Current through Reg. 49, No. 38; September 20, 2024
(a) Applicability.
This section applies to designated doctor assignments made on or after June 5,
2023.
(b) Qualification standards
by type of injury or diagnosis. A designated doctor is qualified to perform a
designated doctor examination on an injured employee if the designated doctor
meets the appropriate qualification standard for the area of the body affected
by the injury and the injured employee's diagnosis and has no disqualifying
associations under §
127.140 of this title (relating to
Disqualifying Associations). A designated doctor's qualification standards are
as follows:
(1) To examine injuries and
diagnoses relating to the hand and upper extremities, a designated doctor must
be a licensed medical doctor, doctor of osteopathy, or doctor of
chiropractic.
(2) To examine
injuries and diagnoses relating to the lower extremities excluding feet, a
designated doctor must be a licensed medical doctor, doctor of osteopathy, or
doctor of chiropractic.
(3) To
examine injuries and diagnoses relating to the spine and musculoskeletal
structures of the torso, a designated doctor must be a licensed medical doctor,
doctor of osteopathy, or doctor of chiropractic.
(4) To examine injuries and diagnoses
relating to feet, including toes and heel, a designated doctor must be a
licensed medical doctor, doctor of osteopathy, doctor of chiropractic, or
doctor of podiatric medicine.
(5)
To examine injuries and diagnoses relating to the teeth and jaw, including a
temporomandibular joint, a designated doctor must be a licensed medical doctor,
doctor of osteopathy, or doctor of dental surgery.
(6) To examine injuries and diagnoses
relating to the eyes, including the eye and adnexal structures of the eye, a
designated doctor must be a licensed medical doctor, doctor of osteopathy, or
doctor of optometry.
(7) To examine
injuries and diagnoses relating to mental and behavioral disorders, a
designated doctor must be a licensed medical doctor or doctor of
osteopathy.
(8) A designated doctor
must be a licensed medical doctor or doctor of osteopathy to examine injuries
and diagnoses relating to other body areas or systems, including, but not
limited to:
(A) internal systems;
(B) ear, nose, and throat;
(C) head and face;
(D) skin;
(E) cuts to skin involving underlying
structures;
(F) non-musculoskeletal
structures of the torso;
(G)
hernia;
(H) respiratory;
(I) endocrine;
(J) hematopoietic; and
(K) urologic.
(9) Notwithstanding paragraphs (1) - (8) of
this subsection, a designated doctor must be a licensed medical doctor or
doctor of osteopathy with the required board certification to examine any of
the following diagnoses.
(A) For purposes of
this section, a designated doctor is "board-certified" in a required specialty
or subspecialty, as applicable, if they hold or previously held:
(i) a general certificate in the required
specialty or a subspecialty certificate in the required subspecialty from the
American Board of Medical Specialties (ABMS); or
(ii) a primary certificate in the required
specialty and a certificate of special qualifications or certificate of added
qualifications in the required subspecialty from the American Osteopathic
Association Bureau of Osteopathic Specialists (AOABOS).
(B) To examine traumatic brain injuries,
including concussion and post-concussion syndrome, a designated doctor must be
board-certified by the ABMS or AOABOS.
(i)
Qualifying ABMS certifications are:
(I)
neurological surgery;
(II)
neurology;
(III) physical medicine
and rehabilitation;
(IV)
psychiatry;
(V) orthopaedic
surgery;
(VI) occupational
medicine;
(VII)
dermatology;
(VIII) plastic
surgery;
(IX) surgery;
(X) anesthesiology with a subspecialty in
pain medicine;
(XI) emergency
medicine;
(XII) internal
medicine;
(XIII) thoracic and
cardiac surgery; or
(XIV) family
medicine.
(ii) Qualifying
AOABOS certifications are:
(I) neurological
surgery;
(II) neurology;
(III) physical medicine and
rehabilitation;
(IV)
psychiatry;
(V) orthopedic
surgery;
(VI) preventive
medicine/occupational-environmental medicine;
(VII) preventive
medicine/occupational;
(VIII)
dermatology;
(IX) plastic and
reconstructive surgery;
(X) surgery
(general);
(XI) anesthesiology with
certificate of added qualifications in pain management;
(XII) emergency medicine;
(XIII) internal medicine;
(XIV) thoracic and cardiovascular surgery;
or
(XV) family practice and
osteopathic manipulative treatment.
(C) To examine spinal cord injuries and
diagnoses, including a spinal fracture with documented neurological injury, or
vascular injury, more than one spinal fracture, or cauda equina syndrome, a
designated doctor must be board-certified by the ABMS or AOABOS.
(i) Qualifying ABMS certifications are:
(I) neurological surgery;
(II) neurology;
(III) physical medicine and
rehabilitation;
(IV) orthopaedic
surgery; or
(V) occupational
medicine.
(ii) Qualifying
AOABOS certifications are:
(I) neurological
surgery;
(II) neurology;
(III) physical medicine and
rehabilitation;
(IV) orthopedic
surgery;
(V) preventive
medicine/occupational-environmental medicine; or
(VI) preventive
medicine/occupational.
(D) To examine severe burns, including
chemical burns defined as deep partial or full thickness burns, also known as
second, third, or fourth-degree burns, a designated doctor must be
board-certified by the ABMS or AOABOS.
(i)
Qualifying ABMS certifications are:
(I)
dermatology;
(II) physical medicine
and rehabilitation;
(III) plastic
surgery;
(IV) orthopaedic
surgery;
(V) surgery; or
(VI) occupational medicine.
(ii) Qualifying AOABOS
certifications are:
(I) dermatology;
(II) physical medicine and
rehabilitation;
(III) plastic and
reconstructive surgery;
(IV)
orthopedic surgery;
(V) surgery
(general);
(VI) preventive
medicine/occupational-environmental medicine; or
(VII) preventive
medicine/occupational.
(E) To examine complex regional pain syndrome
(reflex sympathetic dystrophy), a designated doctor must be board-certified by
the ABMS or AOABOS.
(i) Qualifying ABMS
certifications are:
(I) neurological
surgery;
(II) neurology;
(III) orthopaedic surgery;
(IV) plastic surgery;
(V) anesthesiology with a subspecialty in
pain medicine;
(VI) occupational
medicine; or
(VII) physical
medicine and rehabilitation.
(ii) Qualifying AOABOS certifications are:
(I) neurological surgery;
(II) neurology;
(III) orthopedic surgery;
(IV) plastic surgery;
(V) preventive
medicine/occupational-environmental medicine;
(VI) preventive
medicine/occupational;
(VII)
anesthesiology with certificate of added qualifications in pain management;
or
(VIII) physical medicine and
rehabilitation.
(F) To examine any joint dislocation, one or
more fractures with vascular injury, one or more pelvis fractures, or multiple
rib fractures, a designated doctor must be board-certified by the ABMS or
AOABOS.
(i) Qualifying ABMS certifications
are:
(I) emergency medicine;
(II) orthopaedic surgery;
(III) plastic surgery;
(IV) physical medicine and rehabilitation;
or
(V) occupational
medicine.
(ii) Qualifying
AOABOS certifications are:
(I) emergency
medicine;
(II) orthopedic
surgery;
(III) plastic
surgery;
(IV) physical medicine and
rehabilitation;
(V) preventive
medicine/occupational-environmental medicine; or
(VI) preventive
medicine/occupational.
(G) To examine complicated infectious
diseases requiring hospitalization or prolonged intravenous antibiotics,
including blood borne pathogens, a designated doctor must be board-certified by
the ABMS or AOABOS.
(i) Qualifying ABMS
certifications are:
(I) internal medicine;
or
(II) occupational
medicine.
(ii) Qualifying
AOABOS certifications are:
(I) internal
medicine;
(II) preventive
medicine/occupational-environmental medicine; or
(III) preventive
medicine/occupational.
(H) To examine chemical exposure, excluding
chemical burns, a designated doctor must be board-certified by the ABMS or
AOABOS.
(i) Qualifying ABMS certifications
are:
(I) internal medicine;
(II) emergency medicine; or
(III) occupational medicine.
(ii) Qualifying AOABOS
certifications are:
(I) internal
medicine;
(II) emergency
medicine;
(III) preventive
medicine/occupational-environmental medicine; or
(IV) preventive medicine/occupational.
(I) To examine
heart or cardiovascular conditions, a designated doctor must be board-certified
by the ABMS or AOABOS.
(i) Qualifying ABMS
certifications are:
(I) internal
medicine;
(II) emergency
medicine;
(III) occupational
medicine;
(IV) thoracic and cardiac
surgery; or
(V) family medicine.
(ii) Qualifying AOABOS
certifications are:
(I) internal
medicine;
(II) emergency
medicine;
(III) preventive
medicine/occupational-environmental medicine;
(IV) preventive
medicine/occupational;
(V) thoracic
and cardiovascular surgery; or
(VI)
family practice and osteopathic manipulative treatment.
(c)
Qualification to perform initial examination. To be qualified to perform an
initial examination on an injured employee, a designated doctor, other than a
chiropractor, must be qualified under Labor Code §
408.0043. A designated
doctor who is a chiropractor must be qualified to perform an initial designated
doctor examination under Labor Code §
408.0045.
(d) Exemption from qualification standards.
If a designated doctor is not available with the qualifications listed in
subsections (b)(9)(A) - (I), the division may exempt a medical doctor or doctor
of osteopathy from any of the qualification standards specified in this chapter
to serve as a designated doctor to help timely resolve a dispute or perform a
particular examination.
(e)
Continuity of examinations. A designated doctor who performs an initial
designated doctor examination of an injured employee and meets the appropriate
qualification standard to perform that examination under subsection (b) of this
section will remain assigned to that claim and perform all subsequent
examinations of that injured employee unless the division authorizes or
requires the designated doctor to discontinue providing services on that
claim.
(f) Removal of designated
doctor from a claim. The division may authorize a designated doctor to stop
providing services on a claim if the doctor does any of the following:
(1) decides to stop practicing in the
workers' compensation system.
(2)
decides to stop practicing as a designated doctor in the workers' compensation
system.
(3) relocates their
residence or practice.
(4) asks the
division to indefinitely defer the doctor's availability on the designated
doctor list.
(5) determines that
examining the injured employee would exceed the scope of practice authorized by
their license. The division's assignment of a designated doctor exam does not
alter the scope of practice authorized by the designated doctor's professional
license. Section
127.200(a)(12) of
this title requires a designated doctor to notify the division if continuing to
participate on a claim would exceed their scope of practice.
(6) can otherwise demonstrate to the division
that their continued service on the claim would be impracticable or could
impair the quality of examinations performed on the claim.
(g) Prohibition. The division will prohibit a
designated doctor from providing services on a claim if:
(1) the doctor has failed to become certified
as a designated doctor;
(2) the
doctor no longer meets the appropriate qualification standard under subsection
(b) of this section to perform examinations on the claim;
(3) the doctor has a disqualifying
association specified in §
127.140 of this title that is
relevant to the claim;
(4) the
doctor has repeatedly failed to respond to division appointment, clarification,
or document requests or other division inquiries about the claim;
(5) the doctor's continued service on the
claim could endanger the health, safety, or welfare of either the injured
employee or doctor; or
(6) the
division has revoked or suspended the designated doctor's
certification.
(h)
License revoked or suspended. The division will prohibit a designated doctor
from performing examinations on all new or existing claims if the designated
doctor's license has been revoked or suspended, and the suspension has not been
probated by an appropriate licensing authority.
