Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 42 - MEDICAL BENEFITS › Subchapter A - GENERAL MEDICAL PROVISIONS › Section 42.60 - Required Reports: Special Reports

Current through Reg. 49, No. 28; July 12, 2024
(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.