Texas Regulations 127.1

(1) the impairment caused by the injured employee's compensable injury; (2) the attainment of maximum medical improvement (MMI); (3) the extent of the injured employee's compensable injury; (4) whether the injured employee's disability is a direct result of the work-related injury; (5) the ability of the injured employee to return to work; or (6) issues similar to those described by paragraphs (1) - (5) of this subsection. (b) To request a designated doctor examination a requestor must: (1) provide a specific reason for the examination; (2) explain any change of condition if the requestor indicates that the injured employee's medical condition has changed since a previous designated doctor examination on the same claim; (3) report the injured employee's current medical condition and the type of health care the injured employee is currently receiving; (4) provide a list of all injuries determined to be compensable by the division or accepted as compensable by the insurance carrier; (5) provide general information regarding the identity of the requestor, injured employee, employer, treating doctor, insurance carrier, as well as the statutory date of maximum medical improvement, if any; (6) submit the request on the form prescribed by the division under this section. A copy of the prescribed form can be obtained from: (A) the division's website at www.tdi.state.tx.us/wc/indexwc.html; or (B) the Texas Department of Insurance, Division of Workers' Compensation, 7551 Metro Center Drive, Suite 100, Austin, Texas 78744 or any local division field office location; (7) provide all information listed below applicable to the type of examination the requestor seeks: (A) if the requestor seeks an examination on the attainment of MMI, include the date of MMI if any; the date of certification of MMI if any; and the name of the certifying doctor, if any, and whether the certifying doctor was a treating doctor, required medical examination doctor, or referral doctor; (B) if the requestor seeks an examination on the impairment rating of the injured employee, include the date of MMI, if any, the date of certification of MMI and prior assigned impairment rating, if any, and the name of the certifying doctor, if any, and whether the certifying doctor was a treating doctor, required medical examination doctor, or referral doctor; (C) if the requestor seeks an examination on the extent of the compensable injury or an examination regarding the causation of the claimed injury, include a description of the accident or incident that caused the claimed injury; and a list of all injuries in question; (D) if the requestor seeks an examination on whether the injured employee's disability is a direct result of the work-related injury, include the beginning and ending dates for the claimed periods of disability; state if the injured employee is either not working or is earning less than pre-injury wages as defined by Labor Code § 401.011(16); and list all injuries determined to be compensable by the division or accepted as compensable by the insurance carrier; (E) if the requestor seeks an examination regarding the injured employee's ability to return to work in any capacity and what activities the injured employee can perform, include the beginning and ending dates for the periods to be addressed and a job description for job offers the employer intends to offer the injured employee; (F) if the requestor seeks an examination to determine whether or not an injured employee entitled to supplemental income benefits may return to work in any capacity for the identified period, include the beginning and ending dates for the periods to be addressed and whether or not this period involves the ninth quarter or a subsequent quarter of supplemental income benefits; (G) if the requestor seeks an examination on topics under subsection (a)(6) of this section, specify the issue in sufficient detail for the doctor to answer the question(s); and (8) provide a signature to attest that every reasonable effort has been made to ensure the accuracy and completeness of the information provided in the request. (c) If a party submits a request for a designated doctor examination under subsection (b) of this section that would require the division to schedule an examination within 60 days of a previous examination of the injured employee that party must provide good cause for scheduling that designated doctor examination in order for the division to approve the partys request. For the purposes of this subsection, the commissioner or the commissioners designee shall determine good cause on a case by case basis and will require at a minimum: (1) if that requestor also requested the previous examination, a showing by the requestor that the submitted questions could not have reasonably been included in the prior examination and a designated doctor examination is reasonably necessary to resolve the submitted question(s) and will affect entitlement to benefits; or (2) if that requestor did not request the previous examination, a showing by the requestor a designated doctor examination is reasonably necessary to resolve the submitted question(s) and will affect entitlement to benefits. (d) The division shall deny a request for a designated doctor examination: (1) if the request does not comply with any of the requirements of subsections (b) or (c) of this section; (2) if the request would require the division to schedule an examination in violation of Labor Code §§ 408.0041, 408.123, or 408.151; or (3) if the commissioner or the commissioners designee determines the request to be frivolous because it lacks either any legal or any factual basis that would merit approval. (e) A party may dispute the division's approval or denial of a designated doctor request through the dispute resolution processes outlined in Chapters 140 144 and 147 of this title (relating to Dispute Resolution processes, proceedings, and procedures). Additionally, a party is entitled to seek an expedited contested case hearing under § 140.3 of this title (relating to Expedited Proceedings) to dispute an approved request for a designated doctor examination. The division, upon receipt and approval of the request for expedited proceedings, shall stay the disputed examination pending the decision and order of the expedited contested case hearing. Parties seeking expedited proceedings and the stay of an ordered examination must file their request for expedited proceedings with the division within three days of receiving the order of designated doctor examination under § 127.5(a) of this title (relating to Scheduling Designated Doctor Appointments). (f) This section becomes effective on February 1, 2011.