Designated Doctors

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Designated Doctors

• Training
• Scheduling
• ADA Requirements
• Resources

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Presenters

• Lisa Wharry
• Chuck Whitacre

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• Relevant Statutes and Rules Used in This
  Presentation
• Texas Workers Compensation Act
• 408.0041, Designated Doctor Examination
• 408.1225, Division Designated Doctor List
• TDI-DWC Rules
• 126.7, Designated Doctor Examinations
• 180.21, Division Designated Doctor List

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What is a Designated Doctor?

• A designated doctor is a doctor assigned by the
  Division to recommend a resolution of a dispute
  as to the medical condition of an employee.

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Designated Doctor Training

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• Designated doctor training is a two day course
• Day one
• Maximum Medical Improvement
• Impairment Rating
• Day two
• Extent of Injury
• Whether disability is direct result of
  compensable injury
• Ability to return to work
• Similar issues

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• Designated doctors are required to complete the
  two-day training course which includes an end of
  course assessment regarding their duties
• Under the current rules, twelve hours of training
  and re-registration is required every two years

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• Under current rules, after completing the two day
  course, new designated doctors are then required
  to pass a written impairment rating skills test.

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Designated Doctor List Requirements on or after
1/1/07

• Active practice for 3 years during career
• Authorized to assign impairment ratings
• Complete 12 hours of DWC approved designated
  doctor training
• Pass impairment rating test
• Submit designated doctor application via Division
  website

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Designated doctor list Process to be completed

• Complete designated doctor training course
  including end of course assessment regarding new
  duties
• Under the current rule, twelve hours of training
  and re-registration is required every two years

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• DDL application includes
• General contact information
• Training certificate
• Impairment rating skills test score
• Verification of licensure
• Notarized information on the doctors training
  and experience related to DD duties
• Disciplinary actions or practice restrictions if
  any

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• Doctors on DDL are required to provide DWC with
  updated information on the application within 30
  days of a change of information

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• Updated email address, phone numbers and other
  contact information
• Updated training information
• Updated experience matrix to reflect the services
  personally performed or have performed by the
  doctor

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Designated Doctor List Deletions, Suspensions,
and Sanctions

• Factors that would deny application to DDL
• Failure to complete training or testing when
  required
• Failure to notify DWC of disqualifying
  association within 48 hours of receiving notice
• Conducting an exam when disqualified
• Self-referring or referring to HCP with
  disqualifying association

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• Disqualifying association - Any association that
  may reasonably be perceived as having potential
  to influence the conduct or decision of a
  designated doctor

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• Details of disqualifying association
• Contract with the same workers compensation
  health care network that is responsible for the
  provision of medical benefits to the injured
  employee
• Any other financial arrangement or association
  that may give the appearance of preventing an
  unbiased opinion from the designated doctor

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• Details continued
• Income, compensation, or payment not related to
  health care
• Shared investment or ownership interests
• Contracts or agreements that provide incentives
• Contracts or agreement for services
• Personal or family relationships

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• Designated Doctor
• Scheduling

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Agenda

• Role of Designated Doctors
• Request Process
• Selection Process
• Change of Designated Doctor

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Role of Designated Doctor

• Issues that may be addressed
• Attainment of Maximum Medical Improvement
• Impairment caused by the compensable injury or
  illness
• Extent of injury or illness
• Is disability a direct result of the work-related
  injury or illness
• Ability of injured employee to return to work
• Similar issues

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Request Process

• A designated doctor can be requested by
• Injured employee or representative
• Insurance carrier
• Division of Workers Compensation
• Medical Advisor

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Request Process

• Submitted DWC 32 must be complete and accurate,
  and indicate the reason for designated doctor
  examination request
• DD exams cannot be requested for developing
  treatment plans, determining appropriateness of
  medical care, or for determining the
  compensability of the injury or contribution

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Selection Process

• Criteria
• Injured employees county of residence
• Best possible match between designated doctors
  education, training experience and the medical
  care the injured employee is receiving
• No conflict of interest or disqualifying
  association

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Treatment Definitions

• Physical Medicine Non-invasive treatment that
  involves manual movements of the affected body
  part
• Prescription Medication Medication that cannot
  be obtained without a doctors prescription
• Therapeutic Injections Treatments such as
  epidural and trigger point injections

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Treatment Definitions

• Surgery An operation or other invasive
  treatment
• Treatment Beyond Surgery Treatment and
  management of care after a surgeon has released
  the employee from surgical care
• Behavioral Medicine Includes treatment such as
  psychiatry, psychological testing and counseling,
  biofeedback and related disciplines

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Injured Employee Matrix
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Selection Process

• County based Alphabetical selection
• CompData lists all Designated Doctors
• Scheduler maintains selection spreadsheet for
  each assigned county

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Distributing Appointment Requests

• Volume
• Location
• Timing
• Nature of request
• Statutory deadlines for setting and attendance of
  appointments

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Reasons for Re-designation

• No response to Appointment Coordination Sheet
• Refusal of appointments offered
• Designated doctor is no longer qualified
• Designated doctor is no longer available
• Disqualifying associations

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Designated Doctor ADA Requirements (new)
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• Rules and procedures are being developed to
  assist Designated Doctors to comply with
  accommodation requirements of the Title II of the
  Americans with Disabilities Act (ADA).

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• With these rules and procedures, TDI will take
  steps to ensure that qualified individuals with
  disabilities have access to and benefit from TDI
  programs, services and activities under Title II
  of the Americans with Disabilities Act (ADA).

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• When designated doctors receive a request for
  accommodation, they should make every effort to
  provide the accommodation. If they are not able
  to comply provide the accommodation, the injured
  employee should be instructed to contact the
  local field office.

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• Brown Bag informational sessions are being
  planned for the local Field Offices of the
  Division to provide more information.

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Resources

• Designated Doctor Home Page
• http//www.tdi.state.tx.us/wc/hcprovider/dd.html
• FastFacts for Designated Doctors
• On-line appointment query tool
• TDI-DWC Website
• http//www.tdi.state.tx.us/wc/publications.html

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• QUESTIONS?

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