Opinion ID: 2102504
Heading Depth: 2
Heading Rank: 2

Heading: Choice of Physician

Text: Velasquez argues that the hearing examiner incorrectly held Lopez to be an unauthorized physician. Under workers' compensation, an employee may only be reimbursed for medical costs associated with a designated treating physician. See D.C.Code § 36-307(a). Though the employee is free to select a physician initially, later changes must be authorized by the employer or the Office of Workers' Compensation in order to maintain coverage. See D.C.Code § 36-307(b)(3), -307(d); 7 D.C.M.R. §§ 212.12-13 (1986); King v. District of Columbia Dep't of Employment Servs., 560 A.2d 1067, 1071 (D.C.1989). The hearing examiner acknowledged that the employer must establish that the claimant was aware of her right to choose, and that the chosen physician and the claimant began a `course of treatment.' Although no party disputes that Chardack was initially a mere referral from Sibley's emergency room, Sibley contends, and the hearing examiner agreed, that Lopez was a physician selected by Velasquez without proper authorization. However, the events that led to Velasquez's treatment with Lopez require careful analysis. As stated previously, an injured employee has the initial right to choose her own treating physician. However, accepting a referral from an emergency room does not constitute a choice of physicians under the workers' compensation act. See Ceco Steel, Inc. v. District of Columbia Dep't of Employment Servs., 566 A.2d 1062 (D.C.1989). Ceco Steel acknowledges the possibility of constructive selection of an emergency room referral physician as a treating doctor if follow-up care extended beyond reasonable limits. Id. at 1064. An extended course of treatment may suggest that Chardack at some point constructively became Velasquez's chosen treating physician. Therefore, as the hearing examiner appropriately noted, it is Velasquez's continued treatment by Chardack after the first evidence of her cognizance of her right to choose her own treating physician that may or may not establish Chardack as the sole authorized treating physician under the Ceco Steel standard. The hearing examiner relied on legal correspondence of October 20, 1995, to establish the point at which Velasquez was on notice of her right to choose, and viewed her continuing relationship with Chardack thereafter as an active choice. [5] This analysis neglects the fact that Sibley viewed Velasquez's attempts to initiate her choice as a request to change physicians, and repeatedly declined to authorize the change. Thus, Velasquez may not have been in a position at that time, based on the incorrect stance taken by her employer and the likely hardships it imposed upon her, to fairly exercise her right to make an initial choice of her treating physician. The hearing examiner himself seems unclear on this point, perhaps conflating the concepts of choosing and changing physicians: Likewise, a review of the record supports the conclusion that the claimant became aware of her right to choose a physician no later than October 20, 1995. In this regard, by letter dated October 20, 1995 addressed to counsel for the claimant, counsel for the employer expressly addressed the change of physician issue. The import of viewing Lopez as a chosen and authorized treating physician is twofold. First, it could affect the disability determination, since medical conclusions of treating physicians are given preference and a decision to credit another physician must be explained. See Canlas v. District of Columbia Dep't of Employment Servs., No. 97-AA-1741, slip op. at 2-3, ___ A.2d ___, ___ _ ___ (D.C. January 14, 1999); Stewart v. District of Columbia Dep't of Employment Servs., 606 A.2d 1350, 1353 (D.C.1992). The hearing examiner's stance on Lopez's status as an unauthorized physician may have colored his conclusions about Velasquez's condition, and led him to discount relevant evidence. Further, payment responsibility for Lopez would shift to Sibley if Lopez were determined to be the first patient-chosen physician, rather than an unauthorized change of physicians. See King, supra, 560 A.2d at 1071 (D.C.1989).