OWCP Sample Letter to Your Physician
Requesting a Medical Narrative

At the time you request medical documentation, provide your doctor with this letter, a copy of your employee statement and a copy of the job description (that closely fits your duties). Your doctor needs to have a comprehensive understanding of what duties you perform and what OWCP requires before s/he can write an effective narrative. Note: You may attach a copy of page four of form CA 2 when submitting this letter to the doctor. Page four of form CA 2 verifies your need for a medical narrative.

(copy the text from the body of this letter, paste it into a word document,
modify the date, names and your own personal information and print)

July 3, 2006

Dear Doctor Joe Doe:

I am filing a claim to receive benefits under the Federal Employees Compensation Act, Office of Workers Compensation Program, Department of Labor. I must have a detailed medical report to substantiate my claim of injury. Please use the following guidelines to create a report to help me get my claim approved. Your cooperation is appreciated.

Please complete your statement as soon as possible. I must file my claim within the next ___ days. The medical statement must be submitted with my claim to ensure a successful outcome.

Please address the following as explained:

    a. Dates of examination or treatment:

    b. History given to the physician by the employee:     I am enclosing the statement I wrote for the Department of Labor. This will help you understand what duties I perform. I certify that the statement is accurate. (See attachment).

    c. Detailed description of the physician�s findings: This is self-explanatory. Please include a copy each of my office visit notes in relation to my work related condition along with your narrative. The more documentation I have the better my chances of getting my claim approved.

    d. Results of x-rays, laboratory tests, etc. e. Diagnosis: Must be specific and detailed.

    f. Clinical course of treatment.

    g. Physicians opinion as to whether the disease or illness was caused or aggravated by the employment, along with an explanation of the basis for this opinion. (Medical reports that do not explain the basis for the physician�s opinion are given very little weight in adjudicating the claim.):     I can�t stress this one enough. You must prove causal relationship between my symptoms/injury and my work duties. If the report does not state the condition was caused OR aggravated by employment, the claim will be automatically denied. The Department of Labor will not assume anything. It is clear to me that my condition was caused/aggravated by my employment, but the medical report has to be support my claim.

Please use terms like: "Highly likely", "is consistent with", "I feel strongly that" when you document whether or not you believe my condition/symptoms are caused/aggravated by my work duties. Words like "maybe" or "might" won't help me get my claim approved.

Please keep in mind that "pain" itself is not compensable so a specific and detailed diagnosis is critical.

Any assistance you can provide will be greatly appreciated. Thank you in advance.


Jane Doe