Once again, as we prepare to gather with family and friends to celebrate the season, we must be on our toes for 1-time change shenanigans.
As we are all aware, based on multiple 1st DCA decisions interpreting the 1-time change section of the FL WC statute (440.13(2)(f)), we 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 the doctor. He who controls the doctors controls the claim.
For Thanksgiving week, that means anything emailed, efiled, faxed or received in the mail before 5 p.m. on the Wednesday before Thanksgiving (11/24) must be responded to by 4:59 pm. on Monday (11/29). 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.
A couple of items to be aware of:
- Within 5 calendar days, we must provide a name of a 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.
- 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 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 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)
In an abundance of caution, I would also recommend emailing or faxing authorization to the new provider within the 5 days as well. I know many doctors want to review records before agreeing to see the claimant, but we should at least start the process. We do not need to provide an appointment date within 5 days, but we have top document diligence in following up to get the appointment set.
If you need any help finding doctors, always feel to reach out to me or someone in the firm.
Morgan Indek | Managing Partner