In Texas Workers' Compensation Cases, a change of doctor request is required if an injured employee desires a new primary treating doctor. The treating doctor is responsible for referrals and administrative decisions such as determination of MMI, return to work, and articulating the extent of injury if the adjuster requests.
This is what I consider some general discussion of best practices regarding this requirement. The first thing is to determine whether a form DWC-53 is required to be filed with the Division of Workers' Compensation.
BEFORE PREPARING DWC-53: Determine if the claim is subject to a Workers’ Compensation Certified Healthcare Network (HCN) or a healthcare plan (an “alliance”) or informal network (only for political subdivisions under Tex. Lab. Code 504.053(b)(2)? If so, DWC-53 will be denied or void as all change of doctor requests must be submitted per network, alliance, or informal network requirements (usually requires confirmation with adjuster).
Best practice for determining network status is to either contact adjuster or review DWC-32 filed by carrier representative (Blocks II-22 and II-23).
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