DWC Has Adopted Amendments to Certain DD Rules

On April 10, 2023, DWC announced that they have adopted amendments to the Chapter 127 rules and to Rule 180.23. These rules concern how the designated doctor program operates. They state they are “necessary to maintain and increase participation in the designated doctor program and to allow better access to certain types of specialized examinations. Neither rule concerns billing or reimbursement.”

DWC is also considering updates to three forms that relate to the rules:

      1. DWC Form-032, Request for designated doctor examination.
      2. DWC Form-067, Designated doctor certification application.
      3. DWC Form-068, Designated doctor examination data report.

The new rule amendments clarify:

      • that testing and referral doctors for designated doctor examinations do not have to be in the same workers’ compensation network for health care as the injured employee;
      • that the insurance carrier must pay benefits on the condition to which the designated doctor determines the compensable injury extends;
      • that the DD may provide multiple certifications of maximum medical improvement (MMI) and impairment ratings only when DWC directs them to (DWC concluded that “where multiple certifications are appropriate, DWC administrative law judges are already directing designated doctors to provide them. As a result, the amendment that specifies that designated doctors may provide multiple certifications of MMI and impairment ratings only when directed by DWC will reduce the number of unnecessary multiple certifications that consume time and resources, while continuing to allow for necessary multiple certifications without causing unnecessary delay”);
      • that the requirement to attend a DD exam also applies to a DD referral examination under §127.10(c);
      • that DDs are no longer required to automatically retest and become recertified every 2 years;
      • that DWC may require testing of all designated doctors on renewal of their certification if needed. Examples of when testing might be required include, but are not limited to, individual need for retesting based on substandard performance, changes in the duties of a designated doctor, updates to the guidelines, and legislative changes;
      • that DWC may approve a designated doctor certification but restrict some or all appointments until the designated doctor completes additional training, testing, or other requirements;
      • that in order to evaluate brain injuries, including concussion and post-concussion syndrome, a DD may have certain American Board of Medical Specialties and American Osteopathic Association Bureau of Osteopathic Specialists board certifications (DWC “acknowledges the need to increase the number of board-certified physicians available to examine injured employees with traumatic brain injuries, as well as to improve the ability of physicians with a broader range of board certifications to use testing and referral resources to produce reports that meet the requirements of the designated doctor program. Board-certified physicians are all capable of coordinating referrals of injured employees to other specialists, when necessary, regardless of the types of patients the physicians may see in their medical practice”);
      • the qualification requirements for physicians examining injured employees with spinal cord injuries and diagnoses, a spinal fracture with documented neurological deficit, or cauda equina syndrome. The amendments change the phrase “documented neurological deficit” to “documented neurological injury, or vascular injury,” to clarify what types of conditions require a designated doctor examination by a qualified, board-certified specialist. The amendments also clarify that an injured employee with more than one spinal fracture must be examined by a qualified, board-certified specialist to harmonize with the amendments to the types of multiple fractures, joint dislocation, and pelvis or hip fractures in a later rule;
      • the certifications required for complex fractures. They no longer require a board-certified specialist for multiple fractures unless they are accompanied by vascular injury or are more than one spinal fracture. An injured employee with more than one simple, resolved fracture (without vascular injury) may be examined by a chiropractor or a physician with a different board certification or no board certification;
      • that a chiropractor or a physician with a different board certification or no board certification may examine an injured employee with a hip fracture without vascular injury;
      • that multiple rib fractures, with or without vascular injury, require examination by a board–certified physician (“because multiple rib fractures may be accompanied by damage to internal organs”);
      • that the DD has a duty to notify DWC if continuing to participate on a claim would exceed their scope of practice;
      • that a designated doctor’s failure to attend an examination or comply with rescheduling requirements may be grounds for revoking or suspending a certification or sanctioning a designated doctor;
      • that the DD is required to specify the date the additional testing or referral examination was completed on their report, and also must provide the total amount of time that was required to review the medical records (“necessary for DWC to administer the designated doctor program effectively by ensuring a more complete and descriptive record that provides the required information and better reflects the amount of work involved in producing the report”).

If at any point you have questions about the DD process or would like assistance with requesting a designated doctor, please feel free to reach out to FOL at gqs@fol.com or by clicking the “Designated Doctor Review” tab on our website: www.fol.com.