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Federal Workers' Compensation

The Office of Workers' Compensation Programs administers four major disability compensation programs which provide wage replacement benefits, medical treatment, vocational rehabilitation and other benefits to certain workers or their dependents who experience work-related injury or occupational disease.

Here is a forum for members to share and exchange experiences regarding to workers' compensation related issues.

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Scott O'Donnell  
#1 Posted : Monday, August 5, 2019 5:35:40 PM(UTC)
Scott O'Donnell

Rank: Newbie

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Joined: 7/30/2019(UTC)
Posts: 1
United States
Location: Sebastian, FL

The DMA at OWCP opined that my proposed spinal fusion surgery is "medically unnecessary" because there is no evidence of spinal instability.

My doctor prepared a narrative giving his explanation as to why he thinks it is necessary (cost me $600 for a one page document, BTW - hopefully I will get reimbursed by OWCP).

Then they sent me for a Second Opinion Evaluation two weeks ago today.

The doctor that I saw said that he agrees with my surgeon that I need the surgery.

I have 2 questions regarding this:

Does this definitely mean that my surgery will now be approved?

And, how long should I expect to wait for an answer from OWCP?

Any feedback or input would be appreciated.

jesse slade  
#2 Posted : Wednesday, August 7, 2019 10:11:01 AM(UTC)

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First, just because the doctor told you that s/he agreed with your doctor that you need surgery doesn't mean that's what will be written in the report. It's common for a secop to tell you one thing and write another.

The doctor has 30 days to provide OWCP with the report. After that, OWCP will make their decision.

Whether or not the surgery is approved is something no one can answer. OWCP may not accept the secop's report. They may request clarification which could delay the process further. They may send the secop's report back to the DMA who may not agree. They may decide the secop's report isn't valid and send you to a new secop.

It's also possible the secop says you need surgery and OWCP approves it relatively quickly after receiving the report.

There's just too many variables to say the surgery will be approved or the timeline in which it will be approved.
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