Guide · Updated
Why does OWCP want a second opinion?
OWCP orders a second opinion exam when it needs more medical evidence to decide your claim, such as whether your injury is work related or how much you can work. Federal law requires you to attend. OWCP pays the doctor, and if that doctor disagrees with yours, a third referee doctor may break the tie.
Getting a letter from OWCP that schedules you with a doctor you have never met can feel unsettling. Many injured federal workers wonder if it means OWCP doubts them. Usually it simply means the claims examiner needs more medical information before making a decision. Here is what a second opinion exam is, why it happens, and how to prepare.
What a second opinion exam is
A second opinion exam is a medical exam that OWCP sets up with a doctor it chooses. That doctor reviews your file, examines you, and answers questions OWCP sends, such as:
- Is the condition caused or made worse by your federal job?
- Are you still disabled, partly or fully?
- What work restrictions do you need?
- Is more treatment, such as surgery or therapy, medically needed?
The legal basis is 5 U.S.C. 8123, which says an injured employee must submit to an exam by a physician the Secretary of Labor designates or approves. The rule that carries it out is 20 CFR 10.320. It lets OWCP require exams as often, and at the times and places, that it considers reasonably necessary.
Why OWCP asks for one
OWCP decides claims on the weight of the medical evidence. A second opinion is common when:
- Your doctor’s reports are short or do not explain how work caused the condition.
- Your claim has been open a long time and OWCP wants a current picture.
- OWCP is deciding whether you can return to work or need ongoing wage-loss benefits.
- A surgery or other major treatment request needs support.
Strong, well-reasoned reports from your treating physician can reduce the chance of confusion. That is why a clear CA-20 attending physician’s report and detailed progress notes matter so much.
What happens if the two doctors disagree
Sometimes your doctor and the second opinion doctor reach opposite conclusions. Under 20 CFR 10.321, a true conflict exists when two reports of “virtually equal weight and rationale” disagree. When that happens, OWCP must appoint a third doctor to do a referee exam, sometimes called an impartial medical exam.
The referee doctor must be a specialist in the right field and must have had no prior connection with your case. If one report is clearly better reasoned than the other, OWCP may simply rely on that report instead of sending you to a referee.
Who pays, and what you can bring
You do not pay for the second opinion or referee doctor. Under 20 CFR 10.322, OWCP pays those specialists directly. OWCP also reimburses necessary and reasonable expenses for the exam, including travel, and can repay wages you lose to attend.
You may bring a doctor of your own choosing to observe, but you pay that doctor. Other people are generally not allowed in the room unless OWCP finds exceptional circumstances. One example is an interpreter for a worker who is hearing impaired.
What happens if you miss the exam
Do not skip it. Federal law says that if you refuse or obstruct a required exam, your right to compensation is suspended until you comply. Under 20 CFR 10.323, if you miss the exam you have 14 days to give OWCP an explanation. If OWCP finds you did not have good cause, benefits are suspended until you attend.
If you cannot make the date because of a real conflict, such as another medical procedure, contact OWCP right away and ask to reschedule. Keep a copy of what you send.
How to prepare
A little planning helps you get a fair, complete exam:
- Read the letter carefully. Note the date, time, address, and doctor’s name.
- Bring a list of your symptoms, medicines, and what tasks are hard for you.
- Be honest and specific. Do not downplay or exaggerate your pain. Describe what a normal day looks like.
- Take notes afterward. Write down how long the exam lasted and what was tested.
- Ask for a copy of the report. It becomes part of your claim file.
- Share it with your treating physician. Your doctor can respond in writing if they disagree, with medical reasons.
If the decision goes against you
If OWCP relies on the second opinion or referee report to deny or reduce benefits, you have appeal rights. You can ask for reconsideration, a hearing, or a review by the Employees’ Compensation Appeals Board. Each has its own deadline. Our guide to the federal workers’ comp appeals process walks through all three.
How Alivio can help
At Alivio Health & Rehab, our OWCP doctors document your condition clearly so your file tells the full story, and Dr. Peter Ruiz, MD, reviews and signs FECA medical reports. We are enrolled with OWCP, bill the Department of Labor directly, and offer free help with OWCP forms. Call (956) 679-3451 for a free consultation at our McAllen or Harlingen clinic.
Quick answers
Can I bring my own doctor to an OWCP second opinion exam?
Yes. Federal law lets you have a physician of your choice present, but you pay that doctor yourself. Other people, such as family members, generally cannot attend unless OWCP finds exceptional circumstances, like needing an interpreter.
Does a second opinion exam change who my treating doctor is?
No. The second opinion doctor examines you and writes a report for OWCP. They do not take over your care. Your own treating physician keeps treating you and can respond to the report with a reasoned medical opinion.
Will OWCP pay my mileage to the exam?
Yes. OWCP reimburses necessary and reasonable expenses for an exam it requires, including transportation. It can also repay wages you lose to attend. Keep a record of your miles and any receipts.
Sources
Medically reviewed by Peter Ruiz, MD, Medical Director. MD · Family Medicine · Texas Medical Board license N2270
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