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Law Educator, Esq.
Law Educator, Esq., Lawyer
Category: Consumer Protection Law
Satisfied Customers: 114786
Experience:  Attorney experienced in commercial litigation.
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The question is how may a FECA claims examiner deny payments

Customer Question

The question is how long may a FECA claims examiner deny payments to a claim that has been approved. Do not confuse with accepted. Claim was approved for payments and benefits on August 2014 and to date no payments though all documentary has been provided. A second DOL doctor's exam was conducted in June 2015 and this time the claims examiner says that they requested more clarification from their own second exam doctor. May the claimant file a law suit against the second DOL opinion doctor if he changes his first findings of June? Seems the claims examiner is asking their own second opinion doctor to change his own finding. Seems the system protects these type of claims examiners' abuses and there is no appeal to it. In June the claims examiner issued a notice of suspension of benefits but no benefits had been provided so how can they suspend something that is not happening?
Submitted: 1 year ago.
Category: Consumer Protection Law
Expert:  Law Educator, Esq. replied 1 year ago.

Thank you for your question. I look forward to working with you to provide you the information you are seeking for educational purposes only.

If the claim has been approved, they are supposed to make payment in a reasonable time which courts have held to be 30 days or less, depending on circumstances. If they are not making payments, the claimant has a right to sue them for non-payment in bad faith and also to seek attorney's fees for having to take them to court to collect their payments. The claimant can also seek to sue the second doctor for malpractice if they have changed their opinion after giving one, but the claimant will need another doctor to testify as to why the doctor should not have changed his opinion.