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One Time Change Requests and Holidays

By: Alec Powers, Associate, Orlando

It’s that time of the year again. There is a palpable sense of bliss is in the air as the major holidays are upon us. It is the Wednesday before Thanksgiving, and all you want to do is leave work early to get to your family, friends, and pets. Well, Claimants’ attorneys have another thought in mind – unscrupulously waiting to send a One Time Change in physician request at 4:55 p.m., anticipating it will not been seen until Monday, at the earliest, and effectively giving you until the end of workday on Monday to find a replacement. Is this allowed? Yes, it is! Whether or not this is shady is another question.

Florida Statute 440.13(2)(f) states, “Upon the written request of the employee, the carrier shall give the employee the opportunity for one change of physician during the course of treatment for any one accident. Upon the granting of a change of physician, the originally authorized physician in the same specialty as the changed physician shall become deauthorized upon written notification by the employer or carrier. The carrier shall authorize an alternative physician who shall not be professionally affiliated with the previous physician within 5 days after receipt of the request. If the carrier fails to provide a change of physician as requested by the employee, the employee may select the physician and such physician shall be considered authorized if the treatment being provided is compensable and medically necessary.”

What does this mean, and what is the practical effect? The Claimant must submit a written request for a one time change in physician or for an alternate doctor from the one currently treating.  This can only be done once, but once authorized, will be binding.  Accordingly, make sure to check your file for any prior requests before authorizing. Additionally, simply citing to FL Statute 440.13(2)(f) can satisfy the requirements, so make sure you check the statutes. However, the Claimant may not go out of their way to conceal this request. 

What must you do once receiving a request? The simplest answer is to authorize another physician in the same specialty within FIVE days of the request.

How are five days calculated? The 1st DCA has repeatedly declared that 5 calendar days means 5 CALENDAR DAYS, and not business days. Thus, any request received by your office on Wednesday before 5 pm means you must respond before 5 pm MONDAY, or lose the right to select the doctor.  This essentially places the claim in the Claimant’s hands, which likely increases exposure.

When responding to the request you should email, Fax, and snail mail the response to opposing counsel and the Claimant to cover all bases.  The name of the new doctor selected to treat the Claimant must be indicated, and if this is a walk-in clinic, the name of the doctor at the clinic who will see the Claimant must also be included. You need not go as far as providing an appointment date within the 5 days, nor do you need to confirm the doctor will see the Claimant within the 5 days. If the doctor then refuses to see the Claimant at a later date, you presumably have another 5 days from the refusal to substitute a new doctor. However, you will want to document the refusal and be transparent with the claimant and their attorney as to how you are proceeding with the refusal.

Remember, it does not matter if your office is closed when the request is received.

Final Tip – Always consult with your attorney if you are not sure how to proceed with a one time change request.