Understand Why OWCP Is Sending You to the Examination
Second Opinion
OWCP may obtain a second-opinion evaluation when it needs additional medical information about an issue such as diagnosis, causal relationship, treatment, disability, work capacity, or continuing effects of an accepted condition.
- It does not require a pre-existing conflict in medical opinion.
- OWCP prepares the referral questions and factual background.
- The specialist is expected to provide a complete, rationalized response to the questions posed.
- The claims examiner weighs the report against the other medical evidence of record.
Referee Examination / IME
A referee examination is used when the employee's physician and an OWCP-designated physician have opposing medical opinions of approximately equal weight and rationale on a particular issue.
- The referee is the third physician contemplated by 5 U.S.C. § 8123(a).
- OWCP selects an appropriate specialist with no prior connection to the case.
- Selection is made under OWCP's strict rotational process.
- A sufficiently rationalized impartial opinion normally receives special weight on the issue of conflict.
The Referee Stage Should Not Be Automatic
OWCP's Procedure Manual says a claims examiner must first weigh the opposing reports. A true conflict exists when reports of virtually equal weight and rationale reach opposing conclusions.
A Conflict Is About an Issue—not the Entire Case
OWCP's manual emphasizes that a referee examination is arranged to resolve specified medical issue(s). The fact that a physician is serving as the impartial specialist does not automatically give every opinion the physician expresses special weight on unrelated issues.
What the Claimant Should Expect
OWCP-directed examination notices contain important procedural information. Ignoring the appointment can have serious consequences.
Physician, Date & Time
OWCP provides the referral physician's information and the scheduled examination details.
Why the Exam Is Being Ordered
For an impartial examination, the claimant should be notified that a conflict exists and told the specific nature of that conflict.
Failure to Report
FECA § 8123(d) permits suspension of compensation when an employee refuses or obstructs a required examination, subject to the governing procedure.
Travel & Necessary Expenses
FECA provides for payment of necessary and reasonable expenses incident to an examination required by the Secretary, when authorized or approved.
Your Physician May Participate
For a second-opinion examination, § 8123(a) permits the employee to have a physician designated and paid by the employee present to participate in the examination.
Different Attendance Rule
DOL states the statutory right to have the employee's own physician participate does not apply to a referee examination. Other attendance generally requires exceptional circumstances approved by OWCP.
The Medical Opinion Must Start From the Correct Facts
For these referrals, OWCP uses a Statement of Accepted Facts (SOAF) and specific questions identifying the medical issues to be addressed. For a referee examination, the physician receives the entire case record and the referral identifies the conflict that must be resolved.
MEDICAL EVIDENCE CENTER“Special Weight” Is Earned by a Proper Impartial Opinion
A properly selected impartial specialist does not win merely because of the title “referee.” The report must actually resolve the medical conflict, be based on an accurate factual and medical background, and provide sufficient medical reasoning.
Proper Selection
The physician should be qualified in the appropriate specialty, have no prior connection with the case, and be selected through OWCP's impartial rotation process.
Responsive Opinion
The report should address the actual issue in conflict rather than avoiding or changing the question OWCP referred.
Medical Reasoning
DOL and ECAB authorities repeatedly emphasize that the impartial conclusion must be sufficiently well rationalized and based on a proper background to receive special weight.
Why the Treating Physician's Report Matters Before the IME
A vague or poorly supported attending-physician report may simply be outweighed by a better-reasoned second opinion rather than creating an equal conflict requiring a referee. The medical record is strongest when the treating physician has already documented an accurate history, objective findings, diagnosis, medical mechanism, causation, disability or restrictions, and the reasoning connecting those elements.
OWCP Weighs the Result
Second Opinion Persuades
If one medical opinion has greater probative value, OWCP may rely on that opinion without finding a true conflict.
DECISIONS & APPEALSA True Conflict Exists
If the employee's physician and OWCP-designated physician are equally well reasoned but reach opposing conclusions, OWCP should refer the issue to an impartial specialist.
Referee Resolves Conflict
If the impartial report is complete, rationalized, and based on the proper factual background, it normally becomes the weight of the medical evidence on the issue referred.