Narrative Opinion Summary
In a worker's compensation dispute, the appellant-employer challenged the authorization of a physician change for the appellee-employee without prior notice, and the subsequent payment of medical claims. Following an injury, the appellee received treatment in Utah and Casper, Wyoming, but sought a new physician due to dissatisfaction with initial care. The district court approved the appellee's request to consult Dr. Fred W. Schoonmaker, despite the employer's appeal citing Wyoming Statute 27-12-401(b), which mandates employer notification before payment but does not explicitly require notice for changing physicians. The court affirmed payments for services from Dr. Schoonmaker and authorized specialists but reversed payments for claims related to Dr. Glen L. Loveday, Jr., Dr. Charles F. McMahon, and certain hospital and pharmacy expenses. These claims were remanded for disapproval, as they were not sanctioned under the court's order. The case underscores the procedural requirements for changing medical providers under the Wyoming Worker’s Compensation Act and the necessity for court approval in such matters, ensuring compliance with statutory regulations governing employer and employee rights in compensation claims.
Legal Issues Addressed
Notice Requirement for Change of Physiciansubscribe to see similar legal issues
Application: The employer argued it was entitled to prior notice and an opportunity to contest a change in the employee's physician; however, the statute does not explicitly require such notice.
Reasoning: Appellant argues it was entitled to notice of a change in physician and the chance to object, citing W.S. 27-12-401(b), which mandates employer notification and a hearing before payment for medical services. The statute, however, does not explicitly require notice for changes in physicians.
Payment Authorization for Medical Servicessubscribe to see similar legal issues
Application: The court authorized payment for medical services from Dr. Schoonmaker and related specialists, but not for other services unauthorized by the court order.
Reasoning: Consequently, payments for their claims are deemed appropriate. However, a referral from Dr. Schoonmaker to Dr. Loveday did not meet the criteria for a 'specialist' referral as required, and the court order's exclusivity prevents Dr. Schoonmaker from delegating the attending physician role to others.
Reversal of Improper Medical Claimssubscribe to see similar legal issues
Application: Specific claims not meeting the criteria established by the court and regulations were reversed and remanded for disapproval.
Reasoning: The court reverses its order regarding these claims and remands the case with instructions to disallow them as improper for payment with worker’s compensation funds.
Right to Choose Physician under Worker’s Compensationsubscribe to see similar legal issues
Application: The appellee had the right to select a new physician following inadequate relief from the initial treatment, provided the change was approved by the court.
Reasoning: In his request to change physicians to Dr. Schoonmaker, the claimant acknowledged the Worker’s Compensation Department's rules, stating that he could not change physicians without court permission unless he bore the costs himself.