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Workers' Compensation

Improper Use of 1010 Form For Physician Referral

Improper Use of 1010 Form For Physician Referral
Keith-J-Landry Co-Authored By Keith J. Landry Partner, Lafayette

As anyone who has practiced or worked in the area of Louisiana Workers Compensation can attest, there are an abundance of state forms. Each form has a specific purpose and exists to create a streamlined approach for how each claim is handled through resolution.

However, an increasingly frustrating and confusing misuse of the 1010 Form has caused not only inconvenience for all parties involved but even warranted a pointed bulletin from The Office of Workers’ Compensation Administration a few years ago. For reasons that remain unknown, it has become all too common practice for the injured worker’s treating physician to refer the injured worker to another physician, in a different field or specialty, using the 1010 Form.

The Louisiana Workers Compensation act provides that an injured worker is afforded his or her choice of physician in any field or specialty without the necessity of prior approval for the evaluation, with the only requirement that the treatment be medically necessary per La. R.S. § 23:1203(A).

As anyone who is familiar with the 1010 form can explain, it is to be used by an injured worker’s treating physician to request authorization for medical treatment or testing. When used correctly, the requesting physician will complete the form and indicate what treatment (office visits, procedures, injections, etc.) or testing (x-rays, MRI, EKG, etc.) needs approval, often attaching medical records in support of their request.

The employer, or its insurer/claims administrator, upon receiving the request then has the opportunity to approve, deny, or approve with modification. The employer has the opportunity to review the form and records submitted by the requesting physician and may choose to obtain another opinion from its own physician through a utilization review process.

However, many treating physicians are sending a 1010 Form to the employer requesting approval for an injured worker to treat with another physician, in a different field or specialty. This often occurs for example, when a primary care physician refers an injured worker to see an orthopedic surgeon, or when an orthopedic refers an injured worker to see a pain management specialist.

Using the 1010 Form to request treatment with another physician illustrates a fundamental misunderstanding of the purpose of the 1010 Form, which is to obtain authorization and approval. The Louisiana Workers Compensation Act does not require prior approval for an injured worker to have an initial evaluation with their choice of physician. When the 1010 Form is used for a referral, there is no medical treatment or testing actually requested, therefore, there is nothing that requires approval causing problems for the employer in how to appropriately respond.

If the employer responds with approval, then they are perpetuating the misuse of the form and approving something it cannot under the act. If the employer responds with a denial without just explanation, or does not respond at all, the injured worker may be able to file an appeal to the medical director or a 1008 disputed claim for compensation with the court and expose the employer to liability for penalties and attorney’s fees (albeit both options for recourse based on error and likely not ultimately justiciable).

In order for the employer to be as clear as possible in its response, the recommended response to a 1010 Form request for an injured worker to see another physician is to:

  1. Send written correspondence to the requesting physician’s office stating that the 1010 Form is inappropriate to request a referral to another physician,
  2. Send written correspondence to the injured worker (or his or her attorney) informing them that the new physician will be approved for treatment related to this accident only once the injured worker executes and submits an 1121 Choice of Physician Form selecting said physician as his or her choice in that specialty, and
  3. Respond to the 1010 Form indicating “denied” for “inappropriate use of 1010 Form.”

This way all parties are placed on notice that the request was received, but that it cannot be approved as requested as no approval is mandatory and additional documents are required. This also serves the benefit of obtaining the 1121 Choice of Physician Form prior to the injured worker’s initial evaluation with any new physician.

This clear response will diminish almost any possibility of a potential appeal to the medical director or the right of an injured worker to file a 1008 disputed claim for compensation based upon a choice of physician issue.

Allen & Gooch is providing this legal update for informational purposes only. This article should not be construed as legal advice or a legal opinion as to any specific facts or circumstances. You should consult your own attorney concerning your particular situation and any specific legal questions you may have.