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§ 127.20. Requesting a Letter of Clarification Regarding Designated Doctor Reports

(a) Parties may file a request with the division for clarification of the designated doctor’s report. A copy of the request must be provided to the opposing party. The division may contact the designated doctor if it determines that clarification is necessary to resolve an issue regarding the designated doctor’s report. Parties may only request clarification on issues already addressed by the designated doctor’s report or on issues that the designated doctor was ordered to address but did not address. Additionally, a designated doctor shall only respond to the questions or requests submitted to the designated doctor in the request for clarification and shall not otherwise reconsider the doctor’s previous decision, issue a new or amended decision, or provide clarification on the doctor’s previous decision.

(b) Requests for clarification must:

(1) include the name of the designated doctor, the reason for the designated doctor’s examination, the date of the examination, and the name and signature of the requestor;

(2) explain why clarification of the designated doctor’s report is necessary and appropriate to resolve a future or pending dispute;

(3) include questions for the designated doctor to answer that are neither inflammatory nor leading; and

(4) provide any medical records that were not previously provided to the designated doctor and explain why these records are necessary for the designated doctor to respond to the request for clarification.

(c) The division, at its discretion, may also request clarification from the designated doctor on issues the division deems appropriate.

(d) To respond to the request for clarification, the designated doctor must be on the division’s designated doctor list at the time the request is received by the division. The designated doctor shall respond, in writing, to the request for clarification within five working days of receipt and send copies of the response to the parties listed in § 127.10(f) of this title (relating to General Procedures for Designated Doctor Examinations). If, in order to respond to the request for clarification, the designated doctor has to reexamine the injured employee, the doctor shall:

(1) respond, in writing, to the request for clarification advising of the need for an additional examination within five working days of receipt of the request and provide copies of the response to the parties specified in § 127.10(f) of this title;

(2) if the division orders the reexamination, conduct the reexamination within 21 days from the date the order is issued by the division at the same examination address as the original examination; and

(3) respond, in writing, to the request for clarification based on the additional examination within seven working days of the examination and provide copies of the response to the parties specified in § 127.10(f) of this title.

(e) Any refusal or failure by a designated doctor to conduct a reexamination that is necessary to respond to a request for clarification is an administrative violation.

(f) This section will become effective September 1, 2012.

The provisions of this §127.20 adopted to be effective February 1, 2011, 35 TexReg 11324; amended to be effective September 1, 2012, 37 TexReg 5422.

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At a Glance:

Title:

§ 127.20. Requesting a Letter of Clarification Regarding Designated Doctor Reports

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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