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Code of Federal Regulations Pertaining to ESA |
| Employees' Benefits |
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| Office of Workers' Compensation Programs, Department of Labor |
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| Claims for Compensation Under the Federal Employees' Compensation Act, As Amended |
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| Medical and Related Benefits |
20 CFR 10.321 - What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee?
- Section Number: 10.321
- Section Name: What happens if the opinion of the physician selected by OWCP differs from the opinion of the physician selected by the employee?
(a) If one medical opinion holds more probative value, OWCP will
base its determination of entitlement on that medical conclusion (see
Sec. 10.502). A difference in medical opinion sufficient to be
considered a conflict occurs when two reports of virtually equal weight
and rationale reach opposing conclusions (see James P. Roberts, 31 ECAB
1010 (1980)).
(b) If a conflict exists between the medical opinion of the
employee's physician and the medical opinion of either a second opinion
physician or an OWCP medical adviser or consultant, OWCP shall appoint a
third physician to make an examination (see Sec. 10.502). This is called
a referee examination. OWCP will select a physician who is qualified in
the appropriate specialty and who has had no prior connection with the
case. The employee is not entitled to have anyone present at the
examination unless OWCP decides that exceptional circumstances exist.
For example, where a hearing-impaired employee needs an interpreter, the
presence of an interpreter would be allowed. Also, a case file may be
sent for referee medical review where there is no need for an actual
examination, or where the employee is deceased.
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