GQ Corner

Q. I am not able to find any prohibition under the Tex. Ins. Code, the Tex. Labor Code, or the Tex. Admin. Code which prohibits chiropractors from being selected by an employee as a “treating doctor” under a WC healthcare network.  However, it is my understanding that the AIG TX Healthcare Network prohibits a chiropractor as a “treating doctor.”  Am I correct that this is a “network rule” and not a State mandated rule or law?

A. Under Texas Ins. Code Ann. § 1305.302(d), a network must offer available and accessible chiropractic services. Section 1305.103(a) provides, however, that the “network shall determine the specialty or specialties of doctors who may serve as treating doctor.” Thus, a network may limit the credentialing of treating doctors to medical doctors and may exclude chiropractors from that credentialing process. When this is done, a chiropractor may only serve in the capacity of a referral doctor.

Q. I have a quick question concerning Duration of Death Benefits for Spouse (Rule 132.7). We have a police officer killed in the line of duty 10/9/2014.  This pre-dates the changes to the law about remarriage.  Current Rule 132.7 was amended 3/20/16, and again 12/20/18.  Rule 132.7(f) states that the eligibility for death benefits regardless of remarriage applies to:  (1) eligible spouses who remarry on or after 9/1/17; and (2) eligible spouses who remarried between 9/1/15 and 8/31/17, if the claim is based on a compensable injury that occurred on or after 9/1/15. My question…. Does this rule retroactively apply to our 10/9/14 injury/fatality? 

A. The rule is based on Sec. 408.183(b-1). Part of that subsection states: “This subsection applies regardless of the date on which the death of the first responder occurred.” Based on this language, your claim would be controlled by the statute and the rule.

Q. I have a claim in which the claimant had an attorney who submitted fees which were approved by the Division and then withdrew from the case. Then a new attorney /new firm took the file. Do I pay the first attorneys’ fees first, in order of approval?

A. You pay all the orders in the order of the sequence number on the fee order.