Second Opinion Examinations Ordered by OWCP

This article will explain what SECOPS are and how claimants and their physicians should approach them. The FECA grants OWCP the authority to order an examination of an injured employee as frequently, and at the times and places, as may be reasonable required. SECOPs (second opinion examinations) may occur whenever OWCP determines that the case record contains insufficient medical evidence to answer questions that arise during the life of the claim. SECOPS are used to:

• Verify the casual relationship of work factors to the diagnosed condition in the early stages of the claim.

• Resolve issues regarding the course of treatment.

• Clarify work restrictions.

• Determine if the injured employee still suffers residuals of the accepted injury.

• Address the medical facts involved in a request to expand a claim.

• Determine if a pre-existing has been permanently or temporarily aggravated.

An injured employee cannot opt out of a SECOP. A refusal to participate in the SECOP could result in suspension of compensation unless the employee establishes good cause for their failure to attend. The employee also has certain rights associated with SECOPs. They may have a qualified physician of their choice present at the examination (at the employee’s expense). OWCP will also reimburse the employee all reasonable expenses associated with the examination, including lost wages and transportation costs.

OWCP has great flexibility in selecting physicians to conduct SECOPs. OWCP generally selects a physician from a medical referral group that it has contracted with to provide second opinion referrals.

Problems may arise for claimants when a SECOP disagrees with or supplants an attending physician’s opinion. How OWCP weighs the SECOP against the attending physician’s opinion depends on several factors. OWCP might grant greater weight to the opinion of the SECOP physician if they are a board-certified specialist in the appropriate field and the attending physician is a general practitioner. If both physicians are board certified, OWCP would give greater weight to the opinion that is based on a more comprehensive examination or to the opinion that is unequivocal.

Because you can face a SECOP at any time during the course of your claim, it is vital that the medical development in your claim be done from the outset by your physician rather than leaving it in the hands of a SECOP physician who has much less understanding of your medical history and condition.

It can never be stressed enough that your physician should conduct thorough examinations and document objective clinical findings that support his or her opinions. In cases that may involve a conflict over whether work factors caused the diagnosed condition, they should provide a well-rationalized opinion that explains the physiological mechanism or pathological process by which work factors caused the injury.

If OWCP determines that the SECOP and the opinion of the attending physician have equal weight, it will decide that a conflict exists that will require an IME (Impartial Medical Exam) or referee opinion to resolve the conflict.

Next month’s article will discuss the IMEs (or referee opinion doctors) process.

Be safe and keep smiling.