Greetings, just a reminder today to review everything carefully that came in from the claimants or their attorneys late last week to make sure there are no requests for a 1-time change. See below for guidance, we have till 11:59 pm tonight to respond to anything that came in Wednesday or later.
Hope to see many of you at our Tampa (Thurs) and Orlando (Fri) holiday parties this week!
The end of November is sneaking up on us again, and this is a reminder to be on our toes for 1-time change shenanigans over the Thanksgiving break.
Based on multiple 1st DCA decisions interpreting the 1-time change section of the FL WC statute (440.13(2)(f)), we only have 5 calendar days to respond to a claimant’s written 1-time change request with the name of the doctor we select or the claimant gets to select their doctor. He who controls the doctors controls the claim.
For Thanksgiving week, that means anything emailed, efiled, faxed or received in the mail before 11:59 p.m. on the Wednesday before Thanksgiving (11/26) must be responded to by 11:59 pm. on Monday (12/1). It does not matter if your office closes early on Wednesday, or if you were off that day, it’s the date stamp of when it was received by the carrier/TPA or filed on DOAH.
A couple of items to be aware of:
- Within 5 calendar days, we must provide the name of our choice of 1-time change doctor (who is not affiliated with the current treater)
- The new doctor must be in the same specialty as the original treater.
- If it’s at the walk-in level, we must name a doctor and not just the new facility. It doesn’t matter if the claimant winds up seeing a different doctor at the new walk-in. Call the clinic and get the name of the doctor(s) that practice there.
- The claimant’s request for a 1-time change must be in writing, but that can be in an email, a fax, a letter, a cover letter, a PFB, a Managed Care Grievance form, scan anything received from the claimant or their atty.
- The request does not have to use the words “1-time change”. Look out for an “alternative provider” or a doctor “per 440.13(2)(f)”. It can’t be purely deceptive, but there are no magic words required.
- If a claim is denied, the claimant still gets a 1-time change in most instances (unless its coverage, not an employee, intoxication, etc…non-medical denial reasons).
- Make sure they have not used it prior in the claim, they only get one 1-time change per date of accident, it says it right in the name 😊.
- The newest tactic– The claimant’s attys are arguing if it takes too long to get the appt or if it is too far out, a 1-time change was NOT provided and they get to pick. Start with emailing or faxing authorization to the new provider within the 5 days. I know many doctors want to review records before agreeing to see the claimant. We do not need to provide an appointment date within 5 days, but we have to document diligence in following up to get the appointment set. Document every phone call, email or fax you send to follow up in your notes, and do not let me than few days go by between follow ups. There is caselaw that says if we take too long to get the appt, the claimant gets to choose the doctor.
If you need any help finding doctors, always feel to reach out to me or someone in the firm.
Sincerely,
Morgan Indek | Managing Partner