Workers' Compensation Case Watch
In Clarke v. Hughes Center, LLC., the claimant established a treating physician relationship with a pain management doctor in Danville, VA. The claimant later moved out of state, but continued having appointments with the same treating physician. The claimant was traveling 320 miles round-trip to see the doctor. The defendants filed an Employer’s Application for Hearing seeking a change in treating physician. The Deputy Commissioner denied the Employer’s Application.
On review, the Full Commission listed the six-factors it considers to justify a change in treating physician: 1) inadequate treatment is being rendered; 2) a specialist’s treatment is needed but is not being provided; 3) a lack of improvement in the claimant’s health condition is without sufficient explanation; 4) conventional methods of treatment are not being used; 5) there is not a plan of treatment in long-term disability cases; and 6) the physician fails to cooperate with discovery proceedings as ordered by the Commission. The Commission found that the defendants did not present sufficient evidence of any of these factors to justify a change in doctors.
However, the Commission found that the 320-mile round trip to see the doctor was unreasonable. Because the distance was unreasonable, the Commission exercised its discretion to order the claimant to select a new treating physician from a defendant-provided physician panel or accept a reduced mileage reimbursement for her trips to her doctor. If the claimant chose to continuing seeing the same treating physician, the defendants would be responsible for paying mileage based on the distance for a round-trip between her previous home and the doctor’s office.
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Jessica Hacker Trivizas is a litigator who focuses her practice on workers’ compensation, defending employers and carriers at the trial and appellate levels. She works with insurance carriers, third-party administrators, and self-insureds. Jessica worked on some of the largest settlements in the country, including the historic NFL Concussion Settlement Program, the BP Oil Spill settlement, and the Reglan/MCP Settlement Program. Her background on these mass claims resolution programs gives her unique insight into the work of claims adjusters.