News & Publications

Workers' Compensation Case Watch

In Manion v. Northwestern Regional Adult Detention Ctr., the claimant needed a new physician because her doctor was no longer providing pain management. The employer asked a nurse case manager to find a new doctor for the claimant and to obtain a Functional Capacity Evaluation (“FCE”) from the physician. The nurse got an FCE referral from the new doctor and scheduled the appointment. She told the claimant about the appointment in person and left her several message about it. The claimant said she would not attend and cancelled the FCE.                                                                                                                                   

The defendant filed an Employer’s Application for Hearing alleging refusal of medical treatment because the claimant did not go to the FCE. The Deputy Commissioner denied the Application because the scheduled FCE was not medically necessary treatment. On review, the Full Commission cited the longstanding principal that the claimant’s medical treatment is directed by the treating physician and not the defendants. They noted that a

Workers' Compensation Case Watch

In Umana v. Clark Construction Group, the claimant was injured in a work accident.  The claimant saw a doctor for his work-related injuries.  In his report, the doctor outlined the claimant’s light duty restrictions but also said “there is no light duty work available, so he remains unable to work at this time.”  In his office notes each month, the doctor repeated that because there was no light duty available, the claimant remained unable to work.  The Deputy Commissioner found that the claimant was totally disabled during those periods.

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

By: Eva C. Roffis, Esq.

Often, we find a claim has stalled because the claimant’s treating physician is offering inadequate care. In these situations, either party may seek a change in treating physician.

In Virginia, the circumstances that justify a change in treating physician are as follows:

• Inadequate treatment is being rendered;
• Specialized treatment is needed and is not being provided;
• A lack of progress or improvement of the claimant's condition without any adequate explanation is shown;
• Conventional modalities are not being used;
• No plan of treatment for a long-term disability is established; and 
• The treating physician fails to cooperate with discovery proceedings ordered by the Commission.

Allen & Rocks, Inc. v. Briggs, 28 Va. App. 662, 675, 508 S.E.2d 335, 341 (1998).  It is also worth noting that the party seeking the change in treating physician bears the burden of establishing that a change is warranted. Apple Constr. Corp. v. Sexton, 44 Va. App. 458, 461, 605 S.E.2d 351, 352 (2004). 

A successful change in treating physician application brought by the employer and carrier is illustrated in the case of Hite v. Dupont Cmty. Credit Union, JCN 2251240, 2016 VA Wrk. Comp. LEXIS 49 (Jan. 27, 2016). In this case, the claimant had been treating with her treating physician for almost ten years. The defendants filed an application seeking a change in treating physician on the ground that the claimant had not significantly improved or