JCC Lets Claimant Choose Doctor After Carrier Misses Five-Day Change Deadline

In Washington Diez v. American Airlines/Sedgwick CMS, OJCC Case No. 19-015940JIJ, the claimant sought authorization of an alternate primary care provider of his choosing after the carrier did not respond within five days to his February 26, 2025 request for a one-time change of physician from Premise Health.

Judge Jeffrey I. Jacobs granted the claim under section 440.13(2)(f), finding the employer and carrier lost control of physician selection when they missed the statutory deadline. The order rejected defenses of acquiescence, estoppel, waiver, unclean hands, medical necessity, causation, and lack of treatment-course status, and it held that the claimant did not acquiesce by showing up for an appointment where Dr. San Miguel never actually examined him.

The practical takeaway is that a missed five-day response window can vest the claimant with the right to choose the alternate doctor, and later authorization efforts may not undo that result unless the facts show the claimant truly accepted the carrier’s selection.

Source: Compensation Order