PATIENT EDUCATION for a Designated Doctor Examination

Patient Education for a Designated Doctor Exam


How to Prepare for a Designated Doctor Evaluation

  • Initial Intake Packets and/or Questionnaires should be completed beforehand and brought to your appointment. If you do not have access to a computer/printer, please arrive ½ hour before your scheduled assessment.

  • Bring any supporting documentation- medical records, police records, accident report, etc.

  • Please eat before the appointment; the evaluation usually lasts less than 60 minutes. There will be no breaks offered during your examination.

  • Please take your regularly prescribed medications, as scheduled. Avoid optional medications that cause drowsiness, such as pain killers, and anti-anxiety and allergy medications.

  • Bring a current list of your medications and their dosages.

  • Bring your reading glasses or hearing aids.

  • Bring a valid photo ID.

  • Allow extra time for parking and the check-in process. Your evaluation will start promptly at the scheduled time. Late arrival may result in rescheduling.

What happens during a Designated Doctor Evaluation?

The evaluation involves clinical interviews with the patient and sometimes a family member (when possible) to understand the patient's history and to understand how the injury has affected his or her life. The interview takes less than 30 minutes. The patient then is examined by the provider, and this usually takes less than 30 minutes. The total time of the evaluation depends on the referral questions.

What happens after a Designated Doctor Evaluation?

The Designated Doctor reviews all of the evidence of your case which includes all of the appropriate medical records along with the information he obtained from you during his interview and examination. The Designated Doctor reviews the questions he has been asked to answer. If the Designated Doctor needs additional diagnostic testing or consultation in order to fully answer the questions asked, these additional studies or consultations will be ordered. If additional testing is needed one of our staff will coordinate your schedule and the consultant's schedule to have these tests performed. After the Designated Doctor has received each consultant report or the reports for each diagnostic test, he reviews everything again, and prepares his report.

What is the Purpose of a Designated Doctor Evaluation?

Most of the time a Designated Doctor is asked to perform one or all of the following :

MMI or Maximum Medical Improvemen :.

MMI is defined in two different and separate ways within the protocols of treatment of an injured worker that resides in the State of Texas. Clinical MMI occurs on the date that your treatment of the injury has completed at which time there is not likely to be additional substantial improvement of your injury with continued venues of treatment. If the Designated Doctor identifies that you are likely to improve with additional legitimate venues of treatment, then you have not achieved MMI. If the Designated Doctor identifies that there are no additional venues of treatment that are likely to result in substantial improvement then you have achieved MMI. Please noted that clinical MMI could be assigned on a date that was prior to your Designated Doctor evaluation if the Designated Doctor has identified a point in time previous to the Designated Doctor examination that your treatment was completed. Statutory MMI occurs when you have exceeded 104 weeks of temporary benefits. The carrier calculates the date of statutory MMI because the carrier has the knowledge of when temporarily benefits have started. Although the carrier calculates date of statutory MMI, the Designated Doctor is the person that assigns the MMI date as the statutory date. If temporary benefits are never started then the date of statutory MMI can not be calculated and can not be achieved.

Impairment Rating :

If you have achieved MMI your are entitled to receive an impairment rating as of the date of MMI. Please note that the Designated Doctor will use the findings that are present in the medical records in and around the time of the MMI date to make the calculations of impairment. There is a difference between Disability and Impairment. As a patient you can have a great impairment with no disability, or you can have a great disability with no impairment. Impairments are related to a loss of function of a body part that is related to the injury. For instance if you have an amputated finger you have loss the function of the finger that has been amputated which means you will be assigned an impairment. Impairments are calculated in Texas with reference to the 4th edition of the AMA Guides to the Evaluation of Permanent Impairment. Other states may use the 5th edition, and the Federal government uses the 6th edition. The Designated Doctor has the duty to assign to you the highest impairment rating that is allowed by the AMA guidelines manual.

EOI - Extent of Injury :

When EOI is asked, the Designated Doctor is assigned with the task of identifying the symptoms and findings that are causally related to the injury. If you have symptoms and findings that are related to aging or other disease of life that are not caused by the work related injury then those symptoms and findings are not part of the injury, and the carrier should not be required to cover the medical or surgical treatment for symptoms and findings that are not part of the work related injury. However, if your non-work related problems are made worse by the work related injury they can be considered part of the work related injury.

The EOI question is one of the most important examinations that is performed by the Designated Doctor

Disability :

This evaluation is performed to identify whether the work related injury has caused a disability that prevents you from being able to return to limited duties at work or full duties at work. The Designated Doctor carefully evaluates the symptoms and findings that are causally related to your injury to determine whether your disability has been caused from the injury or is related to some other cause.

Rtw - Return to Work :

This evaluation is performed to identify whether you can return to full duty work or limited duty work. The Designated Doctor may be required to have you perform a Functional Capacity Evaluation with a consultant in order to answer this question.

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What happens when you disagree with the Designated Doctor

You and your treating physician will both get copies of the Designated Doctor report. You should read the Designated Doctor report carefully, and make an appointment with your treating physician and first discuss your concerns with your treating physician. If your treating physician agrees with the the Designated Doctor have your physician explain the report to you and why he believes the Designated Doctor's opinions are reasonable. If you still are in disagreement with the Designated Doctor you have ninety days from the date of the published report to request a BRC (Benifit Review Conference) with the Division of Workers Compensation with the Texas Department of Insurance. Prior to the BRC you also have the right to request for an alternate examination by a physician that has Designated Doctor training, and will be performing an IME (Independent Medical Evaluation) for you. If your physician wants to pursue an IME examination for you we can make arrangements for you to have this evaluation.