Requests for a Letter of Clarification (LOC) of a Designated Doctor’s Report
Pursuant to 28 Texas Administrative Code (TAC) §127.20(a), an insurance carrier, injured employee, or the injured employee’s representative may file a request for a Letter of Clarification regarding a designated doctor’s report with the Texas Department of Insurance, Division of Workers’ Compensation (TDI-DWC). Parties may only request clarification on issues addressed by the designated doctor’s report or on issues that the designated doctor was ordered to address, but did not address in his/her report.
Beginning September 1, 2010, all requests for clarification of a designated doctor’s report are approved or denied by TDI-DWC Benefit Review Officers (BRO) or Contested Case Hearing Officers, also referred to as presiding officers. Requests for clarification received prior to the scheduling of a dispute resolution proceeding will be approved or denied by a BRO.
As provided by 28 TAC §127.20(b)(1-4), requests for a Letter of Clarification regarding a designated doctor’s report must:
- include the name of the designated doctor, the reason for the designated doctor’s examination, the date of the examination, and the name and signature of the requestor;
- explain why clarification of the designated doctor’s report is necessary and appropriate to resolve a future or pending dispute;
- include questions for the designated doctor to answer that are neither inflammatory nor leading; and
- provide any medical records that were not previously provided to the designated doctor and explain why these records are necessary for the designated doctor to respond to the request for clarification.
No later than June 1, 2011, all requests for a Letter of Clarification and responses to a Letter of Clarification should be faxed to the TDI-DWC at 512-804-4005. Workers' compensation system participants may begin using this fax number immediately.
Letter of Clarification (LOC) Resources
- Memo: Letter of Clarification (LOC) Resources 5/02/11
- Samples of Approval/Denials of Requests for a Letter of Clarification of a Designated Doctor’s Report
- Correction of A Mathematical Error in a Designated Doctor’s Report
- Request for Letter of Clarification Appeal Procedure
- Key Letter of Clarification Statistics
- TDI-DWC Orders for Letters Of Clarification:
- Order of Designated Doctor Examination
- Order for Appointment of New Designated Doctor
- Order for Designated Doctor Re-Examination
- Frequently Asked Questions: Letter of Clarification
For more information contact:
Last updated: 12/21/2011