After a work-related injury, occupational illness, or other job-related medical condition occurs, unless your employer is self-insured and has contracted medical care approved by the Industrial Commission of Arizona (the ICA), you have the right under Arizona workers’ compensation to see a doctor of your choice. At the same time, your employer or its insurer may require you to attend an independent medical examination, and additional examinations may be permitted if authorized under Arizona law.
Depending on the workers’ compensation case circumstances, you may want to change the treating doctor you have chosen. Or if the doctor your employer chose to examine you has become your treating doctor, you may want to change to another doctor.
The Arizona workers’ compensation system has a procedure in place to let you change your treating physician, but you must be able to satisfy certain requirements. In this blog post, we at the Matt Fendon Law Group address how you may be able to change your doctor after you begin a workers’ compensation claim.
If you want to know more about how to change your workers’ compensation doctor, or if you believe you have a workers’ compensation claim in Arizona, then call our law office at (800) 229-3880. Or you can contact us online.
How Do You Choose Your Own Doctor Under Workers’ Compensation?
In Arizona, under workers’ comp, most employees have the right to seek medical treatment from a health care provider of their choosing after suffering a work injury, occupational illness, or medical condition. Often, you will seek treatment from a physician shortly after a work-related accident occurs, especially if it resulted in immediate injury.
You might even do this before submitting a claim for workers’ compensation with your employer.
The doctor you choose plays an important role in your workers’ compensation claim. This medical professional will:
- Diagnose you with the injury, illness, or condition that will be the basis of your claim
- Devise the treatment plan for you to recover, either fully or up to your point of maximum medical improvement
- Determine how long you need to recover from your injury
- Decide if or when you can return to work, either full-time or in a light-duty capacity
Generally, if you are satisfied with the doctor of your own choosing, you can stay with this doctor during the duration of your workers’ compensation claim.
Can Your Employer Choose Your Workers’ Compensation Doctor?
Arizona workers’ compensation allows your employer a one-time opportunity to schedule you for an examination by a doctor that your employer’s insurance company chooses. However, there are two situations in which you may lose the right to have a doctor of your choosing.
When Your Employer is Self-Insured
If your employer is self-insured and contracts medical care with a physician registered with the Industrial Commission of Arizona (ICA), you must be treated by a doctor chosen by your employer.
When You Remain With Your Employer-Selected Physician
If you continue to see the doctor your employer and its insurer selected to examine you after this initial examination, that doctor will become your workers’ compensation doctor, or your “attending physician” under Arizona workers’ compensation law.
Some injured workers feel more comfortable receiving treatment from a physician they selected, rather than one initially chosen by the insurer.
What is the Procedure to Change Your Treating Doctor Under Arizona Workers’ Comp?
In Arizona, you can change doctors during the course of examination and treatment for work-related injuries under any of the following circumstances:
- If your current doctor agrees to your request to switch physicians, or refers you to another doctor or specialist
- If the workers’ compensation insurance company approves your request to change doctors
- If your doctor and the insurance company both decline to approve your request, the ICA might grant your written request to change doctors
In situations when you need to request approval from the ICA after your current doctor and the insurer do not approve, it will consider the following factors:
- Whether your health, life, or recovery is endangered or impaired by continuing with your current doctor
- Whether your current attending physician is unavailable to continue your treatment
- Whether your current doctor-patient relationship is such that your further improvement is unlikely
- Whether changing doctors would expedite your recovery
If your employer is self-insured, the only way you can change doctors is when remaining with your current physician would endanger or impair your health or your recovery.
It can be helpful to think of the change-of-doctor process as follows:
Step One: Your Current Doctor Agrees to Your Change Request
Will your current attending physician approve your transfer request or refer you to another doctor?
- If yes, then the doctor will submit a change referral, and your change will be approved.
- If not, then go to Step Two below.
Step Two: The Insurance Carrier Approves Your Change Request
Did the insurance carrier approve your request even though your doctor did not?
- If yes, then your change request will be approved.
- If not, then go to Step Three below.
Step Three: Request Approval from the ICA
Submit a written Request to Change Doctors to the ICA. Your application must be made in writing and include:
- Your claim information
- The names and addresses of your current doctor and the doctor you want to transfer treatment to, and
- An explanation detailing why you want to transfer your medical care
When the ICA receives the request, it will contact your doctor and carrier and review your reasons for requesting the change.
- If the ICA approves your request, you can change doctors
- If the ICA denies your request, you may still request a formal hearing
Note: Do not begin treatment with a different doctor without an approved transfer. If you bypass the change request process and seek medical treatment from an unapproved doctor, then workers’ compensation may not compensate you for your medical bills incurred with the new doctor.
Do You Want to Change Your Workers’ Compensation Doctor?
After a workplace injury—even if you choose your own doctor—depending on the circumstances, you may need to reconsider your initial choice. When this happens, as long as you observe the procedures provided for under Arizona’s workers’ compensation system, you can seek to select a new doctor.
Getting a new treating doctor is not automatic under workers’ compensation. You can improve your chances of having your change request approved if you have an experienced Arizona workers’ compensation attorney to guide you through the process and ensure your request includes all necessary information.
At Matt Fendon Law Group, we have the experienced Arizona workers’ compensation attorneys who can help you with changing doctors, or in any other part of your workers’ compensation claim, from helping you to file the claim, negotiating an insurance settlement, and appealing any denials you may receive from your employer, or your employer’s workers’ compensation insurer, or the ICA.
To speak with one of our workers’ compensation benefits attorneys, call us at (800) 229-3880 to set up a free initial consultation. Or use our online contact form to reach us.
