AI Generated Opinion Summaries

This summary was computer-generated without any editorial revision. It is not official, has not been checked for accuracy, and is NOT citable.

Facts

• A worker was injured and sought to change his health care provider (HCP). Approximately two weeks after the injury, the employer/insurer sent the worker a letter, which they claimed confirmed that they had allowed the worker to make the initial selection of his HCP. The worker had already received treatment from Dr. Sanchez, who was then identified in the letter as the worker's chosen HCP.

Procedural History

• [Not applicable or not found]

Parties' Submissions

• Worker-Appellant: Argued for the entitlement to change his HCP based on the employer/insurer's letter, which was claimed to have allowed him the initial choice of HCP.
• Employer/Insurer-Appellees: Contended that their letter fulfilled the legal requirement by indicating that they had decided to allow the worker to make the initial HCP selection and attempted to distinguish their case from a precedent on factual grounds.

Legal Issues

• Whether the employer/insurer's letter to the worker, stating that the worker had already made a selection of his initial HCP, satisfied the statutory and regulatory requirements for informing the worker of his right to choose an initial HCP.

Disposition

• The Court of Appeals reversed the order sustaining Employer/Insurer’s objection to Worker’s notice of change of HCP and remanded for further proceedings consistent with their opinion.

Reasons

• Per LINDA M. VANZI, J. (JAMES J. WECHSLER, J., and MICHAEL E. VIGIL, J., concurring):
  The court found that the employer/insurer's letter did not comply with the statutory and regulatory requirements to inform the worker of his right to make a prospective choice of HCP. The court referenced a similar case, Cribbs v. Coastal Chemical, where a "confirmatory" letter from the employer/insurer was deemed insufficient for the same reasons. The court held that stating a worker has already made a selection does not constitute proper notice that the worker may make a selection. The additional language in the letter, suggesting the worker contact the employer/insurer or an ombudsman if he disagreed, did not fulfill the requirement to inform the worker of his right to choose. The court also dismissed the employer/insurer's argument regarding the nature and extent of treatment received from Dr. Sanchez as immaterial to the employer/insurer's obligation to provide prompt and legally adequate notice of its decision regarding the initial HCP selection. Finally, the court declined the employer/insurer's request to disregard the Cribbs decision, reaffirming its stance on the statutory obligation to provide notice.