Printing - FECA-PT2 - National Association of Letter Carriers

(2) If examination or treatment was obtained from a Federal medical facility or from the
employing agency, it is the OWCP's responsibility to request reports directly from the
physician or hospital involved. Because the OWCP has requested only a report, a prompt
payment form need not be forwarded with the request, as would be necessary if treatment
has been requested. The agency should be advised that if it fails to provide the requested
information, a decision will be made on the basis of available evidence.
(3) Unless the claimant has established a prima facie case, the CE should not
communicate with providers who attended the claimant in a private capacity. Where a
prima facie case has been established, however, the CE may sometimes find it desirable to
request medical evidence directly from a private source.
d. When Medical Opinion is Required.
(1) When the following criteria are satisfied a case may be accepted without a medical
report:
(a) The condition reported is a minor one which can be identified on visual
inspection by a lay person (e.g., burn, laceration, insect sting or animal bite);
(b) The injury was witnessed or reported promptly, and no dispute exists as to
the fact of injury; and
(c) No time was lost from work due to disability.
(2) In clear-cut traumatic injury claims, where the fact of injury is established and is
clearly competent to cause the condition described (for instance, a worker falls from a
scaffold and breaks an arm), no opinion is needed. The physician's affirmative statement is
sufficient to accept the claim.
(3) In all other traumatic injury claims, rationalized medical opinion supporting causal
relationship is required.
(4) In occupational illness claims, a rationalized medical opinion should be provided by
the attending physician. CEs should use discretion, however, where a condition (such as a
ganglion cyst, for example) resulting from only a few days of exposure is involved and the
evidence pertaining to causal relationship is straightforward with respect to the amount of
rationale required.
(5) In any case where a pre-existing condition involving the same part of the body is
present and the issue of causal relationship therefore involves aggravation or precipitation,
the attending physician must provide rationalized medical opinion which differentiates
between the effects of the employment- related injury or disease and the pre-existing
condition. Such evidence will permit the proper kind of acceptance (temporary vs.
permanent aggravation, for instance).
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