
Why is a Diagnosis Expansion Important?
When your OWCP claim is already approved for the initial accepted conditions, but a more severe medical condition has been diagnosed based on objective medical testing (MRI, X-Rays, etc), you must pursue a diagnosis expansion. Your accepted conditions determine the type of medical treatment OWCP is willing to approve, which includes therapies, medicines, and surgery. OWCP will deny further medical treatment if your “accepted conditions” do not allow for the medical treatment your doctor is requesting.
How do you get an expansion? Your doctor will need to write a medical report requesting the expansion of the claim to include the newly diagnosed injuries. Your doctor will have to explain how and why this new diagnosis should be a part of your approval and that is submitted to OWCP for consideration.
A typical injury scenario is when an employee is injured and seeks initial treatment. The initial hospital diagnosis or their doctor is strain or sprain of a muscle. The initial diagnosis usually is not based on the results of specialized medical tests like MRIs, CT Scans, etc. Medically speaking, strains and sprains generally heal without surgery and maybe some physical therapy. Strains and Sprains rarely require surgery.
MRIs and other diagnostic testing often reveal more severe injuries like disk herniations, ligament or cartilage damage, or carpal tunnel syndrome. If you have been diagnosed with a more severe injury than your original accepted condition, you must request your doctor to expand the claim.
Once the claim is expanded, you will be entitled to further treatments (surgeries, therapies, etc) that are utilized to treat the more severe injury. In addition to helping you get the proper treatment; it also assists the medical provider’s office in requesting the treatments and getting compensated for services. You should make sure that OWCP sends you a letter with the expanded accepted injuries.
Expansions are also needed in cases where multiple injured body parts occur, but not all of them are included in your initial approved conditions. If you are involved in a serious incident and multiple body parts are injured, you must make sure that all body parts injured are listed in your initial accepted conditions. If your injury involves your hand and your foot, make sure that both are listed in your initial acceptance letter. If it both body parts are not listed, you must get your doctor to request an expansion.