Delays in federal workers’ comp can stall medical care, turning injuries into disabilities

Injured federal employees say their treatable injuries are at risk of progressing into lifelong disabilities because the workers’ compensation program that covers their medical costs and procedures is clogged by low staffing, convoluted processes and an increase in claims.

Workers and their advocates say filing a claim is a knotty experience of complicated paperwork and slow response times and, in some extreme cases, it can take years to get an approval.

Joshua Lejeune, 33, is one of those workers. He needs surgery after injuring his knee while on patrol as a police officer at a Veterans Affairs hospital in Louisiana last year and is still waiting for approval. Since filing the workers’ compensation claim in March 2022, he has been unable to safely carry his infant daughter up the stairs of his home.

Because it’s a workers’ compensation case, his insurance won’t cover his procedure and doctors are unable to work on his knee without an approved claim. The longer he waits, the more at risk he is for a complete knee replacement, he said doctors have told him. 

“It’s crazy,” said Lejeune, who can’t afford the $50,000 out-of-pocket estimate for the procedure and who has lost work and employment opportunities because of the injury. “It’s a complete nightmare.”

And he isn’t the only one experiencing this nightmare.

The process has created delays for countless employees across the federal government’s numerous agencies, union officials and labor attorneys said. From the Federal Bureau of Prisons to the U.S. Postal Service, federal workers and their advocates described a Byzantine process that they received little help to navigate. And while their doctors might tell them a procedure or scan is necessary, it can take weeks or months to receive approval from the Office of Workers’ Compensation Programs, or OWCP, an agency that falls under the Labor Department. 

OWCP said it is working readily to remedy concerns.

“OWCP is deeply committed to providing federal workers injured or sickened on the job the benefits they’re entitled to in a timely manner. The current administration has taken many actions to strengthen the FECA program and we will continue to find new ways to make the program work better for those filing a claim,” OWCP Director Chris Godfrey said in a statement, referring to the Federal Employees’ Compensation Act.

‘A tremendous problem’

Joe Mansour, the workers’ compensation specialist at the country’s largest federal employee union, the American Federation of Government Employees, said he has been brought in to work on almost 1,000 cases since the start of the year because of delays and other issues. He emphasized that the union has contended with the problem under both Democrats and Republicans in the White House, but it grew particularly difficult under the Trump administration.

“Many federal employees I speak to say dealing with workers’ comp is one of the most difficult things that they have ever experienced in the government,” he said. “It seems like the current administration is trying to improve things, but it remains a tremendous problem.”

The claims processing workforce shrank while Donald Trump was president, according to data provided by the Labor Department. One of the logjams potentially making the problem worse is that this smaller number of employees has had to tackle a larger number of cases. 

The scale of the requests has grown precipitously. The FECA program received 182,303 new injury claims in fiscal year 2022, according to data provided by the Labor Department. That represents a 62% increase over 2013 when it received 112,807 claims. 

In response, the Biden administration has increased staffing, hiring 281 new claims examiners and 55 medical treatment adjudicators to make the FECA program work better for claimants, according to the Labor Department data. Staffing levels are slowly climbing back to where they sat almost 10 years ago, and the agency said it has created new processes to escalate inquiries, simplified forms and hired an ombudsperson to investigate specific claims.  

Still, claimants said the undertaking can become confrontational when they need to continually check in or involve lawyers to speed up the process. Claims are often denied by case workers, which can cause the entire effort to take much longer.

And when it’s a person’s well-being on the line, union leaders and workers emphasized that a time-consuming approval process can take a cruel hold on people’s lives, whether intentional or not. 

“If a case is denied, we can appeal it — and we do well on appeals,” said a union leader who asked to remain anonymous because the representative works regularly with the Office of Workers’ Compensation Programs. “We get a lot of stuff overturned, but it takes months to do that, and time is not on the workers’ side.”

Pete Hobart, 50, a power plant mechanic at the Dalles Dam, which is operated by the U.S. Army Corps of Engineers on the border between Washington and Oregon, hurt a disk in his back while working in February 2022. With little information on how to navigate the process, it took 10 months for him to obtain the approval for surgery. 

“Now my lower leg is numb,” he said, adding he believes it is nerve damage caused by waiting for the workers’ compensation approval. “You know when the doctor beats on your knee and your leg kicks? Mine doesn’t do that anymore.”

The hardship of a slow process

Federal employees say the process is very complicated and they receive little guidance to navigate the paperwork and requirements. Attorneys and union leaders who have been involved in helping to get claims processed said that delays are not an anomaly of just a few extreme cases but are affecting many claimants.

To help members of his union, Mansour holds workshops at sites across the country and online for federal employees because so many people continue to struggle through the process. He has held more than 30 workshops this year, which included an online course last week attended by more than 160 employees. 

“As of now, the agency just does not provide sufficient information to the injured employee,” he said when asked about the need for the workshops. “When an employee is injured, they’re on their own.”

Two union representatives, each working for a different federal agency, said the problem is so pernicious that they sometimes advise members to file claims under their personal health insurance first and report the workers’ compensation claim after they’ve received the necessary help — or avoid the process altogether. 

Attorneys who have worked on federal workers’ compensation claims said that can be problematic, however, as it still requires individuals to come up with copays and deductibles out of pocket that they may not be able to get reimbursed afterward. It can also affect the evidence workers might need to gather to get claims approved. 

“Part of the problem in many cases is that once a claim is accepted, private insurance companies won’t typically pay for treatment,” said Aaron Aumiller, an attorney who has worked on federal workers’ compensation cases for almost two decades.

The wait can be emotionally excruciating, and it often takes an immense toll on individuals involved in the process. Multiple employees described spiraling in negative thoughts as they waited to get claims approved. 

Jim Karney, 55, who works as a hydropower plant operator in Idaho, slipped on ice outside the Corps dam he worked at two days before Christmas 2021. The accident, which injured both his shoulders, was recorded by cameras at the plant. After filing an OWCP claim, he was unable to receive approval for an MRI until February 2022, and then only for his left shoulder. The following month his doctor told him that a torn rotator cuff had worsened and had permanently affected the muscle in his left shoulder. He was told that because of the delay, he will never be able to regain strength in his shoulder. 

It took five more weeks to be approved for an MRI of his right shoulder, where another rotator cuff tear as well as a bicep tear were identified. Two and a half months later, he was able to get surgery on the right side.

The injuries have limited his range of motion. They forced him to sleep in a recliner every night for months, and he still can’t lift a gallon of milk with his left hand. The process, at times, has left him vacillating from tears of self-pity to intense anger and severe depression. He has just learned to cope with the pain emotionally.

“I never did feel suicidal, but I really wanted the pain to end,” he said. “I wasn’t willing to go that far, but this process drives your mind that way.”

That’s a familiar feeling for many, who said they’re left to spiral in their pain without a sense of recourse.

Lejeune, who quit the VA and is working in sales, said the process presumes that claimants know the workers’ compensation program thoroughly. That assumption and his experience has him swearing off government work forever.

“I don’t ever want to work for another government agency again,” he said. “When I was injured, I had zero help. It’s a joke.”


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