Forcing Reluctant Claimants to Return to the Doctor: WC-PMT(b)

Written by: Ann Baird Bishop, Esq.

Effective July 1, 2017, the State Board of Workers’ Compensation enacted Rule 205(c) in an effort to address complaints regarding claimants’ difficulties in receiving prompt medical attention.  The WC-PMT procedure was enacted to allow injured workers or their lawyers to request that employers/insurers show cause why medical treatment and testing recommended by an authorized treating provider has not been authorized.  The statistics confirm that the WC-PMT has been a resounding success.

On occasion, an injured worker fails to return for authorized treatment or testing.  To allow employers/insurers to combat an employee’s delay in participating  in treatment, in 2019 the State Board of Workers’ Compensation adopted the WC-PMT(b) so that employers/insurers may petition to require the employee to show cause for the failure to attend a medical appointment with an authorized treating physician.  Similar to the WC-PMT, it is necessary, for use of the WC-PMT(b), that the employer/insurer demonstrate that an appointment had been scheduled with an authorized treating physician and that the employee had at least five (5) business days advance notice of the appointment but failed to attend.  The WC-PMT(b) asks the Board to issue a notice of a  telephonic conference, to be scheduled for a date and time not more than five (5) business days from the date of the petition, requiring the employee to show cause why he/she should not be required to attend the missed appointment.

Rule 205(c)(5) has been submitted to the Directors of the State Board of Workers’ Compensation to clarify the procedure required to attempt to compel an injured worker to return for authorized treatment or testing or, in the event of steadfast refusal to do so, to seek suspension of the employee’s disability benefits.  The rule will clarify the procedure which was approved and adopted by the Petition for Medical Treatment B form.

Seeking suspension of disability benefits for failure to attend a medical appointment is a two-step process.  The first step requires filing of section B of the WC-PMT(b).  After the Board issues the notice of telephonic conference, the employee may, in lieu of participation of the telephonic conference, agree to attend the appointment by completing section C of the WC-PMT(b).  If the employee fails to attend the appointment after agreeing to do so or fails to attend the appointment based on an order of the administrative law judge, the employer/insurer may file section D of the WC-PMT(b) requesting another telephonic conference, in accordance with the provisions of Rule 205(c)(3), seeking to have the employee show cause why his/her disability benefits should not be suspended.  If the administrative law judge issues an interlocutory order suspending disability benefits for failure to attend a medical appointment, the employee may request a hearing within 20 days from the date of the order.  The hearing request will act as a supersedeas, just as it does where the employer/insurer oppose an order directing authorization of treatment.

It is hoped that the WC-PMT(b) procedure will further the goal of the Workers’ Compensation Act of providing prompt medical treatment so that injured workers can recover and return to work.