|(a) Duties. All designated doctors must:
(1) Perform designated doctor examinations in a facility:
(A) currently used and properly equipped for medical
examinations or other similar health care services; and
(B) that ensures safety, privacy, and accessibility
for injured employees, injured employee medical records, and other
records containing confidential claim information.
(2) Ensure the confidentiality of medical records,
analyses, and forms provided to or generated by the designated doctor
in the doctor's capacity as a designated doctor for the duration of
the retention period specified in §127.10(i) of this title (relating
to General Procedures for Designated Doctor Examinations) and ensure
the destruction of these medical records after both this retention
period expires and the designated doctor determines the information
is no longer needed.
(3) Ensure that all agreements with persons that permit
those parties to perform designated doctor administrative duties,
including, but not limited to, billing and scheduling duties, on the
designated doctor's behalf:
(A) are in writing and signed by the designated doctor
and the persons with whom the designated doctor is contracting;
(B) define the administrative duties that the person
may perform on behalf of the designated doctor;
(C) require the persons to comply with all confidentiality
provisions of the Labor Code and other applicable laws;
(D) comply with all medical billing and payment requirements
under Chapter 133 of this title (relating to General Medical Provisions);
(E) do not constitute an improper inducement relating
to the delivery of benefits to an injured employee under Labor Code §415.0036
and §180.25 of this title (relating to Improper Inducements,
Influence and Threats); and
(F) are made available to the division on request.
(4) Notify the division in writing and in advance if
the designated doctor voluntarily defers their availability to receive
any offers of examinations for personal or other reasons. The notice
must specify the duration and reason for the deferral.
(5) Notify the division in writing and in advance if
the designated doctor no longer wishes to practice as a designated
doctor before the doctor's current certification as a designated doctor
expires. A designated doctor who no longer wishes to practice before
their current certification expires must expressly surrender their
certification in a signed, written statement to the division.
(6) Be physically present in the same room as the injured
employee for the designated doctor examination or any other health
care service provided to the injured employee that is not referred
to another health care provider under §127.10(c) of this title.
(7) Apply the appropriate edition of the American Medical
Association Guides to the Evaluation of Permanent Impairment and division-adopted
return-to-work guidelines under §137.10 (relating to Return to
Work Guidelines) and consider division-adopted treatment guidelines
under §137.100 (relating to Treatment Guidelines) or other evidence-based
medicine when appropriate.
(8) Provide the division with updated information within
10 working days of a change in any information they provide to the
division on their application for certification.
(9) Maintain a professional and courteous demeanor
when performing the duties of a designated doctor, including, but
not limited to, explaining the purpose of a designated doctor examination
to an injured employee at the beginning of the examination and using
non-inflammatory, appropriate language in all reports and documents
(10) Bill for designated doctor examinations and receive
payment for those examinations in accordance with Chapters 133 and
134 of this title (relating to Benefits--Guidelines for Medical Services,
Charges, and Payments).
(11) Respond timely to all division appointments, clarifications,
document requests, or other division inquiries.
(12) Notify the division if their continued participation
on a claim they have already been assigned would exceed the scope
of practice authorized by their license.
(13) Not perform required medical examinations, utilization
reviews, or peer reviews on a claim they have been assigned as a designated
(14) Identify themselves at the beginning of every
designated doctor examination.
(15) Consent to and cooperate during any on-site visits
by the division under §180.4 of this title (relating to On-Site
(A) Notwithstanding §180.4(e)(2) of this title,
the division's purpose for these visits is to ensure the designated
doctor's compliance with the Labor Code and applicable division rules.
(B) The notice provided to the designated doctor under §180.4
of this title, either in advance or at the time of the on-site visit,
will specify the duties the division will investigate during that
(16) Cooperate with all division compliance audits
and quality reviews.
(17) Complete required training or pass required testing
detailed in the designated doctor's approval of certification.
(18) Comply with all applicable laws and rules.
(b) Agents. For the purposes of this chapter, Chapter
180 of this title (relating to Monitoring and Enforcement), and all
other applicable laws and division rules, any person with whom a designated
doctor contracts or otherwise permits to perform designated doctor
administrative duties on behalf of the designated doctor qualifies
as the doctor's "agent" as defined under §180.1 of this title
(relating to Definitions).