Can A Request For A One Time Change of Physician Be Ambiguous?

We recently obtained a ruling that a request for a one time change of physician contained in a four page Grievance Letter was not clear and unequivocal. The claimant’s attorney argued that the four page Grievance Letter faxed to the carrier was sufficient notice of the request for a one time change, and because the carrier did not provide one, the claimant was free to choose his own physician. The claimant filed a Motion for Summary Final Order arguing that no issue of fact existed because the clamant requested his one time change.

Judge denied the motion and ruled that there were issues of fact as to:

  • whether the four page letter was a good faith attempt to obtain a one time change
  • whether the letter clearly and unambiguously requested a one time change
  •  whether the request for a one time change was a conditional request

So be on the look-out for lengthy letters where in one sentence the claimant seeks a one time change and the rest of the letter seeks benefits already provided or not even applicable to the claim.

James Sullivan v. G4S/Gallagher Bassett Services, Inc., OJCC No. 13-021522MAM

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