How to Change a Doctor in the Middle of an L&I Claim in Washington State

As Seattle workers' compensation attorneys, we frequently help injured workers who need to change their doctor during an ongoing L&I claim. While Washington State law allows you to choose your medical provider, making a switch mid-claim can be complex and overwhelming without proper guidance. You need to understand this process in order to maintain your benefits and ensure continuity of care.

Importance of Your Attending Medical Provider

Every injured worker in Washington State must designate one attending physician to oversee their workers' compensation case. This medical provider serves as the cornerstone of your claim, making critical decisions about your treatment plan, work restrictions, and overall claim progression. They communicate directly with L&I, your employer, and other parties involved in your case, making their role essential to your recovery and benefits.

Common Scenarios Leading to Provider Changes

There are numerous situations where you might need to switch doctors during your L&I claim. Sometimes, your current provider may retire, relocate, or leave their medical practice altogether. In other cases, you might move to a different area and need a provider closer to home. There can also be patients whose medical needs have evolved, requiring a different physician with specialized expertise.

When your current provider directly refers you to a new doctor, the transition usually proceeds smoothly. However, making a change for other reasons can pose difficulties. Our office can assist injured workers who struggle to find new providers, especially when their original doctor retires or closes their practice.

Challenge of Finding a New Doctor in the Middle of an L&I Claim

One of the most significant hurdles in changing providers is finding a new doctor willing to accept your case. Many medical providers within L&I's Medical Provider Network (MPN) hesitate to take on patients whose claims are more than six months old. Even when providers consider accepting new patients with existing claims, they typically require a thorough review of medical records before making their decision.

This creates a challenging cycle: you search for a provider, they review your records, and if they decline, you start the process over. Each rejection further narrows your options, and without proper documentation of your search efforts, L&I might question your cooperation—potentially putting your benefits at risk.

Strategic Approach to Changing an Attending Provider for an L&I Claim

Here's an effective strategy for changing doctors:

1. Early Action and Documentation

Time is critical when you need to change providers. As soon as you know you'll need a new doctor, begin your search process immediately. Document every single step you take along the way. Keep a detailed log of your efforts, including the date and time of each attempt to find a new provider, along with their response. This documentation serves as crucial evidence of your cooperation if L&I ever questions your efforts to secure a new doctor.

2. Systematic Provider Search

Your search should begin with L&I's Find a Doc tool. Focus on identifying all providers within a 15-mile radius of your location. This initial search creates your foundation for finding potential doctors. While the distance might seem extensive, having a broader search area increases your chances of finding a provider willing to accept your case. Remember that limiting your search too narrowly might eliminate potentially excellent providers who are just a few miles further.

3. Thorough Research

Once you have your initial list of providers, invest time in researching each one thoroughly. Start by reading online reviews and ratings from other patients. Reach out to friends and family members who might have experience with these doctors. Pay particular attention to any mentions of experience with workers' compensation cases, as this expertise is invaluable. Consider practical factors such as the office location, parking availability, and accessibility via public transportation if needed.

4. Information Organization

Before you start contacting medical offices, organize all essential information about your claim into an easily accessible format. You'll need your L&I claim number, the exact date of your injury or condition manifestation, and your current claim status. Prepare a clear, concise explanation of why you're seeking a new provider. Create a brief summary of your medical history related to the claim, including any significant treatments or procedures you've undergone. Having this information readily available makes the process more efficient and demonstrates your professionalism to potential providers.

5. Strategic Provider Contact

When you begin reaching out to medical offices, approach each contact with a clear strategy. Start the conversation by explaining that you're an injured worker with an active L&I claim seeking to transfer care. Ask specifically about their experience handling L&I cases and their current capacity for accepting transfer patients. Be prepared to explain your situation concisely and professionally. Make note of the name of each person you speak with and their role in the office. Pay attention to any specific requirements or preferences they mention about accepting transfer patients.

6. Persistent Follow-Up

For medical offices that show interest in accepting your case, maintain consistent and professional follow-up communication. If they request medical records for review, ensure prompt delivery of these materials. Stay in regular contact with the office during their review process, but be mindful of giving them reasonable time to evaluate your case. Keep detailed notes of every interaction, including who you spoke with and what was discussed.

7. Claim Manager Communication

Throughout your search for a new provider, maintain regular communication with your L&I claim manager. Send updates about your progress, including information about which providers you've contacted and their responses. If you're facing difficulties finding a new provider, inform your claim manager promptly and provide documentation of your search efforts. When you do find a willing provider, notify your claim manager immediately and ask about any specific forms or documentation needed to formalize the transfer of care. This consistent communication helps prevent any misunderstandings about your cooperation with the claim process.

Medical Records and Documentation When Changing a Doctor for an L&I Claim

Most new providers will want to review your medical records before accepting you as a patient.

There are several ways to facilitate this review:

• Request temporary online claim access for the provider through L&I.
• Obtain a CD copy of your claim file from L&I or your self-insured employer.
• Work with your current provider's office to transfer relevant records.
• Organize your personal copies of medical documentation.

Once you find a new provider willing to accept your case, you'll need to officially designate them as your attending physician. This can be done either through L&I's online Change a Doc form or by submitting a Transfer of Care Card to your claim manager.

Conclusion

Changing doctors during your L&I claim doesn't have to be overwhelming. While it requires diligence and careful documentation, the process is straightforward: find a provider in the L&I network, get your medical records transferred, and make it official through L&I's system.

If you're finding it difficult to connect with a new attending provider or facing pushback from L&I, remember you don't have to deal with this alone. Contact Lehmbecker Law today — our professional team of Seattle workers' compensation lawyers is here to help protect your right to quality medical care and keep your claim on track.