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ADVISORY 2003-15

SUBJECT: Emergency and Immediate Post-Injury Medical Care

Beginning Sept. 1, 2003, the Texas Workers' Compensation Act (Act) and Commission Rule 180.20(a) require that a doctor be on the NEW Approved Doctor List (ADL) or be granted a temporary exception to this requirement in order to provide treatment to an injured employee and receive payment. The Act and rules allow for some exceptions to this requirement. This advisory addresses exceptions for emergency and immediate post injury medical care.

Section 408.023(f) of the Act allows a doctor who is not on the ADL and who has not received an exception to the requirement to be on the ADL, to provide health care in an emergency or for immediate post-injury medical care as defined by commission rule.

Rule 133.1(a)(7) defines an "emergency" as either a medical or mental health emergency as described below:

  1. a medical emergency consists of the sudden onset of a medical condition manifesting itself by acute symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected to result in placing the patient's health and/or bodily functions in serious jeopardy, and/or serious dysfunction of any body organ or part.

  2. a mental health emergency is a condition that could reasonably be expected to present danger to self or others.

Rule 180.1(11) defines "immediate post-injury medical care" as "that health care provided on the date that the employee first seeks medical attention for the workers' compensation injury."

The Commission clarifies that "emergency" and "immediate post-injury medical care" can include health care that is part of a global surgical package. Exacerbations, recurrence, the presence of other diseases or injuries, or ongoing medical care are not a part of emergency care or immediate post injury medical care. The health care provided as part of emergency or immediate post-injury care may be reimbursed only if it is provided within the global time period.

Signed on this 18th day of August, 2003

Richard F. Reynolds, Executive Director

Distribution:

TWCC Staff
Medical Professional Associations
Carrier Representatives
Forms Notification List
Public Information List
TWCC website



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