| (a) Suspension of benefits. An insurance carrier may
suspend temporary income benefits (TIBs) if an injured employee fails,
without good cause, to attend a designated doctor examination or a
referral examination under §127.10(c) of this title.
(b) No good cause. If there is no division finding
that good cause exists, an insurance carrier may presume that the
injured employee did not have good cause to fail to attend the examination
if, by the day the examination was originally scheduled to occur,
the injured employee has both:
(1) failed to submit to the examination; and
(2) failed to contact the designated doctor's office
to reschedule the examination.
(c) Rescheduling timeframe. If the injured employee
contacts the designated doctor within 21 days of the scheduled date
of the missed examination to reschedule the examination, the designated
doctor must schedule the examination to occur as soon as possible,
but no later than 21 days after the injured employee contacted the
doctor.
(d) New examination request required. If the injured
employee fails to contact the designated doctor within 21 days of
the missed examination date but wishes to reschedule the examination,
the injured employee must request a new examination under §127.1
of this title (relating to Requesting Designated Doctor Examinations).
(e) Reinitiation of benefits. The insurance carrier
must reinstate TIBs effective on the date the injured employee submitted
to the rescheduled examination under subsection (c) of this section
or the date the examination was scheduled at the injured employee's
request under subsection (d) of this section, unless the designated
doctor's report indicates that the injured employee has reached MMI
or is otherwise not eligible for income benefits. The reinitiation
of TIBs must occur no later than the seventh day following:
(1) the date the insurance carrier was notified that
the injured employee submitted to the examination; or
(2) the date the insurance carrier was notified that
the division found the injured employee had good cause for not attending
the examination.
(f) Benefits during suspension. An injured employee
is not entitled to TIBs during the period when the insurance carrier
suspended benefits under this section unless the injured employee
later submits to the examination, and:
(1) the division finds that the injured employee had
good cause for not attending the examination; or
(2) the insurance carrier determines that the injured
employee had good cause for not attending the examination.
|
| Source Note: The provisions of this §127.25 adopted to be effective February 1, 2011, 35 TexReg 11324; amended to be effective September 1, 2012, 37 TexReg 5422; amended to be effective April 30, 2023, 48 TexReg 2123 |
