Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 127 - DESIGNATED DOCTOR PROCEDURES AND REQUIREMENTS › Subchapter C - DESIGNATED DOCTOR DUTIES AND RESPONSIBILITIES › Section 127.220 - Designated Doctor Reports

Current through Reg. 49, No. 28; July 12, 2024
(a) Format and
				  submission. Designated doctor narrative reports must be filed in the form and
				  manner required by the division. At a minimum, they must do all of the
				  following:
(1) Identify the question or
				  questions the division ordered to be addressed by the designated doctor
				  examination.
(2) Provide a clearly
				  defined answer for each question to be addressed by the designated doctor
				  examination and only for each of those questions.
(3) Sufficiently explain how the designated
				  doctor determined the answer to each question within a reasonable degree of
				  medical probability.
(4)
				  Demonstrate, as appropriate, application or consideration of the American
				  Medical Association Guides to the Evaluation of Permanent Impairment,
				  division-adopted return-to-work and treatment guidelines, and other
				  evidence-based medicine, if available.
(5) Include general information about the
				  identity of the designated doctor, injured employee, employer, treating doctor,
				  and insurance carrier.
(6) State
				  the date of the examination and the address where it took place.
(7) Summarize any additional testing
				  conducted or referrals made as part of the evaluation, including:
(A) the identity of any health care providers
				  to which the designated doctor referred the injured employee under §
												127.10(c) of this
				  title (relating to General Procedures for Designated Doctor
				  Examinations);
(B) the types of
				  tests conducted or referrals made;
(C) the dates the testing or referral
				  examinations occurred;
(D) an
				  explanation of why the testing or referral was necessary to resolve a question
				  at issue in the examination; and
(E) the date the testing or referral
				  examination was completed.
(8) Include a narrative description of the
				  medical history, physical examination, and medical decisions the designated
				  doctor made, including the time the designated doctor began taking the medical
				  history of the injured employee, physically examined the employee, and engaged
				  in medical decision making, and the time the designated doctor completed these
				  tasks.
(9) List the specific
				  medical records or other documents the designated doctor reviewed as part of
				  the evaluation, including the dates of those documents and which medical
				  records were provided by the injured employee.
(10) Provide the total amount of time
				  required for the designated doctor to review the medical records.
(11) Be signed by the designated doctor who
				  performed the examination.
(12)
				  Include a statement that there is no known disqualifying association as
				  described in §
											127.140 of this title (relating to
				  Disqualifying Associations) between the designated doctor and the injured
				  employee, the injured employee's treating doctor, the insurance carrier, the
				  insurance carrier's certified workers' compensation health care network, or a
				  network established under Labor Code Chapter 504.
(13) Certify the date that the report was
				  sent to all recipients as required and in the manner required by §
											127.10 of this title.
(14) Indicate on the report that the
				  designated doctor reviewed and approved the final version of the
				  report.