How to Change a Doctor in the Middle of an L&I Claim in Washington State

featured image

Injured workers in Washington State must designate one attending medical provider on their claim. As I've explained previously, the attending provider plays a very important role in workers’ compensation claims. Therefore, I always encourage injured workers to select their attending provider (AP) carefully.

Changing your attending physician in the middle of a claim

For a variety of reasons, an injured worker may need to change attending providers while the claim is open. Sometimes, a current attending provider transfers care to a new attending provider that may be better suited to handle the medical aspects of a claim. However, when current attending providers retire, relocate, or leave a medical practice, injured workers might not have a choice but to find a new attending provider. Sometimes injured workers move and must find a new attending provider. Other times, injured workers simply decide that the attending provider isn't a good fit.

When the change occurs based on a referral from one attending provider to another, the process is often very smooth and easy. However, when an attending provider change is needed for other reasons, then the process can be difficult. Recently, our office has been working to help several injured workers change attending providers due to retirement of the current provider. It has not been easy.

Finding a new medical doctor is not easy

The new attending provider has the right to decide if to accept and assume care of the injured worker. Many providers in L&I's Medical Provider Network (MPN) decline to accept cases that are more than six months old. In some cases the provider is willing to consider the case despite the age. Usually, the provider wants to review claim related medical records before deciding. After review, if the provider decides not to accept the patient, we must begin the process all over again.

As this cycle continues, the injured worker's chance of finding a good fit in a new attending provider declines dramatically. To make matters worse, if the injured worker is unable to find a new attending provider then L&I may threaten to find the injured worker non-cooperative. This can result in termination of benefits under the claim.

Steps and tips for finding a new provider

If you are an injured worker needing to find a new attending provider, here are some tips:

1) As soon as you know that you need a new attending provider, start the search process right away. Keep notes of every step you take to secure a new attending provider;

2) Start by using L&I's Find a Doc. Search all providers in a 15 mile radius from you;

3) Research your options based on the search results: Talk to friends and family, other injured workers, and read online ratings and reviews. Narrow down the list to five or ten providers that seem like a good fit;

4) Gather pertinent information about your claim. Include your claim number, date of injury or manifestation, and current status of your claim. Also include the reason you are looking for a new attending provider;

5) Begin calling the providers on your list to determine if they are accepting new patients. Ask them if they are willing to consider your case. Don't forget to ask what steps you need to take to have them accept you as a new patient;

6) Document which providers you contact and the time and date you contact them. In addition, document their response so that you can provide this information to L&I if needed to prove you are not non-cooperative;

7) Continue to follow through with any providers that may be willing to accept you as a patient. Furthermore, communicate with your claim manger about your progress or any difficulties you experience.

Records and forms

Before accepting injured workers with an existing claim, we find it common for prospective attending providers to ask to review medical records. Sometimes, L&I can give a provider temporary access to view the claim online. However, it is also possible to request a copy of the claim file on CD from L&I or Self-Insured Employer.

Once a new provider agreed to take your case, it is relatively simple to designate that person as your attending provider. One option is to complete the Change a Doc form on the L&I website. This can be done by either the provider or the injured worker. Remember, you'll need to enter the claim number, full name, date of birth, and the date of injury or manifestation. The other option is to complete and submit a Transfer of Care Card to the claim manager.

Leave a Reply

Your email address will not be published. Required fields are marked *