Greetings, hard to believe Thanksgiving is next week. It’s been a year to remember, but don’t forget to stay on the look-out for 1-time changes.
As a reminder, any requests received before 5 pm EST on Wednesday before Thanksgiving (11/25) need to be answered by 5 pm on Monday after Thanksgiving (11/30). Also:
- “Received” means efiled, emailed, or date stamped by the Carrier. It does not matter when it makes it to your desk.
- You have 5 CALENDAR days from receipt to provide the name of the doctor who you will be selecting
- The request from the claimant must be in writing (which includes email). It should not be in a document that appears on its face to exclusively have another purpose, and should be readily apparent, unobscured and unambiguous request for a 1-time change. However, citing the statute, as in a physician per 440.13(2)(f) is acceptable. The words “alternative doctor” or anything similar are also enough to trigger our duty to respond.
- Watch out for cover letters, PFB’s, fax cover sheets, grievances, etc….check everything carefully.
- You have to provide the name of a doctor within the same specialty. Ortho to Ortho, neurosurgeon to neurosurgeon. And the doctor must be unaffiliated with the original doctor.
- If it’s a walk-in clinic level, find the name of one of the doctors at the new clinic and provide that name. (Dr. Jones at Centra Care) If the claimant actually sees a different physician that still works.
- You don’t need the appt date within the 5 days.
- If the doctor wants to review the records first, communicate that info. And be diligent in sending the records and following up. If the doctor opts to decline the claimant after the records review, there is some JCC case law that indicates that starts a new 5 day clock for you.
- If you need help finding a doctor, feel free to reach out to me or anyone in the firm and we will be glad to help you!
Morgan Indek | Managing Partner