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3101 Provisions of the Act

Section 12(n) of the Railroad Unemployment Insurance Act provides in part:

"Any employee claiming, entitled to, or receiving sickness benefits under this Act 

may be required to take such examination, physical, medical, mental, or 

otherwise, in such manner and at such times and by such qualified individuals, 

including medical officers or employees of the United States or a State, as the 

Board may prescribe. The place or places of examination shall be reasonably 

convenient for the employee. No sickness benefits shall be payable under this 

Act with respect to any period during which the employee unreasonably refuses 

to take or willfully obstructs an examination as prescribed by the Board...The 

Board may enter into agreements or arrangements with doctors, hospitals, 

clinics, or other persons for securing the examination, physical, medical, mental, 

or otherwise, of employees claiming, entitled to, or receiving sickness benefits 

under this Act....The Board may compensate any such doctors, hospitals, clinics, 

or other persons upon such reasonable basis as the Board shall prescribe...."

3102 Examination required

3102.01 Conditions for prescribing examination

An examination of the claimant for sickness benefits may be prescribed under 

any of the conditions set forth below:

a. Insufficient evidence for determination

Information on Form SI-1b or Form SI-34 is insufficient to determine ability to 

work.

b. Extended duration of infirmity

A date of recovery reported on a supplemental doctor's statement executed 

within 14 days of the estimated ending date of a period of disability is later than 

such date as determined on the basis of available evidence.

c. Protest

The claimant protests an initial determination that he is able to work and such 

initial determination was not based on an examination by a medical examiner.

d. Questionable evidence

The reliability of the medical evidence presented is questionable.
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e. Test check

The claimant's infirmity, occupation, place of residence or other circumstances 

are such that his case is a proper subject of investigation with a view to 

assembling information relating to the administration of the Act.

3102.02 Additional factors to be considered

The following additional factors are to be considered in prescribing an 

examination:

a. Claimant's reported condition

If the claimant's condition is reported to be such that he could not appear at an 

examiner's office, the examination may be conducted at the place where the 

claimant is confined.

b. Qualification of examiner

If a specialized examination is required, the district office shall select an 

examiner qualified to conduct the type of examination required.

c. Place of examination

The place of examination is to be reasonably convenient for the claimant, taking 

into consideration his reported condition, the distance which he would have to 

travel, transportation facilities, travel cost and travel time.

d. Time of examination

The examination should be scheduled within the period of infirmity indicated by 

the medical information presented.

3102.03 Status of claimed days after determination

No day after the date of determination that a claimant is required to take an 

examination shall be considered as a day of sickness pending:

a. Receipt of a report of examination, or

b. Receipt of information showing that the examination was not made, or

c. Receipt of a new statement of sickness.
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3103 District office responsible for selection of medical 

examiners

3103.01 General

The district office shall make arrangements with a sufficient number of qualified 

medical examiners located in its territory to permit ready scheduling of medical 

examinations of sickness claimants. The district office shall select all medical 

examiners needed.

3103.02 Files

The district office shall originate and maintain a medical examiner's index card 

file. The index card shall show, for each medical examiner, the doctor's name, 

address and telephone number, and the doctor's specialties or special 

equipment.

3104 Scheduling medical examination

3104.01 Request to district office

When requested by the chief of claims operations, the district office shall 

schedule the type of examination called for in the request.

3104.02 District office action

The district office shall:

a. schedule examinations in accordance with instructions in FOM-II-31 (if the 

district office cannot schedule an examination promptly, it shall notify the 

division of claims operations), and

b. send to the chief of claims operations two copies of the authorization letter 

along with the medical report and the doctor's claim for reimbursement for 

conducting the medical examination.

3105 Following up request for medical examination

A request for medical examination shall be followed up provided:

a. A claim is held pending the report of examination, and

b. No medical report or other information is received from the medical 

examiner, the claimant, or the district office on or before the pending date.
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3106 Consideration of medical report

3106.01 Acceptable or unacceptable

A medical report is acceptable if the medical examiner has signed it, has shown 

the date of the examination, and has completed not less than two other items. If 

the report is not acceptable, practicable efforts shall be made to have it 

completed so that it will be acceptable. If, after such efforts have been made, a 

report is not acceptable, notify the medical examiner that he will not be paid for 

the examination, giving the reason.

3106.02 Satisfactory or unsatisfactory

An acceptable medical report shall be considered satisfactory if the examination 

was given no more than two days after the date specified by the district office in 

its authorization letter, and if enough items on the report are completed to permit 

a reasonably accurate determination of the claimant's ability to work. If a 

determination of the claimant's ability to work can be made even though the 

report is unsatisfactory, proceed as though the report were satisfactory.

3107 Denial of claims for refusing or obstructing examination

If it is found that the claimant unreasonably refused or willfully obstructed the 

examination, no benefits shall be paid with respect to the period beginning with 

the day when the claimant was to be examined, or if no such date was set, the 

date shown in the authorization letter as the latest date for conducting the 

examination, and ending immediately prior to (1) the day when the claimant 

places himself in a position to take the examination, or (2) the first day with 

respect to which a new statement of sickness is filed in his behalf.

3108 Instructions superseded

This article supersedes ROM-I-31.