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Injured workers are not entitled to switch from an authorized physician to a doctor in a different specialty if they do not receive a timely response to their request to change doctors under their workers compensation claim, a Florida appellate court has ruled.
Brenton Davis, the defendant in the case, was injured in June 2014 while working for Gallatin, Tennessee-based Servpro Industries Inc., court records show. Servpro was insured for workers comp at that time by Lakeland, Florida-based RetailFirst Insurance Co.
Under Florida workers comp laws, an employee can submit a written request for a one-time “change of physician during the course of treatment for any one accident.” According to court filings, Mr. Davis requested to change his authorized treating physician from a family practice doctor to an orthopedist.
A Florida judge of compensation claims granted Mr. Davis' request, finding that Servpro and RetailFirst failed to respond to the request within five days of receiving it — a timeline that was established under Florida law.
However, a three-judge panel of the Florida 1st District Court of Appeal unanimously reversed that ruling on Monday, saying that the decision was based on a narrow interpretation that effectively allowed the employee to add a physician rather than exchange physicians in a one-for-one manner envisioned under Florida’s workers comp laws.
The appellate court said that the compensation claims judge only focused on a portion of the law that says if a workers comp insurer does not respond to a change of physician as requested, the employee can select a physician who is considered authorized “if the treatment being provided is compensable and medically necessary.”
However, the appellate court found that the judge failed to account for a section of the applicable law that discusses removing authorization for “the originally authorized physician in the same specialty as the changed physician.”
Because Mr. Davis' orthopedist is not in the same specialty as his originally authorized physician, the original treating physician would not lose authorization under case law, the appellate court found. Therefore, the court said Mr. Davis' request would result in him having two doctors, rather than exchanging one doctor for another in the same specialty.
"In essence, Davis’s reading would allow a claimant to add a new physician, rather than change from the originally authorized one," the ruling reads. "And it would allow a claimant, at least in theory, to select a specialist who is wholly unsuitable for the ‘course of treatment’ that has been authorized."
The case was remanded for further consideration.
Injured workers in Texas have better access to physicians than they did 15 years ago, according to a recent study by the Texas Department of Insurance Research and Evaluation Group.