Printing - FECA-PT2 - National Association of Letter Carriers

(5) If the specialist concludes that surgery is not warranted, the CE will issue a formal
decision denying authorization for the surgery, explaining the basis for denial and providing
a copy of the specialist's report. In the latter situation, it is anticipated that the weight of
the medical evidence will rest with the Office consultant and the second opinion doctor,
since both are specialists who have reviewed the medical records and one will have
examined the claimant as well.
(6) Even if payment for surgery is denied, compensation for disability resulting from the
surgery is payable in cases where the claimant was disabled for work prior to the surgery.
Such payment may be made regardless of any indications that the period of disability would
have been shorter without surgery. In addition, continuing medical care after discharge
from the hospital should be authorized just as it would have been if surgery had not been at
issue.
e. In cases involving destructive procedures or organ transplants, the MMA will arrange for a
panel of physicians in the appropriate specialty to evaluate the request for surgery.
(1) After obtaining the minimum documentation required (as described in paragraph 10b
above), the CE will refer the case file to the medical unit for referral to the panel. In some
instances, evaluation of the case file alone may be preferable, and this is acceptable. When
the claimant is to be examined, the usual procedures for notifying him or her of the second
opinion examination and forwarding a copy of the file to the panel will be followed. The
panel will be advised that a copy of the report will be furnished to the claimant and the
attending doctor.
(2) If the panel agrees that surgery is warranted, the CE will authorize it.
(3) If the panel concludes that surgery is not warranted, the CE will issue a formal
decision denying authorization for the surgery, explaining the basis for denial and providing
a copy of the panel's report. In the latter situation, it is anticipated that the weight of the
medical evidence will rest with the panel physicians, since they are medical specialists who
have reviewed the medical records and in most cases have also examined the claimant.
(4) Even if payment for surgery is denied, compensation for disability resulting from the
surgery is payable in cases where the claimant was disabled for work during the period
immediately prior to the surgery. Such payment may be made regardless of any indications
that the period of disability would have been shorter without surgery. Additionally,
continuing medical care after discharge from the hospital should be authorized just as it
would have been if surgery had not been at issue.
f. Where the claimant fails to request prior authorization for surgery, the CE will instruct the
claimant to submit the minimum documentation (described in paragraph 10b above) from the
attending doctor, as well as a copy of the operative report. The CE will then refer the case file to
the medical unit, which will arrange for evaluation of the written record by an Office consultant.
Should the consultant conclude that surgery was unnecessary, a referee examination of the case
file only will be arranged. (A second opinion examination should not be requested under these
circumstances since "hands on" evaluation after the surgery was performed would have limited
FECA-PT2 Printed: 06/08/2010 338