28 Tex. Admin. Code § 127.5 - Scheduling Designated Doctor Appointments
(a) Order assigning a
designated doctor. Within 10 days after approving a valid request, the division
will issue an order that assigns a designated doctor and will notify the
designated doctor, the treating doctor, if any, the injured employee, the
injured employee's representative, if any, and the insurance carrier that the
designated doctor is directed to examine the injured employee. The order will:
(1) indicate the designated doctor's name,
license number, examination address, fax number, 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 to the designated doctor in
compliance with §
127.10(a)(3) of
this title (relating to General Procedures for Designated Doctor
Examinations).
(b) Change
of examination address. The examination address indicated on the order in
subsection (a)(4) of this section may not be changed by any party or by an
agreement of any parties without good cause and the division's
approval.
(c) Availability of
designated doctor. Except as provided in subsection (g) of this section, the
division will 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 certified on the day the examination
is offered and has not failed to timely file for renewal under §
127.100 of this title (relating to
Designated Doctor Certification), if applicable;
(4) has not treated or examined the injured
employee in a different health care provider role:
(A) within the past 12 months; or
(B) for a medical condition being evaluated
in the designated doctor examination.
(d) Designated doctor lists. To select the
next available doctor, the division will maintain two independent designated
doctor lists for each county in Texas.
(1) One
list will consist of designated doctors qualified to perform examinations under
§127.130(b)(1) - (4)] of this title.
(2) The other list will consist of designated
doctors qualified to perform examinations under §
127.130(b)(5) -
(9) of this title.
(3) Nothing in this section prevents a
qualified designated doctor from being on both lists.
(4) 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.
(5)
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.
(6) 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.
(e) Assignment of
designated doctor examinations. Except as provided in subsection (f) of this
section, the division will assign designated doctor examinations as follows:
(1) Each working day, all examination
requests within a 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 assign up to five examinations to the next
available designated doctor at the top of the appropriate list.
(3) An examination assignment 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.
(4) The division may choose not to offer a
designated doctor an examination if it is reasonably probable that the
designated doctor will not be certified on the date of the
examination.
(f)
Exemptions. Nothing in this section prevents the division from exempting a
designated doctor from the applicable qualification standard under §
127.130(d) of
this title. If there is no available designated doctor in the county of the
injured employee, the division may assign a designated doctor as
necessary.
(g) Subsequent
examinations. If the division has previously assigned a designated doctor to
the claim at the time a request is made, the division will assign the same
doctor to a subsequent examination for that claim 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.
(h) Mutual agreement required to reschedule.
The designated doctor's office and the injured employee must contact each other
if there is a scheduling conflict. The designated doctor or the injured
employee who has the scheduling conflict must contact the other at least one
working day before the appointment. The one working day requirement is waived
in an emergency situation. An examination cannot be rescheduled without the
mutual agreement of 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,
indicating the telephone number, fax number, or email used to make
contact;
(4) the reason for the
scheduling conflict; and
(5) the
date and time of the rescheduled designated doctor examination.
(i) Documentation required.
Failure to document and maintain the information in subsection (h) of this
section creates a rebuttable presumption that the examination was rescheduled
without mutual agreement of the designated doctor and injured
employee.
(j) Rescheduling
timeframes. The rescheduled examination must be set to occur no later than 21
days after the originally scheduled examination date. It may not be rescheduled
to occur before the originally scheduled examination date.
(1) Within one working day of rescheduling,
the designated doctor must provide the time and date of the rescheduled
examination to the division, the injured employee or the injured employee's
representative, if any, the injured employee's treating doctor, and the
insurance carrier.
(2) If the
examination cannot be rescheduled to occur within 21 days of the originally
scheduled examination date, or if the injured employee fails to attend the
rescheduled examination, the designated doctor must notify the division within
21 days of the originally scheduled examination date.
(3) After receiving this notice, the division
may select a new designated doctor.
Notes
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