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ADVISORY 2003-16

SUBJECT: The Non ADL Doctor - Exceptions - Patient Transfers

Beginning Sept. 1, 2003, the Texas Workers' Compensation Act and Commission Rule 180.20(a) require that a doctor be on the NEW Approved Doctor List (ADL) or granted a temporary exception to this requirement in order to provide treatment to an injured employee and receive payment. Also see Advisory 2003-15 regarding Emergency and Immediate Post-Injury Medical Care.

Doctors who are currently treating workers' compensation patients and choose not to be on the new ADL should take steps to appropriately terminate their doctor-patient relationship. This termination should provide the injured employee with reasonable notice of the doctor's decision to terminate treatment. The time period necessary for a patient to locate another doctor who is on the ADL will vary depending on factors such as the availability of ADL doctors in the area and the nature and severity of the patient's condition.

To ensure access to health care for an injured employee who is unable to locate an appropriate ADL doctor to serve as the employee's treating doctor, the Commission can, pursuant to Texas Labor Code 408.023(i), grant an exception to the requirement that a doctor be on the ADL in order to treat an injured employee. A doctor who wishes to continue to treat an injured employee in this situation may apply to the Commission for an access exception to the requirement to be on the ADL. To seek an access exception on a case by case basis, doctors may contact the Commission at 1-888-4TxComp, select option 3, then select option 2. If an access exception is granted for the purpose of ensuring access to health care, it will allow the doctor to continue to provide services and be paid for services rendered for that particular injured employee. If an access exception is granted, the Commission will notify the appropriate insurance carrier of the terms of the exception.

Signed on this 18th day of August, 2003

Richard F. Reynolds, Executive Director


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