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Can I choose my own doctor for my L&I claim?

Under the Medical Aid Rules of the Industrial Insurance Act, a person with a workers comp claim may freely choose or find their attending provider. Furthermore, WAC 296-20-065 outlines L&I’s policy for transferring to another provider. With certain exceptions, there’s no reason for a claim manager to deny the request to transfer to a different physician. However, if L&I denies the request, then they must provide the reason for the denial.

Transferring to another doctor or attending provider

As an attorney representing work injury claimants, I work hard to ensure my clients are happy with their attending physician. That means they can treat with a doctor that they choose and are comfortable with. However, as with everything else, nothing is set in stone. There are times when a work injury claimant must transfer to a different attending provider.

Specifically, WAC 296-20-065 allows the Department of Labor and Industries (L&I) or third-party administrator (TPA) to require an attending provider transfer. Explicitly, there are several situations that require transferring to another doctor:
1) If better physicians are available closer to the injured worker, and travel to the current doctor is impacting worker’s recovery.
2) When the current attending provider fails to follow L&I rules or guidelines.
3) If the work injury claimant is temporarily and totally disabled and is not making reasonable progress towards recovery and return to work.
4) The work injury claimant needs special treatment that the current attending physician is unable to render. Alternatively, the treatment may be outside the scope of the provider’s license to practice.

Important final remarks

To summarize, L&I or a third-party administrator can find that a transfer to another provider is necessary. When they do, if the workplace injury claimant fails to change his or her provider, or delays the process, then L&I may select the provider for them. Therefore, it’s very important for people with a workers’ compensation claim to get a good AP from the start. Make sure you are treating with a provider that has the appropriate qualifications and is easily accessible to you. Remember, that person must follow all the rules concerning your L&I claim. Finally, keep in mind that the job of the provider is to implement treatment plans and help you recover and get to maximum medical improvement.

 

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