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Failure to Refer to a Specialist

When you’re feeling ill or you’ve been injured, one of the first things you might do is pick up the phone and call your primary care physician, or a family doctor. Usually this physician is someone you’ve gone to for physicals, routine check-ups, and other basic medical needs over the years. Oftentimes you are required to see a primary care physician before you are turned over to a specialist.

If you are seriously hurt or ill, a diagnosis and treatment might need to be done with speed and accuracy. Your conditions could worsen if a physician lacks expertise but continues to recommend ineffective treatment without referring you. Though it’s important to know that physician referrals have increased dramatically in the last 15 years, there are instances where a physician may elect for a more conservative approach with over-the-counter treatments when you might really need a specialist’s attention. Failure to refer can also occur when a specialist exhausts his or her medical expertise and fails to refer you to another specialist.

Sometimes health plans and medical groups discourage physician referrals as well. The referral process for each insurance plan is complex for both the insurance providers and for you, and there is a significant amount of paperwork and processing involved in getting you connected from your referring physician to a specialist. This can sometimes mean that making a referral is costly and not very efficient.

If a physician fails to refer you to a specialist, you could sustain further issues. In some cases this means a delay in your recovery and healing; in others, early diagnosis of conditions like cancer, heart disease, and diabetes can make all the difference. The sooner these conditions are addressed and treated, the better. The injuries and diseases that can develop or worsen from failure to refer are not to be taken lightly, and you may have an actionable claim depending on the circumstances.

One of the hardest things about cases involving failure to be referred to a specialist is that you look to a physician to help you through your pain or injury so that you can heal. Doctors and other medical professionals have to abide by a standard of care, and failing to refer you to a specialist falls under a breach of that standard of care. If you were not provided adequate diagnosis, treatment, or referral from your physician or were not referred to a specialist for your illness or injury, Staver Law Group may be able to help you determine your legal actions. You can reach us at for a free consultation.