Federal Workers' Comp Coverage

If you're a federal worker who's been injured on the job, establishing your right to receive workers' compensation benefits under the Federal Employees Compensation Act can be an intimidating and frustrating process.

But once your claim is approved, you may face yet another challenge: retaining your benefit coverage until your condition improves.

While the system occasionally pays lifetime benefits to workers whose injuries or illnesses are truly permanent and totally disabling, in most cases lifetime benefits are simply not available.

Once there is medical evidence that you're no longer totally disabled and have regained some ability to work, the Office of Workers' Compensation Programs is obliged to either remove you from the compensation rolls or reduce your benefits.

Types of Medical Evidence

In a federal workers' compensation case, there can be three sources of medical evidence that play a key role in decision:

• The injured person's "treating" doctor
• The "second opinion" doctor
• The "referee" doctor.

Initially, you can select any qualified doctor to be your treating doctor - although the law does place some restrictions on the use of chiropractors.

Usually, if your doctor submits medical reports that address workers' comp officials' questions and concerns, no problem will arise unless your employer asks for a second opinion examination.

Second Opinion Exams

The following guidelines apply to second opinion exams:

• The doctor is chosen by the agency and need not be Board-certified in any field of medical expertise (although many are).
• The agency pays all associated expenses and is responsible for forwarding to the second opinion doctor all relevant medical documents, a statement of accepted facts (a "SOAF"), and any specific questions that it wants the doctor to address.
• Under statute, you have the right to bring your own doctor to these exams.
• Any representative you've appointed must receive formal notice of the exam.
• The doctor must submit a written report within 30 days of the exam.
• The doctor is supposed to provide only medical opinions.
• If the initial second opinion report is unclear, the workers' comp office is responsible for following up and requesting a supplemental report.

If the second opinion doctor's report agrees with your treating doctor's opinions, there generally is no problem and FECA compensation payments will continue uninterrupted.

Two Alternatives

If there are conflicting medical opinions, the office can either weigh the medical evidence to determine which doctor's opinion is more accurate or declare a "tie" and seek a third doctor's opinion.

The workers' comp office will usually give more weight to the second opinion doctor's evaluation than to the treating physician's.

If your compensation is modified based on the second opinion, you have the right to appeal.

If the agency decides the conflicting medical opinions are of equal weight and declares a "tie," it will appoint a third doctor, or "referee," to resolve any conflicts in the medical evidence.

The Referee Doctor's Exam

A computer in the workers' comp office selects the referee from a rotation list.

Except in rare circumstances, a referee doctor must be Board-certified in the area of his or her expertise.

The referee doctor is required to perform a physical examination, review medical records and provide a medical opinion within the boundaries of the accepted facts.

The office usually accepts the referee's findings as medically correct.

To maintain your benefits until you are able to work again, help your doctor get adequate and reliable medical information to the workers' comp office, so you can avoid unnecessary medical exams.

Gordon Reiselt has concentrated his practice in the area of federal workers' compensation (world-wide) before the U.S. Department of Labor.

Federal Workers' Comp Message Board for more help