The Full Commission's decision in the case of Carballo-Cruz v. JC Brothers Construction, LLC, JCN: VA00002155780 (March 27, 2025) illustrates the limits of employer's ability to argue the defense of unauthorized treatment. In Carballo-Cruz the employer did not present a panel to the claimant but the claimant did begin treatment with a physician and establish a course of care with that physician. The claimant then decided to abandon care with that physician and selected a different doctor, Dr. Malek, for ongoing treatment. The Deputy Commissioner held that, even though the defendants never provided a panel, the claimant entered a course of treatment with Dr. Hashemi, and no circumstances justified a change from Dr. Hashemi. The Full Commission reversed and disagreed with the Deputy Commissioner.
The Full Commission in reversing the finding of the Deputy Commissioner noted that "[w]here an insurer denies liability and refuses to pay compensation, a claimant is entitled to choose his own physician." In this particular case the employer had accepted a compensable shoulder injury but as observed by the Full Commission "No agreement as to compensability of the injury was ever communicated to the Commission or memorialized in compliance with the Act." Under this set of facts the Full Commission held that the "course of treatment" doctrine that had been relied upon by the Deputy Commissioner was not appropriate.
The key takeaway for the Virginia adjuster is to be reminded that it is very important to communicate to the Commission and/or submit Agreement forms when at least part of the claim is accepted to avoid a situation where the claimant goes and selects his own doctor that will then become the responsibility of the employer.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
