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 can freely choose or find their provider of care. Additionally, WAC 296-20-065 describes L & I’s policy for transferring to another provider. With certain exceptions, there is no reason for a claims administrator to deny the request for a transfer to another physician. However, if L&I denies the request, you must provide the reason for the denial.

Transfer to another doctor or care provider

As an attorney representing work injury claimants, I work hard to make sure my clients are happy with their treating physician. That means they can deal with a doctor they choose and are comfortable with. However, like everything else, nothing is set in stone. There are times when a work injury claimant must move to a different care provider.

Specifically, WAC 296-20-065 allows the Department of Labor and Industries (L&I) or an outside administrator (TPA) to require an assistant provider transfer. Explicitly, there are several situations that require transfer to another doctor:

1) If better doctors are available closer to the injured worker, and traveling to the current doctor is affecting the worker’s recovery.

2) When your current provider does not follow 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 remarks

In summary, 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 delay the process, 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 right from the start. Make sure you are dealing with a provider who is appropriately qualified and easily accessible to you. Remember, that person must follow all the rules regarding your L&I claim. Lastly, keep in mind that the provider’s job is to implement treatment plans and help you recover and obtain maximum medical improvement.

This article was first published at https://tarareck.com/transfer-attending-provider/