GOOD CLAIM BAD CLAIM A FEW EXAMPLES OF CLAIMS FROM BAY PINES VA MEDICAL CENTER

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GOOD CLAIM - BAD CLAIMA FEW EXAMPLES OF CLAIMS
FROM BAY PINES VA MEDICAL CENTER
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GOOD CLAIMSeveral employees schedules were
being changed in a shop. One man was so upset, he
filed an EEO and in his discussion with the
counselor, he made a threat against his
supervisor. The counselor called management and
the police. The supervisor reacted adversely,
went to a psychologist and filed a workers comp
claim. We disputed the claim and OWCP developed
the claim and OWCP accepted the claim.
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I called the examiner and she said this was the
first stress claim that she had accepted, but it
was so obvious a direct threat she had no choice.
Later she would assure me that any time off
must relate to this particular episode.Several
weeks later this same supervisor came to me and
asked if the psychologist would continue to be
paid. I said I thought so, if it was related to
his claim.
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BAD CLAIMWithin a few days, this same employee
brought me a psychologists report recommending
extended sick leave and the employee reported a
new situation. I called the claims examiner. She
said any comp would have to relate to that single
threat. It wasnt and the employee filed a new
stress claim. Dr. Sutton was of the opinion that
the employee had significant pre-existing
emotional problems and that many of his
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problems were related to his perception of
events. Those events concerned actions of other
employees, but this employee felt that they were
threats to him. The claims examiner requested
proof in his development letter. One thing the
Department of Labor wanted was statements from
all employees showing direct threats by specific
individuals..
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The employee started to harass employees in
person and by e-mail. He tried to pressure Human
Resources to order employees to write a
statement. He was warned that he was close to the
fine line of coercion. The claims examiner
quoted the Human Resources Manager e-mail
response to the employee. The DOL decision found
there were no factors of employment involved.
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BAD CLAIMEmployee claimed an injury on
11/27/01. She was returned to duty by
Occupational Health Physician. However, she went
to a chiropractor. By the end of March and
treament 3 times a week, I requested the The
Department of Labor to request the chiropractors
x-rays be reviewed by our Board Certified
Radiologists.
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Within five days, the The Department of Labor
requested x-ray reports and a report from the
chiropractor how her work related medical problem
is due to subluxation by x-ray evidence. The
information was not forthcoming and the The
Department of Labor denied her claim as she had
not established fact of injury.
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BAD CLAIMAn employee was treated as a veteran
for an abscess in October. In December, he filed
a claim that it was caused by either a bug bite,
palm thorn or cactus puncture from a vacation to
Las Vegas. The medical reports show his abscess
grew out enteric organisms in culture. I based
our dispute on inconsistencies among the the
various histories.
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Apparently, the Department of Labor accepted that
he had received a prick/scratch/cut from an
insect or plant or sharp stick, but found that
the medical reports did not show a causal
relation to his abscess. Remained a lost time
claim (D5 denial)
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GOOD BAD CLAIMEmployee involved in take down
is kicked on left leg. The next day he had pain
in the leg. Dr. Sutton ordered a venous test
immediately. It showed a blood clot. He was
hospitalized. Within a few days he developed
blood clots in his right leg. However, further
tests showed he had terminal cancer.
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I gave COP until he was released from the
hospital and his physician said he could return
to work. The DOL called with decision that blood
clot was not related to work. The employee
wrote his congressman. The claims examiner wrote
his physician, who was unequivocal in her
statement that his blood clots were related to
his cancer.
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All of the information was given to the District
Medical Adviser, who decided that the blood clot
in his LEFT leg was related to the kick. The DOL
accepted only treatment of the left leg, none for
the cancer. We gave him the rest of the COP and
I have asked that his blood thinning medicine be
considered work related. He went to Texas for
treatment for his cancer, and wants us to pay for
all the medication.