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RULE §127.210Designated Doctor Administrative Violations

(a) Grounds for sanctions. In addition to the grounds for issuing sanctions against a doctor under §180.26 of this title (relating to Criteria for Imposing, Recommending and Determining Sanctions; Other Remedies), other division rules, or the Labor Code, the commissioner may revoke or suspend a designated doctor's certification as a designated doctor or sanction a designated doctor for noncompliance with requirements of this chapter for:

  (1) refusing four times within a 90-day period to accept or perform a division-offered appointment or division-ordered appointment for which the doctor is qualified and that relates to a claim to which the doctor has not been previously assigned;

  (2) refusing four consecutive times to perform a division-offered appointment within the required time frames or a division-ordered appointment for which the doctor is qualified and relates to a claim the doctor has not been previously assigned to;

  (3) failing to attend a designated doctor examination;

  (4) not complying with the rescheduling requirements of this chapter;

  (5) refusing at any time to accept or perform a division-offered appointment or division-ordered appointment that relates to a claim on which the doctor has previously performed an examination;

  (6) misrepresenting or omitting pertinent facts in medical evaluation and narrative reports;

  (7) submitting unnecessary referrals to other health care providers to answer any question that the division submits to the designated doctor;

  (8) ordering or performing unnecessary testing of an injured employee as part of a designated doctor's examination;

  (9) submitting inaccurate or inappropriate reports due to insufficient medical history or physical examination and analysis of medical records;

  (10) submitting designated doctor reports that fail to include all elements required by §127.220 of this title (relating to Designated Doctor Reports), §127.10 of this title (relating to General Procedures for Designated Doctor Examinations), and other division rules;

  (11) failing to timely respond to a request for clarification from the division about an examination or any other information the division requests;

  (12) failing to successfully complete training and testing requirements as specified in §127.100 of this title (relating to Designated Doctor Certification);

  (13) self-referring, including referring to another health care provider with whom the designated doctor has a disqualifying association, for treatment or becoming the employee's treating doctor for the medical condition the designated doctor evaluated;

  (14) behaving in an abusive or assaultive manner toward an injured employee, the division, or other system participant;

  (15) failing to maintain the confidentiality of patient medical and claim file information;

  (16) performing a designated doctor examination that the division did not order the doctor to perform;

  (17) failing to complete required training or pass required testing detailed in the designated doctor's approval of certification; or

  (18) violating other applicable statutes or rules while serving as a designated doctor.

(b) Responsibility for agents' actions. Designated doctors are liable for all administrative violations committed by their agents on the designated doctor's behalf under this section, other division rules, or any other applicable law.

(c) Notification and appeal. The process for notification and opportunity for appeal of a sanction is governed by §180.27 of this title (relating to Restoration) except that suspension, revocation, or other sanctions relating to a designated doctor's certification will be in effect during the pendency of any appeal.

Source Note: The provisions of this §127.210 adopted to be effective September 1, 2012, 37 TexReg 5422; amended to be effective April 30, 2023, 48 TexReg 2123

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