How Our Office Handles the Medical Side
How Our Office Handles the Medical Side
Why this page exists
Because the medical care is only half of what an LHWCA claim needs. The other half is documentation, and it's where most claims run into trouble. Reports arrive late. Restrictions are too vague to staff around. Authorization requests get denied because they don't say why the treatment is necessary.
​
None of that is a medical problem. It's an administrative one, and it's fixable.
What we do, specifically
We file the initial report within the deadline. Ten days from first treatment, to OWCP with a copy to the employer or carrier, with charges submitted on a standard billing form.
​
We keep supplementary reports current. Filed regularly on the LS-204 or in narrative form while you're under our care, so nobody has an excuse to pause your benefits for lack of documentation.
​
We write authorization requests that get approved. What's being requested, why it's medically necessary, and how it connects to the injury. Vague requests get denied; specific ones usually don't.
​
We state causation explicitly. Whether the workplace event or exposure caused the condition, said plainly in the report rather than left for someone else to infer.
​
We separate subjective from objective. What you report and what we find on examination and imaging, clearly distinguished.
​
We write restrictions in job language. Pounds, heights, reaches, durations. Not "light duty."
​
We answer within 24 hours. Work status requests, records requests, questions from adjusters, case managers, and attorneys.
​
We bill correctly. Standard CMS-1500 to the employer's carrier or the self-insured employer, with the documentation attached that the claim requires.
What we don't do
We don't give legal advice, and we don't tell you whether your claim will be accepted. Those aren't medical questions and anyone who answers them from a clinic is guessing.
​
We also don't decide your coverage. That's between you, your employer, the carrier, and the Department of Labor. What we control is whether the medical record is complete, accurate, and on time. That's what we're accountable for.
Two clinics, one program
Torrance covers the Los Angeles and Long Beach port complex. The terminals, San Pedro, Wilmington, Carson, Harbor City, and the South Bay. San Diego covers the San Diego waterfront, the shipyards, and the ship repair facilities. Same standards at both.
Where the AMA Guides come in
The Act doesn't apply the AMA Guides to the Evaluation of Permanent Impairment uniformly to every claim. DOL identifies them specifically for permanent partial disability in cases of occupational disease diagnosed after retirement, where the rating is based on a percentage of impairment determined under the Guides. Hearing loss claims also have their own evaluation rules.
​
Practically, ratings are often prepared with reference to the Guides. If a rating matters in your case, that's a conversation to have with your physician and, if you have one, your attorney.
Have questions about your claim or need a medical evaluation?