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 127.210 - Designated Doctor Administrative Violations

Current through Reg. 49, No. 28; July 12, 2024
(a) Grounds for
				  sanctions. In addition to the grounds for issuing sanctions against a doctor
				  under §
										180.26 of this title (relating to
				  Criteria for Imposing, Recommending and Determining Sanctions; Other Remedies),
				  other division rules, or the Labor Code, the commissioner may revoke or suspend
				  a designated doctor's certification as a designated doctor or sanction a
				  designated doctor for noncompliance with requirements of this chapter for:
(1) refusing four times within a 90-day
				  period to accept or perform a division-offered appointment or division-ordered
				  appointment for which the doctor is qualified and that relates to a claim to
				  which the doctor has not been previously assigned;
(2) refusing four consecutive times to
				  perform a division-offered appointment within the required time frames or a
				  division-ordered appointment for which the doctor is qualified and relates to a
				  claim the doctor has not been previously assigned to;
(3) failing to attend a designated doctor
				  examination;
(4) not complying with
				  the rescheduling requirements of this chapter;
(5) refusing at any time to accept or perform
				  a division-offered appointment or division-ordered appointment that relates to
				  a claim on which the doctor has previously performed an examination;
(6) misrepresenting or omitting pertinent
				  facts in medical evaluation and narrative reports;
(7) submitting unnecessary referrals to other
				  health care providers to answer any question that the division submits to the
				  designated doctor;
(8) ordering or
				  performing unnecessary testing of an injured employee as part of a designated
				  doctor's examination;
(9)
				  submitting inaccurate or inappropriate reports due to insufficient medical
				  history or physical examination and analysis of medical records;
(10) submitting designated doctor reports
				  that fail to include all elements required by §
											127.220 of this title (relating to
				  Designated Doctor Reports), §
											127.10 of this title (relating to
				  General Procedures for Designated Doctor Examinations), and other division
				  rules;
(11) failing to timely
				  respond to a request for clarification from the division about an examination
				  or any other information the division requests;
(12) failing to successfully complete
				  training and testing requirements as specified in §
											127.100 of this title (relating to
				  Designated Doctor Certification);
(13) self-referring, including referring to
				  another health care provider with whom the designated doctor has a
				  disqualifying association, for treatment or becoming the employee's treating
				  doctor for the medical condition the designated doctor evaluated;
(14) behaving in an abusive or assaultive
				  manner toward an injured employee, the division, or other system
				  participant;
(15) failing to
				  maintain the confidentiality of patient medical and claim file
				  information;
(16) performing a
				  designated doctor examination that the division did not order the doctor to
				  perform;
(17) failing to complete
				  required training or pass required testing detailed in the designated doctor's
				  approval of certification; or
(18)
				  violating other applicable statutes or rules while serving as a designated
				  doctor.