November 28, 2007 – For some injured workers returning from Iraq, seeking disability compensation through insurance companies is a battle they did not anticipate.
They are employees of the private contractors commissioned by the U.S. government to provide such services as driving trucks, rebuilding clinics and other essential services, including security.
While not all of them are in the line of fire, they are often exposed to the same perils as their military counterparts such as rocket attacks, roadside bombs and convey ambushes,
Claims filed under the federal law providing that injured workers be compensated have risen from 804 in 2003 to 5,749 last year. Officials predict more than 14,000 such claims will be filed this year, primarily from Iraq and Afghanistan. In addition, more than 1,000 civilians have been reported killed in Iraq.
More than 180,000 civilians — including Americans, foreigners and Iraqis — are working in Iraq under U.S. contracts, according to government figures obtained by the Los Angeles Times.
Companies with federal contracts for work overseas are required to provide medical benefits to their employees while on the job. However, upon leaving Iraq or Afghanistan, many of the civilians who still need medical care are getting caught up in a legal process that they find tedious and complicated because contractors’ insurers increasingly dispute claims.
One area of the workers’ compensation claim process that is not well known is that when an employee is injured on the job, the employee must prove that he/she is entitled to and is eligible to receive workers’ compensation benefits. Since the initial burden of proof of eligibility is on the injured worker, an experienced workers’ compensation attorney can provide extensive assistance in compiling the necessary information at the very beginning of the claim process and making timely submittals. You can check more info here about the Workers Compensation Attorney New Jersey.
At issue is the Defense Base Act, a form of workers’ compensation created during World War II to insure workers at remote bases. It requires that federal contractors provide temporary and permanent disability compensation, up to two-thirds of an employee’s average weekly earnings, and compensation for loss of earnings.
However, seeking compensation is not always a straightforward process because claims are sometimes disputed by the contractors’ insurance carriers. Workers must file a claim with the Office of Worker’s Compensation Program, the agency that oversees the law, and the final settlement can take a couple of weeks to several years. You can click reference for more about the worker compensation attorney.
AIG, one of three major insurance companies authorized to offer DBA policies, said it has no incentive to contest claims and more than 90 percent are paid without dispute.
Kiley Law Group Personal Injury Attorneys massachusetts, who represents injured workers, said delays occur in part because of insurance companies’ insistence on second opinions, authorization of medical treatment and diagnostic procedures.
“Conflicts arise over the extent to which the job has caused the injury,” he said. “There are opinions that have to be evaluated,” especially with post-traumatic stress disorder diagnoses.
The civilian workers, unlike wounded veterans, don’t have a support structure when they return home and are on their own to understand the process and find attorneys to pursue their claims, said Jana Crowder, who runs a support Web site called americancontractorsiniraq.com.
“That’s the sad part about it — when you have somebody injured and they are asking a Web site for help,” Crowder said. “They don’t realize that they have one year to file their claims or that they are entitled to an Fielding Law attorney and the right to choose their own doctor.”
Art Faust of Porter, Texas, had spent 14 months at a camp near Baghdad driving trucks before returning home at the end of 2005. Faust was having problems readjusting, plagued by scenes from his time in Iraq, including a convoy ambush that resulted in three deaths. He said that he was suffering from post-traumatic stress disorder, an anxiety disorder than can develop after exposure to terrifying events or ordeals.
His employer, KBR Inc., the leading private contracting firm in Iraq, arranged eight visits with a psychologist who Faust claimed was young and inexperienced. He tried contacting KBR a couple of more times after, to no avail. He wasn’t given a contact at AIG, the insurance carrier for KBR.
“The process is just tiring and time-consuming,” said Faust. “They make it so complicated and just give you the run-around.”
He contacted Houston attorney Gary Pitts, who specializes in DBA law, after AIG declined his claim, he said. Eventually, Pitts requested referral of the claim to the Office of Administrative Law Judges for a formal hearing.
“Civilian contractors don’t have a VA (Veterans Affairs Department) or military health care system,” said Pitts. “They have to figure it out for themselves. There is no association or union representing them.” Pitts has represented nearly 300 employees of companies with contracts in Iraq and Afghanistan. He said that most of his clients with disputed claims were diagnosed with PTSD.
Faust found another therapist at a cost of more than $3,000.
Some DBA lawyers argued that insurance companies are just doing their job when they take the time to investigate claims. “That’s the insurance business,” commented David Barnett, an attorney in Dania Beach, Fla., whose firm has represented about 200 workers. “They are entitled to determine a causal relationship.”
However, Barnett acknowledged that because workers require authorization from their insurance carrier prior to seeing a doctor, the process for disputing a claim is thorny.
“There often becomes a catch-22 in the system,” said Barnett. “Without authorization being extended from the insurance company, injured workers typically cannot secure, on their own, the medical care and documentation needed in order to get their compensation started. They just don’t have the resources to obtain that.”
Defense Base Act: In a nutshell
What is the Defense Base Act?
The act provides disability compensation and medical benefits to employees and death benefits to eligible survivors of U.S. government contractors who work overseas.
American civilians and foreign nationals working for companies under contract to the federal government are eligible. The major federal agencies are the Defense Department, State Department and USAID. AIG, CNA and ACE are the three major insurance companies authorized by the Office of Workers’ Compensation Programs to offer DBA policies.
What are the benefits?
Compensation for total disability is two-thirds of the employee’s average weekly earnings, up to a maximum of $1,114.44 per week. Death benefits are paid at the rate of one-half of weekly earnings to a surviving spouse or one child, or two-thirds of average weekly earnings for two or more eligible survivors up to a maximum rate of $1,114.44 per week.
What are the procedures to obtain medical treatment?
If medical treatment is required for the work-related injury, the employer should be notified in order to authorize treatment.
What are the procedures to obtain compensation for disability?
If disabled for more than three days, the employer or insurance company must be contacted. The worker must submit a written notice using form LS-201 to the employer within 30 days.
A written claim for compensation must be also be filed with the OWCP district office using Form LS-203 within one year of the injury or last payment of compensation, whichever is later.
How do claims get resolved?
When a claim is challenged by the insurance company, the OWCP claims examiners conduct informal conferences to help the parties resolve their disputes by way of mutual agreement or compromise without formal litigation. When unable to resolve informally, they may request the referral of the claim to the Office of Administrative Law Judges for formal hearing. Their decisions are appealable to the Benefits Review Board and thereafter to the District Court or to the Court of Appeals.