Printing - FECA-PT2 - National Association of Letter Carriers

2-0810-18 Transfer of Medical Care
18. Transfer of Medical Care. This paragraph addresses the circumstances under which the CE may
consider transfer of care from one attending physician to another.
a. Section 5 U.S.C. 8103(a) states in part that:
The employee may initially select a physician to provide medical services, appliances, and
supplies, in accordance with such regulations and instructions as the Secretary considers
necessary....
This initial choice must always be honored. Under limited circumstances, however, the Office may
consider transfer of care.
b. Reasons based on OWCP's regulations necessarily include any situation where a provider is
excluded from payment under the FECA because he or she:
(1) Failed, neglected or refused on three or more occasions during a twelve month
period, to submit full and accurate medical reports, or to respond to requests by the Office
for additional reports or information, as required by the Act at 10.410 of this part [20
C.F.R. 10.450 (f)].
(2) Knowingly furnished treatment, services or supplies which are substantially in excess
of the claimant's needs, or of a quality which fails to meet professionally recognized
standards [20 C.F.R. 10.450 (g)].
Well-documented instances of such occurrences should be brought to the attention of the District
Director, who may at his or her discretion issue a warning letter to the physician (see Exhibit 7). A
copy of this letter should be furnished to the Regional Director.
c. Other reasons include the physician's refusal to provide a treatment plan. Such a plan
should be provided within 30 days of the request from the CE or the RN. Only the complete
absence of a plan will justify an attempt to transfer care. A plan that is considered inadequate may
still serve as the basis for further dialogue with the physician, or for referral for second opinion
examination. However, making such a referral to obtain a treatment plan is not usually a viable
option, since the original attending physician cannot be required to follow it.
If the physician refuses to provide a plan, or initially states that one will be forthcoming but then
fails to provide it, the CE (or Staff RN, at the CE's direction) should advise the physician that the
Office will transfer the claimant's care absent submission of a plan within 30 days. The file must be
documented to this effect before the CE or RN contacts the claimant to advise that care must be
transferred. The claimant will be allowed to choose another physician without guidance from the
Office, but at the claimant's request, the Office will prepare a list of three physicians specializing in
the appropriate field of medicine so that the claimant may choose among them.
2-0810-19 Claimants in Prison
19. Claimants in Prison. Incarcerated persons do not lose entitlement to medical treatment for
FECA-PT2 Printed: 06/08/2010 351