An OWCP second-opinion examination obtains another medical opinion, while a referee or impartial examination is used when qualifying medical opinions conflict. The two examinations follow different rules. OWCP selects the examining physician, and the employee should follow the instructions in the examination notice. This guide summarizes the current federal regulations; it is not individualized medical or legal advice.
What is an OWCP second-opinion examination?
Under 20 CFR 10.320 (https://www.ecfr.gov/current/title-20/chapter-I/subchapter-B/part-10/subpart-D/subject-group-ECFRcffd46a08c4c479), OWCP may require an employee to be examined by another qualified physician as often and at the times and places OWCP considers reasonably necessary. OWCP may also send the case file for a second-opinion review when an in-person examination is not needed.
For a second-opinion examination, the regulation allows the employee to have a qualified physician present at the employee's expense. Other people are not automatically permitted unless rationalized medical evidence establishes a need, OWCP finds exceptional circumstances, or an accommodation such as an interpreter is required.
When does OWCP use a referee or impartial examination?
20 CFR 10.321 explains that a qualifying conflict exists when two medical reports of virtually equal weight and rationale reach opposing conclusions. If that conflict is between the employee's physician and an OWCP second-opinion physician, medical adviser, or consultant, OWCP appoints a third physician for a referee or impartial examination.
OWCP selects a physician who is qualified in the appropriate specialty and has had no prior connection with the case. A disagreement alone does not necessarily create a referee examination: if one opinion has more probative value, OWCP may base its determination on that medical conclusion.
The regulation permits an employee-paid qualified physician at a second-opinion examination. At a referee examination, the employee is not entitled to have anyone present unless OWCP finds exceptional circumstances, including an accommodation such as an interpreter.
Who pays for an OWCP-directed examination?
Under 20 CFR 10.322, OWCP pays second-opinion and referee medical specialists directly. OWCP also reimburses necessary and reasonable expenses incident to the required examination, including transportation costs and actual wages lost for the time needed to attend. Keep receipts and follow the reimbursement instructions in the examination notice or provided by OWCP.
Why attendance matters
20 CFR 10.323 and 5 U.S.C. 8123(d) provide that refusing to submit to, or obstructing, an examination required by OWCP can suspend the employee's right to compensation until the refusal or obstruction stops. The regulation also covers testing, such as a functional-capacity determination, when conducted in connection with an OWCP-directed medical examination.
If the date, travel, accommodation, or another instruction creates a problem, contact OWCP promptly using the method in the notice. Do not assume that missing the appointment will be excused.
A practical preparation checklist
- Read the notice carefully and confirm whether it identifies a second-opinion or referee examination.
- Confirm the appointment date, time, location, physician, and any testing listed in the notice.
- Follow the notice's instructions about records, identification, and arrival time.
- Describe symptoms, treatment history, and functional limits accurately and consistently.
- Keep transportation, parking, and wage-loss records that may support a reimbursement request.
- Request any needed accommodation through OWCP before the appointment.
- Keep a copy of the notice and any written communication about the examination.
What the examining physician does—and does not do
The examining physician addresses the medical questions OWCP refers for review. The physician does not independently decide the employee's FECA entitlement. OWCP evaluates the medical evidence and makes the compensation determination under the applicable law and regulations.
Sources
- 20 CFR 10.320–10.323, Directed Medical Examinations (https://www.ecfr.gov/current/title-20/chapter-I/subchapter-B/part-10/subpart-D/subject-group-ECFRcffd46a08c4c479), Electronic Code of Federal Regulations; accessed September 11, 2026.
- 5 U.S.C. 8123, Physical examinations (https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title5-section8123), U.S. House Office of the Law Revision Counsel; accessed September 11, 2026.
- FECA Procedure Manual, Part 2 (https://www.dol.gov/agencies/owcp/FECA/regs/compliance/DFECfolio/FECA-PT2/group2), U.S. Department of Labor; accessed September 11, 2026.
Keep exploring.
- OWCP resource center
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- OWCP forms directory
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- CA-17 duty-status guide
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Common questions.
What is the difference between an OWCP second-opinion and referee examination?
A second-opinion examination obtains another medical opinion at OWCP's direction. A referee or impartial examination is used when OWCP identifies a qualifying conflict between medical opinions of virtually equal weight and rationale that reach opposing conclusions.
Who chooses the OWCP second-opinion physician?
OWCP selects the qualified physician for an OWCP-directed second-opinion examination. The employee may have a qualified physician present at the employee's expense, subject to 20 CFR 10.320.
Who chooses the referee physician?
OWCP appoints a third physician who is qualified in the appropriate specialty and has had no prior connection with the case.
Does OWCP pay for the examination and travel?
OWCP pays the second-opinion or referee specialist directly and reimburses necessary and reasonable expenses incident to the required examination, including transportation and actual wages lost for the time needed to attend, under 20 CFR 10.322.
What can happen if an employee misses or obstructs an OWCP-directed examination?
Refusing or obstructing an examination required by OWCP can suspend the employee's right to compensation until the refusal or obstruction stops under 20 CFR 10.323 and 5 U.S.C. 8123(d). Contact OWCP promptly if the appointment instructions create a problem.
Can someone accompany the employee to the examination?
The rules depend on the exam. For a second-opinion examination, a qualified physician may attend at the employee's expense. For a referee examination, no one is automatically entitled to attend unless OWCP finds exceptional circumstances, including a needed accommodation.