Authorized Treating Physician

The Court of Appeals considered the effect of the claimant’s approved request to begin treatment with a new physician. Specifically, whether her treatment with her newly approved physician automatically terminated her first physician’s status as an authorized treating physician (ATP). The answer to this question mattered because claimant’s first physician opined that claimant had reached maximum medical improvement (MMI) after claimant had begun treating with her new physician. Therefore, if her first physician was no longer an ATP at the time of the MMI determination, claimant’s employer could not properly rely on that finding.

Claimant sustained a compensable injury and began treating with the ATP, Dr. Sharma. Several months later, claimant requested and received permission to begin treatment with Dr. Miller. Despite this change, employer periodically sent claimant to Dr. Sharma for “demand appointments.”

In January 2016, Dr. Sharma saw the claimant and, due to claimant’s noncompliance with Dr. Sharma’s direction, placed her at MMI. However, Dr. Miller disagreed, stating that claimant was not yet at MMI.  Respondents filed a final admission of liability (“FAL”) based on Dr. Sharma’s MMI placement.

The ALJ held that Dr. Sharma’s status as claimant’s ATP terminated when she began treating with Dr. Miller, per C.R.S. § 8-43-404(5)(a)(IV)(C) (enacted July 1, 2016). The Panel reached the opposite conclusion, however, and agreed with employer that section 8-43-404(5)(a)(IV)(C) applied only if the worker sought a change of physician under section 8-43-404(5)(a)(III). The Panel further held that the termination provision in section 8-43-404(5)(a)(VI)(B), enacted in 2016, did not apply either because that provision was not in effect when claimant changed physicians.

The Court affirmed the Panel’s conclusion. In reaching this conclusion, the Court held that the automatic termination provision of C.R.S. § 8-43-404(5)(a)(VI)(B) applies only to a request to change a treating physician made after the effective date of that provision. The Court further held that section 8-43-404(5)(a)(IV) applies only to changes of physician obtained under section 8-43-404(5)(a)(III). Because the claimant’s request to change her physician predated section 8-43-404(5)(a)(VI)(B), and because the request was not granted under section 8-43-404(5)(a)(III), her treatment with her new physician did not automatically terminate her first physician’s status as an authorized treating physician.

Therefore, Dr. Sharma’s MMI placement was valid, and the respondents’ FAL was valid as well.

Berthold v. Indus. Claim Appeals Office, 2017COA145 (Nov. 16, 2017).

Would you like to know more? Contact Ilene Feldmeier at ifeldmeier@pollartmiller.com or 720.488.9586.

 

From the January 2018 Pollart Miller Newsletter

2019-01-29T09:26:11-07:00