Printing - FECA-PT2 - National Association of Letter Carriers

value).
Based on the results of this evaluation, the cost of surgery will be reimbursed or a formal decision
will be issued denying payment for the surgery. Any such decision should address only the surgical
bills, however, including hospitalization expenses, anesthesiologist's fees, etc. Payment of
compensation for disability will not be affected by the decision to deny payment for surgery, and
continuing medical care after discharge from the hospital should be authorized just as it would
have been if surgery had not been at issue.
g. If the claim has not been adjudicated when authorization for surgery is requested, the CE
will advise the claimant and the attending physician that the Office cannot consider a request for
surgery before the case is adjudicated but that the request will be evaluated retroactively if the
case is accepted. The procedure described in the preceding paragraph will be applied in making
such determinations.
h. Where the claimant requests exemption from the requirement that he or she undergo a
second opinion examination because of severe pain or inability to travel great distances, the CE
should confer with the RN, if one is involved in the case, and permit the claimant to forego the
second opinion examination if the objection is deemed reasonable. The discussion with the RN
should be documented by memorandum to the file.
If no RN is involved, the CE should require the claimant to arrange for submission of a report from
the attending doctor to substantiate such a claim. The CE should send this documentation to the
DMA and ask him or her to give an opinion on the reasonableness of the request for exemption. If
an exemption is granted, the CE will so advise the claimant and the attending doctor in writing.
2-0810-11 Referee Specialist Examinations
11. Referee Specialist Examinations. This paragraph describes how and when the CE should obtain an
examination from a referee specialist.
a. Careful analysis of the medical evidence should allow for resolution of most issues without
resorting to a referee or "impartial" specialist. However, where the analysis of the evidence
demonstrates conflicting opinions or conclusions which are supported almost equally, the services
of a referee specialist must be utilized.
FECA-PT2 Printed: 06/08/2010 339