Designating the Authorized Treating Physician

Claimant was working as a bank teller when a robber handed her a note in which he stated he had a gun, knew where the claimant lived and demanded $10,000.   The next day, the claimant complained of anxiety and panic attacks to her manager. The employer referred her to a licensed clinical social worker (“LCSW”) pursuant to the employer’s employee assistance program.  The LCSW opined that the claimant’s PTSD symptoms were caused by the robbery, as did a physician to whom the claimant self-referred, Carolyn Gellrick, M.D.

Claimant filed a claim for compensation over a year later. Additionally, the claimant’s attorney sent the respondents a letter, which advised that the claimant had not been provided a list of four physicians from whom she could treat when she reported her injury and therefore, the claimant asserted that the right to select the treating physician passed to her. The claimant designated Dr. Gellrick as the ATP. The letter also stated that if a list of physicians had been provided, the claimant was now requesting a change of physician to Dr. Gellrick. The respondents replied through counsel, denying the request to change physicians and later sending the claimant a letter containing a list of four medical clinics from which she could choose to obtain treatment.

Following the hearing, the ALJ held that the claimant was a credible witness and had suffered a compensable mental impairment because the robbery caused her PTSD symptoms.

Concerning the designation of the ATP, the ALJ found the claimant had initially agreed to treat with the LCSW upon referral from the employer. The ALJ ruled this represented a selection by the claimant of an ATP. The ALJ determined the claimant’s subsequent request to change physicians to Dr. Gellrick was ineffective because she did not use a WC 197 Form, the document required by the Division when making a request for change of physician. The ALJ denied the change of physician request to Dr. Gellrick. She later reversed her findings regarding the change of physician issue in a supplemental order; however, the supplemental order was deemed out of time and held void.

Both parties appealed.  A panel of the Industrial Claims Appeals Office (“Panel”) held that the if the employer or insurer does not provide a designated provider list within seven days, the right of selection passes to the claimant.  The sanction applicable to the employer’s failure to timely provide the list is that the claimant may select a physician or chiropractor of the claimant’s choosing.  The claimant could not have selected a LCSW as this person is not a chiropractor or physician and therefore, Dr. Gellrick is the selected ATP.

The Panel also affirmed the ALJ’s conclusion regarding the compensable nature of the injury.

Austin v. Wells Fargo, W.C. No. 4-973-614-05 (ICAO Apr. 20, 2018).

Claims Administration Tip:

An employer or insurer can provide the designated provider list, and the insurer should do so if aware of a  deficiency.  Further, if the list is not provided, the injured worker may not select a LCSW, counselor, psychologist, or similar non-physician to act as the ATP.

Would you like to know more? Contact Brad Miller at bmiller@pollartmiller.com 720-488-9586.

 

From the May 2018 Pollart Miller Newsletter

2019-01-29T08:56:06-07:00