A Guide to Handling Referrals from the ATP

By: Ben McClure

In terms of exposure in a claim, nothing holds a candle to the potential exposure generated by a claimant’s medical treatment. Indeed, maintaining control over the claimant’s medical treatment is one of the primary keys to mitigating exposure. The first element of maintaining control over a claimant’s medical treatment is ensuring you have a valid posted panel of physicians, have posted the panel in prominent places on your business premises, and have taken measures to ensure your employees understand the purpose and function of the panel. Having taken care of these items, you are confident at the outset the claimant’s medical treatment will not spiral out of control. Then, while the claimant’s treatment is rocking along, the authorized treating physician (ATP) may ultimately issue a referral to another physician. With the referral in hand, what should you do now? For the answer to this question, and more, let us see how the venerable Captain Jean-Luc Picard handled such a situation.

During an Away Team mission on the Planet Janus VI, Commander Will Riker is struck in the head and neck by a large rock. Once the Away Team beams back to the Enterprise, Riker reports his injury to his supervisor, Captain Picard, and requests medical treatment. Fortunately, Captain Picard is well-versed in the Starfleet regulations regarding the procedures for handling a reported on-the-job injury. Captain Picard takes Riker to his Ready Room, where he provides Riker with a copy of Starfleet’s posted panel of physicians for that sector. From the panel, Riker chooses to treat with Dr. Beverly Crusher, which is fortunate, since Dr. Crusher has an office on the Enterprise. Following Riker’s selection, Captain Picard notifies the Starfleet claims adjuster, who arranges for Riker’s initial appointment with Dr. Crusher as the initial authorized treating physician for Riker’s claim.

Upon examining Riker, Dr. Crusher notes he has sustained a large laceration to the back of his head and notes Riker is complaining of headaches. Further, Riker is complaining of neck pain, asserting the rock hit his head and neck. While Dr. Crusher is more than qualified to treat Riker’s alleged neck pain, she feels he may benefit from being examined by a different physician for his headaches. Dr. Crusher then issues a referral to an unspecified neurologist for examination and treatment of Riker’s headaches.

As is often the case in our claims, now that Dr. Crusher has issued a referral to an unspecified provider, what should the Starfleet claims adjuster do? More often than not, Riker would be provided a copy of the posted panel of physicians again and asked to select a neurologist therefrom. Like many of our posted panels of physicians, however, there are no neurologists listed on this panel. Is all hope lost at this point, with Riker being able to treat with a neurologist of his choosing? Does the lack of a neurologist on the panel invalidate the posted panel of physicians? Are we now forced to try and reach a compromise with Riker and/or his attorney? Fortunately, the answers to these questions are a resounding “NO.”

The purpose of the posted panel of physicians is to allow the claimant to select the initial authorized treating physician (ATP). O.C.G.A. § 34-9-201. Once the ATP is selected, that physician “…may arrange for any consultation, referral, and extraordinary or other specialized medical services as the nature of the injury shall require…” Id. Thus, Captain Picard and the Starfleet claims adjuster are arguably bound to honor the referral. However, because Dr. Crusher did not refer Riker to a specific provider, Captain Picard and the claims adjuster are free to schedule Riker with a neurologist of their choosing without regard to Riker’s wishes. There is no statutory requirement that Riker be provided with a copy of the panel of physicians and be allowed to select the referral physician. Indeed, the only times a claimant should be presented with a copy of the posted panel of physicians are immediately following an accident and when the claimant requests a change of physician.

So, the next time you run into a situation wherein the ATP has issued a referral, just remember, you are still in control. Simply select a referral physician of your choosing, or consult with your friendly neighborhood Swift Currie attorney, and continue on with your mission to explore strange new worlds, to seek out new life and new civilizations and to boldly go where no one has gone before.

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Ben McClure

There is no statutory requirement that Riker be provided with a copy of the panel of physicians and be allowed to select the referral physician.
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