he claims is work-related to his past contract. At this point, insurance will most likely deny the claim not to miss the deadline with OWCP and start investigating the claim.
When I say investigating claim, that does not mean insurance will report it to the enforcement agency and they will initiate some type of investigation. The process will most likely start with a recorded statement interview. It is important to note that recorded statement interview is considered to be voluntary discovery. If Claimant declines to participate in it, his statement may be obtained through the pretrial discovery called deposition.
Insurance carrier usually assigns a recorded interview assignment to their outside vendors. Vendors are claims management companies such as TPA, private investigators, etc. Vendors then contact the employee and ask if he is willing to participate in the investigation. If he agrees, they will set up a mutually acceptable time to get interview done. Claimant will be also asked to provide copies of his contract, medical records, sign off medical release form, receipts for out of pocket expenses and pay slip statements during the interview. It is important for employee to confirm that person who contacts him for the interview has authorization from insurance carrier, since he will be disclosing personal and confidential information.
During the interview, investigator will be going through a questionnaire and ask set of premade questions regarding Claimant’s personal history, educational and employment background, past and present medical history and specific details regarding the accident, which caused alleged injury/illness. Once investigator gathers all these facts, he will create investigation report and forward it with collected records to the Adjuster. Adjuster will review report and records and at that point, Adjuster may reverse their decision and approve the claim or stay with denial.
