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§ 42.60. Required Reports: Special Reports

(a) All special reports shall contain all identifying information required by § 42.30(d) of this title (relating to Written Communications).

(b) The provider shall submit special reports to the carrier and the injured worker, or his or her representative, as provided in § 42.30 of this title (relating to Written Communications) under the following circumstances.

(1) Hospitalization. A report shall be submitted when the patient is discharged from a hospital.

(2) Amputation. When all or part of any limb or digit is amputated, the treating doctor shall submit a report and a chart showing the exact point of amputation.

(3) Vision loss.

(A) Loss of vision shall be calculated on the actual loss of vision as a result of an injury, and not on loss of vision after restoration of vision by proper fitting glasses.

(B) The board considers loss of an eye to have occurred when loss of vision reaches 90%.

(C) A change of status report for a patient who has suffered vision loss shall be based on the board’s Table of Visual Losses of One Eye, published in the appendix to this chapter. (See § 55.25 of this title (relating to Loss of an Eye.))

(4) Hearing impairment.

(A) Hearing tests for use in compensation ratings shall be derived from the pure-tone audiogram calculated to ANSI-S3.6-1969 standards. Examination should be performed by a medical specialist who does hearing evaluations or by an audiologist having the Certificate of Clinical Competence from the American Speech-Language-Hearing Association upon referral. Hearing handicap will be based on the functional state of both ears.

(B) A change of status report for a patient who has suffered hearing impairment shall be based on the board’s Table of Monaural Hearing Impairment, published in the appendix to this chapter. (See § 55.30 of this title (relating to Hearing Impairment.))

(5) Medical examination orders.

(A) The examining doctor shall submit a report within seven days of examining a claimant under board order.

(B) If the examination was ordered on the board’s own motion, the original report and the bill shall be sent to the board. Copies shall be sent to the claimant, or claimant’s representative, and the carrier.

(C) If the examination was ordered at the carrier’s request, the original report and the bill shall be sent to the carrier. Copies shall be sent to the claimant, or claimant’s representative, and the board. (See Chapter 69 of this title (relating to Medical Examination Orders.))

(6) Demand for surgery. The report accompanying a demand for surgery shall establish that, in all reasonable medical probability:

(A) the requested surgical procedure will either effect a cure, or materially and beneficially improve and relieve the patient’s condition; and

(B) the surgery is medically advisable.

The provisions of this § 42.60 adopted to be effective October 20, 1988, 13 TexReg 4990.

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At a Glance:

Title:

§ 42.60. Required Reports: Special Reports

Title:

Title 28. Insurance

Status:

Current

Usage:

Old Law Rule

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