| (a) Applicability. This section applies to designated
doctor assignments made on or after June 5, 2023.
(b) Qualification standards by type of injury or diagnosis.
A designated doctor is qualified to perform a designated doctor examination
on an injured employee if the designated doctor meets the appropriate
qualification standard for the area of the body affected by the injury
and the injured employee's diagnosis and has no disqualifying associations
under §127.140 of this title (relating to Disqualifying Associations).
A designated doctor's qualification standards are as follows:
(1) To examine injuries and diagnoses relating to the
hand and upper extremities, a designated doctor must be a licensed
medical doctor, doctor of osteopathy, or doctor of chiropractic.
(2) To examine injuries and diagnoses relating to the
lower extremities excluding feet, a designated doctor must be a licensed
medical doctor, doctor of osteopathy, or doctor of chiropractic.
(3) To examine injuries and diagnoses relating to the
spine and musculoskeletal structures of the torso, a designated doctor
must be a licensed medical doctor, doctor of osteopathy, or doctor
of chiropractic.
(4) To examine injuries and diagnoses relating to feet,
including toes and heel, a designated doctor must be a licensed medical
doctor, doctor of osteopathy, doctor of chiropractic, or doctor of
podiatric medicine.
(5) To examine injuries and diagnoses relating to the
teeth and jaw, including a temporomandibular joint, a designated doctor
must be a licensed medical doctor, doctor of osteopathy, or doctor
of dental surgery.
(6) To examine injuries and diagnoses relating to the
eyes, including the eye and adnexal structures of the eye, a designated
doctor must be a licensed medical doctor, doctor of osteopathy, or
doctor of optometry.
(7) To examine injuries and diagnoses relating to mental
and behavioral disorders, a designated doctor must be a licensed medical
doctor or doctor of osteopathy.
(8) A designated doctor must be a licensed medical
doctor or doctor of osteopathy to examine injuries and diagnoses relating
to other body areas or systems, including, but not limited to:
(A) internal systems;
(B) ear, nose, and throat;
(C) head and face;
(D) skin;
(E) cuts to skin involving underlying structures;
(F) non-musculoskeletal structures of the torso;
(G) hernia;
(H) respiratory;
(I) endocrine;
(J) hematopoietic; and
(K) urologic.
(9) Notwithstanding paragraphs (1) - (8) of this subsection,
a designated doctor must be a licensed medical doctor or doctor of
osteopathy with the required board certification to examine any of
the following diagnoses.
(A) For purposes of this section, a designated doctor
is "board-certified" in a required specialty or subspecialty, as applicable,
if they hold or previously held:
(i) a general certificate in the required specialty
or a subspecialty certificate in the required subspecialty from the
American Board of Medical Specialties (ABMS); or
(ii) a primary certificate in the required specialty
and a certificate of special qualifications or certificate of added
qualifications in the required subspecialty from the American Osteopathic
Association Bureau of Osteopathic Specialists (AOABOS).
(B) To examine traumatic brain injuries, including
concussion and post-concussion syndrome, a designated doctor must
be board-certified by the ABMS or AOABOS.
(i) Qualifying ABMS certifications are:
(I) neurological surgery;
(II) neurology;
(III) physical medicine and rehabilitation;
(IV) psychiatry;
(V) orthopaedic surgery;
(VI) occupational medicine;
(VII) dermatology;
(VIII) plastic surgery;
(IX) surgery;
(X) anesthesiology with a subspecialty in pain medicine;
(XI) emergency medicine;
(XII) internal medicine;
(XIII) thoracic and cardiac surgery; or
(XIV) family medicine.
(ii) Qualifying AOABOS certifications are:
(I) neurological surgery;
(II) neurology;
(III) physical medicine and rehabilitation;
(IV) psychiatry;
(V) orthopedic surgery;
(VI) preventive medicine/occupational-environmental
medicine;
(VII) preventive medicine/occupational;
(VIII) dermatology;
(IX) plastic and reconstructive surgery;
(X) surgery (general);
(XI) anesthesiology with certificate of added qualifications
in pain management;
(XII) emergency medicine;
(XIII) internal medicine;
(XIV) thoracic and cardiovascular surgery; or
(XV) family practice and osteopathic manipulative treatment.
(C) To examine spinal cord injuries and diagnoses,
including a spinal fracture with documented neurological injury, or
vascular injury, more than one spinal fracture, or cauda equina syndrome,
a designated doctor must be board-certified by the ABMS or AOABOS.
(i) Qualifying ABMS certifications are:
(I) neurological surgery;
(II) neurology;
(III) physical medicine and rehabilitation;
(IV) orthopaedic surgery; or
(V) occupational medicine.
(ii) Qualifying AOABOS certifications are:
(I) neurological surgery;
(II) neurology;
(III) physical medicine and rehabilitation;
(IV) orthopedic surgery;
(V) preventive medicine/occupational-environmental
medicine; or
(VI) preventive medicine/occupational.
(D) To examine severe burns, including chemical burns
defined as deep partial or full thickness burns, also known as second,
third, or fourth-degree burns, a designated doctor must be board-certified
by the ABMS or AOABOS.
(i) Qualifying ABMS certifications are:
(I) dermatology;
(II) physical medicine and rehabilitation;
(III) plastic surgery;
(IV) orthopaedic surgery;
(V) surgery; or
(VI) occupational medicine.
(ii) Qualifying AOABOS certifications are:
(I) dermatology;
(II) physical medicine and rehabilitation;
(III) plastic and reconstructive surgery;
(IV) orthopedic surgery;
(V) surgery (general);
(VI) preventive medicine/occupational-environmental
medicine; or
(VII) preventive medicine/occupational.
(E) To examine complex regional pain syndrome (reflex
sympathetic dystrophy), a designated doctor must be board-certified
by the ABMS or AOABOS.
(i) Qualifying ABMS certifications are:
(I) neurological surgery;
(II) neurology;
(III) orthopaedic surgery;
(IV) plastic surgery;
(V) anesthesiology with a subspecialty in pain medicine;
(VI) occupational medicine; or
(VII) physical medicine and rehabilitation.
(ii) Qualifying AOABOS certifications are:
(I) neurological surgery;
(II) neurology;
(III) orthopedic surgery;
(IV) plastic surgery;
(V) preventive medicine/occupational-environmental
medicine;
(VI) preventive medicine/occupational;
(VII) anesthesiology with certificate of added qualifications
in pain management; or
(VIII) physical medicine and rehabilitation.
(F) To examine any joint dislocation, one or more fractures
with vascular injury, one or more pelvis fractures, or multiple rib
fractures, a designated doctor must be board-certified by the ABMS
or AOABOS.
(i) Qualifying ABMS certifications are:
(I) emergency medicine;
(II) orthopaedic surgery;
(III) plastic surgery;
(IV) physical medicine and rehabilitation; or
(V) occupational medicine.
(ii) Qualifying AOABOS certifications are:
(I) emergency medicine;
(II) orthopedic surgery;
(III) plastic surgery;
(IV) physical medicine and rehabilitation;
(V) preventive medicine/occupational-environmental
medicine; or
(VI) preventive medicine/occupational.
(G) To examine complicated infectious diseases requiring
hospitalization or prolonged intravenous antibiotics, including blood
borne pathogens, a designated doctor must be board-certified by the
ABMS or AOABOS.
(i) Qualifying ABMS certifications are:
(I) internal medicine; or
(II) occupational medicine.
(ii) Qualifying AOABOS certifications are:
(I) internal medicine;
(II) preventive medicine/occupational-environmental
medicine; or
(III) preventive medicine/occupational.
(H) To examine chemical exposure, excluding chemical
burns, a designated doctor must be board-certified by the ABMS or
AOABOS.
(i) Qualifying ABMS certifications are:
(I) internal medicine;
(II) emergency medicine; or
(III) occupational medicine.
(ii) Qualifying AOABOS certifications are:
(I) internal medicine;
(II) emergency medicine;
(III) preventive medicine/occupational-environmental
medicine; or
(IV) preventive medicine/occupational.
(I) To examine heart or cardiovascular conditions,
a designated doctor must be board-certified by the ABMS or AOABOS.
(i) Qualifying ABMS certifications are:
(I) internal medicine;
(II) emergency medicine;
(III) occupational medicine;
(IV) thoracic and cardiac surgery; or
(V) family medicine.
(ii) Qualifying AOABOS certifications are:
(I) internal medicine;
(II) emergency medicine;
(III) preventive medicine/occupational-environmental
medicine;
(IV) preventive medicine/occupational;
(V) thoracic and cardiovascular surgery; or
(VI) family practice and osteopathic manipulative treatment.
(c) Qualification to perform initial examination. To
be qualified to perform an initial examination on an injured employee,
a designated doctor, other than a chiropractor, must be qualified
under Labor Code §408.0043. A designated doctor who is a chiropractor
must be qualified to perform an initial designated doctor examination
under Labor Code §408.0045.
(d) Exemption from qualification standards. If a designated
doctor is not available with the qualifications listed in subsections
(b)(9)(A) - (I), the division may exempt a medical doctor or doctor
of osteopathy from any of the qualification standards specified in
this chapter to serve as a designated doctor to help timely resolve
a dispute or perform a particular examination.
(e) Continuity of examinations. A designated doctor
who performs an initial designated doctor examination of an injured
employee and meets the appropriate qualification standard to perform
that examination under subsection (b) of this section will remain
assigned to that claim and perform all subsequent examinations of
that injured employee unless the division authorizes or requires the
designated doctor to discontinue providing services on that claim.
(f) Removal of designated doctor from a claim. The
division may authorize a designated doctor to stop providing services
on a claim if the doctor does any of the following:
(1) decides to stop practicing in the workers' compensation
system.
(2) decides to stop practicing as a designated doctor
in the workers' compensation system.
(3) relocates their residence or practice.
(4) asks the division to indefinitely defer the doctor's
availability on the designated doctor list.
Cont'd... |
