§ 11-9-514 — Medical services and supplies - Change of physician

Arkansas § 11-9-514

• Jurisdiction: Arkansas
• Title: 11

Text

(a) (1) If the employee selects a physician, the Workers' Compensation Commission shall not authorize a change of physician unless the employee first establishes to the satisfaction of the commission that there is a compelling reason or circumstance justifying a change. (2) (A) If the employer selects a physician, the claimant may petition the commission one (1) time only for a change of physician, and if the commission approves the change with or without a hearing, the commission shall determine the second physician and shall not be bound by recommendations of claimant or respondent. (B) However, if the change desired by the claimant is to a chiropractic physician, optometrist, or podiatrist, the claimant may make the change by giving advance written notification to the employer or carrier. (3) Following establishment of an Arkansas managed care system as provided in § 11-9-508, subdivisions (a)(1) and (2) of this section shall become null and void, and thereafter: (A) (i) The employer shall have the right to select the initial primary care physician from among those associated with managed care entities certified by the commission as provided in § 11-9-508 . (ii) Where the employer has contracted with a managed care organization certified by the commission, the claimant employee, however, shall be allowed to change physicians by petitioning the commission one (1) time only for a change of physician to a physician who must either be associated with the managed care entity chosen by the employer or be the regular treating physician of the employee who maintains the employee's medical records and with whom the employee has a bona fide doctor-patient relationship demonstrated by a history of regular treatment prior to the onset of the compensable injury but only if the primary care physician agrees to refer the employee to the managed care entity chosen by the employer for any specialized treatment, including physical therapy, and only if the primary care physician agrees to comply with all the rules, terms, and conditions regarding services performed by the managed care entity chosen by the employer. (iii) Where the employer does not have a contract with a managed care organization certified by the commission, the claimant employee, however, shall be allowed to change physicians by petitioning the commission one (1) time only for a change of physician, to a physician who must either be associated with any managed care entity certified by the commission or be the regular treating physician of the employee who maintains the employee's medical records and with whom the employee has a bona fide doctor-patient relationship demonstrated by a history of regular treatment prior to the onset of the compensable injury, but only if the primary care physician agrees to refer the employee to a physician associated with any managed care entity certified by the commission for any specialized treatment, including physical therapy, and only if the primary care physician agrees to comply with all the rules, terms, and conditions regarding services performed by any managed care entity certified by the commission. (B) A petition for change of physician shall be expedited by the commission. (b) Treatment or services furnished or prescribed by any physician other than the ones selected according to the foregoing, except emergency treatment, shall be at the claimant's expense. (c) (1) After being notified of an injury, the employer or insurance carrier shall deliver to the employee, in person or by certified or registered mail, return receipt requested, a copy of a notice, approved or prescribed by the commission, which explains the employee's rights and responsibilities concerning change of physician. (2) If, after notice of injury, the employee is not furnished a copy of the notice, the change of physician rules do not apply. (3) Any unauthorized medical expense incurred after the employee has received a copy of the notice shall not be the responsibility of the employer. (d) A request for a hearing on a change of physician by either the employer or the injured employee shall be given preference on the commission's docket over all other matters. (e) Cooperation on the part of both the injured employee and the employer in an effort to select another physician is encouraged. (f) When compensability is controverted, subsection (b) of this section shall not apply if: (1) The employee requests medical assistance in writing prior to seeking the same as a result of an alleged compensable injury; (2) The employer refuses to refer the employee to a medical provider within forty-eight (48) hours after a written request as provided above; (3) The alleged injury is later found to be a compensable injury; and (4) The employer has not made a previous offer of medical treatment. (g) The commission shall by rule require the inclusion of the information set forth in subsection (f) of this section on all AR-P forms.

Legislative History

Amended by Act 2019, No. 315,§ 792, eff. 7/24/2019. Init. Meas. 1948, No. 4, § 11, Acts 1949, p. 1420; Acts 1975, No. 330, § 1; 1979, No. 253, § 3; 1981, No. 290, § 3; 1983, No. 444, § 2; A.S.A. 1947, § 81-1311; Acts 1993, No. 796, § 20; 1999, No. 1167, § 1.