Below are the Idaho workers’ compensation requirements for physician choice and for changing physicians.
Physician Choice
Idaho Code § 72-432 - Medical services, appliances and supplies — Reports.
(1) Subject to the provisions of section 72-706, Idaho Code, the employer shall provide for an injured employee such reasonable medical, surgical or other attendance or treatment, nurse and hospital services, medicines, crutches and apparatus, as may be reasonably required by the employee’s physician or needed immediately after an injury or manifestation of an occupational disease, and for a reasonable time thereafter.
If the employer fails to provide the same, the injured employee may do so at the expense of the employer.
(2) The employer shall also furnish necessary replacements or repairs of appliances and prostheses, unless the need therefor is due to lack of proper care by the employee.
If the appliance or prosthesis is damaged or destroyed in an industrial accident, the employer, for whom the employee was working at the time of accident, will be liable for replacement or repair, but not for any subsequent replacement or repair not directly resulting from the accident.
(3) In addition to the income benefits otherwise payable, the employee who is entitled to income benefits shall be paid an additional sum in an amount as may be determined by the commission as by it deemed necessary, as a medical service, when the constant service of an attendant is necessary by reason of total blindness of the employee or the loss of both hands or both feet or the loss of use thereof, or by reason of being paralyzed and unable to walk, or by reason of other disability resulting from the injury or disease actually rendering him so helpless as to require constant attendance. The commission shall have authority to determine the necessity, character and sufficiency of any medical services furnished or to be furnished and shall have authority to order a change of physician, hospital or rehabilitation facility when in its judgment such change is desirable or necessary.
(4)
(a) The employee upon reasonable grounds, may petition the commission for a change of physician to be provided by the employer; however, the employee must give written notice to the employer or surety of the employee’s request for a change of physicians to afford the employer the opportunity to fulfill its obligations under this section.
If proper notice is not given, the employer shall not be obligated to pay for the services obtained.
Nothing in this section shall limit the attending physician from arranging for consultation, referral or specialized care without permission of the employer. Upon receiving such written notice, the employer shall render its written decision on the claimant’s request within fourteen (14) days.
If any dispute arises over the issue of a request for change of physician, the industrial commission shall conduct an expedited hearing to determine whether or not the request for change of physician should be granted, and shall render a decision within fourteen (14) days after the filing of the response by the employer.
(5) Any employee who seeks medical care in a manner not provided for in this section, or as ordered by the industrial commission pursuant to this section, shall not be entitled to reimbursement for costs of such care.
(6) No provider shall engage in balance billing as defined in section 72-102, Idaho Code.
(7) An employee shall not be responsible for charges of physicians, hospitals or other providers of medical services to whom he has been referred for treatment of his injury or occupational disease by an employer designated physician or by the commission, except for charges for personal items or extended services which the employee has requested for his convenience and which are not required for treatment of his injury or occupational disease.
(8) The employer or surety shall not be subject to tort liability to any health care provider for complying with the provisions of this law.
(13) An injured employee shall be reimbursed for his expenses of necessary travel in obtaining medical care under this section. Reimbursement for transportation expenses, if the employee utilizes a private vehicle, shall be at the mileage rate allowed by the state board of examiners for state employees; provided however, that the employee shall not be reimbursed for the first fifteen (15) miles of any round trip, nor for traveling any round trip of fifteen (15) miles or less. Such distance shall be calculated by the shortest practical route of travel.
(14) An employee who leaves the locality where employed at the time of the industrial accident, or manifestation of an occupational disease, or the locality in which the employee is currently receiving medical treatment for the injury, shall give timely notice to the employer and surety of the employee’s leaving the locality.
The employer or surety may require the claimant to report to the treating physician for examination prior to leaving the locality, if practical. If an examination by the treating physician is not practical prior to leaving the locality, the employer or surety may assist in arranging an examination by an appropriate physician in the new locality.
After receiving notice of relocation, the employer or surety shall have the same responsibility to furnish care as set forth in subsection (1) of this section.
Change of Physician
JRP RULE 20 - CHANGE OF PHYSICIAN
C. Filing and Service.
1. Any documents required by this rule to be filed and/or served on a party and/or the Commission shall be so filed or served by PDF (*.pdf) email attachment whenever possible. If email is unavailable, documents may be filed or served via fax, mail, or by personal delivery. For all documents transmitted by email or fax, the original document is not required to be sent to the Commission. Copies must be served on all other parties the same day of the transmission. Such documents shall be sent to the last known email, fax, or address of the person receiving the document.
2. Proof of service shall be accomplished by a certificate of service from the serving party indicating the type of document served, the method of service, name and email or address of the person receiving service, and the date the document was either emailed, mailed, faxed, or personally delivered.
3. Service by mail shall be presumed to be accomplished 3 days after the date of mailing, unless otherwise shown by the receiving party.
E. Petition.
In order to request a change of physician within the meaning of Idaho Code § 72-432(4), the employee must serve a Petition on the employer or surety.
The Petition may be served at any time, regardless of whether a complaint has been filed pursuant to JRP Rule 3.A.
If a complaint and answer have been filed and the employer/surety is represented by an attorney, the Petition shall be served on said attorney. A copy of the Petition shall be provided to the Commission. The Petition shall be in writing and submitted in a format substantially similar to the form provided in Appendix 7A.
1. The Petition shall be signed by the employee and shall contain the following information:
a. Name and address of the employee;
b. Name and address of the employer;
c. Name and address of surety (if known);
d. Name and address of current physician;
e. Name and address of physician to whom change is being requested;
f. General information (including date, place, and circumstances of injury/disease);
g. Summary statement of the medical treatment received to date;
h. Reason change of physician is requested; and
i. Dates available for hearing within the next 30 days.
2. The employee may attach to the Petition legible and accurate copies of any documentation supporting the request for change of physician. Whether such documents are accepted into evidence is solely within the discretion of the Commission.
F. Response.
The employer shall respond to the Petition within 14 days from the date of service thereof. The Response shall be in writing and be submitted in a format substantially similar to the form provided in Appendix 7B.
1. The Response shall be signed by the employer and shall contain the following information:
a. Name and address of the employer;
b. Name and address of the surety;
c. Name and address of the employee;
d. Indicate whether the Petition is approved or denied;
e. If denied, for reasons other than that no further medical treatment is reasonable or necessary: (1) a statement of the reasons for the denial; and (2) dates available for hearing within the next 14 days.
2. The employer may attach to the Response legible and accurate copies of any documentation supporting the Response. Whether such documents are accepted into evidence is solely within the discretion of the Commission.
3. If the Petition is approved by the employer, the employer shall provide its Response to the Commission. A copy of the Response shall be served on the employee. The parties shall act in accordance with such approval without further action by the Commission.
4. If a copy of the Petition has been filed with the Commission and is denied by the employer, the employer shall file its Response with the Commission.
A copy of the Response shall be served on the employee. On receipt of the Response, the Commission shall deem the Petition filed and the matter in dispute. However, if the employer denies the Petition on the basis that further medical treatment is not reasonable or necessary, the Commission will dismiss the Petition and notify the employee that the matter must be pursued through the complaint process. 5. Default.
If the employer does not respond within 14 days from the date the petition was received and the employee desires a default order, the employee shall file a written statement that there has been no response to the Petition and attach a copy of the certificate of service of the petition.
On receipt of these documents, the Commission shall issue an order granting the Petition. A copy of the order shall be served by the Commission on the parties.
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