How to Resolve Disputes
Disputes can arise in even the best professional relationships, whether the parties involved are employer and employee, colleagues, or health care provider and patient or client. Determining how best to address disputes requires consideration of various factors. The general information that follows lists several options. Keep in mind that no one option will work in all situations.
Note, too, that third-party involvement isn't always required or most effective. Depending on the situation, however, an examination of all of your options may balance in favor of discussing the dispute with legal counsel and/or a trusted colleague, employer, family member, or friend.
Examine the Situation
If you believe that a dispute may give rise to legal or ethical considerations and you are thinking about involving a third party, consider whether you know or can obtain all the facts. For example, key information relative to your analysis may lie in documents that are protected by privacy laws or may only be uncovered by contacting individuals with firsthand knowledge. Knowing all of the facts will impact how you proceed and how others respond.
Review Applicable Laws, Rules, Regulations and Policies
In considering whether you know the facts, examine your facts relative to applicable laws, rules or regulations. Licensure is required in each state in which a physical therapist practices. Physical therapists must practice within the scope of their state physical therapy practice acts. Review state practice acts, along with the accompanying rules and regulations, to assist in assessing legal or ethical issues. Look not only at state laws, but federal laws, rules, and regulations. In addition, you may review applicable entities' corporate policies and rules.
Consider Your Options—Where to File a Complaint
A challenging step is to determine what, if anything, to do. This determination is complex, particularly if you seek resolution from a third party. You may reach your own conclusion about whether something is legal or ethical, but a court, agency, or other authority will engage in their own analysis of the facts relative to applicable laws, rules, regulations, and policies. It may be a challenge if not impossible to know what the third party's final analysis may be. Accordingly, consider the time and cost of obtaining a decision from a third party and whether such a decision will assist in achieving the resolution that you desire. You may want to consider the following options. Please note that this list is not exhaustive.
- Talk with the physical therapist (PT) or physical therapist assistant (PTA): One way to resolve a dispute is to talk about the issue with the PT or PTA with whom you have the dispute. Often 2 parties can reach a resolution without the need to involve a third party. In addition, by engaging in a dialogue you may learn information that better informs your understanding of why something may have occurred. Often this additional information and further discussions can adequately resolve the dispute.
- Seek advice of counsel: You may seek advice of counsel to assist in determining how to proceed. Counsel can examine the facts and provide guidance on applicable laws, rules, and regulations. In so doing, counsel can confidentially provide legal advice or guidance tailored to your unique set of facts.
- Consider the applicable employer or organizational grievance department: You may choose to address the circumstances with the entity that employees the PT or PTA. In addition, many hospitals and other group practices have in place a grievance procedure.
- Consider the applicable student grievance procedures: Check with your college or university to determine the grievance procedure and process for filing a complaint.
- File a complaint (such as an ethics complaint) with the licensing board in your state: Complaints (such as an ethics complaint) against a PT or PTA can be filed with the State Licensing Board Disciplinary Agency. Each state has a process and legal authority to address such complaints. Each state can take action against the license of a PT or PTA. The Federation of State Boards of Physical Therapy (FSBPT) provides sample violations and complaints as well as information on how to file a complaint.
- Review applicable federal agency complaint process information: The following is not an exhaustive list:
- If the matter involves insurance or payment: If the issue deals with a fee dispute, in addition to the parties trying to privately resolve the situation, you may wish to contact the insurance company. For disputes regarding payer-provider relationships, you may also review information provided by the Insurance Commissioner in your state.
- Contact the Better Business Bureau: Consider filing a complaint with the Better Business Bureau.
- Consider civil court: You may consider whether it is appropriate to file an action in a court that has jurisdiction to handle your matter. Seek advice of counsel for further advice on whether filing a suit is appropriate. Some matters may be handled in small claims court, federal or state court, or another legal body.
- Consider local law enforcement: If you are seeking resolution of a criminal matter, you may seek advice of counsel and/or contact the appropriate police department. The US government provides information on reporting a crime.
- If the matter involves fraud or HIPAA consider the following: You may seek assistance from various law enforcement agencies, or you may contact the Medicare fraud hotline or report fraud online to the Office of Inspector General in the US Department of Health & Human Services. If the matter deals with a potential violation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), you may consider whether to contact the US Department of Health & Human Services to file a complaint.
- Removing information from the Internet: If the matter involves information that is on the Internet that you want removed or edited, you may try contacting the applicable company that has published the information.
- Review APTA resources to facilitate ethical decision-making. If you are a PT or PTA in need of further resources to better understand ethical obligations, you may review the numerous ethical decision-making tools. These resources may guide you in your ethical decision-making process. Please note that the ability to answer your individual ethics question regarding whether something is or is not ethical is beyond the scope of APTA's resources.
Resolving disputes or complaints is a complex matter. While this document provides some general information, it does not list every avenue or resource that might be available to you. Examine your situation and research options to determine how best to address your particular complaint or dispute.
Please note: The information provided is offered for general informational purposes only. It is not offered or intended, nor should it be relied upon, as legal advice. Legal doctrines, statutes, and case law vary from state to state. You should consult with your own attorney for specific legal advice on particular legal issues. Get more tips and information on legal matters.