Sample Letter to Claimant Regarding Second Opinion/Referee Physician

 

 

 

Dear Claimant:

 

This letter is in reference to your claim under the Energy Employees Occupational Illness Compensation Program Act (EEOICPA).

 

Under our regulations, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) has the authority to refer an employee for a physical examination by a second opinion physician when it considers such a referral to be reasonably necessary.

 

Because it considers such a referral to be reasonably necessary for the proper adjudication of your claim, DEEOIC has arranged for you to be examined by a second opinion physician.  Please review the attached letter for the time, date, and location of your scheduled appointment.  DEEOIC will pay the out-of-pocket costs you incur in connection with the examination or any diagnostic testing.  Travel costs to attend the examination are reimbursable upon submission of Form OWCP-957 (Attached).

 

DEEOIC recommends that you call QTC Medical Services ahead of time, at the number provided in the attached QTC Appointment Notification Letter, to confirm the appointment.  Ensuring that you provide QTC Medical Services with your name, file number, and any contact information when you call will make the process run as smoothly as possible. 

 

Rescheduling the appointment is strongly discouraged and you should only do so in emergencies.  Altering an appointment schedule can hinder our ability to take substantive action on your claim and promptly deliver services to you.  If you are unavoidably prevented from keeping your appointment, you must immediately call your assigned claims examiner at the district office at XXX-XXX-XXXX.  DEEOIC will evaluate any request to reschedule your appointment.

 

If you do not attend the scheduled appointment, or cannot establish good cause for your failure to appear, DEEOIC will suspend claim adjudication and administratively close your claim.  Reopening of the claim record will not occur until you agree to and attend a DEEOIC scheduled medical examination. 

 

Should someone accompanying you disrupt the scheduled medical examination, DEEOIC will reschedule the exam with a different qualified physician.  You will not be entitled to have anyone else present at the subsequent examination unless DEEOIC determines that exceptional circumstances exist.

 

We appreciate your cooperation in this matter.  If you have any questions regarding the scheduled examination, please contact me at the address listed above or call XXX-XXX-XXXX. 

 

Sincerely,

 

 

 

 

Claims Examiner