Changing Doctors in the Arizona Workers' Compensation System

Choosing your treating physician is a crucial aspect of your recovery in the Arizona workers' compensation system. While you generally have the right to choose your doctor, there are rules and procedures you must follow, especially if you want to change doctors after your initial selection.

Initial Choice of Doctor

• Non-Self-Insured Employers: If your employer is not self-insured, you have the right to choose your treating physician after the initial visit to a doctor selected by your employer. If you return to the employer-selected doctor for a second visit, that doctor becomes your attending physician.

• Self-Insured Employers: If your employer is self-insured and directs care, you are required to see the doctor chosen by your employer. Changing doctors under a self-insured employer's directed care program is more restrictive.

Changing Doctors After Initial Selection

General Rule: You cannot change doctors without written authorization from one of the following:

• Your current attending physician

• The insurance carrier

• The Industrial Commission of Arizona (ICA)

Steps to Request a Change:

1. Obtain Authorization: If you wish to change doctors, first try to get a transfer of care from your current doctor or written authorization the insurance carrier. This is often the simplest way to switch.

2. Apply to the ICA: If your doctor or the carrier does not agree to the change, you can apply to the ICA in writing for approval. You can obtain a request form from the ICA website (www.azica.gov) or request one directly from the ICA.

3. Provide Necessary Information: Your request should include:

   • Your claim information

   • Your signature

   • Names and complete addresses of both the current and the new doctor

   • Reason for the change

4. ICA Review and Decision: The ICA will review your request, contact the carrier and/or the current doctor for their input, and issue an award either approving or denying the change.

Important Points to Consider:

• Do not start seeing the new doctor before the ICA approves your request.  Otherwise, the bills might not be paid.

• You have the right to request a hearing if you disagree with the ICA's award regarding the change of doctor.

• Changing doctors in a self-insured, directed care program is more difficult. The ICA will only approve a change if it finds that your health, life, or recovery is endangered or impaired by continuing with the current doctor.

Additional Considerations for Self-Insured Employers:

• Limited Right to Change: The ICA's authority to approve a change of physician for employees under a self-insured employer's directed care program is limited.

• Grounds for Change: A change is usually only granted if there's reasonable proof that the employee's health or recovery is jeopardized by continuing with the current medical treatment. Lack of confidence in the doctor alone is not sufficient.

• No Retroactive Authorization: The ICA cannot retroactively authorize a change of physician request. You must obtain approval before seeing a new doctor.

Understanding the process and requirements for changing doctors can help ensure a smoother and more effective recovery process under Arizona's workers' compensation system.