Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 127 - DESIGNATED DOCTOR PROCEDURES AND REQUIREMENTS › Subchapter B - DESIGNATED DOCTOR CERTIFICATION, RENEWAL, AND QUALIFICATIONS › Section 127.130 - Qualification Standards for Designated Doctor Examinations

Current through Reg. 49, No. 28; July 12, 2024
(a) Applicability.
				  This section applies to designated doctor assignments made on or after June 5,
				  2023.
(b) Qualification standards
				  by type of injury or diagnosis. A designated doctor is qualified to perform a
				  designated doctor examination on an injured employee if the designated doctor
				  meets the appropriate qualification standard for the area of the body affected
				  by the injury and the injured employee's diagnosis and has no disqualifying
				  associations under §
										127.140 of this title (relating to
				  Disqualifying Associations). A designated doctor's qualification standards are
				  as follows:
(1) To examine injuries and
				  diagnoses relating to the hand and upper extremities, a designated doctor must
				  be a licensed medical doctor, doctor of osteopathy, or doctor of
				  chiropractic.
(2) To examine
				  injuries and diagnoses relating to the lower extremities excluding feet, a
				  designated doctor must be a licensed medical doctor, doctor of osteopathy, or
				  doctor of chiropractic.
(3) To
				  examine injuries and diagnoses relating to the spine and musculoskeletal
				  structures of the torso, a designated doctor must be a licensed medical doctor,
				  doctor of osteopathy, or doctor of chiropractic.
(4) To examine injuries and diagnoses
				  relating to feet, including toes and heel, a designated doctor must be a
				  licensed medical doctor, doctor of osteopathy, doctor of chiropractic, or
				  doctor of podiatric medicine.
(5)
				  To examine injuries and diagnoses relating to the teeth and jaw, including a
				  temporomandibular joint, a designated doctor must be a licensed medical doctor,
				  doctor of osteopathy, or doctor of dental surgery.
(6) To examine injuries and diagnoses
				  relating to the eyes, including the eye and adnexal structures of the eye, a
				  designated doctor must be a licensed medical doctor, doctor of osteopathy, or
				  doctor of optometry.
(7) To examine
				  injuries and diagnoses relating to mental and behavioral disorders, a
				  designated doctor must be a licensed medical doctor or doctor of
				  osteopathy.
(8) A designated doctor
				  must be a licensed medical doctor or doctor of osteopathy to examine injuries
				  and diagnoses relating to other body areas or systems, including, but not
				  limited to:
(A) internal systems;
(B) ear, nose, and throat;
(C) head and face;
(D) skin;
(E) cuts to skin involving underlying
				  structures;
(F) non-musculoskeletal
				  structures of the torso;
(G)
				  hernia;
(H) respiratory;
(I) endocrine;
(J) hematopoietic; and
(K) urologic.
(9) Notwithstanding paragraphs (1) - (8) of
				  this subsection, a designated doctor must be a licensed medical doctor or
				  doctor of osteopathy with the required board certification to examine any of
				  the following diagnoses.
(A) For purposes of
				  this section, a designated doctor is "board-certified" in a required specialty
				  or subspecialty, as applicable, if they hold or previously held:
(i) a general certificate in the required
				  specialty or a subspecialty certificate in the required subspecialty from the
				  American Board of Medical Specialties (ABMS); or
(ii) a primary certificate in the required
				  specialty and a certificate of special qualifications or certificate of added
				  qualifications in the required subspecialty from the American Osteopathic
				  Association Bureau of Osteopathic Specialists (AOABOS).
(B) To examine traumatic brain injuries,
				  including concussion and post-concussion syndrome, a designated doctor must be
				  board-certified by the ABMS or AOABOS.
(i)
				  Qualifying ABMS certifications are:
(I)
				  neurological surgery;
(II)
				  neurology;
(III) physical medicine
				  and rehabilitation;
(IV)
				  psychiatry;
(V) orthopaedic
				  surgery;
(VI) occupational
				  medicine;
(VII)
				  dermatology;
(VIII) plastic
				  surgery;
(IX) surgery;
(X) anesthesiology with a subspecialty in
				  pain medicine;
(XI) emergency
				  medicine;
(XII) internal
				  medicine;
(XIII) thoracic and
				  cardiac surgery; or
(XIV) family
				  medicine.
(ii) Qualifying
				  AOABOS certifications are:
(I) neurological
				  surgery;
(II) neurology;
(III) physical medicine and
				  rehabilitation;
(IV)
				  psychiatry;
(V) orthopedic
				  surgery;
(VI) preventive
				  medicine/occupational-environmental medicine;
(VII) preventive
				  medicine/occupational;
(VIII)
				  dermatology;
(IX) plastic and
				  reconstructive surgery;
(X) surgery
				  (general);
(XI) anesthesiology with
				  certificate of added qualifications in pain management;
(XII) emergency medicine;
(XIII) internal medicine;
(XIV) thoracic and cardiovascular surgery;
				  or
(XV) family practice and
				  osteopathic manipulative treatment.
(C) To examine spinal cord injuries and
				  diagnoses, including a spinal fracture with documented neurological injury, or
				  vascular injury, more than one spinal fracture, or cauda equina syndrome, a
				  designated doctor must be board-certified by the ABMS or AOABOS.
(i) Qualifying ABMS certifications are:
(I) neurological surgery;
(II) neurology;
(III) physical medicine and
				  rehabilitation;
(IV) orthopaedic
				  surgery; or
(V) occupational
				  medicine.
(ii) Qualifying
				  AOABOS certifications are:
(I) neurological
				  surgery;
(II) neurology;
(III) physical medicine and
				  rehabilitation;
(IV) orthopedic
				  surgery;
(V) preventive
				  medicine/occupational-environmental medicine; or
(VI) preventive
				  medicine/occupational.
(D) To examine severe burns, including
				  chemical burns defined as deep partial or full thickness burns, also known as
				  second, third, or fourth-degree burns, a designated doctor must be
				  board-certified by the ABMS or AOABOS.
(i)
				  Qualifying ABMS certifications are:
(I)
				  dermatology;
(II) physical medicine
				  and rehabilitation;
(III) plastic
				  surgery;
(IV) orthopaedic
				  surgery;
(V) surgery; or
(VI) occupational medicine.
(ii) Qualifying AOABOS
				  certifications are:
(I) dermatology;
(II) physical medicine and
				  rehabilitation;
(III) plastic and
				  reconstructive surgery;
(IV)
				  orthopedic surgery;
(V) surgery
				  (general);
(VI) preventive
				  medicine/occupational-environmental medicine; or
(VII) preventive
				  medicine/occupational.
(E) To examine complex regional pain syndrome
				  (reflex sympathetic dystrophy), a designated doctor must be board-certified by
				  the ABMS or AOABOS.
(i) Qualifying ABMS
				  certifications are:
(I) neurological
				  surgery;
(II) neurology;
(III) orthopaedic surgery;
(IV) plastic surgery;
(V) anesthesiology with a subspecialty in
				  pain medicine;
(VI) occupational
				  medicine; or
(VII) physical
				  medicine and rehabilitation.
(ii) Qualifying AOABOS certifications are:
(I) neurological surgery;
(II) neurology;
(III) orthopedic surgery;
(IV) plastic surgery;
(V) preventive
				  medicine/occupational-environmental medicine;
(VI) preventive
				  medicine/occupational;
(VII)
				  anesthesiology with certificate of added qualifications in pain management;
				  or
(VIII) physical medicine and
				  rehabilitation.
(F) To examine any joint dislocation, one or
				  more fractures with vascular injury, one or more pelvis fractures, or multiple
				  rib fractures, a designated doctor must be board-certified by the ABMS or
				  AOABOS.
(i) Qualifying ABMS certifications
				  are:
(I) emergency medicine;
(II) orthopaedic surgery;
(III) plastic surgery;
(IV) physical medicine and rehabilitation;
				  or
(V) occupational
				  medicine.
(ii) Qualifying
				  AOABOS certifications are:
(I) emergency
				  medicine;
(II) orthopedic
				  surgery;
(III) plastic
				  surgery;
(IV) physical medicine and
				  rehabilitation;
(V) preventive
				  medicine/occupational-environmental medicine; or
(VI) preventive
				  medicine/occupational.
(G) To examine complicated infectious
				  diseases requiring hospitalization or prolonged intravenous antibiotics,
				  including blood borne pathogens, a designated doctor must be board-certified by
				  the ABMS or AOABOS.
(i) Qualifying ABMS
				  certifications are:
(I) internal medicine;
				  or
(II) occupational
				  medicine.
(ii) Qualifying
				  AOABOS certifications are:
(I) internal
				  medicine;
(II) preventive
				  medicine/occupational-environmental medicine; or
(III) preventive
				  medicine/occupational.
(H) To examine chemical exposure, excluding
				  chemical burns, a designated doctor must be board-certified by the ABMS or
				  AOABOS.
(i) Qualifying ABMS certifications
				  are:
(I) internal medicine;
(II) emergency medicine; or
(III) occupational medicine.
(ii) Qualifying AOABOS
				  certifications are:
(I) internal
				  medicine;
(II) emergency
				  medicine;
(III) preventive
				  medicine/occupational-environmental medicine; or
(IV) preventive medicine/occupational.
(I) To examine
				  heart or cardiovascular conditions, a designated doctor must be board-certified
				  by the ABMS or AOABOS.
(i) Qualifying ABMS
				  certifications are:
(I) internal
				  medicine;
(II) emergency
				  medicine;
(III) occupational
				  medicine;
(IV) thoracic and cardiac
				  surgery; or
(V) family medicine.
(ii) Qualifying AOABOS
				  certifications are:
(I) internal
				  medicine;
(II) emergency
				  medicine;
(III) preventive
				  medicine/occupational-environmental medicine;
(IV) preventive
				  medicine/occupational;
(V) thoracic
				  and cardiovascular surgery; or
(VI)
				  family practice and osteopathic manipulative treatment.