Greetings, it’s the season for 1-time change shenanigans. So here is a refresher and where the law sits on the process.
- 5 days is 5 days. If a request comes in Wednesday of Thanksgiving anytime before 5:00 (and that is the faxed or efiled timestamp of 4:59:59 or earlier) your response is due Monday before 5:00 pm Eastern Standard time. It doesn’t matter if your office was closed.
- The claimant’s request must be in writing and per caselaw “….should not be inserted into a document that appears on its face to have exclusively another purpose. Rather, the request should be readily apparent, unobscured and unambiguous,….” But other than that it can be a letter, a PFB, a Request for Assistance, a Grievance Form, a cocktail napkin, an email, etc….
- You must give the name of the doctor you are selecting. If it’s a walk-in clinic you must name an actual doctor that serves that clinic, it does not matter if the claimant sees a different doctor at the clinic ultimately.
- The doctor can not be affiliated with the doctor from which the change is being requested. They must be in different groups. BUT, you can send them back to a group where they had seen a doctor in the past as long as it is not the last doctor. What? For example, Doctor A retires, you then send to Doctor B at a different group. One time change requested, you send them to a different doctor in Doctor A’s group because that group is not affiliated with Doctor B. It has to be a change from the last/most recent doctor’s group.
- The doctor must be in the same specialty. This is becoming more of a focus. The claimant can not jump specialties from say walk-in to pain management. BUT neither can the E/C. There is caselaw that says it must be ortho to ortho, not neurosurgeon even if they are “spine specialists”. We are going to see this argument in 2020 applied to podiatrists and orthos. And pain management, check the underlying specialty…physiatry versus anesthesiology, etc. Pain management in itself is not a type of doctor.
- You do not need an appointment before you respond. Nor do you need to confirm the doctor will accept the claimant. Do not wait and miss the deadline
- I do recommend faxing or emailing the doctor within the 5 days to advise of authorization.
- If the doctor refuses to see the patient, there is JCC-level caselaw that says you get a new 5-day clock from when you find out to advise the claimant and select a new doc tor.
- If the doctor needs to review the records first or requires a pre-payment, act promptly, follow up and documents all of your efforts. If you don’t we could lose control of the pick.
On Monday 12/2, shake off the turkey tryptophan daze and scan every document carefully for anything asking for:
- An “alternative” doctor
- 1-time change
- A doctor per 440.13(2)(f) or 440.13(2)
Morgan Indek | Partner