Employers Cannot Expressly Limit Authorized Doctor's Ability to Make a Referral
Ex parte City of Prattville:
On September 10, 2010, the Alabama Court of Civil Appeals considered the issue of whether an employer can limit an authorized treating physician’s ability to make referrals to other doctors. The trial court had ordered pendente lite (while the litigation is pending) medical treatment for the employee. The employer then petitioned the Court of Civil Appeals for a writ of mandamus ordering the trial court to vacate its order. In support of its petition, the employer stated that several doctors had been authorized for purposes of treating the employee. When the employee became dissatisfied with the treatment of his authorized doctors, he sought treatment from his own doctor. When his personal doctor made a surgical referral to Dr. Ryan, the employer refused. The employee went to see Dr. Ryan anyway and surgery was recommended. The employee then went to the authorized treating physician and requested a referral to Dr. Ryan. The authorized physician made the referral because he felt Dr. Ryan was the best available surgeon and the employer refused. Of the several reasons set forth for the refusal was the fact that it had specifically limited its authorized doctor from making referrals without permission from the employer. Therefore, it was the employer’s argument that no such referral could have taken place. The Court disagreed that the employer had such power and cited a prior case (Overnight Transportation Co. v. McDuffie) wherein it stated: "Once (a) physician has been selected by the employer, that physician has the implied authority to refer the employee to a specialist for reasonably necessary medical treatment, and the referred specialist thereby becomes an authorized physician." As a result, the employers petition was denied.
The employer waived its compensability and causation defenses which is why an order compelling medical treatment was allowed without a full scale trial on these issues.
MY TWO CENTS:
It is important to note that it was the authorized treating doctor’s opinion that Dr. Ryan was the best available surgeon for the job. Because of this affirmation, the Court refused to address the issue of what would happen if an authorized doctor simply rubber stamped a specific referral request from a patient/employee. It is the humble opinion of the lawyers at this firm that an authorized doctor needs to have a medically necessary reason for making a specific referral. Without such a reason, the decision should revert back to the employer as the Alabama Workers’ Compensation Act intended (see §25-5-77).