Requesting Change of Physicians - Part 2

Sunday, September 29, 2002 | 0

In our last article we took a look at the various elements to review before moving forward with a Petition for Change of Treating Physician. Now we will look at the examiner's workflow and when to file a Petition.

You should be ready with a draft petition within 30 days of knowledge that the primary treating physician (PTP) has twice failed to submit reports per CCR 9785 requirements and/or the treatment is inappropriate (see IMC Guidelines for clues on the reasonableness of the treatment being rendered).

In preparing your Petition, follow these tips:

1) Use the original petition form (DWC 280).

2) Provide evidence (attach documentation to your Petition) that the PTP was notified of the proper reporting requirements prior to the failure to properly report. 3) Attach copies of the two "Duties Letters" sent to the PTP which included the revised CCR 9785 regulation ( Effective 1/1/99).

4) Attach proof that a panel of 5 other doctors was provided prior to filing of the petition.

5) File only the medical reports relevant to the Petition issues.

6) Provide specific arguments, dates and 9785 violations.

7) Send your Petition draft and justification to your legal department and/or defense attorney for review and pre-approval.

Once you have prepared your draft Petition and sent it to Legal for review and approval, mark your calendar's time frames begin to apply, both formal and informal:

1 ) Have your attorney return the Petition draft to you within 5 calendar days of his or her receipt.

2) Prepare the final, approved Petition within 5 calendar days of receipt from Legal. NOTE: The petition must be signed by the Examiner with an original signature.

3) Attach a proof of service.

4) Copies of the petition must also be served on the injured worker and/or representative and the current PTP.

The original Petition must be mailed to:
Administrative Director, Division of Worker's Compensation
P.O.Box 420603
San Francisco, CA,94142

Calendar marking isn't done yet - there are time frames applicable after the Petition has been filed and served.

Within 45 days of receipt of the Petition, the Administrative Director's office must:
Issue a decision granting, denying or dismissing the petition; or
Set the matter before the Administrative Director; or
Refer the matter for hearing and determination by a WCAB judge; or
Issue a notice extending the time period for a decision.

Appeals of the Administrative Director action is governed by WCAB Rules, Section 10950. Any Administrative Director decisions received in Claims should be routed to Legal. Any Appeal of the AD's decision must be filed within 30 days of service of the decision Granting or Denying the Petition. Your Legal department or defense counsel prepares the Appeal so you need to ensure that you timely advise Legal of this need, and provide them with sufficient time to prepare the documents. The Appeal should be filed directly with the appropriate office of the WCAB.

Finally, so DO Not's of appealing Decisions:

1) Do not file the appeal with the Administrative Director or the WCAB Reconsideration Unit in San Francisco.

2) Do not appeal a decision dismissing a petition - Dismissals are a result of improper filing, so re-file the petition.

3) The physician may not appeal the decision of the Administrative Director.

Requesting a change in Primary Treating Physician is a rarely granted remedy, but is warranted when the circumstances in our first article are present. Such Petitions are highly technical, but paying attention to the rules will increase your odds of success.

Author, Cyndi Koppany, is Director of Corporate Training for Cambridge Integrated Services Group, Inc. E-mail her at ckoppany@earthlink.net.