| (a) Applicability. This section applies to designated
doctor examination requests made on or after the effective date of
this section.
(b) The division, within 10 days after approval of
a valid request, shall issue an order that assigns a designated doctor
and shall notify the designated doctor, the treating doctor, the injured
employee, the injured employee's representative, if any, and the insurance
carrier that the designated doctor will be directed to examine the
injured employee. The order shall:
(1) indicate the designated doctor's name, license
number, examination address and 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 in compliance with §127.10(a)(3)
of this title (relating to General Procedures for Designated Doctor
Examinations).
(c) The examination address indicated on the order
in subsection (b)(4) of this section may not be changed by any party
or by an agreement of any parties without good cause and the approval
of the division.
(d) Except as provided in subsection (h) of this section,
the division shall 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 a certified designated doctor on the day the
examination is offered and has not failed to timely file for recertification
under §127.110 of this title (relating to Designated Doctor Recertification),
if applicable; and
(4) has not treated or examined the injured employee
in a non-designated doctor capacity within the past 12 months and
has not examined or treated the injured employee in a non-designated
doctor capacity with regard to a medical condition being evaluated
in the designated doctor examination.
(e) To select the next available doctor, the division
will maintain two independent designated doctor lists for each county
in this state. One list will consist of designated doctors qualified
to perform examinations under §127.130(b)(1) - (4) of this title,
and the other list will consist of designated doctors qualified to
perform examinations under §127.130(b)(5) - (9) of this title.
Nothing in this section prevents a qualified designated doctor from
being on both lists.
(1) 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.
(2) 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.
(3) 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.
(f) Except as provided in subsection (h) of this section,
the division will assign designated doctor examinations as follows:
(1) Each working day all examination requests within
a given 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 then assign up to five examinations to the next
available designated doctor at the top of the appropriate list.
(3) Assignment of an examination 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.
(g) Nothing in this section prevents the division from
exempting a designated doctor from the applicable qualification standard
under §127.130(d) of this title. The division may assign a designated
doctor as necessary if there is no available designated doctor in
the county of the injured employee.
(h) If the division has previously assigned a designated
doctor to the claim at the time a request is made, the division shall
reassign that doctor again 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.
(i) The designated doctor's office and the injured
employee shall contact each other if a scheduling conflict exists
for the designated doctor appointment. The designated doctor or the
injured employee who has the scheduling conflict must make the contact
at least one working day prior to the appointment. The one working
day requirement will be waived in an emergency situation. An examination
cannot be rescheduled without the mutual agreement of both 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, indicate the
telephone number, facsimile number, or email address used to make
contact;
(4) the reason for the scheduling conflict; and
(5) the date and time of the rescheduled designated
doctor examination.
(j) Failure to document and maintain the information
in subsection (i) of this section, creates a rebuttable presumption
that the examination was rescheduled without mutual agreement of both
the designated doctor and injured employee.
(k) The rescheduled examination shall be set to occur
no later than 21 days after the scheduled date of the originally scheduled
examination and may not be rescheduled to occur before the originally
scheduled examination. Within one working day of rescheduling, the
designated doctor shall contact the division, the injured employee
or the injured employee's representative, if any, the injured employee's
treating doctor, and the insurance carrier with the time and date
of the rescheduled examination. If the examination cannot be rescheduled
no later than 21 days after the scheduled date of the originally scheduled
examination or if the injured employee fails to attend the rescheduled
examination, the designated doctor shall notify the division as soon
as possible but not later than 21 days after the scheduled date of
the originally scheduled examination. After receiving this notice,
the division may select a new designated doctor.
(l) This section will become effective on December
6, 2018.
|
| 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 |
