Current through Reg. 49, No. 38; September 20, 2024
(a) Filing a
clarification request. Parties may file a request with the division for
clarification of the designated doctor's report.
(1) The requesting party must provide copies
of the request to all parties.
(2)
The division may contact the designated doctor if it determines that
clarification is necessary to resolve an issue regarding the designated
doctor's report.
(3) Parties may
only request clarification on issues already addressed by the designated
doctor's report or on issues that the designated doctor was ordered to address
but did not.
(4) A designated
doctor must only respond to the questions or requests submitted to the
designated doctor in the request for clarification and must not reconsider
their previous decision, issue a new or amended decision, or provide
clarification on their previous decision.
(b) Requirements. Requests for clarification
must:
(1) include the name of the designated
doctor, the reason for the examination, the date of the examination, and the
requester's name and signature;
(2)
explain why clarification of the designated doctor's report is necessary and
appropriate to resolve a future or pending dispute;
(3) include questions for the designated
doctor to answer that are not inflammatory or leading; and
(4) provide any medical records that were not
previously provided to the designated doctor and explain why these records are
necessary for the designated doctor to respond to the request for
clarification.
(c)
Requests by the division. At its discretion, the division may also request
clarification from the designated doctor on any issue or issues.
(d) Responses to requests. To respond to a
request for clarification, the designated doctor must be on the division's
designated doctor list on the date of the request.
(1) The designated doctor must respond in
writing to the request for clarification within five working days of receipt
and send copies of the response to the parties listed in §
127.10(g) of this
title (relating to General Procedures for Designated Doctor
Examinations).
(2) If the
designated doctor must reexamine the injured employee to respond to the request
for clarification, the doctor must:
(A)
respond to the request for clarification in writing, advising of the need for
an additional examination within five working days of receiving the request and
provide copies of the response to the parties specified in §
127.10(g) of this
title;
(B) conduct the
reexamination within 21 days from the date the division issues the order for
the reexamination at the same address as the original examination;
and
(C) respond in writing to the
request for clarification based on the additional examination within seven
working days of the examination and provide copies of the response to the
parties specified in §
127.10(g) of this
title.
(e)
Administrative violation. Any refusal or failure by a designated doctor to
conduct a reexamination that is necessary to respond to a request for
clarification is an administrative violation.
