The Texas Department of Insurance, Division of Workers Compensation has recently changed some of the purposes and the procedures for the use of designated doctors in dealing with injured workers in the system. See http://www.tdi.texas.gov/wc/rules/adopted/documents/ddrulesm0712.pdf
Under Texas Administrative Code §270.1, a party may request a designated doctor to resolve questions about the following:
(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.
Under the new rule, the Division of Workers Compensation shall deny a request for a designated doctor if the insurance carrier has denied the compensability of the claim or otherwise denied liability for the claim as a whole and the dispute is not yet resolved. However, a Benefit Review Officer (BRO) or a Hearing Officer (HO) may appoint a designated doctor may order an injured employee for the reason of causation that would require an expert medical opinion expert medical opinion would be necessary to resolve a dispute as to whether the claimed injury resulted from the claimed incident.
Any denial of the request for a designated doctor must be in writing and explain why the request was denied.
Daniel L Morris, The Morris Law Firm, PLLC (214)357-1782