Generally, in the Workers’ Compensation system the workers’ compensation insurance carrier and/or employer are entitled to choose the healthcare provider. However, there are means within the system to request and/or obtain a change of physician.
Within ninety (90) days following the date of injury, but before reaching maximum medical improvement, an injured worker may request a one-time change of authorized treating physician. The new physician must be a physician on the designated provider list or provide medical services for a designated corporate medical provider on the list. The medical provider(s) to whom the injured worker may change is determined by the designated provider list given to the injured worker pursuant to Rule 8-2 or 8-4(C).
To make a change of physician the injured worker must complete and sign the form established by the division for this purpose (form number WC3 Notice of One-Time Change of Physician). The injured worker shall submit the form to the employer by mailing or hand-delivering the completed form to the person(s) designated by the employer to receive the form. The person(s) so designated is listed on the designated provider list given to the injured worker pursuant to Rule 8-2 or 8-4(C) as the respondents’ representative(s). The injured worker may, but is not required to, provide the form to the impacted physicians. In any event, the respondents’ representative(s) shall notify the impacted physicians and the individual adjusting the claim of the change, unless an objection is submitted pursuant to paragraph (C) of this Rule 8-5.
An injured worker may obtain a one time change of physician by providing notice that meets the requirements set out in statute. If the insurer or employer believes the notice does not meet statutory requirements and does not want to recognize the change of physicians, it must provide written objection to the injured worker within seven (7) business days following receipt of the form. The written objection shall set out the reason(s) for the belief that the notice does not meet statutory requirements.
If the employer or insurer does not provide timely objection as set out in the above paragraph, the injured worker’s request to change physicians must be processed and the new physician considered an authorized treating physician as of the time of the injured worker’s initial visit with the new physician.
If written objection is provided and the dispute continues, any party may file a motion or, if there is a factual dispute requiring a hearing, any party may request that the hearing be set on an expedited basis.
In addition to the above, an injured worker may submit a written request to change physicians pursuant to 8- 43-404(5)(a)(VI). The provisions of this Rule relating to a one-time change of physician do not apply to a request for change of physician made under §8- 43-404(5)(a)(VI).
Please contact Bell & Pollock, P.C., to discuss change of physicians or any other matter regarding your workers’ compensation claim.