Texas Administrative Code › Title 28 - INSURANCE › Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION › Chapter 126 - GENERAL PROVISIONS APPLICABLE TO ALL BENEFITS › Section 126.6 - Required Medical Examination

Current through Reg. 49, No. 28; July 12, 2024
(a) When a request
				is made by the insurance carrier (carrier), or the Division, for a medical
				examination, the Division shall determine if an examination should occur. The
				Division shall grant or deny the request within seven days of the date the
				request is received by the Division. A copy of the action of the Division shall
				be sent to the injured employee (employee), the employee's representative (if
				any), and the carrier. The notice shall explain the circumstances under which
				an employee may experience loss of benefits and penalty exposure for failing to
				attend the examination as well as the need to reschedule a missed examination.
				An agreement between the parties for an examination under §
									126.5
				of this title (relating to Entitlement and Procedure for Requesting Required
				Medical Examinations) that the carrier has a right to has the same effect as
				the action of the Division.
(b) All
				examinations required under this section must be scheduled to occur within 30
				days after receipt of the notice, with at least 10 days notice to the employee
				and the employee's representative (if any). If a scheduling conflict exists,
				the employee and the doctor shall contact each other. The doctor or the
				employee who has the scheduling conflict must make contact at least 24 hours
				prior to the appointment. The 24-hour requirement will be waived in an
				emergency situation (such as a death in the immediate family or a medical
				emergency). The rescheduled examination shall be set for a date within seven
				days of the originally scheduled examination, unless an extension is agreed
				upon by the employee and doctor. The extension may not be to a date later than
				the 30th day after the originally scheduled examination. In this event, the
				examining doctor shall notify the carrier and the 10 days notice requirement
				does not apply to a rescheduled examination.
(c) The employee's treating doctor may be
				present at an examination scheduled with a doctor selected by the carrier. The
				employee's treating doctor may observe the conduct of the examination, and may
				consult with the examining doctor about the course of the employee's treatment.
				The employee's treating doctor shall not otherwise participate in, impede, or
				advise the employee not to cooperate with the examination. In initially
				scheduling the examination, a reasonable attempt shall be made to accommodate
				the schedule of the treating doctor if the employee wants the treating doctor
				to attend the examination and the treating doctor is willing to do so. However,
				once an examination is scheduled based on the treating doctor's availability,
				the examination shall not be delayed, canceled, or rescheduled due to the
				treating doctor's scheduling conflicts unless:
(1) the required medical examination (RME)
				doctor agrees to the rescheduling; or
(2) the examination was canceled by the RME
				doctor.