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Printing - FECA-PT2 - National Association of Letter Carriers

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2-0810-9 Second Opinion Examinations<br />

9. Second Opinion Examinations. The purpose <strong>of</strong> this paragraph is to describe when and how the CE<br />

should request a second opinion examination.<br />

a. A second opinion examination may be recommended by an RN, or the decision to make<br />

such referral may originate with the CE, whether or not an RN is involved. A second opinion<br />

specialist should be selected who is administratively qualified as discussed in <strong>FECA</strong> PM Chapter<br />

3-500.3.<br />

The specialist should be provided with a SOAF, copies <strong>of</strong> all medical reports from the case record,<br />

and a blank Form OWCP-5. The physician should also be given a numbered "Prompt Pay" billing<br />

form (Form HCFA-1500/OWCP-1500a) which includes the CPT-4 code for the service requested.<br />

The codes for requested services are:<br />

Case review without exam: CNSLT<br />

Independent consultant exam<br />

(second opinion):<br />

SECOP<br />

Referee medical exam or<br />

case review to resolve conflict: IMPAR<br />

b. A physician who performed a fitness for duty examination <strong>of</strong> the claimant for the employing<br />

agency may not be considered a second opinion specialist for purposes <strong>of</strong> creating a conflict in<br />

medical evidence or for reducing or terminating benefits based on the weight <strong>of</strong> medical evidence.<br />

A report from such a physician must receive due consideration, however, and if its findings or<br />

conclusions differ materially from those <strong>of</strong> the treating physician, the CE should make an<br />

immediate second opinion referral.<br />

c. The second opinion examination should constitute a complete evaluation <strong>of</strong> the claimant.<br />

The specialist should be asked to submit a report which includes: history <strong>of</strong> injury, description <strong>of</strong><br />

objective findings, the claimant's subjective complaints, the results <strong>of</strong> X-rays and other tests,<br />

identification <strong>of</strong> any underlying or preexisting condition(s), diagnosis, prognosis, the recommended<br />

course <strong>of</strong> treatment to be followed, any medically warranted restrictions or limitations (using Form<br />

OWCP-5) and the condition(s) causing the restrictions, and a clinical estimate <strong>of</strong> the date <strong>of</strong> partial<br />

and/or full recovery.<br />

d. If the case has not yet been accepted and causal relationship is at issue, the specialist<br />

should be asked for an opinion with medical rationale confirming or negating a causal relationship<br />

between any condition found and the accepted incident or accepted factors <strong>of</strong> employment,<br />

referring to the SOAF. This opinion should be requested in addition to the information required in<br />

paragraph 9b, above.<br />

<strong>FECA</strong>-<strong>PT2</strong> Printed: 06/08/2010 334

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