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Types of Claims

Traumatic Injuries

A traumatic injury is defined as a wound or other condition of the body caused by external force, including stress or strain. The injury must be identifiable by time and place or occurrence and member of the body affected. It must be caused by a specific event or incident or series of events or incidents within a single day or work shift. Traumatic injuries also include damage to or destruction of prosthetic devices or appliances, including eyeglasses, contact lenses, and hearing aids, if they were damaged incidental to a personal injury requiring medical services.

Occupational Disease

All instances of occupational disease must be documented. An occupational disease is defined as a condition produced in the work environment over a period longer than 1 workday or shift. It can result from systemic infection, repeated stress or strain, exposure to toxins, fumes, or other continuing conditions in the work environment. Examples are carpal tunnel syndrome or asbestosis caused by the duties or work environment.

Recurrences

A recurrence is defined as a spontaneous return or increase of disability due to a previous injury or occupational disease without intervening cause, or a return or increase of disability due to a consequential injury. A recurrence differs from a new injury in that with a recurrence, no event other than the previous injury accounts for the disability. Follow-up medical care for an injury or disease which causes time loss is considered part of the original injury rather than a recurrence unless the employee was previously released from treatment.

A recurrence has a few definitions. A Claimant needs to understand that the medical providers may use the term “recurrence” when describing your condition, but the OWCP defines recurrence differently than most medical providers.

OWCP defines a recurrence of disability as an inability to work after an employee has returned to work, caused by a spontaneous change in a medical condition which had resulted from a previous injury or illness without an intervening injury or new exposure to the work environment that caused the illness. This term also means an inability to work that takes place when a light-duty assignment made specifically to accommodate an employee’s physical limitations due to his or her work-related injury or illness is withdrawn (except when such withdrawal occurs for reasons of misconduct, non-performance of job duties or a reduction-in-force), or when the physical requirements of such an assignment are altered so that they exceed his or her established physical limitations. Recurrence of medical condition means a documented need for further medical treatment after release from treatment for the accepted condition or injury when there is no accompanying work stoppage. Continuous treatment for the original condition or injury is not considered a “need for further medical treatment after release from treatment,” nor is an examination without treatment.

Each type of injury is different. Trying to figure out what you are entitled to is not easy. There are many rules and regulations for various injuries which make it difficult to understand for what injuries you can be compensated and by how much.