Keston O. Smith v. US Food Services, Inc. and Sedgwick CMS

Jerry Hayden (Miami, FL) (Workers’ Compensation) The issue addressed at the Final Hearing included the Claimant’s request for a one-time change of provider. On June 5, 2017, the Claimant submitted an initial written request one-time change of PCP/treating physician by fax containing a lengthy narrative that also requested authorization of medical treatment from an alternate specialist, not a clinic, and specifically sought authorization of a physician to replace Dr. Alan Silbert in the specialty of ophthalmology. At the time of the written request, the Claimant had failed or refused to attend the initial appointment with Dr. Silbert. As such, the E/SA denied the request for alternate ophthalmologist. The Claimant ultimately abandoned his request for an alternate ophthalmologist. Thereafter, the Claimant filed several Petition for Benefits seeking authorization of alternate care. The E/SA argued that the language of each of the requests were ambiguous. In response to the last Petition for Benefits filed on January 9, 2018, the E/SA authorized alternate care with Concentra Medical Center. At Final Hearing, the Claimant argued that Claimant was entitled to a physician of his choice because the E/SA had authorized an alternate an occupational clinic rather than identifying a physician by name. The JCC found no legal support for the Claimant’s arguments and noted there was no evidence that the authorized clinic doctors were not of the same specialty as the original clinic doctors. The JCC denied the Claimant’s choice of one-time change providers, along with the claim for attorney’s fees and costs. The Claimant filed a Notice of Appeal.