U.S. DEPART~IENT OF LABOR 

EMPLOYMENT STANDAJU)l,l A:OMINXSntA"tlON 

Office of Workers' Compensation Programs 

August 12, 1974 No. 18 

NOTICE TO INSURANCE CARRIERS, SELF-INSURED EMPLOYERS 

UNDER THE LONGSHOREMEN'S COMPENSATION ACT, AND OTHER 

INTERESTED PERSONS 

Subject: Medical Care, Supervision Procedures, and Impartial . Medical Examinations under the Longshoremen's 

and Harbor Workers' Compensation Act, As Amended 

This notice is to advise interested parties that the Office 

of Workers' Compensation Programs (OWCP) will begin implementing the procedures described herein, concerning medical 

care under the amended Longshore Act, effective the date of 

this notice, August 12, 1974. This notice should be read in 

conjunction with prior related notices {No. 2 - November 15, 

1972, No. 6 - January 25, 1973, and No. 16 - May 20, 1974). 

In the November 15, 1972, notice, insurance carriers and 

self-insured employers were advised of the basic responsibility of employers to authorize medical care for injuries 

covered by the amended Longshore Act by physicians selected 

by injured workers. This was followed by a notice on 

January 25, 1973, providing instructions for the use of the 

two-part Form LS-1, ltRequest for Examination And/Or Treatment 

and Attending Physician's Report of Injury and Treatment.n . Instructions provide that Form LS-1 be furnished by the 

employer to an injured employee who gives notice of an onthe-job injury, and be addressed to the physician the employee 

designates as his/her choice. The form will be presented 

by the employee to the physician ~elected. 

The law provides that a report of injury and treatment is 

to be completed by the examining physician on a form prescribed by the Secretary of Labor within ten days of the 

initial examination and forwarded to the Deputy Commissioner, 

and to.the insurance carrier or self-insurer. The back of 

Form LS-1 provides a form for this purpose. {It has been 

noted that Form LS-1 is not being used extensively, and we 

urge that information be disseminated to the proper persons 

that this form is to be used, rather than State workers' 

compensation form~ or other substitutes.) 

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The procedures being implemented provide that district offices 

of OWCP are to see that medical reports after the first one 

are submitted to them by treating physicians at 30 day 

intervals on Form BEC-204 (until revision} or by narrative 

reports. In long term disability cases, progress reports 

may be extended to 90 day intervals or as determined by the 

Deputy Commissioner. To insure that adequate medical reports 

are received with respect to any case, the Deputy Commissioner 

may take administrative action within his authority when a 

physician fa.ils to report as described, or when requested to 

do so. 

Impartial Medical Examinations 

Deputy Commissioners have been advised to make liberal use 

of impartial medical examinations under the authority granted 

by Section 7(e} of the Act, as amended. Impartial medical 

examinations are to be utilized where medical questions arise, 

regarding, for instance, the necessity of medical treatment, 

indications for or against medical procedures, or the duration 

of required treatment and the effectiveness of such treatment 

as may have been provided. In addition, when there is a 

question as to the degree of physical impairment, this 

procedure may be utilized. However, the medical examiner will 

not be asked to evaluate the employee's disability, since 

this is an economic question. (Refer to Notice No. 16, 

May 20, 1974) 

The procedures advise the Deputy Commissioners to utilize 

Section 7(i} of the Act, as amended, in appropriate situations, 

by having the respective parties agree to the selection of 

an impartial examiner by the Deputy Commissioner. The parties 

may be asked to agree to an appropriate specialist from a 

list of three or more physicians selected by the Deputy 

Commissioner. 

Board-certified specialists will be used for impartial medical examinations insofar as practicable. However, it is 

recognized that there will be times when a non-certified 

specialist will have to be used due to his/her special 

qualifications or when it is virtually impossible to find 

an individual in a community who, during the period of two 

years prior to such employment has been employed by, or 

accepted or participated in any fee related to a workers' 

compensation claim from any insurance carrier or self-insured 

employer. 
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In order to insure the impartiality of the medical examiner, 

he/she will not have the benefit of prior opinions, or the 

use of reports and conclusions regarding the case, unless 

the Deputy commissioner determines-in a particular case that 

for good cause they should be made available. In such cases 

where reports are furnished the medical examiner, the names 

of the physicians involved will be withheld. The Deputy 

Commissioner will furnish the impartial medical examiner 

with a memorandum of such undisputed facts as the Deputy 

commissioner feels necessary to form the basis for the 

examiner's opinions. It will not be necessary for the 

parties to formally agree on these facts through informal 

conference proceedings prior to an impartial medical examination, unless in the Deputy Commissioner's opinion such 

proceedings are necessary to prepare a memorandum of undisputed facts. 

A right of review or of r~examination will be granted to any 

party who is dissatisfied with the report of the impartial 

examiner, unless such review is determined by the Deputy 

Commissioner to be completely unwarranted. The review will 

be completed within two weeks if it is possible. If the 

parties cannot reach agreement on a medical question after 

a review or reexamination, the adjudicator shall nevertheless 

make a recommendation on the medical question. 

Unreasonable refusal by an employee to submit to a recommended 

examination may result in a suspension of compensation benefits during the period of refusal. The place selected for 

an examination must be located so as to be reasonably convenient to the claimant. 

The cost of impartial medical examinations will be charged 

to the employer if self-insured, to the insurance carrier, 

or to the special fund established by Section 44 of the Act, 

as amended. The Deputy Commissioner, in his discretion, 

shall determine who will pay the cost of the examination. 

Your workers' compensation departments, field representatives 

who service workers' compensation claims under the Act, as 

extended, and the employers whom you service should be advised 

through your information channels of these procedures, which 

become effective August 12, 1974. 

<~ ,!' 0 ....... /i,·~ i _44,.c,b~ 

J• 

GOHN E. STOCKER 

Associate Director for 

Longshore and Harbor 

Workers' Compensation