Texas Administrative Code
Title 28 - INSURANCE
Part 2 - TEXAS DEPARTMENT OF INSURANCE, DIVISION OF WORKERS' COMPENSATION
Chapter 42 - MEDICAL BENEFITS
Subchapter A - GENERAL MEDICAL PROVISIONS
Section 42.60 - Required Reports: Special Reports
Universal Citation: 28 TX Admin Code ยง 42.60
Current through Reg. 49, No. 38; September 20, 2024
(a) All special reports shall contain all identifying information required by § 42.30(d) of this title (relating to Written Communications).
(b) The provider shall submit special reports to the carrier and the injured worker, or his or her representative, as provided in § 42.30 of this title (relating to Written Communications) under the following circumstances.
(1) Hospitalization. A report
shall be submitted when the patient is discharged from a hospital.
(2) Amputation. When all or part of any limb
or digit is amputated, the treating doctor shall submit a report and a chart
showing the exact point of amputation.
(3) Vision loss.
(A) Loss of vision shall be calculated on the
actual loss of vision as a result of an injury, and not on loss of vision after
restoration of vision by proper fitting glasses.
(B) The board considers loss of an eye to
have occurred when loss of vision reaches 90%.
(C) A change of status report for a patient
who has suffered vision loss shall be based on the board's Table of Visual
Losses of One Eye, published in the appendix to this chapter. (See §
55.25
of this title (relating to Loss of an Eye.))
(4) Hearing impairment.
(A) Hearing tests for use in compensation
ratings shall be derived from the pure-tone audiogram calculated to
ANSI-S3.6-1969 standards. Examination should be performed by a medical
specialist who does hearing evaluations or by an audiologist having the
Certificate of Clinical Competence from the American Speech-Language-Hearing
Association upon referral. Hearing handicap will be based on the functional
state of both ears.
(B) A change of
status report for a patient who has suffered hearing impairment shall be based
on the board's Table of Monaural Hearing Impairment, published in the appendix
to this chapter. (See §
55.30 of this
title (relating to Hearing Impairment.))
(5) Medical examination orders.
(A) The examining doctor shall submit a
report within seven days of examining a claimant under board order.
(B) If the examination was ordered on the
board's own motion, the original report and the bill shall be sent to the
board. Copies shall be sent to the claimant, or claimant's representative, and
the carrier.
(C) If the examination
was ordered at the carrier's request, the original report and the bill shall be
sent to the carrier. Copies shall be sent to the claimant, or claimant's
representative, and the board. (See Chapter 69 of this title (relating to
Medical Examination Orders.))
(6) Demand for surgery. The report
accompanying a demand for surgery shall establish that, in all reasonable
medical probability:
(A) the requested
surgical procedure will either effect a cure, or materially and beneficially
improve and relieve the patient's condition; and
(B) the surgery is medically
advisable.
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