(a) Order assigning a designated doctor. Within 10
days after approving a valid request, the division will issue an order
that assigns a designated doctor and will notify the designated doctor,
the treating doctor, if any, the injured employee, the injured employee's
representative, if any, and the insurance carrier that the designated
doctor is directed to examine the injured employee. The order will:
(1) indicate the designated doctor's name, license
number, examination address, fax number, telephone number, and the
date and time of the examination or the date range for the examination
to be conducted;
(2) explain the purpose of the designated doctor examination;
(3) require the injured employee to submit to an examination
by the designated doctor;
(4) require the designated doctor to perform the examination
at the indicated examination address; and
(5) require the treating doctor, if any, and insurance
carrier to forward all medical records to the designated doctor in
compliance with §127.10(a)(3) of this title (relating to General
Procedures for Designated Doctor Examinations).
(b) Change of examination address. The examination
address indicated on the order in subsection (a)(4) of this section
may not be changed by any party or by an agreement of any parties
without good cause and the division's approval.
(c) Availability of designated doctor. Except as provided
in subsection (g) of this section, the division will select the next
available doctor on the designated doctor list for a medical examination
requested under §127.1 of this title (relating to Requesting
Designated Doctor Examinations). A designated doctor is available
to perform an examination at any address the doctor has filed with
the division if the doctor:
(1) does not have any disqualifying associations as
described in §127.140 of this title (relating to Disqualifying
Associations);
(2) is appropriately qualified to perform the examination
in accordance with §127.130 of this title (relating to Qualification
Standards for Designated Doctor Examinations);
(3) is certified on the day the examination is offered
and has not failed to timely file for renewal under §127.100
of this title (relating to Designated Doctor Certification), if applicable;
(4) has not treated or examined the injured employee
in a different health care provider role:
(A) within the past 12 months; or
(B) for a medical condition being evaluated in the
designated doctor examination.
(d) Designated doctor lists. To select the next available
doctor, the division will maintain two independent designated doctor
lists for each county in Texas.
(1) One list will consist of designated doctors qualified
to perform examinations under §127.130(b)(1) - (4) of this title.
(2) The other list will consist of designated doctors
qualified to perform examinations under §127.130(b)(5) - (9)
of this title.
(3) Nothing in this section prevents a qualified designated
doctor from being on both lists.
(4) A designated doctor will be added to the appropriate
designated doctor list for the county of each address the doctor has
filed with the division.
(5) When a designated doctor adds an address for a
county the doctor is not currently listed in, the doctor will be placed
at the bottom of the appropriate list for that county.
(6) When a designated doctor removes the only address
for a county the doctor is currently listed in, the designated doctor
will be removed from the list for that county.
(e) Assignment of designated doctor examinations. Except
as provided in subsection (f) of this section, the division will assign
designated doctor examinations as follows:
(1) Each working day, all examination requests within
a county will be sorted and distributed to the appropriate list based
on the designated doctor qualification standards.
(2) Depending on the volume of requested examinations,
the division will assign up to five examinations to the next available
designated doctor at the top of the appropriate list.
(3) An examination assignment moves the designated
doctor receiving the assignment to the bottom of the list from which
the designated doctor was selected. Receipt of an assignment on one
list does not change a designated doctor's position on the other list.
(4) The division may choose not to offer a designated
doctor an examination if it is reasonably probable that the designated
doctor will not be certified on the date of the examination.
(f) Exemptions. Nothing in this section prevents the
division from exempting a designated doctor from the applicable qualification
standard under §127.130(d) of this title. If there is no available
designated doctor in the county of the injured employee, the division
may assign a designated doctor as necessary.
(g) Subsequent examinations. If the division has previously
assigned a designated doctor to the claim at the time a request is
made, the division will assign the same doctor to a subsequent examination
for that claim unless the division has authorized or required the
doctor to stop providing services on the claim in accordance with §127.130
of this title. Examinations under this subsection must be conducted
at the same examination address as the designated doctor's previous
examination of the injured employee or at another examination address
approved by the division.
(h) Mutual agreement required to reschedule. The designated
doctor's office and the injured employee must contact each other if
there is a scheduling conflict. The designated doctor or the injured
employee who has the scheduling conflict must contact the other at
least one working day before the appointment. The one working day
requirement is waived in an emergency situation. An examination cannot
be rescheduled without the mutual agreement of the designated doctor
and the injured employee. The designated doctor must maintain and
document:
(1) the date and time of the designated doctor examination
listed on the division's order;
(2) the date and time of the agreement to reschedule
with the injured employee;
(3) how contact was made to reschedule, indicating
the telephone number, fax number, or email used to make contact;
(4) the reason for the scheduling conflict; and
(5) the date and time of the rescheduled designated
doctor examination.
(i) Documentation required. Failure to document and
maintain the information in subsection (h) of this section creates
a rebuttable presumption that the examination was rescheduled without
mutual agreement of the designated doctor and injured employee.
(j) Rescheduling timeframes. The rescheduled examination
must be set to occur no later than 21 days after the originally scheduled
examination date. It may not be rescheduled to occur before the originally
scheduled examination date.
(1) Within one working day of rescheduling, the designated
doctor must provide the time and date of the rescheduled examination
to the division, the injured employee or the injured employee's representative,
if any, the injured employee's treating doctor, and the insurance
carrier.
(2) If the examination cannot be rescheduled to occur
within 21 days of the originally scheduled examination date, or if
the injured employee fails to attend the rescheduled examination,
the designated doctor must notify the division within 21 days of the
originally scheduled examination date.
(3) After receiving this notice, the division may select
a new designated doctor.
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Source Note: The provisions of this §127.5 adopted to be effective February 1, 2011, 35 TexReg 11324; amended to be effective September 1, 2012, 37 TexReg 5422; amended to be effective November 4, 2018, 43 TexReg 7149; amended to be effective April 30, 2023, 48 TexReg 2123 |