Prior to the establishment of the PMTb, the Petition for Medical Treatment (hereinafter PMT), took effect on July 1, 2017 as a tool Claimants could use to expedite medical treatment or testing requested by an authorized medical provider. If a PMT is filed, a telephonic conference will be scheduled no more than five business days from the date of the petition. The Employer/Insurer then has a few options; respond to the PMT prior to the teleconference to indicate that the treatment is authorized, respond that it is not authorized, or appear at the judicial teleconference.
Typically, if the Authorized Treating Physician, or an authorized doctor, recommends some treatment or testing, the Judge will approve the Claimant’s petition. However, you should be aware of your defenses and reasons to controvert. They include: the treatment or testing is not related to the on-the-job injury, it is not reasonably required to effect a cure, give relief or restore the Claimant to suitable employment, it is not being offered by an authorized, panel or referral medical provider; or additional information is needed prior to approval (the additional information needed should be specified).
It should also be noted that the PMT is only valid if used for “medical treatment or testing,” if the petition is filed for any other reason, it is invalid. Medical treatment or testing includes diagnostic testing, physical therapy, medications, surgical procedures, but not – for example – to compel payment of mileage reimbursement or to invalidate a panel. Further, an Independent Medical Examination is not an authorized provider because they are not a treating provider.
After the teleconference, the Judge may issue an Interlocutory Order which exclusively addresses authorization of the treatment or testing at issue. If he Employer/Insurer disagrees with the Order, it has 20 days to object. Absent a timely objection, the Order will take effect. In order to object as required within 20 days, the Employer/Insurer would need to file a Request for Hearing over the issue, and that hearing request acts as a supersedeas of the Order (i.e. the treatment or testing does not have to be authorized pending the hearing).
Miraculously, on September 1, 2019, the State Board threw the Employer/Insurer a bone with the newly revised PMTb process. The PMTb expands the PMT process to permit the Employer/Insurer to petition the Board for a judicial teleconference with the Judge to require the Claimant or the Claimant’s attorney to show cause why an Order should not be issued directing the Claimant to attend an appointment with an authorized treating physician. Did I just say the Employer/Insurer now has a form to make the Claimant do something? Yup! I hope you were sitting down when you read that.
Therefore, when an appointment has been scheduled for the Claimant with an authorized treating physician and the Claimant has been provided with at least five business days advanced notice but failed to attend, the Employer/Insurer may file a petition for the Claimant to show cause as to why an Order should not be issued directing the Claimant to attend the appointment. The original notice of missed appointment and the notice of the rescheduled appointment which were served to the Claimant when filing should be included with the filing. In response to this, the Claimant must respond that he will attend, or participate in a conference and explain why he does not agree to attend.
If the Claimant failed to attend the rescheduled medical appointment as agreed or as directed by a previous Order of the Board, the Employer/Insurer can file a second petition, called the PMTb – Failure to Attend Medical Appointment, or by the more appealing name, Suspend Benefits Petition. This petition will be filed with the Board to issue a notice of telephonic conference within 5 days during which the Claimant and/or the Claimant’s attorney shall be directed to show cause why the employee’s disability benefits should not be suspended. However, like the WC-PMT, an Order on a WC-PMTb to suspend benefits can be appealed by the Claimant requesting a hearing on the issue which acts as a supersedeas of the Order, and, in that event, income benefits cannot be suspended pending the hearing. Nonetheless, the PMTb to suspend benefits is not the only avenue to get the Claimant’s benefits suspended, but it can potentially be quicker and more effective than filing a motion or request for hearing and will also require the attention of the Board and a response from the Claimant in a far more timely manner than previous methods.
Now you know why I am thankful this Thanksgiving for the new PMTb. If you have any questions or just want to let me know what you are thankful for this Thanksgiving, feel free to give me a call or email. Remember, all that turkey isn’t going to eat itself. Happy Thanksgiving!