Many times I recieve files from adjusters who already provided a list of doctors for Claimant to choose from, be it for a specialist referral by the PCP or a one time change request.  Under the 2003 law, an Employer/Carrier does not have to provide such list to Claimants.  Even under the managed care statute, section 440.134, the only list you need to provide is for the PCP.  If you provide lists to Claimant, that is ok.  Just note you are not required to do so. 

But, a question arises if an adjuster provides a list, is that considered “authorization” even if the adjuster does not set the appointment?  The First DCA answered that question last week. 

In Florida Fun Bike Super Center v. Hunt, the Employer/Carrier appealed the JCC’s decision where he ruled Claimant’s unauthorized psychiatrist became authorized by statute since the E/C did not authorize a change in doctors timely via s. 440.13(2)(f).  However, the adjuster did provide two lists of psychiatrists on two separate occassions to Claimant after she went through the grievance process and filed a PFB.   The Court found that the willingness to offer Claimant a choice rather than simply scheduling an appointment did not represent a failure to meet its statutory obligation to provide the medical treatment requested. 

As I’ve written about before, an E/C has to provide medical care under the 3-day rule (treament recommended by an authorized provider) and the 5-day rule (written request for one-time change of doctors by Claimant).  But, there is also the “reasonable time” rule–s.440.13(2)(c)— which requires Carrier’s to provide treatment requested by Claimant within a reasonable time.  Granted, if the treatment recommended is not medically necessary, the E/C can deny it.  But, the Claimant can pursue the treatment on her own, unauthorized, and sue for the JCC to recognize said treatment is medically necessary.

Alot of savvy Claimant attorneys are sending their Claimant’s to unauthorized specialists and then litigating the right to have these specialists authorized by statute.   If the E/C has no evidence to counter the treatment is not medically necessary or related to the compensable accident, guess what?  It will become authorized.

So, for an adjuster, you have to be careful on what you authorize and what you deny (making sure that what you deny has medical evidence to support the denial).  Yet, if you are nice enough to offer a list to Claimant when she requests medical treatment or a one-time change, you need not worry if you do not initially set the appointment.  You are still meeting your “reasonable time” rule.  That is, if you provide the list in a reasonable amount of time. 

I think this is a reasonable ruling for a real world scenario.  Keep in mind though, you do not have to provide a list for a one time change  within 5 days or a request of treatment.   If you are going to authorize, just pick the doctor you most feel comfortable with and schedule.  That is the purest way to show you met your statutory requirement.

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