Office of Workers' Compensation Programs: Further Actions Are Needed to Improve Claims Review Page: 4 of 13
This text is part of the collection entitled: Government Accountability Office Reports and was provided to UNT Digital Library by the UNT Libraries Government Documents Department.
Extracted Text
The following text was automatically extracted from the image on this page using optical character recognition software:
by a medical consulting firm contracted by an OWCP district office,
reviews the case, examines the claimant, and provides a report to OWCP.
If the second-opinion physician's reported determination conflicts with the
claimant physician's opinion regarding the injury, the claims examiner
determines if the conflicting opinions are of "equal value."2 If the claims
examiner considers the two conflicting opinions to be of equal value,
OWCP appoints a third or "referee physician" to evaluate the claim and
render an independent medical opinion.
Claims may be approved in full or part, or denied. When all or part of a
claim is denied the claimant has three avenues of recourse for appeal:
(1) an oral hearing or a review of the written record by the Branch of
Hearings and Review (BHR), (2) reconsideration of the claim decision by a
different claims examiner within the district office, or (3) a review of the
claim by the Employees Compensation Appeals Board (ECAB). While
OWCP regulations do not require claimants to exercise these three
methods of appeal in any particular order, certain restrictions apply that, in
effect, encourage claimants to file appeals in a specific sequence-first
going to the BHR, then requesting another review at the OWCP district
office, and finally involving the ECAB.
2 OWCP's procedures manual state that to determine if the medical evidence is of equal
value, each physician's opinion is to be considered against the following factors: (1) whether
the physician involved in the case is a specialist in the appropriate field relevant to the
claimant's injury or illness, (2) whether the physicians' opinions are based upon a complete
and accurate medical and factual history, (3) the nature and extent of findings on
examination of the claimant, (4) whether the physicians' opinions are rationalized, and
(5) whether the physicians' opinions are stated unequivocally and without speculation.GAO-02-725T
Page 3
Upcoming Pages
Here’s what’s next.
Search Inside
This text can be searched. Note: Results may vary based on the legibility of text within the document.
Tools / Downloads
Get a copy of this page or view the extracted text.
Citing and Sharing
Basic information for referencing this web page. We also provide extended guidance on usage rights, references, copying or embedding.
Reference the current page of this Text.
United States. General Accounting Office. Office of Workers' Compensation Programs: Further Actions Are Needed to Improve Claims Review, text, May 9, 2002; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc289981/m1/4/: accessed April 25, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.