Printing - FECA-PT2 - National Association of Letter Carriers

2-0811 Exhibit 1: Sample Letter to Claimant Describing Need for Referee Examination and
Entitlement to Compensation
Dear CLAIMANT NAME:
I am writing in reference to your claim for compensation due to injury on 01/01/01 while employed by the
agency identified below.
Because a conflict in the medical evidence in your case has been identified, a referee examination at the
expense of the Office of Workers' Compensation Programs will shortly be arranged. The conflict has
occurred for the following reason: although your physician, Dr. X, states that you continue to be disabled
for your regular duties because of your work-related injury, Dr. Y, who performed a second opinion
evaluation on 02/02/02, states that no objective findings are present.
You have received compensation through 03/03/03. You are entitled to claim compensation through the
date of receipt of the referee specialist's report. To claim compensation, you should submit the enclosed
Form CA-8 [Or: Based on the claim you have already submitted, you will shortly begin receiving
compensation benefits each 28 days] [Or: Based on the claim you have already submitted, you will
receive compensation benefits from 04/04/04 to 05/05/05]. When the report of the referee specialist is
received, we will determine whether you are entitled to any further compensation and advise you of the
status of your claim.
If you have any questions, I can be reached at the address and telephone number noted above.
Sincerely,
CLAIMS EXAMINER
cc: Employing Agency
FECA-PT2 Printed: 06/08/2010 374