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Advice for OWCP clients for visits with a second-opinion or referee doctor

Years ago I was struck by the following quote in a second-opinion medical report. "The claimant drove herself to the examination. She came on time. She was reading a magazine while waiting for her appointment." Over the years, that comment and others have convinced me that consultative doctors, while being impartial for the most part, take seriously the task of evaluating fully an injured worker's disability.

OWCP pays for second-opinion and referee medical reports, which have become lengthy, replete and somewhat identical in structure and tone, especially since OWCP began contracting with large companies that facilitate claimant examinations, such as Medical Consultants Network (MCN) ("Medical Judgment Nationwide").

A claimant can go to an examination little knowing what to expect. Not many years ago a client and her husband attended an examination together. They wanted two pairs of eyes to oversee the second-opinion doctor's actions. What they didn't see was the doctor or one of his staff follow them to the parking garage and observe the patient get into the driver's seat of her car and swivel her head around to back up. During the examination, the doctor noted that she could barely move her neck. In the report, he emphasized that later in the car she moved her neck freely.

Another client was seen opening the passenger car door and tossing in the cane upon which he'd leaned heavily in the doctor's office. Then he briskly walked around the car to the driver's side.

Now, if it appears I'm telling tales at a client's expense, I'm not. My purpose is not to say he was faking. Instead, I want to point out that you don't have to go to an examination and convince a doctor you're disabled. The doctor should conclude you are disabled from his examination of you. To be disabled from work you don't have to be the most hurting patient the doctor sees. And you don't prove disability by striving to manipulate the doctor's findings.

Doctors may become suspicious by extreme pain behavior, and they have subtle tests to detect if a person is deliberately trying to mislead them about pain and limitations. One test I see claimants "fail" is when a doctor presses down on top of their heads (pain on axial loading of skull), and they say it hurts their necks or backs. Apparently, such an action would not cause pain. I can see where a person is hurting and the test becomes an opportunity to stress to the doctor that he hurts. It's understandable, but in the end it's falling for a tricky test. And there's more than just one test.

The following is adapted from advice I give to all of my clients when they are scheduled to see a second-opinion or referee doctor. I offer it as part of promoting the best outcome for a claim, not as a suggestion that I think my client will somehow misbehave.

• Be courteous and straightforward with the doctor. (With the doctor's permission, you may bring someone along with you to the examination, but do not create a confrontational situation. I recommend against recording the examination.)
• Do not contradict the doctor or critique his approach to the examination.
• Avoid criticizing other doctors.
• The doctor may direct you in range-of-motion tests. Do not be offended if he makes you do movement that hurts.
• Do not exaggerate or try to make yourself appear worse—or better—than you really are.
• Be precise in describing your symptoms. Avoid dramatic statements that may illustrate how you feel but mean little to the examiner. (Examples of what to avoid: "It's like a ton of bricks on my shoulders"; "It's a dead arm.")
• If something hurts, tell the doctor so, but do not say it hurts when it does not.
• Be aware that the doctor or his staff may observe you at any time while you are in or around his office. (This is important if during the examination you made an effort to appear more limited than you actually are. The best approach is to allow the examination to reveal your limitations. If on other days you're worse and more limited, explain that to the doctor.)
• After the examination, do not ask the doctor to tell you his findings. The doctor's conclusions will be the report he prepares based on the examination and his review of your medical records.
• Do not contact the doctor for any reason after your appointment. (This can be disaster—if the doctor perceives harassment.)

I make a number of the above the suggestions because doctors simply do not like the behavior, and that dislike can find its way into a report that becomes an indelible part of your claim record, no matter how unfair. The other suggestions are to prevent you from influencing the doctor's findings in a way you never meant.

Do not attend a second-opinion or referee examination with trepidation. Be frank and cooperative with the doctor, and his report can be a valuable source of information about your medical condition.

October 2009

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