Texas Workers' Compensation

Legal Research Made Easy

§ 127.5. Scheduling Designated Doctor Appointments

(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.

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.

Print Friendly, PDF & Email

At a Glance:

Title:

§ 127.5. Scheduling Designated Doctor Appointments

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

Scroll to Top