Can I choose my own doctor for my L&I claim?
Under the Medical Assistance Rules of the Industrial Insurance Act, a person with a workers’ compensation claim is free to choose or find their assistance provider. Additionally, WAC 296-20-065 outlines L&I’s policy for transferring to another provider. With certain exceptions, there is no reason for a claims administrator to deny a request to transfer to a different doctor. However, if L&I denies the request, then you must provide the reason for the denial.
Transfer to another treating physician or provider
As an attorney representing work injury claimants, I work hard to ensure that my clients are happy with their treating doctor. That means they can deal with a doctor they choose and feel comfortable with. However, as with everything else, nothing is set in stone. There are times when a work injury claimant must transfer to a different care provider.
Specifically, WAC 296-20-065 allows the Department of Labor and Industries (L&I) or third party administrator (TPA) to require the transfer of an assisting provider. Explicitly, there are several situations that require transfer to another doctor:
1) If there are better doctors available closer to the injured worker and traveling to the current doctor is affecting the worker’s recovery.
2) When your current provider is not following L&I rules or guidelines.
3) If the work injury claimant is temporarily and totally disabled and is not making reasonable progress toward recovery and return to work.
4) The work injury claimant needs special treatment that the current treating physician cannot provide. Alternatively, the treatment may be outside the scope of the provider’s license to practice.
Important final comments
In short, L&I or a third-party administrator may find that a transfer to another provider is necessary. When they do, if the workplace injury claimant does not change providers or delays processing, then L&I can select the provider for them. Therefore, it is very important that people with a workers’ compensation claim get a good AP from the start. Make sure you are dealing with a provider who has the appropriate qualifications and is easily accessible to you. Remember, that person must follow all the rules related to your L&I claim. Finally, keep in mind that the provider’s job is to implement treatment plans and help you get back on your feet and achieve maximum medical improvement.
This article was first published at https://tarareck.com/transfer-attending-provider/