Current through Reg. 49, No. 38; September 20, 2024
(a) Grounds for
sanctions. In addition to the grounds for issuing sanctions against a doctor
under §
180.26 of this title (relating to
Criteria for Imposing, Recommending and Determining Sanctions; Other Remedies),
other division rules, or the Labor Code, the commissioner may revoke or suspend
a designated doctor's certification as a designated doctor or sanction a
designated doctor for noncompliance with requirements of this chapter for:
(1) refusing four times within a 90-day
period to accept or perform a division-offered appointment or division-ordered
appointment for which the doctor is qualified and that relates to a claim to
which the doctor has not been previously assigned;
(2) refusing four consecutive times to
perform a division-offered appointment within the required time frames or a
division-ordered appointment for which the doctor is qualified and relates to a
claim the doctor has not been previously assigned to;
(3) failing to attend a designated doctor
examination;
(4) not complying with
the rescheduling requirements of this chapter;
(5) refusing at any time to accept or perform
a division-offered appointment or division-ordered appointment that relates to
a claim on which the doctor has previously performed an examination;
(6) misrepresenting or omitting pertinent
facts in medical evaluation and narrative reports;
(7) submitting unnecessary referrals to other
health care providers to answer any question that the division submits to the
designated doctor;
(8) ordering or
performing unnecessary testing of an injured employee as part of a designated
doctor's examination;
(9)
submitting inaccurate or inappropriate reports due to insufficient medical
history or physical examination and analysis of medical records;
(10) submitting designated doctor reports
that fail to include all elements required by §
127.220 of this title (relating to
Designated Doctor Reports), §
127.10 of this title (relating to
General Procedures for Designated Doctor Examinations), and other division
rules;
(11) failing to timely
respond to a request for clarification from the division about an examination
or any other information the division requests;
(12) failing to successfully complete
training and testing requirements as specified in §
127.100 of this title (relating to
Designated Doctor Certification);
(13) self-referring, including referring to
another health care provider with whom the designated doctor has a
disqualifying association, for treatment or becoming the employee's treating
doctor for the medical condition the designated doctor evaluated;
(14) behaving in an abusive or assaultive
manner toward an injured employee, the division, or other system
participant;
(15) failing to
maintain the confidentiality of patient medical and claim file
information;
(16) performing a
designated doctor examination that the division did not order the doctor to
perform;
(17) failing to complete
required training or pass required testing detailed in the designated doctor's
approval of certification; or
(18)
violating other applicable statutes or rules while serving as a designated
doctor.
(b)
Responsibility for agents' actions. Designated doctors are liable for all
administrative violations committed by their agents on the designated doctor's
behalf under this section, other division rules, or any other applicable
law.
(c) Notification and appeal.
The process for notification and opportunity for appeal of a sanction is
governed by §
180.27 of this title (relating to
Restoration) except that suspension, revocation, or other sanctions relating to
a designated doctor's certification will be in effect during the pendency of
any appeal.
