Rights to Independent Medical Exams / Changes in Physicians

Right to a one-time change in treating physician.

As discussed above, the employer carrier has the right to not only select the initial occupational clinic, but also the right to select the initial specialist. The Workers' Compensation Act does afford the injured worker the right, once during the life of their case, to make a request for a one-time change in treating physicians. However, except in very unusual circumstances, the carrier retains the right to select the one-time change physician. Work comp lawyer brandon

The only exception to this general rule of a carrier’s right to select is if the carrier does not respond to the claimant’s request for a one-time change physician within five days. Under that circumstance, the individual would be permitted to select his or her own physician.

Given the fact that the injured worker has the right to a one-time change only once throughout the life of a case, it is important that this right be exercised only at an appropriate time in the case. For example, it is usually not recommended to have the injured worker take advantage of his/her right to one-time change at the occupational clinic level. This is because to do so would eliminate the right to make a one-time change at a more critical stage in the case, such as at the specialist level.

Once the injured worker requests a one-time change in treating physicians, the initial physician is immediately de-authorized (no longer permitted to provide treatment). The injured worker is then required to stay with the newly appointed physician for the remainder of his/her case, except in unusual circumstances unless that physician were to refer the claimant to another type of specialist. The only way to get a new physician would be if the claimant were to move to another area, or if the initial treating physician were to no longer accept workers' compensation cases, or withdraw from providing treatment for some other reason. Otherwise, the claimant is required to remain with the one-time change physician for the life of his/her case.

Independent Medical Examinations

In addition to the right to make a one-time change in treating physician, the law also grants an injured worker the right to an independent medical examination one time throughout the life of his/her case. An independent medical examination is different from a one-time change in treating physician in several respects. First, an independent medical examination is a single examination with no right to ongoing treatment. Second, except under circumstances where the employer carrier is utilizing a managed care system for the delivery of medical treatment, the injured worker is required to pay for his/her own independent medical examination.

These examinations can be quite costly, typically ranging anywhere between $1,000-$2,000.00 for a single examination.

Typically, the purpose of requesting an independent medical examination is to get the opinion of a truly independent physician, one who is selected by the injured worker. Frankly, given the lack of choice associated with the initially selected physician, or the one-time change physician, it is often essential to have the opinion of a physician in whom the claimant can be confident will render an objective, neutral opinion.

However, the claimant is not reimbursed for the cost associated with the independent medical examination unless it can be demonstrated that the independent medical examiner’s opinion ultimately was responsible for securing benefits that had been denied by the carrier. An example of this might be where an insurance company has denied the medical necessity of a surgical procedure. If the claimant files a petition for benefits seeking authorization for the surgery, and that surgery is established to be medically necessary as a result, in large part, of the claimant’s independent medical examiner’s opinion, the workers' compensation insurance carrier can be obligated to reimburse the claimant for the costs associated with the independent medical examination. Otherwise, if the independent medical examination does not result in the securing of any specific medical benefit, the injured worker must bear the full cost of that independent medical exam.

Read more - Resolution of medical disputes

 

Disclaimer

The information contained in this FAQ section is intended to familiarize an individual with the general laws impacting individuals in Florida. It is not intended to apply to your specific case, and should not be construed as legal advice. If you have questions regarding your specific circumstances, please feel free to call for a free consultation.