Greetings, as I was planning out my BBQ menu for next week it hit me.  July 4^th falls on a Thursday; the week looks an awful lot like Thanksgiving week.  That means it is ripe for the shenanigans of claimant’s 1-time change requests under 440.13 (2)(f).

Due to a series of decisions by the 1^st DCA, including Hinzman, the Employer/Carrier has only 5 calendar days to respond to a 1-time change in physician request or the claimant gets to select the doctor.   And that can change the trajectory of a case significantly in an instant.  So, a request for a 1-time change received on Wednesday July 3^rd must be responded to by Monday July 8^th.  Do not forget the WC Q-Rules of Procedure have been amended to extend the end of the “day” from what previously had been 5:00 pm EST to Midnight.  A request received at 11:59 pm on July 3^rd is considered received on July 3^rd now:

60Q-6.108. FILING AND SERVICE (e) Any document, whether filed by electronic or other means, received by the OJCC after midnight Eastern Time shall be deemed filed as of 8:00 a.m. on the next regular business day.

Be extra diligent in reviewing everything received during that window, and be sure to respond to any requests for a 1-time change before 11:59 pm EST Monday July 8^th.  Here are some 1-time change reminders:

• The claimant only gets one 1-time change per date of accident, no matter the number of specialists they are seeing.  Make sure they have not previously used their request.

• There are no exact magic words the claimant must use in the request, so be watchful for requests such as “an alternative orthopaedist” or simply citing the statute, “an orthopaedist per 440.13 (2)(f)”.

• Within the 5 calendar days, you must name the doctor, and the doctor’s office should be given authorization.  You do not need an appointment date or confirmation the doctor will accept the claimant, do not wait to respond.  If ultimately the doctor refuses to see the claimant, arguably based on caselaw you get a new 5-day clock from when you learn of the refusal.

• Stay diligent and document all of your efforts to secure the appointment with items like prepays and sending records.   There is caselaw that says if the adjuster fails to make reasonable efforts to do secure the appointment, the claimant will get to pick the doctor as it was not “provided”.  

• The 1-time change must be in the same specialty as the treating doctor.  At the walk-in level, you must actually name a doctor at the new clinic, not just the name of the clinic.

• Although you have 14 days to respond to a Petition for Benefits (30 days to avoid fees), if the 1-time change is listed on a PFB it is still the 5-day response time. The request for a 1-time change must be in writing, but 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 attorney.

• 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)

In honor of all of this, I think I am going to add some grilled bologna to my 4th menu of ribs and beer-can chicken.  And speaking of food, come join us for our Tampa CEU Dinner on 7/26!

Hope everyone has a happy and safe holiday!

Sincerely,

Morgan Indek | Managing Partner