The Role of The Designated Doctor in Texas Workers’ Compensation Claims

From time to time during the life of a Texas Workers’ Compensation case, a need may arise for a non-biased, authoritative medical professional to make certain determinations about an injured worker’s medical condition or ability to work. There are also other determinations of medical fact that may need to be decided as well.

In such situations, it is not appropriate for an insurance adjuster, an attorney, or even a judge to make such medical determinations. The Division of Workers’ Compensation, therefore, has allowed for the introduction of state-appointed “Designated Doctors” to make these kinds of judgments. In theory, the Designated Doctor does not work for the insurance carrier or the injured worker (the Claimant). The Designated Doctor is appointed by the Division of Workers’ Compensation to resolve such questions or disputes.

Designated Doctors may be called upon to comment on or resolve questions such as:

  • Has the employee reached MMI, and if so, what is the appropriate Impairment Rating?
  • Is the employee’s injury of a specific body part related to the Compensable Injury?
  • To determine whether the injured worker is able to perform certain job functions or return to work without limitation.

Determinations and opinions made by the Designated Doctor carry great weight when resolving disputes or presenting evidence at a Benefit Review Conference (BRC) or Contested Case Hearing (CCH). It is very difficult to overcome the determinations and findings of a Designated Doctor.

Designated Doctor Alert!

Many Designated Doctors also have “side jobs” as peer review doctors for the insurance carriers. In fact, there are some doctors who (by all appearances) primarily earn their living working for insurance companies, wherein they are paid to conduct examinations of injured workers that often lead to the employee’s loss or reduction of benefits.

If you have an upcoming appointment to see a Designated Doctor, it is important to contact an experienced workers’ compensation lawyer right away. A good attorney can ensure that your Designated Doctor appointment is handled properly and that your interests and rights are preserved to the fullest extent of the law.

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Texas Workers’ Compensation laws are complex and impact many areas of an injured workers’ life and future. The insurance carrier has one goal: to limit or dispute your medical care and your entitlement to income benefits. Call 888-434-COMP (888-434-2667) and talk to our hard-working, experienced workers’ comp lawyers. You owe it to yourself to talk to an attorney who can help you understand your rights, responsibilities and options in this difficult time of your life. The call is free, there is no obligation, and all conversations are kept strictly confidential. Call today.

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