Federal Employees' Compensation Act

Claimants and their representatives have alleged that the Labor Department's Office of Workers' Compensation Programs lacks objectivity and has "shopped" for doctors who, when examining claimants, would be predisposed against supporting their claims for workers' compensation benefits. GAO did not find this to be the case. When claimants' benefits were terminated after a second-opinion examination, these adjustments were usually unrelated to conflicts in medical evidence that would have required an impartial medical examination. Also, the Office has an automated system--the Physician Directory System--in place to ensure that physicians were chosen in an unbiased manner. Finally, given the number of impartial medical examinations done by individual doctors and the amounts paid to those who did both second-opinion examinations and impartial medical examinations, it seems unlikely that the Office was repeatedly using the same doctors to achieve predetermined results. Yet, there have been situations in which districts have been unable to use the Physician Directory System when choosing doctors to do impartial medical examinations. It would be in the Office's best interest to establish controls to ensure the impartial selection of doctors whenever methods other than the Physician Directory System are used to select doctors.

GAO found that: (1) there is no evidence that OWCP selects physicians who are predisposed against claimants; (2) OWCP has terminated claimants' benefits after second-opinion exams because of factors unrelated to conflicts in medical evidence; (3) the OWCP Physician Directory System (PDS) reasonably ensures that IME physicians are selected in an unbiased manner; (4) OWCP district offices have not established procedures to ensure impartial physician selection when PDS is not used due to the lack of physicians in the appropriate specialty or geographic area; (5) nationwide payment data show that OWCP does not rely on a group of selectively chosen physicians for second-opinion exams and IME; (6) OWCP paid most of the physicians or medical groups that conducted IME and second-opinion exams less than $10,000 in fiscal years 1991 and 1992; (7) OWCP takes longer to reimburse claimants' physicians than its selected physicians to ensure the correctness of payment, but its payments to all physicians are within established time limits; and (8) most OWCP district offices have difficulty in recruiting physicians in selected medical specialities to conduct second-opinion exams and IME.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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