Printing - FECA-PT2 - National Association of Letter Carriers

(3) The opinions of the attending physician and the "second opinion" physician (both
Board-certified specialists) differ on an issue such as causal relationship or the nature and
extent of work limitations. However, the opinion of one physician is speculative, equivocal
and/or unrationalized while the opinion of the other physician is supported by objective
findings and is fully rationalized. The opinion of the first physician would be of diminished
probative value and would be of lesser weight than that of the second physician.
2-0810-10 Obtaining Second Opinions for Surgery
10. Obtaining Second Opinions for Surgery. This paragraph describes the steps required when surgery
is requested.
a. Emergency surgery may be defined as any procedure which needs to be performed
promptly after the onset of a condition or injury in order to preserve life or function of an organ or
body part. Elective (or non-emergency) surgery may be defined as any procedure which is
necessary for the adequate or normal function of an organ or body part, but which does not need
to be performed promptly after the onset of the condition in order to achieve its purpose.
b. For emergency surgery, no prior authorization by the Office is required. However, prior
authorization is required for all elective surgery. When requesting authorization, the following
minimum documentation must be submitted from the attending physician: the name of the
surgical procedure; diagnosis of the specific condition(s) which will be treated by the surgery; the
type of surgery (emergency or elective); and the reason surgery is needed. Any ambiguity or
omission in an attending physician's request for surgery should be resolved by telephone if
possible, or by the RN if one is involved in the case. The individual making the call should prepare
a detailed summary of any telephone conversation for the case record.
c. When authorization is requested for certain types of elective surgery, the CE must obtain a
second medical opinion concerning the need for the procedure. The elective surgical procedures
involved are: spinal surgery, organ transplants, and destructive procedures (i.e., chordotomy,
rhizotomy, or amputation of a body part).
d. In cases involving spinal surgery the CE will obtain the minimum documentation described
in paragraph 10b, and send the case file to the medical unit for referral to an Office consultant who
will evaluate the request for surgery on the basis of the written record. The consultant will be
advised that his or her report may be made available to the claimant and the attending doctor.
FECA-PT2 Printed: 06/08/2010 336