Texas Workers' Compensation

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§ 180.27. Restoration

(a) In accordance with Labor Code § 408.0231(d)(2) a doctor, other than a doctor to which Labor Code § 408.023(r) applies, may apply for the restoration of a doctor privilege removed under Labor Code § 408.0231 by sending a letter of consideration to the Medical Advisor.

(b) The request shall be evaluated by the Medical Advisor and /or members of the Medical Quality Review Panel. The requestor shall be liable for the cost of the review, which may include an audit of the records of the requestor.

(1) If, in the Medical Advisor’s opinion, the doctor:

(A) has all the appropriate unrestricted licenses/certifications;

(B) has overcome the conditions that resulted in the sanction;

(C) meets all the division’s qualification standards and conditions for restoration of some or all of the practice privileges removed; and

(D) is not out of compliance with the Labor Code, Insurance Code, a department rule, or a rule, order, or decision of the commissioner the Medical Advisor may recommend that the commissioner lift the sanction(s) or restore some or all of the privileges removed or restricted by the sanction(s).

(2) If in the Medical Advisor’s opinion, the doctor has not met all the requirements for restoration of privileges, the Medical Advisor shall notify the doctor by verifiable means of the intent to recommend to the commissioner that the sanctions not be lifted or that the privileges removed or restricted by the sanction(s) not be restored in whole or in part and the reasons for that recommendation. Within 15 days after receiving the notice, a doctor may file a response that addresses the reasons given in the recommendation to deny lifting the sanction(s) or restoration of some or all of the privileges removed or restricted by the sanction(s). The Medical Advisor shall review the response and make a final recommendation to the commissioner. A copy of the requestor’s response to the division shall be provided to the commissioner for consideration.

(c) The commissioner shall consider the matter and shall notify the requestor of the final decision by verifiable means, and may send a copy to the appropriate licensing or certification authority. If the commissioner does not lift the sanction, the commissioner may include in the final decision the conditions that the doctor must meet before the division will reconsider lifting the sanctions including, but not limited to, the amount of time that the doctor must wait prior to re-requesting lifting the sanction(s) or restoration of some or all of the privileges removed or restricted by the sanction(s).

The provisions of this §180.27 adopted to be effective March 14, 2002, 27 TexReg 1817; amended to be effective September 12, 2004, 29 TexReg 8613; amended to be effective January 9, 2011, 35 TexReg 11873; amended to be effective February 14, 2012, 37 TexReg 691.

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At a Glance:

Title:

§ 180.27. Restoration

Title:

Title 28. Insurance

Status:

Current

Usage:

New Law Rule

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