92-01-02-38. Changes of health care providers.

1. All changes from one health care provider to another must be approved by the organization. Normally, changes will be allowed only after the injured employee has been under the care of the primary health care provider for sufficient time for the health care provider to complete necessary diagnostic studies, establish an appropriate treatment regimen, and evaluate the efficacy of the therapeutic program.

2. North Dakota Century Code section 65-05-28 governs choice of health care provider. For purposes of this rule, the following are not considered changes of health care provider by the injured employee:

a. Emergency services by a health care provider;

b. Examinations at the request of the organization;

c. Consultations or referrals initiated by the health care provider;

d. Referrals to radiologists and pathologists for diagnostic studies;

e. When injured employees are required to change health care providers to receive compensable medical services or time loss authorization because their health care provider is no longer qualified as a primary health care provider; or

f. Changes of primary health care provider required due to conditions beyond the injured employee's control. This would include when the health care provider terminates practice or leaves the area.

3. The injured employee must be advised when and why a change is denied. The organization reserves the right to require an injured employee to select another health care provider or specialist for treatment:

a. When more conveniently located health care providers, qualified to provide the necessary treatment, are available;

b. When the attending health care provider fails to observe or comply with the organization's rules;

c. When, in a time loss case, reasonable progress toward return to work is not shown;

d. When an injured employee requires specialized treatment, which the primary health care provider is not qualified to render, or which is outside the scope of the primary health care provider's license to practice; or

e. When the health care provider is not qualified to treat each of several accepted conditions. This does not preclude concurrent care when indicated as outlined in section 92-01-02-34.

4. When the organization finds the change of health care provider to be appropriate and has requested the injured employee to change under this rule, the organization may select a new primary health care provider if the injured employee unreasonably refuses or delays in selecting another primary health care provider.

5. The organization in its discretion may authorize a change when it finds that a change is in the best interest of returning the injured employee to a productive role in society.

History: Effective January 1, 1994; amended effective April 1, 1997; January 1, 2000; April 1, 2020; January 1, 2022.

General Authority: NDCC 65-02-08, 65-02-20, 65-05-07

Law Implemented: NDCC 65-02-20, 65-05-07