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Advisory 2002-05

Modified TWCC-32 - Request for Designated Doctor Form

In December of 2001, the Commission made changes to rules 130.1 through 130.6, which govern issues relating to MMI and impairment and developed a new TWCC-32 - Request for a Designated Doctor form. The purpose of the new form was to ensure that the Commission is able to select designated doctors in accordance with the statutory requirements.

Attached you will find a modified version of the TWCC-32 (revision date 2/22/02) which was designed to address a problem that the Commission has identified with the existing form and to improve accountability.

Page two of the form did not have any identification information that could tie it to the correct front page because it was originally envisioned as a two sided form. However, the front page of the form has sometimes become separated from page two which includes the matrix of information about the employee's injury and treatment history. Therefore, page two of the newly revised TWCC-32 now requires the employee's Social Security Number and Date of Injury so it can be matched to the information on page one in the event they become separated.

The other change to the form is designed to improve accountability. The Commission is concerned that there is potential to manipulate the system to ensure that certain types of doctors are selected or not selected on a given case by providing incomplete or incorrect information on page two of the form. To ensure the Commission can take appropriate corrective action, the affirmation on page one now also appears on page two to ensure that the requestor can be held responsible if incorrect or incomplete information is provided.

System participants are encouraged to begin using this revised form immediately. Its use will be mandatory for all requests filed with the Commission on or after May 1, 2002. The Commission is monitoring TWCC-32 submissions. System participants are reminded that it may be necessary to contact the treating doctor to ensure that accurate injury and treatment information is provided on the form.

Electronic copies of the revised TWCC-32 are available on the Commission's website at

Signed this 4 th day of March, 2002

Richard F. Reynolds, Executive Director

TWCC Staff
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