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You are here: Home . wc . news . advisories . ad2001-12

Advisory 2001-12

Changes to Process for Requesting a Designated Doctor -New TWCC-32 -Request for Designated Doctor Form

House Bill 2600 (HB-2600) passed by the 77 th Texas Legislature made changes to the way Designated Doctors are requested. To implement these changes, the Commission made changes to rules 130.1 through 130.6, which govern issues relating to Maximum Medical Improvement (MMI) and impairment and has developed a new TWCC-32 - Request for a Designated Doctor Form (which is attached). The statutory/rule changes are effective for requests for a Designated Doctor made on or after January 1, 2002 and the new form is mandatory as well.

Key Legislative/Rules Changes:

  • A Designated Doctor can now be requested at any time during the claim to evaluate MMI and/or impairment. Parties no longer have to wait until there has been a certification by another doctor before requesting a Designated Doctor.
  • Although a Designated Doctor examination can be requested at any time, the exam cannot be conducted more frequently than once every 60 days unless good cause exists to do so. An example of good cause might be if the Designated Doctor initially found the employee to not be at MMI, but estimated that the employee might be at MMI in four weeks.
  • The treating doctor and the insurance carrier are now permitted to provide the Designated Doctor with an analysis of the employee's medical condition, functional abilities, and return-to-work opportunities. However, by rule, if either chooses to provide such an analysis, a copy must be forwarded to the other party as well.
  • Carriers can provide a list of peer reviewers whom the Designated Doctor is permitted to contact for information.
  • System participants will no longer be permitted to agree upon a Designated Doctor.
  • Also, when the Commission selects a Designated Doctor, the selection does not have to be a doctor of the same licensure type as the treating doctor. Per Rule 130.5, when the Commission assigns a Designated Doctor to evaluate MMI and/or impairment, the Commission shall assign the next doctor who "has credentials appropriate to the issue in question, is trained and experienced with the treatment and procedures used by the doctor treating the patients medical condition, and whose scope of practice includes the treatment and procedures performed. In selecting a designated doctor, completed medical procedures may be considered secondary selection criteria".

Changes to TWCC-32 to implement statutory/rules changes and other process improvements:

  • The new TWCC-32 now covers all request for Designated Doctors (not just for disputes involving MMI/impairment).
  • There is space to identify the employee's representative to ensure the representative gets a copy of the Designated Doctor's report as required.
  • There is space for the facsimile numbers of the treating doctor, carrier, and representative to ensure that the reports are sent by facsimile as required.
  • There is space to identify the address that the carrier wants the medical bill for the examination sent.
  • The carrier's reasonable assessment of the correct impairment rating has been deleted as it was redundant. Carriers provide the reasonable assessment to claimants on the TWCC-28 when they are disputing as assigned impairment rating.
  • Processing is simplified as the Commission can fax the new form to the selected Designated Doctor for the doctor to provide the appointment time and date.
  • Space is provided for the date of the last Designated Doctor examination and for a description of the reason for the request, including why good cause exists to have an examination less than 60 days after a previous one.
  • The back of the form has a matrix that allows the Commission to classify injuries and treatments performed on the employee according to a standardized model.

Designated Doctor Selection

The Commission has broken injury types into 21 categories that each correspond to a particular chapter or section of the Fourth Edition of the American Medical Association's Guides to the Evaluation of Permanent Impairment (AMA Guides). If it is unclear what injury area should be selected for a given condition, the answer can be found by reviewing the AMA Guides. For example, hernias should be reported as "Digestive" on the matrix because the Digestive chapter provides the instructions for assignment of an impairment rating for a hernia.

The Commission has also categorized the most common treatments and procedures used in the workers' compensation system into five categories as follows:

  • Physical Medicine - Non-invasive treatment that involves manual movements of the affected body part. This includes treatments such as massage, myofacial release, physical therapy, manipulations, mobilizations, acupuncture, work hardening, work conditioning, etc.
  • Prescription Medication - Medication that has to be obtained from a pharmacist or the prescribing doctor and that can't be obtained without a doctor's prescription.
  • Therapeutic Injections - Includes treatments such as epidural and trigger point injections and not minor/routine injections such as tetanus shots, or IVs.
  • Surgery - An operation or other invasive treatment often performed at a hospital. This does not include minor procedures such as treating minor cuts or lacerations.
  • Behavioral Medicine - Includes treatments such as psychiatry, psychological testing and counseling, biofeedback and related disciplines.

The TWCC-32 matrix requires the requestor to indicate what injury areas are part of the compensable injury, which of the five basic forms of treatment have been provided to each injury area, and whether each form of treatment has concluded. For example, if a claim involved surgery to the knee and the employee still had follow-up appointments scheduled with the surgeon, then the treatment would be considered to be continuing. This would also be the case if an employee was undergoing a series of injections. However, if an employee had received prescription medication but was no longer taking the medication, then the system would treat the prescription medication as a secondary selection criteria in the Designated Doctor selection. When requesting a Designated Doctor it will sometimes be necessary to contact the Treating Doctor regarding this information, so that the Commission can select an appropriate doctor.

The Commission is creating a system for profiling all the Designated Doctors so that when the Commission receives a TWCC-32 with the proper information on it, the information can be entered into the selection system and it will match the treatment by injury with the profiles to find the next Designated Doctor who meets the criteria for selection. Where a given category of treatment continues, the system will treat it as a primary selection criteria. Where a treatment is discontinued, the system will treat it as a secondary selection criteria and not require it to be within the Designated Doctor's scope of licensure.

Complete text of the statutory and rules changes as well as electronic copies of the new TWCC-32 are available on the Commission's website at www.tdi.texas.gov.

Signed this 21 st day of December, 2001

Richard F. Reynolds, Executive Director



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