Ariz. Admin. Code § 20-5-113

Current through Register Vol. 30, No. 50, December 13, 2024

Section R20-5-113 - Physician's Duty to Provide Signed Reports; Rating of Impairment of Function; Restriction against Interruption or Suspension of Benefits; Change of Physician

A. If a claimant's disability extends beyond seven days, every physician who attends, treats, or examines the claimant shall provide to the insurance carrier, self-insured employer, or special fund division, at least once every 30 days while the claimant's disability continues, a personally signed report describing the:

1. Claimant's condition,

2. Nature of treatment,

3. Expected duration of disability, and

4. Claimant's prognosis.

B. When a physician discharges a claimant from treatment, the physician:

1. Shall determine whether the claimant has sustained any impairment of function resulting from the industrial injury. The physician should rate the percentage of impairment using the standards for the evaluation of permanent impairment as published by the most recent edition of the American Medical Association in Guides to the Evaluation of Permanent Impairment, if applicable; and

2. Shall provide a final signed report to the insurance carrier, self-insured employer, or special fund division that details the rating of impairment and the clinical findings that support the rating.

C. A carrier, self-insured employer, and special fund division shall not interrupt or suspend a claimant's temporary disability compensation benefits because a physician fails to comply with any requirement of subsection (A).

D. A carrier, self-insured employer, and special fund division may withhold payment to a physician for services rendered to a claimant until the physician complies with subsection (A).

E. Upon application of a party, the Commission shall authorize a change of physician if:

1. The Commission determines that the health, life, or recovery of a claimant is retarded, endangered, or impaired;

2. The attending physician agrees to the change or is unavailable to continue treatment;

3. The Commission determines that the relationship between the attending physician and claimant renders further progress or improvement unlikely;

4. The Commission determines that the claimant's recovery may be expedited by a change of physician or conditions of treatment; or

5. The insurance carrier agrees to the change.

F. Except as provided in A.R.S. § 23-1070 and this subsection, a claimant who is examined by a physician under A.R.S. § 23-908(E) is not required to obtain written authorization to change to another physician. If, however, the claimant continues to see, or treat with, a physician who the claimant initially saw or treated with under A.R.S. § 23-908(E), then that physician is an attending physician and the claimant shall obtain written authorization to change under A.R.S. § 23-1071(B) if the claimant seeks to change to another physician.

Ariz. Admin. Code § R20-5-113

Former Rule 13. Amended effective March 1, 1987, filed February 26, 1987 (Supp. 87-1). R20-5-113 recodified from R4-13-113 (Supp. 95-1). Amended by final rulemaking at 7 A.A.R. 3966 and 7 A.A.R. 4995, effective August 17, 2001 (Supp. 01-3).