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Morgan’s Tip of the Week – 1-Time Change Authorization

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Greetings,

A JCC just ruled that the E/C took too long after selecting a 1-time change doctor to “provide” the doctor, and thus the claimant was allowed to select their own physician.  This is a JCC level decision, and not an appellate decision, but other judges could follow the rationale. (the link to the case is below).

In that case, the adjuster timely responded within 5 days to the request for a 1-time change on a PFB (its still 5 days even if its on a PFB BTW).  However, from the record, it appears they did not actually confirm authorization with the doctor they selected for 58 days.  There may have been other steps taken, but that was all that was in evidence.  

Some good quotes from the JCC below, but basically he ruled that 1-time change rule is satisfied if the E/C provides the name of the doctor to the claimant, HOWEVER, a JCC must look at the entire circumstance surrounding the request.  He did not give us a specific number of days, it’s a matter of reasonableness.

I know often the doctor’s office will want to review the records and/or have a pre-payment before they give you an appointment.  The key is to document every step you take in moving the request for the appointment along.  

I would strongly recommend that within the 5 days or as soon as possible thereafter, send an email or fax to the doctor’s office authorizing the provider.   And then follow up as often as reasonably possible to move it along.  And document, document, document everything….keep your defense attorney (me) in the loop so we can keep the other side informed.


Some quotes:

“I find that it is incumbent on the JCC to review each request for a one time change in the totality of the circumstances surrounding the request and authorization. A strict interpretation of the case law allowing the employer/carrier to meet the requirements of the statute merely by naming a doctor would allow for the circumventing of the 5 day limit, such as is the case here where the employer/carrier did not communicate with the new doctor until almost two months after the request for the change and the de-authorization of the first treating doctor, thus stranding the Claimant without authorized care for over two months. To accept the employer/carrier’s strict interpretation of the law, the E/C could merely name a doctor and then take an unlimited time to actually provide a one-time change, thus subverting the 5 day limit in §440.13(2)(f).”

“The courts have indicated that the employer/carrier meets its obligation to authorize a change in doctor by providing the name of the new doctor to the claimant. However, there is no case law defining what the statute requires for the employer/carrier to provide a change in physician.”

https://www.jcc.state.fl.us/jccdocs20/LKL/Polk/2016/024401/16024401_229_04112018_01580569_i.pdf

 Sincerely,
Morgan Indek | Partner