Why does the DOL rule have no provision for independent physician panel reviews where there are disputes over causation from exposure to toxic substances?
A – The regulations provide DOL with the authority to obtain additional medical evidence by referring the employee (or the medical records in the file) to another physician for a second opinion, and also provide for a referee examination where there is a conflict between the second opinion physician’s opinion and the one provided by the claimant’s physician. The final adjudication of claims by DOL will be undertaken by hearing representatives who will be able to obtain any medical evidence necessary for a fair determination. One of the principal obstacles to prompt adjudication of claims under repealed Part D was the required use of Physician Panels. The DOL rule gives the Department the latitude to ask several specialists to review a particularly complex condition if needed, but allows DOL to dispense with such cumbersome reviews where a single physician’s evaluation is likely to be sufficient.
