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ADVISORY 2003-16b

SUBJECT: Update to Advisory 2003-16 and release of TWCC-75 - NON-ADL Doctor Request for Case-By-Case Exception

This Advisory updates Advisory 2003-16 released August 18, 2003. Attached please find the new form TWCC-75 [Word, PDF], NON-ADL Doctor Request for Case-by-Case Exception, to be used by health care providers in conjunction with Texas Labor Code 408.023(i) and Rule 180.23(b) to request a temporary exception to the NEW Approved Doctor List (ADL) requirements.

A doctor on the Commission's Approved Doctor List (ADL) must use this form to request the use of a NON-ADL doctor to provide treatment or services to an injured employee on a case-by-case basis. It can also be used by a NON-ADL doctor to request an exception to provide treatment or services to an injured employee on a case-by-case basis. This form must be used in place of the telephone contact recommended in Advisory 2003-16. This form is not for use by out-of-state or Independent Review Organization (IRO) doctors. Those doctors should contact the Commission for additional information.

The new form is ready for immediate use and may be faxed to the Medical Review Division at 512-804-4714 for processing. The form contains the new business address for the Commission, which is as of September 29, 2003. The new form is available on the Commission's website at

The Commission must approve a request for a case-by-case exception prior to any treatment being provided. If the exception is granted, the Commission will notify the appropriate insurance carrier, the ADL and NON-ADL doctors, the injured employee and the employee's representative, if any, of the terms of the exception.

Signed on this 3rd day of October, 2003

Richard F. Reynolds, Executive Director

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