AWCA § 56(B): One Mandatory Change of Treating Physician, Additional Changes Permitted at the ALJ’s Discretion

Introduction

In ST. ANTHONY v. GOODWIN and the WORKERS’ COMPENSATION COMMISSION (2026 OK 3), the Oklahoma Supreme Court resolved a recurring dispute under the Administrative Workers’ Compensation Act (AWCA): whether 85A O.S.Supp.2013 § 56(B) limits a claimant to a single change of treating physician per claim. The employer (St. Anthony South Behavioral Health and its own-risk administrator) argued the statute authorizes only one change total. The claimant (Monica Moreno Goodwin) contended the statute guarantees one automatic change and does not bar additional changes when needed to secure treatment.

The conflict arose after the claimant suffered admitted compensable injuries (right shoulder and neck), later litigated a consequential right-arm condition (cubital tunnel syndrome), and then sought a further physician change for the right arm when the employer-designated physician released her without treatment. The Court of Civil Appeals (COCA) reversed the Commission, reading § 56(B) as “one change per case.” The Supreme Court granted certiorari to decide the statutory question.

Summary of the Opinion

The Supreme Court held that ordering more than one change of treating physician per claim does not violate 85A O.S.Supp.2013 § 56(B). The Court concluded:

  • § 56(B) makes the first change of treating physician mandatory upon the employee’s application (“shall order one change”).
  • § 56(B) is silent about subsequent change requests and contains no numeric cap “per claim” or “per body part.”
  • Because of that silence, decisions on additional changes fall within the ALJ/Commission’s authority and discretion under the AWCA.
  • COCA’s reliance on Small v. Applied Home Solutions was misplaced because that case interpreted a repealed statute with materially different limits.

Disposition: Certiorari previously granted; COCA vacated; the Workers’ Compensation Commission affirmed.

Analysis

1) Precedents Cited

Standard of review and statutory interpretation framework

  • Legarde-Bober v. Okla. State Univ. and Patterson v. Sue Estell Trucking Co.
    The Court cited these decisions for the proposition that statutory interpretation is a question of law reviewed de novo—plenary, independent, and non-deferential. This mattered because COCA and the Commission read § 56(B) differently; the Supreme Court treated the issue as purely legal.
  • Rickard v. Coulimore
    Used to restate the “fundamental purpose” of construction—ascertain legislative intent—beginning with the statutory text, applying plain meaning if unambiguous, and resorting to other rules only if ambiguity or conflict prevents discerning intent from the words.
  • Thurston v. State Farm Mut. Auto. Ins. Co. (quoting Heath v. Guardian Interlock Network, Inc.)
    These cases anchor a textualist presumption: the Legislature “expressed its intent and intended what it expressed.” The Court relied on this to reject adding an implied “one total change” limitation not found in the text of § 56(B).

Strict construction under the AWCA

  • Brown v. Claims Mgmt. Res.
    Cited in a footnote to note that when a statute’s meaning is ambiguous, AWCA provisions are to be strictly construed. Importantly, the Court’s holding did not turn on expanding § 56(B) by implication; it turned on the absence of an express cap and the allocation of authority elsewhere in the Act.

Agency authority and discretion

  • Robinson v. Fairview Fellowship Home for Senior Citizens, Inc.
    Quoted for the Commission’s quasi-judicial role: investigating and ascertaining facts, drawing conclusions, and exercising discretion of a judicial nature in administering matters entrusted to it. This supported the Court’s conclusion that, where § 56(B) is silent, the ALJ/Commission may decide additional change requests.

COCA’s reliance rejected

  • Small v. Applied Home Solutions
    The Supreme Court explained COCA’s reliance was “misplaced” for two reasons: (1) Small construed the former Workers’ Compensation Code’s physician-change provision, not the AWCA; and (2) the Legislature could not be presumed to have adopted Small when it repealed and replaced the Code in 2013—one month before COCA decided Small.

2) Legal Reasoning

A. The text of § 56(B) creates an automatic entitlement to a first change

The Court reads the command that the Commission “shall order one change of treating physician” as a mandatory grant of the first application. From this, the Court draws operational consequences: no evidentiary showing is required, the employer may not object to the first change, and the ALJ has no discretion to deny it. This is a strong clarification of the “Form A” mechanism in non-certified workplace medical plan claims: the first change is not a contested matter; it is an entitlement.

B. Silence on later changes is not a hidden prohibition

The core interpretive move is the Court’s treatment of statutory silence. Section 56(B) “does not address subsequent applications,” and it does not:

  • cap the number of applications that may be filed,
  • cap the number of changes per claim,
  • cap the number of changes per injured body part, or
  • set a “one per body part” rule.

The Court refuses to infer a numeric limitation simply because the statute guarantees “one” change. In the Court’s view, “one change” answers only the question whether the first application must be granted; it does not answer whether later applications are forbidden.

C. The repealed Code demonstrates the Legislature knew how to impose numeric limits—and chose not to

The opinion contrasts § 56(B) with the repealed provision 85 O.S.2011 § 326(E), which expressly addressed: one change “for any affected body part,” a maximum of two changes per claim, time-without-care limits, and hearing procedures upon objection. By highlighting those missing features, the Court applies a classic textual inference: when earlier law contained explicit limitations and the replacement law omits them, courts should be cautious about re-inserting the omitted limits judicially.

D. Residual authority rests with the ALJ/Commission, subject to ordinary review

Having rejected an implied cap, the Court explains where the decision-making power goes: to the Commission/ALJ under 85A O.S.Supp.2013 § 27(A) (“full power and authority to determine all questions in relation to claims”). The Court then emphasizes accountability: an ALJ’s decision on an additional change can still be appealed and reviewed under 85A O.S.Supp.2013 § 78(C) and related standards (e.g., clearly erroneous, arbitrary/capricious, error of law).

3) Impact

Practical effects on medical management in AWCA claims

  • Employers/insurers: lose a bright-line “one change only” defense. They must instead litigate additional change requests on the merits (necessity, reasonableness, access to treatment, compliance with prior orders), knowing the ALJ has discretion.
  • Claimants: gain a clearer pathway to seek a new treating physician when the designated physician effectively provides no treatment, when body-part-specific treatment becomes necessary, or when a consequential condition is later adjudicated compensable.
  • ALJs/Commission: receive an express endorsement of discretionary authority for subsequent requests, which may lead to more frequent evidentiary hearings focused on whether an additional change is warranted rather than whether it is categorically barred.

Doctrinal effects

  • Textualism and omission-based reasoning: The comparison to repealed 85 O.S.2011 § 326(E) signals that limits must be express. Future AWCA disputes may turn on whether the Legislature included (or omitted) detailed procedural/quantitative constraints.
  • Reduced force of pre-AWCA physician-change case law: By distinguishing Small v. Applied Home Solutions, the Court warns against importing interpretations from the repealed Code into the AWCA when the statutory text is materially different.

Likely future litigation questions left open

The Court deliberately does not define a substantive test for granting additional changes (e.g., “good cause,” “breakdown of the physician-patient relationship,” “refusal to treat,” or “inadequate care”). Those standards will likely develop through Commission practice and future appellate review under the “clearly erroneous” and “arbitrary or capricious” constraints.

Complex Concepts Simplified

  • Change of treating physician / “Form A”: A statutory process allowing an injured worker to replace the employer-selected treating doctor (in non-certified workplace medical plan cases). Under this decision, the first request must be granted; later requests may be granted at the ALJ’s discretion.
  • Certified workplace medical plan: A structured employer medical network. Section 56(B) applies when the employer is not covered by such a plan.
  • Consequential injury: A condition that develops as a result of a compensable injury (here, cubital tunnel syndrome allegedly resulting from the shoulder injury).
  • IME (Independent Medical Examiner): A physician appointed under 85A O.S.Supp.2013 § 112(B) to assist in deciding disputed medical issues. If the IME finds more treatment is needed, 85A O.S.Supp.2013 § 112(F) requires the employer to designate a treating physician to provide it.
  • MMI (Maximum Medical Improvement): The point at which a physician believes further meaningful recovery is not expected with additional treatment.
  • De novo review: The appellate court gives no deference on pure legal questions (like statutory meaning) and decides the issue anew.
  • Arbitrary/capricious and clearly erroneous: Appellate guardrails ensuring discretionary decisions still have a rational basis and evidentiary support.

Conclusion

ST. ANTHONY v. GOODWIN and the WORKERS’ COMPENSATION COMMISSION establishes a clear rule for AWCA medical-management disputes: 85A O.S.Supp.2013 § 56(B) guarantees an employee one automatic change of treating physician, but it does not impose a per-claim cap. When additional changes are requested, the statute’s silence does not operate as a prohibition; rather, it leaves the decision to the ALJ/Commission’s discretion under the AWCA’s broad grant of authority—subject to ordinary appellate review for legal error and reasonableness.

The decision is significant because it (1) prevents courts from reintroducing numeric limits that existed under the repealed Workers’ Compensation Code, (2) narrows reliance on pre-AWCA physician-change jurisprudence such as Small v. Applied Home Solutions, and (3) reshapes the practical leverage in treatment disputes by allowing claimants, in appropriate circumstances, to seek additional physician changes when access to effective treatment breaks down.